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Abstract Branched-chain amino acids (BCAAs), particularly leucine, are indispensable AAs for immune regulation through metabolic rewiring. However, the molecular mechanism underlying this phenomenon remains unclear. Our investigation revealed that T-cell receptor (TCR)-activated human CD4+ T cells increase the expression of BCAT1, a cytosolic enzyme responsible for BCAA catabolism, and SLC7A5, a major BCAA transporter. This upregulation facilitates increased leucine influx and catabolism, which are particularly crucial for Th17 responses. Activated CD4+ T cells induce an alternative pathway of cytosolic leucine catabolism, generating a pivotal metabolite, β-hydroxy β-methylbutyric acid (HMB), by acting on BCAT1 and 4-hydroxyphenylpyruvate dioxygenase (HPD)/HPD-like protein (HPDL). Inhibition of BCAT1-mediated cytosolic leucine metabolism, either with BCAT1 inhibitor 2 (Bi2) or through BCAT1, HPD, or HPDL silencing using shRNA, attenuates IL-17 production, whereas HMB supplementation abrogates this effect. Mechanistically, HMB contributes to the regulation of the mTORC1-HIF1α pathway, a major signaling pathway for IL-17 production, by increasing the mRNA expression of HIF1α. This finding was corroborated by the observation that treatment with L-β-homoleucine (LβhL), a leucine analog and competitive inhibitor of BCAT1, decreased IL-17 production by TCR-activated CD4+ T cells. In an in vivo experimental autoimmune encephalomyelitis (EAE) model, blockade of BCAT1-mediated leucine catabolism, either through a BCAT1 inhibitor or LβhL treatment, mitigated EAE severity by decreasing HIF1α expression and IL-17 production in spinal cord mononuclear cells. Our findings elucidate the role of BCAT1-mediated cytoplasmic leucine catabolism in modulating IL-17 production via HMB-mediated regulation of mTORC1-HIF1α, providing insights into its relevance to inflammatory conditions.

Background/Aims: Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. Methods: The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Results: Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (

Abstract Nutrient data obtained from field observations have the potential to enhance our understanding of oceanic biogeochemical cycling and productivity changes. In particular, long-term nutrient data can provide valuable information on the links between climate change and biogeochemical changes. However, unlike other observational variables such as sea surface temperature, nutrient data are limited in terms of their broad-scale observations and automated sensor-based measurements. In this study, we analyzed nitrate and phosphate data obtained from coastal regions in Northeast Asia and the northwest Pacific from 1980 to 2019 using the spatiotemporal kriging technique and provide results in a spatiotemporal grid format. The data are available at monthly intervals and may be attractive to researchers in the fields of oceanography, marine ecology, and marine biogeochemistry at the climate change scale. Furthermore, sharing the source code of the data production process can contribute to better long-term data reproduction in the future.

Abstract Keloid disorder is an abnormal fibroproliferative reaction that can occur on any area of skin, and it can impair the quality of life of affected individuals. To investigate the pathogenesis and develop a treatment strategy, a preclinical animal model of keloid disorder is needed. However, keloid disorder is unique to humans, and the development of an animal model of keloid disorder is highly problematic. We developed the patient-derived keloid xenograft (PDKX), which is a humanized mouse model, and compared it to the traditional mouse xenograft model (transplantation of only keloid lesions). To establish the PDKX model, peripheral mononuclear cells (PBMCs) from ten keloid patients or five healthy control subjects were injected into NOD/SCID/IL-2Rγnull mice, and their keloid lesions were grafted onto the back after the engraftment of immune cells (transplantation of keloid lesions and KP PBMCs or HC PBMCs). Four weeks after surgery, the grafted keloid lesion was subjected to histologic evaluation. Compared to the traditional model, neotissue formed along the margin of the grafted skin, and lymphocyte infiltration and collagen synthesis were significantly elevated in the PDKX model. The neotissue sites resembled the margin areas of keloids in several respects. In detail, the levels of human Th17 cells, IL-17, HIF-1a, and chemokines were significantly elevated in the neotissue of the PDKX model. Furthermore, the weight of the keloid lesion was increased significantly in the PDKX model, which was due to the proinflammatory microenvironment of the keloid lesion. We confirmed that our patient-derived keloid xenograft (PDKX) model mimicked keloid disorder by recapitulating the in vivo microenvironment. This model will contribute to the investigation of cellular mechanisms and therapeutic treatments for keloid disorders.

Abstract Ribosomally synthesized and post‐translationally modified peptides (RiPPs) are a structurally diverse class of natural products with a distinct biosynthetic logic, the enzymatic modification of genetically encoded precursor peptides. Although their structural and biosynthetic diversity remains largely underexplored, the identification of novel subclasses with unique structural motifs and biosynthetic pathways is challenging. Here, it is reported that peptide/protein L‐aspartyl O‐methyltransferases (PAMTs) present in several RiPP subclasses are highly homologous. Importantly, it is discovered that the apparent evolutionary transmission of the PAMT gene to unrelated RiPP subclasses can serve as a basis to identify a novel RiPP subclass. Biochemical and structural analyses suggest that homologous PAMTs convert aspartate to isoaspartate via aspartyl‐O‐methyl ester and aspartimide intermediates, and often require cyclic or hairpin‐like structures for modification. By conducting homology‐based bioinformatic analysis of PAMTs, over 2,800 biosynthetic gene clusters (BGCs) are identified for known RiPP subclasses in which PAMTs install a secondary modification, and over 1,500 BGCs where PAMTs function as a primary modification enzyme, thereby defining a new RiPP subclass, named pamtides. The results suggest that the genome mining of proteins with secondary biosynthetic roles can be an effective strategy for discovering novel biosynthetic pathways of RiPPs through the principle of “guilt by association”.

