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Abstract Objective Motorcyclists face a higher risk of severe morbidity and mortality compared to automobile passengers. This study aimed to determine the injury characteristics of motorcyclists according to their body mass index (BMI). Methods A retrospective observational cross‐sectional study was conducted using data from the Emergency Department‐based Injury In‐depth Surveillance (EDIIS) registry. Motorcycle riders aged 18 or older who were injured and admitted to study hospitals between 2019 and 2020 were included. Patients were divided into three groups based on BMI cutoffs of 18.5 and 25 kg/m2: the low, optimal, and high BMI groups. The primary outcome was anatomical injury location according to the abbreviated injury scale. The secondary outcomes were the surgery and intensive care unit admission rate, and the 48‐h and 30‐day in‐hospital mortality. Multivariable logistic regression analysis was performed to assess the impact of BMI on outcomes. Results Among 1280 patients, the low and high BMI groups had higher risk of abdominal injuries (AIS ≥ 2) than the optimal BMI group, with adjusted odds ratios of 2.82 (95% CI 1.41–5.63) and 1.61 (95% CI 1.17–2.21), respectively. Only the low BMI group had a significant association with severe abdominal injury (AIS ≥ 3), with an adjusted odds ratio of 3.11 (95% CI 1.31–7.39). No significant association was found between BMI and surgery, ICU admission, or mortality. Conclusion The low BMI group was more likely to have an abdominal injury (AIS score ≥2 or AIS score ≥3) during motorcycle injuries. BMI was not associated with surgery, ICU admission, or mortality.

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a significant public health issue worldwide and is associated with low survival rates and poor neurological outcomes. The generation of optimal coronary perfusion pressure (CPP) via high-quality chest compressions is a key factor in enhancing survival rates. However, it is often challenging to provide adequate CPP in real-world cardiopulmonary resuscitation (CPR) scenarios. Based on animal studies and human trials on improving CPP in patients with nontraumatic OHCA, resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising technique in these cases. This study aims to investigate the benefits of REBOA adjunct to CPR compared with conventional CPR for the clinical management of nontraumatic OHCA. Methods This is a parallel-group, randomized, controlled, multinational trial that will be conducted at two urban academic tertiary hospitals in Korea and Taiwan. Patients aged 20–80 years presenting with witnessed OHCA will be enrolled in this study. Eligible participants must fulfill the inclusion criteria, and written informed consent should be collected from their legal representatives. Patients will be randomly assigned to the intervention (REBOA-CPR) or control (conventional CPR) group. The intervention group will receive REBOA and standard advanced cardiovascular life support (ACLS). Meanwhile, the control group will receive ACLS based on the 2020 American Heart Association guidelines. The primary outcome is the return of spontaneous circulation (ROSC). The secondary outcomes include sustained ROSC, survival to admission, survival to discharge, neurological outcome, and hemodynamic changes. Discussion Our upcoming trial can provide essential evidence regarding the efficacy of REBOA, a mechanical method for enhancing CPP, in OHCA resuscitation. Our study aims to determine whether REBOA can improve treatment strategies for patients with nontraumatic OHCA based on clinical outcomes, thereby potentially providing valuable insights and guiding further advancements in this critical public health area. Trial registration ClinicalTrials.gov NCT06031623. Registered on September 9, 2023

Abstract Background In patients with out‐of‐hospital cardiac arrest (OHCA), low blood pressure after return of spontaneous circulation (ROSC) can be a sign of hemodynamic instability. We aimed to investigate whether systolic blood pressure (SBP) measured immediately after ROSC is associated with survival on admission. Methods Patients with ROSC after OHCA between 2015 and 2018 were included. The primary outcome was survival on admission. Included patients were divided into three groups based on the SBP measured at the time of ROSC: group 1 (SBP ≤90 mmHg), group 2 (SBP 90–120 mmHg), and group 3 (SBP >120 mmHg). Multivariable logistic regression was used to investigate the relationship between the groups by SBP and outcomes. Results In the final analysis, 519 patients were included. In the restrictive cubic spline curve, the probability of achieving survival on admission increased gradually from low SBP to approximately 120–130 mmHg, then plateaued at a higher SBP. In the multivariable logistic regression analysis, group 1 was independently associated with decreased survival on admission compared to group 2. There was no significant difference between groups 2 and 3. Conclusions Low blood pressure (SBP ≤90 mmHg) at the time of ROSC was independently associated with a lower likelihood of survival on admission in patients with non‐traumatic OHCA. However, high blood pressure (SBP >120 mmHg) was not associated with a higher likelihood of survival. These suggest that low blood pressure measured in the prehospital phase can serve as an indicator predicting the poor short‐term prognosis of patients.

