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ImportanceDistraction using virtual reality (VR) has been found to provide a clinically significant reduction in the experience of pain during various painful procedures. Commercially available VR systems usually require the user to wear a head-mounted display helmet, which can be challenging for young children, and whether VR can reduce pain during intravenous (IV) placement in young children is currently unknown.ObjectiveTo determine whether a VR environment using a novel domed ceiling screen reduces distress among children over the course of IV placement compared with standard care in a pediatric emergency department.Design, Setting, and ParticipantsThis randomized clinical trial was conducted from June 3, 2020, to February 8, 2021, at an urban tertiary academic children’s hospital. Included were children aged 6 months to 4 years undergoing IV placement in the pediatric emergency department.InterventionChildren in the intervention group lay on a bed to experience a VR animation using a domed ceiling screen during the IV placement procedure, which was performed as usual. Children in the control group also lay on a bed during the procedure but did not view a VR animation.Main Outcomes and MeasuresThe primary outcome was pain scores measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 4 time points during IV placement: immediately after the child lay down on the bed (T1), the moment the tourniquet was applied (T2), the moment a sterile alcohol swab was applied (T3), and the moment the needle penetrated the skin (T4).ResultsOf the 88 children included in the final analysis, 44 received VR distraction (median [IQR] age, 24.0 [14.5-44.0] months; 27 boys [61.4%]), and 44 received standard care (median [IQR] age, 23.0 [15.0-40.0] months; 26 boys [59.1%]). The median [IQR] FLACC scores at T4 were 6.0 (1.8-7.5) in the intervention group and 7.0 (5.5-7.8) in the control group. The ordinal logistic regression model showed that children in the VR intervention group vs the control group had a lower probability of higher FLACC scores (odds ratio, 0.53; 95% CI, 0.28-0.99; P = .046).Conclusions and RelevanceThe findings of this trial indicate that displaying VR using a domed ceiling screen may be an effective distraction method that reduces distress in young children undergoing IV placement.Trial Registrationisrctn.org Identifier: KCT0005122

Osteoporosis is characterized by low bone mass and elevated structural deterioration of the bone tissue, resulting in bone weakness with an increased risk of fracture. Considering biological activities of various phytochemicals extracted from apples, we herein demonstrated the potential antiosteoporotic effects of apple-derived nanovesicles (apple NVs) using osteoblastic MC3T3-E1 cells. Apple NVs significantly stimulated the growth of MC3T3-E1 cells. The cellular alkaline phosphatase (ALP) activity was significantly upregulated in the 5

The engineering modelling of ship hull girder strength usually consists of global and local levels. The Smith-type progressive collapse method is a typical example of this kind, in which the global model requires input from the local model with the underpinning local structural behaviour, i.e., load-shortening curve (LSC). However, the modelling is prone to uncertainty due to the statistical variability of the basic variables (aleatoric uncertainty) and the inadequacy of engineering models in both global and local levels (epistemic uncertainty). The former can be well tackled by a probabilistic sampling, whereas dealing with the latter for ship hull girder strength lacks an established approach. There can be different sources of epistemic uncertainty. In the modelling of ship hull girder strength, this may be partially manifested as that caused by different choices of local engineering models for predicting the LSC. In the light of this, a probabilistic method is applied in this research to investigate and quantify the uncertainty related to the local models. The adopted approach is a hybrid method incorporating the Smith-type progressive collapse method with Monte-Carlo Simulation and an adaptable LSC algorithm. Case studies on four merchant ships show that the ultimate strength in sagging is subjected to the most significant computational uncertainty as compared with those in hogging and horizontal bending. In a bi-axial load case, the computational uncertainty estimated for vertical bending will be counteracted as the horizontal bending increases. Nevertheless, this change is not directly proportional to the bi-axial load component ratio and appreciably varies between different ship types. The insights and data provided by this study may eventually resolve the epistemic uncertainty in the modelling of ship hull girder strength. It would also be useful to improve the ultimate limit state-based reliability analysis with regards to the strength model uncertainty evaluation.

