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This article describes a case of ecthyma gangrenosum (EG) in a previously healthy ten-month-old boy. The patient presented with a five-day history of fever, general weakness and a red spot on the right buttock. The child was given antibiotics and surgical repair was performed on the buttock lesion. A discussion on EG is included.

The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and spread of local anesthetics. We present a case of interscalene brachial plexus block under ultrasound guidance in a 17-month-old child with acute drug-induced hepatitis who required fixation of a fracture of the lateral humeral condyle. [ABSTRACT FROM AUTHOR]

The effect of changing sampling timing in intermediate frequency (IF) sampling receivers is analyzed for the case when symbol timing recovery is performed by controlling the IF sampling clock. We note that changing the sampling timing in IF sampling causes a phase discontinuity which is detrimental to the stable operation of the phase recovery loop. We propose a new IF sampling scheme which makes it possible to control sampling timing while maintaining the continuous phase of the output samples so that the subsequent phase recovery properly works. [ABSTRACT FROM AUTHOR]

Resistance band training (RBT) with functional electrical stimulation (FES) may be an effective exercise regimen for improving age-related motor impairments. This preliminary study investigated the potential effects of bimanual RBT with FES on upper limb motor functions in older adults. This study randomly assigned 22 elderly people to the bimanual RBT with FES (Bi-RBT+FES) group and the RBT without FES (Bi-RBT) group. All participants performed isometric hand-grip force control tasks in unimanual (dominant and non-dominant) and bimanual conditions before and after four weeks of exercise for each group. We quantified the mean force, force accuracy, force variability, and force regularity at two targeted force levels (i.e., 10 % and 40 % of maximum voluntary contraction; MVC) to estimate changes in force control capabilities. The results revealed that the Bi-RBT+FES group demonstrated a greater force accuracy in the dominant hand at 10 % of MVC after training. Non-dominant hands in the Bi-RBT+FES group increased force accuracy at 40 % of MVC and reduced force variability collapsed across two targeted force levels. Both groups showed a decrease in force regularity after training. These preliminary results indicate that Bi-RBT+FES may be a viable option to facilitate functional recovery of the upper limbs in older adults.

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

Our study involved an investigation of the venting analysis of payload fairing of Korea Space Launch Vehicle II with vent valves. Two types of vent valves with a spring-loaded door were developed for a payload adapter and compartments of Korea Space Launch Vehicle II. First, the performance of the vent valves was evaluated through three-axis random vibration tests and flow tests. Structural robustness of the vent valves was validated through random vibration tests. Flow characteristics were investigated through flow tests. The cracking pressure of the vent valves for the payload adapter was in the range of 74-86 Pa, whereas the cracking pressure of the vent valves for compartment was in the range of 384-447 Pa. The results of flow tests were used to determine valve models of the vent valves for the venting analysis. Subsequently, venting analysis was conducted to predict the maximum pressure difference and pressure drop rate of payload fairing, and the results were compared with those of other space launch vehicles. The maximum values of the pressure difference were -5.34 and 1.27 kPa. The maximum pressure drop rate was 4.68 kPa/s. The values were lower than the maximum values of other space launch vehicles. Consequently, the vent valves were suitable for Korea Space Launch Vehicle II. [ABSTRACT FROM AUTHOR]

Background/Aims: The clinical efficacy and safety of CT-P13 are comparable to originator infliximab for Crohn’s disease in CT-P13 3.4 study (NCT02096861). We performed a multivariate logistic analysis to demonstrate the association between early infliximab trough levels and treatment outcomes of CT-P13 and originator infliximab. Methods: Early serum infliximab trough levels and anti-drug antibody (ADA) levels were compared between CT-P13 (n=100) and originator infliximab (n=98) groups. Receiver operating characteristic (ROC) analysis and multivariate logistic analysis were conducted to identify optimal cutoffs of serum infliximab trough levels and predictive factors for clinical outcomes. Results: The median infliximab trough levels were not different between CT-P13 and originator infliximab groups at week 6, week 14, and in median ADA levels at week 14, respectively. ROC analysis found an infliximab concentration threshold of 4.5 μg/mL at week 6 and 4.0 μg/mL at week 14 as the cutoff value with the highest accuracy for the prediction of clinical outcomes. Serum infliximab trough levels at weeks 6 and 14 predicted clinical remission at weeks 30 and 54, and endoscopic remission at week 54. The combinations of clinical remission or C-reactive protein normalization with an early infliximab trough level improved the prediction of long-term clinical or endoscopic remission. Conclusions: A threshold in serum infliximab trough level at week 6 and week 14 was highly predictive for long-term clinical outcomes. There were no statistical differences in serum infliximab trough levels and ADA levels between CT-P13 and originator infliximab.

