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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.

Alcoholic liver disease (ALD) is a major liver disease worldwide and can range from simple steatosis or inflammation to fibrosis/cirrhosis, possibly through leaky gut and systemic endotoxemia. Many patients with alcoholic steatohepatitis (ASH) die within 60 days after clinical diagnosis due to the lack of an approved drug, and thus, synthetic and/or dietary agents to prevent ASH and premature deaths are urgently needed. We recently reported that a pharmacologically high dose of pomegranate extract prevented binge alcohol-induced gut leakiness and hepatic inflammation by suppressing oxidative and nitrative stress. Herein, we investigate whether a dietary antioxidant ellagic acid (EA) contained in many fruits, including pomegranate and vegetables, can protect against binge alcohol-induced leaky gut, endotoxemia, and liver inflammation. Pretreatment with a physiologically-relevant dose of EA for 14 days significantly reduced the binge alcohol-induced gut barrier dysfunction, endotoxemia, and inflammatory liver injury in mice by inhibiting gut dysbiosis and the elevated oxidative stress and apoptosis marker proteins. Pretreatment with EA significantly prevented the decreased amounts of gut tight junction/adherent junction proteins and the elevated gut leakiness in alcohol-exposed mice. Taken together, our results suggest that EA could be used as a dietary supplement for alcoholic hepatitis patients.

Objective To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage.Methods A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children normal), grade 2 (2 SDs>normal), and grade 3 (3 or more SDs>normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group.Results Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P

Background: Human respiratory syncytial virus (RSV) is one of the leading causes of respiratory infections, especially in infants and young children. Previous RSV sequencing studies have primarily focused on partial sequencing of G gene (200-300 nucleotides) for genotype characterization or diagnostics. However, the genotype assignment with G gene has not recapitulated the phylogenetic signal of other genes and there is no consensus on RSV genotype definition. Methods: We conducted Maximum Likelihood phylogenetic analysis with 10 RSV individual genes and whole-genome sequence (WGS) that are published in GenBank. RSV genotypes were assigned by the statistical support monophyletic clusters with at least 10-year detection time from the WGS phylogeny. Results: In this study, we first statistically examined the phylogenetic incongruence, rate variation for each RSV gene sequence and WGS. We then proposed a new RSV genotyping system based on a comparative analysis of WGS and the spatial and temporal distribution of each lineage. We also provided an RSV classification tool to perform RSV genotype assignment. Conclusions: This revised RSV genotyping system will provide important information for disease surveillance, epidemiology, and vaccine development.

In this study, a useful solution is proposed for assessing the safety of the ship’s hull damaged by grounding in Northern Sea Route (NSR) or Arctic sea. In particular, the residual ultimate longitu...

Background: Antimicrobial resistant continues to pose a threat to public health. Therefore, rapid and accurate antimicrobial susceptibility testing is very important. The objectives of this study were to evaluate the performance of the MicroScan system (Beckman Coulter, USA) with newly developed Korean Antimicrobial Susceptibility Testing Panels (KSCM panels) for antimicrobial susceptibility testing (AST) against clinical isolates in South Korea.Methods: Three KSCM panels were designed in this study. For the performance evaluation, a total of 1,325 clinical isolates including 1,027 of Gram-negative bacilli and 298 Gram-positive cocci collected from eight general hospitals in South Korea were used. The results by KSCM panels were compared with those by conventional methods.Results: By KSCM-1 panel for Gram-positive cocci, the rates of categorical agreement (CA) were ＞90% in all the antimicrobials tested in this study. The rates of major error (ME) were also 90%, ME rates

Objectives The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence. Methods We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups. Results In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to -0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605). Conclusions Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.

