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Brain swelling after cardiac arrest may affect brain ventricular volume. This study aimed to investigate the prognostic implications of ventricular volume on early thin-slice brain computed tomography (CT) after cardiac arrest. We measured the gray-to-white matter ratio (GWR) and the characteristics and volumes of the lateral, third, and fourth ventricles. The primary outcome was a poor 6-month neurological outcome. Of the 166 patients, 115 had a poor outcome. The fourth ventricle was significantly smaller in the poor outcome group (0.58 cm3 [95% CI, 0.43–0.80]) than in the good outcome group (0.74 cm3 [95% CI, 0.68–0.99], p < 0.001). Ventricular characteristics and other ventricular volumes did not differ between outcome groups. The area under the curve for the fourth ventricular volume was 0.68, comparable to 0.69 for GWR. Lower GWR (3) predicted poor outcomes with 100% specificity and sensitivities of 8.7% (95% CI, 4.2–15.4) and 20.9% (95% CI, 13.9–29.4), respectively. Combining these measures improved the sensitivity to 25.2% (95% CI, 17.6–34.2). After adjusting for covariates, the fourth ventricular volume was independently associated with neurologic outcome. A marked decrease in fourth ventricular volume, with concomitant hypoattenuation on CT scans, more accurately predicted outcomes.

Patients suffering from Parkinson’s disease suffer from voice impairment. In this study, we introduce models to classify normal and Parkinson’s patients using their speech. We used an AST (audio spectrogram transformer), a transformer-based speech classification model that has recently outperformed CNN-based models in many fields, and a CNN-based PSLA (pretraining, sampling, labeling, and aggregation), a high-performance model in the existing speech classification field, for the study. This study compares and analyzes the models from both quantitative and qualitative perspectives. First, qualitatively, PSLA outperformed AST by more than 4% in accuracy, and the AUC was also higher, with 94.16% for AST and 97.43% for PSLA. Furthermore, we qualitatively evaluated the ability of the models to capture the acoustic features of Parkinson’s through various CAM (class activation map)-based XAI (eXplainable AI) models such as GradCAM and EigenCAM. Based on PSLA, we found that the model focuses well on the muffled frequency band of Parkinson’s speech, and the heatmap analysis of false positives and false negatives shows that the speech features are also visually represented when the model actually makes incorrect predictions. The contribution of this paper is that we not only found a suitable model for diagnosing Parkinson’s through speech using two different types of models but also validated the predictions of the model in practice.

Abstract Background Although the use of cardiac patches is still controversial, cardiac patch has the significance in the field of the tissue engineered cardiac regeneration because it overcomes several shortcomings of intra-myocardial injection by providing a template for cells to form a cohesive sheet. So far, fibrous scaffolds fabricated using electrospinning technique have been increasingly explored for preparation of cardiac patches. One of the problems with the use of electrospinning is that nanofibrous structures hardly allow the infiltration of cells for development of 3D tissue construct. In this respect, we have prepared novel bi-modal electrospun scaffolds as a feasible strategy to address the challenges in cardiac tissue engineering . Methods Nano/micro bimodal composite fibrous patch composed of collagen and poly (D, L-lactic-co-glycolic acid) (Col/PLGA) was fabricated using an independent nozzle control multi-electrospinning apparatus, and its feasibility as the stem cell laden cardiac patch was systemically investigated. Results Nano/micro bimodal distributions of Col/PLGA patches without beaded fibers were obtained in the range of the 4-6% collagen concentration. The poor mechanical properties of collagen and the hydrophobic property of PLGA were improved by co-electrospinning. In vitro experiments using bone marrow-derived mesenchymal stem cells (BMSCs) revealed that Col/PLGA showed improved cyto-compatibility and proliferation capacity compared to PLGA, and their extent increased with increase in collagen content. The results of tracing nanoparticle-labeled as well as GFP transfected BMSCs strongly support that Col/PLGA possesses the long-term stem cells retention capability, thereby allowing stem cells to directly function as myocardial and vascular endothelial cells or to secrete the recovery factors, which in turn leads to improved heart function proved by histological and echocardiographic findings. Conclusion Col/PLGA bimodal cardiac patch could significantly attenuate cardiac remodeling and fully recover the cardiac function, as a consequence of their potent long term stem cell engraftment capability.

