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Early and precise diagnosis of craniosynostosis (CSO), which involves premature fusion of cranial sutures in infants, is crucial for effective treatment. Although computed topography offers detailed imaging, its high radiation poses risks, especially to children. Therefore, we propose a deep-learning model for CSO and suture-line classification using 2D cranial X-rays that minimises radiation-exposure risks and offers reliable diagnoses. We used data comprising 1,047 normal and 277 CSO cases from 2006 to 2023. Our approach integrates X-ray-marker removal, head-pose standardisation, skull-cropping, and fine-tuning modules for CSO and suture-line classification using convolution neural networks (CNNs). It enhances the diagnostic accuracy and efficiency of identifying CSO from X-ray images, offering a promising alternative to traditional methods. Four CNN backbones exhibited robust performance, with F1-scores exceeding 0.96 and sensitivity and specificity exceeding 0.9, proving the potential for clinical applications. Additionally, preprocessing strategies further enhanced the accuracy, demonstrating the highest F1-scores, precision, and specificity. A qualitative analysis using gradient-weighted class activation mapping illustrated the focal points of the models. Furthermore, the suture-line classification model distinguishes five suture lines with an accuracy of > 0.9. Thus, the proposed approach can significantly reduce the time and labour required for CSO diagnosis, streamlining its management in clinical settings., (© 2024. The Author(s).)

Metabolic dysfunction-associated steatotic liver disease (MASLD), which encompasses a spectrum of conditions ranging from simple steatosis to hepatocellular carcinoma, is a growing global health concern associated with insulin resistance. Since there are limited treatment options for MASLD, this study investigated the therapeutic potential of Atractylodes lancea , a traditional herbal remedy for digestive disorders in East Asia, and its principal component, atractylodin, in treating MASLD. Following 8 weeks of high-fat diet (HFD) feeding, mice received oral doses of 30, 60, or 120 mg/kg of Atractylodes lancea . In HFD-fed mice, Atractylodes lancea treatment reduced the body weight; serum triglyceride, total cholesterol, and alanine aminotransferase levels; and hepatic lipid content. Furthermore, Atractylodes lancea significantly ameliorated fasting serum glucose, fasting serum insulin, and homeostatic model assessment of insulin resistance levels in response to HFD. Additionally, a glucose tolerance test demonstrated improved glucose homeostasis. Treatment with 5 or 10 mg/kg atractylodin also resulted in anti-obesity, anti-steatosis, and glucose-lowering effects. Atractylodin treatment resulted in the downregulation of key lipogenic genes ( Srebf1 , Fasn , Scd2 , and Dgat2 ) and the upregulation of genes regulated by peroxisome proliferator-activated receptor-α. Notably, the molecular docking model suggested a robust binding affinity between atractylodin and AMP-activated protein kinase (AMPK). Atractylodin activated AMPK, which contributed to SREBP1c regulation. In conclusion, our results revealed that Atractylodes lancea and atractylodin activated the AMPK signaling pathway, leading to improvements in HFD-induced obesity, fatty liver, and glucose intolerance. This study suggests that the phytochemical, atractylodin, can be a treatment option for MASLD.

Objectives: Menopausal symptoms severely impact women's quality of life (QoL). Digital health interventions provide an accessible, personalized alternative for managing menopausal symptoms. In this study, we validated the Menopause Assistant Manager (MAMA®; Hudit, Seoul, S. Korea) app developed to provide personalized information, exercise coaching, and management of appointments and medications to menopausal women, and evaluated its efficacy on their QoL., Study Design: This nonrandomized interventional trial enrolled 48 peri- and postmenopausal women into experimental (MAMA) and control (Waitlist) groups (n = 24 each). Participants in the MAMA group used the app for 8 weeks, whereas the Waitlist group received no intervention. Both groups continued their usual treatments., Main Outcome Measures: Clinical assessments at baseline and study completion included the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Menopause Rating Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 (PHQ-15), Menopause Emotional Symptom Questionnaire, and Subjective Memory Complaints Questionnaire., Results: Compared with the Waitlist group, the MAMA group showed postintervention improvements in WHOQOL-BREF physical health (F = 4.84, P = .03) and environmental (F = 5.01, P = .03) domains and GAD-7 (F = 5.53, P = .02) and PHQ-15 (F = 4.14, P = .048) scores. Changes in WHOQOL-BREF physical health scores negatively correlated with PHQ-15 scores (ρ = -0.53, P = .004)., Conclusion: By increasing treatment accessibility, the app improved physical and environmental QoL and reduced anxiety and somatic symptoms. App-based exercise coaching alleviated somatic symptoms, and the in-app psychological content reduced anxiety by normalizing menopausal symptoms, providing accurate information, decreasing uncertainty, and improving symptom perception., Trial Registration: Clinical Research Information Service KCT 0008603; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25078&status=5&seq_group=25078&search_page=M., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Study Objective: Asystole is the most common initial rhythm in out-of-hospital cardiac arrest (OHCA) but indicates a low likelihood of neurologic recovery. This study aimed to develop a novel scoring system to be easily applied at the time of emergency department arrival for identifying favorable neurologic outcomes in OHCA survivors with an asystole rhythm., Methods: This study is a secondary analysis based on a previously collected nationwide database, targeting nontraumatic adult OHCA patients aged ≥18 years with an asystole rhythm who achieved return of spontaneous circulation (ROSC) between January 2016 and December 2020. The primary outcome was a favorable neurologic outcome defined as Cerebral Performance Categories scores of 1 or 2 at hospital discharge. A prediction model was developed through multivariable logistic regression analysis in a derivation cohort in the form of a scoring system (WBC-ASystole). The performance and calibration of the model were tested using an internal validation cohort., Results: Among 19,803 OHCA patients with survival to hospital admission, 6,322 had asystole, and 285 (4.5%) achieved good neurologic outcomes. Factors associated with favorable outcomes included age, witness arrest, bystander cardiopulmonary resuscitation, time from call to hospital arrival, and out-of-hospital ROSC achievement. The WBC-ASystole score, totaling 11 points, exhibited a predictive performance with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval [CI] 0.76 to 0.83) and 0.79 (95% CI 0.74 to 0.83) in the derivation and validation cohorts, respectively. After categorizing patients into 3 groups based on probability for good neurologic outcomes, the sensitivity and specificity were as follows: 0.98 (95% CI 0.97 to 0.99) and 0.09 (95% CI 0.09 to 0.10) for the very low predicted probability group (WBC-ASystole ≤2), 0.85 (95% CI 0.82 to 0.89) and 0.54 (95% CI 0.53 to 0.55) for the low predicted probability group (WBC-ASystole 3 to 4), and 0.36 (95% CI 0.34 to 0.39) and 0.93 (95% CI 0.92 to 0.93) for fair predicted probability group (WBC-ASystole≥5), respectively., Conclusions: Although external validation studies must be performed, among OHCA patients with asystole, the WBC-ASystole scoring system may identify those patients who are likely to have a favorable neurologic outcome., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: Therapeutic interventions are crucial for perimenopausal women, given the challenging physical and psychological symptoms they face. This study focused on the development and verification of the efficacy of a cognitive behavioral therapy (CBT) protocol designed specifically for Korean perimenopausal women., Study Design: A CBT protocol for perimenopausal women was newly developed based on theory and evidence. Forty menopausal women were randomly assigned to either the CBT group (n = 19) or treatment-as-usual (TAU) group (n = 21). Participants in the CBT group underwent 60-min weekly sessions for eight weeks. The TAU group received standard care from gynecologists., Main Outcome Measures: At baseline and follow-up, participants completed the Menopausal Rating Scale (MRS), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 (PHQ-15), Menopause Emotional Symptom Questionnaire (MESQ), and Subjective Memory Complaints Questionnaire., Results: The CBT group showed significant changes in their MRS (F = 4.18, p = .048), WHOQOL-BREF (7.60, 0.009), GAD-7 (4.61, 0.038), PHQ-15 (5.49, 0.025), and MESQ scores (7.19, 0.011) compared to the TAU group. In the CBT group, changes in GAD-7 scores were correlated with PHQ-15 (ρ = 0.57, p < .05), MESQ (0.57, < 0.05), and WHOQOL-BREF scores (-0.53, < 0.05)., Conclusion: CBT prevents the worsening of menopausal and emotional symptoms, anxiety, and quality of life. CBT may have had a therapeutic effect through the following mechanisms: managing anxiety by changing perceptions of menopause through education and training for coping with various menopausal symptoms and improving self-efficacy in symptom management., Clinical Trial Registration Number: KCT0007517., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Dual leucine zipper kinase (DLK) mediates multiple neuronal stress responses, and its expression levels are constantly suppressed to prevent excessive stress signaling. We found that Wallenda (Wnd), the Drosophila ortholog of DLK, is highly enriched in the axon terminals of Drosophila sensory neurons in vivo and that this subcellular localization is necessary for Highwire-mediated Wnd protein turnover under normal conditions. Our structure-function analysis found that Wnd palmitoylation is essential for its axon terminal localization. Palmitoylation-defective Wnd accumulated in neuronal cell bodies, exhibited dramatically increased protein expression levels, and triggered excessive neuronal stress responses. Defective intracellular transport is implicated in neurodegenerative conditions. Comprehensive dominant-negative Rab protein screening identified Rab11 as an essential factor for Wnd localization in axon terminals. Consequently, Rab11 loss-of-function increased the protein levels of Wnd and induced neuronal stress responses. Inhibiting Wnd activity significantly ameliorated neuronal loss and c-Jun N-terminal kinase signaling triggered by Rab11 loss-of-function. Taken together, these suggest that DLK proteins are constantly transported to axon terminals for protein turnover and a failure of such transport can lead to neuronal loss. Our study demonstrates how subcellular protein localization is coupled to protein turnover for neuronal stress signaling., Competing Interests: SK, YQ, MS, JK No competing interests declared, (© 2024, Kim et al.)