Background and objective: Since industrialization, various communities worldwide have had to deal with the negative effects of pollution. Previous studies have investigated how communities affected by pollution can recover. However, few studies have explored the ways in which recovery takes place over time. This study examined the restoration process of the village of Jangjeom in Iksan, South Korea. The environmental contamination of the air and soil of this area, caused by a fertilizer factory, has been officially recognized. As such, its regional administration is planning its recovery with governmental support.Methods: This study conducted a content analysis of the meeting minutes of the government-civilian committee on environmental emergency measures in the village, using time-series text mining. The main phases and problems in the process of environmental pollution recovery were analyzed.Results: The results of the analysis show that, in the early days of this initiative, there were many discussions regarding the physical and environmental aspects of pollution and the legal framework required to investigate the sources of pollution. However, in later meetings, the focus shifted to how pollution affects the residents, covering topics such as residents’ health check-ups and consultations with experts and administrative agencies.Conclusion: This study shows that for the long-term recovery of communities damaged by pollution, a human-centered approach that goes beyond the physical and environmental aspects of recovery is needed.

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by inappropriate hyperglycemia, which causes endothelial dysfunction and peripheral neuropathy, ultimately leading to multiple complications. One prevalent complication is diabetic erectile dysfunction (ED), which is more severe and more resistant to treatment than nondiabetic ED. The serum glycoprotein leucine-rich ɑ-2-glycoprotein 1 (LRG1) is a modulator of TGF-β-mediated angiogenesis and has been proposed as a biomarker for a variety of diseases, including DM. Here, we found that the adhesion GPCR latrophilin-2 (LPHN2) is a TGF-β-independent receptor of LRG1. By interacting with LPHN2, LRG1 promotes both angiogenic and neurotrophic processes in mouse tissue explants under hyperglycemic conditions. Preclinical studies in a diabetic ED mouse model showed that LRG1 administration into the penile tissue, which exhibits significantly increased LPHN2 expression, fully restores erectile function by rescuing vascular and neurological abnormalities. Further investigations revealed that PI3K, AKT, and NF-κB p65 constitute the key intracellular signaling pathway of the LRG1/LPHN2 axis, providing important mechanistic insights into LRG1-mediated angiogenesis and nerve regeneration in DM. Our findings suggest that LRG1 can be a potential new therapeutic option for treating aberrant peripheral blood vessels and neuropathy associated with diabetic complications, such as diabetic ED.

Purpose: The intervertebral disc is a leading avascular organ in the body that may gather nutrition through diffusion. It maintains homeostasis by the use of autophagy and apoptosis to survive in unfavorable conditions such as stress and mechanical force. Therefore, excessive force and stress beyond normal conditions may cause intervertebral disc degeneration. The purpose of this study was to examine which is the better method, either external fixator (EF) or saline injection (SI), for inducing autophagy and apoptosis-mediated nucleus pulposus (NP) cell death in the discs of rat tail’s. Methods: Sixteen, nine-weeks-old male Sprague–Dawley rat tails were treated with 0.9% saline and EF (two-cross Kirschner wires) for a period ofsix and twelve weeks. Treated discs were dissected to identify the participation of autophagy and apoptosis in intervertebral disc degeneration. For identification purposes, H&E staining, Masson’s trichrome staining, and immunohistochemistry (IHC) for LC3, beclin-1, and P62 in addition to MMP-2, MMP-3, and TIMP-1 were performed. Furthermore, we performed real-time polymerase chain reaction (RT-PCR) to observe autophagy-related gene expression (beclin-1, LC3, and P62) and apoptosis-related gene expression (MMP-2, MMP-3, and TIMP-1). Results: TheEF group showed more insidious NP cell degeneration than the control (Ctrl) group. Degeneration was elevated with increasing compression duration of EF group, whereas the SI group could not distinguish the margin of annulus fibrosus (AF) and NP cells. LC3, beclin-1, and P62 showed the highest and lateral expression whilst MMP-2, MMP-3, and TIMP-1 showed up-regulated and central expression in both groups, although the SI group could not recognize the boundary between NP and AF cells. The EF group showed the highest autophagy-related gene expression whereas the SI group showed lower expression. In addition, the EF group showed more autophagy-accumulating materials than the SI group which elevated with increasing compression duration. Furthermore, the SI group induced the highest apoptotic gene expression, but the EF group showed the lowest expression. Conclusion: The EF method was better for studying autophagy and apoptosis because it enhanced intervertebral disc degeneration after compression, which is actively linked to autophagy and apoptosis. The degeneration process was elevated by increasing the compression duration, but SI could not distinguish AF and NP cell margins.

