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Ongoing obstacles in preclinical drug testing have raised significant concerns within the pharmaceutical industry. Recently, utilizing the potential of three‐dimensional (3D) bioprinting offers a solution for creating tissue models for screening of the effectiveness and safety of new drugs. In this study, the anti‐inflammatory potential of garlic extracts is assessed, specifically N‐Benzyl‐N‐methyl‐dodecan‐1‐amine (BMDA), using a 3D bioprinted artificial skin model. Comprehensive physicochemical characterization and immunocytochemical analysis demonstrate that the 3D bioprinted skin model exhibits structures and functions resembling human skin. BMDA treatment in a prepared skin model reveals its capacity to mitigate H2O2‐induced oxidative stress and trigger anti‐inflammatory responses. Notably, BMDA reduces the expression of pro‐inflammatory cytokines and chemokines by downregulating NF‐κB and mitogen‐activated protein kinase inflammatory signaling pathways. In summary, our findings highlight the potential of an artificial skin model as a robust platform for the development of new drugs.

Objective: This study aimed to evaluate the diagnostic utility, disease activity, and phenotypic association of serum anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), PR3-ANCA, and MPO-ANCA in pediatric patients with inflammatory bowel disease (IBD). Methods: Pediatric patients diagnosed with IBD were recruited and classified as Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) through full investigation. The Paris classification was used to evaluate disease phenotypes of pediatric CD and UC. Results: In all, 229 pediatric patients with IBD (CD 147, UC 53, IBD-U 29) were included. The ASCA IgG seropositivity significantly differed among the three groups (CD 75.4%, UC 17.5%, and IBD-U 60.0%; p < 0.001). PR3-ANCA positive rates were the highest in UC (24.0%), followed by IBD-U (17.6%), and none in CD (p = 0.002); pANCA-positive rates were higher in IBD-U (33.6%), followed by UC (28.0%) than in CD (1.4%) (p < 0.001). Regarding disease phenotype, perianal disease revealed higher serum ASCA IgG titers (median 36.7 U/mL in P1 vs. 25.2 U/mL in P0, p = 0.019). Serum ASCA IgG and IgA cutoff values to distinguish CD were 32.7 (U/mL) and 11.9 (U/mL), respectively, with a specificity of 80.0%. Conclusion: Serological biomarkers of ASCA IgG and IgA were effective for differentiating CD in pediatric IBD patients, and serum pANCA and PR3-ANCA, but not MPO-ANCA, were effective in distinguishing UC and IBD-U. Furthermore, measuring serological titers of ASCA IgG and IgA may help differentiate CD and evaluate the disease activity and phenotype of pediatric IBD in practice.

Abstract Temporal parameters during swallowing are analyzed for objective and quantitative evaluation of videofluoroscopic swallowing studies (VFSS). Manual analysis by clinicians is time-consuming, complicated and prone to human error during interpretation; therefore, automated analysis using deep learning has been attempted. We aimed to develop a model for the automatic measurement of various temporal parameters of swallowing using deep learning. Overall, 547 VFSS video clips were included. Seven temporal parameters were manually measured by two physiatrists as ground-truth data: oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration. ResNet3D was selected as the base model for the deep learning of temporal parameters. The performances of ResNet3D variants were compared with those of the VGG and I3D models used previously. The average accuracy of the proposed ResNet3D variants was from 0.901 to 0.981. The F1 scores and average precision were 0.794 to 0.941 and 0.714 to 0.899, respectively. Compared to the VGG and I3D models, our model achieved the best results in terms of accuracy, F1 score, and average precision values. Through the clinical application of this automatic model, temporal analysis of VFSS will be easier and more accurate.

Objective To demonstrate the sonoanatomy of the medial antebrachial cutaneous nerve (MACN) in the elbow region using high-resolution ultrasonography (HRUS) to identify areas at a high risk of MACN injury. Methods A total of 44 arms were included in the study. In the supine position, the participants’ arms were abducted 45° with the elbow fully extended. The MACN was visualized in the transverse view. The anterior branch of the MACN (ABMACN), posterior branch of the MACN (PBMACN), and location of the branching sites were determined. The distance between the ABMACN and superficial veins, including the basilic vein (BV) and median cubital veins (MCV) was measured. For the PBMACN, the distance to the ulnar nerve (UN) and to BV were measured. Results The MACN was subdivided into 2.18±1.00 branches, including ABMACN and PBMACN. The ABMACN and PBMACN were subdivided into 1.60±0.78 and 1.07±0.25 branches, respectively. The branching point of the MACN was 8.40±2.42 cm proximal to the interepicondylar line (IEL). We demonstrated that the ABMACN is located close to the BV and MCV in the elbow region, and the PBMACN was located approximately 1 cm and 0.8 cm anterior to the UN and posterior to the BV at the IEL level, respectively. Conclusion Considering the location of the MACN, including ABMACN and PBMACN, clinicians can perform invasive procedures around the elbow region more carefully to lower the risk of MACN injury.