Persistent dysregulation of IL-6 production and signaling have been implicated in the pathology of various cancers. In systemic mastocytosis, increased serum levels of IL-6 associate with disease severity and progression, although the mechanisms involved are not well understood. Since systemic mastocytosis often associates with the presence in hematopoietic cells of a somatic gain-of-function variant in KIT, D816V-KIT, we examined its potential role in IL-6 upregulation. Bone marrow mononuclear cultures from patients with greater D816V allelic burden released increased amounts of IL-6 which correlated with the percentage of mast cells in the cultures. Intracellular IL-6 staining by flow cytometry and immunofluorescence was primarily associated with mast cells and suggested a higher percentage of IL-6 positive mast cells in patients with higher D816V allelic burden. Furthermore, mast cell lines expressing D816V-KIT, but not those expressing normal KIT or other KIT variants, produced constitutively high IL-6 amounts at the message and protein levels. We further demonstrate that aberrant KIT activity and signaling are critical for the induction of IL-6 and involve STAT5 and PI3K pathways but not STAT3 or STAT4. Activation of STAT5A and STATB downstream of D816V-KIT was mediated by JAK2 but also by MEK/ERK1/2, which not only promoted STAT5 phosphorylation but also its long-term transcription. Our study thus supports a role for mast cells and D816V-KIT activity in IL-6 dysregulation in mastocytosis and provides insights into the intracellular mechanisms. The findings contribute to a better understanding of the physiopathology of mastocytosis and suggest the importance of therapeutic targeting of these pathways This work was supported by the Division of Intramural Research within the National Institute of Allergy and Infectious Diseases (NIAID), at the National Institutes of Health. SI

Background Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4 days of fever) of KD. Methods Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24 h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1 month to 15 years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014. Results One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24 h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1 pg/ml; interquartile range [IQR], 515.4–1570.0184.8–767.8 pg/ml) than in patients without CAD (396.4 pg/ml; IQR, 184.8–767.8 pg/ml) (p ≤ 0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4 pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642–0.856). Conclusion Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED.

본 연구에서는 충남 서해안의 가로림만(加露林灣)지역을 중심으로 개발로 인해 연안환경이 어떻게 변화해 왔는지를 환경의 관점에서 추적해보고, 인근 어촌주민을 대상으로 가로림만이 제공하는 자연혜택 혹은 생태계서비스에 대한 주관적 인식 정도를 확인해 보고자 했다. 가로림만의 자연환경은 오랜 시간 동안 인간의 간섭으로 변화해왔다. 특히 1960년대 이후 국토확장 및 식량생산, 산업단지 확보 등을 목적으로 한 정부주도의 대규모 간척사업은 가로림만 갯벌에 돌이킬 수 없는 규모의 훼손을 가져왔으며, 어업근대화 정책은 해양쓰레기 및 어족자원의 고갈이라는 부정적 외부효과를 불러왔다. 설문조사 결과를 보면 주민들은 어업과 관련해 가로림만의 자연혜택이 과거에 비해 많이 축소되었다는 부정적 인식을 높게 드러냈다. 그리고 자연혜택이 축소된 주요 원인으로 해양쓰레기 및 수질오염 등에 의한 바다오염, 간척 및 공업단지, 화력발전소로 대표되는 무분별한 지역개발, 기후변화로 인한 바다환경의 변화 등을 지적했다. 어촌사회의 경제 및 사회문화적 순환과정은 생태학적 순환과정과 밀접하게 연계되어 있다. 즉 어촌사회의 지속가능성은 어업의 토대인 건강한 해양에 있다. 가로림만 주민들 또한 건강한 해양은 자신들의 삶과 분리된 자연만의 고유한 영역이 아니라는 인식을 강하게 드러냈다. 즉 이들이 생각하는 건강한 해양이란 안정적 수입과 적정 수준의 수산물을 획득할 수 있는 사회경제적 삶의 터전으로서의 해양이다.

We performed a large, population-based study to analyze the risk factors of the febrile seizures and the subsequent afebrile epileptic seizures.Relevant data from children born between 2002-2007 were retrieved from the Korean National Health Insurance Service-National Sample Cohort 2002-2013. Children who did not survive the first five years were excluded from the analysis. The risk factors for febrile seizures were assessed separately in per-person and per-febrile case analyses, and factors contributing to an increased risk of subsequent afebrile epileptic seizures were identified.A total of 54,233 children were included and the five-year prevalence rate of febrile seizure was 11.19%. In the per-person analysis, male sex, preterm birth and brain injury at birth increased the risk of febrile seizure with odds ratios of 1.17, 1.40 and 1.97 (all p 0.001), respectively. A high household income level was associated with reduced odds of febrile seizure. In the per-febrile illness analysis, male sex, brain injury at birth, presumed bacterial infection, gastrointestinal or genitourinary infection and unspecified sepsis were independent risk factors of a febrile seizure during febrile illness. The cumulative number of febrile seizure episodes, especially more than the third episodes, was associated with a new diagnosis of an afebrile epileptic seizure within one year.Sex, preterm birth, brain injury at birth, presumed bacterial infection, genitourinary and gastrointestinal infections and unspecified sepsis were identified as likely risk factors for febrile seizures. A greater number of febrile seizure episodes was associated with a higher probability of subsequent afebrile epileptic seizures.