We aimed to find the ideal chest compression point undergoing cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. The most recent saved chest computed tomography images of all patients 8 years or older with a single ventricle who underwent Fontan surgery were retrospectively analysed. We defined the ideal chest compression point as the largest part of the compressed single ventricle. To find the ideal chest compression point, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. Fifty-eight patients (male 67.2%) were analysed. The mean right deviation from the midline of the sternum as the ideal compression point was almost like the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal point, the area fraction of the single ventricle statistically significant increased by 7%, wider than conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, p < 0.05). When performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression is better than the conventional location.

In soil dams and embankments made of soil, deterioration and stress release owing to internal and external influences occur, and the instability of the body increases as the shear strength decreases. In particular, understanding the location and flow of underground water is very important for securing the long-term stability of waterfront structures in contact with water. However, the physical limitations of measuring equipment cause many difficulties in understanding the existence and location of groundwater over a long period of time. In this study, measuring equipment using electric capacity was developed for the long-term measurement of groundwater, and contactless measuring sensors were manufactured to eliminate the possibility of corrosion by water. In addition, the precision of the measurement data was improved by applying waterproof and water-repellent coatings to the measurement sensor. Laboratory tests conducted using the developed equipment demonstrate the high precision of the measurement data according to the groundwater level change and enhanced durability of the sensor, which facilitate long-term measurements in the field.

Purpose: Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea.Methods:We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed.Results: A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001).Conclusion: Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.

Purpose: In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data.Methods: From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score (< -2, underweight; > 2, overweight or obese). Results: A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively.Conclusion: BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.

The serum glycoprotein leucine-rich ɑ-2-glycoprotein 1 (LRG1), primarily produced by hepatocytes and neutrophils, is a multifunctional protein that can modulate various signalling cascades, mainly TGFβ signalling. Serum LRG1 and neutrophil-derived LRG1 have different molecular weights due to differences in glycosylation, but what impact the differential glycan composition in LRG1 has on its cellular function is largely unknown. We previously reported that LRG1 can promote both angiogenic and neurotrophic processes under hyperglycemic conditions by interacting with LPHN2. Here, we determined the crystal structure of LRG1, identifying the horseshoe-like solenoid structure of LRG1 and its four N-glycosylation sites. In addition, our biochemical and cell-biological analysis found that de-glycosylation of LRG1, particularly the removal of glycans on N325, is critical for high-affinity binding of LRG1 to LPHN2, thereby promoting LRG1/LPHN2-mediated angiogenic and neurotrophic processes in mouse tissue explants, even under normal glucose conditions. Moreover, intracavernous administration of de-glycosylated LRG1 in a diabetic mouse model ameliorated vascular and neurological abnormalities and restored erectile function. Collectively, these data indicate a novel role of LRG1’s glycans as molecular switches that can tune the range of LRG1’s cellular functions, particularly the LRG1/LPHN2 signalling axis.