Abstract Background Postoperative pain is a common phenomenon after surgery and is closely associated with the development of postoperative cognitive dysfunction (POCD). Persistent pain and systemic inflammation caused by surgery have been suggested as key factors for the development of POCD. Fractalkine (CX3CL1) and its receptor, the CX3C chemokine receptor 1 (CX3CR1), are known to play a key role in pain and inflammation signaling pathways. Recent studies have shown that the regulation of CX3CR1/L1 signaling influences the development of various diseases including neuronal diseases. We determined whether CX3CR1/L1 signaling is a putative therapeutic target for POCD in a mouse model. Methods Adult (9–11 weeks) male mice were treated with neutralizing antibody to block CX3CR1/L1 signaling both before and after surgery. Inflammatory and behavioral responses including pain were assessed postoperatively. Also, CX3CR1 mRNA level was assessed. Hippocampal astrocyte activation, Mao B expression, and GABA expression were assessed at 2 days after surgery following neutralizing antibody administration. Results The behavioral response indicated cognitive dysfunction and development of pain in the surgery group compared with the control group. Also, increased levels of pro-inflammatory cytokines and CX3CR1 mRNA were observed in the surgery group. In addition, increased levels of GABA and increased Mao B expression were observed in reactive astrocytes in the surgery group; these responses were attenuated by neutralizing antibody administration. Conclusions Increased CX3CR1 after surgery is both necessary and sufficient to induce cognitive dysfunction. CX3CR1 could be an important target for therapeutic strategies to prevent the development of POCD.

Febrile convulsion (FC) is the most common seizure disease in children, which occurs with a fever. We investigated the Korean Health Insurance Review and Assessment Service data of patients aged between 6 months and 5 years at the time of FC diagnosis. Diseases that can cause seizures with fever, such as neoplasms, metabolic disorders, nervous system disorders, cerebrovascular diseases, perinatal problems, and congenital abnormalities, were excluded. Weekly virus-positive detection rate (PDR) data were obtained from the Korea Disease Control and Prevention Agency for adenovirus, parainfluenza virus, respiratory syncytial virus (HRSV), influenza virus, coronavirus (HCoV), rhinovirus (HRV), bocavirus, metapneumovirus (HMPV), rotavirus, norovirus, and astrovirus. Using the Granger test, we then analyzed the monthly PDR and investigated the association between FC incidence and monthly PDR. We additionally identified monthly and seasonal FC incidence trends using the autoregressive integrated moving average. Between 2015 and 2019, 64,291 patients were diagnosed with FC. Annually, the incidence was the highest in May and the lowest in October. Most patients were diagnosed during the spring (26.7%). The PDRs for HRSV, HCoV, HRV, HMPV, and norovirus were associated with FC incidence after 1 month.

We evaluated genetic variation in Middle East respiratory syndrome coronavirus (MERS-CoV) imported to South Korea in 2018 using specimens from a patient and isolates from infected Caco-2 cells. The MERS-CoV strain in this study was genetically similar to a strain isolated in Riyadh, Saudi Arabia, in 2017.

Serotonin: Flipping a cellular switch The drugs ketamine and MK801, which are derivatives of phencyclidine (PCP, or angel dust), may provide clues to treatment of schizophrenia and hypertension. Both ketamine and MK801 have been reported to induce symptoms of schizophrenia and hypertension, and are used as to study these illnesses. The two drugs are known to affect serotonin receptors, but the mechanism remains unclear. Young Min Bae at Konkuk University School of Medicine, Chungju, South Korea, and colleagues investigated how ketamine and MK801 interact with a type of electrically activated biological switch known as a voltage-gated ion channel to influence serotonin receptors. They found that both ketamine and MK801 blocked the switch and enhanced activity of serotonin receptors, with MK801 having a stronger effect than ketamine. These results may help identify drug targets for treating hypertension and schizophrenia.

BackgroundPostoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers.MethodsThis retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities.ResultsThe pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07–2.71; P < 0.05) were independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P < 0.001).ConclusionsThe present study revealed that preoperative low albumin levels and high lactate levels were significantly associated with pressure ulcer development after surgery.

Abstract The clinical importance of serum hepcidin in non-dialysis chronic kidney disease (CKD) patients is unclear. The database of a large-scale multicentre prospective study in Korea of 2238 patients enrolled from 2011–2016 was analysed. After excluding patients with missing serum hepcidin (n = 125) and haemoglobin (n = 23) levels, the study included 2090 non-dialysis CKD patients. Markers of inflammation and iron status were positively associated with serum hepcidin level, regardless of CKD stage. However, estimated glomerular filtration rate was inversely associated with serum hepcidin level, particularly in patients with CKD stages 3b–5 but not in those with CKD stages 1–3a. Use of erythropoiesis-stimulating agents was associated with increased serum hepcidin levels, particularly in patients with CKD stages 3b–5 but not in those with CKD stages 1–3a, and serum hepcidin levels positively correlated with the dose of erythropoiesis-stimulating agent. These findings suggest that serum hepcidin may be a uremic toxin and play an important role in erythropoietin resistance. However, future prospective studies are needed to confirm our results.

MXene, a 2D material, is used as a filler to manufacture polymer electrolytes with high ionic conductivity because of its unique sheet shape, large specific surface area and high aspect ratio. Because MXene has numerous -OH groups on its surface, it can cause dehydration and condensation reactions with poly(4-styrenesulfonic acid) (PSSA) and consequently create pathways for the conduction of cations. The movement of Grotthuss-type hydrogen ions along the cation-conduction pathway is promoted and a high ionic conductivity can be obtained. In addition, when electrolytes composed of a conventional acid or metal salt alone is applied to an electrochromic device (ECD), it does not bring out fast response time, high coloration efficiency and transmittance contrast simultaneously. Therefore, dual-cation electrolytes are designed for high-performance ECDs. Bis(trifluoromethylsulfonyl)amine lithium salt (LiTFSI) was used as a source of lithium ions and PSSA crosslinked with MXene was used as a source of protons. Dual-Cation electrolytes crosslinked with MXene was applied to an indium tin oxide-free, all-solution-processable ECD. The effect of applying the electrolyte to the device was verified in terms of response time, coloration efficiency and transmittance contrast. The ECD with a size of 5 × 5 cm2 showed a high transmittance contrast of 66.7%, fast response time (8 s/15 s) and high coloration efficiency of 340.6 cm2/C.

BackgroundIntravenous tissue-type plasminogen activator (tPA) is recognized as the standard treatment for ischemic stroke. However, its narrow therapeutic window and association with an increased risk of intracranial hemorrhage have required caution when used. In this context, several approaches are required to deal with the shortcomings of such a double-edged drug. Anesthetics are known to protect against ischemic reperfusion injury, and their protective role in ischemic post-conditioning is crucial for reducing ischemia-related injury. The aim of this study was to assess the effect of isoflurane post-treatment on intracranial hemorrhage and cerebral infarction after tPA treatment for transient cerebral ischemia.MethodsCerebral ischemia was modeled in male Sprague-Dawley rats (n = 32) by occluding the right middle cerebral artery for 1 h, followed by intravenous tPA administration. Rats were randomly divided into control and isoflurane post-treatment group, and isoflurane post-treatment group was post-treated by administering 1.5% isoflurane for 1 h from the start of reperfusion. Twenty-four h after reperfusion, neurobehavioral changes were assessed. The extent of cerebral infarction and intracranial hemorrhage were also assessed by quantification of infarction volume and cerebral hemoglobin concentration from brain tissue, respectively.ResultsNeurobehavioral testing showed better functional outcomes in the isoflurane post-treatment group than the control group. The extent of cerebral infarction and intracranial hemorrhage were both reduced in isoflurane post-treatment group compared to control group.ConclusionsIsoflurane post-treatment may mitigate infarction volume and intracranial hemorrhage in tPA-exaggerated brain injury. Our findings provide an encouraging novel approach for enhancing clinical outcomes in tPA-exaggerated brain injury.

