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Global warming caused by climate change can increase heat stress and greenhouse gas (GHG) emissions, leading to food problems and livestock crises. Thus, pre-emptive responses are required to mitigate the food problems and livestock crises. The potential of a livestock crisis caused by global warming highlights the need for sustainable livestock production in response to climate change using a farm animal algorithm in order to address the population increase and avoid food problems in the future. In particular, the demand for animal-based foods has increased. Such a climate change threatens the livestock environment, production, reproductive efficiency, animal behaviour and welfare, while increasing the heat stress, livestock malodours, and GHG emissions. For these reasons, it is necessary to understand the concurrent mechanisms related to these effects of global warming, animal nutrition, animal feeding and management, animal heat stress and in ovo injection, and carbon neutral livestock. Climate-smart livestock systems are being implemented to overcome the livestock crisis caused by climate change and to maintain sustainable livestock production. This review emphasises the importance of sustainable livestock production using farm animal algorithms in response to a future livestock crisis caused by climate change in 2050.

In response to climate change, the use of digital livestock systems and probiotic mixtures as technological strategies to improve animal health and production is driving new innovations in the farm animal industry. However, there is little information available regarding the effects of digital livestock systems and probiotic mixtures (consisting of Bacillus subtillus, Streptomyces galilaeus, and Sphingobacteriaceae) on the growth performance of the growth-finishing swine. Thus, the objective of this study was to investigate the effects of digital livestock systems and probiotic mixtures on the immune function, cecal bacteria, short-chain fatty acids, nutrient digestibility, and growth performance of growth-finishing swine. A total of 64 crossbred male swine (Duroc × Landrace × Yorkshire, average body weight: 60.17 ± 1.25 kg) were randomly assigned to four treatment groups: CON (control group with a conventional livestock system without a probiotic mixture), CON0.4 (a conventional livestock system with a 0.4% probiotic mixture), DLSC (a digital livestock system without a probiotic mixture), and DLS0.4 (a digital livestock system with a 0.4% probiotic mixture). The swine were reared under standard environmental conditions until their average body weight reached 110 kg. The results indicated that the growth performance of the swine improved with an increase in nutrient digestibility and immune function via modulation of blood immune markers in the group with a digital livestock system compared to the CON group, although the growth performance of the swine was similar between the DLSC and CON0.4 groups. Moreover, the application of the digital livestock system and the probiotic mixture maintained higher levels of Lactobacillus and balanced short-chain fatty acid profiles compared to the CON group. These results suggest that a digital livestock system and a probiotic mixture can improve the growth performance of swine by enhancing their nutrient digestibility, improving their immune function, and maintaining balanced cecal bacteria and short-chain fatty acids. Therefore, this study provides insights into the application of digital livestock systems and probiotic mixtures as a climate change response strategy to improve swine production.

Mutations in the peroxisomal half-transporter ABCD1 cause X-linked adrenoleukodystrophy, resulting in elevated very long-chain fatty acids (VLCFA), progressive neurodegeneration and an associated pain syndrome that is poorly understood. In the nervous system of mice, we found ABCD1 expression to be highest in dorsal root ganglia (DRG), with satellite glial cells (SGCs) displaying higher expression than neurons. We subsequently examined sensory behavior and DRG pathophysiology in mice deficient in ABCD1 compared to wild-type mice. Beginning at 8 months of age, Abcd1−/y mice developed persistent mechanical allodynia. DRG had a greater number of IB4-positive nociceptive neurons expressing PIEZO2, the mechanosensitive ion channel. Blocking PIEZO2 partially rescued the mechanical allodynia. Beyond affecting neurons, ABCD1 deficiency impacted SGCs, as demonstrated by high levels of VLCFA, increased glial fibrillary acidic protein (GFAP), as well as genes disrupting neuron-SGC connectivity. These findings suggest that lack of the peroxisomal half-transporter ABCD1 leads to PIEZO2-mediated mechanical allodynia as well as SGC dysfunction. Given the known supportive role of SGCs to neurons, this elucidates a novel mechanism underlying pain in X-linked adrenoleukodystrophy.