Objective: To examine associations between the amount and changes in regular physical activity (PA) before and after diagnosis of dementia and all-cause mortality risk, and whether these associations differ by PA intensity (light, moderate or vigorous)., Methods: This retrospective cohort study used data from the Korean National Health Insurance Service Database, including 60 252 individuals newly diagnosed with dementia between 2010 and 2016 who underwent health examinations both before and after diagnosis. PA was assessed using the International Physical Activity Questionnaire-Short Form. Multivariable Cox proportional hazards regression models were used to analyse the associations between PA (amount and changes) and all-cause mortality risk., Results: During a mean follow-up of 3.7 years, 16 431 (27.3%) deaths occurred. Higher PA levels after dementia diagnosis were associated with a dose-dependent decrease in mortality risk (p for trend <0.001). Maintaining regular PA, compared with remaining inactive, was associated with the lowest mortality risk (HR=0.71, 95% CI 0.65 to 0.79). Sustained engagement in PA of any intensity was associated with decreased mortality risk: light (HR=0.70, 95% CI 0.67 to 0.75), moderate (HR=0.74, 95% CI 0.64 to 0.86) and vigorous PA (HR=0.70, 95% CI 0.61 to 0.79). Initiating any PA intensity after dementia diagnosis was associated with at least 20% reduced mortality risk. These associations were consistent in Alzheimer's disease., Conclusions: Maintaining or initiating regular PA, regardless of intensity, after dementia diagnosis was associated with a reduced risk of all-cause mortality. Lifestyle modifications promoting PA might offer survival benefits for individuals with dementia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The sustainable development goals (SDGs) are a blueprint for a better and more sustainable future for all. Understanding these initiatives helps everyone develop insights into critical global issues, including health care management, education, gender equality, and other challenges related to the 17 SDGs. Implementing these goals will contribute to sustainable development for cleft care in the least developed countries. The authors critically reviewed relevant articles on cleft lip and palate from 2014 to 2022. The authors' review utilized the online search tools Springer Nature, PubMed, and Google Scholar, using keywords of "cleft lip and palate," "cleft outreach program," "sustainable cleft care," "sustainable development goals for cleft," and "sustainable outreach program." In addition, the authors investigated the potentially necessary SDGs for sustainable cleft care management., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Geographical remoteness, limited resources, and socioeconomic disparities contribute to the migration of rural Alaska Native Elders to urban areas to access medical services and resources, improve economic situations, or reunite with family. We compared the discourse of 12 Elders in Anchorage who previously lived in four remote traditional villages in the Norton Sound region (ages 60-84) and 13 Elders in those villages (ages 48-80). Using Gee's discourse analysis framework, two patterns emerged detailing cultural effects on identity and Eldership, illuminating differences in the self-evaluation of successful aging based on cultural influences and the role of contextual factors.

Nitrogen (N) is the most essential element for growth, development, and grain yield determination in crops. However, excessive nitrogen application can result in environmental pollution and greenhouse gas emissions that contribute to climate change. In this study, we used 158 rice genetic resources to evaluate the relationships between the soil and plant analysis development (SPAD) value and grain yield (GY) and its components. The SPAD value ranged between 30.5 and 55.8, with a mean of 41.7 ± 5.3, under normal nitrogen conditions (NN, 9 kg/10a), and between 27.5 and 52.3, with a mean of 38.6 ± 4.8, under low nitrogen conditions (LN, 4.5 kg/10a). Under NN conditions, the SPAD values were in the following order: japonica (43.5 ± 5.8), Tongil -type (41.7 ± 2.5), others (41.7 ± 5.2), and indica (38.3 ± 3.8). By contrast, under LN conditions, the SPAD values were in the following order: Tongil -type (40.4 ± 2.1), others (40.1 ± 4.5), japonica (39.6 ± 5.2), and indica (35.6 ± 3.9). The 158 genetic resources showed no correlation between SPAD and yield. Therefore, the low-decrease rate (LDR) and high-decrease rate (HDR) SPAD groups were selected to reanalyze the relationships between the surveyed traits. The SPAD values were positively correlated with 1000-grain weight (TGW) for both LDR and HDR groups (NN: 0.63, LN: 0.53), However, SPAD and GY were positively correlated only in the LDR group. For TGW, the coefficient of determination ( R 2 ) was 20% and 13% under NN and LN conditions, respectively. For GY, R 2 values of 32% and 52% were observed under NN and LN conditions, respectively. Genetic resources with higher SPAD values in the LDR group exhibited the highest yield (NN: 1.19 kg/m 2 , LN: 1.04 kg/m 2 ) under both NN and LN conditions. In conclusion, we selected 10 genetic resources that exhibited higher GY under both NN and LN conditions with minimal yield reductions. These genetic resources represent valuable breeding materials for nitrogen deficiency adaptation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kim and Kim.)

In this study, silver nanoparticles (AgNPs) were synthesized using a green method from an extract of the edible insect Oxya chinensis sinuosa (O&#95;extract). The formation of AgNPs (O&#95;AgNPs) was confirmed via UV-vis spectroscopy, and their stability was assessed using Turbiscan analysis. The size and morphology of the synthesized particles were characterized using transmission electron microscopy and field-emission scanning electron microscopy. Dynamic light scattering and zeta potential analyses further confirmed the size distribution and dispersion stability of the particles. The average particle size was 111.8 ± 1.5 nm, indicating relatively high stability. The synthesized O&#95;AgNPs were further characterized using X-ray photoelectron spectroscopy (XPS), high-resolution X-ray diffraction (HR-XRD), and Fourier transform infrared (FTIR) spectroscopy. XPS analysis confirmed the chemical composition of the O&#95;AgNP surface, whereas HR-XRD confirmed its crystallinity. FTIR analysis suggested that the O&#95;extract plays a crucial role in the synthesis process. The antibacterial activity of the O&#95;AgNPs was demonstrated using a disk diffusion assay, which revealed effective activity against common foodborne pathogens, including Salmonella Typhimurium, Escherichia coli , Staphylococcus aureus , and Bacillus cereus . O&#95;AgNPs exhibited clear antibacterial activity, with inhibition zones of 15.08 ± 0.45 mm for S . Typhimurium, 15.03 ± 0.15 mm for E. coli , 15.24 ± 0.66 mm for S. aureus , and 13.30 ± 0.16 mm for B. cereus . These findings suggest that the O&#95;AgNPs synthesized from the O&#95;extract have potential for use as antibacterial agents against foodborne bacteria.

Feedback field-effect transistors (FBFETs) have been studied to obtain near-zero subthreshold swings at 300 K with a high on/off current ratio ~10 10 . However, their structural complexity, such as an epitaxy process after an etch process for a Si channel with a thickness of several nanometers, has limited broader research. We demonstrated a FBFET using in-plane WSe 2 p-n homojunction. The WSe 2 FBFET exhibited a minimum subthreshold swing of 153 mV/dec with 30 nm gate dielectric. Our modeling-based projection indicates that the swing of this device can be reduced to 14 mV/dec with 1 nm EOT. Also, the gain of the inverter using the WSe 2 FBFET can be improved by up to 1.53 times compared to a silicon CMOS inverter, and power consumption can be reduced by up to 11.9%.