Background/Purpose: To investigate the virulence profiles and identify clinical and microbiological predictors of mortality in patients with carbapenem-resistant Acinetobacter baumannii (A. baumannii) bacteremia. Methods: This retrospective cohort study enrolled adult patients with carbapenem-resistant A. baumannii (CRAB). Multivariate logistic regression was used to identify the predictors of 30-day mortality. All isolates were subjected to real-time polymerase chain reaction for virulence factors and genotyped using multilocus sequence typing. Results: Among the 153 patients with CRAB bacteremia, 66 % received appropriate definitive antibiotic therapy. The in-hospital and 30-day mortality rates were 58.3 and 23.5 %, respectively. Ultimately, we enrolled 125 patients with CRAB bacteremia in the analysis, excluding early mortality cases. All CRAB isolates carried blaOXA-23 and blaOXA-51. The clinical strains belonged to 10 sequence types (STs), and the major genotypes were ST191, ST195, ST451, and ST784. The distribution of virulence factors included surface adhesion (Ata, 84.8 %; ChoP, 7.2 %), biofilm formation (OmpA, 76.8 %), killing of host cells (AbeD, 99.2 %), toxins (LipA, 99.2 %), and conjugation (BfmR, 90.4 %). In multivariate logistic regression analysis, hemodialysis due to acute kidney injury and moderate to severe thrombocytopenia were significant risk factors associated with 30-day mortality. However, microbiological factors were not significant predictors. Conclusions: Clinical factors such as hemodialysis due to acute renal injury and moderate to severe thrombocytopenia have a greater influence on mortality in CRAB bacteremia compared with microbiological factors.

Abstract This study aimed to characterize the molecular features and virulence profiles of carbapenem-resistant Acinetobacter baumannii (CRAB) isolates. Clinical CRAB isolates were obtained from blood cultures of adult patients with CRAB bacteremia, collected between July 2015 and July 2021 at a Korean hospital. Real-time polymerase chain reaction was used to detect 13 virulence genes, genotyping was conducted via multilocus sequence typing (MLST), and a Tenebrio molitor infection model was selected for survival analysis. Herein, 170 patients, from whom CRAB isolates were collected, showed the in-hospital mortality rate of 57.6%. All 170 clinical CRAB isolates harbored bla OXA-23 and bla OXA-51. MLST genotyping identified 11 CRAB sequence types (STs), of which ST191 was predominant (25.7%). Virulence genes were distributed as follows: basD, 58.9%; espA, 15.9%; bap, 92.4%; and ompA, 77.1%. In the T. molitor model, ST195 showed a significantly higher mortality rate (73.3% vs. 66.7%, p = 0.015) than the other groups. Our findings provide insights into the microbiological features of CRAB blood isolates associated with high mortality. We suggest a potential framework for using a T. molitor infection model to characterize CRAB virulence. Further research is warranted to elucidate the mechanisms by which virulence improves clinical outcomes.

Objective A new blind intubation device (BID) has been developed for endotracheal intubation. This study aimed to test the usability of the BID in comparison to direct laryngoscopy (DL) and video laryngoscopy (VL) with inexperienced healthcare providers for endotracheal intubation. Methods This was a randomized crossover simulation study. Participants who had conducted fewer than five live intubation sessions were included in the study. The manikin simulation was conducted using a Laerdal trainer airway manikin. Participants performed intubation using all three devices, DL, VL, and BID. The primary outcome was intubation success rate in the first pass the secondary outcome was intubation time to first ventilation, and the tertiary outcome was dental injury. Results A total of 45 healthcare workers who were novices in intubation participated in this study, including 13 physicians (interns), 14 emergency medical technicians, and 18 nurses. The intubation success rates in the first pass with BID, DL, and VL were 93.3%, 91.1%, and 97.8%, respectively (P=0.53). The intubation times to first ventilation with BID, DL, and VL were 13.15±6.16, 19.07±7.71, and 17.31±6.57 seconds, respectively (P