This paper was inspired to answer the fundamental question on whether electric battery powered ships can ultimately be a promising solution for future maritime environmental protection. The overall process was designed to demystify the holistic environmental benefits and harms of 14 primary energy sources for electricity production in consideration of the national-specific cases of 33 countries. A series of comparative analyses between the diesel as the reference fuel and the battery-electric propulsions were conducted with 27 short-route ferries engaged in Scotland coastal areas. A key message obtained from the analysis results were that the impact of battery application was far from the zero-emission shipping in the lifecycle perspective. Moreover, the same vessels were found to yield completely different environmental performances, depending on how those countries produce electricity. In some Asian countries heavily relying on fossil-based power generation, the environmental impact of battery operation was estimated far greater than that of diesel operation in the UK. Case studies were, then, scaled-up to about 5500 marine vessels presently engaged in international voyages. In general, consistent results were found. Research findings distinctively demonstrated the misguidance of current maritime policies for encouraging battery-powered ships and identified that these shortcomings would stem from the limitations of current practices of maritime environmental assessment. Lastly, it strongly suggested to the marine industry and stakeholders that the environmental protection from shipping activities would be not only a matter of ships but also a matter of how the national power grid develops.

This study proposes an empirical formula to predict the ultimate strength of the initially deflected plate subjected to combined longitudinal compression and lateral pressure. The reliable plate scenarios selected are analysed by the ALPS/ULSAP (= Analysis of Large Plated Structures/Ultimate Limit State Assessment Program) method. In total, 5,600 plate scenarios, including the effects of geometry, material and applied load properties, are generated and used as input data for structural analysis to obtain the ultimate strength of the plates. In particular, five water depths (h) cases (i.e., 0, 5, 10, 15, and 20 m), four material yield strength (i.e., 235, 275, 315, and 355 MPa) and various initial deflection amounts were considered together with the wide range of geometric properties. The empirical formula obtained shows good agreement with ALPS/ULSAP simulation results ( R 2 = 0.994). The applicability of the outcome verified by statistical analysis and the effect of individual parameters considered on the ultimate strength of the plate is documented. The valuable examples are also provided with a detailed user guide. The obtained result may help estimate the ULS characteristic of the plate under combined compression and lateral pressure. Also, it can be used as a practical design guide for the robust design of the ship's plate.

In this study, a comprehensive technical review on existing empirical formulations that predict the ultimate limit state (ULS) of a stiffened panel under longitudinal compression was conducted. Recently, Kim et al. (2017) proposed a curve-fitting-based empirical formulation to predict the ultimate compressive strength of a stiffened panel. They found that the ULS behaviour of the stiffened panel fluctuated in the range of 0 λ ) λ was conducted using ANSYS Nonlinear Finite Element Method (NLFEM)-based numerical simulation. A total of 10,500 cases were modelled using ANSYS numerical simulation by considering relevant size changes in plate thickness, web thickness, flange thickness, height of web, and breadth of flange. In the case of initial imperfection, only the average level of initial deflection to the plate and initial distortion to stiffener elements were considered, while the residual stress due to welding was not considered. A detailed procedure including the selection of reliable scenarios, Finite Element (FE) modelling, FE analysis, and sensitivity analysis results, was also documented. The obtained outcome will be useful for understanding the ultimate compressive strength behaviour of a stiffened panel. Moreover, the applicability of existing empirical formulations can also be assessed from the statistical analysis results.

