Recently, our understanding of the elusive bacterial communities in the lower respiratory tract and their role in chronic lung disease has increased significantly. However, little is known about the ...respiratory microorganisms in patients with endobronchial tuberculosis (EBTB), which is a chronic inflammatory disease characterized by destruction of the tracheobronchial tree due to Mycobacterium tuberculosis (MTB) infection. We retrospectively reviewed data for histopathologically and microbiologically confirmed EBTB patients diagnosed at a tertiary referral hospital in South Korea between January 2013 and January 2019. Bacterial cultures were performed on bronchial washing from these patients at the time of EBTB diagnosis. A total of 216 patients with EBTB were included in the study. The median age was 73 years and 142 (65.7%) patients were female. Bacteria were detected in 42 (19.4%) patients. Additionally, bacterial co-infection was present in 6 (2.8%) patients. Apart from MTB, the most common microorganisms identified were Staphylococcus aureus (n = 14, 33.3%) followed by Klebsiella species (n = 12, 28.6%; 10 Klebsiella pneumoniae, 2 Klebsiella oxytoca), Streptococcus species (n = 5, 11.9%), Enterobacter species (n = 4, 9.5%), and Pseudomonas aeruginosa (n = 3, 7.1%). A variety of microorganisms were isolated from the bronchial washing indicating that changes in microorganism composition occur in the airways of patients with EBTB. Further studies are needed to investigate the clinical significance of this finding.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Context Laminoplasty is a major surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Sometimes, patients with cervical ...OPLL demonstrate postoperative kyphosis despite sufficient preoperative lordosis. Recently, the impact of T1 slope has emerged as a predictor of kyphotic alignment change after laminoplasty. However, the relationship between T1 slope and postoperative cervical alignment change is not yet fully established. Purpose The goals of the present study were to investigate the relationship between T1 slope and loss of cervical lordosis (LCL), and to identify the role of T1 slope as a predictor of postoperative kyphosis after laminoplasty in patients with OPLL. Study Design This is a retrospective case study. Patient Sample Between January 2011 and January 2012, 64 consecutive patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=47:17; mean age=55.9 years). Cervical spine lateral radiographs in neutral, flexion, and extension were taken before surgery and at 2-year follow-up. Outcome Measures The C2–C7 Cobb angle, cervical range of motion (ROM), T1 slope, neck tilt, and C2–C7 sagittal vertical axis (SVA) were measured from lateral radiographs of the cervical spine preoperatively and postoperatively at 2-year follow-up. Methods Patients were divided into two groups according to preoperative T1 slope, and the postoperative cervical alignment change was compared between the groups. Postoperative kyphosis and LCL incidence were also evaluated at 2-year follow-up. The relationships between postoperative cervical alignment change and preoperative variables, including age, T1 slope, cervical ROM, C2–C7 SVA, and T1 slope minus C2–C7 Cobb angle (T1S−CL), were investigated. Results Patients were divided into two groups above and below median preoperative T1 slope (23.2°). There were no differences in age, sex, type of OPLL, or operation level between the two groups. Patients with higher preoperative T1 slope demonstrated significantly more lordotic preoperative cervical alignment (p=.001). Patients with higher preoperative T1 slope were more likely to exhibit postoperative LCL (p=.03), and when it occurred the degree of LCL was greater (p=.06). In multiple linear regression analysis, higher T1 slope (B=0.414, p=.04) and lower T1S−CL (B=−0.412, p=.03) were significantly associated with more postoperative LCL. In spite of these results, postoperative kyphosis did not occur more frequently in patients with higher T1 slope (p=.64). Conclusions Patients with higher T1 slope had more lordotic curvature before surgery and demonstrated more LCL at 2-year follow-up. Cervical alignment was compromised after laminoplasty, and the degree of LCL was correlated with preoperative T1 slope. After laminoplasty for cervical OPLL, patients with higher T1 slope tended to exhibit a greater LCL yet did not drift into frank postoperative kyphosis.