Amyloidosis has been reported to be associated with non-Hodgkin lymphoma. Amyloidosis and lymphoma can be related in two ways: lymphoma-associated systemic amyloidosis and peritumoral amyloidosis with lymphoma. We report a rare case of peritumoral amyloidosis in a patient with head and neck mucosa-associated lymphoid tissue lymphoma. On CT, the oropharyngeal mass showed an irregularly shaped soft-tissue density with multifocal amorphous calcifications and heterogeneous enhancement. On MRI, the mass showed heterogeneous low signal intensity on both T1- and T2-weighted images. On contrast-enhanced MR images, the mass showed good enhancement with several inner non-enhancing foci. Concurrent pathologies, such as peritumoral amyloidosis, should be considered when calcifications are noted in patients with pre-treatment lymphoma.

Abstract Photochemical internalization (PCI) is a promising intervention using photodynamic therapy (PDT) to enhance the activity of chemotherapeutic drugs. However, current bladder cancer treatments involve high‐dose chemotherapy and high‐irradiance PDT which cause debilitating side effects. Moreover, low penetration of light and drugs in target tissues and cumbersome light delivery procedures hinder the clinical utility of PDT and chemotherapy combination for PCI. To circumvent these challenges, a photodynamic‐chemotherapy approach is developed comprising tumor‐targeting glycosylated nanocarriers, coloaded with chlorin e6 (Ce6) and gemcitabine elaidate (GemE), and a miniaturized implantable wirelessly powered light‐emitting diode (LED) as a light source. The device successfully delivers four weekly light doses to the bladder while the nanocarrier promoted the specific accumulation of drugs in tumors. This approach facilitates the combination of low‐irradiance PDT (1 mW cm−2) and low‐dose chemotherapy (≈1500× lower than clinical dose) which significantly cures and controls orthotopic disease burden (90% treated vs control, 35%) in mice, demonstrating a potential new bladder cancer treatment option.

Abstract Background Attempted suicide remains difficult for clinicians to predict with some established risk factors. We investigate the detailed characteristics of attempted suicide especially according to age and methods of suicide attempts. Methods A retrospective study was conducted to evaluate patients who visited the emergency department due to attempted suicide. A retrospective medical record review of all patients who presented to the emergency department (ED) of two tertiary teaching hospitals in Korea after suicide attempt between January 1, 2010, and December 31, 2017 was performed. Demographic information and detailed variables (methods and reasons of suicide attempts and variables regarding reattempts) were investigated. Total participants were classified into 3 groups according to age, young group, middle aged group and the older group, and each characteristics were compared. Results A total of 3698 patients were enrolled in this study. Deliberate self-poisoning (DSP) was the most common method of attempted suicide (66.5%) followed by cutting (24.4%), hanging (7.9%), falling (2.6%), and drowning (1.1%). In patients who had previous suicide attempts (n = 1029, 27.8%), attempted methods were likely to be concordant with previous attempted methods. The most common reason for suicide attempts was interpersonal relationship issues followed by socio-economic reasons. Older patients (n = 412, 11.2%) were significantly different from other 2 groups (n = 3286, 88.8%) regarding gender, suicide re-attempt, occupation, alcohol co-ingestion, previous psychiatric history, and discharge outcomes (all p-values

Abstract Cholangiopathy is a diverse spectrum of chronic progressive bile duct disorders with limited treatment options and dismal outcomes. Scaffold‐ and stem cell‐based tissue engineering technologies hold great promise for reconstructive surgery and tissue repair. Here, we report a combined application of 3D scaffold fabrication and reprogramming of patient‐specific human hepatocytes to produce implantable artificial tissues that imitate the mechanical and biological properties of native bile ducts. The human chemically derived hepatic progenitor cells (hCdHs) were generated using two small molecules A83‐01 and CHIR99021 and seeded inside the tubular scaffold engineered as a synergistic combination of two layers. The inner electrospun fibrous layer was made of nanoscale–macroscale polycaprolactone fibers acting to promote the hCdHs attachment and differentiation, while the outer microporous foam layer served to increase mechanical stability. The two layers of fiber and foam were fused robustly together thus creating coordinated mechanical flexibility to exclude any possible breaking during surgery. The gene expression profiling and histochemical assessment confirmed that hCdHs acquired the biliary epithelial phenotype and filled the entire surface of the fibrous matrix after 2 weeks of growth in the cholangiocyte differentiation medium in vitro. The fabricated construct replaced the macroscopic part of the common bile duct (CBD) and re‐stored the bile flow in a rabbit model of acute CBD injury. Animals that received the acellular scaffolds did not survive after the replacement surgery. Thus, the artificial bile duct constructs populated with patient‐specific hepatic progenitor cells could provide a scalable and compatible platform for treating bile duct diseases.