Non-viral vectors for mRNA delivery primarily include lipid nanoparticles (LNPs) and polymers. While LNPs are known for their high mRNA delivery efficiency, they can induce excessive immune responses and cause off-target effects, potentially leading to side effects. In this study, we aimed to explore polymer-based mRNA delivery systems as a viable alternative to LNPs, focusing on their mRNA delivery efficiency and potential application in mRNA vaccines. We created a library of poly(β-amino ester) (PBAE) polymers by combining various amine monomers and acrylate monomers. Through screening this polymer library, we identified specific polymer nanoparticles (PNPs) that demonstrated high mRNA expression efficiency, with sustained mRNA expression for up to two weeks. Furthermore, the PNPs showed mRNA expression only at the injection site and did not exhibit liver toxicity. Additionally, when assessing immune activation, the PNPs significantly induced T-cell immune activation and were effective in the plaque reduction neutralization test. These results suggest that polymer-based mRNA delivery systems not only hold potential for use in mRNA vaccines but also show promise for therapeutic applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: The adverse effects of social isolation and loneliness (SI/L) have been documented among older adults in rural communities and contribute to poor health outcomes, premature disability and mortality, and increased burden on the healthcare system. The identification of factors contributing to SI/L among older adults can build the foundation for rural policymakers and leaders to allocate resources and develop tailored strategies more efficiently. The purpose of this article is to describe findings from a needs assessment designed to understand local factors that contribute to SI/L among rural older adults in a county in Northeast Tennessee. Findings from the needs assessment will be used by local stakeholders to develop strategies to promote age-friendly initiatives., Methods: Eighty-two older adults [ages 62 to 74 years (59%); non-Hispanic white (95%); female (71%)] from three senior apartment complexes in a Northeast Tennessee county completed an 87-item needs assessment survey. The evaluation of social isolation utilized Lubben's 6-item Social Network Scale, while loneliness was assessed using the 3-item UCLA Loneliness Scale. Logistic regression analysis was used to identify predictors of SI/L. Given the limited sample size, statistical significance was considered at p  < 0.10., Results: The prevalence of social isolation and loneliness was 42% and 37%, respectively. Residing in the county <5 years [Adjusted OR (AOR): 3.35; 95% CI: 1.04-10.81; p = 0.04] and reporting resource-related barriers to aging-in-place (AOR: 6.56; 95% CI: 2.00-21.57; p = 0.004) were associated with increases in the odds of social isolation; whereas interest in intergenerational activities decreased the odds of social isolation (AOR: 0.19; 95% CI: 0.05-0.69; p = 0.01). Boredom (AOR: 4.06; 95% CI: 1.63-12.11; p = 0.01) and limited knowledge about community services (AOR: 4.61; 95% CI: 1.42-15.02; p = 0.01) quadrupled the odds of loneliness. Similarly, older adults who were frail (AOR: 2.69; 95% CI: 0.88-8.17; p = 0.08) and who rated their community livability as low (AOR: 3.35; 95% CI: 0.81-13.87; p = 0.09) were more likely to experience loneliness., Discussion: This needs assessment provided important information about the individual and social drivers of SI/L among rural older adults in the community. Findings support the generation of localized data to support muti-partner efforts to design sustainable programs to address SI/L., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Southerland, Zheng, Dodson, Mauck, Bacsu, Brown, Holloway, Kim, Malatyali and Smith.)

Background : The peptidyl-prolyl isomerase (PIN1) plays a vital role in cellular processes, including intracellular signaling and apoptosis. While oxidative stress is considered one of the primary mechanisms of pathogenesis in brain ischemic injury, the precise function of PIN1 in this disease remains to be elucidated. Objective : We constructed a cell-permeable PEP-1-PIN1 fusion protein and investigated PIN1's function in HT-22 hippocampal cells as well as in a brain ischemic injury gerbil model. Methods : Transduction of PEP-1-PIN1 into HT-22 cells and signaling pathways were determined by Western blot analysis. Intracellular reactive oxygen species (ROS) production and DNA damage was confirmed by DCF-DA and TUNEL staining. Cell viability was determined by MTT assay. Protective effects of PEP-1-PIN1 against ischemic injury were examined using immunohistochemistry. Results : PEP-1-PIN1, when transduced into HT-22 hippocampal cells, inhibited cell death in H 2 O 2 -treated cells and markedly reduced DNA fragmentation and ROS production. This fusion protein also reduced phosphorylation of mitogen-activated protein kinase (MAPK) and modulated expression levels of apoptosis-signaling proteins in HT-22 cells. Furthermore, PEP-1-PIN1 was distributed in gerbil hippocampus neuronal cells after passing through the blood-brain barrier (BBB) and significantly protected against neuronal cell death and also decreased activation of microglia and astrocytes in an ischemic injury gerbil model. Conclusions : These results indicate that PEP-1-PIN1 can inhibit ischemic brain injury by reducing cellular ROS levels and regulating MAPK and apoptosis-signaling pathways, suggesting that PIN1 plays a protective role in H 2 O 2 -treated HT-22 cells and ischemic injury gerbil model.

Introduction: The factors contributing to blood loss during HD procedures remain underexplored. This study aimed to quantify blood loss during HD and identify the potential factors associated with it., Methods: The study included 70 ESRD patients undergoing HD. After dialysis, the extracorporeal blood circuits were rinsed with 1,000 mL of 0.05% NH3 solution in distilled water, and hemoglobin (Hb) levels were measured. Univariate regression was used to assess the linear relationship between residual red blood cell (RBC) volume and various parameters, including HD mode, dialyzer surface area, ultrafiltration goal (UFG), hypotension during HD, blood flow rate, activated partial thromboplastin time (aPTT), and C-reactive protein (CRP). Multivariate regression was also conducted to explore the relationships among these parameters., Results: The mean RBC volume remaining in the extracorporeal blood circuit after HD was 1.6 ± 0.9 ml (mode: 1.0, range: 0.3-6.5 ml). When converted to whole blood volume per patient, the mean blood volume was 5.3 ± 3.0 ml (median: 4.1 ml, mode: 4.0 ml, range: 1.0-19.0 ml). Multivariate analysis identified the dialyzer surface area as the only significant determinant of residual RBC volume., Conclusion: After HD, the remaining RBC volume in the extracorporeal blood circuit varies from 1.6 to 6.5 ml. When the RBC volume was converted to whole blood volume for each case, the blood loss ranged from 1.0 to 19.0 ml. Dialyzer surface area was the only significant determinant of residual RBC volume., (S. Karger AG, Basel.)

Off-target pesticide drift in paddy fields following unmanned aerial vehicle (UAV) spraying was evaluated using cellulose deposition samplers (CDSs). An analytical method for quantifying ferimzone Z and E isomers deposited on CDSs was developed using LC-MS/MS. The suitability of the CDS method was confirmed by comparing deposition patterns on CDSs with residue levels in rice plant samples. To assess pesticide deposition in paddy fields, CDSs were strategically placed at varying distances from target areas, followed by UAV spraying. The fungicide agrochemicals were applied with and without adjuvants, and wind direction affected the drift trajectory for all treatment groups. Adjuvants, particularly soy lecithin as the major component, significantly enhanced pesticide deposition within the spray pathway while reducing drift rates relatively by 47.9-68.0 %. Higher wind speeds were found to exacerbate drift, but adjuvant-treated sprays showed less variability in deposition patterns under these conditions. Pesticide residues in harvested brown rice were found to be below the maximum residue limits (MRLs), ensuring safety for consumption. These findings highlight the importance of selecting appropriate adjuvants in UAV-based pesticide applications to optimize deposition efficiency and minimize environmental contamination., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Glutathione (GSH) is indispensable for maintaining redox homeostasis in biological fluids and serves as a key component in cellular defense mechanisms. Accurate assessment of GSH relative to its oxidized counterpart, glutathione disulfide (GSSG), is critical for the early diagnosis and understanding of conditions related to oxidative stress. Despite existing methods for their quantification, the label-free and simultaneous measurement of GSH and GSSG in biological fluid presents significant challenges. Herein, we report the use of an alpha-hederin (Ah) nanopore for the direct measurement of the GSH:GSSG ratio in simulated biological fluid, containing fetal bovine serum (FBS). This system hinges on detecting characteristic relative ion blockades (ΔI/I o ) as GSH and GSSG molecules pass through the Ah nanopore under an applied electric field. The distinct current blockage signals derived from the translocation of GSH and GSSG enabled us to determine the molar ratio of GSH and its oxidized form. Notably, the interactions between the hydroxyl groups of the sugar moiety lining the nanopore's inner surface and the sulfhydryl group of GSH significantly influence the translocation dynamics, resulting in a longer translocation time for GSH compared to GSSG. The Ah nanopore technology proposed in this study offers a promising approach for real-time, single molecule-level monitoring of glutathione redox status in biological fluids, eliminating the need for labeling or extensive sample preparation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Exercise is considered as a cost-efficient option for individuals with mild cognitive impairment (MCI). Although the potential benefits of exercise for improving cognitive function are recognized, its impact on neuropsychiatric symptoms (NPS) and the quality of life (QoL) in individuals with MCI remains unclear., Objective: This study aims to investigate the effects of exercise interventions on NPS, including depression, anxiety, sleep disorders, and the quality of life in individuals with MCI., Results: There were 17 randomized controlled trials (RCTs) involving 1,575 participants were included. The findings indicate a small but significant positive effect of exercise on depression (standardized mean difference [SMD] = -0.47, 95% confidence interval [CI]: -0.73 to -0.21), but the quality of the evidence is low. Mind-body exercises were relatively more effective in alleviating depression. No significant improvements were observed in sleep disorders (SMD = -1.27, 95% CI: -2.80 to 0.26). Exercise improved anxiety in one study but had no effect in the other. It also improved quality of life in seven studies, with two showing no effect., Conclusion: The findings suggest that exercise, particularly mind-body exercises, can improve depression in individuals with MCI. However, the effect of exercise on anxiety, sleep disorders, and quality of life is still uncertain, necessitating additional research. These findings underscore the significance of integrating customized exercise programs in managing MCI to boost quality of life and mitigate NPS., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/. ID: CRD42023445369., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chen and Kim.)

