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Abstract Background The connection between early postoperative fever and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy remains unclear. This study aimed to investigate this association and assess the predictive value of early postoperative fever for CR-POPF. Methods This retrospective observational study included adult patients who underwent pancreaticoduodenectomy at a tertiary teaching hospital between 2007 and 2019. Patients were categorized into those with early postoperative fever (≥ 38 °C in the first 48 h after surgery) and those without early postoperative fever groups. Weighted logistic regression analysis using stabilized inverse probability of treatment weighting (sIPTW) and multivariable logistic analysis were performed. The c-statistics of the receiver operating characteristic curves were calculated to evaluate the impact on the predictive power of adding early postoperative fever to previously identified predictors of CR-POPF. Results Of the 1997 patients analyzed, 909 (45.1%) developed early postoperative fever. The overall incidence of CR-POPF among all the patients was 14.3%, with an incidence of 19.5% in the early postoperative fever group and 9.9% in the group without early postoperative fever. Early postoperative fever was significantly associated with a higher risk of CR-POPF after sIPTW (adjusted odds ratio [OR], 1.73; 95% confidence interval [CI], 1.34–2.22; P

Abstract Background This study evaluated the effect of head rotation on the first-attempt success rate of i-gel insertion, aiming to alleviate the effect of gravity on the tongue and reduce resistance between the device and the tongue. Methods Adult surgical patients were randomized to standard and head rotation technique groups. In the head rotation technique group, patients’ heads were maximally rotated to the left before i-gel insertion. The primary endpoint was the first-attempt success rate. Secondary endpoints included the success rate within two attempts (using the allocated technique), time required for successful i-gel placement within two attempts, and success rate at the third attempt (using the opposite technique). Results Among 158 patients, the head rotation technique group showed a significantly higher first-attempt success rate (60/80, 75.0%) compared to the standard technique group (45/78, 57.7%; P = 0.021). The success rate within two attempts was similar between the groups (95.0% vs. 91.0%, P = 0.326). The time required for successful i-gel placement was significantly shorter in the head rotation technique (mean [SD], 13.4 [3.7] s vs. 16.3 [7.8] s; P = 0.030). When the head rotation technique failed, the standard technique also failed in all cases (n = 4), whereas the head rotation technique succeeded in five out of the seven patients where the standard technique failed. Conclusions The head rotation technique significantly improved the first-attempt success rate and reduced the time required for successful i-gel insertion. It was effective when the standard technique failed. The head rotation technique may be an effective primary or alternative method for i-gel insertion. Clinical trial registration ClinicalTrials.gov (NCT05201339).

Abstract The optimal anesthetic agent for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) and its impact on the recovery profiles remain uncertain. We compared the recovery and hemodynamic parameters between the remimazolam-flumazenil and propofol groups during RFCA. Patients were randomized into the remimazolam-flumazenil and propofol groups. The primary outcome measure was the time to eye opening following the discontinuation of anesthetic agents. Secondary outcomes included time to extubation, time to discharge from the operating room, intraprocedural hemodynamic variables and postoperative quality outcomes. Fifty-three patients were included in the final analysis (n = 26 in the remimazolam-flumazenil and n = 27 in the propofol group). The time to eye opening was significantly shorter in the remimazolam-flumazenil group compared to the propofol group (median [interquartile range]: 174 [157–216] vs. 353 [230–483] s, P

