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Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare entity characterized by the presence of lupus anticoagulant (LA) and prothrombin (factor II) deficiency. It may cause severe bleeding contrary to classical antiphospholipid syndrome. Here, we report a case of LAHPS presenting with a hemorrhagic ovarian cyst in a 17-year-old girl with systemic lupus erythematosus (SLE) nephritis. She had been followed up for 8 years. Her first manifestation of SLE was prolonged gingival bleeding after tooth extraction at 9 years of age. During the follow-up period, she had neither severe bleeding nor thrombotic complications despite a positive LA and a prolonged activated partial thromboplastin time (aPTT). At this visit, the patient presented with colicky abdominal pain, a hemorrhagic ovarian cyst, a prolonged prothrombin time, a prolonged aPTT, a low factor II level, and a positive LA, leading to the diagnosis of LAHPS. While a hemorrhagic ovarian cyst resolved completely in 3 months, she received oral pill, transfusions of red blood cells and plasma, and intravenous cyclophosphamide pulse therapy in combination with glucocorticoids due to persistent menorrhagia, anemia, prolonged aPTT, and lupus flaring. Thus, LAHPS needs to be considered in SLE patients with positive LA and prolonged aPTT.

Background: Small non-coding RNAs (ncRNAs) have recently emerged as potential biomarkers of sarcopenia. However, previous studies have rarely explored the association of small ncRNAs with sarcopenic components, especially muscle strength and physical performance. We aimed to examine circulating small ncRNA profiles to detect low muscle strength and physical performance in older adults. Methods: Ninety-eight older adults were randomly selected from Korean Frailty and Aging Cohort Study and classified into the “Normal,” “Low muscle strength (MS) only,” “Low physical performance (PP) only,” and “Low MS and PP” groups by Asian Working Group for Sarcopenia 2019 criteria. We used high-throughput sequencing to delineate small ncRNA profiles in plasma. Differentially expressed small ncRNAs were analyzed to reveal distinct patterns based on muscle strength and physical performance status. Results: In “Low MS and PP” group, 119 miRNAs, 86 piRNAs, 92 snoRNAs, 106 snRNAs, and 15 tRNAs were differentially expressed compared to “Normal” group (p 0.05). Conclusion: The expression of circulating small ncRNAs were comprehensively characterized, revealing distinct signatures in older adults with both low muscle strength and physical performance compared to normal individuals. Although preliminary, this characterization can advance small ncRNA research on age-related declines in muscle strength and physical performance by providing foundational data for further investigation.

Background: Coexistent sarcopenia and frailty is more strongly associated with adverse health outcomes than each condition alone. As the importance of coexistent sarcopenia and frailty increases, exploring their underlying mechanisms is warranted. Recently, noncoding ribonucleic acids (RNAs) have been suggested as potential biomarkers of sarcopenia and frailty. This systematic review aimed to summarize noncoding RNAs commonly expressed in sarcopenia and frailty, and to search the predicted target genes and biological pathways of them. Methods: We systematically searched the literatures on PubMed, Embase, Cochrane Library, Web of Science, and Scopus for literature published till November 15, 2023. A total of 7,202 literatures were initially retrieved. After de-duplication, 34 studies (26 sarcopenia-related and 8 frailty-related) were full-text reviewed, and 15 studies (11 sarcopenia-related and 4 frailty-related) were finally included. Results: miR-29a-3p, miR-29b-3p, and miR-328 were identified as commonly expressed in same direction in sarcopenia and frailty. These microRNAs (miRNAs), identified in the literature search using PubMed, modulate transforming growth factor-β signaling via extracellular matrix components and calcineurin/nuclear factor of activated T cells 3 signaling via sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a, which are involved in regulating skeletal muscle fibrosis and the growth of slow-twitch muscle fibers, respectively. miR-155-5p, miR-486, and miR-23a-3p were also commonly expressed in two conditions, although in different or conflicting directions. Conclusion: In this systematic review, we highlight the potential of shared miRNAs that exhibit consistent expression patterns as biomarkers for the early diagnosis and progression assessment of both sarcopenia and frailty.