Maternal nutrition during the critical period of pregnancy increases the susceptibility of offspring to the development of diseases later in life. This study aimed to analyze metabolite profiles to investigate the effect of maternal diet during pregnancy on changes in offspring plasma metabolites and to identify correlations with metabolic parameters. Pregnant Sprague-Dawley rats were exposed to under- and overnutrition compared to controls, and their offspring were fed a standard diet after birth. Plasma metabolism was profiled in offspring at 16 weeks of age using liquid chromatography-mass spectrometry (LC-MS/MS) and gas chromatography-tandem mass spectrometry (GC-MS/MS). We analyzed 80 metabolites to identify distinct metabolites and metabolic and neurodegenerative disease-associated metabolites that were sex-differentially altered in each group compared to controls ( p < 0.05, VIP score > 1.0). Specifically, changes in 3-indolepropionic acid, anthranilic acid, linoleic acid, and arachidonic acid, which are involved in tryptophan and linoleic acid metabolism, were observed in male offspring and correlated with plasma leptin levels in male offspring. Our results suggest that fatty acids involved in tryptophan and linoleic acid metabolism, which are altered by the maternal diet during pregnancy, may lead to an increased risk of metabolic and neurodegenerative diseases in the early life of male offspring.

Background: Preeclampsia (PE) is a hypertensive pregnancy disorder linked to placental dysfunction, often involving pathological lesions like acute atherosis, decidual vasculopathy, accelerated villous maturation, and fibrinoid deposition. However, there is no gold standard for the pathological diagnosis of PE and this limits the ability of clinicians to distinguish between PE and non-PE pregnancies. Recent advances in computational pathology have provided the opportunity to automate pathological analysis for diagnosis, classification, prediction, and prediction of disease progression. In this study, we assessed whether computational pathology could be used to identify PE placentas., Methods: A total of 168 placental whole-slide images (WSIs) of patients from Seoul National University Hospital (comprising 84 PE cases and 84 normal controls) were used for model development and internal validation. For external validation of the model, 76 placental slides (including 38 PE cases and 38 normal controls) were obtained from the Boramae Medical Center (BMC). To establish standard criteria for diagnosing PE and distinguishing it from controls using placental WSIs, patch characteristics and quantification of terminal and intermediate villi were employed. In unsupervised learning, K -means clustering was conducted as a feature obtained through an Auto Encoder to extract the ratio of each cluster for each WSI. For supervised learning, quantitative assessments of the villi were obtained using a U-Net-based segmentation algorithm. The prediction model was developed using an ensemble method and was compared with a clinical feature model developed by using placental size features., Results: Using ensemble modeling, we developed a model to identify PE placentas. The model showed good performance (area under the precision-recall curve [AUPRC], 0.771; 95% confidence interval [CI], 0.752-0.790), with 77.3% of sensitivity and 71.1% of specificity, whereas the clinical feature model showed an AUPRC 0.713 (95% CI, 0.694-0.732) with 55.6% sensitivity and 86.8% specificity. External validation of the predictive model employing the BMC-derived set of placental slides also showed good discrimination (AUPRC, 0.725; 95% CI, 0.720-0.730)., Conclusion: The proposed computational pathology model demonstrated a strong ability to identify preeclamptic placentas. Computational pathology has the potential to improve the identification of PE placentas., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Background: The growth of patient and public involvement in clinical research highlights the paucity of literature on operational practices that ensure the success of large, patient-centered outcomes trials. The authors' objective was to identify tools launched by the Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer (CISTO) study team to determine their effectiveness in maximizing patient enrollment in this observational, pragmatic trial., Methods: The primary outcomes for this study were patient screening and enrollment across 36 CISTO study sites. The operational strategies included CISTOquestion email correspondence and All Sites Meetings, specifically poll performance data from meetings, and a nonanonymized feedback survey about the CISTO study's management practices. Effectiveness was measured using correlation analysis with patient cohort data, including screenings, enrollments, post-hoc exclusions, and the post-hoc exclusion rate., Results: Average screenings and enrollment rose after the implementation of CISTOquestion in April 2021, with the average number of screenings rising from 7.42 to 26.8 patients per month and enrollment rising from 3.76 to 16 patients per month. Use of CISTOquestion was correlated strongly with increased patient screenings and enrollment across all study sites. Eighty-three percent of sites with above-average post-hoc exclusion rates (≥0.092) sent below the average number of CISTOquestion inquiries. Poll performance and survey data revealed that all survey respondents who used CISTOquestion found that it was a valuable and accessible resource., Conclusions: Of the several operational tools implemented within the CISTO study that aimed to improve patient enrollment, CISTOquestion, a centralized email for addressing eligibility questions, was most beneficial to overall patient accrual., (© 2024 American Cancer Society.)

Background : Recent advancements in hip arthroplasty aim to enhance the stability, longevity, and functionality of femoral implants. However, the distal fitting of femoral stems, often caused by metaphyseal-diaphyseal mismatch, remains a significant issue, particularly in patients with Dorr type A femora. Such mismatches can result in suboptimal implant performance, leading to potential complications. This study focuses on evaluating the anatomical compatibility of five representative single-tapered wedge mid-short stems with the mediolateral (ML) anatomy of the proximal femur in an East Asian population, where these mismatches are often more pronounced. Methods : A total of 742 patients from two hospitals, all of whom underwent unilateral primary total hip arthroplasty, were included in the study. The contralateral proximal femur was confirmed to have normal anatomy in each patient. Hip anteroposterior radiographs were used for measurements, which were standardized in conjunction with CT images. Key anatomical parameters were measured, including proximal and distal medial-lateral canal dimensions, vertical offset, and medial offset. Five femoral stem designs-Tri-lock ® , Taperloc ® , Anthology ® , Accolade II ® , and Fit ® -were evaluated. R programming was employed for a detailed fit analysis to match stem sizes with patient anatomy, categorizing the fit as proximal, simultaneous proximal-distal, or distal engagement. Results : Among the femoral stems analyzed, the Fit ® stem demonstrated the closest alignment with the regression line for ML widths in the study population (slope = 0.69; population ML slope = 0.38). This was followed by Accolade II ® , which had a slope of 0.83. In terms of offset options, the Accolade II ® offered the largest offset coverage, making it particularly suitable for this population. The fit analysis revealed that the Fit ® stem had the highest suitable fit rate (90.56%), followed by Accolade II ® (73.04%). Taperloc ® , Anthology ® , and Tri-lock ® had similar fit rates of approximately 59%. Overall, optimal results were obtained for 92.05% of the population in the automated fitting trial, regardless of the product type. Conclusions : When designing modern cementless femoral stems intended for press-fit fixation, it is crucial to account for the anatomical variations specific to the target population. In this study, Fit ® and Accolade II ® femoral components demonstrated superior compatibility with the femoral anatomy of the East Asian population, particularly in those with a higher incidence of Dorr type A femora. These stems, characterized by slimmer distal dimensions and high-offset options, appear to minimize metaphyseal-diaphyseal mismatch and associated complications.

Hyperadrenocorticism (HAC) is a common endocrine disorder in dogs, which is associated with diverse metabolic abnormalities. We hypothesized that elevated cortisol levels in dogs with HAC disrupt the gut microbiome (GM), and this disruption persists even after trilostane treatment. This study explored GM composition in dogs with HAC. We included 24 dogs, 15 with HAC and 9 healthy controls, and followed up with 5 dogs with HAC who received trilostane treatment. The GM analysis revealed significant compositional changes in dogs with HAC, including reduced microbiome diversity compared to healthy controls, particularly in rare taxa, as indicated by the Shannon index ( p = 0.0148). Beta diversity analysis further showed a distinct clustering of microbiomes in dogs with HAC, separating them from healthy dogs ( p < 0.003). Specifically, an overrepresentation of Proteobacteria (Pseudomonadota), Actinobacteria, Bacteroides , Enterococcus , Corynebacterium , Escherichia , and Proteus populations occurred alongside a decreased Firmicutes (Bacillota) population. Despite trilostane treatment, gut dysbiosis persisted in dogs with HAC at a median of 41 d post treatment, suggesting its potential role in ongoing metabolic issues. We identified GM dysbiosis in dogs with HAC by examining key bacterial genera, offering insights into potential interventions like probiotics or fecal microbiota transplants for better HAC management.