Rivaroxaban (RXB), a novel oral anticoagulant that directly inhibits factor Xa, is a poorly soluble drug belonging to Biopharmaceutics Classification System (BCS) class II. In this study, a hot-melt extruded amorphous solid dispersion (HME-ASD) containing RXB is prepared by changing the drug:polymer ratio (Polyvinylpyrrolidione-vinyl acetate 64, 1:1–1:4) and barrel temperature (200‒240 °C), fixed at 20% of Cremophor® RH 40 and 15 rpm of the screw speed, using the hot-melt extruding technique. This study evaluates the solubility, dissolution behavior, and bioavailability for application to oral drug delivery and optimizes the formulation of rivaroxaban amorphous solid dispersion (RXB-ASD). Based on a central composite design, optimized RXB-ASD (PVP VA 64 ratio 1:4.1, barrel temperature 216.1 °C, Cremophor® RH 40 20%, screw speed 15 rpm) showed satisfactory results for dependent variables. An in vitro drug dissolution study exhibited relatively high dissolution in four media and achieved around an 80% cumulative drug release in 120 min. Optimized RXB-ASD was stable under the accelerated condition for three months without a change in crystallinity and the dissolution rate. A pharmacokinetic study of RXB-ASD in rats showed that the absorption was markedly increased in terms of rate and amount, i.e., the systemic exposure values, compared to raw RXB powder. These results showed the application of quality by design (QbD) in the formulation development of hot-melt extruded RXB-ASD, which can be used as an oral drug delivery system by increasing the dissolution rate and bioavailability.

Myelomeningocele (MMC) affects one in 1000 newborns annually worldwide and each surviving child faces tremendous lifetime medical and caregiving burdens. Both genetic and environmental factors contribute to disease risk but the mechanism is unclear. This study examined 506 MMC subjects for ultra-rare deleterious variants (URDVs, absent in gnomAD v2.1.1 controls that have Combined Annotation Dependent Depletion score ≥ 20) in candidate genes either known to cause abnormal neural tube closure in animals or previously associated with human MMC in the current study cohort. Approximately 70% of the study subjects carried one to nine URDVs among 302 candidate genes. Half of the study subjects carried heterozygous URDVs in multiple genes involved in the structure and/or function of cilium, cytoskeleton, extracellular matrix, WNT signaling, and/or cell migration. Another 20% of the study subjects carried heterozygous URDVs in candidate genes associated with gene transcription regulation, folate metabolism, or glucose metabolism. Presence of URDVs in the candidate genes involving these biological function groups may elevate the risk of developing myelomeningocele in the study cohort.

Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes.A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% (P .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure.The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

Therapeutic applications of extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) have attracted considerable attention because of their immunomodulatory properties against immune-mediated, inflammatory diseases. Here, we demonstrated enhanced immunomodulatory properties of EVs secreted from endoplasmic reticulum (ER) stress inducer thapsigargin (TSG)-primed human Wharton’s jelly-derived MSCs (WJ-MSCs). EVs from TSG-primed WJ-MSCs (TSG-EV) showed increased yield and expression of immunomodulatory factors, such as transforming growth factor-β1 (TGFβ), cyclooxygenase-2 (COX2), and especially indoleamine 2,3-dioxygenase (IDO), compared to control EVs. TSG-EV showed a significantly enhanced immunosuppressive effect on human peripheral blood-derived T cell proliferation and Th1 and Th17 differentiation, whereas Treg and M2-type macrophage were enriched compared to a control EV-treated group. Furthermore, TSG-EV substantially mitigated mouse experimental colitis by reducing the inflammatory response and maintaining intestinal barrier integrity. A significant increase of Tregs and M2-type macrophages in colitic colons of a TSG-EV-treated mouse suggests an anti-inflammatory effect of TSG-EV in colitis model, possibly mediated by Treg and macrophage polarization. These data indicate that TSG treatment promoted immunomodulatory properties of EVs from WJ-MSCs, and TSG-EV may provide a new therapeutic approach for treatment of colitis.

This study presents the two-dimensional numerical simulations of a flow around a rotating cylinder at Re = 3900 using standard k-e turbulence model. The two-dimensional incompressible Navier-stokes equations are solved using OpenFoam. Hydrodynamic coefficients and vortex shedding patterns for flow around cylinder are studied. The predicted responses are in good agreement with the published literature. The transverse, streamwise, grid size and time steps have significant effect on the wake formation and hydrodynamic coefficients. These investigations are helpful for better understanding the flow around the circular cylinders and improve the structural designs.

