COVID-19 vaccination-related myocarditis: a Korean nationwide study.

AIMS: A comprehensive nationwide study on the incidence and outcomes of COVID-19 vaccination-related myocarditis (VRM) is in need. METHODS AND RESULTS: Among 44 276 704 individuals with at least 1 dose of COVID-19 vaccination, the incidence and clinical courses of VRM cases confirmed by the Expert Adjudication Committee of the Korea Disease Control and Prevention Agency were analyzed. COVID-19 VRM was confirmed in 480 cases (1.08 cases per 100 000 persons). Vaccination-related myocarditis incidence was significantly higher in men than in women (1.35 vs. 0.82 per 100 000 persons, P < 0.001) and in mRNA vaccines than in other vaccines (1.46 vs. 0.14 per 100 000 persons, P < 0.001). Vaccination-related myocarditis incidence was highest in males between the ages of 12 and 17 years (5.29 cases per 100 000 persons) and lowest in females over 70 years (0.16 cases per 100 000 persons). Severe VRM was identified in 95 cases (19.8% of total VRM, 0.22 per 100 000 vaccinated persons), 85 intensive care unit admission (17.7%), 36 fulminant myocarditis (7.5%), 21 extracorporeal membrane oxygenation therapy (4.4%), 21 deaths (4.4%), and 1 heart transplantation (0.2%). Eight out of 21 deaths were sudden cardiac death (SCD) attributable to VRM proved by an autopsy, and all cases of SCD attributable to VRM were aged under 45 years and received mRNA vaccines. CONCLUSION: Although COVID-19 VRM was rare and showed relatively favorable clinical courses, severe VRM was found in 19.8% of all VRM cases. Moreover, SCD should be closely monitored as a potentially fatal complication of COVID-19 vaccination.

Impacts of the COVID-19 pandemic on enrollment in medications for opioid use disorder (MOUD) in Vancouver, Canada: An interrupted time series analysis.

BACKGROUND: In anticipation of COVID-19 related disruptions to opioid use disorder (OUD) care, new provincial and federal guidance for the management of OUD and risk mitigation guidance (RMG) for prescription of pharmaceutical opioids were introduced in British Columbia, Canada, in March 2020. This study evaluated the combined impacts of the COVID-19 pandemic and counteracting OUD policies on enrollment in medications for OUD (MOUD). METHODS: Using data from three cohorts of people with presumed OUD in Vancouver, we conducted an interrupted time series analysis to estimate the combined effects impact of the COVID-19 pandemic and counteracting OUD policies on the prevalence of enrollment in MOUD overall, as well as in individual MOUDs (methadone, buprenorphine/naloxone, slow-release oral morphine) between November 2018 and November 2021, controlling for pre-existing trends. In sub-analysis we considered RMG opioids together with MOUD. RESULTS: We included 760 participants with presumed OUD. In the post-COVID-19 period, MOUD and slow-release oral morphine prevalence rates showed an estimated immediate increase in level (+7.6%, 95% CI: 0.6%, 14.6% and 1.8%, 95% CI: 0.3%, 3.3%, respectively), followed by a decline in the monthly trend (-0.8% per month, 95% CI: -1.4%, -0.2% and -0.2% per month, 95% CI: -0.4, -0.1, respectively). There were no significant changes in the prevalence trends of enrollment in methadone, buprenorphine/naloxone, or when RMG opioids were considered together with MOUD. CONCLUSIONS: Despite immediate improvements in MOUD enrollment in the post-COVID-19 period, this beneficial trend reversed over time. RMG opioids appeared to have provided additional benefits to sustain retention in OUD care.

A rabbit model of tracheal collapse for optimal self-expanding metal stents.

Investigating the characteristics of tracheas can help the understanding of diseases related to the trachea, particularly tracheal collapse (TC) in dogs. This study aimed to compare the mechanical properties of tracheas from New Zealand White (NZW) rabbits and dogs and to introduce a method for inducing a model of TC in the normal trachea. Tracheal samples were obtained from NZW rabbit cadavers (n=5) weighing 3.62-3.92 kg and from dog cadavers (n=5) weighing 2.97-3.28 kg. Three live NZW rabbits weighing 3.5-4.0 kg were used to establish the model. The radial forces of both sample sets were measured using a digital force gauge and statistically compared. Subsequently, TC was surgically induced in three female NZW rabbits by physically weakening their tracheal cartilage under general anesthesia. Their clinical signs were monitored for 3 months, and radiographic examinations were performed monthly for 3 months. The mean radial forces of the two sample sets were comparable (P>0.05). The clinical signs, radiographic examinations, and macroscopic examinations were all comparable to those of dogs with TC. The cadaveric study between the rabbits and dogs demonstrated that the surgically induced rabbit model of TC is an excellent candidate for the experimental study of dogs with TC. This study also provides a reference of tracheal radial force values to enable selection of appropriate mesh types and wire diameters of self-expanding metal stents.