Background We aimed to investigate the optimal surgical timing in patients with preoperative coronavirus disease 2019 (COVID-19) infection to minimize postoperative morbidity and mortality during the COVID-19 vaccination era. Methods The Korean nationwide data on patients who underwent standard surgery under general anesthesia in 2021 were analyzed. Patients were categorized based on the time from COVID-19 diagnosis to surgery: 0–4, 5–8, > 8 weeks, and those without preoperative COVID-19 infection. Multivariable logistic regression analysis, considering preoperative COVID-19 vaccination status (fully vaccinated vs. unvaccinated or partially vaccinated), was performed to associate the preoperative COVID-19 infection timing with 30- and 90-day postoperative mortality and 30-day respiratory complications. Results Among the 750,175 included patients, 28.2% were preoperatively fully vaccinated. Compared with patients without prior COVID-19 infection, those who had surgery 0–4 weeks (adjusted odds ratio [OR]: 4.28, 95% CI [1.81, 10.13], P = 0.001) and 5–8 weeks (adjusted OR: 3.38, 95% CI [1.54, 7.44], P = 0.002) after COVID-19 infection had a significantly increased risk of 30-day mortality. Preoperative full vaccination was significantly associated with a decrease in 90-day mortality (adjusted OR: 0.93, 95% CI [0.89, 0.98], P = 0.007) and 30-day respiratory complications (adjusted OR: 0.85, 95% CI [0.82, 0.87], P < 0.001), but not with 30-day mortality (P = 0.916). Conclusions COVID-19 infection eight weeks preoperatively was associated with an increased 30-day postoperative mortality. Preoperative full vaccination was not associated with 30-day mortality but was related to lower risk of 90-day mortality and 30-day respiratory complications.

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose.

Abstract Background This field evaluation was designed to evaluate the efficacy of a new porcine reproductive and respiratory syndrome virus‐2 (PRRSV‐2) modified live virus vaccine at three independent pig farms. Methods Three farms were selected for this study based on their respiratory disease status caused by PRRSV‐2 infection in post‐weaning and growing pigs. Each farm housed a total of 40, 18‐day‐old pigs that were randomly allocated to one of two treatment groups. Pigs were administered a 1.0 mL dose of the bivalent vaccine intramuscularly at 21 days of age in accordance with the manufacturer's recommendations, whereas unvaccinated pigs were administered a single dose of phosphate buffered saline at the same age. Results Vaccinated groups were measured and calculated significantly (p

Background: Although non-steroidal anti-inflammatory drugs (NSAIDs) are useful options for multimodal opioid-sparing analgesia, their effect on anastomotic leakage (AL) after colorectal surgery remains unclear. We aimed to investigate the association between early postoperative NSAID use and AL occurrence in patients who underwent colorectal cancer surgery at a high-volume tertiary care center. Methods: This retrospective observational study included all adult patients who underwent elective colorectal cancer resection surgery during 2011–2021 at a tertiary teaching hospital. Based on NSAID use within five postoperative days, patients were classified into either NSAID or no NSAID groups. We performed multivariable logistic regression analysis for the primary outcome, AL, within the first 30 postoperative days, before and after propensity score analysis using stabilized inverse probability of treatment weighting (sIPTW). Results: Among the 7928 patients analyzed, 0.6% experienced AL after surgery. The occurrence rates of AL were 1.7% (12/714) and 0.5% (37/7214) in the NSAID and no NSAID groups, respectively. Multivariable logistic regression analysis revealed that early postoperative NSAID use was significantly associated with AL [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.76–6.60; P

Abstract Although pulmonary artery catheter (PAC) has been used during liver transplantation surgery, the usefulness of PAC has rarely been investigated. We evaluated whether the use of PAC is associated with better clinical outcomes compared to arterial waveform-based monitoring after liver transplantation. A total of 1565 cases undergoing liver transplantation were reviewed. We determined whether patients received PAC or not and divided our cohort into the PAC with hemodynamic monitoring using PAC and the non-PAC with arterial waveform-based monitoring using FloTrac-Vigileo. Propensity score matching was performed. Acute kidney injury (AKI), early allograft dysfunction (EAD) and 1-year all-cause mortality or graft failure were compared in the matched cohorts. Logistic regression analysis was performed in the inverse probability of treatment-weighted (IPTW) cohort for postoperative EAD and AKI, respectively. Five-year overall survival was compared between the two groups. In the matched cohort, there was no significant difference in the incidence of AKI, EAD, length of hospital or ICU stay, and 1-year all-cause mortality between the groups. In the IPTW cohort, the use of PAC was not a significant predictor for AKI or EAD (AKI: odds ratio (95% confidence interval) of 1.20 (0.47–1.56), p = 0.229; EAD: 0.99 (0.38–1.14), p = 0.323). There was no significant difference in the survival between groups after propensity score matching (Log-rank test p = 0.578). In conclusion, posttransplant clinical outcomes were not significantly different between the groups with and without PAC. Anesthetic management without the use of PAC may be possible in low-risk patients during liver transplantation. The risk should be carefully assessed by considering MELD scores, ischemic time, surgical history, previous treatment of underlying liver disease, and degree of portal and pulmonary hypertension. Registration: https://clinicaltrials.gov/ct2/show/NCT05457114 (registration date: July 15, 2022).