Introduction The delta neutrophil index (DNI) is a reported marker that can be used to predict the diagnosis, prognosis, and disease severity of bacteremia and sepsis. We determined whether the DNI is useful in differentiating bacterial infection without bacteremia from viral infections in pediatric febrile patients in the emergency department (ED). Method This study involved a retrospective analysis of patient medical records from the pediatric ED of the teaching hospital. After extracting the list of patients with complete blood count (CBC) and DNI data,patients with bacterial infection (BI) without bacteremia and those with viral infection (VI) were identified. The primary outcome was the diagnostic performance of DNI in differentiating BI without bacteremia from VI. The secondary outcome was a comparison of the diagnostic performances of DNI, CRP, WBC, and neutrophil count between the two groups. Results After excluding 756 patients, a total of 574 patients were included in the study. A total of 151 (26.3%) patients were in the BI group, and 423 (73.7%) were in the VI group. There was no significant difference in DNI between the two groups (3.07 (2.52~3.63) vs. 3.51 (2.40~4.62), mean (95% CI), BI vs. VI). There was no difference in WBC count, neutrophil levels, or RDW between the two groups, but CRP levels were significantly higher in the BI group than in the VI group (1.39 (1.19~1.60) vs. 4.56 (3.66~5.45), mean (95% CI), VI vs. BI, p < 0.05). The AUROCs achieved in analyses of DNI, WBC count, neutrophil levels, RDW, and CRP levels were 0.5016, 0.5531, 0.5631, 0.5131, and 0.7389, respectively, and only CRP levels were helpful in differentiating BI from VI. Conclusion In the absence of bacteremia, DNI wound not be helpful in differentiating BI from VI in pediatric febrile patients.

Food allergy is a hypersensitive immune reaction to food proteins including cow’s milk protein. Extracellular vesicles (EVs), such as exosomes, are newly discovered intercellular conveyors of functional molecular mechanisms and mediated intercellular interactions involving mast cells and are particularly relevant to allergy. In this study, we investigated whether cow’s milk casein-induced allergy (CIA)-derived EVs can modulate mast cell activation. EVs in CIA mice and control mice were isolated using the ultracentrifugation method and the isolated EVs were quantified using BCA analysis. CIA responses were determined through changes in body temperature and systemic symptom score. The number of EVs was higher in CIA-derived EVs compared to normal EVs. EVs marker proteins such as CD63 and CD9 were elevated in CIA-derived EVs. The levels of EV-associated cytokines such as IL-6, IL-8, and TNF-α were significantly elevated in CIA-derived EVs. In addition, CIA-derived EVs significantly induced degranulation via Lyn kinase activation in mouse bone marrow-derived mast cells and human mast cells. Our results demonstrate that CIA-derived EVs can induce a reaction similar to cow’s milk allergic reaction via mast cell activation. These results provide an insight into the pathology of cow’s milk allergy and a potential therapeutic approach through targeting EV release and/or uptake.

Background Ankle sprains are the most common orthopedic pathology experienced during sports and physical activity and often result in chronic ankle instability (CAI). The purpose of this study was to assess osteoarthritic changes in the ankle joint in a surgical CAI mouse model. Method The experiments were performed using 14-week-old ICR male mice (n = 19). Mice were randomly placed into the SH group (sham; control, n = 5), ATFL group (resected anterior talofibular ligament; mild ankle sprain, n = 7), or ATFL + CFL group (resected anterior talofibular ligament / calcaneofibular ligament; severe, n = 7) and housed individually. Behavioral analysis using the frequency of standing on the hind leg was performed. To evaluate the clinical severity of arthritis, bodyweight, paw thickness, and ankle thickness were assessed immediately before sacrifice. Immunohistochemical staining and micro-computed tomography were performed to analyze the arthritic changes of the ankle joint. Serological analysis of inflammatory cytokines and C-terminal telopeptide of type I bone resorption markers was performed using enzyme-linked immunosorbent assay (ELISA). Results Compared with the control group, the ATFL + CFL group significantly aggravated the clinical severity of arthritis. In the ATFL and ATFL + CFL groups, the number of mice standing on the hind leg was significantly decreased. ELISA confirmed that the inflammatory cytokines were significantly increased in the ATFL + CFL group. C-terminal telopeptide of type I levels were increased in the ATFL + CFL group but the difference was not statistically significant. Conclusions This study demonstrated that the surgical induction of chronic ankle instability (ATFL + CFL) in a mouse model results in the development of osteoarthritis of an ankle joint.