Investigating test delivery modes within video-conferenced English speaking proficiency assessment

Nonverbal behavior is essential in human interaction (Gullberg, de Bot, & Volterra, 2008;McNeill, 1992, 2005). For second language speakers, nonverbal features can be helpful for successful and efficient communication (e.g., Dahl & Ludvigsen, 2014). However, due to the complexity of nonverbal features, language testing institutions have conventionally employed an asynchronous format (e.g., audio-only mode), focusing on the test-taker's verbal features. Recently, the advance in technology, and most importantly, the coronavirus pandemic (COVID-19) outbreak in late 2019 and early 2020, have accelerated the use of video-conferencing applications in educational contexts, including speaking tests (Nakatsuhara, Inoue, Berry, & Galaczi, 2021). Accordingly, the synchronous test delivery mode (video-conferencing), which presents test-takers' visual information, is a timely and necessary approach to addressing the impact of nonverbal features on L2 oral communication. In response to these issues, I investigated the comparability of different delivery modes of speaking proficiency assessment. This study aimed to understand the dimensionality of the measured speaking construct and the impact of test-takers' visual information on rater behavior. Two datasets were used to address the research goals: first dataset (i.e., dataset 1) included scores of 110 test-takers, assessed by eight trained raters;second dataset (i.e., dataset 2) included scores of 284 prospective international teaching assistants (ITAs), assessed by 12 professional and certified raters. I collected dataset 1, and English language learning and testing program at a Midwest University provided dataset 2. I used two quantitative techniques to analyze both datasets: confirmatory factor analysis (CFA) and Multifaceted Rasch model (MFRM) analysis. For dataset 1, I qualitatively analyzed the raters' verbal reports.Dataset 1 had an asynchronous format;all test-takers' performances were recorded for rating. Eight trained raters gave scores to the audio-recorded and video 1 mode (test-taker and test giver were displayed). Three weeks later, the raters assessed video 2 mode (only test-taker's visual information was displayed). Within one month, raters participated in a one-on-one semi-structured interview. Dataset 2 stems from an operational testing context. This dataset has only scores, as I borrowed the data from the operational English testing program at the university. The scores were first given by examiners in a synchronous format (Live mode) and later by raters in an asynchronous format (Recorded mode). CFA findings indicated the multi-dimensional aspect of the underlying construct of speaking for both datasets, but the high inter-correlations showed that these are associated. Findings of MFRM revealed that raters showed leniency when rating (a) video mode over audio-only mode (dataset 1) and (b) synchronous mode over asynchronous mode (dataset 2). Findings suggest that using the video-conferenced delivery mode may be beneficial. However, the degree of usefulness across video modes differed, and how the raters utilized test-takers' nonverbal behaviors (e.g., gaze) varied. Thus, I decided that further investigation is needed to sufficiently support the use of video-conferencing applications to complement the physical face-to-face delivery mode. Overall, future research is highly recommended regarding the standardization of scoring of nonverbal features about the types of video mode, which would assist with the practical and valid application of virtual speaking tests. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Proteolytic Biosensors with Functional Nanomaterials: Current Approaches and Future Challenges.

Proteolytic enzymes are one of the important biomarkers that enable the early diagnosis of several diseases, such as cancers. A specific proteolytic enzyme selectively degrades a certain sequence of a polypeptide. Therefore, a particular proteolytic enzyme can be selectively quantified by changing detectable signals causing degradation of the peptide chain. In addition, by combining polypeptides with various functional nanomaterials, proteolytic enzymes can be measured more sensitively and rapidly. In this paper, proteolytic enzymes that can be measured using a polypeptide degradation method are reviewed and recently studied functional nanomaterials-based proteolytic biosensors are discussed. We anticipate that the proteolytic nanobiosensors addressed in this review will provide valuable information on physiological changes from a cellular level for individual and early diagnosis.

Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study.

OBJECTIVE: This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. RESULTS: When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st-2nd) (p=0.045). After COVID-19 (2nd-3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. CONCLUSION: Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

Liquid Crystalline Systems from Nature and Interaction of Living Organisms with Liquid Crystals.

Biomaterials, which are substances interacting with biological systems, have been extensively explored to understand living organisms and obtain scientific inspiration (such as biomimetics). However, many aspects of biomaterials have yet to be fully understood. Because liquid crystalline phases are ubiquitously found in biomaterials (e.g., cholesterol, amphiphile, DNA, cellulose, bacteria), therefore, a wide range of research has made attempts to approach unresolved issues with the concept of liquid crystals (LCs). This review presents these studies that address the interactive correlation between biomaterials and LCs. Specifically, intrinsic LC behavior of various biomaterials such as DNA, cellulose nanocrystals, and bacteriaare first introduced. Second, the dynamics of bacteria in LC media are addressed, with focus on how bacteria interact with LCs, and how dynamics of bacteria can be controlled by exploiting the characteristics of LCs. Lastly, how the strong correlation between LCs and biomaterials has been leveraged to design a new class of biosensors with additional functionalities (e.g., self-regulated drug release) that are not available in previous systems is reviewed. Examples addressed in this review convey the message that the intersection between biomaterials and LCs offers deep insights into fundamental understanding of biomaterials, and provides resources for development of transformative technologies.

Characteristics of Cognitive Function Changes and Related Factors in Individuals with Cognitive Impairment during the Pandemic of COVID‐19

Background This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment affected by the coronavirus disease 2019 (COVID‐19) pandemic. Method Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID‐19 and tested regularly at least three times within the last 5 years were included. Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID‐19. Result When comparing CDR changes before and after COVID‐19, there was no significant difference between the two groups (p = .317). Alternatively, the main effect of the time when the test was conducted was significant (p<.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/improved group significantly decreased before COVID‐19 (1st–2nd) (p = .045). After COVID‐19 (2nd–3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<.001). MMSE recall memory and changes in activity during COVID‐19 were significantly associated with CDR deterioration. Conclusion Memory dysfunction and decreased activity during the COVID‐19 pandemic are strongly related to the deterioration of cognitive impairment.

Recent Development in Plasmonic Nanobiosensors for Viral DNA/RNA Biomarkers.

Recently, due to the coronavirus pandemic, the need for early diagnosis of infectious diseases, including viruses, is emerging. Though early diagnosis is essential to prevent infection and progression to severe illness, there are few technologies that accurately measure low concentrations of biomarkers. Plasmonic nanomaterials are attracting materials that can effectively amplify various signals, including fluorescence, Raman, and other optical and electromagnetic output. In this review, we introduce recently developed plasmonic nanobiosensors for measuring viral DNA/RNA as potential biomarkers of viral diseases. In addition, we discuss the future perspective of plasmonic nanobiosensors for DNA/RNA detection. This review is expected to help the early diagnosis and pathological interpretation of viruses and other diseases.

Impacts of the COVID-19 lockdown in China on new particle formation and particle number size distribution in three regional background sites in Asian continental outflow.

Despite the curtailment of atmospheric condensing precursor gases during the Coronavirus disease 2019 (COVID-19) lockdown (LD) period, unexpected haze events via the formation of new particles and their subsequent growth have been identified. This study investigated the impact of emission reduction during the Chinese LD period on the new particle formation (NPF) frequency and corresponding particle number size distribution (PNSD) at three regional background atmospheric monitoring sites in the western coastal areas of the Korean Peninsula. During this duration, the number concentrations of the nucleation- (<25 nm) and accumulation-mode (>90 nm) particles significantly decreased in Baengryeong (BRY), showing decreases of 34% and 29%, respectively. Unlike BRY, the PNSD in Anmyeon (AMY), which is influenced by nearby industrial emissions, remained nearly unchanged during the LD period, possibly because the reduction in industrial emissions was not significant during the social distancing period enforced by Korea. Bongseong (BOS) showed a similar variation to that of BRY; however, the magnitude of the reduction was weaker because of its higher altitude compared to other sites. The cyclostationary empirical orthogonal function technique was applied to the measured PNSDs at the three sites to objectively classify NPF events. Because mode 1 of cyclostationary loading vectors commonly represented the typical diurnal variation of PNSD during regional NPF events at three sites, mode 1 of the corresponding principal component time series was used for NPF classification. The NPF frequency decreased by 7%, 1%, and 7% in BRY, AMY, and BOS, respectively, despite favorable meteorological conditions, such as increased temperature and insolation during the LD period. The diurnal variation in the sulfuric acid (H2SO4) proxy implied that the H2SO4 proxy acted as a determining factor for NPF events during the NPF occurrence time (8-12 local hours) in AMY and BOS; however, NPF occurrence in BRY was not connected to the H2SO4 proxy level. This suggests that BRY was more likely to be influenced by the reduction in organic species in the continental upwind regions, while the occurrence of NPF events in AMY and BOS can be suppressed in association with the distinct reduction in inorganic compounds represented by the H2SO4 proxy during the LD period.