Recently, many researchers have made progress in studies aimed at enhancing the power conversion efficiency (PCE) of n-type dye-sensitized solar cells (DSSCs). This paper presents a systematic investigation focused on improving the PCEs of n-type DSSCs by synthesizing TiO2 nanoparticle active layers and varying their thickness. The study found that increasing the TiO2 layer thickness up to 17 µm resulted in a steady 41% increase in PCE, primarily owing to the enhanced photocurrent density in the n-type DSSCs. This improvement is attributed to the enhanced light harvesting effect. As a result, n-type DSSC with 17 µm thick TiO2 layer demonstrates a relatively high Jsc value of 8.42 mA/cm2, achieving an overall PCE of 4.02%. In contrast, the n-type DSSC with a 6 µm thick TiO2 layer exhibits a much lower Jsc value of 5.55 mA/cm2, leading to a reduced PCE. This result represents at least a 52% increase in current density, indicating that the optimal thickness of the TiO2 active layer is a critical factor influencing the PCE of DSSCs.

ABSTRACTMany studies have analyzed causation factors for piracy, but failed to quantitatively examine how piracy trends in regions have changed. The research aimed to establish the changing patterns of maritime piracy in Africa. The study utilized world piracy data from the National Geospatial Intelligence Agency, which was analyzed using spatial auto-correlation tools. Getis-Ord Gi* statistic identified piracy clusters and hot spot comparison tool compared the hot spot layers in East and West Africa. Autocorrelation analysis results suggest changing frequency of piracy incidents in the study areas before and after 2012. The mean Getis-Ord Gi* values for East Africa were 0.35946 and 0.07839 before and after 2012, illustrating agreater change. However, West Africa mean values were 0.60917 and 0.43408 pre and post 2012, suggesting minimal change. The comparison analysis results generated a smaller similarity value for East Africa (0.43350) and a larger index for West Africa (0.9867). West Africa recorded many incidents in the study period; hence, piracy intensity was almost similar. The study revealed high similarities in piracy events in West Africa, and low similarities in East Africa pre and post 2012. These have implications for understanding the changing dynamics of maritime piracy in Africa, and asserting spatial analysis.

Summary: Current trends in wound care research focus on creating dressings for diverse wound types, aiming to effectively control the wound healing process. We proposed a wound dressing composed of oxidized hyaluronic acid and amine gelatin with embedded lysine-modified gelatin nanoparticles (HGel-GNPs-lysine). This dressing improves mechanical properties and reduces degradation rates. The storage modulus for HGel-GNPs-lysine was 3,800 Pa, exceeding that of HGel (1,750 Pa). The positively charged surface of GNPs-lysine effectively eliminated Escherichia coli and Staphylococcus aureus. In a diabetic mice model (C57BL/6), HGel-GNPs-lysine immobilized with basic-fibroblast growth factor promoted granulation tissue thickness and collagen density. Gene expression analysis indicated that HGel-GNPs-lysine reduced inflammation and enhanced angiogenesis. This study highlights that HGel-GNPs-lysine could offer alternative treatment strategies for regulating the inflammatory response at the injury site in wound dressing applications.

This study investigates the use of an alkaline earth metal precursor (MgF2) to enhance the performance of chalcogenide-based Cu(In,Ga)Se2 (CIGS) solar cells with a chemically bath deposited-Zn(O,S) (CBD-Zn(O,S)) buffer layer via post-deposited treatment (PDT). The optimal substrate temperature and layer thickness are 570 °C and 5 nm, and the light soaking (LS) treatment does not be required in this condition. The morphological properties and chemical reaction at the p-n junction of CIGS/CBD-Zn(O,S) are examined as a function of MgF2 PDT layer thickness. As the MgF2 PDT layer thickness increases, the CIGS surface becomes rough with vigorously agglomerated Cu clusters owing to the substantially high substrate temperature, which increases the incorporation of In-Se bonds and the oxygenation rate of MgF2. Density functional theory (DFT) clarifies the improved cell efficiency without the need for LS treatment (MgF2 PDT, 5 nm) by calculating the defect-related electronic behavior. The MgF2 phase effectively passivates metastable defect Cu-Se vacancy defects (VCu-Se), related to the LS effect without the additional formation of deep-level defect states into the CIGS bandgap. Moreover, VCu-Se states exert the most influence on the LS effect, and the control of defect states in the CIGS layer (not the buffer layer) is crucial for cell efficiency.

