Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study.

BACKGROUND: Early identification of patients at risk of potential death and timely transfer to appropriate healthcare facilities are critical for reducing the number of preventable trauma deaths. This study aimed to establish a cutoff value to predict in-hospital mortality using the reverse shock index multiplied by the Glasgow Coma Scale (rSIG). METHODS: This multicenter retrospective cohort study used data from 23 emergency departments in South Korea between January 2011 and December 2020. The outcome variable was the in-hospital mortality. The relationship between rSIG and in-hospital mortality was plotted using the shape-restricted regression spline method. To set a cutoff for rSIG, we found the point on the curve where mortality started to increase and the point where the slope of the mortality curve changed the most. We also calculated the cutoff value for rSIG using Youden's index. RESULTS: A total of 318,506 adult patients with trauma were included. The shape-restricted regression spline curve showed that in-hospital mortality began to increase when the rSIG value was less than 18.86, and the slope of the graph increased the most at 12.57. The cutoff of 16.5, calculated using Youden's index, was closest to the target under-triage and over-triage rates, as suggested by the American College of Surgeons, when applied to patients with an rSIG of 20 or less. In addition, in patients with traumatic brain injury, when the rSIG value was over 25, in-hospital mortality tended to increase as the rSIG value increased. CONCLUSIONS: We propose an rSIG cutoff value of 16.5 as a predictor of in-hospital mortality in adult patients with trauma. However, in patients with traumatic brain injury, a high rSIG is also associated with in-hospital mortality. Appropriate cutoffs should be established for this group in the future.

The current trend of emergency airway management: a clinical review.

Airway management is a fundamental and intricate process that involves a sequence of integrated tasks. Situations requiring emergency airway management may occur in emergency department, intensive care units, and various other spaces. Emergency airway management can face a variety of challenges during preparation, intubation, and post-intubation, and may result in significant complications for the patients. Therefore, many countries are establishing step-by-step systemization and detailed guidelines, and updating the content based on the latest research. This clinical review introduces the current trends in emergency airway management, such as emergency airway management algorithms, comparison of video and direct laryngoscopy, rapid sequence intubation, pediatric airway management, pre-hospital airway management, surgical airway management, and airway management education.

Phenolic compounds in the freshwater environment in South Korea: Occurrence and tissue-specific distribution.

In this study, we investigated the occurrence and distribution of phenolic compounds, including phenol, cresols, chlorophenols, nitrophenol, and bromophenols, in freshwater environments. We also focused on phenolic compounds in crucian carp (Carassius auratus) tissues, specifically the muscle, gills, brain, blood, liver, and gonads, to assess their potential bioaccumulation in fish and human health risks. Phenolic compounds were found to be widespread in various freshwater environments throughout South Korea. Phenol was predominant in all matrices, with median concentrations of 57.0 ng/L in freshwater, 54.3 ng/g dry weight (dw) in sediment, and ranging from 71 ng/g wet weight (ww) to 621 ng/g ww in crucian carp tissues. Cresols were the second most dominant compound, with m-cresol exhibiting the highest prevalence. Most of the compounds detected in crucian carp samples were also detected in freshwater and sediment, whereas pentachlorophenol and 2,4,6-tribromophenol were exclusively detected in crucian carp tissues. A high bioaccumulation potential in the liver was observed for most phenolic compounds [median log bioconcentration factor (BCF): 3.2-3.7]. Interestingly, only m-cresol showed high bioaccumulation potential in the gills (median log BCF: 3.1). The estimated daily intake of phenolic compounds suggested that it does not pose an immediate concern for human exposure owing to crucian carp consumption. These findings enhance our understanding of the exposure status, distribution, and bioaccumulation potency of phenolic compounds in aquatic ecosystems and emphasize the importance of ongoing monitoring and risk assessment efforts.

Construction of land-use change matrix and estimation of greenhouse gas inventory focusing on settlements in South Korea.