Serious bacterial infection (SBI) in children, such as bacterial meningitis or sepsis, is an important condition that can lead to fatal outcomes. Therefore, since it is very important to accurately diagnose SBI, SBI prediction tools such as ‘Refined Lab-score’ or ‘clinical prediction rule’ have been developed and used. However, these tools can predict SBI only when there are values of all factors used in the tool, and if even one of them is missing, the tools become useless. Therefore, the purpose of this study was to develop and validate a machine learning-driven model to predict SBIs among febrile children, even with missing values. This was a multicenter retrospective observational study including febrile children

Background Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. Methods This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year. To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. Results In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. Conclusion A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies. Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic., Graphical Abstract

Background Peyronie’s disease (PD) is a severe fibrotic disease of the tunica albuginea that causes penis curvature and leads to penile pain, deformity, and erectile dysfunction. The role of pericytes in the pathogenesis of fibrosis has recently been determined. Extracellular vesicle (EV)–mimetic nanovesicles (NVs) have attracted attention regarding intercellular communication between cells in the field of fibrosis. However, the global gene expression of pericyte-derived EV–mimetic NVs (PC–NVs) in regulating fibrosis remains unknown. Here, we used RNA-sequencing technology to investigate the potential target genes regulated by PC–NVs in primary fibroblasts derived from human PD plaque. Methods Human primary fibroblasts derived from normal and PD patients was cultured and treated with cavernosum pericytes isolated extracellular vesicle (EV)–mimetic nanovesicles (NVs). A global gene expression RNA-sequencing assay was performed on normal fibroblasts, PD fibroblasts, and PD fibroblasts treated with PC–NVs. Reverse transcription polymerase chain reaction (RT-PCR) was used for sequencing data validation. Results A total of 4135 genes showed significantly differential expression in the normal fibroblasts, PD fibroblasts, and PD fibroblasts treated with PC–NVs. However, only 91 contra-regulated genes were detected among the three libraries. Furthermore, 20 contra-regulated genes were selected and 11 showed consistent changes in the RNA-sequencing assay, which were validated by RT-PCR. Conclusion The gene expression profiling results suggested that these validated genes may be good targets for understanding potential mechanisms and conducting molecular studies into PD.

The development of numerical simulations is potentially useful in predicting the most suitable manufacturing processes and ultimately improving product quality. Seamless pipes are manufactured by a rotary piercing process in which round billets (workpiece) are fed between two rolls and pierced by a stationary plug. During this process, the material undergoes severe deformation which renders it impractical to be modelled and analysed with conventional finite element methods. In this paper, three-dimensional numerical simulations of the piercing process are performed with an arbitrary Lagrangian&ndash, Eulerian (ALE) formulation in LS-DYNA software. Details about the material model as well as the elements&rsquo, formulations are elaborated here, and mesh sensitivity analysis was performed. The results of the numerical simulations are in good agreement with experimental data found in the literature and the validity of the analysis method is confirmed. The effects of varying workpiece velocity, process temperature, and wall thickness on the maximum stress levels of the product material/pipes are investigated by performing simulations of sixty scenarios. Three-dimensional surface plots are generated which can be utilized to predict the maximum stress value at any given combination of the three parameters.

This research aims to study the ultimate limit state (ULS) behaviour of stiffened panel under longitudinal compression by a non-linear finite element method (NLFEM). There are different types of stiffeners mainly being used in shipbuilding, i.e., T-bar, flat-bar, and angle-bar. However, this research focuses on the ultimate compressive strength behaviour of flat-bar stiffened panel. A total of 420 reliable scenarios of flat-bar stiffened panel were selected for numerical simulation by the ANSYS NLFEM. The ultimate strength behaviours obtained were used as data for the development of closed form shape empirical formulation. Recently, our group proposed an advanced empirical formulation for T-bar stiffened panel, and the applicability of the proposed formulation to flat-bar stiffened panel is confirmed by this study. The accuracy of the empirical formulation obtained for flat-bar stiffened panel was validated by finite element (FE) simulation results of statistical analysis (R2 = 0.9435). The outcome obtained will be useful for ship structural designers in predicting the ultimate strength performance of flat-bar type stiffened panel under longitudinal compression.

Governments throughout the world can learn many critical lessons from examining instances of ineffective communication with the public during the global coronavirus disease (COVID-19) pandemic. Ineffective government communication has resulted in a great deal of public confusion and misunderstanding, as well as serious errors in responding to this evolving health threat, leading to disastrous health and social outcomes for the public and prolonging the pandemic, especially within the United States. This article uses systems theory as a template for analyzing government communication in the United States during the COVID-19 pandemic, providing governments with recommendations for establishing effective health risk communication strategies for use with the public. The communication strategies offered here promote the delivery of relevant, accurate, and sensitive information to key public groups, minimizing communication noise to guide desirable coordinated actions. These communication strategies can be applied locally, nationally, and internationally.

