Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad

BACKGROUND

Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative.

RESULTS

Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU.

CONCLUSION

Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.

qEEG as Biomarker for Alzheimer's Disease: Investigating Relative PSD Difference and Coherence Analysis

Purpose

Electroencephalography (EEG) is a non-intrusive technique that provides comprehensive insights into the electrical activities of the brain's cerebral cortex. The brain signals obtained from EEGs can be used as a neuropsychological biomarker to detect different stages of Alzheimer's disease (AD) through quantitative EEG (qEEG) analysis. This paper investigates the difference in the abnormalities of resting state EEG (rEEG) signals between eyes-open (EOR) and eyes-closed (ECR) in AD by analyzing 19-scalp electrode EEG signals and making a comparison with healthy controls (HC).

Participants and Methods

The rEEG data from 534 subjects (ages 40-90) consisting of 269 HC and 265 AD subjects in South Korea were used in this study. The qEEG for EOR and ECR states were performed separately for HC and AD subjects to measure the relative power spectrum density (PSD) and coherence with functional connectivity to evaluate abnormalities. The rEEG data were preprocessed and analyzed using EEGlab and Brainstorm toolboxes in MATLAB R2021a software, and statistical analyses were carried out using ANOVA.

Results

Based on the Welch method, the relative PSD of the EEG EOR and ECR states difference in the AD group showed a significant increase in the delta frequency band of 19 EEG channels, particularly in the frontal, parietal, and temporal, than the HC groups. The delta power band on the source level was increased for the AD group and decreased for the HC group. In contrast, the source activities of alpha, beta, and gamma frequency bands were significantly reduced in the AD group, with a high decrease in the beta frequency band in all brain areas. Furthermore, the coherence of rEEG among different EEG electrodes was analyzed in the beta frequency band. It showed that pair-wise coherence between different brain areas in the AD group is remarkably increased in the ECR state and decreased after subtracting out the EOR state.

Conclusion

The findings suggest that examining PSD and functional connectivity through coherence analysis could serve as a promising and comprehensive approach to differentiate individuals with AD from normal, which may benefit our understanding of the disease.

The eveningness chronotype is associated with nightmare distress and dream recall: a cross-sectional study

Dreaming may be affected by sleep behavior; however, evidence of the effect of chronotypes on dreaming is limited. We investigated sleep patterns, dream recall, and nightmare distress according to chronotypes. This cross-sectional study retrospectively enrolled adult participants (age > 18 years) who visited a sleep laboratory between 2016 and 2021 and underwent standard polysomnography (PSG) and completed a self-reported questionnaire. Patients with major sleep disorders were excluded. Chronotypes and dreaming components were assessed using the Korean version of the morningness-eveningness questionnaire and a nine-item dreaming questionnaire (nightmare distress and dream recall), respectively. Among healthy participants without major sleep disorders, the eveningness chronotype correlated with better dream recall than the morningness and intermediate chronotypes. Participants with the eveningness chronotype were younger and more likely to be unmarried than those with the other chronotypes. No significant chronotype-based difference was observed in the subjective measurements of sleep quality, insomnia, daytime sleepiness, depression, and anxiety or in respiration and movement events on PSG. In multivariate linear regression analysis, the chronotypes were independently related to nightmare distress (b = - 0.296; p = 0.002) and dream recall (b = - 0.334; p = 0.002). The apnea-hypopnea index was associated with nightmare distress (b = - 0.209; p = 0.029) and dream recall (b = - 0.189; p = 0.044). Depression was positively correlated with nightmare distress (b = 0.450; p = 0.002). Dream recall was best in the eveningness group among healthy adults. Greater eveningness was associated with higher nightmare distress and better dream recall. Further research is needed to understand the role of chronotypes in dreaming.

Erratum: CNN for a Regression Machine Learning Algorithm for Predicting Cognitive Impairment Using qEEG [Corrigendum]

[This corrects the article DOI: 10.2147/NDT.S404528.].

Sleep and Circadian Rhythm in Relation to COVID-19 and COVID-19 Vaccination-National Sleep Survey of South Korea 2022

BACKGROUND

Currently, information on sleep and circadian patterns in relation to COVID-19 or vaccination remains limited. We aimed to investigate sleep and circadian patterns according to history of COVID-19 and COVID-19 vaccination side effects.

METHODS

We used data from the National Sleep Survey of South Korea 2022, a nationwide cross-sectional population-based survey regarding sleep-wake behaviors and sleep problems among Korean adults. Analysis of covariance (ANCOVA) and logistic regression analyses were performed to explore the different sleep and circadian patterns according to the history of COVID-19 or self-reported side effects of the COVID-19 vaccination.

RESULTS

The ANCOVA showed that individuals with a history of COVID-19 presented a later chronotype than individuals without a history of COVID-19. Individuals who had experienced vaccine-related side effects had a shorter sleep duration, poorer sleep efficiency, and worse insomnia severity. Multivariable logistic regression analysis showed a later chronotype related to COVID-19. A short sleep duration, poorer sleep efficiency, and worse insomnia severity were associated with self-reported side effects of the COVID-19 vaccination.

CONCLUSIONS

Individuals who recovered from COVID-19 had a later chronotype than those without a history of COVID-19. Individuals who had experienced vaccine-related side effects presented with poorer sleep than those without side effects.

CNN for a Regression Machine Learning Algorithm for Predicting Cognitive Impairment Using qEEG

Purpose

Electroencephalogram (EEG) signals give detailed information on the electrical brain activities occurring in the cerebral cortex. They are used to study brain-related disorders such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). Brain signals obtained using an EEG machine can be a neurophysiological biomarker for early diagnosis of dementia through quantitative EEG (qEEG) analysis. This paper proposes a machine learning methodology to detect MCI and AD from qEEG time-frequency (TF) images of the subjects in an eyes-closed resting state (ECR).

Participants and Methods

The dataset consisted of 16,910 TF images from 890 subjects: 269 healthy controls (HC), 356 MCI, and 265 AD. First, EEG signals were transformed into TF images using a Fast Fourier Transform (FFT) containing different event-rated changes of frequency sub-bands preprocessed from the EEGlab toolbox in the MATLAB R2021a environment software. The preprocessed TF images were applied in a convolutional neural network (CNN) with adjusted parameters. For classification, the computed image features were concatenated with age data and went through the feed-forward neural network (FNN).

Results

The trained models', HC vs MCI, HC vs AD, and HC vs CASE (MCI + AD), performance metrics were evaluated based on the test dataset of the subjects. The accuracy, sensitivity, and specificity were evaluated: HC vs MCI was 83%, 93%, and 73%, HC vs AD was 81%, 80%, and 83%, and HC vs CASE (MCI + AD) was 88%, 80%, and 90%, respectively.

Conclusion

The proposed models trained with TF images and age can be used to assist clinicians as a biomarker in detecting cognitively impaired subjects at an early stage in clinical sectors.

Association between Fiber Intake and Risk of Incident Chronic Kidney Disease: The UK Biobank Study

OBJECTIVES

Dietary fiber intake is associated with a lower risk of diabetes, cardiovascular disease, and cancer. However, it is unknown whether dietary fiber has a beneficial effect on preventing the development of chronic kidney disease (CKD).