Background There are conflicting results regarding the association between body mass index and the prognosis of cardiac arrest patients. We investigated the association of the composition and distribution of muscle and fat with neurologic outcomes at hospital discharge in successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. Methods This prospective, single-centre, observational study involved adult OHCA patients, conducted between April 2019 and June 2021. The ratio of total skeletal muscle, upper limb muscle, lower limb muscle, and total fat to body weight was measured using InBody S10, a bioimpedance analyser, after achieving the return of spontaneous circulation. Restricted cubic spline curves with four knots were used to examine the relationship between total skeletal muscle, upper limb muscle, and lower limb muscle relative to total body weight and neurologic outcome at discharge. Multivariable logistic regression analysis was performed to assess an independent association. Results A total of 66 patients were enrolled in the study. The proportion of total muscle and lower limb muscle positively correlated with the possibility of having a good neurologic outcome. The proportion of lower limb muscle showed an independent association in the multivariable analysis (adjusted odds ratio, 2.29; 95% confidence interval, 1.06–13.98), and its optimal cut-off value calculated through receiver operating characteristic curve analysis was 23.1%, which can predict a good neurological outcome. Conclusions A higher proportion of lower limb muscle to body weight was independently associated with the probability of having a good neurologic outcome in OHCA patients.

Background : This study explored emergency physicians’ experiences and perspectives related to brain death organ tissue donation (OTD) after the enforcement of the Life-Sustaining Treatment (LST) Decision Act in Korea. Methods : Using the Braun and Clarke thematic analysis method, this qualitative study analyzed interview data—comprising experiences and perspectives of brain death OTD since the LST Decision Act—of 10 emergency physicians who specialized in targeted temperature management (TTM) and cared for post-cardiac arrest patients. Results : Data analysis revealed 13 subthemes and 5 themes: the LST Decision Act is easier to explain to family members than brain death OTD, but it does not fit well in an emergency medical setting; many family members decide to stop LST even before physicians mention brain death or OTD; family members view stopping LST as being about comforting patients without bothering them, and decision-makers are therefore no longer willing to choose OTD; stopping LST does not always result in brain death, but cases of brain death are preceded by stopping LST; and since the LST Decision Act, the number of TTM cases and potential brain death donors has decreased. Conclusions: Unless a supplementary policy that connects stopping LST to brain death OTD is prepared, the withdrawal of LST in patients resuscitated after cardiac arrest is expected to continue, and brain death OTD is expected to decrease.

Objective The clinical benefit of automatic temperature control devices remains unclear. We investigated the outcomes of out-of-hospital cardiac arrest (OHCA) survivors who had undergone either target temperature management (TTM) with a temperature feedback system (TFS) or maintenance of normothermia without a TFS during post-resuscitation care. Methods This study was a retrospective analysis of a multicenter prospective cohort of OHCA survivors who had received postcardiac arrest care from August 2014 to December 2018. The overlap propensity score weighting method was applied for adjustment between groups. Results A total of 405 OHCA survivors were included. TTM with a TFS and normothermia without a TFS were applied to 318 and 87 patients, respectively. Fever events were more common in patients with normothermia without a TFS. After propensity score matching, no statistically significant differences were observed in the 1-month good neurologic outcome (odds ratio 0.99, 95% confidence interval [CI] 0.56–1.25) or survival rate (odds ratio 1.25, 95% CI 0.88–1.78). Conclusion No significant differences in the 1-month neurologic outcome were observed between patients receiving TTM with a TFS and those undergoing normothermia without a TFS.

Abstract Background The effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods This multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (

The low survival rate of out-of-hospital cardiac arrest (OHCA) patients is a global public health challenge. We analyzed the relationship between the number of prehospital EMS personnel and survival admission, survival discharge, and good neurologic outcomes in OHCA patients. This was a retrospective observational study. Adult nontraumatic OHCA patients from January 1, 2015, to December 31, 2018, were included from 12 cities in the Gyeonggi province, a metropolitan area located in the suburbs of the capital of the Republic of Korea. By comparing the insufficient EMS team (four or five EMS personnel) and the sufficient EMS team (six EMS personnel), we showed the survival rate of each group. Using propensity score matching, we reduced the bias of the confounding variables. A total of 3,632 OHCA patients were included. After propensity score matching, survival to admission was higher in the sufficient EMS team than in the insufficient EMS team (odds ratio (OR): 1.38, 95% confidence interval (CI): 1.04–1.84, P=0.03). Survival-to-discharge was similar (OR: 1.70, CI: 1.20–2.40, P=0.03), but there was no significant outcome in good neurologic outcomes (OR: 0.88, CI: 0.57–1.36, P=0.58). Our findings suggest that a sufficient EMS team (six EMS personnel) could improve the survival admission and discharge of OHCA patients compared to an insufficient EMS team (four or five EMS personnel). However, there was no significant difference in neurologic outcomes according to the number of EMS personnel.