Background Immediate breast reconstruction after mastectomy can be challenging in some patients for medical or oncological reasons. Delayed two-stage tissue expander/implant breast reconstruction is a reliable option for these patients. However, data regarding surgical techniques, outcomes, and complication rates are limited. This study reports our experience using the two-stage tissue expander/implant procedure for delayed breast reconstruction. Methods This retrospective study included 32 patients (34 breasts) who underwent delayed two-stage tissue expander/implant breast reconstruction at our institution from January 2018 to July 2022. We summarized the techniques used in the procedure and evaluated the 1-year postoperative outcomes and complication rates. Results The mean time from mastectomy to expander insertion was 210±25 days, and 8.2±2.3 additional expansions were required prior to the implant insertion. The mean time of tissue expansion was 187±15 days, and the mean volume of expansion was 495±31 mL. No major complications occurred that required reoperation, and the patients were highly satisfied with the surgical results. Conclusions Although delayed two-stage tissue expander/implant breast reconstruction resulted in satisfactory outcomes, consensus regarding the operative technique is still needed. Two-stage tissue expander/implant breast reconstruction is a safe and effective option for delayed breast reconstruction.

Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures. Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient. Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces. Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.

Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.

Abstract Patients undergoing autologous breast reconstruction (ABR) are more likely to require perioperative transfusions due to the increased intraoperative bleeding. In addition to the mastectomy site, further incisions and muscle dissection are performed at the donor sites, including the back or abdomen, increasing the possibility of transfusion. The purpose of this study was to evaluate perioperative transfusion rates and risk factors according to the type of ABR through analysis of big data. Patients who underwent total mastectomy for breast cancer between 2014 and 2019 were identified. The patients were divided into mastectomy only and immediate ABR groups. The transfusion rate was 14-fold higher in the immediate ABR group (16.1%) compared to the mastectomy only group (1.2%). The transfusion rate was highest with the pedicled transverse rectus abdominis myocutaneous flap (24.2%). Performance of the operation in medical institutions located in the provinces and coronary artery disease (CAD) were significant risk factors for the need for transfusion. The perioperative transfusion risk among patients undergoing immediate ABR was related to the flap type, location of medical institution, and CAD. Based on the higher transfusion rate in this study (16.1%) compared to previous studies, the risk factors for the need for transfusion should be determined and evidence-based guidelines should be developed to reduce the transfusion rates.

Keloid is an abnormal fibrotic disease after cutaneous injury characterized by exaggerated scar tissue formation, which often extends beyond the boundaries of the original wound. Although chronic inflammation is known to be associated with the excessive inflammation in keloid tissue, there are few studies on the role of autophagy in the pathogenesis of keloid. In this study, we evaluated the pattern of autophagy in keloid fibroblasts (KF) and normal fibroblasts (NF). Expression of HIF-1α, STAT3 and autophagic flux markers were evaluated in KF and NF. Defective autophagy caused by IL-17 was evaluated, and the relationship between defective autophagy and necroptosis was also examined. The expression of IL-17, HIF-1α and STAT3 was significantly increased in keloid tissue, and autophagosome-to autophagolysosome conversion was defective in KF. IL-17 treatment significantly elevated the expression of STAT3 and HIF-1α in NF and caused defective autophagy, which was reversed by HIF-1α inhibitor. In addition, the defective autophagy was associated with the increased necroptosis and fibrosis. In keloid tissue, the elevated necroptosis marker was confirmed, and with the HIF-1α inhibitor, the defective autophagy, necroptosis and fibrosis was decreased in KF. In conclusion, autophagy was defective in keloid tissue, which was associated with increased necroptosis and fibrosis. The IL-17-STAT3-HIF-1α axis was involved in defective autophagy in KF, and this suggests that targeting the axis could alleviate chronic inflammation in keloid disease.