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Using the UK Biobank prospective cohort, 110,412 participants who completed at least one dietary questionnaire and had an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, urinary albumin-to-creatinine ratio <30 mg/g, and no history of CKD were included. The primary exposure was total dietary fiber density, calculated by dividing the absolute amount of daily total fiber intake by total energy intake (g/1,000 kcal). We separately examined soluble and insoluble fiber densities as additional predictors. The primary outcome was incident CKD based on diagnosis codes.

RESULTS

A total of 3,507 (3.2%) participants developed incident CKD during a median follow-up of 9.9 years. In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for incident CKD were 0.85 (0.77-0.94), 0.78 (0.70-0.86), and 0.76 (0.68-0.86), respectively, for the second, third, and highest quartiles of dietary fiber density (reference: lowest quartile). In a continuous model, the aHR for each +∆1.0g/1,000 kcal increase in dietary fiber density was 0.97 (95% CI, 0.95-0.99). This pattern of associations was similar for both soluble and insoluble fiber densities and did not differ across subgroups of sex, age, body mass index, hypertension, diabetes, smoking, and inflammation.

CONCLUSION

Increased fiber intake was associated with a lower risk of CKD in this large well-characterized cohort.

Is Functional Connectivity after a First Unprovoked Seizure Different Based on Subsequent Seizures and Future Diagnosis of Epilepsy?

Background and Purpose: There are no highly sensitive biomarkers for epilepsy to date. Recently, promising results regarding functional connectivity analysis have been obtained, which may improve epilepsy diagnosis even in the absence of visible abnormality in electroencephalography. We aimed to investigate the differences in functional connectivity after a first unprovoked seizure between patients diagnosed with epilepsy within 1 year due to subsequent seizures and those who were not.Methods: We compared quantitative electroencephalography power spectra and functional connectivity between 12 patients who were diagnosed with epilepsy (two or more unprovoked seizures) within 1 year and 17 controls (those not diagnosed within 1 year) using iSyncBrain^® (iMediSync Inc., Suwon, Korea; https://isyncbrain.com/). In the source-level analysis, the current distribution across the brain was assessed using the standardized low-resolution brain electromagnetic tomography technique, to compare relative power values in 68 regions of interest and connectivity (the imaginary part of coherency) between regions of interest.Results: In the epilepsy group, quantitative electroencephalography showed lower alpha2 band power in left frontal, central, superior temporal, and parietal regions and higher beta2 power in both frontal, central, temporal, occipital, and left parietal regions compared with the control group. Additionally, epilepsy patients had significantly lower connectivity in alpha2 and beta2 bands than the controls.Conclusions: Patients experiencing their first unprovoked seizure presented different brain function according to whether they have subsequent seizures and future epilepsy. Our results propose the potential clinical ability to diagnose epilepsy after the first unprovoked seizure in the absence of interictal epileptiform discharges.

Is Functional Connectivity after a First Unprovoked Seizure Different Based on Subsequent Seizures and Future Diagnosis of Epilepsy?

Background and Purpose

There are no highly sensitive biomarkers for epilepsy to date. Recently, promising results regarding functional connectivity analysis have been obtained, which may improve epilepsy diagnosis even in the absence of visible abnormality in electroencephalography. We aimed to investigate the differences in functional connectivity after a first unprovoked seizure between patients diagnosed with epilepsy within 1 year due to subsequent seizures and those who were not.

Methods

We compared quantitative electroencephalography power spectra and functional connectivity between 12 patients who were diagnosed with epilepsy (two or more unprovoked seizures) within 1 year and 17 controls (those not diagnosed within 1 year) using iSyncBrain^® (iMediSync Inc., Suwon, Korea; https://isyncbrain.com/). In the source-level analysis, the current distribution across the brain was assessed using the standardized low-resolution brain electromagnetic tomography technique, to compare relative power values in 68 regions of interest and connectivity (the imaginary part of coherency) between regions of interest.

Results

In the epilepsy group, quantitative electroencephalography showed lower alpha2 band power in left frontal, central, superior temporal, and parietal regions and higher beta2 power in both frontal, central, temporal, occipital, and left parietal regions compared with the control group. Additionally, epilepsy patients had significantly lower connectivity in alpha2 and beta2 bands than the controls.

Conclusions

Patients experiencing their first unprovoked seizure presented different brain function according to whether they have subsequent seizures and future epilepsy. Our results propose the potential clinical ability to diagnose epilepsy after the first unprovoked seizure in the absence of interictal epileptiform discharges.

Increased pulsatility index of the basilar artery is a risk factor for neurological deterioration after stroke: a case control study

Background

Higher pulsatility of the middle cerebral artery (MCA) is known to be associated with stroke progression. We investigated whether pulsatility index (PI) of the basilar artery (BA) can predict neurological deterioration (ND) after acute cerebral infarction.

Methods

A total of 708 consecutive patients with acute ischemic stroke who had undergone transcranial Doppler (TCD) ultrasonography were included. ND was defined as an increase in the National Institutes of Health Stroke Scale scores by two or more points after admission. The patients were categorized into quartiles according to BA PI. Multivariable logistic regression analysis was performed to examine whether BA PI is independently associated with ND.

Results

BA PI was well correlated with the right (n = 474, r² = 0.573, P < 0.001) by Pearson correlation analysis although MCA PI could not be measured from right MCA (n = 234, 33.05%) and left MCA (n = 252, 35.59%) by TCD owing to insufficient temporal bone window. Multivariable logistic regression analysis including age, sex, cerebral atherosclerosis burden, National Institutes of Health Stroke Scale at admission, and the proportion of patients with current smoking status, hypertension, diabetes mellitus, atrial fibrillation revealed that the higher BA PI (odds ratio, 3.28; confidence interval, 1.07–10.17; P = 0.038) was independently associated with ND.

Conclusions

BA PI, which would be identified regardless of temporal window, could predict ND among acute stroke patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40885-022-00210-9.

Quantitative electroencephalography changes in patients with mild cognitive impairment after choline alphoscerate administration

There is limited evidence on the effectiveness of choline alphoscerate for mild cognitive impairment (MCI) in studies using neuropsychological markers. The aim of this study was to evaluate the spectral change at a source level using quantitative electroencephalography (qEEG) as a biomarker for cognitive function after choline alphoscerate administration to patients with MCI. This study used the qEEG data of patients with MCI who visited the Department of Neurology of the Chung-Ang University Hospital between April 2017 and December 2018. Resting-state EEG studies were performed on 33 patients with MCI at baseline and compared with those of the 18 normal controls selected from the community. After baseline qEEG, choline alphoscerate 400 mg was administered twice daily for 2 months to the patients with MCI. Follow-up qEEG was performed in 20 subjects. Baseline qEEG of patients with MCI was compared to qEEG after choline alphoscerate administration. We found that the MCI group exhibited a decreased alpha power compared to that of the control group. Patients with MCI treated with choline alphoscerate exhibited a decrease in the theta and delta power of the parietal and temporal lobe and an increase in the alpha power spectrum of the occipital lobes. We also identified the trend of default mode network enhancement after choline alphoscerate administration. Our results suggest that choline alphoscerate may have a positive effect in patients with MCI and support the usefulness of qEEG for monitoring the therapeutic effect of nootropics.

Aggression is more strongly associated with suicidality, independent of depression, than emotional instability and impulsivity in people with epilepsy

PURPOSE

We evaluated the relative contributions of emotional instability, impulsivity, and aggression to the presence of suicide risk in people with epilepsy after adjusting for depressive symptoms.