Abstract Background The 2015 AHA guidelines recommend that amiodarone should be used for patients with refractory ventricular fibrillation (RVF). However, the optimal time interval between the incoming call and amiodarone administration (call-to-amiodarone administration interval) in RVF patients has not been investigated. We hypothesized that the time elapsed until amiodarone administration could affect the neurological outcome at hospital discharge in patients with RVF. Methods and results This study is a retrospective analysis of prospectively collected data. One hundred thirty-four patients were enrolled. In univariate logistic regression, the probability of a good neurological outcome at hospital discharge decreased as the time elapsed until amiodarone administration increased (OR 0.89 [95% CI = 0.80–0.99]). In multivariate logistic regression, the patients who were administered amiodarone in less than 20 min showed higher rates of prehospital ROSC, survival at hospital arrival, any ROSC, survival at admission, survival to discharge, and good CPC at hospital discharge. The call-to-amiodarone administration interval of ≤20 min (OR 6.92, 95% CI 1.72–27.80) was the independent factor affecting the neurological outcome at hospital discharge. Conclusion Early amiodarone administration (≤ 20 min) showed better neurological outcome at hospital discharge for OHCA patients who showed initial ventricular fibrillation and subsequent RVF.

Following the publication of the original article [1], the authors unfortunately became aware of some typesetting and resolution problems in Figs. 1 and 2.

Introduction. Refractory shockable rhythm has a high mortality rate and poor neurological outcome. Treatments for refractory shockable rhythm presenting after defibrillation and medical treatment are not definite. We conducted research on the application of double simultaneous defibrillation (DSiD) for refractory shockable rhythms. Methods. This is a retrospective pilot study performed using medical records from 1 January 2016 to 31 December 2017. The prephase was from January to December 2016. The post-phase was from January to December 2017. During the prephase, we conducted conventional defibrillation with one defibrillator, and during the post-phase, we conducted DSiD using two defibrillators. Primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and good neurological outcome at 12 months. Statistical analysis was conducted using Fisher’s exact test. Data were regarded statistically significant when p

Objective. Heart rate (HR), an essential vital sign that reflects hemodynamic stability, is influenced by myocardial oxygen demand, coronary blood flow, and myocardial performance. HR at the time of the return of spontaneous circulation (ROSC) could be influenced by the β1-adrenergic effect of the epinephrine administered during cardiopulmonary resuscitation (CPR), and its effect could be decreased in patients who have the failing heart. We aimed to investigate the association between HR at the time of ROSC and the outcomes of adult out-of-hospital cardiac arrest (OHCA) patients. Methods. This study was a secondary analysis of a cardiac arrest registry from a single institution from January 2008 to July 2014. The OHCA patients who achieved ROSC at the emergency department (ED) were included, and HR was retrieved from an electrocardiogram or vital sign at the time of ROSC. The patients were categorized into four groups according to the HR (bradycardia (HR

Abstract 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

Quercetin (QE; 3,5,7,3′,4′-pentahydroxyflavone), a well-known flavonoid, has been shown to prevent against neurodegenerative disorders and ischemic insults. However, few studies are reported regarding the neuroprotective mechanisms of QE after ischemic insults. Therefore, in this study, we investigated the effects of QE on ischemic injury and the expression of antioxidant enzymes in the hippocampal CA1 region of gerbils subjected to 5 minutes of transient cerebral ischemia. QE was pre-treated once daily for 15 days before ischemia. Pretreatment with QE protected hippocampal CA1 pyramidal neurons from ischemic injury, which was confirmed by neuronal nuclear antigen immunohistochemistry and Fluoro-Jade B histofluorescence staining. In addition, pretreatment with QE significantly increased the expression levels of endogenous antioxidant enzymes Cu/Zn superoxide dismutase, Mn superoxide dismutase, catalase and glutathione peroxidase in the hippocampal CA1 pyramidal neurons of animals with ischemic injury. These findings demonstrate that pretreated QE displayed strong neuroprotective effects against transient cerebral ischemia by increasing the expression of antioxidant enzymes.