Abstract Guidelines from the World Health Organization strongly recommend the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anesthesia to reduce surgical site infection (SSI). However, previous meta-analyses reported inconsistent results. We aimed to address this controversy by focusing specifically on abdominal surgery with relatively high risk of SSI. Medline, EMBASE, and Cochrane CENTRAL databases were searched. Randomized trials of abdominal surgery comparing high to low perioperative FiO2 were included, given that the incidence of SSI was reported as an outcome. Meta-analyses of risk ratios (RR) were performed using a fixed effects model. Subgroup analysis and meta-regression were employed to explore sources of heterogeneity. We included 27 trials involving 15977 patients. The use of high FiO2 significantly reduced the incidence of SSI (n = 27, risk ratio (RR): 0.87; 95% confidence interval (CI): 0.79, 0.95; I2 = 49%, Z = 3.05). Trial sequential analysis (TSA) revealed that z-curve crossed the trial sequential boundary and data are sufficient. This finding held true for the subgroup of emergency operations (n = 2, RR: 0.54; 95% CI: 0.35, 0.84; I2 = 0%, Z = 2.75), procedures using air as carrier gas (n = 9, RR: 0.79; 95% CI: 0.69, 0.91; I2 = 60%, Z = 3.26), and when a high level of FiO2 was maintained for a postoperative 6 h or more (n = 9, RR: 0.68; 95% CI: 0.56, 0.83; I2 = 46%, Z = 3.83). Meta-regression revealed no significant interaction between SSI with any covariates including age, sex, body-mass index, diabetes mellitus, duration of surgery, and smoking. Quality of evidence was assessed to be moderate to very low. Our pooled analysis revealed that the application of high FiO2 reduced the incidence of SSI after abdominal operations. Although TSA demonstrated sufficient data and cumulative analysis crossed the TSA boundary, our results should be interpreted cautiously given the low quality of evidence. Registration: https://www.crd.york.ac.uk/prospero (CRD42022369212) on October 2022.

Red seabream iridovirus (RSIV) is a major cause of marine fish mortality in Korea, with no effective vaccine available since its first occurrence in the 1990s. This study evaluated the efficacy of a formalin-killed vaccine against RSIV in rock bream under laboratory and field conditions. For the field trial, a total of 103,200 rock bream from two commercial marine cage-cultured farms in Southern Korea were vaccinated. Farm A vaccinated 31,100 fish in July 2020 and monitored them for 18 weeks, while farm B vaccinated 30,700 fish in August 2020 and monitored them for 12 weeks. At farm A, where there was no RSIV infection, the vaccine efficacy was assessed in the lab, showing a relative percentage of survival (RPS) ranging from 40% to 80%. At farm B, where natural RSIV infections occurred, cumulative mortality rates were 36.43% in the vaccinated group and 80.32% in the control group, resulting in an RPS of 54.67%. The RSIV-infectious status and neutralizing antibody titers in serum mirrored the cumulative mortality results. This study demonstrates that the formalin-killed vaccine effectively prevents RSIV in cage-cultured rock bream under both laboratory and field conditions.

Abstract Background To maintain adequate oxygenation is of utmost importance in intraoperative care. However, clinical evidence supporting specific oxygen levels in distinct surgical settings is lacking. This study aimed to compare the effects of 30% and 80% oxygen in off-pump coronary artery bypass grafting (OPCAB). Methods This multicenter trial was conducted in three tertiary hospitals from August 2019 to August 2021. Patients undergoing OPCAB were cluster-randomized to receive either 30% or 80% oxygen intraoperatively, based on the month when the surgery was performed. The primary endpoint was the length of hospital stay. Intraoperative hemodynamic data were also compared. Results A total of 414 patients were cluster-randomized. Length of hospital stay was not different in the 30% oxygen group compared to the 80% oxygen group (median, 7.0 days vs 7.0 days; the sub-distribution hazard ratio, 0.98; 95% confidence interval [CI] 0.83–1.16; P = 0.808). The incidence of postoperative acute kidney injury was significantly higher in the 30% oxygen group than in the 80% oxygen group (30.7% vs 19.4%; odds ratio, 1.94; 95% CI 1.18–3.17; P = 0.036). Intraoperative time-weighted average mixed venous oxygen saturation was significantly higher in the 80% oxygen group (74% vs 64%; P