Summary
Simultaneous splenectomy (SSPX) in adult living donor liver transplantation (ALDLT) has definitely beneficial roles such as portal flow modulation in small‐for‐size graft and correction of ...hypersplenism‐related pancytopenia, and so on, but disastrous complications after SSPX often occur. For the first time, we devised unique and innovative splenic devascularization (SDV) procedure to alleviated untoward effects of SSPX but to maintain its benefits for the indicated patients. From April 2013 to December 2014, 520 recipients underwent ALDLT, and the SSPX and SDV were simultaneously performed in 62 (11.9%) and 61 (11.7%) patients, respectively. The most common indication was hypersplenism‐related pancytopenia (n = 101), small‐for‐size graft (n = 14), hepatitis C virus (HCV) (n = 7), and splenic artery aneurysm (n = 1). Postoperative small‐for‐size graft syndrome (SFSS) was absent in both SSPX and SDV, and preoperative pancytopenia was improved in both groups since postoperative 1 week, although SSPX was more substantial than SDV. Preoperative splenic volume (706.2 ± 282.9 ml) after SDV significantly decreased to 425.5 ± 204.4 ml on 1 month, respectively. In contrast to SDV, SSPX resulted in longer operation time and higher incidence of postoperative complications including mortality. In conclusion, SDV can replace SSPX during ALDLT without hampering its beneficial roles seriously, but get rid of splenectomy‐related lethal complication.
O3-type NaNi1/3Fe1/3Mn1/3O2 (NaNFM) is considered as a promising cathode material for sodium-ion batteries; however, its poor cycling stability is still a concern. In this study, we discuss the ...structural, surface and electrochemical properties of Mg-doped NaMgxNi1/3Fe1/3Mn1/31–xO2 materials and their enhanced cycling performance. The variations of the lattice parameters by substitution of Mg ion and its uniform distribution on the particles are confirmed using X-ray diffraction and transmission electron microscopy. The optimized NaMg0.05Ni1/3Fe1/3Mn1/30.95O2 delivers a discharge capacity of ~120 mAh g−1 and has a diffusion coefficient of Na ranging from 6.5 × 10−13 to 2.7 × 10−10 cm2 s−1. In particular, it shows a relatively high discharge capacity of 42 mAh g−1 even at a high current density of 1200 mA g−1 and exhibits considerably enhanced cycling stability (77% capacity retention after 50 cycles), compared with that of the undoped NaNFM (40%). Based on structural and electrochemical analyses, it is suggested that Mg doping can effectively suppress the irreversible structural degradation and induce more reversible phase transitions; this results in a more stable cycling performance of the Mg-doped NaNFM than that of undoped NaNFM.
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•Mg doping onto O3-type NaNi1/3Fe1/3Mn1/3O2 for sodium-ion batteries.•Uniform distribution of Mg on the surface and bulk of the doped cathode particle.•Mg doping suppress the irreversible structural degradation.•The composition modification results in improved rate-capability and cyclability.
Intraoperative electroencephalogram (EEG) patterns associated with postoperative delirium (POD) development have been studied, but the differences in EEG recordings between sevoflurane- and ...desflurane-induced anesthesia have not been clarified. We aimed to distinguish the EEG characteristics of sevoflurane and desflurane in relation to POD development.
We collected frontal four-channel EEG data during the maintenance of anesthesia from 148 elderly patients who received sevoflurane (n = 77) or desflurane (n = 71); 30 patients were diagnosed with delirium postoperatively. The patients were divided into four subgroups based on anesthetics and delirium status: sevoflurane delirium (n = 17), sevoflurane non-delirium (n = 60), desflurane delirium (n = 13), and desflurane non-delirium (n = 58). We compared spectral power, coherence, and pairwise phase consistency (PPC) between sevoflurane and desflurane, and between non-delirium and delirium groups for each anesthetic.
In patients without POD, the sevoflurane non-delirium group exhibited higher EEG spectral power across 8.5–35 Hz (99.5% CI bootstrap analysis) and higher PPC from alpha to gamma bands (p < 0.005) compared to the desflurane non-delirium group. Conversely, in patients with POD, no significant EEG differences were observed between the sevoflurane and desflurane delirium groups. For the sevoflurane-induced patients, the sevoflurane delirium group had significantly lower power within 7.5–31.5 Hz (99.5% CI bootstrap analysis), reduced coherence over 8.9–23.8 Hz (99.5% CI bootstrap analysis), and lower PPC values in the alpha band (p < 0.005) compared with the sevoflurane non-delirium group. For the desflurane-induced patients, there were no significant differences in the EEG patterns between delirium and non-delirium groups.