Objective(s): The alteration of glucose transporters is closely related with the pathogenesis of brain edema. We compared neuronal damage/death in the hippocampus between adult and young gerbils following transient cerebral ischemia/reperfusion and changes of glucose transporter-1(GLUT-1)-immunoreactive microvessels in their ischemic hippocampal CA1 region. Materials and Methods: Transient cerebral ischemia was developed by 5-min occlusion of both common carotid arteries. Neuronal damage was examined by cresyl violet staining, NeuN immunohistochemistry and Fluoro-Jade B histofluorescence staining and changes in GLUT-1 expression was carried out by immunohistochemistry. Results: About 90% of pyramidal neurons only in the adult CA1 region were damaged after ischemia/reperfusion; in the young, about 53 % of pyramidal neurons were damaged from 7 days after ischemia/reperfusion. The density of GLUT-1-immunoreactive microvessels was significantly higher in the young sham-group than that in the adult sham-group. In the ischemia-operated-groups, the density of GLUT-1-immunoreactive microvessels was significantly decreased in the adult and young at 1 and 4 days post-ischemia, respectively, thereafter, the density of GLUT-1-immunoreactive microvessels was gradually increased in both groups after ischemia/reperfusion. Conclusion: CA1 pyramidal neurons of the young gerbil were damaged much later than that in the adult and that GLUT-1-immunoreactive microvessels were significantly decreased later in the young. These data indicate that GLUT-1 might differently contribute to neuronal damage according to age after ischemic insults.

Ischemic preconditioning (IPC) is a condition of sublethal transient global ischemia and exhibits neuroprotective effects against subsequent lethal ischemic insult. We, in this study, examined the neuroprotective effects of IPC and its effects on immunoreactive changes of antioxidant enzymes including superoxide dismutase (SOD) 1 and SOD2, catalase (CAT) and glutathione peroxidase (GPX) in the gerbil hippocampal CA1 region after transient forebrain ischemia. Pyramidal neurons of the stratum pyramidale (SP) in the hippocampal CA1 region of animals died 5 days after lethal transient ischemia without IPC (8.6% (ratio of remanent neurons) of the sham-operated group); however, IPC prevented the pyramidal neurons from subsequent lethal ischemic injury (92.3% (ratio of remanent neurons) of the sham-operated group). SOD1, SOD2, CAT and GPX immunoreactivities in the sham-operated animals were easily detected in pyramidal neurons in the stratum pyramidale (SP) of the hippocampal CA1 region, while all of these immunoreactivities were rarely detected in the stratum pyramidale at 5 days after lethal transient ischemia without IPC. Meanwhile, their immunoreactivities in the sham-operated animals with IPC were similar to (SOD1, SOD2 and CAT) or higher (GPX) than those in the sham-operated animals without IPC. Furthermore, their immunoreactivities in the stratum pyramidale of the ischemia-operated animals with IPC were steadily maintained after lethal ischemia/reperfusion. Results of western blot analysis for SOD1, SOD2, CAT and GPX were similar to immunohistochemical data. In conclusion, IPC maintained or increased the expression of antioxidant enzymes in the stratum pyramidale of the hippocampal CA1 region after subsequent lethal transient forebrain ischemia and IPC exhibited neuroprotective effects in the hippocampal CA1 region against transient forebrain ischemia.

Background. In South Korea, the prehospital treatment of cardiac arrest is generally led by an emergency medical technician-paramedic (EMT-P), and defibrillation is delivered by the automatic external defibrillator (AED). This study aimed at examining the effects of direct medical guidance by an emergency physician through a video call that enabled prompt manual defibrillation. Methods. Two-hundred eighty-eight paramedics based in Gyeonggi Province were studied for four months, from July to November 2015. The participants were divided into 96 teams, and the teams were randomly divided into either a conventional group that was to use the AED or a video call guidance group which was to use the manual defibrillators, with 48 teams in each group. The time to first defibrillation, total hands-off time, and hands-off ratio were compared between the two groups. Results. The median value of the time to the first defibrillation was significantly shorter in the video call guidance group (56 s) than in the conventional group (73 s) (p