METHODS

This was a cross-sectional study that used the short form of the Affective Lability Scale (ALS-18), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Brief Aggression Questionnaire (BAQ), and the Patient Health Questionnaire-9 (PHQ-9). Suicidality was assessed using the Mini International Neuropsychiatric Interview (MINI), and the presence of suicide risk was defined as a MINI suicidality score ≥1. Stepwise logistic regression and mediation analyses using a two-stage regression method were performed.

RESULTS

Of the 171 subjects (63.2% men) included, suicide risk was present in 38 subjects (22.2%). The stepwise logistic regression analysis identified four variables that were independently associated with suicide risk: higher PHQ-9 score, higher BAQ score, longer duration of epilepsy, and unemployment. The univariate analysis showed that ALS-18 and BIS-11 scores were significantly associated with suicide risk; however, they were backward eliminated from the logistic model according to the criterion of p > 0.1. The mediating effects of ALS-18 and BIS-11 scores on suicide risk via PHQ-9 scores (but not BAQ scores) were significant, with the proportion mediated 61.5% and 54.0% of the total effect, respectively.

CONCLUSIONS

Alongside depressive symptoms, aggression may be a more useful concept than emotional instability and impulsivity for identifying suicidal risk in people with epilepsy.

Impulsivity in persons with epilepsy: Association with seizure severity and suicide risk

PURPOSE

Clinical research regarding impulsivity in patients with epilepsy is limited. The present study investigated the associations between impulsivity and seizure-related factors or suicidality in patients with epilepsy, independent of depression and anxiety.

METHODS

The multicenter study included 146 subjects (63% men). We utilized the Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and suicidality module of the Mini International Neuropsychiatric Interview (MINI). Stepwise regression analyses and an analysis of covariance with interaction terms were performed.

RESULTS

The mean BIS-11 score was 59.3 (SD = 10.7). Psychiatric pathologies, including suicidality, were reported in relatively large proportions of patients, including PHQ-9 score ≥ 10 in 29 (19.9%) patients, GAD-7 score ≥ 7 in 35 (24.0%) patients, and MINI suicidality score ≥ 6 in 15 (10.3%) patients. Stepwise linear regression revealed that BIS-11 score was positively associated with the PHQ-9 scores (p < 0.001), antiseizure medication polytherapy (p < 0.001), use of lamotrigine (p = 0.009), and recurrence of generalized or focal to bilateral tonic clonic seizures (p = 0.010). The coefficient of determination for the model was 0.397. Generalized or focal to bilateral tonic clonic seizure recurrence tended to be positively associated with total BIS-11 scores in men but not in women. In subscale analyses, somewhat different variables were associated with different BIS-11subscales. A trend for a positive association between BIS-11 score and suicidality was found (p = 0.066).

CONCLUSIONS

This study identified a positive association between clinical seizure severity and impulsivity, and found that this association tended to be sex-specific, occurring only in males. Impulsivity could potentially be weakly associated with suicidality in patients with epilepsy.

Insomnia moderates the association between recurrent seizures and emotional instability in persons with epilepsy

PURPOSE

We investigated the moderating effect of sleep disturbance on the association between seizure recurrence and emotional instability in patients with epilepsy, independent of psychological distress.

METHODS

This was a cross-sectional study. Patients completed the short form of the Affective Lability Scale (ALS-18), Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). A stepwise linear regression analysis and an analysis of covariance with an interaction term were performed.

RESULTS

A total of 171 subjects (63.2% men) were included. The mean ALS-18 score was 15.6 ± 11.3. An ISI ≥ 15, PHQ-9 ≥ 10, and GAD-7 ≥ 7 were noted in 20.5%, 18.1%, and 23.4% of subjects, respectively. A stepwise linear regression analysis found that recurrent seizures in the last year, an ISI ≥ 15, a GAD-7 ≥ 7, and use of levetiracetam were significant and independent factors that were positively associated with higher ALS-18 scores. The coefficient of determination for the model was 0.331. The interaction between recurrent seizures and an ISI ≥ 15 had a significant effect on the ALS-18 scores (F = 6.812, p = 0.010, partial eta² = 0.040). An ISI ≥ 15 was associated with ALS-18 scores in patients without seizure recurrence (p < 0.001). This association almost reached significance (p = 0.084) in those with recurrent seizures. In contrast, the presence of recurrent seizures was associated with ALS-18 scores in patients with an ISI < 15 (p < 0.001), but not in those with an ISI ≥ 15 (p = 0.360).

CONCLUSIONS

The significant interaction between insomnia and seizure status may have an effect on emotional instability. These findings have clinical implications in the development of potential interventions for emotional instability in patients with epilepsy.

Surprisingly good thermoelectric performance of monolayer C3N

The rapid emergence of graphene has attracted numerous efforts to explore other two-dimensional materials. Here, we combine first-principles calculations and Boltzmann theory to investigate the structural, electronic, and thermoelectric transport properties of monolayer C₃N, which exhibits a honeycomb structure very similar to graphene. It is found that the system is both dynamically and thermally stable even at high temperature. Unlike graphene, the monolayer has an indirect band gap of 0.38 eV and much lower lattice thermal conductivity. Moreover, the system exhibits obviously larger electrical conductivity and Seebeck coefficients for the hole carriers. Consequently, theZTvalue ofp-type C₃N can reach 1.4 at 1200 K when a constant relaxation time is predicted by the simple deformation potential theory. However, such a largerZTis reduced to 0.6 if we fully consider the electron-phonon coupling. Even so, the thermoelectric performance of monolayer C₃N is still significantly enhanced compared with that of graphene, and is surprisingly good for low-dimensional thermoelectric materials consisting of very light elements.

Sex differences in seizure effects on social anxiety in persons with epilepsy

PURPOSE

We investigated sex differences in the effect of seizures on social anxiety in persons with epilepsy.

METHOD

In this cross-sectional multicenter study, social anxiety was measured using the short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12 were considered to indicate social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9, Stigma Scale-Revised, and Family Adaptation-Partnership-Growth-Affection-Resolve scale were also completed. A logistic regression analysis with an interaction term was used to analyze the data.

RESULTS

Out of 285 participants, a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12 were noted in 62 (21.8%) and 36 (12.6%) of participants, respectively. There was no difference in the prevalence of social anxiety between men and women. Intractable seizures and lack of seizure freedom were associated with a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12, but statistical significance was lost in the adjusted models. However, intractable seizures and lack of seizure freedom significantly interacted with sex for a SPS-6 score ≥ 9 (p = 0.018) and a SIAS-6 score ≥ 12 (p = 0.048) in both the separate and adjusted models. Specifically, intractable seizures tended to be positively associated with SPS-6 scores ≥ 9 than non-intractable seizures in men only (odds ratio = 2.602, p = 0.068), whereas lack of seizure freedom tended to be negatively associated with SIAS-6 scores ≥ 12 than seizure freedom in women only (odds ratio = 4.804, p = 0.053).

CONCLUSION

We found significant sex differences in seizure effects on social anxiety. Intractable seizures were associated with social phobia in men, whereas lack of seizure freedom in the last year was associated with social interaction anxiety in women.