BackgroundThe association of body mass index with outcome in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) is unclear. The purpose of this study was to examine the effect of body mass index (BMI) on neurological outcomes and mortality in resuscitated patients treated with TTM after OHCA.MethodsThis multicenter, prospective, observational study was performed with data from 22 hospitals included in the Korean Hypothermia Network KORHN-PRO registry. Comatose adult patients treated with TTM after OHCA between October 2015 and December 2018 were enrolled. The BMI of each patient was calculated and classified according to the criteria of the World Health Organization (WHO). Each group was analyzed in terms of demographic characteristics and associations with six-month neurologic outcomes and mortality after cardiac arrest (CA).ResultsOf 1,373 patients treated with TTM identified in the registry, 1,315 were included in this study. One hundred two patients were underweight (BMI ConclusionsBMI was not associated with six-month neurologic outcomes or mortality in patients surviving OHCA. However, in the subgroup analysis, underweight patients were associated with poor neurologic outcomes when treated with TTM at 33°C.

Objective To determine the factors associated with unmet needs in immigrant patients complaining of abdominal pain, by analyzing those associated with the time from symptom onset to emergency room visit. Methods We retrospectively reviewed the medical records of immigrants with abdominal pain who visited a tertiary hospital emergency department from January to December 2016. The dependent variable was the time from symptom onset to emergency room visit. The independent variables were age, sex, vital signs, disposition, health insurance status, date of visit, time of visit, level of education, employment status, economic satisfaction, marital status, living with family, duration of residence, having a native spouse, and subjective proficiency in Korean. We analyzed the association of the dependent variable with each independent variable. Results In total, 102 immigrant patients with abdominal pain were enrolled in this study. The patients who had earlier visits had good subjective proficiency in Korean, high economic satisfaction, longer durations of residence, a tendency to have a native spouse, and a high employment rate. After linear regression analysis, the time from symptom onset to emergency room visit was negatively associated with employment (adjusted odds ratio, -13.67; 95% confidence interval, -23.25 to -4.09; P=0.006) and having a native spouse (adjusted odds ratio, -11.7; 95% confidence interval, -20.61 to -2.8; P=0.011). Conclusion The factors influencing the time from symptom onset to emergency room visit in immigrant patients with abdominal pain are associated with social capital, which improves access to emergency care. Policies that improve immigrant access to emergency care should be considered.

Abstract Background We hypothesized that the absence of P25 and the N20–P25 amplitude in somatosensory evoked potentials (SSEPs) have higher sensitivity than the absence of N20 for poor neurological outcomes, and we evaluated the ability of SSEPs to predict long-term outcomes using pattern and amplitude analyses. Methods Using prospectively collected therapeutic hypothermia registry data, we evaluated whether cortical SSEPs contained a negative or positive short-latency wave (N20 or P25). The N20–P25 amplitude was defined as the largest difference in amplitude between the N20 and P25 peaks. A good or poor outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 1–2 or 3–5, respectively, 6 months after cardiac arrest. Results A total of 192 SSEP recordings were included. In all patients with a good outcome (n = 51), both N20 and P25 were present. Compared to the absence of N20, the absence of N20–P25 component improved the sensitivity for predicting a poor outcome from 30.5% (95% confidence interval [CI], 23.0–38.8%) to 71.6% (95% CI, 63.4–78.9%), while maintaining a specificity of 100% (93.0–100.0%). Using an amplitude

Abstract Background SSBP2, single-stranded DNA binding protein 2, is a subunit of the ssDNA-binding complex that is involved in the maintenance of genome stability. The majority of previous studies have suggested a tumor-suppressive role of SSBP2, which is silenced by promoter hypermethylation in several human malignancies, such as hematologic malignancies, prostate cancer, esophageal squamous cell carcinoma, ovarian cancer, and gallbladder cancer. However, an oncogenic role of SSBP2 has been suggested in glioblastoma patients. We investigated the clinicopathologic significance of SSBP2 expression in hepatocellular carcinoma. Methods We constructed tissue microarrays consisting of 21 normal liver parenchyma and 213 hepatocellular carcinoma tissues with corresponding adjacent non-neoplastic tissues. SSBP2 expression was investigated by immunohistochemistry, and positive expression was defined as more than 10% of the tumor cells to show nuclear staining. We then analyzed the correlations between SSBP2 expression and various clinicopathologic characteristics, and further studied the role of SSBP2 in cell growth and migration. Results Hepatocytes were negative for SSBP2 immunohistochemistry in all normal liver samples, whereas the nuclei of normal bile duct epithelium and sinusoidal endothelium were immunoreactive. Positive immunoreactivity was found in one (0.6%) out of 180 non-neoplastic liver tissue samples adjacent to the tumor and in 16 (8.5%) out of 189 hepatocellular carcinomas. Positive SSBP2 expression was significantly correlated with tumor multifocality (P = 0.027, chi-square test), high histologic grade (P = 0.003, chi-square test), and frequent vascular invasion (P = 0.001, chi-square test). Kaplan-Meier survival curves revealed that patients with SSBP2 expression had poor prognosis in both disease-free and overall survival (P = 0.004 and P = 0.026, respectively, log-rank test). SSBP2-positive tumors also had a higher Ki-67 proliferation index (P