BACKGROUND: Five ministries are involved in estimating the greenhouse gas (GHG) inventory in the South Korean land use, land-use change, and forestry (LULUCF) sectors. However, these ministries have not established a consistent land classification standard between land-use categories. Therefore, the GHG inventory is estimated at the approach 1 level with no spatial clarity between land-use categories. Moreover, the settlements category is not estimated because activity data and the spatial scope are lacking. This study proposed a methodology for constructing a land-use change (LUC) matrix in the LULUCF sector for improving approach level and estimating the GHG inventory in the settlements. RESULT: We examined 10 sets of spatiotemporal data in South Korea to construct a LUC matrix. To maintain consistency in the spatial land classification, we constructed a LUC matrix using cadastral maps, which provide useful data for consistent land-use classification in South Korea. The LUC matrix was divided into remaining and land-converted settlements between 2005 and 2019 with estimated areas of 878,393.17 and 203,260.42 ha, respectively. CO2 emissions, according to Intergovernmental Panel Climate Change's Guideline Tier 1, were estimated at 18.94 MtCO2 for 15 years, with an annual CO2 emission of 1.26 MtCO2 yr-1. CO2 emission by land conversion type was found to be the largest at 16.93 MtCO2 in the case of forest converted to settlements. In addition, the area with the largest CO2 emission density was Sejong-si at 7.59 tCO2/ha. CONCLUSION: Based on reviewing available spatial data in South Korea, it is possible to improve Approach 3, which is more advanced than previous Approach 1 in the settlement category. In addition, the national GHG inventory also can be estimated by our constructed LUC matrix and activity data in this study. Under the many discussions about developing the Approach system, this study can provide in-detail information on developing LUC in South Korea in the settlement category as well as suggesting a methodology for constructing the LUC matrix for countries with similar problems to South Korea.

Exposure and Risk Assessment of Korean Firefighters to PBDEs and PAHs via Fire Vehicle Dust and Personal Protective Equipment.

In this study, the levels of polycyclic aromatic hydrocarbons (PAHs) and polybrominated diphenyl ethers (PBDEs) were characterized in firefighters' personal protective equipment (PPE) (i.e., jackets, pants, hoods, and gloves) and vehicle dust wipe samples to assess the exposure and potential risk of firefighters to these combustion-related toxic pollutants. The mean levels of ∑PBDEs in the fire vehicle dust samples (778 and 449 pg/cm2 for pump trucks and command cars, respectively) were significantly higher than those in the private vehicles (31.2 pg/cm2) (Kruskal-Wallis test, p < 0.05), which was similar to the ∑PAH levels (521, 185, and 46.8 pg/cm2 for pump trucks, command cars, and private vehicles, respectively). In the case of firefighters' PPE, the levels of ∑PBDEs and ∑PAHs in used jackets and pants were found to be, respectively, 70- to 2242-folds and 11- to 265-folds higher than those in their unused counterparts. Biomass/petroleum combustion was found to be the main source of PAH contamination in fire vehicle dust and used PPE in the present study. Both carcinogenic and noncarcinogenic risks via vehicle dust ingestion and dermal absorption from wearing of PPE were within permissible limits, although the relative risk evaluation showed that PAH/PBDE absorption via wearing of PPE could pose a higher likelihood of carcinogenic and noncarcinogenic risks than the ingestion of pollutants via fire vehicle dust, warranting the need for appropriate management of firefighters' personal protective ensembles.

Metabolic engineering of Mannheimia succiniciproducens for malic acid production using dimethylsulfoxide as an electron acceptor.