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

MK801 (dizocilpine), a phencyclidine (PCP) derivative, is a potent noncompetitive antagonist of the N-Methyl-D-aspartate receptor (NMDAr). Another PCP derivative, ketamine, was reported to block voltage-gated K+ (Kv) channels, which was independent of NMDAr function. Kv currents are major regulators of the membrane potential (Em) and excitability of muscles and neurons. Here, we investigated the effect of MK801 on the Kv channels and Em in rat mesenteric arterial smooth muscle cells (RMASMCs). We used the whole-cell patch clamp technique to analyze the effect of MK801 enantiomers on Kv channels and Em. (+)MK801 inhibited Kv channels in a concentration-dependent manner (IC50 of 89.1 ± 13.1 μM, Hill coefficient of 1.05 ± 0.08). The inhibition was voltage- and state- independent. (+)MK801 didn't influence steady-state activation and inactivation of Kv channels. (+)MK801 treatment depolarized Em in a concentration-dependent manner and concomitantly decreased membrane conductance. (−)MK801 also similarly inhibited the Kv channels (IC50 of 134.0 ± 17.5 μM, Hill coefficient of 0.87 ± 0.09). These results indicate that MK801 directly inhibits the Kv channel in a state-independent manner in RMASMCs. This MK801-mediated inhibition of Kv channels should be considered when assessing the various pharmacological effects produced by MK801, such as schizophrenia, neuroprotection, and hypertension.

Inflammation is implicated in ischemic stroke and is involved in abnormal homeostasis. Activation of the immune system leads to breakdown of the blood–brain barrier and, thereby, infiltration of immune cells into the brain. Upon cerebral ischemia, infiltrated macrophages and microglia (resident CNS immune cell) are activated, change their phenotype to M1 or M2 based on the microenvironment, migrate toward damaged tissue, and are involved in repair or damage. Those of M1 phenotype release pro-inflammatory mediators, which are associated with tissue damage, while those of M2 phenotype release anti-inflammatory mediators, which are related to tissue recovery. Moreover, late inflammation continually stimulates immune cell infiltration and leads to brain infarction. Therefore, regulation of M1/M2 phenotypes under persistent inflammatory conditions after cerebral ischemia is important for brain repair. Herein, we focus on apoptosis signal-regulating kinase 1 (ASK1), which is involved in apoptotic cell death, brain infarction, and production of inflammatory mediators after cerebral ischemia. We hypothesized that ASK1 is involved in the polarization of M1/M2 phenotype and the function of microglia and macrophage during the late stage of ischemia/hypoxia. We investigated the effects of ASK1 in mice subjected to middle cerebral artery occlusion and on BV2 microglia and RAW264.7 macrophage cell lines subjected to oxygen-glucose deprivation. Our results showed that ASK1 silencing effectively reduced Iba-1 or CD11b-positive cells in ischemic areas, suppressed pro-inflammatory cytokines, and increased anti-inflammatory mediator levels at 7 days after cerebral ischemia. In cultured microglia and macrophages, ASK1 inhibition, induced by NQDI-1 drug, decreased the expression and release of M1-associated factors and increased those of M2-associated factors after hypoxia/reperfusion (H/R). At the gene level, ASK1 inhibition suppressed M1-associated genes and augmented M2-associated genes. In gap closure assay, ASK1 inhibition reduced the migration rate of microglia and macrophages after H/R. Taken together, our results provide new information that suggests ASK1 controls the polarization of M1/M2 and the function of microglia and macrophage under sustained-inflammatory conditions. Regulation of persistent inflammation via M1/M2 polarization by ASK1 is a novel strategy for repair after ischemic stroke.

BACKGROUND: Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation. METHODS: This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed. RESULTS: The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant. CONCLUSIONS: Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

Background Many people have an interest in the correction of facial scars or deformities caused by trauma. The increasing ability to correct such flaws has been one of the reasons for the increase in the popularity of facial plastic surgery. In addition to its roles in communication, breathing, eating, olfaction and vision, the appearance of the face also plays an important role in human interactions, including during social activities. However, studies on the importance of the functional role of facial appearance. As a function of the face are scare. Therefore, in the present study, we evaluated the importance of the functions of the face in Korea. Methods We conducted an online panel survey of 300 participants (age range, 20-70 years). Each respondent was administered the demographic data form, Facial Function Assessment Scale, Rosenberg Self-Esteem Scale, and standard gamble questionnaires. Results In the evaluation on the importance of facial functions, a normal appearance was considered as important as communication, breathing, speech, and vision. Of the 300 participants, 85% stated that a normal appearance is important in social activities. Conclusions The results of this survey involving a cross-section of the Korean population indicated that a normal appearance was considered one of the principal facial functions. A normal appearance was considered more important than the functions of olfaction and expression. Moreover, a normal appearance was determined to be an important facial function for leading a normal life in Korea.