[Effect of occupational stress on depression in gas field workers]

Objective: To explore the occurrence level of depressive symptoms and it's influencing factors among gas field workers. Methods: In October 2018, a cross-sectional study was conducted in 1726 gas field workers from a gas field by using cluster sampling method. Questionaire was used to evaluate the individual factors, depressive symptoms, occupational stress factors and stress regulatory factors. The correlation between depressive symptoms and occupational stress was analyzed. Multivariate logistic regression was used to analyze the influencing factors of depressive symptoms. Results: The depressive symptoms score of gas field workers was 12.00 (7.00, 19.00) point. Correlation analysis revealed that depressive symptoms score was positively related to sleep disorders (r=0.598) , effort (r=0.186) , daily tension (r=0.478) , negative affectivity (r=0.565) , social support (r=0.446) and monotony of work (r=0.484) (P<0.01) . And it was negatively related to reward (r=-0.386) , work stability (r=-0.294) , promotion opportunities (r=-0.258) , positive affectivity (r= -0.310) , self-efficacy (r=-0.312) , contral strategy (r=-0.268) , support strategy (r=-0.209) and job satisfaction (r=-0.398) (P<0.01) . Multivariate logistic regression analysis revealed that sleep disorder, high negative affectivity, low support from colleagues, low support from family, high monotony of work and high daily tension were the risk factors for depressive symptoms of gas field worker (OR=3.423, 95%CI: 2.644-4.397; OR=2.847, 95%CI: 2.200-3.683; OR=1.646, 95%CI: 1.215-2.116; OR=1.496, 95%CI: 1.164-1.923; OR=1.578, 95%CI: 1.227-2.303; OR=1.903, 95%CI: 1.480-2.440; P<0.01) . High work stability, high self-efficacy and high job satisfaction were protective factors for depressive symptoms of gas field workers (OR=0.752, 95%CI: 0.591-0.958; OR=0.590, 95%CI: 0.465-0.749; OR=0.718, 95%CI: 0.516-0.999; P<0.05) . Conclusion: Occupational stress factors have a great influence on the depressive symptoms of gas field workers. Increased work stability, self-efficacy and job satisfaction could reduce the risk of depressive symptoms.

Analysis of microRNA signatures in ischemic stroke thrombus

BACKGROUND

We investigated the microRNA expression pattern from thrombus retrieved by mechanical thrombectomy in acute stroke patients to understand the stroke mechanism.

METHODS

This study included acute ischemic stroke patients who had undergone intra-arterial thrombectomy at Chung-Ang University Hospital in Seoul, Korea between February 2016 and March 2019. The thrombus was retrieved and stored at -70℃ after obtaining informed consent. MicroRNA microarray analysis was performed for the patients with identified stroke mechanisms including (1) large artery atherosclerosis, (2) cardioembolism with atrial fibrillation, and (3) cardioembolism with valvular heart disease. The microRNAs derived from microarray analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR) from different patient populations. The correlation analysis was performed between microRNA levels and laboratory data to understand the functional relevance of the altered microRNA.

RESULTS

In total, 55 thrombi were obtained from 74 patients, and the microRNAs were analyzed in 45 samples. Microarray analysis of 2578 microRNAs revealed that 50 microRNAs were significantly altered among the three groups. Validation using qRT-PCR showed that miR-378f and miR-450b-5p were significantly elevated among the cardioembolic thrombi; both microRNAs were inversely correlated with the ejection fraction from echocardiography. Thrombi from patients with early neurological deterioration exhibited higher levels of miR-93-5p and lower levels of miR-629-5p than those from neurologically stable patients.

CONCLUSIONS

The microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.

Survey on Antiepileptic Drug Therapy in Patients with Drug Resistant Epilepsy

Background and Purpose

Individualized anti-epileptic drug (AED) selection in patient with epilepsy is crucial. However, there is no unified opinion in treating patients with drug resistant epilepsy (DRE). This survey aimed to make a consolidate consensus with epileptologists’ perspectives of the treatment for Korean DRE patients by survey responses.

Methods

The survey was conducted with Korean epilepsy experts who have experience prescribing AEDs via e-mail. Survey questionnaires consisted of six items regarding prescription patterns and practical questions in treating patients with DRE in Korea. The research period was from February 2021 to March 2021.

Results

The survey response rate was 83.3% (90/108). Most (77.8%) of the responders are neurologists. The proportion of patients whose seizures were not controlled by the second AED was 26.9%. The proportion of patients who had taken five or more AEDs is 13.9%, and those who are currently taking five or more AEDs are 7.3%, of which 54.5% and 37.9% reported positive effects on additional AED, respectively. The majority (91.1%) of respondents answered that the mechanism of action was the top priority factor when adding AED. Regarding data priority, responders considered that expert opinion should have the top priority, followed by clinical experiences, reimbursement guidelines and clinical evidence. Responders gave 64.9 points (range from 0 to 100) about overall satisfaction on reimbursement system of Health Insurance Review and Assessment Service for AED.

Conclusions

This study on AED therapy for DRE patients is the first nationwide trial in Korean epilepsy experts. In five drug failure, the top priorities on AED selection are mechanism of action and expert opinion. These findings might help to achieve consensus and recognize the insight on optimal therapy of AED in DRE.

Strong interlayer coupling in two-dimensional PbSe with high thermoelectric performance

It was generally believed that weak van der Waals interactions exist between neighboring layers in the two-dimensional group-IV chalcogenides. Using PbSe as a prototypal example, we find additional strong coupling between the Pb-Pb layers, as evidenced by detailed analysis of the differential charge density plot. The coupling is covalent-like and can be fine-tuned to obviously reduce the phonon thermal conductivity but slightly change the electronic transport of PbSe layer. As a consequence, a maximumZTvalue of 2.5 can be realized at 900 K for thep-type system. Our work also offers an effective and feasible design strategy to enhance the thermoelectric performance of similar layered structures.

Obstructive sleep apnea in airline pilots during daytime sleep following overnight flights

To identify the vulnerability of recovery sleep, this study investigated the occurrence of obstructive sleep apnea during daytime sleep following overnight flights in healthy airline pilots. We conducted daytime polysomnography following a long-haul night-time flight in 103 pilots. The following variables were assessed: apnea-hypopnea index, respiratory disturbance index and oxygen desaturation index. Moderate-to-severe obstructive sleep apnea was defined as an apnea-hypopnea index ≥15. Seventy-three pilots (70.9%) with no known history of obstructive sleep apnea presented with moderate-to-severe obstructive sleep apnea. Pilots showed high mean apnea-hypopnea, respiratory disturbance and oxygen desaturation indices. The body mass index, Berlin questionnaire score and cumulative flight time contributed to these indices, with both body mass index and cumulative flight time remaining significant at an apnea-hypopnea index ≥15. We found that pilots are vulnerable to obstructive sleep apnea during daytime sleep after night-time flights, which may deteriorate their health, increase fatigue and impair overall flight safety. Further research is needed to ensure flight safety, as daytime recovery sleep is unavoidable for night-time flight pilots. The pilots' normal and recovery sleep patterns should both be studied to develop an effective sleep management protocol.