Background: Early risk stratification is crucial due to septic patients' heterogeneity. Serum albumin level may reflect the severity of sepsis and host status. This study aimed to evaluate the prognostic ability of the initial sequential organ failure assessment (SOFA) score alone and combined with serum albumin levels for predicting 28-day mortality in patients with septic shock. Methods: We conducted an observational study using a prospective, multicenter registry of septic shock patients between October 2015 and May 2022 from 12 emergency departments in the Korean Shock Society and the results were validated by examining those from the septic shock cohort in Asan Medical Center. The primary outcome was 28-day mortality. The area under the receiver operating characteristic (ROC) curve was used to compare the predictive values of SOFA score alone and SOFA score combined with serum albumin level. Results: Among 5805 septic shock patients, 1529 (26.3%) died within 28 days. Mortality increased stepwise with decreasing serum albumin levels (13.6% in albumin ≥3.5, 20.7% in 3.5-3.0, 29.7% in 3.0-2.5, 44.0% in 2.5-2.0, 56.4% in <2.0). The albumin SOFA score was calculated by adding the initial SOFA score to the 4 points assigned for albumin levels. ROC analysis for predicting 28-day mortality showed that the area under the curve for the albumin SOFA score was 0.71 (95% CI 0.70-0.73), which was significantly higher than that of the initial SOFA score alone (0.68, 95% CI: 0.67-0.69). Conclusions: The combination of the initial SOFA score with albumin can improve prognostic accuracy for patients with septic shock, suggesting the albumin SOFA score may be used as an early mortality stratification tool.

A two-year-old neutered male Turkish Angora cat presented with respiratory signs, including chronic snoring sounds and dyspnea with open-mouth breathing. Nasopharyngeal stenosis (NPS) was diagnosed based on endoscopy and computed tomography (CT). An attempt was made to break down the membrane, causing stenosis in the nasopharynx through balloon dilation using a valvuloplasty balloon dilation catheter (12 mm × 3 cm) and retroflexed endoscope. The balloon size was selected according to the identified diameter of the stenotic site on nasopharyngeal CT images. The balloon was inflated with radiographic contrast medium and maintained for 2 min; the similar procedure was repeated four additional times. The stenotic membrane was excised after balloon dilation. Topical Mitomycin C (MMC) was then administered to the stenotic region. After 2 weeks, an additional MMC application was repeated to prevent recurrence. The cat remained free of clinical signs without recurrence for 12 months after the most recent procedure. In this study, effective treatment results were obtained using a combination of balloon dilation, membrane excision, and topical MMC for membranous nasopharyngeal stenosis in a cat., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kwak, Kim, Yu, Kim and Woo.)

Background: Omicron variants have rapidly diversified into sublineages with mutations that enhance immune evasion, posing challenges for vaccination and antibody responses. This study aimed to compare serum cross-neutralizing antibody responses against various SARS-CoV-2 Omicron sublineages (BA.1, BA.5, XBB.1.17.1, FK.1.1, and JN.1) in recipients of monovalent COVID-19 boosters, bivalent booster recipients, and individuals who had recovered from Omicron BA.5 infections., Methods: We conducted a micro-neutralization assay on serum samples from monovalent BNT162b2 booster recipients (N = 54), bivalent BNT162b2 booster recipients (N = 24), and SARS-CoV-2 Omicron BA.5-recovered individuals (N = 13). The history of SARS-CoV-2 Omicron infection was assessed using ELISA against the SARS-CoV-2 NP protein., Results: Bivalent booster recipients exhibited significantly enhanced neutralization efficacy against Omicron sublineages compared to those who had received monovalent booster vaccinations. Omicron BA.5-recovered individuals displayed similar neutralizing antibodies (NAbs) to the bivalent booster recipients. Despite the improved neutralization in bivalent recipients and BA.5-recovered individuals, there were limitations in neutralization against the recently emerged Omicron subvariants: XBB.1.17.1 FK.1.1, and JN.1. In both monovalent and bivalent booster recipients, a history of Omicron breakthrough infection was associated with relatively higher geometric mean titers of NAbs against Omicron BA.1, BA.5, and XBB.1.17.1 variants., Conclusion: This study underscores the intricate interplay between vaccination strategies, immune imprinting, and the dynamic landscape of SARS-CoV-2 variants. Although bivalent boosters enhance neutralization, addressing the challenge of emerging sublineages like XBB.1.17.1, FK.1.1, and JN.1 may necessitate the development of tailored vaccines, underscoring the need for ongoing adaptation to effectively combat this highly mutable virus., (© 2024 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: The interest toward the association between atopic dermatitis (AD) and obesity is increasing, yet the possibility of abnormal lipid metabolism has never been investigated before., Objective: To identify the characteristics of patients with AD who are obese and analyze the serum lipid profiles of these patients., Methods: This observational study included 167 patients diagnosed with AD and underwent evaluations for serum lipid panels between July 2017 and October 2017. The patients' body mass index was used to determine obesity and the serum lipid panels were analyzed between patients who are obese and non-obese. Also, the disease severity and subjective symptoms were evaluated and serum total immunoglobulin E (IgE) and specific IgE levels were assessed., Results: Of the 167 patients with AD, there were 36 obese and 131 non-obese subjects. Obese patients were found to have a significantly higher disease severity, as well as higher serum triglyceride and low-density lipoprotein-cholesterol levels and lower high-density lipoprotein-cholesterol levels, which was most pronounced in adult males. Obesity AD patients also had a significantly higher serum total IgE, itch intensity score, and number of allergens sensitized., Conclusion: Patients with AD who are obese should be monitored for possible abnormalities in lipid metabolism. Obesity may be a factor that contributes to a higher disease severity of AD., Competing Interests: The authors have nothing to disclose., (© 2024 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Background/purpose: Peri-implantitis is a representative etiology that affects the long-term survival of dental implants. It is known that decontamination of the implant surface is essential for the successful outcome of regenerative therapy for peri-implantitis. In the present study, the stability of a novel separable dental implant (SDI) was evaluated and compared with a conventional non-separable dental implant (NDI) using biomechanical and histomorphometric analyses., Materials and Methods: In this animal study, 40 rabbits were implanted with two SDI fixtures in the left tibia and two NDI fixtures in the right tibia. The rabbits were sacrificed 3 and 6 weeks after implantation, and the implant samples were evaluated using resonance frequency analysis (RFA), micro-computed tomography (CT), removal torque testing, and histomorphometric analysis., Results: SDI exhibited comparable or better osseointegration and implant stability to NDI. In particular, SDI showed significantly higher implant stability quotient (ISQ) values immediately and 6 weeks after implantation, while removal torque values were significantly higher at both 3 and 6 weeks. In addition, microgaps on the histomorphometric images were not observed and abnormal signs or inflammation did not occur at the connection between the top and bottom parts of the SDI., Conclusion: The novel SDI fixture demonstrated sufficient osseointegration and biomechanical stability compared with NDI in this animal study. In addition, the changeable top part of SDI indicates that it may be effective in easily treating peri-implantitis in clinical practice. Additional future studies on the stability and clinical application after loading to the fixture are necessary., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2024 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Microbridge structures have been widely used in microelectromechanical systems. When the devices with microbridges operate in diverse environments, including wet conditions, structural failures such as crumples, clustering, and collapse of micro/nanostructures occur due to the capillary force of liquid in this environment. It is necessary to establish comprehensive design criteria to address this. Herein, we investigate the structural stability of microbridges on microsized apertures in wet conditions. The multiscale structure is fabricated with microbridge width, spacing of 10 μm, and height of 6 μm while varying the supporting micro aperture size. The behavior of the microbridges is observed through an optical microscope during water dispensing on the bridges and evaporation. It is found that the microbridges remain stable on apertures of 100 μm in diameter, while clustering occurs on larger-sized apertures (300, 500 μm). Interestingly, in contrast to the 500 μm-sized aperture, the clustered microbridges on the 300 μm-sized aperture gradually recover to their original configuration after completely evaporating water. A simple theoretical model for capillary force-induced clustering and recovery is proposed to elucidate this phenomenon, which agrees with the experimental results. The microbridges constructed following the design rule can ensure robust and stable operation even in wet conditions. These findings contribute to advancing micro/nanoscale engineering and offer insights for developing innovative microdevices.