Plasma bioscience for medicine, agriculture and hygiene applications.

Nonthermal biocompatible plasma (NBP) sources operating in atmospheric pressure environments and their characteristics can be used for plasma bioscience, medicine, and hygiene applications, especially for COVID-19 and citizen. This review surveyed the various NBP sources, including a plasma jet, micro-DBD (dielectric barrier discharge) and nanosecond discharged plasma. The electron temperatures and the plasma densities, which are produced using dielectric barrier discharged electrode systems, can be characterized as 0.7 ~ 1.8 eV and (3-5) × 1014-15 cm-3, respectively. Herein, we introduce a general schematic view of the plasma ultraviolet photolysis of water molecules for reactive oxygen and nitrogen species (RONS) generation inside biological cells or living tissues, which would be synergistically important with RONS diffusive propagation into cells or tissues. Of the RONS, the hydroxyl radical [OH] and hydrogen peroxide H2O2 species would mainly result in apoptotic cell death with other RONS in plasma bioscience and medicines. The diseased biological protein, cancer, and mutated cells could be treated by using a NBP or plasma activated water (PAW) resulting in their apoptosis for a new paradigm of plasma medicine.

Ultrasensitive Electrochemical Detection of Mutated Viral RNAs with Single-Nucleotide Resolution Using a Nanoporous Electrode Array (NPEA).

The detection of nucleic acids and their mutation derivatives is vital for biomedical science and applications. Although many nucleic acid biosensors have been developed, they often require pretreatment processes, such as target amplification and tagging probes to nucleic acids. Moreover, current biosensors typically cannot detect sequence-specific mutations in the targeted nucleic acids. To address the above problems, herein, we developed an electrochemical nanobiosensing system using a phenomenon comprising metal ion intercalation into the targeted mismatched double-stranded nucleic acids and a homogeneous Au nanoporous electrode array (Au NPEA) to obtain (i) sensitive detection of viral RNA without conventional tagging and amplifying processes, (ii) determination of viral mutation occurrence in a simple detection manner, and (iii) multiplexed detection of several RNA targets simultaneously. As a proof-of-concept demonstration, a SARS-CoV-2 viral RNA and its mutation derivative were used in this study. Our developed nanobiosensor exhibited highly sensitive detection of SARS-CoV-2 RNA (∼1 fM detection limit) without tagging and amplifying steps. In addition, a single point mutation of SARS-CoV-2 RNA was detected in a one-step analysis. Furthermore, multiplexed detection of several SARS-CoV-2 RNAs was successfully demonstrated using a single chip with four combinatorial NPEAs generated by a 3D printing technique. Collectively, our developed nanobiosensor provides a promising platform technology capable of detecting various nucleic acids and their mutation derivatives in highly sensitive, simple, and time-effective manners for point-of-care biosensing.

COVID-19 pandemic and mental health problems of adults in United States: mediating roles of cognitive concerns and behavioral changes.

