Recent trends in ginseng research.

Ginseng, the dried root of Panax ginseng, contains ginsenosides and has long been used in Korea, China, and Japan to treat various symptoms. Many studies on the utility of ginseng have been conducted and in this paper we investigate recent trends in ginseng research. P. ginseng studies were collected from scientific databases (PubMed, Web of Science, and SciFindern) using the keywords "Panax ginseng C.A. Meyer", "ginsenosides", "genetic diversity", "biosynthesis", "cultivation", and "pharmacology". We identified 1208 studies up to and including September 2023: 549 studies on pharmacology, 262 studies on chemical components, 131 studies on molecular biology, 58 studies on cultivation, 71 studies on tissue culture, 28 studies on clinical trials, 123 reviews, and 49 studies in other fields. Many researchers focused on the characteristic ginseng component ginsenoside to elucidate the mechanism of ginseng's pharmacological action, the relationship between component patterns and cultivation areas and conditions, and gene expression.

Genetic diversity of Panax ginseng cultivated in Japan and its relation with some plant characteristics.

In East Asia, Panax ginseng is one of the most important medicinal plants and has been used in traditional medicines from ancient times. Today, P. ginseng is cultivated in Korea, China, and Japan. Although the genetic diversity of P. ginseng in Korea and China has been reported previously, that of P. ginseng cultivated in Japan is largely unknown. In the present study, genetic diversity of P. ginseng cultivated in Japan was analyzed using eight simple sequence repeat markers that have been used in other studies, and the results were compared with previous results for Korea and China. The correlation between genetic diversity and plant characteristics, such as ginsenoside contents, were also examined. The genetic diversity of P. ginseng in Japan was substantially different from that in Korea and China, probably due to Japan's history of cultivation and the ginseng reproduction system of agamospermy. The genetic analysis indicated that P. ginseng cultivated in Japan could be classified into two clusters. The classification was related to the contents of ginsenosides Re and Ro in the main root but not to the cultivation region of the samples. These results may be useful for the cultivation and quality control of P. ginseng in Japan.

Evaluation of rooting characteristics of Ephedra cuttings by anatomy and promising strain selection based on rooting characteristics and alkaloid content.

The differences in rooting characteristics of cuttings prepared from E. sinica strains were investigated and found that cuttings prepared from strains with high rooting characteristics showed approximately 90% of the cuttings were rooted, whereas cuttings prepared from low rooting characteristics did not root. To understand the reason for this substantial difference, the anatomy of nodes was examined and found that adventitious roots were generated from the cortex and parenchyma in pith. Calculations of the correlation coefficients between the rooting rate and the value of anatomy indicated that the rooting rate was positively correlated with the parenchyma in pith in the node. On the basis of the positive correlation, it is possible to estimate the rooting characteristics of new strains without having to prepare cuttings. Next, we conducted a screening for E. sinica strains on the basis of total alkaloids content [ephedrine (E) + pseudoephedrine (PE)] and selected strains having no less than 0.7% total alkaloids content as defined by the Japanese Pharmacopoeia 18th edition. Strains having characteristic E or PE content were uncovered: E-rich strains had 100% E content and PE-rich strains had 99% PE content. We were able to select E. sinica strains on the basis of two factors: high rooting rate of cuttings and high or characteristic alkaloid content. These strains are valuable for breeding.

The Contribution of Chest X-Ray to Predict Extubation Failure in Mechanically Ventilated Patients Using Machine Learning-Based Algorithms.

OBJECTIVES: To evaluate the contribution of a preextubation chest X-ray (CXR) to identify the risk of extubation failure in mechanically ventilated patients. DESIGN: Retrospective cohort study. SETTINGS: ICUs in a tertiary center (the Medical Information Mart for Intensive Care IV database). PATIENTS: Patients greater than or equal to 18 years old who were mechanically ventilated and extubated after a spontaneous breathing trial. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 1,066 mechanically ventilated patients, 132 patients (12%) experienced extubation failure, defined as reintubation or death within 48 hours of extubation. To predict extubation failure, we developed the following models based on deep learning (EfficientNet) and machine learning (LightGBM) with the training data: 1) model using only the rapid-shallow breathing index (RSBI), 2) model using RSBI and CXR, 3) model using all candidate clinical predictors (i.e., patient demographics, vital signs, laboratory values, and ventilator settings) other than CXR, and 4) model using all candidate clinical predictors with CXR. We compared the predictive abilities between models with the test data to investigate the predictive contribution of CXR. The predictive ability of the model using CXR as well as RSBI was not significantly higher than that of the model using only RSBI (c-statistics, 0.56 vs 0.56; p = 0.95). The predictive ability of the model using clinical predictors with CXR was not significantly higher than that of the model using all clinical predictors other than CXR (c-statistics, 0.71 vs 0.70; p = 0.12). Based on SHapley Additive exPlanations values to interpret the model using all clinical predictors with CXR, CXR was less likely to contribute to the predictive ability than other predictors (e.g., duration of mechanical ventilation, inability to follow commands, and heart rate). CONCLUSIONS: Adding CXR to a set of other clinical predictors in our prediction model did not significantly improve the predictive ability of extubation failure in mechanically ventilated patients.