Microbial production of various TCA intermediates and related chemicals through the reductive TCA cycle has been of great interest. However, rumen bacteria that naturally possess strong reductive TCA cycle have been rarely studied to produce these chemicals, except for succinic acid, due to their dependence on fumarate reduction to transport electrons for ATP synthesis. In this study, malic acid (MA), a dicarboxylic acid of industrial importance, was selected as a target chemical for mass production using Mannheimia succiniciproducens, a rumen bacterium possessing a strong reductive branch of the TCA cycle. The metabolic pathway was reconstructed by eliminating fumarase to prevent MA conversion to fumarate. The respiration system of M. succiniciproducens was reconstructed by introducing the Actinobacillus succinogenes dimethylsulfoxide (DMSO) reductase to improve cell growth using DMSO as an electron acceptor. Also, the cell membrane was engineered by employing Pseudomonas aeruginosa cis-trans isomerase to enhance MA tolerance. High inoculum fed-batch fermentation of the final engineered strain produced 61 g/L of MA with an overall productivity of 2.27 g/L/h, which is the highest MA productivity reported to date. The systems metabolic engineering strategies reported in this study will be useful for developing anaerobic bioprocesses for the production of various industrially important chemicals.

Investigating Activity Recognition for Hemiparetic Stroke Patients Using Wearable Sensors: A Deep Learning Approach with Data Augmentation.

Measuring the daily use of an affected limb after hospital discharge is crucial for hemiparetic stroke rehabilitation. Classifying movements using non-intrusive wearable sensors provides context for arm use and is essential for the development of a home rehabilitation system. However, the movement classification of stroke patients poses unique challenges, including variability and sparsity. To address these challenges, we collected movement data from 15 hemiparetic stroke patients (Stroke group) and 29 non-disabled individuals (ND group). The participants performed two different tasks, the range of motion (14 movements) task and the activities of daily living (56 movements) task, wearing five inertial measurement units in a home setting. We trained a 1D convolutional neural network and evaluated its performance for different training groups: ND-only, Stroke-only, and ND and Stroke jointly. We further compared the model performance with data augmentation from axis rotation and investigated how the performance varied based on the asymmetry of movements. The joint training of ND + Stroke yielded an increased F1-score by a margin of 31.6% and 10.6% compared to ND-only training and Stroke-only training, respectively. Data augmentation further enhanced F1-scores across all conditions by an average of 11.3%. Finally, asymmetric movements decreased the F1-score by 25.9% compared to symmetric movements in the Stroke group, indicating the importance of asymmetry in movement classification.

Lack of Specificity in Geobacter Periplasmic Electron Transfer.

Reduction of extracellular acceptors requires electron transfer across the periplasm. In Geobacter sulfurreducens, three separate cytoplasmic membrane cytochromes are utilized depending on redox potential, and at least five cytochrome conduits span the outer membrane. Because G. sulfurreducens produces 5 structurally similar triheme periplasmic cytochromes (PpcABCDE) that differ in expression level, midpoint potential, and heme biochemistry, many hypotheses propose distinct periplasmic carriers could be used for specific redox potentials, terminal acceptors, or growth conditions. Using a panel of marker-free single, quadruple, and quintuple mutants, little support for these models could be found. Three quadruple mutants containing only one paralog (PpcA, PpcB, and PpcD) reduced Fe(III) citrate and Fe(III) oxide at the same rate and extent, even though PpcB and PpcD were at much lower periplasmic levels than PpcA. Mutants containing only PpcC and PpcE showed defects, but these cytochromes were nearly undetectable in the periplasm. When expressed sufficiently, PpcC and PpcE supported wild-type Fe(III) reduction. PpcA and PpcE from G. metallireducens similarly restored metal respiration in G. sulfurreducens. PgcA, an unrelated extracellular triheme c-type cytochrome, also participated in periplasmic electron transfer. While triheme cytochromes were important for metal reduction, sextuple ΔppcABCDE ΔpgcA mutants grew near wild-type rates with normal cyclic voltammetry profiles when using anodes as electron acceptors. These results reveal broad promiscuity in the periplasmic electron transfer network of metal-reducing Geobacter and suggest that an as-yet-undiscovered periplasmic mechanism supports electron transfer to electrodes. IMPORTANCE Many inner and outer membrane cytochromes used by Geobacter for electron transfer to extracellular acceptors have specific functions. How these are connected by periplasmic carriers remains poorly understood. G. sulfurreducens contains multiple triheme periplasmic cytochromes with unique biochemical properties and expression profiles. It is hypothesized that each could be involved in a different respiratory pathway, depending on redox potential or energy needs. Here, we show that Geobacter periplasmic cytochromes instead show evidence of being highly promiscuous. Any of 6 triheme cytochromes supported similar growth with soluble or insoluble metals, but none were required when cells utilized electrodes. These findings fail to support many models of Geobacter electron transfer, and question why these organisms produce such an array of periplasmic cytochromes.