Various additives ranging from inorganic nanoparticles to organic additives have been suggested to improve the insulation performance of polymeric materials for high-voltage engineering applications. Herein, we present a simple method for doping fluorine into a polypropylene (PP) matrix by melt-blending of isotactic PP (iPP) with a small amount of polyvinylidene fluoride (PVDF) as a thermoplastic voltage stabilizer (TVS). During melt-mixing, the PVDF TVS, which is immiscible with PP, is gradually split into smaller domains within the iPP matrix and was finely distributed, especially at a low PVDF content. The well-distributed PVDF acted as a nucleating agent for the facile crystallization of PP molecules, thus increasing the crystallization temperature (Tc) and decreasing the spherulite size. We found that the direct current (DC) breakdown strength (BDS) values of the PVDF-doped iPP increased by 110% and 149% at 20 and 110°C, respectively, compared to those of the pristine PP. We hypothesize that the presence of fluorine sites as well as the increase in interfaces between spherulites with decreased size, without any significant degradation in the tensile strength and elongation at break below 1.0 phr of PVDF, were the reasons for our findings. Therefore, we anticipate that such PVDF-doped iPP is a potential candidate for high-voltage insulation systems.

This study proposes a simplified empirical formulation to predict the ultimate strength of the initially deflected plate subjected to longitudinal compression. The empirical formulation's applicability and accuracy were verified by comparing the nonlinear finite element method (NLFEM). In total, 700 cases of initially deflected plate scenarios by assuming the buckling mode shape were adopted as the input data. For the simplification of the plate design process, a general shape of the empirical formula is proposed based on input data. A reliable technical solution is obtained with good agreements (R2 = 0.98 to 0.99) compared to NLFEM. The advantage of the proposed outcome is documented by comparing the previous study. The obtained result could be beneficial for the structural design of the initially deflected plate in predicting its ultimate strength performance under longitudinal compression.

Considerable efforts have been devoted to developing rapid methodologies for predicting the residual strength of ship hull girders for a given damage scenario (e.g., R–D diagram). This task is usually challenged by the difficulty of a proper definition of damaged scenarios, which is a function of the damage location and extent. The concept of damage index (DI) was proposed to resolve this issue, and its application has been demonstrated previously through the incorporation of the Intelligent Supersize Finite Element Method (ISFEM) and Modified Paik–Mansour (P–M) approach. Alternatively, a Smith-type progressive collapse can be adopted. In fact, this may enable a more comprehensive application of the DI concept, as the Smith-type approach is codified in the Common Structural Rule (CSR) for assessing the longitudinal strength of the hull girder. In light of this, the damage index based assessment tools (i.e., R–D diagram) incorporated with a Smith-type progressive collapse method is presented in this paper. This also facilitates a comparison with the R–D diagram previously developed by ISFEM and Modified P–M approach. Discussion is given regarding the discrepancy between different methods, and recommendations for future research are outlined.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC), is a chronic recurrent inflammatory disease of the digestive tract and increases the risk of colon cancer.This study evaluates the effects of dietary intervention with freeze-dried plum (FDP), a natural antioxidant and anti-inflammatory fruit with no toxicity on dextran sulfate sodium (DSS)-induced acute and chronic experimental colitis in a mouse model and studies the molecular mechanisms of protection through the gut-liver axis. The results show that FDP decreases the levels of inflammatory mediators, which is a nitrative stress biomarker in both acute and chronic models. FDP markedly reduces DSS-induced injury to the colonic epithelium in both acute and chronic models. In addition, FDP significantly decreases the levels of pro-oxidant markers such as CYP2E1, iNOS, and nitrated proteins (detected by anti-3-NT antibody) in DSS-induced acute and chronic colonic injury models. Furthermore, FDP markedly reduces markers of liver injury such as serum ALT/AST, antioxidant markers, and inflammatory mediators in DSS-induced acute and chronic colonic injury.These results demonstrate that the FDP exhibits a protective effect on DSS-induced acute and chronic colonic and liver injury through the gut-liver axis via antioxidant and anti-inflammatory properties.

