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Background The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53.6%) and infection (39.0%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Background: Fontan-associated liver disease (FALD) is a hepatic disorder caused by hemodynamic changes and systemic venous congestion following the Fontan procedure. FALD includes liver cirrhosis and hepatocellular carcinoma (HCC), both of which may require liver transplantation (LT). However, the Fontan circulation, characterized by elevated central venous pressure and reduced cardiac output, is a challenging issue for surgeons and anesthesiologists.Case: We report a living-donor LT for the treatment of HCC. The patient was a 24-year-old male who underwent the Fontan procedure for pulmonary atresia and right ventricle hypoplasia. We focused on maintaining enough blood volume for cardiac output without causing pulmonary edema, as the patient is not well adapted to changes in volume. Owing to a multidisciplinary approach, the surgery was successfully performed without fatal adverse events.Conclusions: To our knowledge, this is the first case of isolated LT in a recipient who became an adult after having undergone the Fontan procedure.

Background Smartphone usage is indispensably beneficial to people's everyday lives. However, excessive smartphone usage has been associated with physical and mental health problems. This study aimed to evaluate the association of smartphone usage with depressive symptoms, suicidal thoughts, and suicide attempts in Korean adolescents. Methods This cross-sectional study was conducted in 54,603 Korean adolescent participants (26,930 male and 27,673 female) in the Korea Youth Risk Behavior Survey in 2017 who reported their smartphone use. We performed multiple logistic regression analysis to evaluate the association of smartphone use with mental health after adjusting for relevant covariates. Results Among the participants, 25.6% of male students and 38.4% of female students reported using their smartphone for at least 30 hours per week. As time duration of smartphone usage increased, the risk of experiencing depressive symptoms, suicidal thoughts, and suicide attempt tended to increase, with odds ratios (95% confidence interval) of 1.18 (1.10-1.26), 1.18 (1.08-1.29), and 1.34 (1.11-1.60), respectively, for high smartphone usage compared with low smartphone usage. These associations remained significant with only slight change in odds ratios after consideration of problems that may be caused by smartphone usage, such as conflicts with family members or peers, or disturbance in school work. Conclusion Smartphone overuse was independently associated with an increased risk of mental health problems, which did not seem to be mediated by the problems caused by smartphone usage.

Background Distinguishing prostatic stromal invasion (PSI) by urothelial carcinoma (UC) from in situ UC involving prostatic ducts or acini with no stromal invasion (in situ involvement) may be challenging on hematoxylin and eosin stained sections. However, the distinction between them is important because cases with PSI show worse prognosis. This study was performed to assess the utility of double cocktail immunostains with high molecular weight cytokeratin (HMWCK) and GATA-3 to discriminate PSI by UC from in situ UC involvement of prostatic ducts or acini in the prostate. Methods Among 117 radical cystoprostatectomy specimens for bladder UCs, 25 cases showed secondary involvement of bladder UC in prostatic ducts/acini only or associated stromal invasion and of these 25 cases, seven cases revealed equivocal PSI. In these seven cases with equivocal PSI, HMWCK, and GATA-3 double immunohistochemical stains were performed to identify whether this cocktail stain is useful to identify the stromal invasion. Results In all cases, basal cells of prostate glands showed strong cytoplasmic staining for HMWCK and UC cells showed strong nuclear staining for GATA-3. In cases with stromal invasion of UC, GATA-3-positive tumor cells in the prostatic stroma without surrounding HMWCK-positive basal cells were highlighted and easily recognized. Among seven equivocal cases, two cases showed PSI and five in situ UC in the prostate. In two cases, the original diagnoses were revised. Conclusions Our study suggested that HMWCK and GATA-3 double stains could be utilized as an adjunct method in the distinction between PSI by UC from in situ UC involving prostatic ducts or acini.

The primary goal of this study was to investigate how the degree of internationalization affects firms' investment-cash flow sensitivity (ICFS) using a sample of Taiwanese listed firms. Our empirical results indicate that a higher degree of internationalization tends to lower its ICFS. Moreover, our findings also suggest that there is no significant difference between group-affiliated firms and unaffiliated firms in the relationship between internationalization and firms’ ICFS. The findings contribute to the financial literature by clarifying internationalization, ICFS and business groups.