Real-world prescribing trends of valproate in women with epilepsy in Korea

Avoiding valproate is recommended in women of childbearing age due to possible teratogenicity and infertility. We aimed to examine the recent trend of valproate prescriptions in Korea to review the adequacy of anticonvulsant prescriptions in women with epilepsy (WWE). Oral valproate utilization was assessed using nationwide and unselected data from the Korean National Health Insurance Service from 2009 to 2017. The temporal trends of the proportions of valproate prescriptions were analyzed using the Poisson regression model and expressed as average annual percentage change (AAPC). Among the WWE of childbearing age, valproate was prescribed in 37.0% overall and 29.4% as initial prescription in 2017. The proportion of valproate utilization showed a decreasing trend in overall prescription (AAPC = -1.10%) and initial prescription (AAPC = -2.63%). However, the proportion was static over time in the initial monotherapy group (AAPC = -0. 53%), while it was significantly decreasing in the initial polytherapy group (AAPC = -8.25%). A noticeable proportion of WWE was still being prescribed valproate in Korea. In particular, the use of valproate for initial monotherapy has not decreased over the past nine years. This result calls not only for reinforcement of education regarding anticonvulsant selection but also for monitoring the actual prescription.

Association of Bone Mineral Density to Cerebral Small Vessel Disease Burden

OBJECTIVE

To test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke.

METHODS

We analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). White matter hyperintensities, silent lacunes, cerebral microbleeds, and extensive perivascular space were assessed from brain MRI. Multinomial logistic regression model was used to examine the association between osteoporosis and total SVD score. We also recruited 70 patients with stroke to study serum bone turnover markers and microRNAs related to both cerebral atherosclerosis and bone metabolism to understand bone and brain interaction.

RESULTS

Osteoporosis was determined among 284 patients (23.9%), and 450 patients (37.8%) had osteopenia. As bone mineral density decreased, total SVD score and the incidence of every SVD phenotype increased except strictly lobar cerebral microbleeds. Multinomial logistic regression analysis showed that osteoporosis was independently associated with severe SVD burden. The levels of microRNA-378f were significantly increased among the patients with osteoporosis and maximal total SVD score and positively correlated with parathyroid hormone and osteocalcin.

CONCLUSIONS

These findings suggest a pathophysiologic link between bone mineral loss and hypertensive cerebral arteriolar degeneration, possibly mediated by circulating microRNA.

Differences between memory encoding and retrieval failure in mild cognitive impairment: results from quantitative electroencephalography and magnetic resonance volumetry

BACKGROUND

The memory impairments in mild cognitive impairment (MCI) can be classified into encoding (EF) and retrieval (RF) failure, which can be affected by underlying pathomechanism. We explored the differences structurally and functionally.

METHODS

We compared quantitative electroencephalography (qEEG) power spectra and connectivity between 87 MCI patients with EF and 78 MCI with RF using iSyncBrain® (iMediSync Inc., Republic of Korea) ( https://isyncbrain.com/ ). Voxel-based morphometric analysis of the gray matter (GM) in the MCI groups and 71 cognitive normal controls was also done using the Computational Anatomy Toolbox 12 ( http://www.neuro.uni-jena.de/cat/ ).

RESULTS

qEEG showed higher frontal theta and lower beta2 band power, and higher theta connectivity in the EF. There was no statistically significant difference in GM volume between the EF and RF. However, when compared to normal control, GM volume reductions due to EF in the left thalamus and bilateral hippocampi and reductions due to RF in the left thalamus, right superior frontal lobe, right superior temporal lobe, and right middle cingulum were observed (p < 0.05, family-wise error correction).

CONCLUSIONS

MCI differs functionally and structurally according to their specific memory impairments. The EF findings are structurally and functionally more consistent with the prodromal Alzheimer's disease stage than the RF findings. Since this study is a cross-sectional study, prospective follow-up studies are needed to investigate whether different types of memory impairments can predict the underlying pathology of amnestic MCI. Additionally, insufficient sample size may lead to ambiguous statistical findings in direct comparisons, and a larger patient cohort could more robustly identify differences in GM volume reductions between the EF and the RF group.

Association between arterial stiffness and the presence of cerebral small vessel disease markers

OBJECTIVE

We investigated the effect of arterial stiffness on the severity of enlarged perivascular spaces (EPVSs) and cerebral microbleeds (CMBs) at different brain locations.

METHODS

A total of 854 stroke patients underwent both brachial-ankle pulse wave velocity (baPWV) measurement and brain MRI. The extent of EPVS was separately rated at the levels of the basal ganglia (BG) and centrum semiovale (CS). The CMBs were categorized as strictly lobar CMB and deep CMB. The patients were categorized according to baPWV quartiles, and multivariable logistic regressions were performed to evaluate whether the baPWV increment was independently associated with each cerebral SVD marker at different locations. The odds ratio (OR) with 95% confidence interval (CI) was derived on the reference of the first quartile.

RESULTS

Severe EPVSs at BG and CS were detected in 243 (28.5%) and 353 patients (41.3%), respectively. The increment of baPWV quartiles was associated with both severe BG EPVS burden (Q4: OR = 2.58, CI = 1.45-4.60) and severe CS EPVS burden (Q4: OR = 2.06, CI = 1.24-3.42). Deep CMBs were found in 259 patients (30.3%), and strictly lobar CMBs were found in 170 patients (19.9%). Multivariable logistic regression model revealed deep CMB was independently associated with the baPWV increment (Q4: OR = 2.52, CI = 1.62-3.94). However, strictly lobar CMB had a neutral relationship with baPWV.

CONCLUSION

Increased arterial stiffness is consistently associated with the presence of deep CMB and severe EPVS burden at the BG and CS, suggesting a common pathophysiologic mechanism.

[Correlation between social support and occupational stress among gas production workers in the field]

Objective: To investigate the level of social support and its correlation with occupational stress among gas production workers in the field. Methods: In October 2018, the cluster sampling method was used to perform a cross-sectional survey for 1726 gas production workers in the field, and related data of these workers were collected, including age, education level, marital status, level of social support, and related factors for occupational stress. A Spearman's rank correlation analysis was used to investigate the correlation between social support and occupational stress, and the levels of occupational stress-related factors were compared between the groups with different social support scores. Results: The gas production workers in the field had a median (25th percentile, 75th percentile) social support score of 24.00 (19.00, 28.00) , and there was a significant difference in social support score between the workers with different posts or work shifts (P<0.01) . Social support score was positively correlated with effort, daily stress, negative emotion, and job routinization (P<0.05) and was negatively correlated with job satisfaction, reward, working stability, and promotion opportunity (P<0.05) . The group with a high social support score had significantly higher scores of effort, job routinization, sleep disorders, and daily stress than the other two groups (P<0.01) , and the group with a low social support score had significantly higher scores of reward, self-efficacy, positive affection, and job satisfaction than the other two groups (P<0.01) . Conclusion: High-level social support plays an important role in alleviating occupational stress and protecting mental health among gas production workers in the field.

Risk factors and renal outcomes of low bone mineral density in patients with non-dialysis chronic kidney disease

Bone disorder is a common complication of chronic kidney disease (CKD). The clinical usefulness of bone mineral density (BMD) in CKD is not well known. Our study shows that low BMD is associated with physical activity and dietary Na/K intake ratio and can predict poor renal outcome in non-dialysis CKD.

PURPOSE

Despite evidence of a link between bone mineral disorders and chronic kidney disease (CKD), the clinical implications of bone mineral density (BMD) in CKD are not well established. We investigated risk factors and renal outcomes of low BMD in CKD.