Abstract Since the etiology of diabetic chronic kidney disease (CKD) is multifactorial, studies on DNA methylation for kidney function deterioration have rarely been performed despite the need for an epigenetic approach. Therefore, this study aimed to identify epigenetic markers associated with CKD progression based on the decline in the estimated glomerular filtration rate in diabetic CKD in Korea. An epigenome-wide association study was performed using whole blood samples from 180 CKD recruited from the KNOW-CKD cohort. Pyrosequencing was also performed on 133 CKD participants as an external replication analysis. Functional analyses, including the analysis of disease-gene networks, reactome pathways, and protein–protein interaction networks, were conducted to identify the biological mechanisms of CpG sites. A phenome-wide association study was performed to determine the associations between CpG sites and other phenotypes. Two epigenetic markers, cg10297223 on AGTR1 and cg02990553 on KRT28 indicated a potential association with diabetic CKD progression. Based on the functional analyses, other phenotypes (blood pressure and cardiac arrhythmia for AGTR1) and biological pathways (keratinization and cornified envelope for KRT28) related to CKD were also identified. This study suggests a potential association between the cg10297223 and cg02990553 and the progression of diabetic CKD in Koreans. Nevertheless, further validation is needed through additional studies.

Abstract Corticosteroids remain the mainstay of immunosuppression for liver transplant recipients despite several serious complications including infection, hepatitis C virus (HCV) recurrence, diabetes mellitus (DM), and hypertension. We attempted to compare the safety and efficacy of T-cell specific antibody induction with complete corticosteroid avoidance. We searched MEDLINE, EMBASE, and Cochrane central library. Randomized controlled trials comparing T-cell specific antibody induction with corticosteroid induction immunosuppression were included. Our primary outcome was the incidence of biopsy-proven acute rejection. Eleven trials involving 1683 patients were included. The incidence of acute rejection was not significantly different between the antibody and steroid induction groups (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.72, 1.01, P = 0.06, I2 = 0%). However, T-cell specific antibody induction significantly reduced the risk of cytomegalovirus infection (RR 0.48, 95% CI 0.33, 0.70, P = 0.0002, I2 = 3%), HCV recurrence (RR 0.89, 95% CI 0.80, 0.99, P = 0.03, I2 = 0%), DM (RR 0.41, 95% CI 0.32, 0.54, P

Abstract We aimed to compare the effect of sugammadex to that of neostigmine with respect to the occurrence of postoperative nausea and vomiting (PONV) during the first 24 h following general anesthesia. This retrospective cohort study included patients who underwent elective surgery under general anesthesia in 2020 at an academic medical center in Seoul, South Korea. The exposure groups were determined according to whether the patient received sugammadex or neostigmine as a reversal agent. The primary outcome was PONV occurrence during the first 24 h postoperatively (overall). The association between the type of reversal agent and primary outcome was investigated using logistic regression while adjusting for confounding variables using stabilized inverse probability of treatment weighting (sIPTW). Of the 10,912 patients included in this study, 5,918 (54.2%) received sugammadex. Sugammadex was associated with a significantly lower incidence of overall PONV (15.8% vs. 17.7%; odds ratio, 0.87; 95% confidence interval [CI], 0.79–0.97; P = 0.010) after sIPTW. In conclusion, compared with neostigmine/glycopyrrolate, sugammadex use has a lower risk of PONV during the first 24 h following general anesthesia.