BackgroundActive upper respiratory tract infection (URI), orotracheal intubation and use of inhalation anesthetics are known risk factors for perioperative respiratory adverse events (RAE). This study investigated the risk factors of perioperative RAE in children with these risk factors.MethodsThe records of 159 children who underwent general anesthesia with an orotracheal tube and inhalation were reviewed. These patients also had at least one of the following URI symptoms on the day of surgery: clear or green nasal secretion, dry or moist cough, nasal congestion, or fever. RAE such as laryngospasm, bronchospasm, oxygen desaturation and sustained cough were collected before induction, during intubation, during extubation, after extubation and in the postanesthesia care unit.ResultsForty-five patients had RAE. The patients with RAE were younger than those without RAE. There were more passive smokers and a greater number of intubation attempts in patients with RAE than in those without RAE. The type of surgery and type of inhalation agents were not different between patients with and without RAE. Passive smoking was the only independent risk factor for RAE.ConclusionsIn children with an active URI using orotracheal tube and inhalation anesthetics, passive smoking is an important risk factor for RAE.

BackgroundImmediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT) not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated the optimal timing of breast reconstruction by observing patients who underwent mastectomy followed by PMRT, based on their overall health and aesthetic satisfaction.MethodsWe retrospectively reviewed 21 patients who underwent breast reconstruction with PMRT between November 2004 and November 2010. We collected data regarding the various methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy, hormone therapy, and radiotherapy. Telephone interviews were conducted to study the general and aesthetic satisfaction.ResultsPatients who received PMRT after breast reconstruction showed a greater complication rate than those undergoing breast reconstruction after PMRT (P=0.02). Aesthetic satisfaction was significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03). Patients who underwent breast reconstruction before PMRT developed complications more frequently, but they expressed greater aesthetic satisfaction with the treatment.ConclusionsIt is recommended that the complication rates and aesthetic satisfaction after breast reconstruction be carefully considered when determining the optimal timing for radiotherapy.

Abstract.: Dextromethorphan (3-methoxy-17-methylmorphinan) has complex pharmacologic effects on the central nervous system. Although some of these effects are neuropsychotoxic, this review focuses on the neuroprotective effects of dextromethorphan and its analogs. Some of these analogs, particularly dimemorfan (3-methyl-17-methylmorphinan) and 3-hydroxymorphinan, have promising neuroprotective properties with negligible neuropsychotoxic effects. Their neuroprotective effects, the mechanisms underlying these effects, and their therapeutic potential for the treatment of diverse neurodegenerative disorders are discussed. Keywords:: dextromethorphan, dimemorfan, 3-hydroxymorphinan, neuroprotection, neuropsychotoxicity, neurodegenerative disorder

Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.

In the present work, we found that the ethyl acetate-soluble fraction of Cnidium officinale MAKINO (COEA) decreased nitric oxide (NO) production in the lipopolysaccharide (LPS)-stimulated BV-2 and primary microglia and suppressed expression of inducible nitric oxide synthase (iNOS) in BV-2 cells with the same pattern of NO production. In addition, we showed that excessive NO production played an important role in neuronal cell death in LPS-treated rat hippocampal slice cultures. Our data suggest that the COEA inhibits neuronal cell death by reduction of excessive NO production in LPS-treated rat hippocampal slice cultures. The ethyl acetate-soluble fraction of C. officinale reduced propidium iodide uptake and NO production in cultured media at the same time.

Irisin is a recently found myokine that aids obesity control and improves glucose homeostasis by acting on white adipose tissue cells and increases total energy consumption. The aim of this study was to evaluate serum irisin levels in patients with non-alcoholic fatty liver disease (NAFLD) and to compare these levels with those of normal controls. Among 595 health screen examinees who had visited our institute between January 2013 to March 2013, 355 patients (84 NAFLD patients and 271 normal controls) were enrolled depending on whether they gave written informed consents and their history of alcohol intake, blood tests, and abdominal ultrasonographic findings. Age; sex; laboratory test parameters; homeostasis model assessment-insulin resistance; and levels of leptin, adiponectin, and irisin were assessed. Serum irisin levels (ng/ml) were significantly higher in the NAFLD group than in normal controls (63.4 ± 32.6 vs. 43.0 ± 29.7, p