Human periodontal ligament cells (hPDLCs) contain multipotent postnatal stem cells that can differentiate into PDL fibroblasts, osteoblasts, and cementoblasts. Interaction between the extracellular environment and stem cells is an important factor for differentiation into other progenitor cells. To identify cell surface molecules that induce PDL fibroblastic differentiation, we developed a series of monoclonal antibodies against membrane/ECM molecules. One of these antibodies, an anti-PDL25 antibody, recognizes approximately a 100 kDa protein, and this antigenic molecule accumulates in the periodontal ligament region of tooth roots. By mass spectrometric analysis, we found that the antigenic molecule recognized by the anti-PDL25 antibody is fibroblast activation protein α (FAPα). The expression level of FAPα/PDL25 increased in TGF-β1-induced PDL fibroblasts, and this protein was localized in the cell boundaries and elongated processes of the fibroblastic cells. Ectopic expression of FAPα induced fibroblastic differentiation. In contrast, expression of representative markers for PDL differentiation was decreased by knock down and antibody blocking of FAPα/PDL25. Inhibition of dipeptidyl peptidase activity by a potent FAPα inhibitor dramatically inhibited PDL fibroblastic marker expression but did not affect in cell proliferation and migration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Importance: A proportion of people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have a relapsing disease course and persistent anti-myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) seropositivity. Few studies have investigated whether treatment of the first MOGAD attack is associated with the long-term disease course and/or MOG-IgG seronegative conversion., Objective: To investigate the association of time to treat the first acute MOGAD attack with relapse risk and MOG-IgG serostatus., Design, Setting, and Participants: This was a retrospective, nationwide, multicenter cohort study involving 14 secondary or tertiary hospitals in South Korea between November 2009 and August 2023. People with adult-onset MOGAD, who either had a relapse or were followed up for more than 12 months after disease onset and had a detailed medical record of their first attack, were included. Individuals were excluded for adolescent-onset MOGAD or short disease duration., Exposures: Patients were categorized based on the time to treat the first acute MOGAD attack: early (<5 days), intermediate (5-14 days), and late (not treated within 14 days)., Main Outcomes and Measures: A multivariable analysis for clinical and treatment factors associated with relapsing disease course and/or MOG-IgG seronegative conversion. Further subgroup analyses were conducted among those without long-term nonsteroidal immunosuppressant (NSIS) maintenance treatment., Results: Among the 315 individuals screened, 75 were excluded. A total of 240 patients (median [IQR] age at onset, 40.4 [28.8-56.1] years; 125 female [52.1%]) with median (IQR) disease duration of 3.07 (1.95-6.15) years were included. A total of 110 of 240 patients (45.8%) relapsed after a median (IQR) of 0.45 (0.18-1.68) years, and 29 of 116 patients (25.0%) experienced a conversion to seronegative MOG-IgG. Both the time to treatment of the first MOGAD attack (late vs early: adjusted hazard ratio [aHR], 2.64; 95% CI, 1.43-4.84; P = .002; intermediate vs early: aHR, 2.02; 95% CI, 1.10-3.74; P = .02) and NSIS maintenance treatment (aHR, 0.24; 95% CI, 0.14-0.42; P < .001) were independently associated with the risk of relapse. In a subgroup without NSIS maintenance, the time to treat of the first MOGAD attack was still associated with higher risk of relapse (late vs early: aHR, 3.51; 95% CI, 1.64-7.50; P = .001; intermediate vs early: aHR, 2.68; 95% CI, 1.23-5.85; P = .01). Lastly, the time to treat of the first MOGAD attack was also associated with MOG-IgG seronegative conversion (early vs late: adjusted odds ratio, 7.04; 95% CI, 1.58-31.41; P = .01), whereas NSIS maintenance treatment was not., Conclusions and Relevance: Results of this cohort study suggest that early treatment of the first acute MOGAD attack was associated with a reduction in the proportion of relapsing disease course and an increase in the likelihood of MOG-IgG seronegative conversion. These data suggest that timing of acute phase treatment for the first MOGAD attack can be associated with the long-term prognosis and autoimmune status of patients.

Background: Cardiopulmonary resuscitation (CPR) is the cornerstone intervention for cardiac arrest, with extracorporeal CPR (ECPR) demonstrating enhanced survival and neurologic outcomes in in-hospital cardiac arrest. This study explores the time interval between CPR initiation and the onset of extracorporeal membrane oxygenation (ECMO) in ECPR recipients, investigating its impact on survival outcomes., Methods: This retrospective analysis included 1950 adults who received CPR at a single medical center between March 2019 and April 2023. Data from 198 adult patients who had ECMO inserted during CPR were analyzed. The interval from CPR initiation to ECMO initiation was quantified and categorized as ≤20, 20-40, and >40 min. Cox regression analysis assessed associations between CPR-to-ECMO time and short- and long-term mortalities., Results: Among the 198 patients who underwent ECPR, 116 (58.6%) experienced 30-day mortality. Initiation of ECMO within 20 min occurred in 46 (23.2%), whereas 74 (37.4%) had ECMO initiated after 40 min. Cox regression revealed a significant association between time from CPR to ECMO initiation and 30-day mortality (adjusted hazard ratio [HR]: 2.20 in >40 min, HR: 2.63 in 20-40 min, p = 0.006) and 6-month mortality (HR: 1.81, in >40 min, HR: 1.99 in 20-40 min, p = 0.021)., Conclusions: This study revealed that, in ECPR recipients, a shorter duration between CPR initiation and ECMO flow commencement is associated with improved short- and long-term patient prognoses. These findings emphasize the critical role of timely ECMO application in optimizing outcomes for patients undergoing ECPR., (© 2024 The Association for the Publication of the Journal of Internal Medicine.)

The presence of foreign bodies in the mandible is not listed as a risk factor or absolute contraindication for implant rehabilitation. However, possible complications caused by foreign bodies, such as infection and cyst formation, could lead to implant failure. The authors report a case of dental implant placed 4 months after the surgical removal of embedded amalgam in the mandibular alveolus using a trephine bur and bone grafting with mineralized freeze-dried bone allograft. Clinical and radiographic evaluations were performed at each appointment to assess factors such as pain, implant mobility, probing depth, and marginal bone loss around the implant. Within 3 years of implant placement, there were no clinical signs and symptoms and no obvious radiographic marginal bone loss. Dental implant installation appears to be safe following the elimination of foreign materials, so long as anatomic and biological factors and appropriate implant choice, are taken into consideration., Competing Interests: The authors report conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: The interferon-gamma releasing assay (IGRA) has been widely used to diagnose latent tuberculosis infection (TBI). However, there are limited data on the association between performance in the IGRA and risk of tuberculosis disease (TBD), as well as on the appropriate IGRA threshold for initiating TBI treatment., Methods: The analysis was performed using the IGRA results in the Korean Military Manpower Administration database (January 2017 to December 2021), and TBD cases reported to the Korean Military Medical Command (January 2017 to June 2023). All Korean candidates for 18-month military service underwent the IGRA in the pre-enlistment examination, and enlistees who tested positive (≥0.35 IU/mL) were advised to receive TBI treatment before enlistment., Results: From 2017 to 2021, 1 647 941 individuals were screened, with 29 574 testing positive for IGRA. Excluding nonenlistees namely individuals with TBD before enlistment, 19 387 individuals were IGRA positive and 1 356 324 IGRA negative. Of the positives, 4351 were excluded due to discontinued or ongoing TBI treatment at or after enlistment. During follow-up of 9219 untreated and 5818 treated positive individuals and 1 356 324 negatives, TBD occurred in 22 of the IGRA-positive individuals (97.5/100 000 person-years [95% CI, 61.1-147.7]), predominantly in the untreated group (18 cases, 130.1/100 000 person-years [95% CI, 77.1-205.7]) compared to the treated group (4 cases, 45.9/100 000 person-years [95% CI 12.5 - 117.4]), whereas 57 cases occurred in the IGRA-negative group (2.8/100 000 person-years [95% CI, 2.2-3.6]). Elevating the cutoff of IGRA from 0.35 IU/mL to 1.33 IU/mL increased positive predictive value (0.2% vs. 0.4%, p 0.03), with insignificant loss of sensitivity (24% vs. 20%, p 0.69) and decreased numbers needing treatment from 790.5 to 415.3., Discussion: Elevated IGRA levels before enlistment are associated with risk of TBD during military service. It is worth considering raising the IGRA threshold for treatment of TBI in cohorts of healthy, young military individuals., (Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Trained immunity, an innate immune response characterized by enhanced cellular responsiveness, exhibits a profound memory akin to adaptive immunity. This phenomenon involves intricate metabolic and epigenetic reprogramming triggered by stimuli such as β-glucan and BCG, shaping innate immune memory. Following elucidation of the background on trained immunity, it is important to explore its multifaceted roles in various pathological contexts. In this review, we delve into the specific contributions of trained immunity in the intricate landscape of viral infections, tumorigenesis, and diverse inflammatory diseases, shedding light on its potential as a therapeutic target, and offering comprehensive understanding of its broader immunological implications. [BMB Reports 2024; 57(10): 431-440].