Transcranial direct current stimulation (tDCS) is one of the non-invasive brain stimulation techniques that can improve motor functions. As bimanual motor actions require high motor cortical activations between hemispheres, applying bilateral anodal stimulation on left and right sides of primary motor cortex (M1) can improve for improvements in bimanual motor tasks. This study investigated which bilateral tDCS protocol effectively improves bimanual hand-grip force control capabilities in healthy young adults. We used three different bilateral tDCS protocols: (a) dual-anodal stimulation on the M1 of bilateral hemispheres (Bi-AA), (b) anodal–cathodal stimulation on the M1 of dominant and nondominant hemispheres (Bi-AC), and (c) sham stimulation (Sham). The results indicated that applying the Bi-AA significantly improved bilateral motor synergies estimated by uncontrolled manifold analysis relative to Sham. However, these differences were not observed in the comparison between Bi-AA and Bi-AC as well as between Bi-AC and Sham. These findings suggest that facilitating motor cortical activations between both hemispheres may be an additional option for advancing interlimb motor coordination patterns.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that is difficult to diagnose, with a period of 10.0± 9.6 years from symptom onset to diagnosis. A 32-year-old Asian man presented with bilateral postauricular abscesses that first appeared 5 years previously. Despite several incisions and drainage, the symptoms only temporarily improved and continued to recur. On physical examination, chronic scars and sinus tracts were observed around the lesion. Postauricular HS was diagnosed, and surgical treatment was performed. We performed a wide excision and reconstructed the defect using a posterior auricular artery perforator-based keystone flap. Histological examination confirmed the diagnosis of HS. The reconstruction was successful, and there was no recurrence for 2 years after surgery. HS is difficult to diagnose without specific attention. Although the postauricular region is not a typical site of HS, it can occur in this area. Therefore, if a patient presents with recurrent abscesses in the postauricular region, HS should be considered. Additionally, if HS is diagnosed in the postauricular region, wide excision with reconstruction using a posterior auricular artery perforator-based keystone flap can lead to a favorable outcome. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is increasingly common, and closely related with overweight or obesity. In the obese state, macrophages infiltrate to the adipose tissue (AT), resulting in chronic inflammation and insulin resistance in the AT cells. Recently, attention has been paid to the role of AT macrophages in metabolic disorders should be applied to the initial drug screening step, but it was difficult to mimic the inflammatory adipocytes using the traditional 2-dimensional (2D) culture. In this study, we developed the 3-dimensional (3D) culture system to overcome this limitation. After adipogenic differentiation, lipid droplets were highly accumulated in cells, and differentiation of preadipocytes was not declined by macrophage co-culture. However, only co-cultured cells expressed the insulin resistance features. Compare to mono-cultured adipocytes, co-cultured adipocytes showed reduced glucose uptake and GLUT4 did not translocated to cell membrane even though treatment of high concentration of insulin. Using 3D co-culture model, we develop a microwell-scale drug screening protocol to test anti-obesity effect. 3D cultured cells reacted more sensitive to drugs, and PPARγ antagonist GW9662 (10, 20 μM) repressed adipogenic differentiation in a concentration-dependent manner in 3D co-cultured cells.