Evaluation of sample preparation methods for suspect and non-target screening in water, sediment, and biota samples using gas chromatography coupled to high-resolution mass spectrometry.

In this study, the sample preparation methods were proposed for the suspect and non-target screening (SNTS) using gas chromatography coupled to high-resolution mass spectrometry in the aquatic environment. The pretreatment methods were evaluated based on detection rates, recoveries, and screening detection limits (SDLs) for 316 substances spiked into surface water, sediment, and biota samples. The detection rates of the spiked compounds were 92.1 % and 98.7 % by the sample preparation methods for water (solid-phase extraction using HLB cartridge) and sediment (ultrasonic extraction (USE) with HLB cartridge clean-up), respectively. Similarly, USE with HLB cartridge clean-up gave the highest detection rate (87.9 %) for biota samples; however, additional pretreatment method using deactivated silica gel clean-up was necessary for the detection of persistent organic pollutants (POPs). The SDL ranges of spiked compounds by the suggested pretreatment methods were 0.01-23.5 ng/L for surface water, 0.02-37.5 ng/g dry weight for sediment, and 0.01-12.2 ng/g wet weight for biota. Although some pollutants, such as POPs had SDLs that were higher than the levels normally detected in the aquatic environment as reported in previous studies, the analytical methods suggested in the present study were satisfactory for the SNTS of most pollutants originated from anthropogenic sources.

Cryo-EM structure of an extracellular Geobacter OmcE cytochrome filament reveals tetrahaem packing.

Electrically conductive appendages from the anaerobic bacterium Geobacter sulfurreducens were first observed two decades ago, with genetic and biochemical data suggesting that conductive fibres were type IV pili. Recently, an extracellular conductive filament of G. sulfurreducens was found to contain polymerized c-type cytochrome OmcS subunits, not pilin subunits. Here we report that G. sulfurreducens also produces a second, thinner appendage comprised of cytochrome OmcE subunits and solve its structure using cryo-electron microscopy at ~4.3 Å resolution. Although OmcE and OmcS subunits have no overall sequence or structural similarities, upon polymerization both form filaments that share a conserved haem packing arrangement in which haems are coordinated by histidines in adjacent subunits. Unlike OmcS filaments, OmcE filaments are highly glycosylated. In extracellular fractions from G. sulfurreducens, we detected type IV pili comprising PilA-N and -C chains, along with abundant B-DNA. OmcE is the second cytochrome filament to be characterized using structural and biophysical methods. We propose that there is a broad class of conductive bacterial appendages with conserved haem packing (rather than sequence homology) that enable long-distance electron transport to chemicals or other microbial cells.

Prevalence of Reticulocytosis in the Absence of Anemia in Dogs with Cardiogenic Pulmonary Edema Due to Myxomatous Mitral Valve Disease: A Retrospective Study.

Myxomatous mitral valve disease (MMVD) is the most common heart disease in small breed dogs. Dogs with MMVD commonly show clinical signs of dyspnea due to cardiogenic pulmonary edema (CPE). Reticulocytosis in the absence of anemia (RAA) is a hematological finding in hypoxic conditions. We aimed to assess the prevalence of RAA in dogs with CPE due to MMVD, and evaluate whether RAA is reversible with amelioration of dyspnea. Twenty-nine client-owned dogs with CPE due to MMVD were included. Dogs who died within 6 weeks of the onset of CPE were included in the non-survival group, while the others comprised the survival group. Of the 21 dogs, RAA was observed in 17 dogs (80.9%). In the RAA group, the absolute reticulocyte count significantly decreased as CPE resolved (p < 0.001). The mean absolute reticulocyte count in the RAA group was 163.90 ± 50.77 on the first measurement and 78.84 ± 25.64 after resolution of CPE. In the RAA group, no significant differences in mean absolute reticulocyte count were observed between the survival and non-survival groups at either the first or second measurement. Our results indicate that RAA occurs in dogs with MMVD-related CPE and can resolve after resolution of CPE.