Introduction: We aimed to describe the health and well-being of family caregivers of Native Hawaiian and Pacific Islander (NHPI) adults living with Alzheimer's disease and related dementias (ADRD), explore cultural values related to caregiving, and characterize barriers and facilitators to their health and well-being., Methodology: Caregivers of NHPIs living with ADRD were recruited from across the United States to complete a multimethod study including a survey followed by an interview about their health and well-being., Results: Eleven participants completed surveys, six of whom completed an interview. Themes included caring as a community, lōkahi (balance), and the importance of sleep, food, and physical activity. Cultural values included connection to cultural practices, kūpuna (elders) as cultural knowledge holders, and the kuleana (responsibility) of caregiving., Discussion: Caregiving for an NHPI adult living with ADRD occurs beyond the dyad, and is a matter of family and community. Culturally-based interventions offered through community and healthcare organizations may be critical to promoting caregiver health., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction and Objectives: Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat., Methods: A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm 2 )/height 2 (m 2 ) at the L3 level. The primary outcome was all-cause mortality during follow-up., Results: Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis., Conclusions: Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: Certain studies propose that antibiotic use may influence rheumatoid arthritis (RA) incidence, but the clear association between antibiotics and RA remains unclear. Therefore, this study aimed to examine the relationship between antibiotics and RA risk to provide additional epidemiological evidence., Methods: This population-based retrospective cohort study was conducted with adults aged 40 years or older using the Korean National Health Insurance Service (NHIS) database. Antibiotic exposure was measured from 2003 to 2007. Study participants were followed up from January 1, 2008, to December 31, 2019. Multivariable Cox hazard regression was utilized to evaluate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of RA according to accumulative days of antibiotic use and the number of antibiotic classes used, respectively., Results: During 3,395 590 person-years of follow-up, 29 274 cases of RA were identified. Participants who used antibiotics for 91 or more days had a higher risk of RA (aHR, 1.79; 95% CI, 1.67-1.92) than antibiotic non-users. Additionally, individuals who used four or more kinds of antibiotic classes had a higher risk of RA (aHR, 1.61; 95% CI, 1.51-1.71) than those who did not prescribe antibiotics. The risk of RA was positively associated with both higher cumulative days of antibiotic exposure and a larger number of drug classes. These trends were maintained in sensitivity analyses, including variations in antibiotic exposure periods., Conclusion: Our findings suggest a possible association between the long-term use of antibiotics and RA incidence. Further studies are necessary for a clearer understanding of this association., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Smart grids arose as the largest cyber-physical systems with the integration of sophisticated control, computing, and state-of-the-art communications. Like all cyber-physical systems, the smart grids are vulnerable to malicious cyber assaults due to their enormous dependency on communication networks. Various machine learning-based schemes are being investigated in the industry and academia to develop robust defense mechanisms to counter cyber assaults. However, the curse of high dimensionality, which increases with the escalating evolution of an electric power system, infringes upon the efficiency of machine learning models employed to detect such assaults. To this end, this paper proposes a deep denoising autoencoder (DAE)-based framework for dimensionality reduction that learns salient feature representation for high-dimensional, multi-variant smart grid measurement data collected from the smart grids. The latent space apprehended by DAE is then fed to binary support vector machine (SVM) to determine the assaulted data. Various standard IEEE test cases are employed in simulations. The results show that the proposed scheme learns more robust features that reveal the nonlinear properties exhibited in the smart grid measurements, further leading to improved detection accuracy of the classifier as compared to existing approaches., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Acute hepatopancreatic necrosis disease (AHPND) is one of the most important diseases in the global shrimp industry. The emergence of mutant AHPND-associated V . parahaemolyticus ( Vp AHPND ) strains has raised concerns regarding potential misdiagnosis and unforeseen pathogenicity. In this study, we report the first emergence of a type II ( pirA - , pirB + ) natural mutant, Vp AHPND (strain 20-082A3), isolated from cultured Penaeus vannamei in Korea. Phenotypic and genetic analyses revealed a close relationship between the mutant strain 20-082A3 and the virulent Korean Vp AHPND strain 19-021-D1, which caused an outbreak in 2019. Detailed sequence analysis of AHPND-associated plasmids showed that plasmid pVp&#95;20-082A3B in strain 20-082A3 was almost identical (>99.9%) to that of strain 19-021-D1. Moreover, strains 20-082A3 and 19-021-D1 exhibited the same multilocus sequence type (ST 413) and serotype (O1:Un-typeable K-serogroup), suggesting that the mutant strain is closely related to and may have originated from the virulent strain 19-021-D1. Similar to previous reports on the natural mutant Vp AHPND , strain 20-082A3 did not induce AHPND-related symptoms or cause mortality in the shrimp bioassay. The emergence of a mutant strain which is almost identical to the virulent Vp AHPND highlights the need for surveillance of the pathogen prevalent in Korea. Further investigations to elucidate the potential relationship between ST 413 and recent Korean Vp AHPND isolates are needed.

Cancer therapies have evolved from traditional chemotherapy to more precise molecular-targeted immunotherapies, which have been associated with improved side effects and outcomes. These modern strategies rely on cancer-specific biomarkers that differentiate malignant from normal cells. The B7 family of immune checkpoint molecules is crucial for cancer immune evasion and a prime therapeutic target. B7-H6, a recently identified member of the B7 family, has emerged as a promising therapeutic target. Unlike other B7 proteins, B7-H6 is not expressed in healthy tissues but is upregulated in several cancers. It binds to NKp30, activating natural killer (NK) cells and triggering immune responses against cancer cells. This review explores the expression of B7-H6 in different cancers, the factors that regulate its expression, and its intrinsic and extrinsic pathways. Additionally, we discuss potential anticancer therapies targeting B7-H6, highlighting its significance in advancing precision medicine. Understanding the role of B7-H6 in cancer immunity may inform the development of appropriate therapies that exploit its cancer-specific expression.

Companion diagnostics are increasing clinical demand globally, regulatory frameworks for clinical validation are strengthening. Post-marketing verification is an important aspect of providing high-quality, personalized treatment to patients because it can ensure long-term safety and effectiveness, while also generating effective risk management and performance evidence. Certain compliance issues related to the requirements for post-marketing clinical trials can potentially impact manufacturers, so it is essential to have a clear understanding of the regulatory process. In this study, we perform an institutional comparison as well as a case analysis by country (U.S. Food & Drug Administration, European Medicines Agency, Pharmaceuticals and Medical Devices Agency, and Ministry of Food and Drug Safety) on the post-marketing safety and effectiveness of companion diagnostics. We collected guidelines and guidance documents published by each regulatory agency and Post-marketing research case analysis examined the data collection items as well as the materials or templates required to be submitted. The results indicate that there are institutional differences in the post-marketing surveillance activities carried out by different regulatory authorities, and the data required may vary accordingly. The findings of this study are expected to provide new insights that can support manufacturers and developers of companion diagnostics in securing evidence regarding post-marketing safety and effectiveness., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Compton cameras have emerged as promising tools in biomedical imaging, offering sensitive gamma-ray imaging capabilities for diverse applications. This review paper comprehensively overviews the latest advancements in Compton camera image reconstruction technologies. Beginning with a discussion of the fundamental principles of Compton scattering and its relevance to gamma-ray imaging, the paper explores the key components and design considerations of Compton camera systems. We then review various image reconstruction algorithms employed in Compton camera systems, including analytical, iterative, and statistical approaches. Recent developments in machine learning-based reconstruction methods are also discussed, highlighting their potential to enhance image quality and reduce reconstruction time in biomedical applications. In particular, we focus on the challenges posed by conical back-projection in Compton camera image reconstruction, and how innovative signal processing techniques have addressed these challenges to improve image accuracy and spatial resolution. Furthermore, experimental validations of Compton camera imaging in preclinical and clinical settings, including multi-tracer and whole-gamma imaging studies are introduced. In summary, this review provides potentially useful information about the current state-of-the-art Compton camera image reconstruction technologies, offering a helpful guide for investigators new to this field., Competing Interests: Conflict of interestLee JS is the editor-in-chief of Biomedical Engineering Letters but has not been involved in the peer review and decision-making process of this paper. Kim SM has no relevant and financial and or non-financial interest to disclose., (© The Author(s) 2024.)

Reactive oxygen species (ROS) are chemically reactive oxygen-containing compounds generated by various factors in the body. Antioxidants mitigate the damaging effects of ROS by playing a critical role in regulating redox balance and signaling. In this study, the interplay between reactive oxygen species (ROS) and antioxidants in the context of lipid dynamics were investigated. The interaction between hydrogen peroxide (H 2 O 2 ) as an ROS and vitamin E (α-tocopherol) as an antioxidant was examined. Model membranes containing both saturated and unsaturated lipids served as experimental platforms to investigate the influence of H 2 O 2 on phospholipid unsaturation and the role of antioxidants in this process. The results demonstrated that H 2 O 2 has a negative effect on membrane stability and disrupts the lipid membrane structure, whereas the presence of antioxidants protects the lipid membrane from the detrimental effects of ROS. The model membranes used here are a useful tool for understanding ROS-antioxidant interactions at the molecular level in vitro.

Absolute quantity imaging of biomolecules on a single cell level is critical for measurement assurance in biosciences and bioindustries. While infrared (IR) transmission microscopy is a powerful label-free imaging modality capable of chemical quantification, its applicability to hydrated biological samples remains challenging due to the strong IR absorption by water. Traditional IR imaging of hydrated cells relies on powerful light sources, such as synchrotrons, to mitigate the light absorption by water. However, we overcome this challenge by applying a solvent absorption compensation (SAC) technique to a home-built benchtop IR microscope based on an external-cavity quantum cascade laser. SAC-IR microscopy adjusts the incident light using a pair of polarizers to precompensate the IR absorption by water while retaining the full dynamic range. Integrating the IR absorbance over a cell yields the total mass of biomolecules per cell. We monitor the total mass of the biomolecules of live fibroblast cells over 12 h, demonstrating promise for advancing our understanding of the biomolecular processes occurring in live cells on the single-cell level.