Abstract The purpose of this study was to determine the effect of different visual conditions and targeted force levels on bilateral motor synergies and bimanual force control performances. Fourteen healthy young participants performed bimanual isometric force control tasks by extending their wrists and fingers under two visual feedback conditions (i.e., vision and no-vision) and three targeted force levels (i.e., 5%, 25%, and 50% of maximum voluntary contraction: MVC). To estimate bilateral motor synergies across multiple trials, we calculated the proportion of good variability relative to bad variability using an uncontrolled manifold analysis. To assess bimanual force control performances within a trial, we used the accuracy, variability, and regularity of total forces produced by two hands. Further, analysis included correlation coefficients between forces from the left and right hands. In addition, we examined the correlations between altered bilateral motor synergies and force control performances from no-vision to vision conditions for each targeted force level. Importantly, our findings revealed that the presence of visual feedback increased bilateral motor synergies across multiple trials significantly with a reduction of bad variability as well as improved bimanual force control performances within a trial based on higher force accuracy, lower force variability, less force regularity, and decreased correlation coefficients between hands. Further, we found two significant correlations in (a) increased bilateral motor synergy versus higher force accuracy at 5% of MVC and (b) increased bilateral motor synergy versus lower force variability at 50% of MVC. Together, these results suggested that visual feedback effectively improved both synergetic coordination behaviors across multiple trials and stability of task performance within a trial across various submaximal force levels.

Abstract Gastric cancer ranks the fifth most common and third leading cause of cancer‐related deaths worldwide. Alterations in the RTK/MAPK, WNT, cell adhesion, TP53, TGFβ, NOTCH, and NFκB signaling pathways could be identified as main oncogenic drivers. A combination of altered pathways can be associated with molecular subtypes of gastric cancer. In order to generate model systems to study the impact of different pathway alterations in a defined genetic background, we generated three murine organoid models: a RAS‐activated (KrasG12D, Tp53R172H), a WNT‐activated (Apcfl/fl, Tp53R172H), and a diffuse (Cdh1fl/fl, Apcfl/fl) model. These organoid models were morphologically and phenotypically diverse, differed in proteome expression signatures and possessed individual drug sensitivities. A differential vulnerability to RTK/MAPK pathway interference based on the different mitogenic drivers and according to the level of dependence on the pathway could be uncovered. Furthermore, an association between RTK/MAPK pathway activity and susceptibility to HDAC inhibition was observed. This finding was further validated in patient‐derived organoids from gastric adenocarcinoma, thus identifying a novel treatment approach for RTK/MAPK pathway altered gastric cancer patients.

The Przewalski's horse is a rare and endangered species and the last existing wild horses. Therefore, its genetic characterization is important to facilitate the systematic preservation and promotion of its gene pool. Karyotypes of chromosomes confirmed that the two tested horses were indeed Przewalski's horses (2n=66). Their genome was characterized using whole-genome re-sequencing and a comprehensive list of genetic variants including SNPs and INDELs was developed. We found a total number of 5,879,868 SNPs in the male and 6,040,778 SNPs in the female. Homozygous variations were more abundant than heterozygous variations, probably caused by inbreeding during the restoration process of species from only 13 horses. In conclusion, our results provide valuable information such as additional sequence information for equine researchers and can help to figure out how the horse genome was changed by domestication in recent years. [ABSTRACT FROM AUTHOR]

Australia has suffered devastating wildfires recently, and is predisposed to them due to several factors, including topography, meteorology, vegetation, and ignition sources. This study utilized a geographic information system (GIS) technique to analyze and understand the factors that regulate the spatial distribution of wildfire incidents and machine learning to predict wildfire susceptibility in Sydney. Wildfire inventory data were constructed by combining the fire perimeter through field surveys and fire occurrence data gathered from the visible infrared imaging radiometer suite (VIIRS)-Suomi thermal anomalies product between 2011 and 2020 for the Sydney area. Sixteen wildfire-related factors were acquired to assess the potential of machine learning based on support vector regression (SVR) and various metaheuristic approaches (GWO and PSO) for wildfire susceptibility mapping in Sydney. In addition, the 2019–2020 “Black Summer” fire acted as a validation dataset to assess the predictive capability of the developed model. Furthermore, the information gain ratio (IGR) method showed that driving factors such as land use, forest type, and slope degree have a large impact on wildfire susceptibility in the study area, and the frequency ratio (FR) method represented how the factors influence wildfire occurrence. Model evaluation based on area under the curve (AUC) and root average square error (RMSE) were used, and the outputs showed that the hybrid-based SVR-PSO (AUC = 0.882, RMSE = 0.006) model performed better than the standalone SVR (AUC = 0.837, RMSE = 0.097) and SVR-GWO (AUC = 0.873, RMSE = 0.080) models. Thus, optimizing SVR with metaheuristics improved the accuracy of wildfire susceptibility modeling in the study area. The proposed framework can be an alternative to the modeling approach and can be adapted for any research related to the susceptibility of different disturbances.