Background Postoperative nausea and vomiting (PONV) commonly occurs after spinal anesthesia; however, its incidence rate and predictors have been scarcely studied. Therefore, we aimed to investigate its incidence rate and potential predictors. Methods The electronic medical records of 6,610 consecutive patients undergoing orthopedic surgery under spinal anesthesia were reviewed between January 2016 and December 2020. The primary outcome was PONV incidence within 24 h after spinal anesthesia. Along with its incidence rate, we investigated its predictors using multivariable logistic regression analysis. Results Among the 5,691 patients included in the analysis, 1,298 (22.8%) experienced PONV within 24 h after spinal anesthesia. Female sex (odds ratio [OR]: 3.23, 95% CI [2.72, 3.83], P < 0.001), nonsmoker (OR: 2.12, 95% CI [1.46, 3.07], P < 0.001), history of PONV (OR: 1.52, 95% CI [1.26, 1.82], P < 0.001), prophylactic 5-hydroxytryptamine receptor antagonist use (OR: 0.35, 95% CI [0.24, 0.50], P < 0.001), prophylactic steroid use (OR: 0.53, 95% CI [0.44, 0.62], P < 0.001), baseline heart rate ≥ 60 beats/min (OR: 1.38, 95% CI [1.10, 1.72], P = 0.005), and postoperative opioid use (OR: 2.57, 95% CI [1.80, 3.67], P < 0.001), were significant predictors of the primary outcome. Conclusions Our study showed the common incidence of PONV after spinal anesthesia and its significant predictors. A better understanding of its predictors may provide important information for its management.

Background: This study aimed to investigate the effects of Oenanthe javanica (OJ) extracts on rats with potassium oxonate (PO)-induced hyperuricemia. Methods: The effects of OJ extract on rats with PO-induced hyperuricemia-induced were monitored. Changes in the body weight and organ indices of hyperuricemic rats were calculated to detect anti-hyperuricemic effects. Blood samples were collected to observe the effect of reducing serum uric acid concentration. Kidney tissues were stained to observe histopathological changes under a microscope. The activity of xanthine oxidase (XO), which catalyzes xanthine to uric acid in the liver, was assessed to observe the inhibitory effect of XO. Results: 1. The body weight of hyperuricemic rats showed no considerable differences between the control group and the treatment group. The OJ group had significantly improved liver index, whereas the allopurinol group had improved liver and kidney indices. 2. Serum uric acid levels increased significantly after PO injection, and the OJ and allopurinol groups showed a significant reduction effect. 3. PO injection led to the inflammation of kidney tissues, and OJ improved it significantly. 4. The activity of XO after PO injection was significantly increased, and allopurinol significantly inhibited XO activity in the liver. Conclusion: In the hyperuricemia rat model, OJ extract reduced uric acid concentration and demonstrated its anti-inflammatory effects. Thus, OJ extracts can be used to lower uric acid levels.

Background Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients for whom it is difficult to establish peripheral IV access. We aimed to investigate the feasibility and safety of EJV cannulation in surgical patients. Methods We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collected clinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included any EJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis, pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronic medical records during the hospitalization period for surgery. Results We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery (49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%). Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases. The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site (65 cases, 0.7%). There was only one case of unplanned intensive care unit admission due to swelling related to EJV cannulation. Conclusions Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

Bearings might be damaged due to shock loads caused by disturbances, in addition to static loads. In this study, a flexible structure was applied to enhance the lubrication characteristics of misaligned journal bearings subjected to impact loads. When an impact load is added to the bearing, a misaligned journal bearing has a high possibility of metal-to-metal contact. It might also lead to failure. Misalignment can occur at any time during bearing operation. A flexible structure is applied to the end of the bearing as a way to improve lubrication performance in a system where impact loads might be applied. The bearing’s lubrication performance was numerically assessed under unsteady-state conditions. An elastohydrodynamic lubrication analysis was conducted, taking into account elastic deformation. The lubrication characteristics of misaligned journal bearings were compared with the dimensionless minimum film thickness. The flexible structure and elastic modulus of the bearing were investigated so that it could support the load without contact according to the change in the maximum magnitude of the impact load. When subjected to oil film pressure, this flexible structure underwent elastic deformation, resulting in enlargement of the oil film. A misaligned journal bearing with a suitable flexible structure provided stable lubrication without metal-to-metal contact, even under shock load conditions. The flexible structure was incorporated into the high-load-bearing region of the journal bearing as a groove. Therefore, the application of a flexible structure in misaligned journal bearings can effectively enhance lubrication performance in misaligned conditions and under shock loads.