Comparison of Social Inequality in Human Papillomavirus (HPV) Vaccination among Teenagers with Parental Reports and Healthcare Providers' Records in the 2019 National Immunization Survey-Teen.

BACKGROUND: Relatively little is known about social inequality in human papillomavirus (HPV) vaccination among teenagers in the United States. This study aims to investigate whether there is a social disparity in HPV vaccination among teenagers and if so, whether it can differ according to the source of teen vaccination information (parental reports and provider records). METHODS: We used the data from the 2019 National Immunization Survey-Teen (NIS-Teen; 42,668 teenagers, aged 13-17) including parent-reported vaccination status. Among them, 18,877 teenagers had adequate provider-reported vaccination records. Two socioeconomic status (SES) measures were used: mother's education and annual family income. Multivariate logistic analyses were conducted. RESULTS: False negatives of parental reports against provider records were more than two times higher (p < 0.001) in low-SES teens than in high-SES teens. In both SES measures, the proportion of HPV-unvaccinated teenagers was lowest at the highest SES level in analyses with parental reports. However, it was the opposite in analyses with provider records. Interestingly, regardless of the vaccination information source, the HPV unvaccinated rate was highest in the middle-SES teens (>12 years, non-college graduates; above poverty level, but not >USD 75 K). CONCLUSIONS: Significant social inequality in HPV vaccination among teenagers exists in the United States. The pattern of social inequality in HPV vaccination can be distorted when only parent-reported vaccination information is used.

Characteristics of crashes and injuries on delivery motorcycles: A retrospective cohort study.

Objectives: The food delivery market is growing rapidly. As most delivery riders use motorcycles, motorcycle crashes will increase along with the growing delivery market size. This study aimed at examining the proportions of motorcycle crashes and characteristics of injuries incurred while using motorcycles for occupational purposes.Methods: This retrospective analysis included motorcycle crash patients aged 16 years or older, who were treated in 23 emergency rooms in Korea, between 2014 and 2018. Patients were divided into two groups: delivery riders (delivery group) and others (nondelivery group). Crash and injury characteristics were compared between the two groups. In addition, trends of patients in the delivery group were compared from 2014 to 2018.Results: This study examined 26,982 motorcycle crash patients, including 3894 (14.43%) patients in the delivery group and 23,088 (85.57%) in the nondelivery group. The number of patients in the delivery group increased drastically from 583 in 2014 to 1029 in 2018, whereas the number of patients in the nondelivery group did not considerably increase (4411 in 2014 and 4462 in 2018). The delivery group had a higher proportion of crashes caused by collisions with cars or other motorcycles (p < 0.001); however, injury severity was lower. The delivery group had a lower proportion of head and face injuries but a higher proportion of extremity injuries. Furthermore, 39.9% of all crashes in this group occurred between 17:00 and 21:00. Over time, there were neither any changes in the injury severities, nor any changes in the characteristics of the delivery group, with the exception of increases in both the proportion of motorist insurance and the proportion of wearing a helmet.Conclusions: The results indicated differences in characteristics between delivery motorcycle crashes and other motorcycle crashes. Although delivery motorcycle crash severity was low compared to other motorcycle crashes, the number of patients increased significantly. Therefore, to prevent crashes, it is necessary to improve the working environment. In addition, to prevent the extremity injuries of delivery riders, the policy of wearing extremity protective gears should be considered.

The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey.

BACKGROUND: Person-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined. OBJECTIVES: The aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients. METHODS: This study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression. RESULTS: Person-centred care was associated with 'awareness of surroundings' (ß = 0.29, p < .001), 'frightening experiences' (ß = -0.31, p < .001), and 'satisfaction with care' (ß = 0.54, p < .001). However, there was no significant association between person-centred care and 'recall of experience'. CONCLUSIONS: We observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.