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

The n-6/n-3 metabolic pathway associated with hepatic glycerolipid portioning plays a key role in preventing obesity. In this nutrition metabolism study, we used in vivo monitoring techniques with 40 obese male Sprague-Dawley strain rats attached with jugular-vein cannula after obesity was induced by a high-fat diet to determine the molecular mechanism associated with hepatic glycerolipid partitioning involving the n-6/n-3 metabolic pathway. Rats were randomly assigned to four groups (10 animals per group), including one control group (CON, n-6/n-3 of 71:1) and three treatment groups (n-6/n-3 of 4:1, 15:1 and 30:1). They were fed with experimental diets for 60 days. Incorporation rates of [14C]-labeling lipid into glycerolipid in the liver were 28.87–37.03% in treatment groups fed with diets containing an n-6/n-3 ratio of 4:1, 15:1 and 30:1, which were significantly (p < 0.05) lower than that in the CON (40.01%). However, 14CO2 emission % of absorbed dose showed the opposite trend. It was significantly (p < 0.05) higher in a treatment groups (n-6/n-3 of 4:1, 15:1 and 30:1, 30.35–45.08%) than in CON (27.71%). Regarding the metabolic distribution of glycerolipid to blood from livers, phospholipid/total glycerolipid (%) was significantly (p < 0.05) lower in CON at 11.04% than in treatment groups at 18.15% to 25.15%. Moreover, 14CO2/[14C]-total glycerolipid (%) was significantly (p < 0.05) higher in treatment groups at 44.16–78.50% than in CON at 39.50%. Metabolic distribution of fatty acyl moieties flux for oxidation and glycerolipid synthesis in the liver were significantly (p < 0.05) better in order of 4:1 > 15:1 > 30:1 than in the CON. Our data demonstrate that n-6/n-3 of 4:1 could help prevent obesity by controlling the mechanism of hepatic partitioning through oxidation and esterification of glycerolipid in an obese animal biomodel.

이 연구의 목적은 국내 조직 구성원의 주관적 경력성공 관련 연구에서 주관적 경력 성공의 선행 변인들을 파악하여 네트워크 분석을 실시함으로써 주관적 경력성공 연구 의 동향을 파악하고, 주관적 경력성공에 대한 이론적 시사점과 실천적 시사점을 제시하 는 것이다. 이러한 연구 목적 달성을 위하여 국내에서 진행된 주관적 경력성공 관련 연 구들을 수집하고 연구 목적에 부합하는 125편의 연구를 선정하였고, 경력만족 95개, 직 무만족 61개, 고용가능성 70개의 키워드가 도출되었다. Net Miner4.3 평가판을 활용하여 네트워크 분석을 실시하였다. 분석 결과는 다음과 같다. 첫째, 주관적 경력성공의 하위 변인인 경력만족과 직무만족은 네트워킹과, 고용가능성은 성장욕구와 높은 연결중심성 을 갖는 것으로 나타났다. 둘째, 주관적 경력성공의 하위변인인 경력만족, 직무만족, 고 용가능성은 프로티언 경력태도와 가장 높은 출현빈도를 갖는 것을 확인할 수 있었다. 셋째, 주관적 경력성공의 선행변인으로 개인차원의 관련 변인뿐만 아니라 조직/사회 차 원의 관련 변인들이 중요함을 확인할 수 있었다. 이상의 연구결과를 바탕으로 조직 구 성원의 주관적 경력성공 함양을 위한 이론적 및 실천적 시사점과 향후 연구 방향을 제공하였다.