Decommissioning of the offshore platform as an artificial reef, known as Rigs-to-Reefs (R2R), has become a sustainable approach for oil companies. The platform was reused to serve the underwater ecosystem as an artificial reef for a new marine ecosystem which helps to tackle food security issue. This paper presents the findings of the formulation of the reefing viability index to recognize an offshore region that can be used for R2R projects within the South China Sea. The combined effects of spatial data, numerical modelling, and geographic system (GIS) are proposed to study the relationship of spawning ground coral reefs, diversity, and planula larvae in the process of colonization to establish a map of the reef potential environment. Coral connectivity and spawning behaviour were studied to determine the possible source of coral seedling released during the spawning season, twice a year. A geographic reef viability index was established consisting of seven parameters which are coral larval density, pelagic larval length, sea currents, temperature, chlorophyll-a, depth, and substrate availability. The ocean hydrodynamic model was designed to resemble the pattern of larval scattering. By using the simulations and rankings, there were 95 (21%) sites which could probably be used for in situ reefing, whereas 358 (79%) sites were likely ideal for ex situ reefing. Validation of the viability index was carried out using media footage assessment of remotely operated vehicle (ROV).

Background Previous studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage. Methods This was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class. Results During the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant (P < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state (P = 0.502) and the case of air transport (P = 0.468). Conclusion Down-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered., Graphical Abstract

Background A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries. Methods A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries. Results Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51–147.72). Conclusion The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery., Graphical Abstract

The assessment of the buckling and ultimate collapse strength is a mandatory step in the ultimate limit state design of ship structures. The collapse analysis of ship-type stiffened panels under longitudinal compression is highly affected by initial geometric imperfection. Several geometric imperfection models are available in the literature. Broadly speaking, they can be categorised into deterministic and probabilistic approaches. The deterministic approach describes the initial deflection field with a presumed geometric shape and a characteristic maximum distortion magnitude. Several geometric deflection shapes are commonly adopted, including hungry-horse (HH) mode, Admiralty Research Establishment (ARE) mode and critical buckling (CM) mode. Each of these deflection mode shapes is used in conjunction with a characteristic maximum distortion magnitude. Except otherwise specified, an average-level magnitude is usually applied. By contrast, the probabilistic approach evaluates the initial geometric imperfection as a random field, generated based on the prescribed statistics. A comparative study is presented in this study in the light of analysing the uncertainty in ultimate compressive strength of stiffened plated grillages induced by different modelling of geometric imperfection. In addition, the influence of relative deflection in the adjacent panels is analysed. Recommendations for choosing an imperfection model for buckling analysis of ship-type stiffened plated structures are reported.

This paper presents a method for assessing the reliability of a corroded pipeline placed in series, with special consideration given to the effect of the length scale imposed by each segment of the pipe. The features of corrosion in different pipe segments are statistically correlated; thus, a failure in one section may impact the adjacent sections. Herein, using a correlation distance parameter, such statistical correlation is described considering the length-scale effects. The reliability of the corroded pipeline is presented in the form of a failure probability. The results show that analysing a corroded pipeline by considering length-scale effects produces a higher failure probability compared with the case where such effects are excluded, even when the parameters that govern corrosion in a pipeline are included in the analysis.

Background This study examined the role of superficial vein surgery in patients with combined superficial venous reflux and segmental popliteal vein reflux. Methods We retrospectively reviewed 42 limbs in 38 patients with combined superficial venous reflux and segmental popliteal vein reflux who underwent saphenous vein ablation between January 2014 and February 2017. Patients underwent outpatient follow-up duplex ultrasonography at 3, 6, and 12 months postoperatively. Resolution of deep vein reflux was defined as reversed blood flow in a popliteal segment for less than 1.0 second and a decrease in the reflux time of more than 20% of the preoperative reflux time. Results The mean follow-up period was 9 months (range, 3-23 months). Saphenous vein ablations were performed by stripping in 24 limbs and radiofrequency ablation in 18 limbs. Preoperative segmental popliteal vein reflux resolved in 21 of the 42 limbs (50%). Conclusion This study demonstrated that superficial venous surgery corrected segmental popliteal vein reflux in 50% of limbs with combined superficial venous reflux and segmental popliteal vein reflux. Other prospective studies are necessary to elucidate the etiology of the non-reversible cases.