Abstract Background Sepsis has a high mortality rate, but no specific drug has been proven effective, prompting the development of new drugs. Immunologically, sepsis can involve hyperinflammation, immune paralysis, or both, which might pose challenges during drug development. Recently, mitochondrial transplantation has emerged as a treatment modality for various diseases involving mitochondrial dysfunction, but it has never been tested for sepsis. Methods We isolated mitochondria from L6 muscle cells and umbilical cord mesenchymal stem cells and tested the quality of the isolated mitochondria. We conducted both in vivo and in vitro sepsis studies. We investigated the effects of intravenous mitochondrial transplantation on cecal slurry model in rats in terms of survival rate, bacterial clearance rate, and the immune response. Furthermore, we observed the effects of mitochondrial transplantation on the immune reaction regarding both hyperinflammation and immune paralysis. To do this, we studied early- and late-phase cytokine production in spleens from cecal slurry model in rats. We also used a lipopolysaccharide (LPS)-stimulated human PBMC monocyte model to confirm the immunological effects of mitochondrial transplantation. Apoptosis and the intrinsic apoptotic pathway were investigated in septic spleens. Results Mitochondrial transplantation improved survival and bacterial clearance. It also mitigated mitochondrial dysfunction and apoptosis in septic spleens and attenuated both hyperinflammation and immune paralysis in the spleens of cecal slurry model in rats. This effect was confirmed with an LPS-stimulated human PBMC study. Conclusions In rat polymicrobial cecal slurry model, the outcome is improved by mitochondrial transplantation, which might have an immunomodulatory effect.

Virginal mammary hypertrophy (VMH), also known as juvenile mammary hypertrophy, is characterized by excessive enlargement of the breasts. Especially in adolescent patients, this condition can cause a negative body image to develop and result in significant psychological stress. Furthermore, social problems can arise from difficulties in finding appropriately-fitting attire and having trouble exercising. Although the mechanism of VMH has not been fully elucidated, several associated drugs have been identified. In this report, we present a 15-year-old female patient with Wilson disease who developed macromastia after administration of penicillamine for 8 months. Despite cessation of penicillamine for 3 months, the condition remained stable; thus, reduction mammoplasty was performed. After surgery, the patient was able to return to activities of daily living. Although rare, physicians should be aware of the fact that penicillamine can cause VHM. Therefore, patients with Wilson disease should be checked regularly for changes in breast volume in order to minimize possible complications.

Background Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforatorcentralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group. Methods From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap. Results No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022). Conclusions The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

This study proposes a 2D surface correlation-based indoor localization technology using LTE fingerprinting with an accuracy of several meters. The most important problem with RF fingerprinting is that the location discernment of signal strength becomes exceedingly low as the distance from the RF signal source increases. Instantaneous RSS measurement based conventional fingerprinting involves the installation of several signal sources to improve location discernment. However, additional installations of LTE base stations (BSs) are impossible. To improve location discernment, the proposed technology utilizes a spatial RSS pattern extracted using the Pedestrian-Dead Reckoning during user movement. The use of the proposed technology greatly improves the accuracy and availability of LTE signals using the pattern. Additionally, the following two points should be considered. First, the spatially accumulated pattern contains location errors that can cause pattern distortion. The proposed technology performs pattern correction through feature matching using RSS mark and crossroad locations. Second, the accuracy of pattern matching may be decreased prior to sufficient pattern accumulation. For the rapid convergence of the pattern matching, the proposed technology performs correlation pattern analysis. This approach detects the point in which the discernment is increased by pattern accumulation and limits the search range around the matching point. To verify the performance, we conducted tests in a shopping mall where only one LTE BS ID is available. Consequently, the convergence distance of pattern matching was improved by 69% after pattern analysis. Furthermore, it was confirmed that the localization error after convergence improved from 4.16 m to 2.82 m.

The emphasis on tip plasty in Asian rhinoplasty has led to heightened concerns about complications regarding nasal tip skin. Although uncommon, these complications can cause tremendous frustration to surgeons when encountered. Conventional methods such as skin graft or healing by secondary intention cause an unpleasant scar. Instead, an extended dermofat graft in revision rhinoplasty enables both replacement of the dorsal implant and adequate coverage of the nasal tip without modifying the previous tip plasty. A patient who experienced nasal tip skin thinning after augmentation rhinoplasty was treated successfully with an extended dermofat graft. The authors believe that this is a solid method for managing patients with nasal tip skin complications.

Background Subbrow blepharoplasty (SBB) has advantages over traditional blepharoplasty in that it results in more natural-looking creases and contours and is more effective for lateral periorbital rejuvenation. However, in older patients with sunken upper eyelid, this procedure might make the superior eyelid sulcus appear worse because the thicker upper eyelid tissue in the subbrow area is replaced by thinner tissue. To overcome this limitation, we developed a de-epithelialized musculocutaneous flap for SBB. Methods From August 2016 to January 2018, 13 patients with sunken upper eyelid deformity underwent SBB. For each of these patients, a typical SBB incision was made, but the tissue usually removed in SBB was dissected as a flap based on the branch of the ophthalmic vessel. After elevation, the flap was transposed or folded to correct the sunken deformity. The results were assessed by the patients themselves and by three plastic surgeons at 6 months postoperatively. Results The mean age of the patients was 63 years (range, 47–81 years). There were no postoperative complications related to wound dehiscence, hypertrophic scarring, or sensory changes. All patients and plastic surgeons provided scores indicating good to excellent results and were satisfied with the cosmetic outcomes. All patients reported improved functional visual acuity after surgery. Conclusions Our technique is simple and effectively addresses both sunken upper eyelid deformity and dermatochalasis. Unlike fat or dermofat grafting, our new technique does not require an additional donor site, and it is more reliable in terms of vascularity.