The metabolic distribution via blood from liver of glycerolipids by omega-6 to omega-3 fatty acid ( n -6 ∕ n -3) ratio in monogastric animal nutrition is very important. In vivo monitoring technique using jugular-vein-cannulated rats as a nutritional model for monogastric animal can yield important insights into animal nutrition. This study was conducted to determine the effect of different n -6 ∕ n -3 ratios ( 71:1 , 4:1 , 15:1 , 30:1 ) on metabolic distribution of glycerolipids newly synthesized and secreted in the liver of the rats and explore the mechanism involved. Regarding 14CO2 released from oxidation of glycerolipid metabolism, it was the highest (22.5 %) in groups with a n -6 ∕ n -3 ratio of 4:1 ( P ). The control group showed the highest total glycerolipid level, followed by the 30:1 , 15:1 , and 4:1 groups in order ( P ). When secreted triacylglycerol level of each group was compared with that of the control group, the 4:1 , 15:1 , and 30:1 groups were decreased by 36.3 %, 20.9 %, and 13.3 %, respectively ( P ). Regarding the distribution of phospholipid against total glycerolipid compared to the control group, the 4:1 , 15:1 , and 30:1 groups were 1.38, 1.29, and 1.17 times higher, respectively ( P ). In the comparison of 14CO2 emission against total glycerolipid compared with the control group, the 4:1 , 15:1 , and 30:1 groups were 1.61, 1.52, and 1.29 times higher, respectively ( P ). These results demonstrate that a dietary n -6 ∕ n -3 fatty acid ratio of 4:1 could significantly decrease harmful lipid levels in the blood by controlling the mechanism of metabolic distribution via blood from triglyceride and phospholipid newly synthesized in the liver of cannulated rat.

IntroductionIn conventional basic life support (c-BLS), a lone rescuer is recommended to start chest compressions (CCs) after activating the emergency medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs while calling for help using a handheld cellular phone with the other free hand. This study aimed to compare the quality of BLS between c-BLS and m-BLS.MethodsThis was a simulation study performed with a randomised cross-over controlled trial design. A total of 108 university students were finally enrolled. After training for both c-BLS and m-BLS, participants performed a 3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over order. The paired mean difference with SE between c-BLS and m-BLS was assessed using paired t-test.ResultsThe m-BLS had reduced lag time before the initiation of CCs (with a mean estimated paired difference (SE) of −35.0 (90.4) s) (pConclusionIn simulated lone-rescuer BLS, the m-BLS could deliver significantly earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary resuscitation.

Background A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries. Purpose To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA). Material and Methods The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively. Results The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781–121.926; P Conclusion A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.

High stocking density (HSD) and heat stress (HS) caused by climate change can lower blood homeostasis and negatively impact the behavioral traits of animals. The objective of this study was to explore the influence of stocking densities on behavioral traits, blood parameters, immune responses, and stress hormones in meat ducks (Cherry valley, Anas platyrhynchos) exposed to HS. A total of 320 meat ducks were assigned to four groups with different stocking densities using a randomized complete block design. The ducks were then reared for 42 days. The assigned density groups were as follows: (1) control group (CON, three birds m−2, normal environmental heat conditions); (2) low stocking density (LSD, three birds m−2, heat stress conditions); (3) medium stocking density (MSD, four birds m−2, heat stress conditions); and (4) high stocking density (HSD, six birds m−2, heat stress conditions). To induce HS, the environment of the poultry house was set to a temperature of 34±2∘C with a relative humidity of 70 % from 11:00 to 16:00 for the finisher period (from day 22 to day 42 of the rearing period). Concentrations of blood triacylglycerol, total cholesterol, low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were higher in the HS groups compared with the CON group, with HSD showing the highest levels (P < 0.05). The concentrations of high-density lipoprotein cholesterol (HDL-C) and glucose were lower in the HSD groups than in the CON group (P<0.05). Red blood cell (RBC) and platelet (PLT) counts were lower in HS groups compared with the CON group, with the HSD group displaying the lowest counts (P<0.05). Blood pH values were also higher in the HS groups than in the CON group, with the highest values observed in the HSD group (P<0.05). Concentrations of blood pCO2, HCO3, and TCO2 were higher in the HS groups than in the CON group, with HSD showing the lowest levels (P<0.05). The concentration of PO2 was higher in CON than in any of the HS groups, with the lowest levels found in the HSD group (P<0.05). The concentrations of blood IgG and corticosterone were increased in the HS groups compared with the CON group (P<0.05). Animal behavioral trait scores were also higher in HS groups than in the CON group (P<0.05); these scores were the highest in the HSD group. Overall, animal behavioral traits, blood biochemical parameters, and immune responses in meat ducks exposed to heat stress were highest in the HSD group, but not significantly different between the LSD or MSD groups.