In normal patients without POD, sevoflurane demonstrates a higher power spectrum and prefrontal connectivity than desflurane. Furthermore, reduced frontal alpha power, coherence, and connectivity of intraoperative EEG could be associated with an increased risk of POD. These intraoperative EEG characteristics associated with POD are more noticeable in sevoflurane-induced anesthesia than in desflurane-induced anesthesia.
•Sevoflurane induced higher power across alpha-to-beta bands compared with desflurane during anesthesia. // Sevoflurane increased frontal connectivity from the alpha-to-gamma bands compared with desflurane during anesthesia.•In sevoflurane-induced anesthesia, patients with POD have reduced power across 7.5–31.5 Hz than non-delirium patients. // Sevoflurane-induced patients with POD have decreased coherence and weaker alpha connectivity than non-delirium patients.•Intraoperative EEG markers associated with POD are more noticeable in sevoflurane anesthesia than in desflurane anesthesia.
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Tryptophan hydroxylase 1 (TPH1) has emerged as a target for the treatment of metabolic diseases including obesity and fatty liver disease. A series of xanthine derivatives were ...synthesized and evaluated for their TPH1 inhibition. Among the synthesized compounds, compound 40 showed good in vitro activity and liver microsomal stability. Docking studies revealed that compound 40 showed better binding to TPH1 via key intermolecular interactions involving the xanthine scaffold, imidazo-thiazolyl ring, and hydroxyl-containing phenacyl moiety. In addition, compound 40 effectively suppressed the adipocyte differentiation of 3 T3-L1 cells.
•153 miRNA/mRNA pairs were affected by PHMG-phosphate exposure.•PHMG-phosphate affected genes associated with cell cycle, apoptosis and epithelial-mesenchymal transition.•Induction of ...epithelial-mesenchymal transition by PHMG-phosphate was confirmed.
Polyhexamethylene guanidine phosphate (PHMG-phosphate), an active component of humidifier disinfectant, is suspected to be a major cause of pulmonary fibrosis. Fibrosis, induced by recurrent epithelial damage, is significantly affected by epigenetic regulation, including microRNAs (miRNAs). The aim of this study was to investigate the fibrogenic mechanisms of PHMG-phosphate through the profiling of miRNAs and their target genes. A549 cells were treated with 0.75 μg/mL PHMG-phosphate for 24 and 48 h and miRNA microarray expression analysis was conducted. The putative mRNA targets of the miRNAs were identified and subjected to Gene Ontology analysis. After exposure to PHMG-phosphate for 24 and 48 h, 46 and 33 miRNAs, respectively, showed a significant change in expression over 1.5-fold compared with the control. The integrated analysis of miRNA and mRNA microarray results revealed the putative targets that were prominently enriched were associated with the epithelial-mesenchymal transition (EMT), cell cycle changes, and apoptosis. The dose-dependent induction of EMT by PHMG-phosphate exposure was confirmed by western blot. We identified 13 putative EMT-related targets that may play a role in PHMG-phosphate-induced fibrosis according to the Comparative Toxicogenomic Database. Our findings contribute to the comprehension of the fibrogenic mechanism of PHMG-phosphate and will aid further study on PHMG-phosphate-induced toxicity.
We investigated the epidemiologic characteristics of childhood brain tumors (CBT) in Korea, and compared our findings with those from the United States.
We searched the Korea National Cancer ...Incidence Database of the Korea Central Cancer Registry (KCCR) from 2005 to 2014, which included all Korean patients with CBT aged 0 to 19 years at diagnosis. The age-standardized incidence rates (ASR) and the 5-year relative survival rate (RSR) were determined. The Central Brain Tumor Registry of the United States (CBTRUS) classification and definitions were applied to allow direct comparison with U.S.