Immune suppression is known to occur during sepsis. Endotoxin tolerance is considered a mechanism of immune suppression in sepsis. However, the timing and serial changes in endotoxin tolerance have not been fully investigated. In this study, we investigated serial changes in endotoxin tolerance in a polymicrobial sepsis model. Herein, we used a rat model of fecal slurry polymicrobial sepsis. After induction of sepsis, endotoxin tolerance of peripheral blood mononuclear cells (PBMCs) and splenocytes was measured at various time points (6 h, 12 h, 24 h, 48 h, 72 h, 5 days, and 7 days), through the measurement of TNF-α production after stimulation with lipopolysaccharide (LPS) in an ex vivo model. At each time point, we checked for plasma tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 levels. Moreover, we analyzed reactive oxygen species (ROS) as measured by 2′,7′-dichlorodihydrofluorescein, plasma lactate, serum alanine aminotransferase (ALT), and creatinine levels. Nuclear factor (NF)-κB, IL-1 receptor-associated kinase (IRAK)-M, and cleaved caspase 3 levels were measured in the spleen. Endotoxin tolerance, measured by TNF-α production stimulated through LPS in PBMCs and splenocytes, was induced early in the sepsis model, starting from 6 h after sepsis. It reached a nadir at 24 to 48 h after sepsis, and then started to recover. Endotoxin tolerance was more prominent in the severe sepsis model. Plasma cytokines peaked at time points ranging from 6 to 12 h after sepsis. ROS levels peaked at 12 h and then decreased. Lactate, ALT, and serum creatinine levels increased up to 24 to 48 h, and then decreased. Phosphorylated p65 and IRAK-M levels of spleen increased up to 12 to 24 h and then decreased. Apoptosis was prominent 48 h after sepsis, and then recovered. In the rat model of polymicrobial sepsis, endotoxin tolerance occurred earlier and started to recover from 24 to 48 h after sepsis.

Acute myocardial infarction (AMI) is lethal and causes myocardial necrosis via time-dependent ischemia due to prolonged occlusion of the infarct-related artery. No effective therapy or potential therapeutic targets can prevent myocardial ischemia/reperfusion (I/R) injury. Targeted temperature management (TTM) may reduce peri-infarct regions by inhibiting the extracellular release of high mobility group box-1 (HMGB1) as a primary mediator of the innate immune response. We used a rat left anterior descending (LAD) coronary artery ligation model to determine if TTM at 33°C and 36°C had similar myocardial protective effects. Rats were divided into sham, LAD I/R+37°C normothermia, LAD I/R+33°C TTM, and LAD I/R+36°C TTM groups (n = 5 per group). To verify the cardioprotective effect of TTM by specifically inhibiting HMGB1, rats were assigned to sham, LAD I/R, and LAD I/R after pre-treatment with glycyrrhizin (known as a pharmacological inhibitor of HMGB1) groups (n = 5 per group). Different target temperatures of 33°C and 36°C caused equivalent reductions in infarct volume after myocardial I/R, inhibited the extracellular release of HMGB1 from infarct tissue, and suppressed the expression of inflammatory cytokines from peri-infarct regions. TTM at 33°C and 36°C significantly attenuated the elevation of cardiac troponin, a sensitive and specific marker of heart muscle damage, after injury. Similarly, glycyrrhizin alleviated myocardial damage by suppressing the extracellular release of HMGB1. TTM at 33°C and 36°C had equivalent myocardial protective effects by similar inhibiting HMGB1 release against myocardial I/R injury. This is the first study to suggest that a target core temperature of 36°C is applicable for cardioprotection.

Steroids are currently being used in sepsis, particularly in septic shock. However, clinical trials to date have shown contradictory results. This could be attributed to the different patient endotypes and steroid doses, which have also contributed to the inconclusive results. We investigated the effects of glucocorticoid therapy on sepsis in a polymicrobial sepsis model in a variety of settings, such as steroid dose, severity, and sepsis phase. We used a rat model of fecal slurry polymicrobial sepsis. First, we investigated the optimum dose of steroids in a sepsis model. We administered different doses of dexamethasone after sepsis induction (0.1DEX; 0.1 mg/kg, 0.2DEX; 0.2 mg/kg, 5DEX; 5 mg/kg). Second, we used two different severities of the fecal slurry polymicrobial sepsis rat model to examine the effects of the steroids. A moderate or severe model was defined as a survival rate of approximately 70% and 30%, respectively. Third, we administered steroids in an early (1 h after sepsis induction) or late phase (25 h after sepsis). In all the experiments, we investigated the survival rates. In the determined optimal model and settings, we measured serum lactate, alanine transferase (ALT), creatinine, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10, and arterial blood gas. We evaluated the bacterial burden in the blood and spleen. Endotoxin tolerance of peripheral blood mononuclear cells (PBMCs) and splenocytes was also investigated to determine the level of immune suppression 24 h after sepsis by measuring TNF-α production after stimulation with lipopolysaccharide (LPS) in an ex vivo model. Early treatment of 0.2 mg/kg dexamethasone in a severe sepsis model showed the best beneficial effects. In moderate- or late-phase sepsis, there was no survival gain with steroid treatment. DEX0.2 group showed less acute kidney injury manifested by serum creatinine and blood urea nitrogen. DEX decreased the levels of cytokines, including IL-6, IL-10, and TNF-α. Colony-forming units were significantly decreased in the blood when administered with dexamethasone. Endotoxin tolerance was not significantly different between the DEX0.2 and control groups. In conclusion, early treatment of 0.2 mg/kg dexamethasone improved the outcomes of rats in a severe sepsis model.