This study examines the effects of corporate governance and corporate social responsibility (CSR) on credit ratings for firms in Taiwan. We examine this causal relationship using ordered logit regr...

This paper analyzes the roles of controlling shareholders as either minority shareholder entrenchers or monitors in the relationship between conservative accounting practices and cash holding value. This issue is especially meaningful in countries such as Taiwan that have large numbers of firms with concentrated shareholdings. Consistent with the findings of Louis et al. (2012), our results indicate that accounting conservatism enhanced the value of cash holdings. In addition, our findings support both hypotheses H2a and H2b depending on the proportion of control-affiliated directors, agency problems, and financial crises. In general, the incentive effect of controlling shareholders, H2b, is supported at a relatively low proportion of control-affiliated directors, whereas the entrenchment effect of controlling shareholders, H2a, is confirmed at a relatively high proportion of control-affiliated directors. Moreover, the entrenchment effect is aggravated when a firm suffers a serious agency problem during a period of financial crisis. This study contributes to the current literature on the influence of accounting conservatism on cash value in the presence or absence of controlling shareholders.

Background:This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus.Methods:Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15 degrees were included. All patients underwent a pedobarographic examination along with weightbearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the 2 groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability.Results:The HVA ( P < .001), intermetatarsal angle ( P = .001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instability of the first tarsometatarsal joint ( P = .924). The HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability ( P = .001).Conclusion:The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus. Patients with a greater HVA should be assessed for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered.Level of Evidence:Level III, comparative study.

COVID-19 affects 213 countries and territories around the world. This pandemic prompts substantial negative repercussions on social, health, economic, education, and tourism domains. New norms of life activities are designed as a solution so that life can be continued as before. This situation includes the education field, whereby various methods are created so that the progression of learning and teaching can be carried out even in limited circumstances. An imperative solution was chosen to integrate ICT into this field. Thus, the ICT applications in teaching and learning were the researchers’ focus of attention. This research centred predominantly on Malay foreign language teaching and learning that must adapt and renew itself to be compatible with the ICT. The goal of this study was to examine the impact of ICT and highlight the positive effects of it in order to keep up with the prevailing situation of the coronavirus COVID-19 pandemic. The writing of this paper was based on research focusing on Malay foreign language teaching and learning using ICT. Studies revealed that the application of ICT in language learning begins to get recognition from educators. Although there are some strengths in integrating the ICT on the other, it still holds considerable vulnerability which requires improvements to be made in order to meet teaching and learning requirements. Therefore, this study further illustrated the level of impact of integrating ICT in the education as a source of reference to the educator and education apps developer who created more sophisticate apps and fulfilled the demand of education. This analysis too would become a reference to literature review in extemporising the quality of teaching and learning in Malay foreign language.

Objective Autonomic neuropathy is a major component of familial amyloid polyneuropathy (FAP) due to mutated transthyretin, with sudomotor failure as a common manifestation. This study aimed to investigate the pathology and clinical significance of sudomotor denervation. Methods Skin biopsies were performed on the distal leg of FAP patients with a follow-up duration of 3.8 ± 1.6 years. Sudomotor innervation was stained with 2 markers: protein gene product 9.5 (PGP 9.5), a general neuronal marker, and vasoactive intestinal peptide (VIP), a sudomotor nerve functional marker, followed by quantitation according to sweat gland innervation index (SGII) for PGP 9.5 (SGIIPGP 9.5) and VIP (SGIIVIP). Results There were 28 patients (25 men) with Ala97Ser transthyretin and late onset (59.9 ± 6.0 years) disabling neuropathy. Autonomic symptoms were present in 22 patients (78.6%) at the time of skin biopsy. The SGIIPGP 9.5 and SGIIVIP of FAP patients were significantly lower than those of age- and gender-matched controls. The reduction of SGIIVIP was more severe than that of SGIIPGP 9.5 (p = 0.002). Patients with orthostatic hypotension or absent sympathetic skin response at palms were associated with lower SGIIPGP 9.5 (p = 0.019 and 0.002, respectively). SGIIPGP 9.5 was negatively correlated with the disability grade at the time of skin biopsy (p = 0.004), and was positively correlated with the interval from the time of skin biopsy to the time of wheelchair usage (p = 0.029). Interpretation This study documented the pathological evidence of sudomotor denervation in FAP. SGIIPGP 9.5 was functionally correlated with autonomic symptoms, autonomic tests, ambulation status, and progression of disability. Ann Neurol 2015;78:272℃283