Purpose: Although several cases of anatomical variants of the proximal portion of the long head of the biceps brachii tendon have been reported, most are case reports on single patients; few studies have investigated the classification and incidence of this phenomenon. We aimed to classify the variants of the long head of the biceps brachii tendon by their morphology and characterize them in regard to incidence, demography, and the relationship with biceps tendon or other shoulder diseases. Methods: We retrospectively reviewed 760 arthroscopic images spanning 31 months from October 2008 and found 45 variations of the proximal portion of the long head of the biceps brachii tendon. We classified the variants using Dierickx classification system and calculated the incidence of each subtype. We investigated age, gender, bicipital morbidity rate, procedure rate, and the frequency of related shoulder disease among the variant groups using patient data and compared the groups to normal patients. Results: The overall incidence of variants was 6.5% (67.4%, mesotenon; 32.6%, adherent; 0% split (SPL); and 0% absent (ABS) type). Morbidity and procedure rates of the long head of the biceps (LHB) tendon in the variant group (27.9% and 25.6%, respectively) were lower than in the normal group (40.5% and 38.9%, respectively), but the difference was not statistically significant ( p = 0.102 and 0.082, respectively). Rotator cuff tear was significantly less common in the mesotenon (44.8%) group than in the normal group (62.4%; p = 0.004). Shoulder joint instability was more prevalent in the mesotenon (27.6%) group than in the normal group (14.9%), but the difference was not significant ( p = 0.305). The distribution of other shoulder diseases in the adherent group was similar to that in the normal group. Conclusions: The incidence of variants of the long head of the biceps brachii tendon was 6.5%, and most variants were mesotenon or adherent type. The SPL and ABS types were rare. Morbidity and procedure rates of the LHB were not significantly different between the variant group and the normal group, and rotator cuff tear was less common in the mesotenon group.

Monocarboxylate transporters (MCTs), which carry monocarboxylates such as lactate across biological membranes, have been associated with cerebral ischemia/reperfusion process. In this study, we studied the effect of ischemic preconditioning (IPC) on MCT4 immunoreactivity after 5 minutes of transient cerebral ischemia in the gerbil. Animals were randomly designated to four groups (sham-operated group, ischemia only group, IPC + sham-operated group and IPC + ischemia group). A serious loss of neuron was found in the stratum pyramidale of the hippocampal CA1 region (CA1), not CA2/3, of the ischemia-only group at 5 days post-ischemia; however, in the IPC + ischemia groups, neurons in the stratum pyramidale of the CA1 were well protected. Weak MCT4 immunoreactivity was found in the stratum pyramidale of the CA1 in the sham-operated group. MCT4 immunoreactivity in the stratum pyramidale began to decrease at 2 days post-ischemia and was hardly detected at 5 days post-ischemia; at this time point, MCT4 immunoreactivity was newly expressed in astrocytes. In the IPC + sham-operated group, MCT4 immunoreactivity in the stratum pyramidale of the CA1 was increased compared with the sham-operated group, and, in the IPC + ischemia group, MCT4 immunoreactivity was also increased in the stratum pyramidale compared with the ischemia only group. Briefly, present findings show that IPC apparently protected CA1 pyramidal neurons and increased or maintained MCT4 expression in the stratum pyramidale of the CA1 after transient cerebral ischemia. Our findings suggest that MCT4 appears to play a significant role in the neuroprotective mechanism of IPC in the gerbil with transient cerebral ischemia.

Objective International Liaison Committee on Resuscitation guidelines advocate an arterial saturation of 94% to 96% after return of spontaneous circulation (ROSC). However, a few clinical trials have investigated the impact of postresuscitative O2 therapy after cardiac arrest. We studied whether early hyperoxemia is associated with a poor post-ROSC outcome after in-hospital cardiac arrest. Methods We retrospectively reviewed patients who experienced an in-hospital cardiac arrest from January 2005 to January 2011. Based on the results of the first arterial blood gas analysis (ABGA) within 10 minutes and a second ABGA from 60 to 120 minutes after ROSC, patients were classified into three groups: hyperoxemia (PaO2 ≥ 300 mmHg), normoxemia (300 mmHg > PaO2 ≥ 60 mmHg), and hypoxemia (PaO2 < 60 mmHg or ratio of PaO2 to fraction of inspired oxygen < 300). We examined whether early hyperoxemia was associated with survival and neurological outcome. Results There were 792 patients who met the inclusion criteria: 638 (80.6%) in the hypoxemia group, 62 (7.8%) in the normoxemia group, and 92 (11.6%) in the hyperoxemia group. Multiple logistic regression analysis showed that hyperoxemia was not associated with survival (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.30 to 3.84) or neurological outcome (OR, 1.03; 95% CI, 0.31 to 3.40). Conclusion Postresuscitation hyperoxemia was not associated with survival or neurological outcome in patients with ROSC after in-hospital cardiac arrest.