METHODS

We analyzed data from the KNOW-CKD. BMD measured by dual-energy x-ray absorptiometry was classified by T score: normal (T score ≥ - 1.0), osteopenia (- 1.0 > T score > - 2.5), and osteoporosis (T score ≤ - 2.5) of the lumbar spine, hip, or femoral neck. Logistic regression analysis to assess risk factors of low BMD (T score < - 1.0) and Cox proportional hazards models to estimate risk of incident end-stage renal disease (ESRD).

RESULTS

Low BMD was prevalent (osteopenia 33%; osteoporosis 8%) in 2128 adults with CKD (age 54 ± 12 years; male 61%). Over a median follow-up of 4.3 years, there were 521 cases of incident ESRD. Lower BMD was associated with female sex, older age, low eGFR, low BMI, and lifestyle factors of physical activity (odds ratio (OR) = 0.62, 95% confidence interval (0.49-0.77)) and spot urine Na/K ratio (1.07 (1.00-1.15)). In adjusted Cox models, low BMD was associated with increased incident ESRD (hazard ratio (HR) = 1.14 (0.92-1.41) for osteopenia; 1.43 (1.01-2.04) for osteoporosis, P for trend < 0.05) compared with the reference of normal BMD. The association between low BMD and ESRD was similar according to T score discordance classification.

CONCLUSIONS

Low BMD was associated with modifiable lifestyle factors including low physical activity and high dietary Na/K intake ratio. The presence of low BMD is associated with poor renal outcomes in non-dialysis CKD.

A Real-Time Depth of Anesthesia Monitoring System Based on Deep Neural Network With Large EDO Tolerant EEG Analog Front-End

In this article, we present a real-time electroencephalogram (EEG) based depth of anesthesia (DoA) monitoring system in conjunction with a deep learning framework, AnesNET. An EEG analog front-end (AFE) that can compensate ±380-mV electrode DC offset using a coarse digital DC servo loop is implemented in the proposed system. The EEG-based MAC, EEGMAC, is introduced as a novel index to accurately predict the DoA, which is designed for applying to patients anesthetized by both volatile and intravenous agents. The proposed deep learning protocol consists of four layers of convolutional neural network and two dense layers. In addition, we optimize the complexity of the deep neural network (DNN) to operate on a microcomputer such as the Raspberry Pi 3, realizing a cost-effective small-size DoA monitoring system. Fabricated in 110-nm CMOS, the prototype AFE consumes 4.33 μW per channel and has the input-referred noise of 0.29 μVrms from 0.5 to 100 Hz with the noise efficiency factor of 2.2. The proposed DNN was evaluated with pre-recorded EEG data from 374 subjects administrated by inhalational anesthetics under surgery, achieving an average squared and absolute errors of 0.048 and 0.05, respectively. The EEGMAC with subjects anesthetized by an intravenous agent also showed a good agreement with the bispectral index value, confirming the proposed DoA index is applicable to both anesthetics. The implemented monitoring system with the Raspberry Pi 3 estimates the EEGMAC within 20 ms, which is about thousand-fold faster than the BIS estimation in literature.

High thermoelectric performance of half-Heusler compound BiBaK with intrinsically low lattice thermal conductivity

Half-Heusler compounds usually exhibit relatively higher lattice thermal conductivity that is undesirable for thermoelectric applications. Here we demonstrate by first-principles calculations and Boltzmann transport theory that the BiBaK system is an exception, which has rather low thermal conductivity as evidenced by very small phonon group velocity and relaxation time. Detailed analysis indicates that the heavy Bi and Ba atoms form a cage-like structure, inside which the light K atom rattles with larger atomic displacement parameters. In combination with its good electronic transport properties, the BiBaK shows a maximum n-type ZT value of 1.9 at 900 K, which outperforms most half-Heusler thermoelectric materials.

Multilayered Regulation of Membrane-Bound ONAC054 Is Essential for Abscisic Acid-Induced Leaf Senescence in Rice

In most plants, abscisic acid (ABA) induces premature leaf senescence; however, the mechanisms of ABA signaling during leaf senescence remain largely unknown. Here, we show that the rice (Oryza sativa) NAM/ATAF1/2/CUC2 (NAC) transcription factor ONAC054 plays an important role in ABA-induced leaf senescence. The onac054 knockout mutants maintained green leaves, while ONAC054-overexpressing lines showed early leaf yellowing under dark- and ABA-induced senescence conditions. Genome-wide microarray analysis showed that ABA signaling-associated genes, including ABA INSENSITIVE5 (OsABI5) and senescence-associated genes, including STAY-GREEN and NON-YELLOW COLORING1 (NYC1), were significantly down-regulated in onac054 mutants. Chromatin immunoprecipitation and protoplast transient assays showed that ONAC054 directly activates OsABI5 and NYC1 by binding to the mitochondrial dysfunction motif in their promoters. ONAC054 activity is regulated by proteolytic processing of the C-terminal transmembrane domain (TMD). We found that nuclear import of ONAC054 requires cleavage of the putative C-terminal TMD. Furthermore, the ONAC054 transcript (termed ONAC054α) has an alternatively spliced form (ONAC054β), with seven nucleotides inserted between intron 5 and exon 6, truncating ONAC054α protein at a premature stop codon. ONAC054β lacks the TMD and thus localizes to the nucleus. These findings demonstrate that the activity of ONAC054, which is important for ABA-induced leaf senescence in rice, is precisely controlled by multilayered regulatory processes.

Does the new Korean term for epilepsy reduce the stigma for Korean adults with epilepsy?

PURPOSE

The purpose of this study was to evaluate differences in stigma, disclosure management of epilepsy, and knowledge about epilepsy between patients with epilepsy who recognized and did not recognize the new Korean term for epilepsy.

METHODS

This was a cross-sectional, multicenter study. The Stigma Scale-Revised, the Disclosure Management Scale, the Patient Health Questionnaire-9, and a questionnaire assessing knowledge about epilepsy were used. The set of questionnaires had two versions, using either the old or new name for epilepsy. Multivariate logistic regression analyses were used.

RESULTS

A total of 341 patients with epilepsy and 509 family members were recruited. Approximately 62% of patients felt some degree of epilepsy-related stigma. Mild stigma, severe concealment of epilepsy diagnosis, and increased knowledge about epilepsy were independently identified as factors associated with recognition of the new term in patients. Recognition of the new term was more prevalent in patients and family members with higher education, female family members, and family members having patients with younger age at seizure onset and shorter duration of epilepsy. There were no significant differences between the two types of questionnaires. About 81% of patients and 93% of family members had a positive attitude about renaming epilepsy.

CONCLUSION

The use of the new Korean term for epilepsy (cerebroelectric disorder) increased knowledge about epilepsy but did not reduce stigma and concealment of epilepsy diagnosis in Korean adults with epilepsy. Higher education may be an important factor for knowing the new term in patients and family members.

Factors associated with social anxiety in South Korean adults with epilepsy

PURPOSE

The aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors.

METHOD

This was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥9 and SIAS-6 scores ≥12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used.

RESULTS

Of a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥9 and SIAS-6 scores ≥12, respectively. In logistic regression analysis, SPS-6 scores ≥9 were independently associated with SS-R scores of 4-9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515-29.587, p = .001), SS-R scores 1-3 (OR: 5.496, 95% CI: 1.757-17.197, p = .003), and PHQ-9 scores ≥10 (OR: 4.092, 95% CI: 1.823-9.185, p = .001). In contrast, SIAS-6 scores ≥12 were related only to PHQ-9 scores ≥10 (OR: 8.740, 95% CI: 3.237-23.599, p < .001). Belonging to a dysfunctional family and lack of knowledge about epilepsy tended to be associated with social phobia (p = .071) and social interaction anxiety (p = .090), respectively. Epilepsy-related variables were not related to social anxiety.

