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Background The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. Methods We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. Results We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p Conclusions Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.

Understanding the enzymes responsible for biological nitrogen fixation in the natural environment is crucial for understanding the global nitrogen cycle. The isotopic acetylene reduction assay (ISARA) is currently one of the only ways to distinguish between nitrogenase enzymes and it involves measuring the δ13C of ethylene generated via the reduction of acetylene. However, the classical method can only be applied to samples with ethylene concentrations >1,000 ppm which is limiting for environmental samples, where N2 fixation activity is generally low resulting in a low headspace ethylene concentration (Here we describe an improved analytical method for analyzing δ13C of ethylene using a homemade gas pre-concentration system and reproducible in-house standards developed from commercially available ethylene tanks. We also present a simple methodology using mutants of Azotobacter vinelandii (Mo-only and V-only nitrogenase) and the removal of headspace acetylene by chemical precipitation to easily scale the ISARA experiment from δ13C to complementary nitrogenase contribution without the uncertainty and tediousness surrounding measurement of the source acetylene.The new Low activity - ISARA (LISARA) method can now estimate contribution of complementary nitrogenase from environmental samples with as little as 10 ppm of ethylene. Updated limit of quantification for δ13C of ethylene is < 2 ppm. Finally, we demonstrate the applicability of the method using samples with characteristically low N2 fixation activity (termites, wood, leaf litter, soil, moss), with substantial contribution of complementary nitrogenase across multiple sites in the northeastern United States.Our results expand our knowledge of the contribution of complementary nitrogenase to temperate ecosystems. The new methodology will allow broader access to the classical ISARA method for pure culture experiments and high activity samples through the outsourcing of δ13C ethylene measurements, facilitating the study of complementary nitrogenases.

OBJECTIVES Only 5% to 10% of patients who visit the emergency department (ED) with isolated dizziness without neurologic abnormalities may have central lesions; however, it is important to distinguish central lesions through brain imaging. This study was conducted to create a nomogram to provide an objective medical basis for selectively performing magnetic resonance imaging (MRI) among patients with isolated dizziness. METHODS This retrospective observational study enrolled patients who visited the ED of a tertiary hospital with isolated dizziness and underwent diffusion-weighted MRI and subsequently consulted with the departments of neurology, neurosurgery, or otorhinolaryngology. Multivariable logistic regression analysis was performed to identify risk factors in patients diagnosed with central lesions to create a nomogram with the significant variables. RESULTS Of the 1,078 patients who were screened, 119 were diagnosed with central lesions. Significant variables in the multivariable logistic regression analysis were albumin levels (odds ratio [OR] = 0.339, 95% confidence interval [CI] = 0.188 to 0.610, p = 0.0003), inorganic phosphate levels (OR = 0.891, 95% CI = 0.832 to 0.954, p = 0.0010), history of ischemic stroke (OR = 3.170, 95% CI = 1.807 to 5.560, p

A pilot project using epinephrine at the scene under medical control is currently underway in Korea. This study aimed to determine whether prehospital epinephrine administration is associated with improved survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who received epinephrine during cardiopulmonary resuscitation (CPR) in the emergency department.This retrospective observational study used a nationwide multicenter OHCA registry. Patients were classified into two groups according to whether they received epinephrine at the scene or not. The associations between prehospital epinephrine use and outcomes were assessed using propensity score (PS)-matched analysis. Multivariable logistic regression analysis was performed using PS matching. The same analysis was repeated for the subgroup of patients with non-shockable rhythm.PS matching was performed for 1084 patients in each group. Survival to discharge was significantly decreased in the patients who received prehospital epinephrine [odds ratio (OR) 0.415, 95% confidence interval (CI) 0.250-0.670,Prehospital epinephrine administration was associated with decreased survival rates in OHCA patients but not statistically associated with neurological outcome in this PS-matched analysis. Further research is required to investigate the reason for the detrimental effect of epinephrine administered at the scene.

Seasonal variations in the condition, biochemical composition, and reproduction of Ruditapes philippinarum were investigated from August 2009 to October 2010, 18 months after the Hebei Spirit oil spill off Malipo Beach on the west coast of Korea. No significant differences in physical and nutritional conditions were found between the oil-damaged and the undamaged control beaches. At the undamaged Mongsanpo Beach, all the biometric components (dry tissue weights and biochemical components) remained at low levels during autumn–winter but increased rapidly through spring, followed by a dramatic drop in August. In contrast, at the oil-damaged beach, no clear seasonal fluctuations were detected in the biometric components during the study period. Absolute values of all the components were much higher at the control than at the damaged site. This lack of energy reserves in the clams in the damaged area likely resulted in a failure of gametogenic development. Gonadal maturity index peaked in summer at both beaches. However, the gross egg weight was much higher at the control than at the damaged site during June–July. In addition, its different peak timing between sites indicated a month’s lag in the major spawning pulse at the oil-damaged beach. The spatial variations in all the biometric components of the clams observed in this study clearly implied that the Hebei Spirit oil spill may interfere with the clam phenology at Malipo Beach within 2 to 3 years after the incident.