In the current work, stable prenucleated PbS quantum dots (QDs) with a sub-nanometer (0.8 nm) size have been successfully synthesized via a systematically designed experiment. A detailed analysis of critical nucleation, growth, and stability for such ultrasmall prenucleated clusters is done. The experimental strategy is based on controlled concentration, temperature and injection of respective precursors, thus enabling us to control nucleation rate and separation of stable sub-nanometer PbS QDs with size 0.8 nm. Significantly, by providing additional thermal energy to sub-nanometer PbS QDs, we achieved the fully nucleated cubic crystalline structure of PbS with size of around 1.5 nm. The size and composition of the prenucleated QDs are investigated by sophisticated tools like X-ray photoelectron spectroscopy (XPS) and medium energy ion scattering (MEIS) spectroscopy which confirms the synthesis of PbS with Pb2+ rich surface while the UV-Vis spectroscopy and X-ray diffraction (XRD) data suggests an alternative crystallization path. Non-classical nucleation theory is employed to substantiate the growth mechanism of prenucleated PbS QDs.

Purpose: Previous studies have suggested that serum phosphate concentration is a prognostic factor in critically ill patients. However, the association between changes in serum phosphate levels and prognosis of patients with trauma remains unclear. Materials and Methods: This study included patients with severe trauma who were treated at the emergency department. Delta phosphate (Δ phosphate) was defined as the difference between serum phosphate concentrations measured at baseline and after 24 hours from the initial measurement. Patients were divided into five groups according to their Δ phosphate levels: group I (Δ phosphate <-2 mg/dL), group II (Δ phosphate -2 to -0.5 mg/dL), group III (Δ phosphate -0.5 to 0.5 mg/dL), group IV (Δ phosphate 0.5 to 2 mg/dL), and group V (Δ phosphate ≥2 mg/dL). Results: Overall, 1905 patients with severe trauma were included in the analysis. The 30-day mortality was the lowest in group III and tended to increase in groups with a larger Δ phosphate in both the positive and negative directions (group I: 13.7%, group II: 6.8%, group III: 4.6%, group IV: 6.6%, and group V: 26.8%). In multivariable analysis with group III as the reference group, the odds ratios (ORs) of mortality were statistically significant in group IV [OR, 1.92; 95% confidence interval (CI), 1.05-3.56] and group V (OR, 5.28; 95% CI, 2.47-11.24). Conclusion: An increase in serum phosphate concentrations 24 hours after the initial measurement could be considered as an independent prognostic factor in patients with severe trauma. [ABSTRACT FROM AUTHOR]

Calling is one of the unique amphibian characteristics that facilitates social communication and shows individuality; however, it also makes them vulnerable to predators. Researchers use amphibian call properties to study their population status, ecology, and behavior. This research scope has recently broadened to species identification and taxonomy. Dryophytes flaviventris has been separated from the endangered anuran species, D. suweonensis, based on small variations in genetic, morphometric, and temporal call properties observed in South Korea. The Chilgap Mountain (CM) was considered as the potential geographic barrier for the speciation. However, it initiated taxonomic debates as CM has been hardly used and is considered a potential barrier for other species. The calls of populations from both sides are also apparently similar. Thus, to verify the differences in call properties among populations of D. suweonensis sensu lato (s.l.; both of the species), we sampled and analyzed call data from five localities covering its distribution range, including the southern (S) and northern (N) parts of CM. We found significant differences in many call properties among populations; however, no specific pattern was observed. Some geographically close populations, such as Iksan (S), Wanju (S), and Gunsan (S), had significant differences, whereas many distant populations, such as Pyeongtaek (N) and Wanju (S), had no significant differences. Considering the goal of this study was only to observe the call properties, we cautiously conclude that the differences are at the population level rather than the species level. Our study indicates the necessity of further investigation into the specific status of D. flaviventris using robust integrated taxonomic approaches, including genetic and morphological parameters from a broader array of localities. [ABSTRACT FROM AUTHOR]