OBJECTIVES: We examined the associations of statewide COVID-19 conditions (i.e., state-level case and death rates) with individual-level Generalized Anxiety Disorder (GAD) and Major Depression Disorder (MDD) focusing on the salient mediating roles of individual-level cognitive concerns and behavioral changes. METHODS: Using a national representative sample of adults in the United States (n = 585,073), we fitted logistic regressions to examine the overall associations between the COVID-19 pandemic and GAD/MDD. We employed a causal mediation analysis with two mediators: cognitive concerns (i.e., concerns on going to the public, loss of income, food insufficiency, housing payment, and the economy) and behavioral changes (i.e., taking fewer trips, avoiding eating-out, more online-purchase, more curbside pick-up, and cancelling doctor's appointments). RESULTS: We found relationships of statewide COVID-19 cases with GAD (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.05, 1.07) and MDD (OR = 1.08; 95% CI = 1.07, 1.09). The ORs were mediated by cognitive concerns for GAD (OR = 1.02, proportion mediated: 29%) and MDD (OR = 1.01, 17%). Another salient mediator was behavioral changes for GAD (OR = 1.02, 31%) and MDD (OR = 1.01, 15%). Similar associations were found with statewide COVID-19 death. CONCLUSIONS: Our mediation analyses suggest that cognitive concerns and behavioral changes are important mediators of the relationships between statewide COVID-19 case/death rates and GAD/MDD. COVID-19 pandemic may involve individual-level concerns and behavior changes, and such experiences are likely to affect mental health outcomes. Public health approaches to alleviate adverse mental health consequences should take into account the mediating factors.

Clustered Regularly Interspaced Short Palindromic Repeats-Mediated Amplification-Free Detection of Viral DNAs Using Surface-Enhanced Raman Spectroscopy-Active Nanoarray.

Nucleic acid biomarkers have been widely used to detect various viral-associated diseases, including the recent pandemic COVID-19. The CRISPR-Cas-based trans-activating phenomenon has shown excellent potential for developing sensitive and selective detection of nucleic acids. However, the nucleic acid amplification steps are typically required when sensitive and selective monitoring of the target nucleic acid is needed. To overcome the aforementioned challenges, we developed a CRISPR-Cas12a-based nucleic acid amplification-free biosensor by a surface-enhanced Raman spectroscopy (SERS)-assisted ultrasensitive detection system. We integrated the activated CRISPR-Cas12a by viral DNA with a Raman-sensitive system composed of ssDNA-immobilized Raman probe-functionalized Au nanoparticles (RAuNPs) on the graphene oxide (GO)/triangle Au nanoflower array. Using this CRISPR-based Raman-sensitive system improved the detection sensitivity of the multiviral DNAs such as hepatitis B virus (HBV), human papillomavirus 16 (HPV-16), and HPV-18 with an extremely low detection limit and vast detection range from 1 aM to 100 pM without the amplification steps. We suggest that this ultrasensitive amplification-free detection system for nucleic acids can be widely applied to the precise and early diagnosis of viral infections, cancers, and several genetic diseases.

Effects of social prescribing pilot project for the elderly in rural area of South Korea during COVID-19 pandemic.

BACKGROUND: Older adults-classified as a high-risk group-are highly likely to experience increased loneliness due to the implementation of various policies designed to prevent the spread of COVID-19. Accordingly, this study aims to examine the effects of a pilot social prescribing project for elderly people in rural area of South Korea during the COVID-19 pandemic. METHODS: Using the PRECEDE-PROCEED model, the effectiveness of the pilot project was verified through pre- and post-impact and outcome evaluation. RESULTS: According to the results of the impact evaluation, loneliness reduced significantly, while the social participation attitude score increased. Although the average score of self-efficacy increased, it was not statistically significant. Moreover, it was found that self-esteem increased significantly. In the outcome evaluation, depression reduced considerably. CONCLUSION: To conclude, the pilot social prescribing project was effective in reducing depression and loneliness for the elderly in rural areas of Korea. It was also confirmed that there is potential to develop a new health promotion project that can improve the self-esteem of the elderly, and expand their social activities. Second, the pilot project was carried out in an integrated manner by utilizing resources in communities with good accessibility. Therefore, it is expected to be used as a new "Integrated community care model" to improve the mental health of the elderly in rural areas. Third, during the COVID-19 pandemic, the elderly tend to experience increasing feelings of depression, isolation, and loneliness due to "social distancing." Therefore, it is expected that social prescribing programs for the elderly in rural areas would become a new alternative for relieve mental disorder of the seniors.

Characteristics of community-acquired respiratory viruses infections except seasonal influenza in transplant recipients and non-transplant critically ill patients.