The gray-to-white matter ratio (GWR) has been used to identify brain damage in comatose patients after cardiac arrest. However, Hounsfield units (HUs), the measurement of brain density on computed tomography (CT) images, may vary depending on the machine type or parameter. Therefore, differences in CT scanners may affect the GWR in post-cardiac arrest patients. We performed a retrospective study on comatose post-cardiac arrest patients who visited the hospital from 2007 to 2017. Two CT, Lightspeed and SOMATOM, scanners were used. Two observers independently measured the HUs of the caudate nucleus, putamen, posterior internal capsule, and corpus callosum using regions of interest. We compared the GWR calculated from the HUs measured at different CT scanners. The analysis of different scanners showed statistically significant differences in the measured HUs and GWR. The HUs and GWR of Lightspeed were measured lower than SOMATOM. The difference between the two CT scanners was also evident in groups divided by neurological prognosis. The area under the curve of the receiver operating characteristic curve to predict poor outcomes of Lightspeed was 0.798, and the cut-off value for 100% specificity was 1.172. The SOMATOM was 0.855, and the cut-off value was 1.269. The difference in scanners affects measurements and performance characteristics of the GWR in post-cardiac arrest patients. Therefore, when applying the results of the GWR study to clinical practice, reference values for each device should be presented, and an integrated plan should be prepared.

Early prognostication in cardiac arrest survivors is challenging for physicians. Unlike other prognostic modalities, biomarkers are easily accessible and provide an objective assessment method. We hypothesized that in cardiac arrest patients with targeted temperature management (TTM), early circulating microRNA (miRNA) levels are associated with the 6-month neurological outcome. In the discovery phase, we identified candidate miRNAs associated with cardiac arrest patients who underwent TTM by comparing circulating expression levels in patients and healthy controls. Next, using a larger cohort, we validated the prognostic values of the identified early miRNAs by measuring the serum levels of miRNAs, neuron-specific enolase (NSE), and S100 calcium-binding protein B (S100B) 6 h after cardiac arrest. The validation cohort consisted of 54 patients with TTM. The areas under the curve (AUCs) for poor outcome were 0.85 (95% CI (confidence interval), 0.72–0.93), 0.82 (95% CI, 0.70–0.91), 0.78 (95% CI, 0.64–0.88), and 0.77 (95% CI, 0.63–0.87) for miR-6511b-5p, -125b-1-3p, -122-5p, and -124-3p, respectively. When the cut-off was based on miRNA levels predicting poor outcome with 100% specificity, sensitivities were 67.7% (95% CI, 49.5–82.6), 50.0% (95% CI, 32.4–67.7), 35.3% (95% CI, 19.7–53.5), and 26.5% (95% CI, 12.9–44.4) for the above miRNAs, respectively. The models combining early miRNAs with protein biomarkers demonstrated superior prognostic performance to those of protein biomarkers.

Abstract Background There are conflicting data regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients, and whether the specific sex advantage is age-specific remains unclear. We assessed the impact of the interactions between sex and age on the neurological outcomes of OHCA patients receiving targeted temperature management (TTM). Methods Data collected from 2007 to 2012 for a multicenter, registry-based study of the Korean Hypothermia Network were analyzed. We used a multivariate logistic regression model with an interaction term (age × sex) as the final model for the outcomes. To evaluate the association between sex and outcome in specific age groups, all patients were divided into specific age subgroups, and the adjusted ORs and 95% CIs of good neurological outcomes for males were calculated for each age group. Finally, the ORs of a good neurological outcome for the specific age groups compared with the 50- to 59-year-old group were calculated for both sexes. Results In the interaction analysis, age was a negative prognostic factor (OR, 0.95 [95% CI, 0.93-0.98]), whereas sex was not associated with neurological outcomes (OR, 3.74 [95% CI, 0.85–16.35]), and reproductive age in females (age,