Background Ischemia-reperfusion (I/R) injuries consist of enhanced oxidative and inflammatory responses along with microvascular dysfunction after prolonged ischemia and reperfusion. Because I/R injuries induce chronic postischemia pain (CPIP) in laboratory animals, it is possible that surgical procedures using prolonged ischemia may result in chronic postoperative pain. Glycemic modulation during ischemia and reperfusion could affect pain after I/R injury because glucose triggers oxidative, inflammatory, and thrombotic reactions, whereas insulin has antioxidative, antiinflammatory, and vasodilatory properties. Methods One hundred ten rats underwent a 3-h period of ischemia followed by reperfusion to produce CPIP. Rats with CPIP had previously been divided into six groups with differing glycemic modulation paradigms: normal feeding; fasting; fasting with normal saline administration; fasting with dextrose administration; normal feeding with insulin administration; and normal feeding with insulin and dextrose administration. Blood glucose concentration was assessed during I/R in these separate groups of rats, and these rats were tested for mechanical and cold allodynia over the 21 days afterward (on days 2, 5, 7, 9, 12, and 21 after I/R injury). Results I/R injury in rats with normoglycemia or relative hyperglycemia (normal feeding and fasting with dextrose administration groups) led to significant mechanical and cold allodynia; conversely, relative hypoglycemia associated with insulin treatment or fasting (fasting, fasting with normal saline administration, and normal feeding with insulin administration groups) reduced allodynia induced by I/R injury. Importantly, insulin treatment did not reduce allodynia when administered to fed rats given dextrose (normal feeding with dextrose and insulin administration group). Conclusion Study results suggest that glucose levels at the time of I/R injury significantly modulate postinjury pain thresholds in rats with CPIP. Strict glycemic control during I/R injury significantly reduces CPIP and, conversely, hyperglycemia significantly enhances it, which could have potential clinical applications especially in the surgical field.

This paper examines that the impact of firm-specific characteristic on firm capital structure in Chinese-listed companies and attempts to solve a few puzzles existing in previous related studies. The key factors include state ownership, institutional ownership, and the risk of default. From the analyses of all samples, our results confirm that the expected default risk is important in explaining debt decision, but the influence of ownership structure is not significant. However, after separating high- and low-level from the firm leverage we find that the ownerships of state and institutions have a positive effect on corporate leverage in high-leveraged companies but not in low-leveraged firms. In addition, the positive impacts of external governance commonly occur in large firms. The observed findings provide some important implications for the role of external governance in Chinese-listed companies.

Category: Basic Sciences/Biologics Introduction/Purpose: Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated regarding effects of walking speed and slope. This study examined pedobarographic findings in young healthy adults with regard to different walking speeds and slopes. Methods: Twenty young healthy adults (mean age 22.4 years, SD 1.2 years; 10 males and 10 females) were recruited. Dynamic pedobarographic data were obtained during treadmill walking with different walking speeds (3.2 km/hr, 4.3 km/hr, and 5.4 km/hr) and slopes (-8°, -4°, 0°, 4°, and 8°). Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Distribution of foot pressure between medial and lateral sides, and between anterior and posterior aspects were calculated as varus/valgus index and forefoot/heel index, respectively. Walking speed of 4.3 km/hr on 0° of slope was considered as standard walking condition. Results: Varus/valgus index of peak pressure showed significant increase on the slope of 8° and the walking speed of 4.3 km/hr (p=0.036) and 5.4 km/hr (p=0.007). Forefoot/heel index of peak pressure significantly decreased on downhill walking. Varus/valgus index of pressure-time integral showed significant increase when uphill and downhill slope was greater and walking speed was faster compared with standard with walking condition. Forefoot/heel index of pressure-time integral showed significant increase in downhill walking while significant decrease was observed during uphill walking. Conclusion: Changes of walking speed and slope caused those of foot pressure distribution. Therefore, combination of walking speed and speed might be associated with pressure related symptoms and disorders of the foot.