Assessment of Exposure of Korean Firefighters to Polybrominated Diphenyl Ethers and Polycyclic Aromatic Hydrocarbons via Their Measurement in Serum and Polycyclic Aromatic Hydrocarbon Metabolites in Urine.

This study investigated the occupational exposure of Korean firefighters to a suite of combustion-related pollutants. Exposure to polybrominated diphenyl ethers (PBDEs) and polycyclic aromatic hydrocarbons (PAHs) was assessed by measurement of their levels in serum and metabolites in urine (i.e., monohydroxylated PAHs, OH-PAHs). The mean level of ∑PBDEs in the serum of firefighters (17.1 ng/g lipid weight (lw)) was significantly higher than that of the general population (1.39 ng/g lw) (Mann-Whitney U Test, p < 0.05), which is similar to the ∑PAH levels (1286 ng/g lw for firefighters and 1016 ng/g lw for the general population). Individual OH-PAH levels showed 2.1- to 4.2-fold increases in postfire urine samples compared to the control urine samples, with the mean ∑OH-PAHs being significantly higher in postfire urine samples (22,658 ng/g creatinine) than in the control urine samples (10,253 ng/g creatinine) (Mann-Whitney U test, p < 0.05). It was found that ∑PBDEs correlated with firefighters' length of service and years dedicated to on-site dispatch, while ∑OH-PAHs was strongly associated with firefighters' exposure duration, age, length of service, and years dedicated to on-site dispatch. Indeed, the results of the present study indicate that Korean firefighters are prone to elevated risk of exposure to toxic combustion-related pollutants compared with the general population.

Organophosphate Flame Retardants and Perfluoroalkyl Substances in Drinking Water Treatment Plants from Korea: Occurrence and Human Exposure.

In this study, the concentrations of organophosphate flame retardants (OPFR) and perfluoroalkyl substances (PFAS) were investigated in raw water and treated water samples obtained from 18 drinking water treatment plants (DWTPs). The ∑13OPFR concentrations in the treated water samples (29.5-122 ng/L; median 47.5 ng/L) were lower than those in the raw water (37.7-231 ng/L; median 98.1 ng/L), which indicated the positive removal rates (0-80%) of ∑13OPFR in the DWTPs. The removal efficiencies of ∑27PFAS in the DWTPs ranged from -200% to 50%, with the ∑27PFAS concentrations in the raw water (4.15-154 ng/L; median 32.0 ng/L) being similar to or lower than those in the treated water (4.74-116 ng/L; median 42.2 ng/L). Among OPFR, tris(chloroisopropyl) phosphate (TCIPP) and tris(2-chloroethyl) phosphate (TCEP) were dominant in both raw water and treated water samples obtained from the DWTPs. The dominant PFAS (perfluorooctanoic acid (PFOA) and perfluorohexanoic acid (PFHxA)) in the raw water samples were slightly different from those in the treated water samples (PFOA, L-perfluorohexane sulfonate (L-PFHxS), and PFHxA). The 95-percentile daily intakes of ∑13OPFR and ∑27PFAS via drinking water consumption were estimated to be up to 4.9 ng/kg/d and 0.22 ng/kg/d, respectively. The hazard index values of OPFR and PFAS were lower than 1, suggesting the risks less than known hazardous levels.

Legacy and novel perfluoroalkyl and polyfluoroalkyl substances in industrial wastewater and the receiving river water: Temporal changes in relative abundances of regulated compounds and alternatives.