This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke. RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6. A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214–5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761–0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score. Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.

The objective of this study was to determine effect of the diet containing 1200 betaine diet on blood biomarkers, electrolytes, gas and cecum short-chain fatty acid profile in meat ducks exposed to very hot environment (high relative humidity) conditions from d 21–42 (11:00 to 17:00 h; 33–43 °C; 70% relative humidity). On the day of hatching, a total of 320 meat ducks(average, 48.6 g body weight) were randomly assigned to 4 treatments with 4 pens per treatment and 20 ducks per pen for 42 d. Dietary treatments consisted of: 1) the control diet fed ad libitum, 2) the betaine diet fed ad libitum, 3) the betaine diet fed from 05:00 to 10:00 and 17:00 to 20:00 h, and 4) the betaine diet fed from 17:00 to 20:00 h. Ducks fed the betaine diets had greater body weight at d 42 than those fed the control diet (P

Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.

Background In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak. Methods This is a case–cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact. Results The index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient. Conclusions Our study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients. Trial registration NCT02605109, date of registration: 11th November 2015.

Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for predicting acute kidney injury (AKI). The purpose of this study was to evaluate the diagnostic performance of urinary NGAL in predicting AKI in sepsis patients in the emergency department.A total of 140 patients were enrolled. We compared serum procalcitonin and urinary NGAL concentrations between patients with local infection, sepsis, and septic shock, and between patients who did and did not develop AKI with sepsis. Receiver-operating characteristic curve analysis was used to evaluate the ability to predict AKI in sepsis patients.Both serum procalcitonin and urinary NGAL concentrations were significantly higher in the sepsis and septic shock groups than in the local infection group (both p 0.001). In sepsis patients, serum procalcitonin and urinary NGAL concentrations were higher in AKI patients than in those without AKI (p = 0.006, p 0.001, respectively). The area under the curve for predicting of AKI was higher for a urinary NGAL of 0.820 (95% confidence interval (CI) 0.721-0.895) than for a serum procalcitonin concentration of 0.76 (95% CI 0.597-0.800).Urinary NGAL concentration may predict AKI in patients with sepsis in the emergency department.

Summary The ingestion of egg has been reported to lower blood cholesterol, but the mechanism is unclear. Here, the biochemical metabolic mechanism by which the oral administration of egg yolk affects blood lipid reduction was investigated using normal rats. Blood triglycerides and total cholesterol were lower and high-density lipoprotein cholesterol was higher in an egg yolk-given group compared to other groups, while low-density lipoprotein cholesterol was increased in the pork belly oil-given group. HMG-CoA reductase activity was higher in the pork belly oil-given group, compared to an egg yolk-given group, a weekly alternating administration of pork belly oil and egg yolk-given group, and the saline-given normal control group. However, faecal excretions of total sterol, neutral sterol and acid sterol in an egg yolk-given group were higher compared to the pork belly oil-given group, a weekly alternating administration of pork belly oil and egg yolk-given group, and a normal control group. The results suggested that ingestion of egg decreased blood lipids.

Aims This study aimed to evaluate the effects of esmolol treatment for patients with refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest (OHCA). Methods This single-centre retrospective pre-post study evaluated patients who were treated between January 2012 and December 2015. Some patients had received esmolol (loading dose: 500μg/kg, infusion: 0-100μg/kg/min) for RVF (≥3 defibrillation attempts), after obtaining consent from the patient's guardian. Results Twenty-five patients did not receive esmolol (the control group), and 16 patients received esmolol. Sustained return of spontaneous circulation (ROSC) was significantly more common in the esmolol group, compared to the control group (56% vs. 16%, p=0.007). Survival and good neurological outcomes at 30 days, 3 months and at 6 months were >2-fold better in the esmolol group, compared to the control group, although these increases were not statistically significant. Conclusions The findings of our study suggest that administration of esmolol may increase the rate of sustained ROSC and ICU survival among patients with RVF in OHCA. Further larger-scale, prospective studies are necessary to determine the effect of esmolol for RVF in OHCA.