Author(s): Do Young Kim [sup.1] , Hyung Eun Yim [sup.1] , Min Hwa Son [sup.1] , Kee Hwan Yoo [sup.2] Author Affiliations: (1) grid.411134.2, 0000 0004 0474 0479, Department of [...], Background To determine whether urine neutrophil gelatinase-associated lipocalin (uNGAL) might be superior to pyuria for detecting urinary tract infection (UTI) regardless of urine specific gravity (SG) in young children. Methods We conducted a retrospective analysis of children aged < 3 years who were evaluated for UTI with urinalysis, urine culture, and uNGAL measurements during a 5-year period. Sensitivity, specificity, likelihood ratios (LRs), predictive values (PVs), area under the curves (AUCs) of uNGAL cut-off levels, and various microscopic pyuria thresholds for detecting UTI were calculated for dilute (SG < 1.015) and concentrated urine (SG [greater than or equal to] 1.015). Results Of 456 children included, 218 had UTI. The diagnostic value of urine white blood cell (WBC) concentration to define UTI changed with urine SG. For detecting UTI, uNGAL cut-off of 68.4 ng/mL had higher AUC values than pyuria [greater than or equal to] 5 WBCs/high power field (HPF) for dilute and concentrated urine samples (both P 0.05). Positive LR and PV and specificity of uNGAL were all greater than those of pyuria [greater than or equal to] 5 WBCs/HPF regardless of urine SG, although the sensitivity of pyuria [greater than or equal to] 5 WBCs/HPF was higher than that of uNGAL cut-off for dilute urine (93.8% vs. 83.5%) (P < 0.05). At uNGAL [greater than or equal to] 68.4 ng/mL and [greater than or equal to] 5 WBCs/HPF, posttest probabilities of UTI were 68.8% and 57.5% for dilute urine and 73.4% and 57.3% for concentrated urine, respectively. Conclusions Urine SG can affect the diagnostic performance of pyuria for detecting UTI and uNGAL might be helpful for identifying UTI regardless of urine SG in young children. Graphical abstract

Antenatally diagnosed urinary tract dilatation (UTD), previously referred to as antenatal hydronephrosis, is the most commonly detected abnormality by prenatal ultrasonography. Several grading systems have been developed for the classification of antenatal UTD using prenatal and postnatal ultrasonography. UTD comprises a wide variety of congenital abnormalities of the kidney and urinary tract ranging from transient UTD to more significant abnormalities such as vesicoureteral reflux, ureteropelvic junction obstruction, ureterocele, ureterovesical junction obstruction, posterior urethral valves, and non-refluxing megaureter. Optimizing the evaluation of antenatally detected UTD is essential to recognize children with important disorders while avoiding excessive investigations. Conservative approach with close follow-up is increasingly accepted as an appropriate treatment option for patients with asymptomatic vesicoureteral reflux and ureteropelvic junction obstruction in recent years. However, predicting permanent kidney damage in an unselected group of children with antenatal UTD is still challenging. The management and follow-up of children with UTD should be individualized based on recommendations from a pediatric nephrologist, a pediatric urologist, or both. Future research directed at predicting long-term outcomes of children diagnosed with UTD from mild findings to severe disease is needed to refine management for those at higher risk of kidney disease progression.

Purpose Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods We retrospectively reviewed the medical records of 147 patients