Objective: To analyze and improve the accuracy of preoperative assessment and intraoperative frozen-section analysis (FSA) for malignant ovarian germ cell tumors (MOGCTs), especially in the context of fertility preservation., Methods: A retrospective review of 48 women aged under 40 years, diagnosed with MOGCTs, and treated at Chonnam National University Hospital between July and December 2022 was conducted. The results of preoperative magnetic resonance imaging (MRI), measurement of serum tumor markers (α-fetoprotein [AFP], β-human chorionic gonadotropin, lactate dehydrogenase [LDH], cancer antigen [CA] 125, CA 19-9, CA 72-4, carcinoembryonic antigen), and intraoperative FSA were compared with the final pathology diagnosis., Results: MRI demonstrated a sensitivity of 95.5%, whereas FSA showed a sensitivity of 72.9% for all MOGCTs. Sensitivities varied according to the subtype, but were consistently higher in MRI (100% for dysgerminoma, 88.9% for immature teratoma, 100% for endodermal sinus tumor, 100% for others). However, there were differences in FSA according to subtype (100% for dysgerminoma, 50.0% for immature teratoma, 100% for endodermal sinus tumor, 25.0% for others). Serum tumor markers also provided diagnostic insights, particularly LDH for dysgerminoma (82.4%) and AFP for immature teratoma (75.0%) and endodermal sinus tumor (100%)., Conclusion: Preoperative MRI and serum tumor marker measurement may be effective in guiding fertility-sparing surgical decisions. MRI could outperform FSA in terms of accuracy, especially for immature teratoma., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Despite the detailed imaging information provided by optical coherence tomography (OCT) during percutaneous coronary intervention (PCI), clinical benefits of this imaging technique in this setting remain uncertain. The aim of the OCCUPI trial was to compare the clinical benefits of OCT-guided versus angiography-guided PCI for complex lesions, assessed as the rate of major adverse cardiac events at 1 year., Methods: This investigator-initiated, multicentre, randomised, open-label, superiority trial conducted at 20 hospitals in South Korea enrolled patients aged 19-85 years for whom PCI with drug-eluting stents was clinically indicated. After diagnostic angiography, clinical and angiographic findings were assessed to identify patients who met the criterion of having one or more complex lesions. Patients were randomly assigned 1:1 to receive PCI with OCT guidance (OCT-guidance group) or angiography guidance without OCT (angiography-guidance group). Web-response permuted-block randomisation (mixed blocks of four or six) was used at each participating site to allocate patients. The allocation sequence was computer-generated by an external programmer who was not involved in the rest of the trial. Outcome assessors were masked to group assignment. Patients, follow-up health-care providers, and data analysers were not masked. PCI was done according to conventional standard methods with everolimus-eluting stents. The primary endpoint was major adverse cardiac events (a composite of cardiac death, myocardial infarction, stent thrombosis, or ischaemia-driven target-vessel revascularisation), 1 year after PCI. The primary analysis was done in the intention-to-treat population. The margin used to establish superiority was 1·0 as a hazard ratio. This trial is registered with ClinicalTrials.gov (NCT03625908) and is completed., Findings: Between Jan 9, 2019, and Sept 22, 2022, 1604 patients requiring PCI with drug-eluting stents for complex lesions were randomly assigned to receive either OCT-guided PCI (n=803) or angiography-guided PCI (n=801). 1290 (80%) of 1604 patients were male and 314 (20%) were female. The median age of patients at randomisation was 64 years (IQR 57-70). 1588 (99%) patients completed 1-year follow-up. The primary endpoint occurred in 37 (5%) of 803 patients in the OCT-guided PCI group and 59 (7%) of 801 patients in the angiography-guided PCI group (absolute difference -2·8% [95% CI -5·1 to -0·4]; hazard ratio 0·62 [95% CI 0·41 to 0·93]; p=0·023). Rates of stroke, bleeding events, and contrast-induced nephropathy were not significantly different across the two groups., Interpretation: Among patients who required drug-eluting stent implantation for complex lesions, OCT guidance resulted in a lower incidence of major adverse cardiac events at 1 year compared with angiography guidance. These findings indicate the existence of a therapeutic benefit of OCT as an intravascular imaging technique for PCI guidance in patients with complex coronary lesions., Funding: Abbott Vascular and Cardiovascular Research Center., Translation: For the Korean translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests S-JH reports speaker fees from AstraZeneca, Amgen, ChongKunDang, Hanmi, and Viatris; and participation on the data safety monitoring board of the IVUS-DCB trial. S-JL reports research grants and speaker fees from Boston Scientific, Medtronic, ChongKunDang, and Sam Jin Pharmaceutical. JHH reports consulting and speaker fees from Abbott Vascular. J-WL reports consulting fees from Genoss; speaker fees from Yuhan, Boryoung, Sam Jin Pharmaceutical, ChongKunDang, Korea United Pharm, HK inno.N, Novartis, Boehringer Ingelheim, AstraZeneca, Medtronic, Abbott Vascular, Amgen, Sanofi, Boston Scientific, Daiichi-Sankyo, Daewoong Pharmaceutical, Biosensors, Dong-A ST, and JW Pharmaceutical; and participation on the data safety monitoring board of the Rescue-SHOCK trial. J-SK reports grants from Sam Jin Pharmaceutical, Yuhan, Daiichi-Sankyo, Biosensors, and Qualitech Korea and proctoring fees from Abbott Vascular. Y-GK reports research grants from Medtronic, Korea United Pharm, Cook Medical, Boston Scientific, Otsuka Korea, Dong-A ST, Sam Jin Pharmaceutical, Cordis, HK inno.N, and GC Biopharma. M-KH reports research grants, paid to their institution, from Sam Jin Pharmaceutical and ChongKunDang and honoraria for lectures from Medtronic and Edwards Lifesciences. YJ reports research grants, paid to their institution, from Abbott Vascular. B-KK reports research grants and speaker or consulting fees from Abbott Vascular, Yuhan, Sam Jin Pharmaceutical, ChongKunDang, Medtronic, Boston Scientific, Biotronik, Genoss, CGBIO, MicroPort, Daewoong Pharmaceutical, Amgen, Bayer Korea, DIO Medical, Hanmi, AstraZeneca, and Novartis. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Timely and accurate assessment of coagulopathy is crucial for the management of primary postpartum hemorrhage (PPH). Thromboelastography (TEG) provides a comprehensive assessment of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. This study aimed to evaluate the role of TEG in predicting hypofibrinogenemia in emergency department (ED) patients with primary PPH., Methods: We conducted a retrospective observational study in the ED of a university-affiliated tertiary hospital between November 2015 and August 2023. TEG was performed upon admission. The cutoff value for hypofibrinogenemia was 200 mg/dL. The primary outcome was the presence of hypofibrinogenemia., Results: Among the 174 patients, 73 (42.0%) had hypofibrinogenemia. The need for massive transfusion was higher in the hypofibrinogenemia group (37.0% vs. 5.0%, p < 0.001). Among the TEG parameters, all values were significantly different between the groups, except for lysis after 30 min, suggesting a tendency toward hypocoagulability. Multivariable analysis revealed that the alpha angle (odds ratio (OR) 0.924, 95% confidence interval (CI) 0.876-0.978) and maximum amplitude (MA) (OR 0.867, 95% CI 0.801-0.938) were independently associated with hypofibrinogenemia. The optimal cutoff values for the alpha angle and maximum amplitude (MA) for hypofibrinogenemia were 63.8 degrees and 56.1 mm, respectively., Conclusion: Point-of-care TEG could be a valuable tool for the early identification of hypofibrinogenemia in ED patients with primary PPH., (© 2024. The Author(s).)

Background: We investigated the relationship between employment status, work patterns, and sudden cardiac arrest (SCA). Methods: This was a case-control study from September 2017 through December 2022 involving 17 emergency departments and 9 public health centers. The cases included patients aged 20-79 years with SCA, excluding those with traumatic arrest, terminal illness, pregnancy, unreliable information, or a "Do Not Resuscitate" order. Controls were selected from various health screening centers in Korea. All participants completed structured questionnaires. Propensity score matching was used to ensure comparability by age, sex, and socioeconomic status. Results: Of the 1536 patients enrolled, 116 from the case group were excluded due to missing employment data, leaving 1420 cases and 2304 controls for analysis. Employment was reported by 47.5% of cases and 59.4% of controls. There was no significant difference in the proportion of sole proprietors (20.6% vs. 22.5%, p = 0.39). The case group had a higher proportion of employers (13.2% vs. 6.5%, p < 0.001) and fewer employees (63.3% vs. 69.1%, p = 0.02). Professional roles were more common among controls (23.6% vs. 31.6%, p < 0.001), while labor-intensive jobs were more frequent in cases (27.7% vs. 17.8%, p < 0.001). The case group had more evening and night shifts (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.06; OR: 1.05, 95% CI: 1.01-1.09) and longer workdays (OR: 1.06, 95% CI: 1.03-1.08). Conclusions: SCA patients were more likely to work evening and night shifts and have longer workdays, often exceeding 10 h.