Aim This study compared endotracheal intubation (ETI) performance during cardiopulmonary resuscitation (CPR) between direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope ® ) by experienced intubators (>50 successful ETIs). Methods This was a prospective randomized controlled study conducted in an emergency department between 2011 and 2013. Intubators who used DL or VL were randomly allocated to ETI during CPR. Data were collected from recorded video clips and rhythm sheets. The success, speed, complications, and chest compressions interruption were compared between the two devices. Results Total 140 ETIs by experienced intubators using DL ( n =69) and VL ( n =71) were analysed. There were no significant differences between DL and VL in the ETI success rate (92.8% vs. 95.8%; p =0.490), first-attempt success rate (87.0% vs. 94.4%; p =0.204), and median time to complete ETI (51 [36–67] vs. 42 [34–62]s; p =0.143). In both groups, oesophageal intubation and dental injuries seldom occurred. However, longer chest compressions interruption occurred using DL (4.0 [1.0–11.0]s) compared with VL (0.0 [0.0–1.0]s) and frequent serious no-flow (interruption>10s) occurred with DL (18/69 [26.1%]) compared with VL (0/71) ( p 80 successful ETIs), frequent serious no-flow occurred in DL (14/55 [25.5%] vs. 0/57 in VL). Conclusions The ETI success, speed and complications during CPR did not differ significantly between the two devices for experienced intubators. However, the VL was superior in terms of completion of ETI without chest compression interruptions. Trial Registration Clinical Research Information Service (CRIS) in South Korea KCT0000849.

The metabolic distribution via blood from liver of glycerolipids by omega-6 to omega-3 fatty acid (n-6 / n-3) ratio in monogastric animal nutrition is very important. In vivo monitoring technique using jugular-vein-cannulated rats as a nutritional model for monogastric animal can yield important insights into animal nutrition. This study was conducted to determine the effect of different n-6 / n-3 ratios (71:1, 4:1, 15:1, 30:1) on metabolic distribution of glycerolipids newly synthesized and secreted in the liver of the rats and explore the mechanism involved. Regarding 14CO2 released from oxidation of glycerolipid metabolism, it was the highest (22.5 %) in groups with a n-6 / n-3 ratio of 4:1 (P

OBJECTIVE Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA. METHODS This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed. RESULTS In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm3, P=0.020). The best cutoff platelet count was 195,000/mm3, and patients with platelet counts of

Aim The cardiopulmonary resuscitation (CPR) guidelines recommend that endotracheal intubation (ETI) should be performed only by highly skilled rescuers. However, the definition of ‘highly skilled’ is unclear. This study evaluated how much experience with ETI is required for rescuers to perform successful ETI quickly without complications including serious chest compression interruption (interruption time Methods This was a clinical observation study using review of CPR video clips in an urban emergency department (ED) over 2 years. Accumulated ETI experience and performance of ETI were analysed. Main outcomes were 1) ‘qualified ETI’: successful ETI within 60 s without complications and 2) ‘highly qualified ETI’: successful ETI within 30 s without complications. Results We analysed 110 ETIs using direct laryngoscopy during CPR. The success rate improved and the time to successful ETI decreased with increasing experience; however, the total interruption time of chest compression did not decrease. A 90% success rate for qualified ETI required 137 experiences of ETIs (1218 days of training). A 90% success rate for highly qualified ETI required at least 243 experiences of ETIs (1973 days of training). Conclusions Accumulated experience can improve the ETI success rate and time to successful ETI during CPR. Because ETI must be performed quickly without serious interruption of chest compression during CPR, becoming proficient at ETI requires more experience than that required for non-arrest patients. In our analysis, more than 240 experiences were required to achieve a 90% success rate of highly qualified ETI.