Attention-deficit hyperactivity disorder (ADHD) is a chronic condition and pharmacotherapy is the mainstay of treatment, with a variety of ADHD medications available to patients. However, it is unclear to what extent the long-term safety and efficacy of ADHD drugs have been evaluated prior to their market authorization. We aimed to quantify the number of participants studied and their length of exposure in ADHD drug trials prior to marketing.We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug's clinical efficacy and safety. For each ADHD medication, we measured the total number of participants studied and the length of participant exposure and identified any FDA requests for post-marketing trials.A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75 (IQR 0, 419). Eleven drugs (55%) were approved after

Objectives: We analyzed the correlation between the infectivity and transmissibility of the severe acute respiratory syndrome coronavirus 2 Omicron sublineages BA.1, BA. 2, BA.4, and BA.5. Methods: We assessed viral replication kinetics and infectivity at the cellular level. Nasopharyngeal and oropharyngeal specimens were obtained from patients with coronavirus disease 2019, confirmed using whole-genome sequencing to be caused by the Omicron sublineages BA.1, BA.2, BA.4, or BA.5. These specimens were used to infect Vero E6 cells, derived from monkey kidneys, for the purpose of viral isolation. Viral stocks were then passaged in Vero E6 cells at a multiplicity of infection of 0.01, and culture supernatants were harvested at 12-hour intervals for 72 hours. To evaluate viral replication kinetics, we determined the cycle threshold values of the supernatants using real-time reverse transcription polymerase chain reaction and converted these values to genome copy numbers. Results: The viral load was comparable between BA.2, BA.4, and BA.5, whereas BA.1 exhibited a lower value. The peak infectious load of BA.4 was approximately 3 times lower than that of BA.2 and BA.5, while the peak load of BA.2 and BA.5 was about 7 times higher than that of BA.1. Notably, BA.1 demonstrated the lowest infectivity over the entire study period. Conclusion: Our results suggest that the global BA.5 wave may have been amplified by the higher viral replication and infectivity of BA.5 compared to other Omicron sublineages. These analyses could support the rapid assessment of the impact of novel variants on case incidence. [ABSTRACT FROM AUTHOR]

Although WHO declared the end of the public health emergency for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), XBB lineages continue to evolve and emerge globally. In particular, XBB.1.5 and XBB.1.16 are raising concerns because of their high immune evasion, leading to apprehensions regarding vaccine efficacy reduction and potential reinfection. We aimed to investigate the COVID-19 outbreak in Korea and predict the likelihood of reinfection by testing neutralizing activity against live viruses from the S clade and 19 Omicron sublineages. We found a significant risk of infection with the currently prevalent XBB lineage for individuals who were either vaccinated early or infected during the initial Omicron outbreak. Vaccinated individuals were better equipped than unvaccinated individuals to produce neutralizing antibodies for other SARS-CoV-2 variants upon infection. Therefore, unvaccinated individuals do not easily develop neutralizing activity against other variants and face the highest risk of reinfection by the XBB lineage. Our study provides important information to facilitate the development of strategies for monitoring populations that would be the most susceptible to new COVID-19 outbreaks. [ABSTRACT FROM AUTHOR]

Background Thrombi retrieved from patients with acute ischemic stroke may contain prognostic information. Objective: To investigate the relationship between the immunologic phenotype of thrombi and future vascular events in patients with a stroke. Methods This study included patients with acute ischemic stroke who underwent endovascular thrombectomy at Chung-Ang University Hospital in Seoul, Korea, between February 2017 and January 2020. Laboratory and histological variables were compared between patients with and without recurrent vascular events (RVEs). Kaplan-Meier analysis followed by the Cox proportional hazards model was used to identify factors related to RVE. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of the immunologic score by combining immunohistochemical phenotypes to predict RVE. Results A total of 46 patients were included in the study with 13 RVEs (mean±SD age, 72.8±11.3 years; 26 (56.5%) men). Thrombi with a lower percentage of programmed death ligand-1 expression (HR=11.64; 95% CI 1.60 to 84.82) and a higher number of citrullinated histone H3 positive cells (HR=4.19; 95% CI 0.81 to 21.75) were associated with RVE. The presence of high-mobility group box 1 positive cell was associated with reduced risk of RVE, but the association was lost after adjustment for stroke severity. The immunologic score, which consists of the three immunohistochemical phenotypes, showed good performance in predicting RVE (area under the ROC curve, 0.858; 95% CI 0.758 to 0.958). Conclusions The immunological phenotype of thrombi could provide prognostic information after stroke. [ABSTRACT FROM AUTHOR]