Sarcopenia is a comprehensive degenerative disease with the progressive loss of skeletal muscle mass with age, accompanied by the loss of muscle strength and muscle dysfunction. Individuals with unmanaged sarcopenia may experience adverse outcomes. Periodically monitoring muscle function to detect muscle degeneration caused by sarcopenia and treating degenerated muscles is essential. We proposed a digital biomarker measurement technique using surface electromyography (sEMG) with electrical stimulation and wearable device to conveniently monitor muscle function at home. When motor neurons and muscle fibers are electrically stimulated, stimulated muscle contraction signals (SMCSs) can be obtained using an sEMG sensor. As motor neuron activation is important for muscle contraction and strength, their action potentials for electrical stimulation represent the muscle function. Thus, the SMCSs are closely related to muscle function, presumptively. Using the SMCSs data, a feature vector concatenating spectrogram-based features and deep learning features extracted from a convolutional neural network model using continuous wavelet transform images was used as the input to train a regression model for measuring the digital biomarker. To verify muscle function measurement technique, we recruited 98 healthy participants aged 20–60 years including 48 [49%] men who volunteered for this study. The Pearson correlation coefficient between the label and model estimates was 0.89, suggesting that the proposed model can robustly estimate the label using SMCSs, with mean error and standard deviation of -0.06 and 0.68, respectively. In conclusion, measuring muscle function using the proposed system that involves SMCSs is feasible.

Cystinuria, a genetically inherited disorder, is a rare cause of kidney stones. It is characterized by impaired transport of cystine and amino acids in the proximal renal tubule and the small intestine. Most patients develop cystine stones throughout their lifetime. Recurrent renal stones need to be extracted by repeated urologic interventions. Treatment options of cystinuria for preventing stone recurrence are limited and poorly tolerated. In this study, we report a pediatric case of cystinuria with a heterozygous SLC3A1 mutation diagnosed by stone analysis, measurement of urine cystine excretion, and genetic analysis. There were recurrent renal stones despite repetitive shock wave lithotripsy and retrograde intrarenal surgery. However, the rate of stone formation seemed to be slower after D-penicillamine was added into adequate hydration and urinary alkalinization.

Nutcracker syndrome (NCS) is a disease caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Immunoglobulin A (IgA) nephropathy (IgAN) is characterized by the predominance of IgA deposits in the glomerular mesangial area. Hematuria and proteinuria can be present in both diseases, and some patients can be concurrently diagnosed with NCS and IgAN; however, a causal relationship between the two diseases has not yet been clarified. Here, we report two pediatric cases of NCS combined with IgAN. The first patient presenting with microscopic hematuria and proteinuria was diagnosed with NCS at the initial visit, and the second patient was later diagnosed with NCS when proteinuria worsened. Both patients were diagnosed with IgAN based on kidney biopsy findings and treated with angiotensin-converting enzyme inhibitors and immunosuppressants. A high index of suspicion and timely imaging or biopsy are essential for the proper management of NCS combined with glomerulopathy.

The gut microbiota plays a crucial role in host physiology and the disruption of host–microbiota relationships caused by environmental stressors can impact host growth and survival. In this study, we used Daphnia galeata as a model organism to investigate the interactive effects of fish kairomones on the life-history traits and gut microbiota alterations of D. galeata, as well as the relationship between life-history traits and gut microbiota composition. The presence of fish kairomones enhanced fecundity, decreased growth, and altered gut microbiota, with significant changes in alpha diversity but not in beta diversity in the genotype KB5 of D. galeata. Statistical analysis revealed that the relative abundance of the Pseudomonadaceae family significantly increased upon exposure to fish kairomone, while the relative abundance of the Comamonadaceae family significantly decreased. The decreased growth in genotype KB5 may be associated with a significant increase in Pseudomonas, a member of the family Pseudomonadaceae, which is generally deficient in essential fatty acids, potentially negatively impacting growth. Meanwhile, it is speculated that the significant decrease in Limnohabitans belonging to the Comamonadaceae family is associated with the reduction of body size and increased fecundity of KB5 when exposed to fish kairomones. Furthermore, the genus Candidatus Protochlamydia was observed only under the fish kairomones-treated condition. These data suggest that variations in host life-history traits related to reproduction and growth are potentially associated with the relative abundance or presence of these microbial genera. Our research findings provide valuable insights into understanding the impact of biotic stress on the interaction between hosts and microbiota.