Background: Early prediction of the clinical outcomes for health care-associated pneumonia (HCAP) patients is challenging. Objectives: This is the first study to evaluate procalcitonin (PCT) as a predictor of outcomes in HCAP patients. Methods: We conducted an observational study based on data for HCAP patients prospectively collected between 2011 and 2014. Outcome variables were intensive care unit (ICU) admission and 30-day mortality. PCT was categorized into three groups: 2.0 ng/ml. We analysed multiple variables including age, sex, comorbidities, clinical findings, and PCT group to assess their association with outcomes. Results: Of 245 HCAP patients, 99 (40.4%) were admitted to an ICU and 44 (18.0%) died within 30 days. The median PCT level was significantly higher in the ICU admission (1.19 vs. 0.4 ng/ml; p < 0.001) and 30-day mortality (3.3 vs. 0.4 ng/ml; p < 0.001) groups. In multivariate analysis, high PCT (>2.0 ng/ml) was strongly associated with ICU admission [odds ratio 3.734, 95% confidence interval (CI) 1.753-7.951; p = 0.001] and 30-day mortality (hazard ratio 2.254, 95% CI 1.250-5.340; p = 0.035). In receiver operating characteristic analysis, PCT had a poor discrimination power regarding ICU admission [0.695 of the area under the curve (AUC)] and a fair discrimination power regarding 30-day mortality in HCAP patients (0.768 of the AUC). Conclusions: High PCT on admission was strongly associated with ICU admission and 30-day mortality in HCAP patients. However, application of PCT alone seems to be limited to predicting outcomes.

To compare the first-attempt success in endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) using direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope(®)) among novice emergency physicians (EPs).This study is a historically controlled clinical design. From May 2011 to April 2013 out-of-hospital cardiac arrest patients were intubated during CPR by novice EPs. CPR data was automatically recorded by pre-installed video and subsequently analysed. The primary outcome was the success rate of the first-attempt at ETI. In addition, time to successful ETI from first-attempt (T-complete), duration of chest compression interruptions, and incidence of oesophageal intubation were compared.Of 305 patients undergoing ETI, 83 were intubated by novice EPs. The success rate of first-attempt ETI in the VL group (n=49) was higher than that in the DL group (n=34, 91.8% vs. 55.9%; p0.001). The median T-complete was significantly shorter with VL than with DL (37 [29-55] vs. 62 [56-110] s; p0.001). Oesophageal intubation was observed only in the DL group (n=6, 17.6%). The median duration of chest compression interruptions was greater with DL (7 [3-6] s) than with VL (0 [0-0] s). Improvements in ETI during CPR were observed in the VL group after the first 3 months, but not the DL group during regular use for 1 year.For novice EPs, the VL could significantly improve the first-attempt success in ETI during CPR while the DL couldn't improve it.

Aim. The optimal method for advanced airway management during cardiac arrest remains controversial. Most patients with out-of-hospital cardiac arrest (OHCA) in Korea are managed with a bag-valve mask by paramedics, while physicians perform advanced airway management in emergency departments (ED). Endotracheal intubation (ETI) has a risk of failure at the first attempt. By contrast, I-gel, a supraglottic airway device, is easier to insert than an endotracheal tube and shows a higher first-attempt success rate than ETI in out-of-hospital settings by paramedics in the United States. We reviewed the use of ETI and I-gel by ED physicians to assess the first attempt success rate in a hospital setting. Methods. We conducted a retrospective chart review of patients with non-traumatic OHCA who were managed with either ETI using a Macintosh laryngoscope, or I-gel in the ED of Korean hospital from January 2012 to January 2014. Results. Of 322 adult patients with non-traumatic OHCA, 160 received I-gel and 162 received ETI. The first-attempt success rate was higher in the I-gel group (96.9%) than in the ETI group (84.6%, p < 0.001). The time from arrival to obtaining advanced airway management was shorter in the I-gel group than in the ETI group. Conclusions. I-gel showed a better first-attempt success rate and shorter insertion time compared with ETI when performed by physicians in a hospital setting.