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headache and reversible multifocal vasoconstrictions of the cerebral arteries. There are no treatment guidelines despite its potential for precarious outcomes. A 52-year-old woman with recurrent episodes of severe headache was diagnosed with RCVS and treated with oral nimodipine, which has been widely used for RCVS. However, her vessel status worsened despite treatment for several days and only improved after administration of intra-arterial (IA) and per os (PO) verapamil, which has been used to reverse vasoconstrictions in variant angina. Based on this case and literatures, we propose an alternative strategy using verapamil. The presence of a vascular reaction after an IA verapamil challenge during initial digital subtraction angiography can diagnose RCVS while also serving as an emergent treatment. Based on the response to IA verapamil, PO verapamil can be prescribed if there are no contraindications or side effects.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition with an unclear etiopathogenesis that is considered to be a follicular occlusive disease. We present a case of HS that was suspected to have developed as a complication of subdermal excision. A 19-year-old man who had undergone subdermal excision due to osmidrosis presented 7 months after surgery with a persistent painful mass in his left axilla. Despite medical treatment, incision, and drainage, a painful enlarged abscess recurred in the left axilla and was cured completely by deroofing surgery. However, 15 months after subdermal excision, he revisited the hospital because of a painful mass in the right axilla. The patient’s condition met the diagnostic criteria of HS. After several recurrences, a cure was achieved by radical wide excision. Mechanical stress like that associated with subdermal excision is considered to be a possible etiological factor of HS. In addition, pathological changes at the sebofollicular junction allow rupture and leakage of folliculopilosebaceous units upon exposure to mechanical stress, which may result in the aggressive subcutaneous extension of inflammation. We suggest that HS should be considered in patients with a recurrent abscess after subdermal excision, and recommend surgical treatment as a possible option if conservative treatment is clinically ineffective.

Abstract Background Gastric cancer is among the most lethal human malignancies. Previous studies have identified molecular aberrations that constitute dynamic biological networks and genomic complexities of gastric tumors. However, the clinical translation of molecular-guided targeted therapy is hampered by challenges. Notably, solid tumors often harbor multiple genetic alterations, complicating the development of effective treatments. Methods To address such challenges, we established a comprehensive dataset of molecularly annotated patient derivatives coupled with pharmacological profiles for 60 targeted agents to explore dynamic pharmacogenomic interactions in gastric cancers. Results We identified lineage-specific drug sensitivities based on histopathological and molecular subclassification, including substantial sensitivities toward VEGFR and EGFR inhibition therapies in diffuse- and signet ring-type gastric tumors, respectively. We identified potential therapeutic opportunities for WNT pathway inhibitors in ALK-mutant tumors, a significant association between PIK3CA-E542K mutation and AZD5363 response, and transcriptome expression of RNF11 as a potential predictor of response to gefitinib. Conclusions Collectively, our results demonstrate the feasibility of drug screening combined with tumor molecular characterization to facilitate personalized therapeutic regimens for gastric tumors.

OBJECTIVE:To evaluate not only the risk of total preterm birth (PTB) but also spontaneous preterm birth (sPTB) and indicated preterm birth (iPTB) in vanishing twin (VT). STUDY DESIGN:This is a secondary analysis of a multicenter prospective cohort study. In 12 different healthcare institutions, women with singleton pregnancies were enrolled in early pregnancy and followed up till delivery. RESULTS:A total of 4,746 women were included in the final analysis, and. the frequency of VT was 1.1% (54/4746). VT group had a higher risk for total PTB (PTB

PurposeThe purpose of this study was to examine how different threshold ranges of online-bandwidth visual feedback influence unilateral force control capabilities in healthy young women.MethodsTwenty-five right-handed young women (mean±standard deviation age = 23.6±1.5 years) participated in this study. Participants unilaterally executed hand-grip force control tasks with their dominant and non-dominant hands, respectively. Each participant completed four experimental blocks in a different order of block presentation for each hand condition: (a) 10% of maximum voluntary contraction (MVC) with ±5% bandwidth threshold range (BTR), (b) 10% of MVC with ±10% BTR, (c) 40% of MVC with ±5% BTR, and (d) 40% of MVC with ±10% BTR. Outcome measures on force control capabilities included: (a) force accuracy, (b) force variability, (c) force regularity, and (d) the number of times and duration out of BTR.ResultsThe non-dominant hand showed significant improvements in force control capabilities, as indicated by higher force accuracy, less force variability, and decreased force regularity from ±10% BTR to ±5% BTR during higher targeted force level task. For both hands, the number of times and duration out of BTR increased from ±10% BTR to ±5% BTR.ConclusionsThe current findings suggested that the narrow threshold range of online-bandwidth visual feedback effectively revealed transient improvements in unilateral isometric force control capabilities during higher targeted force level tasks.