CONCLUSION

Social anxiety is not rare in patients with epilepsy. In this study, social phobia was associated with perceived stigma and depressive symptoms, whereas social interaction anxiety was related only to depressive symptoms in patients with epilepsy.

Acute effects of continuous positive airway pressure in patients with obstructive sleep apnea

Objectives. To enhance the initial compliance of continuous positive airway pressure (CPAP) in the patient with obstructive sleep apnea (OSA), we investigate the acute effects of one-night CPAP on morning blood pressure (BP) and, if any exist, to determine which factors predict BP-lowering effects of one-night CPAP in OSA subgroups stratified by the presence or absence of uncontrolled hypertension. Design. Newly diagnosed OSA patients (a respiratory distress index (RDI) ≥ 15) without a history of hypertension were stratified by the presence or absence of morning hypertension. Comparisons were made of morning BP, overnight change in mean BP (MBP), and circadian BP pattern (R_M/E, the ratio of morning to evening MBP) between two time points of diagnostic and CPAP titrations in each subgroup. In the subgroup with a significantly reduced morning BP, predictors of changes in morning MBP were determined by multiple linear regression analyses. Results. The prevalence of morning hypertension was 48.8%. One-night CPAP reduced BP immediately only in patients with morning hypertension. By contrast, patients without morning hypertension did not experience any BP-lowering effects. In the subgroup with morning hypertension, baseline morning MBP, female sex, and R_M/E were independently associated with reduced morning MBP, and R_M/E was the most important predictor. Conclusions. These results confirm the acute effects of one-night CPAP on lowering BP in OSA patients with morning hypertension. An unfavorable circadian BP pattern is the most important predictor.

Restless legs syndrome is associated with arterial stiffness and clinical outcome in stroke patients

OBJECTIVE

Restless legs syndrome (RLS) has been associated with vascular diseases, including cerebrovascular and cardiovascular diseases. Among the various mechanisms in RLS, peripheral vascular endothelial dysfunction in patients with RLS has recently been proposed as a vascular pathophysiology of RLS. This study investigated arterial stiffness related to RLS in acute ischemic stroke patients and its influence on stroke outcome.

METHODS

RLS in patients with acute ischemic stroke was assessed based on the four essential criteria of the International Restless Legs Syndrome Study Group described in 2003. The patients' clinical and laboratory characteristics, arterial stiffness, small vessel disease occurrence, and burden on brain MRI were recorded. Stroke severity was determined using the National Institute of Health Stroke Scale (NIHSS), and clinical outcomes were determined using the modified Rankin Scale.

RESULTS

Of 296 patients with acute ischemic stroke, 16 (5.4%) were diagnosed with restless legs syndrome. Logistic regression analysis showed that a 1 m/s increase in brachial arterial pulse wave velocity was associated with the diagnosis of RLS (odds ratio, 1.092; 95% confidence interval, 1.019-1.170, p = 0.012). Diagnosis of RLS in patients with acute ischemic stroke was associated with poor clinical outcome three months after stroke (modified Rankin Scale 3-6) (odds ratio, 4.263; 95% confidence interval, 1.229-14.792, p = 0.022) along with initial NIHSS score.

CONCLUSION

RLS in patients with acute ischemic stroke is associated with increased arterial stiffness and poor clinical outcomes.

Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients

BACKGROUND

Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates.

METHODS

Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included.

RESULTS

Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P = .03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24-8.68; P = .02), lung transplantation (OR, 4.50; 95% CI, 1.19-17.03; P = .03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72-22.45; P = .005) were associated with acquisition of CPE.

CONCLUSIONS

Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.

A Sub- μW/Ch Analog Front-End for ∆-Neural Recording With Spike-Driven Data Compression

We present a fully implantable neural recording IC with a spike-driven data compression scheme to improve the power efficiency and preserve crucial data for monitoring brain activities. A difference between two consecutive neural signals, ∆-neural signal, is sampled in each channel to reduce the full dynamic range and the required resolution of an analog-to-digital converter (ADC), enabling the whole analog chain to be operated at a 0.5-V supply. A set of multiple ∆-signals are stored in analog memory to extract the magnitude and frequency features of the incoming neural signals, which are utilized to discriminate spikes in these signals instantaneously after the acquisition in the analog domain. The energy- and area-efficient successive approximation ADC is implemented and only converts detected spikes, decreasing the power dissipation and the amount of neural data. A prototype 16-channel neural interface IC was fabricated using a 0.18-μm CMOS process, and each component in the analog front-end was fully characterized. We successfully demonstrated precise spike detection through both in vitro and in vivo acquisition of the neural signal. The prototype chip consumed 0.88 μW/channel at a 0.5-V supply for the recording and compressed about 89% of neural data, saving the power consumption and bandwidth in the system.

Devising negative pressure within intercuff space reduces microaspiration

Background

Microaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia. The objective of the current study was to evaluate whether creating negative pressure between the tracheal double cuffs could block the fluid passage past the tracheal tube cuffs.

Methods

A new negative pressure system was devised between the double cuffs through a suction hole in the intercuff space. Blue-dyed water was instilled above the cuff at negative suction pressures of − 54, − 68, − 82, − 95, − 109, − 122, and − 136 cmH₂O, and the volume leaked was measured in an underlying water trap after 10 min. Leakage tests were also performed during positive pressure ventilation, and using higher-viscosity materials. The actual negative pressures delivered at the hole of double cuffs were obtained by placing microcatheter tip between the intercuff space and the artificial trachea.

Results

No leakage occurred past the double cuff at − 136 cmH₂O suction pressure at all tracheal tube cuff pressures. The volume leaked decreased significantly as suction pressure increased. When connected to a mechanical ventilator, no leakage was found at − 54 cmH₂suction pressure. Volume of the higher-viscosity materials (dynamic viscosity of 63–108 cP <cP> and 370–430 cP) leaked was small compared to that of normal saline (0.9–1.1 cP). The pressures measured in the intercuff space corresponded to 3.8–5.9% of those applied.

Conclusions

A new prototype double cuff with negative pressure in the intercuff space completely prevented water leakage. The negative pressure transmitted to the tracheal inner wall was a small percentage of that applied.

Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations

This study investigated the effects of irradiance and exposure duration on dual-cured resin cements irradiated through ceramic restorative materials. A single light-curing unit was calibrated to three different irradiances (500, 1000, and 1500 mW/cm²) and irradiated to three different attenuating materials (transparent acryl, lithium disilicate, zirconia) with 1-mm thicknesses for 20 or 60 seconds. The changes in irradiance and temperature were measured with a radiometer (or digital thermometer) under the attenuating materials. The degree of conversion (DC) of dual-cure resin cement after irradiation at different irradiances and exposure durations was measured with Fourier transform near infrared spectroscopy. Two-way analysis of variance revealed that irradiance ( p<0.001) and exposure duration ( p<0.001) significantly affected temperature and DC. All groups showed higher DCs with increased exposure times ( p<0.05), but there were no statistically significant differences between the groups irradiated with 1000 mW/cm² and 1500 mW/cm² ( p>0.05). Higher-intensity irradiances yielded higher temperatures ( p<0.05), but exposure time did not affect temperature when materials were irradiated at 500 mW/cm² ( p>0.05).