Mast cells are derived from hematopoietic precursors and as mature cells reside in tissues. Mast cells express receptors that endow their function in innate and acquired immunity. In addition to FceRI, the high-affinity receptor of IgE, and other immunoglobulin Fc receptors, mast cells express microbial pattern recognition receptors; Toll-like and NOD-like receptors (TLR and NLR); Mas-related G-protein-coupled receptor member X2 (MRGX2) that recognizes cationic neuropeptides, antimicrobial peptides, and insect-venom peptides; and receptors that recognize molecules associated with tissue damage, such as ST2, the IL-33 receptor. Mast cells are thus able to respond to both exogenous and endogenous stimuli with release of histamine and lipid mediators, cytokines, chemokines, growth factors, and proteases. Mast cells are potentially lethal cells (anaphylaxis) or can cause tissue damage if their activation is sustained. Mutations, principally in KIT, the receptor for stem cell factor (SCF), lead to excess mast cell proliferation and mastocytosis.

Objective: We developed a novel compression assist device (palm presser) to perform chest compressions using a palm in infant cardiopulmonary resuscitation (CPR). We hypothesized that the p...

Mast cells are critical effector cells in IgE-mediated allergic responses. The aim of this study was to investigate the anti-allergic effects of 3-[(aminocarbonyl)amino]-5-(3-fluorophenyl)-N-(3S)-3-piperidinyl-2-thiophenecarboxamide (AZD7762) in vitro and in vivo. AZD7762 inhibited the antigen-stimulated degranulation from RBL-2H3 (IC50, ∼27.9 nM) and BMMCs (IC50, ∼99.3 nM) in a dose-dependent manner. AZD7762 also inhibited the production of TNF-α and IL-4. As the mechanism of its action, AZD7762 inhibited the activation of Syk and its downstream signaling proteins, such as Linker of activated T cells (LAT), phospholipase (PL) Cγ1, Akt, and mitogen-activated protein (MAP) kinases (Erk1/2, p38, and JNK) in mast cells. In in vitro protein kinase assay, AZD7762 inhibited the activity of Lyn and Fyn kinases, which are important for the activation of Syk in mast cells. Furthermore, AZD7762 also suppressed the degranulation of LAD2 human mast cells (IC50, ∼49.9 nM) and activation of Syk in a dose-dependent manner. As observed in experiments with mast cells in vitro, AZD7762 inhibited antigen-mediated passive cutaneous anaphylaxis in mice (ED50, ∼35.8 mg/kg). Altogether, these results suggest that AZD7762 could be used as a new therapeutic agent for mast cell-mediated allergic diseases.

Mitochondrial aldehyde dehydrogenase (ALDH2) metabolizes endogenous and exogenous aldehydes and protects cells against oxidative injury. Inactivating genetic polymorphisms in humans are common and associate with alcohol flush reactions. However, whether mast cell Aldh2 activity impacts normal mast cell responses is unknown. Using bone marrow-derived mast cells from Aldh2 knockout mice, we found evidence for a role of mast cell Aldh2 in Kit-mediated responses. Aldh2-deficient mast cells showed enhanced Kit tyrosine kinase phosphorylation and activity after stimulation with its ligand (stem cell factor) and augmentation of downstream signaling pathways, including Stat4, MAPKs, and Akt. The activity of the phosphatase Shp-1, which attenuates Kit activity, was reduced in Aldh2&minus, /&minus, mast cells, along with an increase in reactive oxygen species, known to regulate Shp-1. Reduced Shp-1 activity concomitant with sustained Kit signaling resulted in greater proliferation following Kit engagement, and increased mediator and cytokine release when Aldh2&minus, mast cells were co-stimulated via Kit and Fc&epsilon, RI. However, Fc&epsilon, RI-mediated signaling and responses were unaffected. Therefore, our findings reveal a functional role for mast cell intrinsic Aldh2 in the control of Kit activation and Kit-mediated responses, which may lead to a better understanding of mast cell reactivity in conditions related to ALDH2 polymorphisms.

In this study, an advanced method was proposed for the empirical formation of current profiles. A probabilistic approach was adopted to generate a reliable empirical model which can be expressed as...