This study investigates the correlation among the three institutional investors, general individual investors, and the stock market using the multivariate GARCH model. We also analyze the effect of releasing the restriction of foreign investment. The empirical results reveal that trading behavior of foreign institutional investors holds a crucial influence on domestic dealers and general individual investors, and the counter-trading phenomenon of foreign institutional investors and domestic institutional investors is due to different investment judgments. A verification of the impulse response equation reveals institutional investors perform at a faster information transmission effect. Overall, a full opening up of foreign capital might not be as powerful as expected.

This study investigates the costs incurred by patients diagnosed with uncomplicated malaria at a formal rural health facility in Myanmar. Across-sectional survey of 410 patients indicated that the majority of patients were male (89.3%) married (84.6%) and the head of their family (80.2%); this spectrum reflected the deliberate selection of persons for whom relatively accurate costing was feasible. The average total costs incurred for an episode of malaria was kyats 173.58 (95% CI = 166.13–181.02) with the highest cost contribution being the loss of earnings due to absence from work (mean = kyats 135.05; 95% CI = 128.14–141.96). Total costs to the patient per episode were on the average equivalent to 4.2 days of per capita economic output indicating that malaria imposes a significant financial burden on the patient even though medical services and treatment are provided free of charge. Variables significantly positively associated with patient cost included the duration of illness (P < 0.001) income of the patient (P < 0.001) presence of accompanying person at the health facility (P < 0.001) and being a farmer (P = 0.026). The results of this study highlight the importance of using confirmatory diagnosis in rural settings to minimize the financial burden of malaria to the patient and family. (authors)

BACKGROUND AND OBJECTIVES Hydroxyapatite has biocompatibility and bioactivity and similar to bone of in human body. The purpose of this study is to evaluate osteogenic differentiation of bone marrow stem cell (BMSC) in PLGA Scaffold added various ratio of hydroxyapatite (HAp). METHODS AND RESULTS PLGA and PLGA/HAp scaffold were prepared using solvent casting/salt-leaching method. BMSC was seeded on the PLGA and PLGA/HAp scaffold and the samples were cultured in 37℃ incubator with 5% CO2 for 28 days. Alkaline phosphatase (ALP) was carried out to evaluate alkaline phosphatase activity at 1, 3, 7, 10 and 14 days. Alizarin Red S stating was performed to identify calcium in scaffold at 1, 7, 14, 21 and 28 days. Compressive strength was measured to evaluate mechanical property of scaffold. To confirm cell viability, MTT was carried out at 1, 3, 7, 14 and 28 days. RT-PCR was performed to verify specific marker expression of osteoblast and stem cell at 7, 14, 21 and 28 days. CONCLUSIONS Osteogenic differentiation of BMSC was confirmed through ALP, RT-PCR, and alizarin red S staining in this study. These results suggest that HAp helps osteogenic differentiation of BMSC.

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

To evaluate the relationship between caregiving burden to improve the quality of life of caregivers of stroke patients. Against the care burden and quality of life in it investigated the caregivers of stoke patient of Busan external 4 cities. The evaluation tool which is used WHOQOL-BREF and care burden inventory. Valid 100 parts of the recovered parts were only 110 statistics. Correlation analysis showed an inverse correlation statistically very significant level of quality of life in all areas(physical, psychological, social relationship, environmental area) and caregiving burden in all areas(physical, social, developmental, financially, time dependence). The Burden of stroke caregivers showed that affects the quality of life. The higher the care burden means that a low quality of life. It shows the largest relevant financial burden and viewed to evaluate the relationship of the quality of life. Stroke caregivers are women of age 60 years or obove. It is require comprehensive discussion of the financial burden, emotional burden, physical burden, time dependence burden.