Background This retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis. Methods The data from 650 patients were divided into positive and negative appendectomy groups (histologically normal appendicitis). The patients in the acute appendicitis group were further sub-divided into simple and complicated appendicitis groups. Results The DNI was significantly higher in the positive group than in the negative appendectomy group (0.4 vs. −0.4, p

This study was carried out to investigate the effect of feeding fermented earthworm cast additives (FEC) on egg production, egg yolk fatty acids, blood lipid, cecal microorganism and fecal odor. The completely randomized experiment was applied, and the treatments were designed as 2 feeding regimens (control vs. FEC feeding), and FEC contained 3.5% top dressing to common diet. Egg production and egg weight of FEC group were significantly higher than that of control (p

Background The usefulness of plasma neutrophil gelatinase-associated lipocalin (NGAL) concentration for predicting the outcome of community-acquired pneumonia (CAP) is unclear. We evaluated the prognostic value of plasma NGAL concentration for predicting disease severity in comparison with other widely used biological markers of inflammation in patients with CAP. Methods NGAL, procalcitonin, and C-reactive protein concentrations were measured in 362 patients with CAP, who were followed for up to 30 days. The Pneumonia Severity Index (PSI) and CURB-65 score were obtained for all patients. Results The median plasma NGAL concentration increased with CAP severity classified according to the PSI. Plasma NGAL concentration was higher in nonsurvivors than in survivors. The AUC for predicting mortality was highest for NGAL concentration (0.871), followed by that for PSI (0.865) and procalcitonin concentration (0.744). Multivariable logistic regression analysis showed that plasma NGAL concentration was an independent predictor of hospital mortality in CAP patients. Plasma NGAL concentration correlated positively with C-reactive protein and procalcitonin concentrations, CURB-65 score, and PSI. Conclusions Plasma NGAL concentration is a valuable biological marker in the assessment of the severity and prediction of the prognosis of patients with CAP in the emergency department.

Introduction.The goal of this study was to determine the preventive effect on head injury by helmet type: full face helmet (FFH), open face helmet (OFH), and half-coverage helmet (HCH).Methods.This is a retrospective observational study of motorcycle crash victims between June 2012 and May 2015 in a rural town in Korea. We performed multiple linear regression to predict the effect of each type of helmet compared to unhelmeted status in preventing head injury using dependent variables based on the Abbreviated Injury Scale (AIS) and applied logistic regression modeling to compare the incidence of head injury.Results.Of the 738 patients, the number of FFH patients was 33.5%, followed by unhelmeted (27.8%), OFH (17.6%), and HCH (13.0%) patients. The FFH and OFH group had a lower head maximum AIS than unhelmeted group (coefficient: −0.368, 95% CI: −0.559 to −0.177 and coefficient: −0.235, 95% CI: −0.459 to −0.010, resp.) and only FFHs experienced a reduction effect of severe and minor head injury (OR: 0.206, 95% CI: 0.080 to 0.533 and OR: 0.589, 95% CI: 0.377 to 0.920, resp.).Conclusions.FFHs and OFHs reduce the risk of head injury, and FFHs have a more preventive effect on head injury in motorcycle crashes.

This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality.Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups.Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased.Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

Organophosphate (OP) intoxication remains a serious worldwide health concern, and many patients with acute OP intoxication have also consumed alcohol. Therefore, we evaluated the association of blood alcohol concentration (BAC) with mortality among patients with OP intoxication. We retrospectively reviewed records from 135 patients who were admitted to an emergency department (ED) for OP intoxication between January 2000 and December 2012. Factors that were associated with patient survival were identified via receiver operating characteristic curve, multiple logistic regression, and Kaplan-Meier survival analyses. Among 135 patients with acute OP poisoning, 112 patients survived (overall mortality rate: 17 %). The non-survivors also exhibited a significantly higher BAC, compared to the survivors [non-survivors: 192 mg/dL, interquartile range (IQR) 97-263 mg/dL vs. survivors: 80 mg/dL, IQR 0-166.75 mg/dL; p 0.001]. A BAC cut-off value of 173 mg/dL provided an area under the curve of 0.744 [95 % confidence interval (CI) 0.661-0.815], a sensitivity of 65.2 %, and a specificity of 81.2 %. A BAC of 173 mg/dL was associated with a significantly increased risk of 6-month mortality in the multiple logistic regression model (odds ratio 4.92, 95 % CI 1.45-16.67, p = 0.001). The Cox proportional hazard model revealed that a BAC of 173 mg/dL provided a hazard ratio of 3.07 (95 % CI 1.19-7.96, p = 0.021). A BAC of 173 mg/dL is a risk factor for mortality among patients with OP intoxication.