Three cruises were undertaken along a meridional transect in the East/Japan Sea (EJS) in spring (May 2007), summer (July 2009), and fall (October 2012) to determine the geographic variations in phytoplankton biomass and community composition. This study revealed a gradient of surface temperature and a fluctuation of hydrographic conditions along the transect. Although a subpolar front (SPF) formed between the warm- and cold-water masses (37–40°N), no significant differences in phytoplankton biomass and community composition were detected between the southern and northern parts of the EJS. These results disprove our initial hypothesis that different water masses may contain differently structured phytoplankton communities. In the present study, isothermal layers (≤ 12 °C) fluctuated over a depth of 50 m in both warm- and cold-water masses, depending on the SPF. In contrast, the nitracline (i.e. 2.5 μM nitrate isopleth) depth was recorded within a limited range of 20–40 m in spring, 30–50 m in summer, and 40–60 m in fall. The chlorophyll a concentrations at the subsurface chlorophyll maxima (SCM) were significantly higher in spring and summer (356 ± 233 and 270 ± 182 ng L –1 , respectively) than in fall (117 ± 89 ng L –1 ). The relative contributions of individual phytoplankton groups to the depth-integrated chlorophyll a concentration conformed to the composition of the phytoplankton community in the SCM layer, showing a dominance of diatoms (58 ± 19% in spring, 48 ± 11% in summer, and 30 ± 20% in fall). Canonical correspondence analysis revealed that the geographic structures of phytoplankton communities were strongly associated with the vertical structures of water temperature and nutrient concentration in the water column rather than with horizontal gradients of hydrographic conditions. Finally, our findings suggest that water column stability and light–nutrient availability in the euphotic zone play a key role in determining geographical consistency of the biomass and the community structure of phytoplankton in the EJS.

Seasonal variability of sinking fluxes of total mass (TMF), particulate organic carbon and nitrogen (POC and PON) was examined using sinking particles collected from sediment traps during July 2011 to December 2011, and December 2012 to June 2013 at an offshore channel site; and from November 2013 to August 2014 at a nearshore slope site of the Ulleung Basin in the East/Japan Sea. δ13C and δ15N values of sinking particles were measured to elucidate the major export processes of POC and PON. Annual TMF (112–638 g m−2 yr−1) and fluxes of POC and PON (9.6–32.1 g C m–2 yr–1 and 1.2–4.5 g N m−2 yr−1, respectively) in the Ulleung Basin corresponded to the upper limit of values reported for other open seas and oceans in the world. No great seasonal variability in both quantitative (TMF, and fluxes and contents of POC and PON) and qualitative (C/N ratios, and δ13C and δ15N values) estimates of vertical fluxes was observed, reflecting a steady standing stock of chlorophyll a in the upper part of water column. Furthermore, high contents of POC and PON and nearly constant δ13C and δ15N values in sinking particles collected in the sediment traps, indicate that primary production in the euphotic zone may be a good predictor of TMF and export flux of organic matter. In this regard, our pilot study points out the importance of high annual primary production and low water temperature (

Stable isotopes (δ 13 C and δ 15 N) together with chlorophyll a and densities of surf diatoms were used to analyze changes in trophic niches of species in two sandy beaches of Uruguay with contrasting morphodynamics (i.e. dissipative vs. reflective). Consumers and food sources were collected over four seasons, including sediment organic matter (SOM), suspended particulate organic matter (POM) and the surf zone diatom Asterionellopsis guyunusae . Circular statistics and a Bayesian isotope mixing model were used to quantify food web differences between beaches. Consumers changed their trophic niche between beaches in the same direction of the food web space towards higher reliance on surf diatoms in the dissipative beach. Mixing models indicated that A. guyunusae was the primary nutrition source for suspension feeders in the dissipative beach, explaining their change in dietary niche compared to the reflective beach where the proportional contribution of surf diatoms was low. The high C/N ratios in A. guyunusae indicated its high nutritional value and N content, and may help to explain the high assimilation by suspension feeders at the dissipative beach. Furthermore, density of A. guyunusae was higher in the dissipative than in the reflective beach, and cell density was positively correlated with chlorophyll a only in the dissipative beach. Therefore, surf diatoms are important drivers in the dynamics of sandy beach food webs, determining the trophic niche space and productivity. Our study provides valuable insights on shifting foraging behavior by beach fauna in response to changes in resource availability.

The effects of blooms of opportunistic green macroalgae, Ulva prolifera, on the trophic structure of the macrobenthic food web in a temperate intertidal zone on the western coast of Korea were evaluated using carbon and nitrogen stable isotopes. Biomasses of Ulva and microphytobenthos (MPB) increased significantly at the macroalgae-bloom and the non-bloom sites, respectively, from March to September 2011. The δ(13)C values of most the consumers were arrayed between those of MPB and Ulva at both sites, and differed according to feeding strategies at the macroalgae-bloom site. Seasonally increasing magnitudes in δ(13)C and δ(15)N values of consumers were much steeper at the macroalgae-bloom site than at the non-bloom site. Our findings provide evidence that blooming green macroalgae play a significant role as a basal resource supporting the intertidal macrobenthic food web and their significance varies with feeding strategies of consumers as well as the resource availability.