Although it is very rare, hemopneumothorax can occur during breast augmentation. This potentially fatal surgical complication can be experienced by any plastic surgeon who performs breast augmentation surgery. In this article, we present a case from our institution and review the related literature in order to explore the etiological mechanism of hemopneumothorax, as well as preventive measures and treatments. In addition, we have tried to emphasize the importance of a thorough knowledge of anatomical variations and proper surgical techniques as ways to minimize the likelihood of this complication.

OBJECTIVES The purpose of the study was to investigate weight distribution, posture alignment, and gait parameters while a mother was transporting a baby with varied baby carriers during gait. METHODS Five mothers transported their babies with three different baby carriers(baby carrier, hipseat carrier, & hipseat) and carried babies with their arms. Ten cameras, marker sets, and forceplatforms were used to get the kinematic, force, and gait parameters. RESULTS The hipseat showed that the range of motion in the hip joint was small, the step length and stride length was short, and the gait velocity was slow. Mothers carried their babies with arms showed that lower in the trunk flexion angle, larger in the stride length, and faster in the gait velocity were than any other baby carriers. CONCLUSIONS The baby carrier is important for infant's growth and care, but there is lack of product appropriateness, use, and scientific basis. Therefore, further study is needed to investigate varied performance with transporting a baby with baby carriers.

Some of the shopping malls, airports, hospitals, etc. have underground parking lots where hundreds of vehicles can be parked. However, first-time visitors find it difficult to determine their current location and need to keep moving the vehicle to find an empty parking space. Moreover, they need to remember the parked location, and find a nearby staircase or elevator to move toward the destination. In such a situation, if the user location can be estimated, a new navigation system can be offered, which can assist users. This study presents an underground parking lot navigation system using long-term evolution (LTE) signals. As the proposed system utilizes LTE network signals for which the infrastructure is already installed, no additional infrastructure is required. To estimate the location of the vehicle, the signal strength of the LTE signal is accumulated, and the location of the vehicle is estimated by comparing it with the previously stored database of the LTE received signal strength (RSS). In addition, the acceleration and gyroscope sensors of a smartphone are used to improve the vehicle position estimation performance. The effectiveness of the proposed system is verified by conducting an experiment in a large shopping-mall underground parking lot where approximately 500 vehicles can be parked. From the results of the experiment, an error of less than an average of 10 m was obtained, which shows that seamless navigation is possible using the proposed system even in an environment where GNSS does not function.

Sialocele formation is a recognised complication of parotid surgery. Most cases resolve after conservative therapy consisting of pressure dressing, fasting, and repeated aspiration. However, some cases are resistent to such treatment and require further intervention. In this report, we present the method of botulinum toxin (BTX) injection into the parotid gland under ultrasonographic guidance along with atropine injection. A 63-year-old female underwent excision of a pleomorphic adenoma abutting an accessory parotid gland. Sialocele formation persisted after almost 3 weeks of conservative therapy. BTX A was given under ultrasonographic guidance and the sialocele disappeared after two doses of treatment. BTX injection under ultrasonographic guidance was thus a safe and effective method for treating persistent sialocele.

A defining characteristic of the urbanization is the transformation of existing pervious areas into impervious areas during development. This leads to numerous hydrologic and environmental problems such as an increase in surface runoff due to excess rainfall, flooding, the deterioration of water quality, and an increase in nonpoint source pollution. Several studies propose supplementary measures on environmental change problems in development areas using the low impact development technique. This study investigated the reduction of nonpoint source pollutant loads and flooding in catchments through urban catchment rainfall–runoff management. For the quantitative assessment of flood disasters and water pollution problems, we propose a reliability evaluation technique. This technique refers to a series of analysis methods that determine the disaster prevention performance of the existing systems. As the two factors involve physical quantities of different dimensions, a reliability evaluation technique was developed using the distance measure method. Using the storm water management model, multiple scenarios based on synthetic rainfall in the catchment of the Daerim 2 rainwater pumping station in Seoul, South Korea, were examined. Our results indicate the need for efficient management of natural disaster risks that may occur in urban catchments. Moreover, this study can be used as a primary reference for setting a significant reduction target and facilitating accurate decision making concerning urban drainage system management.

Background and Objectives: Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea. Materials and Methods: The systematic review was conducted in accordance with the “preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma”. PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors. Results: A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate. Conclusion: After reviewing other countries’ experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant.