The Pediatric Emergency Care Applied Research Network (PECARN) rule is commonly used for predicting the need for computed tomography (CT) scans in children with mild head trauma. The objective of this study was to validate the PECARN rule in Korean children presenting to the pediatric emergency department (PED) with head trauma. This study was a multicenter, retrospective, observational cohort study in two teaching PEDs in Korea between August 2015 and August 2016. In this observational study, 448 patients who visited PEDs were included in the final analysis. Risk stratification was performed with clinical decision support software based on the PECARN rule, and decisions to perform CT scans were subsequently made. Patients were followed-up by phone call between 7 days and 90 days after discharge from the PED. The sensitivity and specificity were analyzed. The sensitivity was 100% for all age groups, and no cases of clinically important traumatic brain injury (ciTBI) were identified in the very-low-risk group. CT scans were performed for 14.7% of patients in this study and for 33.8% in the original PECARN study. The PECARN rule successfully identified low-risk patients, and no cases of ciTBI were missed despite the reduced proportion of patients undergoing CT scans.

Cylindrical shell is a common structural design solution in many engineering fields, such as the foundation supporting structures and buoyant column of the offshore wind turbine in the maritime sector. Operating in an ocean environment, these cylindrical shell structures need to withstand a combination of axial compression, bending moment, torsion and external pressure. This study contributes a parametric investigation for unstiffened cylindrical shells subjected to axial compression. Emphasis is placed on the ultimate strength characteristics and their relation with the initial geometric imperfection. The nonlinear finite element method is adopted by considering geometric and material nonlinearities in conjunction with an arc-length incrementation to solve the governing equilibrium equation. The numerical prediction is compared with the prevailing code-based approach, i.e. DNV, ABS, API and Eurocode. This study shows that the ultimate strength of unstiffened cylindrical shells in axial compression is highly sensitive to initial geometric imperfection. The code-based formulae appear to be overly conservative for predicting the ultimate compressive strength of cylindrical shells.

Introduction: We sought to determine whether the delta neutrophil index (DNI), a marker that is reported to be used to predict the diagnosis, prognosis, and disease severity of bacteremia and sepsis, is useful in differentiating bacterial infection without bacteremia (BIWB) from viral infections (VI) in pediatric febrile patients in the emergency department (ED). Method: We conducted a retrospective analysis of febrile patients’ medical records from the pediatric ED of the teaching hospital. The patients with BIWB and those with VI were identified with a review of medical records. The primary outcome was the diagnostic performance of DNI in differentiating BIWB from VI. The secondary outcome was a comparison of the diagnostic performances of DNI, CRP, WBC, and neutrophil count between the two groups. Results: A total of 151 (26.3%) patients were in the BIWB group, and 423 (73.7%) were in the VI group. There was no significant difference in DNI between the two groups (3.51 ± 6.90 vs. 3.07 ± 5.82, mean ± SD, BIWB vs. VI). However, CRP levels were significantly higher in the BIWB group than in the VI group (4.56 ± 5.45 vs. 1.39 ± 2.12, mean ± SD, BIWB vs. VI, p < 0.05). The AUROCs of DNI, WBC count, neutrophil levels, RDW, and CRP levels were 0.5016, 0.5531, 0.5631, 0.5131, and 0.7389, respectively, and only CRP levels were helpful in differentiating BIWB from VI. Conclusion: In the absence of bacteremia, DNI would not be helpful in differentiating BIWB from VI in pediatric febrile patients.