The broad temperature range on the temperate coast of Korea has led fishermen to develop a unique and specialized procedure for the longline culture of ascidians. In Korea, warming of the coastal sea in winter has accelerated over the past few decades. After warmer winters, the rising temperatures of earlier springs have precluded the rearing of the ascidian spat in the culturing area and have imposed spring spat cultivation in colder-water nursery grounds. To examine the seasonal dynamics of energy reserves and the physiological strategies to optimize energy balance for the growth in the cultured sea squirt Halocynthia roretzi, its gross biochemical composition and physiological energetics were investigated monthly over two culturing periods from July 2005 to January 2006 and July 2013 to January 2014 in Geoje-Hansan Bay on the south coast of Korea. No indicators of the growth performance of sea squirts showed differences between the two culture practices (2005–2006 and 2013–2014) carried out using spat reared in different localities, i.e., the grow-out area and the colder nursery grounds. The seasonal patterns in accumulation and utilization of biochemical constituents in the sea squirt tissues were similar between the two periods. During the culturing period in the grow-out area, sea squirts retained physiological functions across the temperature range. Food energy acquisition and metabolic cost were positively related to water temperatures in the field conditions, probably due to the low and narrow range of suspended particulate matter (SPM) concentrations. A less-clear seasonal variability in food consumption rates yielded a seasonal discrepancy in scope for growth (SFG; i.e., negative during summer vs positive during autumn–winter). Consequently, the tissue weight and protein reserves of sea squirts varied concomitantly with the seasonal changes in SFG, supporting a fast growth during autumn–winter. Our results suggest that the spat reared in colder nursery grounds are suitable for cultivating sea squirts in the traditional grow-out area and support their sustainable culturing performance as an adaptation strategy to the winter–spring warming conditions that are unique to coastal seas.

We examined trophic relationships in a newly established community 1.5 years after the Hebei Spirit oil spill on the west coast of Korea. Carbon and nitrogen stable isotope ratios in consumers and their potential food sources were compared between the oil-spill site and reference site, located 13.5 km from the oil-spill spot. The isotopic mixing model and a novel circular statistics rejected the influx of petrogenic carbon into the community and identified spatial consistencies such as the high contributions of microphytobenthos, food-chain length, and the isotopic niche of each feeding guild between sites. We suggested that high level of trophic plasticity and the prevalence of omnivory of consumers may promote the robustness of food web against the oil contamination. Furthermore, we highlighted the need of holistic approaches including different functional groups to quantify changes in the food web structure and assess the influence of different perturbations including oil spill.

An assessment of the patterns of thermal acclimation of physiological processes of the stalked sea squirt Styela clava is needed to further understand growth patterns associated with large seasonal fluctuations in ambient temperature. The effects of different exposure temperatures on physiological processes of S. clava were measured at 5, 10, 15, 20, and 25 °C. The impact of temperature on energy balance at a whole organism level was then assessed by scope for growth (SFG) and net growth efficiency (K 2 ) measures. Physiological rates of S. clava were well correlated with its dry tissue weight (DW). Positive allometry with DW indicated that all physiological rates investigated were generally higher in the larger individuals regardless of temperature. Some allometric equations ( e.g. , feces production rate vs. DW and respiration rate vs. DW) exhibited identical estimates of exponents, enabling accurate comparisons of the rates across temperatures. In contrast, disparities across temperatures of the values for the weight exponent were detected in other allometric equations, revealing that thermal effects on these rates have different degrees for large and small individuals. The SFG value in S. clava of different sizes was similar at lower temperatures (5–10 °C), peaking at 15 °C. The SFG was positive with a relatively constant K 2 in this temperature range. This positive energy balance reflects the reduction in metabolic costs at lower temperatures. In contrast, increased metabolic costs at higher temperatures (20–25 °C) resulted in lowered SFG and K 2 values, indicating that the feeding rate did not increase as greatly in compensation for the increased metabolic costs at higher temperatures. The lowered absorption at 25 °C (compared with 20 °C) resulted in negative SFG and K 2 values. Finally, our results confirm that the absence of compensatory adjustment to warmer conditions leads to energetic disruption at a whole organism level at such temperatures.

To assess the potential for nutritional exploitation of caged-fish-derived waste through the use of extractive co-cultured species in a pilot system for an integrated multi-trophic aquaculture (IMTA), we compared their C and N stable isotope ratios with those of uncultured macroinvertebrates in and around the system. Black rockfish were co-cultured with sea cucumber, oyster, and two macroalgae as extractive species. Isotope signatures of the co-cultured sea cucumber at the IMTA site differed from those at the control site, indicating their assimilation of aquaculture wastes. In contrast, δ(13)C and δ(15)N of individual taxa of the cultured oyster and uncultured invertebrates were consistent between sites, suggesting a minor contribution of the aquaculture waste to benthic and pelagic food chains in and around the IMTA system. These results provide evidence of the suitability of using sea cucumber as an extractive species to reduce the impact of a monoculture system on the ambient environment.