Numerical and empirical studies of soil slurry transport and deposition in urban stormwater sewers are few, presumably due to the difficulty of direct observation of soil slurry flow in stormwater pipes. Slurry in a sewer system includes both suspended load and bedload, but few studies have attempted to demarcate these two components. A boundary layer is a crucial determinant of sediment transport capacity. Stormwater runoff enters the sewer in turbulent flow, mostly mixed with soil slurry generated by rainfall. In this paper, we attempt analysis using ANSYS Fluent commercial CFD software. We describe the development of a numerical analytical methodology capable of predicting the flow of soil slurry in stormwater pipes, and propose a method for estimating the sediment–flow boundary layer. Using this model, we simulated stormwater runoff with a large content of soil slurry during a rainfall event. We investigated soil slurry transport and predict the formation of shear boundary layer by varying the inlet conditions (volume of soil slurry entering the stormwater sewer system) and by analyzing the flow velocity field and soil slurry volume fraction in the pipes under various experimental flow conditions. Based on the shear and settling velocity of sediment particles, we propose criteria for the formation of a shear boundary layer in stormwater pipes.

Elucidating the structural details of proteins is highly valuable and important for the proper understanding of protein function. In the case of intrinsically disordered proteins (IDPs), however, obtaining the structural details is quite challenging, as the traditional structural biology tools have only limited use. Nuclear magnetic resonance (NMR) is a unique experimental tool that provides ensemble conformations of IDPs at atomic resolution, and when studying IDPs, a slightly different experimental strategy needs to be employed than the one used for globular proteins. We address this point by reviewing many NMR investigations carried out on the α-synuclein protein, the aggregation of which is strongly correlated with Parkinson’s disease.

This study proposes criteria for both optimal-shape and magnetizer-system designs to be used for a high-output spoke-type motor. The study also examines methods of reducing high-cogging torque and torque ripple, to prevent noise and vibration. The optimal design of the stator and rotor can be enhanced using both a response surface method and finite element method. In addition, a magnetizer system is optimally designed for the magnetization of permanent magnets for use in the motor. Finally, this study verifies that the proposed motor can efficiently replace interior permanent magnet synchronous motor in many industries.

In this study, we evaluate the performance of permanent magnets (PMs). The efficiency of attraction in the high speed region was studied using the variable flux memory motor (VFMM). It is presented in order to analyze the magnetic characteristics of PMs, using the second quadrant plan data with re- and de-magnetization. In addition, this study focuses on the evaluation of operational characteristics relative to the magnetizing directions according to the d-axis currents, by using one of the finite element solutions. The feasibility of application for the VFMM has been experimentally demonstrated.

This study analyses the permanent magnet (PM) used in the rotor of an interior permanent magnet synchronous motor (IPMSM) used for driving an electric railway vehicle (ERV) in the context of controllable shape, temperature, and external magnetic field. The positioning of the inserted magnets is a degree of freedom in the design of such machines. This paper describes a preliminary analysis using parametric finite-element method performed with the aim of achieving an effective design. Next, features of the experimental design, based on methods such as the central-composition method, Box-Behnken and Taguchi method, are explored to optimise the shape of the high power density. The results are used to produce an optimal design for IPMSMs, with design errors minimized using Maxwell 2D, a commercial program. Furthermore, the demagnetization process is analysed based on the magnetization and demagnetization theory for PM materials in computer simulation. The result of the analysis can be used to calculate the magnetization and demagnetization phenomenon according to the input B-H curve. This paper presents the conditions for demagnetization by the external magnetic field in the driving and stopped states, and proposes a simulation method that can analyse demagnetization phenomena according to each condition and design the IPMSM that maximizes efficiency and torque characteristics. Finally, operational characteristics are analysed in terms of the operation patterns of railway vehicles, and control conditions are deduced to achieve maximum efficiency in all sections. This was experimentally verified.

This study was undertaken to suggest an effective fisheries resources management system by using stock assessment and potential yield analyses of crucian carp population in the mid-upper system of the Seomjin River. Fieldwork was conducted seasonally from 2008 to 2009 in the mid-upper system of the Seomjin River. The stock assessment was carried out by the swept area method and the potential yield was estimated by improved fisheries resource potential estimation system based on the Allowable Biological Catch. Also, the yield-per-recruit analysis was used to review the efficient management implication of the resource, Carassius auratus. As a result, the age at first capture (tc) was estimated as 1.468 year, converted body length (BL) was 10.8 cm. Meaning the current fishing intensities, the instantaneous coefficient of fishing mortality (F) was 0.067 year-1, and the yield-per-recruit analysis showed that the current yield per recruit was estimated to be 15.999 g with F and tc. The instantaneous rate of fishing mortality that provides for Allowable Biological Catch (FABC) based on the current tc and F was estimated as 0.618 year-1. Therefore, the optimum fishing intensities could be achieved at the higher fishing intensity for Carassius auratus. The calculated annual stock of C. auratus was estimated as 7,608 kg, and the potential yield was estimated as 343 kg with tc and F at the fixed current level. Using yield-per-recruit analysis, if F and tc were set at 0.618 year-1 and 2 year, the yield per recruit and total allowable catch would be predicted to increase to 62 g and 2,531 kg by about 3.9 times and 7.3 times, respectively.