Concentrations of 28 novel and legacy perfluoroalkyl and polyfluoroalkyl substances (PFASs) in wastewater from 77 industrial plants in the largest industrial complex in Korea were determined. The industrial plants were of eight types (advanced electronic, battery, chemical, general electronic, glass and ceramic, metal, polymer, and textile). PFAS concentrations in river water receiving the wastewater were determined to assess the impact of wastewater from the industrial complex. Only 19 and nine target PFASs were detected in untreated industrial wastewater and river water, respectively. Novel PFASs such as F53B (6:2 chlorinated polyfluoroalkyl ether sulfonate) were not detected. The mean PFASs concentration in industrial wastewater treatment plant effluent was 5.18 µg/L. The mean total PFASs concentration was highest in advanced electronic plant effluent, second highest in general electronic plant effluent, and lowest in battery and chemical plant effluents. Perfluorohexane sulfonate was the dominant homolog, being detected in effluent from plants of all classes and contributing 96% of total discharged PFASs by mass. Perfluorooctane sulfonate (included in the Stockholm Convention) use has decreased markedly since previous studies. Perfluorooctane sulfonate has largely been replaced by PFASs with fewer than seven carbon atoms. A similar change was found for river water receiving industrial wastewater.

Hexane extract of green tea (Camellia sinensis) leaves is an exceptionally rich source of squalene.

Squalene is a cancer chemo-preventive and skin protective agent with high commercial demand. Here, we report for the first time that the green tea (Camellia sinensis) leaves is a surprisingly rich plant-based source of squalene. Young and tender leaves and old and turf leaves were collected at four different collecting seasons (April-August). Lipophilic compounds in the leaves and commercial green teas were extracted with hexane. The squalene contents in the hexane extracts varied greatly with the types of the leaves and collecting seasons. The hexane extract of turf leaves contained significantly higher contents of squalene than the extract of tender leaves. The hexane extract of the turf leaves collected in August contained the highest content of squalene (29.2 g/kg extract). This represents the first report on the qualitative and quantitative information on squalene in green tea leaves.

2018 Korean Clinical Imaging Guideline for Hemoptysis.

In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of hemoptysis and risk for lung cancer. However, the application of the ACR guideline in Korea may not be appropriate, because many patients in Korea have active tuberculosis or pulmonary fibrosis due to previous tuberculosis. The Korean Society of Radiology and Korean Society of Thoracic Radiology have proposed a new guideline suitable for Korean practice. This new guideline was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on an evidence-based clinical imaging guideline proposed by the development committee. Clinical imaging guideline for adult patients with hemoptysis is as follows: Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast-enhanced chest CT is recommended in patients with two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history), moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis. Contrast-enhanced chest CT is also recommended in patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

Comparison of mid- to long-term clinical outcomes between anatomical testing and usual care in patients with suspected coronary artery disease: A meta-analysis of randomized trials.

BACKGROUND: Controversies remain regarding clinical outcomes following initial strategies of coronary computed tomography angiography (CCTA) vs usual care with functional testing in patients with suspected coronary artery disease (CAD). HYPOTHESIS: CCTA as initial diagnostic strategy results in better mid- to long-term outcomes than usual care in patients with suspected CAD. METHODS: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials comparing clinical outcomes during ≥6 months' follow-up between initial anatomical testing by CCTA vs usual care with functional testing in patients with suspected CAD. Occurrence of all-cause mortality, nonfatal myocardial infarction (MI), and major adverse cardiovascular events (MACE), and use of invasive coronary angiography and coronary revascularization, were compared between the 2 diagnostic strategies. RESULTS: Twelve trials were included (20 014 patients; mean follow-up, 20.5 months). Patients undergoing CCTA as initial noninvasive testing had lower risk of nonfatal MI compared with those treated with usual care (risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.52-0.94, P = 0.02). There was a tendency for reduced MACE following initial CCTA strategy, but not for risk of all-cause mortality. Compared with functional testing, the CCTA strategy increased use of invasive coronary angiography (RR: 1.53, 95% CI: 1.12-2.09, P = 0.007) and coronary revascularization (RR: 1.49, 95% CI: 1.11-2.00, P = 0.007). CONCLUSIONS: Anatomical testing with CCTA as the initial noninvasive diagnostic modality in patients with suspected CAD resulted in lower risk of nonfatal MI than usual care with functional testing, at the expense of more frequent use of invasive procedures.