In the aftermath of the COVID-19 pandemic, the urgent need for the rapid deployment of healthcare facilities propelled the rise of modular construction using an infill approach. In these modular, negative-pressure wards, the design of indoor airflow and pressure plays a crucial role in meeting the ventilation strategies required for isolation facilities. Accordingly, this paper focuses on modular negative-pressure wards employing an infill construction method and proposes an appropriate spatial pressure distribution to address the problem of air tightness degradation due to leakage. This study analyzed the indoor airflow and pressure distribution of a unit module corresponding to an infill. It aimed to examine whether the pressure difference with the adjacent room is maintained and to assess its effectiveness in isolating contaminated air. First, the airflow rate of the heating, ventilation, and air conditioning system in the unit module was calculated to ensure that it would meet the performance criteria of the negative-pressure ward. Afterward, based on the calculated rate, the study assessed the airflow and room-specific pressure within a typical floor, encompassing both the unit module and associated nursing support facilities. Here, the airflow in the external corridor of the typical floor was divided into two cases according to the pressure distribution: negative pressure and atmospheric pressure. The calculation results were compared using a computational fluid dynamics tool. The analysis results confirm that the air isolation performance is adequate as the pressure difference between adjacent rooms in the unit module and the typical floor was maintained at 2.5 Pa. Additionally, the indoor airflow in the negative-pressure isolation room formed a stable flow at a slow speed of 0.1–0.2 m/s, minimizing the possibility of air contamination from outside the isolation room. In particular, Case B of the typical floor design proposes a method to optimize the pressure distribution in the modular negative-pressure ward by designing the ventilation flow rate at atmospheric pressure level. Thus, this study emphasizes that atmospheric pressure design is appropriate when designing pressure in areas where negative-pressure control is difficult and can contribute to the design and improvement of similar medical facilities in the future.

Background Alternative complement pathway dysregulation plays a key role in glomerulonephritis (GN) and is associated with C3 deposition. Herein, we examined pathological and clinical differences between cases of primary GN with C3-dominant (C3D-GN) and nondominant (C3ND-GN) deposition. Methods We extracted primary GN data from the Korean GlomeruloNEphritis sTudy (KoGNET). C3D-GN was defined as C3 staining two grades greater than C1q, C4, and immunoglobulin via immunofluorescence analysis. To overcome a large difference in the number of patients between the C3D-GN and C3ND-GN groups (31 vs. 9,689), permutation testing was used for analysis. Results The C3D-GN group exhibited higher serum creatinine (p ≤ 0.001), a greater prevalence of estimated glomerular filtration rate of

The messenger RNA-based vaccine for the coronavirus disease 2019 (COVID-19) may induce glomerulonephritis, including immunoglobulin A nephropathy (IgAN). New-onset IgAN triggered by vaccination against COVID-19 has been reported rarely, especially in children. Herein, we report a pediatric case of newly diagnosed IgAN after administration of the Pfizer vaccine for COVID-19. A 12-year-old girl was referred to our hospital for evaluation of gross hematuria after inoculation with the second dose of Pfizer’s COVID-19 vaccine; she had no adverse effects after the first dose. At the time of admission, she showed heavy proteinuria and persistent hematuria. Kidney biopsy revealed an IgAN, and she was treated with an oral steroid and an angiotensin-converting enzyme inhibitor. Four months after discharge, the proteinuria and hematuria resolved completely.

The Chinese mitten crab (CMC) also known as Eriocheir sinensis has great significance in the aquaculture industry. The bacterial communities inhabiting the CMC’s gut may differ depending on the host habitat and can aid in their normal biological functioning. These microbes are also known to have certain effects on their flavor. In this study, we utilized MiSeq high-throughput sequencing technology to explore the diversity of bacterial communities in the gut of CMCs from three different geographical locations in Korea: the Geum (GD), Han (HD), and Tamjin (TD) rivers. Although most of the environmental parameters were similar at the three sites, significant differences in conductivity (CDS), dissolved oxygen (DO), and salinity were observed. The results show that CMCs sampled from these locations exhibited distinct microbial composition and abundance. For example, the genus Candidatus Hepatoplasma displayed significantly higher abundance in CMCs from HD than those in the other locations, suggesting nutritional stress. Similarly, the crabs collected from TD showed a higher abundance of pathogenic Helicobacter than those from HD and GD sites. We also observed differences in the amino acid, nucleotide, and lactic acid concentrations between different tissues such as the muscle, hepatopancreas, and testis of CMCs. However, only small differences were observed when these characteristics were compared in CMCs from different locations. Our results offer important insights into the intestinal bacterial composition in CMCs which in turn may help in designing better culturing strategies for these important species of crabs.