To investigate the genetic background for the emergence of macrolide resistance, we characterized the genetic features of Mycoplasma pneumoniae using multilocus sequence typing. Of the 146 M. pneumoniae strains collected during the 5 consecutive outbreaks of M. pneumoniae pneumonia during 2000–2016 in South Korea, macrolide resistance increased from 0% in the first outbreak to 84.4% in the fifth. Among the 8 sequence types (STs) identified, ST3 (74.7%) was the most prevalent, followed by ST14 (15.1%). Macrolide-susceptible strains comprised 8 different STs, and all macrolide-resistant strains were ST3 (98.3%) except 1 with ST14. The proportion of macrolide-resistant strains in ST3 remained 2.2% (1/46) until the 2006–2007 outbreak and then markedly increased to 82.6% (19/23) during the 2010–2012 outbreak and 95.0% (38/40) during the 2014–2016 outbreak. The findings demonstrated that clonal expansion of ST3 M. pneumoniae was associated with the increase in macrolide resistance in South Korea.

Neuroblastoma is the most common pediatric extracranial solid tumor derived from primitive neural crest cells of the sympathetic nervous system. Although one-fifths of all neuroblastomas occurs within the thorax, thoracic neuroblastomas detected in fetus have been rarely reported. We report a case of fetal thoracic neuroblastoma with massive pleural effusion detected with prenatal ultrasonography. A 34-year-old Korean second-gravida was referred to our hospital at 30 weeks of gestation for evaluation, after the right lung mass found in the fetus. Approximately 3 cm, well-defined, hyperechoic mass was found in the right thorax with right pleural effusion, with the initial suspicion of teratoma. However, as mass continued to grow with deteriorating pleural effusion and fetal hydrops, the mass was considered malignant after 3 weeks. After a cesarean delivery, an approximately 4 cm mass with peripheral calcification and hemothorax was found on neonatal ultrasonography. Neuroblastoma was diagnosed on excision biopsy.

The performance of a vent valve with a spring-loaded door is evaluated for the test launch vehicle of Korea Space Launch Vehicle II. Twelve vent valves are manufactured for the three compartments of the test launch vehicle. The structural robustness of the vent valves is evaluated via random vibration tests of 20 Grms. All the vent valves properly operate even after the vibration tests. The flow characteristics of the vent valves are investigated via flow tests. The cracking pressure of the vent valves is 431-514 Pa. The flow area of the vent valves is calculated from the test results, and two models for the valves for the venting analysis are determined on the basis of the flow area. The pressure difference between inside and outside the compartments and the pressure drop rate in the compartments during flight are predicted via a venting analysis. The maximum values of the pressure difference are -6.62 and 7.30 kPa. The maximum pressure drop rate is 3.73 kPa/s. The maximum pressure difference in the test launch vehicle is much lower than that in Korea Space Launch Vehicle I measured in the first flight test, and the maximum pressure drop rate of the test launch vehicle is similar to that of Korea Space Launch Vehicle I. Consequently, the vent valve with a spring-loaded door is suitable for the test launch vehicle. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence of gestational diabetes mellitus (GDM) and use of anti-diabetic medications for patients with GDM in Korea, using data of the period 2007-2011 from the Health Insurance Review and Assessment (HIRA) database, which includes the claims data of 97% of the Korean population.We used the Healthcare Common Procedure Coding System codes provided by the HIRA to identify women with delivery in the HIRA database between 2009 and 2011. GDM was defined according to ICD-10 codes, and patients with pre-existing diabetes between January 1, 2007 and pregnancy were excluded. A Poisson regression was performed to evaluate the trends in annual prevalence rates.The annual numbers of deliveries in 2009-2011 were 479,160 in 2009, 449,747 in 2010, and 377,374 in 2011. The prevalence of GDM during that period was 7.5% in 2009-2011: 5.7% in 2009, 7.8% in 2010, and 9.5% in 2011. The age-stratified analysis showed that the prevalence of GDM was highest in women aged 40-44 years, at 10.6% in 2009-2011, and that the annual prevalence significantly increased even in young women aged 20-29 years during that period (P < 0.05). More than 95% of the patients with GDM did not take any anti-diabetic medication. Among the anti-diabetic medications prescribed for patients with GDM, insulin was most commonly prescribed (for >98% of the patients with GDM on medication).The prevalence of GDM in Korean women recently reached 5.7-9.5% in recent years. This represents a public health concern that warrants proper screening and medical care for GDM in women during the childbearing years.