Benthic diatoms isolated from tidal flats in the west coast of Korea were identified through both traditional morphological method and molecular phylogenetic method for methodological comparison. For the molecular phylogenetic analyses, we sequenced the 18S rRNA and the ribulose bisphosphate carboxylase large subunit coding gene, rbcL. Further, the comparative analysis allowed for the assessment of the suitability as a genetic marker for identification of closely related benthic diatom species and as potential barcode gene. Based on the traditional morphological identification system, the 61 isolated strains were classified into 52 previously known taxa from 13 genera. However, 17 strains could not be classified as known species by morphological analyses, suggesting a hidden diversity of benthic diatoms. The Blast search on NCBI's Genebank indicated that the reference sequences for most of the species were absent for the benthic diatoms. Of the two genetic markers, the rbcL genes were more divergent than the 18S rRNA genes. Furthermore, a long branch attraction artefact was found in the 18S rRNA phylogeny. These results suggest that the rbcL gene is a more appropriate genetic marker for identification and classification of benthic diatoms. Considering their high diversity and simple shapes, and thus the difficulty associated with morphological classification of benthic diatoms, a molecular approach could provide a relatively easy and reliable classification system. However, this study suggests that more effort should be made to construct a reliable database containing polyphasic taxonomic data for diatom classification.

Background As the obese population increases in Korea, the number of patients who are trying to lose weight has been increasing steadily. In these patients, skin laxity and deformation of the body contour occurs, which could possibly be corrected by various body contouring surgeries. Here, we introduce the brachioplasty method and our experience of various body contouring surgeries performed in our center. Methods From November 2009 to August 2011, five cases of brachioplasty were performed. When the patient presented with sagging of the lateral inframammary crease and bat wing deformity in the axilla, extended brachioplasty was performed; in this case, the deformation of the axilla and lateral chest was corrected at the same time. A traditional brachioplasty was performed when contouring was needed only for skin laxity in the upper arm. Results Complications, such as hematomas or nerve injuries, were not evident. Some patients experienced partial wound dehiscence due to tension or hypertrophic scars found during the follow-up. In general, all of the patients were satisfied with the improvement in their upper arm contour. Conclusions Given the demands for body contouring surgery, the number of brachioplasty surgical procedures is expected to increase significantly, with abdominoplasty comprising a large portion of these surgeries. For the brachioplasty procedure, preparation and preoperative consultation regarding design of the surgery by experienced surgeons was important to prevent complications such as nerve damage or hematoma formation.

The Global Satellite Navigation System (GNSS) used in various location-based services is accurate and stable in outdoor environments. However, it cannot be utilized in an indoor environment because of low signal availability and degradation of accuracy due to the multipath distortion of satellite signals in urban areas. On the contrary, LTE signals are available almost everywhere in urban areas and are quite stable without much variation throughout the year. This is because of the fixed location of base stations and the well-maintained policy of mobile communication service providers. Its varied stability and reliability make LTE signals a more viable method for localization. However, there are some complexities in utilizing LTE signals including signal interference distortion phenomena during propagation multipath fading, and various types of noise. In this paper, we propose a surface correlation-based fingerprinting method to utilize LTE signals for localization in urban areas. The surface correlation converts timely measured signal strength into spatial pattern using the walking distance from a Pedestrian Dead-Reckoning (PDR). The surface correlation is carried out by comparing the spatial signal strength pattern of a pedestrian`s movement trajectory with a fingerprinting database to estimate the location. A reference trajectory of the moving pedestrian is chosen to have a greater correlation among the multiple trajectory candidates generated from a link-based fingerprinting database. By comparing spatial signal strength patterns, the proposed method can improve robustness in localization overcoming the accuracy degradation problem due to RF multipath and noise that are dominant in the conventional RSS measurement-based LTE localization scheme. The test results in urban areas demonstrate that the proposed surface correlation-based fingerprinting method has improved performance compared to the other conventional methods, thus proving to be a useful complementary method to the GNSS in urban areas.

To monitor water quality continuously over the entire sewer network is important for efficient management of the system. However, it is practically impossible to implement continuous water quality monitoring of all junctions of a sewer system due to budget constraints. Therefore, water quality monitoring locations must be selected as those points which are the most representative of the dataset throughout a system. However, the optimal selection of water quality monitoring locations in urban sewer networks has rarely been studied. This study proposes a method for the optimal selection of water quality monitoring points in sewer systems based on entropy theory. The proposed model searches for a quantitative assessment of data collected from monitoring points. The points that maximize the total information among the collected data at multiple locations are selected using genetic algorithm (GA) for water quality monitoring. The proposed model is demonstrated for a small urban sewer system.

Massive weight loss results in skin excess, leading to an unsatisfying body contour. Variousthigh lift procedures can correct flabby skin in the lower leg. We present a lower bodycontouring technique with a report on two patients. The procedure is determined by the bodycontour of the patient. As the skin excess in the thigh area tended to appear mostly on themedial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks andthe lateral thigh area. The extent of tissue to excise was determined by pinching the patientin a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpfulfor lifting the tissue and preventing the widening of the scar. After the operation, a drain waskept for 3 to 4 days. A compressive garment was used after removing the drain. There wereno complications. The patients were discharged 6 to 8 days after the operation. In conclusion,skin excess, especially in the lower body, can be corrected by a thigh lift combining severalprocedures, varying from person to person.