Background Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension. Methods In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of

Stroke-related disabilities cause poor physical performance, especially among older adults, and can lead to sarcopenia. Functional electrical stimulation (FES) has been used to improve physical performance in individuals with neurological disorders and increase muscle mass and strength to counteract muscle atrophy. This review covers the principles, underlying mechanisms, and therapeutic effects of FES on physical performance and skeletal muscle function in post-stroke older adults. We found that FES restored weakened dorsiflexor and hip abductor strength during the swing and stance phases of gait, respectively, to help support weight-bearing and upright posture and facilitate static and dynamic balance in this population. FES may also be effective in improving muscle mass and strength to prevent muscle atrophy. However, previous studies on this topic in post-stroke older adults are scarce, and further studies are needed to confirm this supposition.

Background Organ crosstalk between the kidney and the heart has been suggested. Acute kidney injury (AKI) and acute heart failure (AHF) are well-known independent risk factors for mortality in hospitalized patients. This study aimed to investigate if these conditions have an additive effect on mortality in hospitalized patients, as this has not been explored in previous studies. Methods We retrospectively reviewed the records of 101,804 hospitalized patients who visited two tertiary hospitals in the Republic of Korea over a period of 5 years. AKI was diagnosed using serum creatinine-based criteria, and AHF was classified using International Classification of Diseases codes within 2 weeks after admission. Patients were divided into four groups according to the two conditions. The primary outcome was all-cause mortality. Results AKI occurred in 6.8% of all patients (n = 6,920) and AHF in 1.2% (n = 1,244). Three hundred thirty-one patients (0.3%) developed both conditions while AKI alone was present in 6,589 patients (6.5%) and AHF alone in 913 patients (0.9%). Among the 5,181 patients (5.1%) who died, 20.8% died within 1 month. The hazard ratio for 1-month mortality was 29.23 in patients with both conditions, 15.00 for AKI only, and 3.39 for AHF only. The relative excess risk of interaction was 11.85 (95% confidence interval, 2.43‒21.27), and was more prominent in patients aged

Due to the close relationship between pets and humans, pet owners are highly invested in proper diets for their pets. Even though pet food mislabeling is concerning, there are few studies on this topic. This study investigated pet food mislabeling in South Korea’s market based on DNA barcoding. In total, 10 pet food products were purchased, and 200 sequences of the partial Cytochrome c oxidase subunit 1 (COI) gene were generated from clones of the samples. The obtained sequences were compared to available public databases to identify species present in the ingredients. The data analyses showed that the labeled species were consistent with species detected by COI sequences in 6 of the products. However, the expected species were not detected in 4 products, revealing possible mislabeling in these samples. Our findings indicated that DNA barcoding might represent a promising tool to detect pet food mislabeling.