Nicotinamide adenine dinucleotide (NAD

Angiopoietin (Angpt)-Tie receptor 2 (Tie2) plays key roles in vascular development and homeostasis as well as pathological vascular remodeling. Therefore, Tie2-agonistic antibody and engineered Angpt1 variants have been developed as potential therapeutics for ischemic and inflammatory vascular diseases. However, their underlying mechanisms for Tie2 clustering and activation remain elusive and the poor manufacturability and stability of Angpt1 variants limit their clinical application. Here, we develop a human Tie2-agonistic antibody (hTAAB), which targets the membrane proximal fibronectin type III domain of Tie2 distinct from the Angpt-binding site. Our Tie2/hTAAB complex structures reveal that hTAAB tethers the preformed Tie2 homodimers into polygonal assemblies through specific binding to Tie2 Fn3 domain. Notably, the polygonal Tie2 clustering induced by hTAAB is critical for Tie2 activation and are resistant to antagonism by Angpt2. Our results provide insight into the molecular mechanism of Tie2 clustering and activation mediated by hTAAB, and the structure-based humanization of hTAAB creates a potential clinical application., Angiopoietin (Angpt)-Tie receptor 2 (Tie2) regulates vascular stability and is thus a potential therapeutic target in vascular diseases. Here, the authors report a Tie2-agonistic antibody which targets a site distinct from the Angpt 1-binding site and which influences Tie2 clustering and activation in an Angpt2 inhibition-resistant manner.

Cylindrical shell is a fundamental building block of many engineering structures. They are usually designed to be the primary load-carrying component to withstand different combinations of environmental loads. This paper presents a fibre-based approach to modelling the progressive collapse of cylindrical shells under combined axial compression and bending moment. In this method, the progressive collapse behaviour of cylindrical shells is incrementally evaluated by accounting for the local response of each fibre element. This approach offers a computationally efficient and robust scheme to compute the ultimate strength of cylindrical shells. Moreover, it enables the modelling of load-shedding between the buckled and intact shell elements on the compressive side, and the yielding failure on the tensile side, which appears to be ignored in existing design codes. Analyses are performed on cylindrical shells with a wide range of design parameters. Validation using the finite element method demonstrates a reasonably well performance of the proposed fibre-based modelling technique.

Environmental pollution causes severe damage to local communities, which is perceived differently by different victims, that is, the damage is discriminatory. However, previous studies have not focused on this aspect. Here, we explored the perceptions of different victims of the Hebei Spirit oil spill incident of Korea. Additionally, we explored the importance of considering discriminatory aspects of damage when planning recovery governance. The damages from the oil spill were analyzed using a text mining technique for each subject based on factor analyses. Women and residents older than 60 years were interested in the social relations of the village community, residents in their 40s, who were raising children and teenagers, were interested in the economic aspects, boat fishermen, who had discontinued fishing to participate in the pollution response activity in the early stages of the incident, were interested in disaster prevention, and women divers were interested in health issues. Hence, restoring the economy and environment and reversing indirect social damages are essential for recovery from pollution damage. Furthermore, governance for recovery must not exclude specific victims based on the discriminatory aspects of damages. A political process is necessary to secure the validity of governance and alternatives by involving different victim groups.

For high voltage (HV) power cable applications, various studies have been performed to improve the mechanical and electrical properties of polypropylene (PP)-based insulation materials to replace crosslinked polyethylene. However, studies on the effect of additives to yield additional PP properties are still lacking. Herein, we prepared PP blends by melt-mixing widely used commercial flame retardants for PP with isotactic PP (iPP) and investigated their electrical breakdown, flame retardancy behaviors, and UV stability. Among the five kinds of flame retardants employed, aluminum hypophosphite (AHP), aluminum diethyl phosphinate, melamine pyrophosphate, ammonium polyphosphate (APP), and APP treated with silane, AHP was very effective in minimizing the decrease of the direct current breakdown strength of iPP at both 25 °C and 110 °C in the range of 5–20 phr. Particularly, only AHP afforded V-2 grade flame retardancy to iPP, and the flame retardancy was maintained even when the content was reduced to 3 phr. Furthermore, upon exposure to ultraviolet (UV) rays for 5 d, the tensile strength of pristine iPP decreased by approximately 44%, while that of a blend with 3 phr AHP decreased by only 10%. The study results will contribute to the optimization of power cable products through the use of appropriate flame retardants in the design of high-performance PP-based HV insulation materials.