Comparison of phenolic compounds contained in Aquilaria leaves of different species.

Leaves of Aquilaria plants contain a variety of phenolic compounds such as iriflophenone glycosides, mangiferin, and genkwanin. Previous studies showed that Aquilaria leaf extracts exhibit many pharmacological activities, including antidiabetic and laxative effects. However, a few studies have reported differences in the chemical content and compositions of Aquilaria species. Here, three Aquilaria species were identified using matK and trnL-trnF sequences and their leaves were analyzed by HPLC and LC/MS. Comparison of the chemical components and α-glucosidase inhibition activity of the three species showed that the level of iriflophenone glycosides in A. rugosa was higher than in A. sinensis and A. crassna. There was no difference in the α-glucosidase inhibition activity of leaf extracts of the three species, but the strength of the inhibition activity can possibly be explained by the total sum of active compounds in the leaf extracts.

External validation of the POP score for predicting obstetric and gynecological diseases in the emergency department.

BACKGROUND: The POP score was developed as an easy screening tool for predicting obstetrics and gynecological (OBGYN) diseases in the emergency department (ED), and consists of three predictors, each representing one point: past history of OBGYN diseases, no fever or digestive symptoms, and peritoneal irritation signs). However, its external validity has not yet been evaluated. We aimed to perform the external validation of the POP score. METHODS: This is a multi-center, retrospective cohort study using ED data of three tertiary care hospitals in Japan between Jan 2017 and October 2020. Young adult women aged 16-49 years with abdominal pain were included in the analysis. The probability of OBGYN diseases was calculated using a logistic regression model of the POP score. Predictions were compared with observations to evaluate the calibration of the model. Further, the diagnostic ability (sensitivity, specificity, and likelihood ratio) of the POP score was evaluated. RESULTS: Of 66,599 ED visits, 1026 young adult women (median age [interquartile range]: 31 [23-41] years) were included for the analysis. The c-statistic was 0.645 [95% confidence interval (CI): 0.603-0.687]. The predicted probabilities of OBGYN diseases was generally well-calibrated to the observations. When the cut-off was set between 2 and 3 points for the ruling in of OBGYN diseases, the positive likelihood ratio was 9.72 [95% CI: 3.33-28.4]. When the cut-off was set between 0 and 1 points for ruling out of OBGYN diseases, negative likelihood ratio was 0.181 [95% CI: 0.059-0.558]. CONCLUSIONS: Using ED data of three tertiary care hospitals, we externally validated the POP score for prediction of OBGYN diseases in the ED. The POP score likely has clinical value for screening OBGYN diseases in young adult women with abdominal pain in the ED.

Risk factors of sepsis among patients with qSOFA<2 in the emergency department.

OBJECTIVE: Studies have suggested that qSOFA can be used for early detection of sepsis immediately upon arrival at the emergency department (ED). Despite this, little is known about the risk factors associated with the subsequent diagnosis of sepsis among patients with qSOFA<2 in the ED. METHODS: This is a retrospective cohort study using ED data from a large tertiary medical center in Japan, 2018-2020. We included adult patients (aged ≥18 years) presenting to the ED with suspected infection (e.g., having a fever) and qSOFA<2. We identified patients who developed sepsis based on the Sepsis-3 criteria, and compared patient characteristics (e.g., demographics, vital signs upon the initial triage, chief complaint, and comorbidities) between patients who developed sepsis or not. Additionally, we identified the potential risk factors of sepsis among patients with qSOFA<2 using a multivariable logistic regression model. RESULTS: We identified 151 (7%) patients who developed sepsis among 2025 adult patients with suspected infection and qSOFA<2. Compared with patients who did not develop sepsis, patients who developed sepsis were likely to be older and have vital signs suggestive of imminent sepsis (e.g., high respiratory rate). In the multivariable logistic regression model, the potential risk factors of sepsis among patients with qSOFA<2 were older age (adjusted OR, 1.92 [95%CI 1.19-3.19]), vital signs suggestive of imminent sepsis (e.g., adjusted OR of altered mental status, 3.50 [95%CI 2.25-5.50]), receipt of oxygen therapy upon arrival at the ED (adjusted OR, 1.91 [95%CI 1.38-2.26]), chief complaint of sore throat (adjusted OR, 2.15 [95%CI 1.08-4.13]), and the presence of comorbid diabetes mellitus, ischemic heart disease, and chronic kidney disease (e.g., adjusted OR of diabetes mellitus, 1.47 [95%CI 1.10-1.96]). On the contrary, chief complaint of abdominal and chest pain were associated with a lower risk of sepsis (e.g., adjusted OR of abdominal pain, 0.26 [95%CI 0.14-0.45]). CONCLUSIONS: We found that older age, vital signs prognosticating sepsis, and the presence of some comorbidities were the potential risk factors of sepsis in patients with qSOFA<2. These potential risk factors could be useful to efficiently recognize patients who might develop sepsis in the ED.