Massive weight loss results in skin excess, leading to an unsatisfying body contour. Various thigh lift procedures can correct flabby skin in the lower leg. We present a lower body contouring technique with a report on two patients. The procedure is determined by the body contour of the patient. As the skin excess in the thigh area tended to appear mostly on the medial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks and the lateral thigh area. The extent of tissue to excise was determined by pinching the patient in a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpful for lifting the tissue and preventing the widening of the scar. After the operation, a drain was kept for 3 to 4 days. A compressive garment was used after removing the drain. There were no complications. The patients were discharged 6 to 8 days after the operation. In conclusion, skin excess, especially in the lower body, can be corrected by a thigh lift combining several procedures, varying from person to person.

This study proposed a pressure driven entropy method (PDEM) that determines a priority order of pressure gauge locations, which enables the impact of abnormal condition (e.g., pipe failures) to be quantitatively identified in water distribution networks (WDNs). The method developed utilizes the entropy method from information theory and pressure driven analysis (PDA), which is the latest hydraulic analysis method. The conventional hydraulic approach has problems in determining the locations of pressure gauges, attributable to unrealistic results under abnormal conditions (e.g., negative pressure). The proposed method was applied to two benchmark pipe networks and one real pipe network. The priority order for optimal locations was produced, and the result was compared to existing approach. The results of the conventional method show that the pressure reduction difference of each node became so excessive, which resulted in a distorted distribution. However, with the method developed, which considers the connectivity of a system and the influence among nodes based on PDA and entropy method results, pressure gauges can be more realistically and reasonably located.

Inflammation is considered the root cause of various inflammatory diseases, including cancers. Decursinol angelate (DA), a pyranocoumarin compound obtained from the roots of Angelica gigas, has been reported to exhibit potent anti-inflammatory effects. In this study, the anti-inflammatory effects of DA on the MAP kinase and NFκB signaling pathways and the expression of pro-inflammatory cytokines were investigated in phorbol 12-myristate 13-acetate (PMA)-activated human promyelocytic leukemia (HL-60) and lipopolysaccharide (LPS)-stimulated macrophage (Raw 264.7) cell lines. PMA induced the activation of the MAP kinase-NFκB pathway and the production of pro-inflammatory cytokines in differentiated monocytes. Treatment with DA inhibited the activation of MAP kinases and the translocation of NFκB, and decreased the expression and exogenous secretion of IL-1β and IL-6. Furthermore, LPS-stimulated Raw 264.7 cells were found to have increased expression of M1 macrophage-associated markers, such as NADPH oxidase (NOX) and inducible nitric oxide synthase (iNOS), and the M2 macrophage-associated marker CD11b. LPS also activated pro-inflammatory cytokines and Erk-NFκB. Treatment with DA suppressed LPS-induced macrophage polarization and the inflammatory response by blocking Raf-ERK and the translocation of NFκB in Raw 264.7 cells. Treatment with DA also inhibited the expression of pro-inflammatory cytokines, such as IL-1β and IL-6, NOX, and iNOS in Raw 264.7 cells. These results suggest that DA has the potential to inhibit macrophage polarization and inflammation by blocking the activation of pro-inflammatory signals. These anti-inflammatory effects of DA may contribute to its potential use as a therapeutic strategy against various inflammation-induced cancers.

Soil slurry deposited on the surface of the Earth during rainfall mixes with fluids and flows into urban sewer conduits. Turbulent energy and energy dissipation in the conduits lead to separation, and sedimentation at the bottom lowers the discharge capacity of conduits. This study proposes a functional relationship between shear stress in urban sewer conduits and the physical properties of particles in a conduit bed containing less than 20 mm of soil. Several conditions were implemented for analyzing two-phase flow (soil slurry and fluid in urban sewer conduits) in terms of turbulent flow by considering soil slurry flowing into urban sewer conduits. The internal flows of fluid and soil slurry in urban sewer conduits were numerically analyzed and modeled by applying the Navier–Stokes equation and the k-ε turbulence model. The transfer deposition of the soil slurry in the conduits was reviewed and, based on the results, a limiting tractive force was calculated and used to propose criteria for transfer deposition occurring in urban sewer conduits.

Sedimentation commonly occurs in urban drainage systems, disrupts flow, and is one of the major causes of inundation. The complicated phenomena that alter the cross-section of sewer conduits include transportation, precipitation, and sedimentation, and need to be analyzed for the proper design and efficient maintenance of urban drainage systems. In this study, the discharge capacity of urban drainage systems is simulated and analyzed by considering the pattern of flow of sediments in sewer conduits through a numerical analysis model. The sites of the highest and lowest accumulation of soil were examined as sedimentation occurred, as was discharge due to accumulation in sewer conduits. The purpose of this study is the examination of mathematical models for two-phase fluid flow analysis and the prediction of sedimentation in urban sewer conduits. An expression for the height of the sedimentation was obtained to assess the discharge capacity of urban drainage systems, and a model to predict accumulation in sewer conduits was developed using non-dimensional variables for inlet velocity, inlet particle volume fraction, and particle size. When subjected to linear regression analysis, the model yielded a high correlation coefficient (R2) of 0.899. This satisfied the aims of this study, to obtain a higher discharge capacity and a plan for the design of urban drainage systems.