Background/AimsCancer is known to be a disease by many factors. However, specific results of reprogramming by pluripotency-related transcription factors remain to be scarcely reported. Here, we verified potential effects of pluripotent-related genes in hepatocellular carcinoma cancer cells.Methods : To better understand reprogramming of cancer cells in different genetic backgrounds, we used four liver cancer cell lines representing different states of p53 (HepG2, Hep3B, Huh7 and PLC). Retroviral-mediated introduction of reprogramming related genes (KLF4, Oct4, Sox2, and Myc) was used to induce the expression of proteins related to a pluripotent status in liver cancer cells.Results : Hep3B cells (null p53) exhibited a higher efficiency of reprogramming in comparison to the other liver cancer cell lines. The reprogrammed Hep3B cells acquired similar characteristics to pluripotent stem cells. However, loss of stemness in Hep3B-iPCs was detected during continual passage.Conclusion : sWe demonstrated that reprogramming was achieved in tumor cells through retroviral induction of genes associated with reprogramming. Interestingly, the reprogrammed pluripotent cancer cells (iPCs) were very different from original cancer cells in terms of colony shape and expressed markers. The induction of pluripotency of liver cancer cells correlated with the status of p53, suggesting that different expression level of p53 in cancer cells may affect their reprogramming.

Objective The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED). Methods We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED. The primary outcome was all-cause in-hospital mortality. Multivariate logistic analysis was performed. Results A total of 811 patients were finally included in this study. The mean age was 76±7 years, and 438 subjects (54%) were male. The in-hospital mortality rate was 9.0% (73 patients). The hs-CRP/albumin ratio was higher in nonsurvivors than in survivors (34.2±37.6 vs. 16.2±25.5, P

Objective Insertion of a nasogastric tube (NGT) in patients who have been intubated with an endotracheal tube while under general anesthesia can cause difficulties and lead to complications, including hemorrhage. A visualization-aided modality was recently used to facilitate NGT insertion. Some studies have focused on the role of modified Magill forceps, which have angles similar to those of the GlideScope blade (Verathon, Bothell, WA, USA). Methods Seventy patients were divided into a control group (Group C) and an experimental group (GlideScope and modified Magill forceps, Group M). Results The total NGT insertion time was significantly shorter in Group M than C (71.3 ± 22.6 vs. 96.7 ± 57.5 s; mean difference, –25.3 s; 95% confidence interval [CI], 20.8–71.5). There were also significantly fewer mean insertion attempts in Group M than C (1.0 ± 0.0 vs. 2.11 ± 0.93). The success rate for the first attempt in Group C was 37.1%, while that in Group M was 100% (relative risk, 2.7; 95% CI, 1.7–4.1). Conclusion The use of the GlideScope with modified Magill forceps for insertion of an NGT in patients who are already intubated and under general anesthesia will shorten the insertion time and improve the success rate.

Time domain electric pulse measurements were conducted on a capacitor consisting of a Pt film as the top electrode, atomic-layer-deposited 6.5-nm-thick amorphous Al2O3 as the dielectric layer, and two-dimensional electron gas (2DEG) at the interface between Al2O3 and SrTiO3 as the bottom electrode. The sample showed highly useful current-voltage characteristics as the selector in cross-bar array resistance switching random access memory. The long-term (order of second) variation in the leakage current when the Pt electrode was positively biased was attributed to the field-induced migration of oxygen vacancies between the interior of the Al2O3 and the 2DEG region. Relaxation of the vacancy concentration occurred even at room temperature.

Background and purposeDespite enormous advances in identifying genetic variants responsible for many neurological diseases, access to genetic testing may be limited in clinical practice. The objective of this study was to assess worldwide access to genetic tests for movement disorders and factors impacting their utilization.MethodsThe Rare Movement Disorders Study Group of the International Parkinson and Movement Disorder Society designed an online survey electronically mailed to all 7815 members.ResultsSurvey data completed by 1269 participants from 109 countries were analysed. Limited access to geneticists and genetic counsellors was reported in many world regions compared to Europe and North America. Availability of genetic testing was limited, with rates of access lower than 50%. Genetic testing for chorea was the most commonly available. For parkinsonism, dystonia, ataxia, hereditary spastic paraplegias and metabolic disorders, there was limited access to genetic testing in all countries compared to Europe and North America, with significant differences found for Africa, Central/South America, Asia. In many regions, genetic testing was supported by either private or public funding. Genetic testing was free of charge in Europe according to 63.5% of respondents. In North America, Africa, Central/South America, Asia and the Middle East access to free of charge genetic testing was by far significantly lower compared to Europe.ConclusionsThis survey highlights difficulties in accessing genetic testing and individuals with expertise in genetics at the worldwide level. In addition, major disparities in genetic testing amongst world regions are highlighted, probably due to a variety of factors including financial barriers.