Abstract Background The effect of hyperoxia due to supplemental oxygen administration on postoperative outcomes in patients undergoing cardiac surgery remains unclear. This retrospective study aimed to evaluate the relationship between intraoperative oxygen tension and mortality after off-pump coronary artery bypass grafting (OPCAB). Methods The study included adult patients who underwent isolated OPCAB between July 2010 and June 2020. Patients were categorised into three groups based on their intraoperative time-weighted average arterial oxygen partial pressure (PaO2): normoxia/near-normoxia (< 150 mmHg), mild hyperoxia (150–250 mmHg), and severe hyperoxia (> 250 mmHg). The risk of in-hospital mortality was compared using weighted logistic regression analysis. Restricted cubic spline analysis was performed to analyse intraoperative PaO2 as a continuous variable. The risk of cumulative all-cause mortality was compared using Cox regression analysis. Results The normoxia/near-normoxia, mild hyperoxia, and severe hyperoxia groups included 229, 991, and 173 patients (n = 1393), respectively. The mild hyperoxia group had a significantly lower risk of in-hospital mortality than the normoxia/near-normoxia (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06–0.22) and severe hyperoxia groups (OR, 0.06; 95% CI, 0.03–0.14). Intraoperative PaO2 exhibited a U-shaped relationship with in-hospital mortality in the non-hypoxic range. The risk of cumulative all-cause mortality was significantly lower in the mild hyperoxia group (hazard ratio, 0.72; 95% CI, 0.52–0.99) than in the normoxia/near-normoxia group. Conclusions Maintaining intraoperative PaO2 at 150–250 mmHg was associated with a lower risk of mortality after OPCAB than PaO2 at < 150 mmHg and at > 250 mmHg. Future randomised trials are required to confirm if mildly increasing arterial oxygen tension during OPCAB to 150–250 mmHg improves postoperative outcomes.

Abstract Poly(dimethylsiloxane) (PDMS) has been widely employed in biomedical disciplines due to its several advantages, including biocompatibility, nontoxicity, and low‐cost preparation. However, the intrinsic hydrophobicity of this material encourages biofouling and reduces cell regulation capacity, thereby limiting its biomedical applicability. The purpose of this study is to explore the surface modification and functionalization of PDMS and PDMS‐based biomaterials to improve their properties for biomedical applications. The content of this review is organized based on physical and chemical surface modification strategies to improve surface hydrophilicity to enhance antibiofouling and the regulation of immunomodulation and cell modulation on the surface of PDMS and PDMS‐based biomaterials. Future developments in this area are also discussed.

OBJECTIVES The aim of this study was to clarify the clinical trait of familial diabetes mellitus (DM) by analyzing participants’ risk of DM according to the age of DM onset in parents and siblings, and to evaluate individuals’ risk of DM-associated cardiometabolic diseases. METHODS Altogether, 211,173 participants aged ≥40 years from the Korean Genome and Epidemiology Study were included in this study. The participants were divided into groups based on the number (1 or 2 relatives) and age of onset (no DM and early, common, or late onset) of familial DM. Participants’ risk of DM was assessed using a Cox regression model with hazard ratios and 95% confidence intervals (CIs). A logistic regression model with odds ratios was used to evaluate associations among the participants’ likelihood of acquiring cardiometabolic diseases such as hypertension, chronic kidney disease (CKD), and cardiovascular disease. RESULTS The risk of developing DM was 2.02-fold (95% CI, 1.88 to 2.18) and 2.88-fold (95% CI, 2.50 to 3.33) higher, respectively, in participants with 1 and 2 family members diagnosed with familial DM. It was 2.72-fold (95% CI, 2.03 to 3.66) higher in those with early-onset familial DM. In the early-onset group, the respective risks of hypertension and CKD were 1.87-fold (95% CI, 1.37 to 2.55) and 4.31-fold (95% CI, 2.55 to 7.27) higher than in the control group. CONCLUSIONS The risk of DM and related cardiometabolic diseases was positively associated with the number of family members diagnosed with DM and an early diagnosis in family members with DM.