BACKGROUND/PURPOSE: Transplant recipients are vulnerable to life-threatening community-acquired respiratory viruses (CA-RVs) infection (CA-RVI). Even if non-transplant critically ill patients in intensive care unit (ICU) have serious CA-RVI, comparison between these groups remains unclear. We aimed to evaluate clinical characteristics and mortality of CA-RVI except seasonal influenza A/B in transplant recipients and non-transplant critically ill patients in ICU. METHODS: We collected 37,777 CA-RVs multiplex real-time reverse transcription-polymerase chain reaction test results of individuals aged ≥18 years from November 2012 to November 2017. The CA-RVs tests included adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus, and respiratory syncytial virus A/B. RESULTS: We found 286 CA-RVI cases, including 85 solid organ transplantation recipients (G1), 61 hematopoietic stem cell transplantation recipients (G2), and 140 non-transplant critically ill patients in ICU (G3), excluding those with repeated isolation within 30 days. Adenovirus positive rate and infection cases were most prominent in G2 (p < 0.001). The median time interval between transplantation and CA-RVI was 30 and 20 months in G1 and G2, respectively. All-cause in-hospital mortality was significantly higher in G3 than in G1 or G2 (51.4% vs. 28.2% or 39.3%, p = 0.002, respectively). The mechanical ventilation (MV) was the independent risk factor associated with all-cause in-hospital mortality in all three groups (hazard ratio, 3.37, 95% confidence interval, 2.04-5.56, p < 0.001). CONCLUSIONS: This study highlights the importance of CA-RVs diagnosis in transplant recipients even in long-term posttransplant period, and in non-transplant critically ill patients in ICU with MV.

What surgeons should know about emergency operation for COVID-19 confirmed patients: A case report.

INTRODUCTION: This case is shared to reiterate and confirm the principles of ensuring the safety of the surgical team caring for COVID-19-confirmed patients, thus, preventing the spread of infection within the hospital. CASE PRESENTATION: A 54-year-old male, COVID-19-confirmed patient complaining of abdominal pain since two days prior was transferred to our hospital. Perforated appendicitis with a periappendiceal abscess was diagnosed by computed tomography. Laparoscopic appendectomy was performed in a negative-pressure operating room. The surgical team wore enhanced personal protective equipment. Electrocautery was not used during surgery and no other special instruments were applied to reduce aerosol generation. No special instruments or filters were used for the removal of intra-abdominal gas. The operation was completed successfully and no immediate surgical complications occurred. The patient advanced to a normal diet on the 4th postoperative day. The patient was treated with antibiotics for bacteremia and antiviral therapy for underlying pneumonia in the setting of COVID-19 with most symptoms dissipating by the 7th postoperative day. The patient was discharged on the 30th postoperative day without any complications. DISCUSSION: A well-designed manual, a well-trained surgical team, and a negative-pressure operating room are essential for safe laparoscopic appendectomies in COVID-19 patients. CONCLUSION: When surgery is performed in a negative-pressure operating room by a well-trained surgical team, a laparoscopic appendectomy can be successfully performed under the principles of obtaining optimum clinical outcomes while faithfully ensuring the safety of healthcare providers and the hospital environment.

Risk management-based security evaluation model for telemedicine systems.

BACKGROUND: Infectious diseases that can cause epidemics, such as COVID-19, SARS-CoV, and MERS-CoV, constitute a major social issue, with healthcare providers fearing secondary, tertiary, and even quaternary infections. To alleviate this problem, telemedicine is increasingly being viewed as an effective means through which patients can be diagnosed and medications prescribed by doctors via untact Thus, concomitant with developments in information and communication technology (ICT), medical institutions have actively analyzed and applied ICT to medical systems to provide optimal medical services. However, with the convergence of these diverse technologies, various risks and security threats have emerged. To protect patients and improve telemedicine quality for patient safety, it is necessary to analyze these risks and security threats comprehensively and institute appropriate countermeasures. METHODS: The security threats likely to be encountered in each of seven telemedicine service areas were analyzed, and related data were collected directly through on-site surveys by a medical institution. Subsequently, an attack tree, the most popular reliability and risk modeling approach for systematically characterizing the potential risks of telemedicine systems, was examined and utilized with the attack occurrence probability and attack success probability as variables to provide a comprehensive risk assessment method. RESULTS: In this study, the most popular modelling method, an attack tree, was applied to the telemedicine environment, and the security concerns for telemedicine systems were found to be very large. Risk management and evaluation methods suitable for the telemedicine environment were identified, and their benefits and potential limitations were assessed. CONCLUSION: This research should be beneficial to security experts who wish to investigate the impacts of cybersecurity threats on remote healthcare and researchers who wish to identify new modeling opportunities to apply security risk modeling techniques.