A total of 6,027 CBTs were identified. The ASR of all CBTs was 5.08 per 100,000 population, which was significantly lower than that in the United States (5.57). However, the ASR of nonmalignant CBTs in Korea (2.48) was significantly higher than that in the United States (2.15). Embryonal tumors (ASR: 0.99 and 0.72 in the 0-4 and 5-9 year age groups, respectively) were the most common CBTs in these respective age groups. Germ cell tumors (0.78) and pituitary tumors (1.63) were the most common CBTs in the 10-14 and 15-19 year age groups, respectively. The 5-year RSR of CBTs was 84% and varied according to histology.
High incidences of nonmalignant and germ cell tumors are distinct CBT features in Korean children and adolescents.
To our knowledge, this is the first and largest population-based epidemiologic study of CBTs in Asia. Our findings support the notion that East Asian populations have a higher incidence of central nervous system germ cell tumors than other races.
Background. The complications after stroke inhibit functional recovery and worsen the prognosis of patients. The implementation of a critical pathway (CP) can facilitate functional recovery after ...stroke by enabling comprehensive and systematic structured rehabilitation. Objective. To evaluate the effects of the implementation of CP in stroke patients for 10 years. Methods. The data were collected from 960 patients who were diagnosed with a stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase, and who were discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The modified Rankin Scale (mRS) and the Korean version of the Modified Barthel Index (K-MBI) were used to evaluate functional states. Results. There were no significant differences in demographic and stroke characteristics before and after CP implementation. For those with preexisting medical conditions, there was no significant difference between before and after CP implementation. The majority of the complications were significantly decreased after the implementation of CP. Except for hemorrhagic stroke patients, the Brunnstrom stage in the ischemic and total stroke patients after CP implementation was significantly increased in the upper and lower extremities. The total hospitalization LOS and rehabilitation center hospitalization times were significantly reduced in ischemic and total stroke patients. There was no statistically significant difference in the functional gain of K-MBI and the efficiency of rehabilitation between before and after CP implementation. Conclusion. The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practices in hospital care for stroke patients.
The newly emerging Middle East respiratory syndrome coronavirus (MERS-CoV) causes a severe respiratory infection with a high mortality rate (~35%). MERS-CoV has been a global threat due to continuous ...outbreaks in the Arabian peninsula and international spread by infected travelers since 2012. From May to July 2015, a large outbreak initiated by an infected traveler from the Arabian peninsula swept South Korea and resulted in 186 confirmed cases with 38 deaths (case fatality rate, 20.4%). Here, we show the rapid emergence and spread of a mutant MERS-CoV with reduced affinity to the human CD26 receptor during the South Korean outbreak. We isolated 13 new viral genomes from 14 infected patients treated at a hospital and found that 12 of these genomes possess a point mutation in the receptor-binding domain (RBD) of viral spike (S) protein. Specifically, 11 of these genomes have an I529T mutation in RBD, and 1 has a D510G mutation. Strikingly, both mutations result in reduced affinity of RBD to human CD26 compared to wild-type RBD, as measured by surface plasmon resonance analysis and cellular binding assay. Additionally, pseudotyped virus bearing an I529T mutation in S protein showed reduced entry into host cells compared to virus with wild-type S protein. These unexpected findings suggest that MERS-CoV adaptation during human-to-human spread may be driven by host immunological pressure such as neutralizing antibodies, resulting in reduced affinity to host receptor, and thereby impairs viral fitness and virulence, rather than positive selection for a better affinity to CD26.
Recently, a large outbreak initiated by an MERS-CoV-infected traveler from the Middle East swept South Korea and resulted in 186 confirmed cases with 38 deaths. This is the largest outbreak outside the Middle East, and it raised strong concerns about the possible emergence of MERS-CoV mutations. Here, we isolated 13 new viral genomes and found that 12 of them possess a point mutation in the receptor-binding domain of viral spike protein, resulting in reduced affinity to the human cognate receptor, CD26, compared to the wild-type virus. These unexpected findings suggest that MERS-CoV adaptation in humans may be driven by host immunological pressure.
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