Background A laparoscopic approach is widely used in abdominal surgery. Although several studies have compared surgical and oncological outcomes between laparoscopic surgery (LS) and open surgery (OS) in rectal cancer patients, there have been few studies on postoperative renal outcomes. Methods We conducted a retrospective cohort study involving 1,633 patients who underwent rectal cancer surgery between 2003 and 2017. Postoperative acute kidney injury (AKI) was diagnosed according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification. Results Among the 1,633 patients, 1,072 (65.6%) underwent LS. After matching propensity scores, 395 patients were included in each group. The incidence of postoperative AKI in the LS group was significantly lower than in the OS group (9.9% vs. 15.9%; p = 0.01). Operation time, estimated blood loss, and incidence of transfusion in the LS group were significantly lower than those in the OS group. Cox proportional hazard models revealed that LS was associated with decreased risk of postoperative AKI (hazard ratio [HR], 0.599; 95% confidence interval [CI], 0.402–0.893; p = 0.01) and postoperative transfusion was associated with increased risk of AKI (HR, 2.495; 95% CI, 1.529–4.072; p < 0.001). In the subgroup analysis, the incidence of postoperative AKI in patients with middle or high rectal cancer who underwent LS was much lower than in those who underwent OS (HR, 0.373; 95% CI, 0.197–0.705; p = 0.002). Conclusion This study showed that LS may have a favorable effect on the development of postoperative AKI in patients with rectal cancer.

Purpose We aimed to study the association of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and leukocyte differential count in children with febrile urinary tract infection (UTI). Methods Medical records of 154 children aged 1 month to 13 years with febrile UTI who were hospitalized were retrospectively reviewed. Associations between pNGAL levels and blood leukocyte differential count at admission and after 48 hours of treatment were investigated in children with or without acute pyelonephritis (APN). Results The APN group (n=82) showed higher pNGAL levels, neutrophil count, monocyte count, and neutrophil-to-lymphocyte ratio (NLR), compared to the non-APN group (n=72) (all P

Background: Among risk factors of developing frailty, dietary factor played an important role as a potentially modifiable risk factor. Eating alone is associated with malnutrition, depression, and social isolation, which are risk factors of frailty. We evaluated the longitudinal association between a change to eating alone and deterioration in frailty status in a cohort of community-dwelling elderly persons. Methods: The study subjects were 2072 non-frail Korean elderly persons aged 70–84 years who were recruited for the Korean Frailty and Aging Cohort Study (KFACS). The subjects were divided into 4 groups based on changes in eating with others or alone between the baseline survey (2016–2017) and the follow-up survey (2018–2019): group I (ate with others consistently), group II (ate with others at baseline but ate alone at follow-up), group III (ate alone at baseline but ate with others at follow-up), group IV (ate alone consistently). We assessed physical frailty using the Cardiovascular Health Study (CHS) frailty phenotype. The association between changes in eating with others or alone and frailty progression was assessed by multiple logistic regression analysis after adjusting for covariates. Results: The mean age of the study subjects was 76.2 (SD: 3.8) years old and 50.8 % were female. At follow-up, 364 new cases (34.5 %) of pre-frailty (n = 348) and frailty (n = 16) were identified among those who were robust at baseline (n = 1056), while 88 new cases (8.7 %) of frailty were identified among those who were pre-frail at baseline (n = 1016). Compared to group I, group II showed an increased risk of deterioration in frailty status after adjustments with multivariables including social isolation and malnutrition (adjusted odds ratio [aOR] = 1.61, 95 % confidence interval [CI]: 1.03–2.50). However, the association disappeared after further adjustment for depression. When we examined the longitudinal association between changes in eating with others or alone and changes in each frailty domain, group II showed an increased risk for the weight loss (aOR = 3.07, 95 % CI: 1.39–6.76) compared to group I. Group IV showed an increased risk for the weight loss (aOR = 2.39, 95 % CI: 0.95–6.00) and weakness (aOR = 2.07, 95 % CI: 1.16–3.68). Conclusions: A change from eating with others to eating alone was found to significantly increase the risk of deterioration in frailty status in elderly people, and the association seemed to be mediated by depression. These findings suggest that interventions to maintain eating partners and manage depression are needed to prevent frailty progression in elderly people.

A human induced pluripotent stem cell (hiPSC) line, KSCBi017-A, was generated from a 50-year-old male individual using non-integrating episomal vectors expressing reprogramming factors. The generated hiPSCs were integration-free, expressed pluripotency markers, exhibited the potential for differentiation into three germ layers in vivo, and maintained the normal karyotype. This cell line can be used as a control for a disease model and is available from Korea National Stem Cell Bank.