[This corrects the article DOI: 10.1371/journal.pone.0153107.].

BackgroundThe use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated.MethodsEighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 µg/ml) or sufentanil (group S1: sufentanil 0.5 µg/ml, group S2: sufentanil 0.75 µg/ml, and group S3: sufentanil 1.0 µg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery.ResultsPostoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3.ConclusionsThe incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 µg/ml). Therefore, 0.5 µg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.

Climate change has caused shifts in species' ranges and extinctions of high-latitude and altitude species. Most cold-tolerant evergreen broadleaved woody plants (shortened to cold-evergreens below) are rare species occurring in a few sites in the alpine and subalpine zones in the Korean Peninsula. The aim of this research is to 1) identify climate factors controlling the range of cold-evergreens in the Korean Peninsula; and 2) predict the climate change effects on the range of cold-evergreens. We used multimodel inference based on combinations of climate variables to develop distribution models of cold-evergreens at a physiognomic-level. Presence/absence data of 12 species at 204 sites and 6 climatic factors, selected from among 23 candidate variables, were used for modeling. Model uncertainty was estimated by mapping a total variance calculated by adding the weighted average of within-model variation to the between-model variation. The range of cold-evergreens and model performance were validated by true skill statistics, the receiver operating characteristic curve and the kappa statistic. Climate change effects on the cold-evergreens were predicted according to the RCP 4.5 and RCP 8.5 scenarios. Multimodel inference approach excellently projected the spatial distribution of cold-evergreens (AUC = 0.95, kappa = 0.62 and TSS = 0.77). Temperature was a dominant factor in model-average estimates, while precipitation was minor. The climatic suitability increased from the southwest, lowland areas, to the northeast, high mountains. The range of cold-evergreens declined under climate change. Mountain-tops in the south and most of the area in the north remained suitable in 2050 and 2070 under the RCP 4.5 projection and 2050 under the RCP 8.5 projection. Only high-elevations in the northeastern Peninsula remained suitable under the RCP 8.5 projection. A northward and upper-elevational range shift indicates change in species composition at the alpine and subalpine ecosystems in the Korean Peninsula.

Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT). The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected.

Study Objective: To evaluate whether ramosetron increases the corrected QT (QTc) interval. Design: Prospective, randomized, controlled study. Setting: Operating room. Patients: 135 patients undergoing elective laparoscopic cholecystectomy. Patients: 135 patients undergoing elective laparoscopic cholecystectomy. Intervention: Patients were allocated to three groups to receive ondansetron 4 mg (Group O4), ramosetron 0.3 mg (Group R), or ondansetron 8 mg (Group O8). The study drugs were administered intravenously approximately 15 minutes before the end of surgery. Measurement: The QT interval for 10 minutes after administration was recorded. The QTc interval was calculated according to the Fridericia (QTcF) formula. The primary outcome was the QTcF interval among the three groups during the 10 minutes after administration of the study drugs. Main Results: The QTcF interval was not significantly prolonged after administration of ondansetron 4 mg and ramosetron. It was significantly increased from one minute after administration until 7 minutes after ondansetron 8 mg (Group O8). The QTcF interval was significantly longer in Group O8 at 1, 2, 3, 4, and 5 minutes. Conclusions: The prophylactic administration 0.3 mg of ramosetron does not increase the QTc interval. Ondansetron 8 mg increases the QTc interval more so than 4 mg of ondansetron. [ABSTRACT FROM AUTHOR]

ABSTRACT In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid - ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi - rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy. Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2 O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method. Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.