Microscopic hematuria is a risk factor of incident chronic kidney disease in the Korean general population: a community-based prospective cohort study

BACKGROUND

Although asymptomatic microscopic hematuria (MH) is a common finding in clinical practice, its long-term outcome remains unknown.

AIM

This study evaluated the clinical implication of MH in the general population using a large-scale long-term longitudinal cohort database.

METHODS

This study included 8719 participants from the Korean Genome and Epidemiology Study between 2001 and 2014. MH was defined as ≥5 red blood cells per high-power field in random urinalysis without evidence of pyuria. The primary study outcome measure was incident chronic kidney disease (CKD), defined as estimated glomerular filtration rate <60 ml min-1⋅1.73⋅m-2.

RESULTS

During a median follow-up of 11.7 years, CKD occurred in 677 (7.8%) subjects. In Cox regression after adjustment for multiple confounders, subjects with MH had a significantly higher risk of incident CKD than those without [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.12-1.87; P = 0.005]. Isolated MH without proteinuria was also a risk factor of incident CKD (HR 1.37, 95% CI 1.04-1.79; P = 0.023) and the risk was further increased in MH with concomitant proteinuria (HR 5.41, 95% CI 2.54-11.49; P < 0.001). In propensity score matching analysis after excluding subjects with proteinuria, multi-variable stratified Cox regression analysis revealed that subjects with isolated MH had a significantly higher risk of incident CKD than those without (HR 1.83, 95% CI 1.14-2.94; P = 0.012).

CONCLUSION

The presence of MH is associated with an increased risk of incident CKD in the general population. Therefore, attentive follow-up is warranted in persons with MH for early detection of CKD.

P300 latency changes in patients with mild cognitive impairment after taking choline alphoscerate; A preliminary study

Choline alphoscerate in clinical studies improved cognitive dysfunction in dementia, but it did not show any clear clinical benefit on mild cognitive impairment (MCI). There is limited evidence of neuropsychological markers in showing the effects of cholinergic precursors in MCI. Object of this preliminary study is to evaluate the change of the P300 latency as a biomarker for cognitive function after taking choline alphoscerate in patients with MCI. Event related evoked potential study were done in baseline (n = 27) and 3 months after taking choline alphoscerate (n = 17). When compared to our previous reported control database, the difference of the P300 latencies between MCI and control group at baseline was statistically significant (P < 0.01). Although Follow-up P300 latencies after taking choline alphoscerate did not show the significant change, the tendency of shortened P300 latencies was identified. Even though there are some limitations, choline alphoscerate could improve the electrophysiological markers in MCI patients. To identify the effect of cholinergic precursor in MCI and the usefulness of electrophysiological biomarkers, well-designed further study is needed.

•

The P300 latencies in the mild cognitive impairment were significantly prolonged.

•

We followed up P300 latency in the patients with mild cognitive impairment after taking choline alphoscerate for 3 months.

•

The change of P300 latency in the patients was not significant but showed some tendency of shortened P300.

Current-induced magnetic switching with spin-orbit torque in an interlayer-coupled junction with a Ta spacer layer

Spin-orbit torque has attracted considerable attention as a means to overcome limits of devices based on spin-transfer torque. However, a small magnetic field that is collinear to the current flow must be applied to break symmetry and induce deterministic current-induced magnetization switching. Recently, a junction utilizing interlayer coupling mediated by a Ru spacer layer between two CoFe layers was designed for symmetry breaking and exhibited current-induced magnetization switching without a magnetic field. Here, we demonstrate zero-field current-induced switching of the perpendicular magnetization of a Co layer that is indirectly coupled with a CoFe layer via a Ta spacer. The weak interlayer coupling exhibited by Ta allows the layer thickness to be relatively small (≈0.5 nm), enabling appropriate interlayer coupling to induce spin-orbit torque for current-induced magnetic switching. External magnetic field effects on switching characteristics show that the current switching process is quite stable against external environments.

Author Correction: The F-box protein FKF1 inhibits dimerization of COP1 in the control of photoperiodic flowering

The previously published version of this Article contained errors in Figure 5. In panel c, the second and fourth blot images were incorrectly labeled 'α-Myc' and should have been labelled 'α-HA'. These errors have been corrected in both the PDF and HTML versions of the Article.

The F-box protein FKF1 inhibits dimerization of COP1 in the control of photoperiodic flowering

In Arabidopsis thaliana, CONSTANS (CO) plays an essential role in the regulation of photoperiodic flowering under long-day conditions. CO protein is stable only in the afternoon of long days, when it induces the expression of FLOWERING LOCUS T (FT), which promotes flowering. The blue-light photoreceptor FLAVIN-BINDING, KELCH REPEAT, F-BOX1 (FKF1) interacts with CO and stabilizes it by an unknown mechanism. Here, we provide genetic and biochemical evidence that FKF1 inhibits CONSTITUTIVE PHOTOMORPHOGENIC1 (COP1)-dependent CO degradation. Light-activated FKF1 has no apparent effect on COP1 stability but can interact with and negatively regulate COP1. We show that FKF1 can inhibit COP1 homo-dimerization. Mutation of the coiled-coil domain in COP1, which prevents dimer formation, impairs COP1 function in coordinating flowering time. Based on these results, we propose a model whereby the light- and day length-dependent interaction between FKF1 and COP1 controls CO stability to regulate flowering time.

CONSTANS promotes flowering under long-day conditions in Arabidopsis but is rapidly degraded in short-day conditions. Here the authors show that the blue-light photoreceptor FKF1 can interact with the E3 ligase COP1 in a light-dependent manner and prevent degradation of CO in long-day conditions.

Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance

BACKGROUND

Device-associated infection (DAI) is an important issue related to patient safety. It is important to reduce unnecessary device utilization in order to decrease DAI rates.

AIM

To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS).

METHODS

DURs from 2006 to 2015 in 190 intensive care units (ICUs) participating in KONIS were included in this study. DURs were calculated as the ratio of device-days to patient-days. The pooled incidences of DAIs and DURs were calculated for each year of participation, and the year-wise trends were analysed.

FINDINGS

Year-wise ventilator utilization ratio (V-DUR) increased significantly from 0.40 to 0.41 (F = 6.27, P < 0.01), urinary catheter utilization ratio (U-DUR) increased non-significantly from 0.83 to 0.84 (F = 1.66, P = 0.10), and C-line utilization ratio (CL-DUR) decreased non-significantly from 0.55 to 0.51 (F = 1.62, P = 0.11). In the subgroup analysis, 'medical ICU' (F = 2.79, P < 0.01) and 'hospital with >900 beds' (F = 3.07, P < 0.01) were associated with the significant increase in V-DUR.

CONCLUSION

In Korea, V-DUR showed a significant, year-wise increasing trend. The trends for U-DUR and CL-DUR showed no significant decrease. Efforts are required to ensure the reduction of DURs.

Rice 7-Hydroxymethyl Chlorophyll a Reductase Is Involved in the Promotion of Chlorophyll Degradation and Modulates Cell Death Signaling

The loss of green coloration via chlorophyll (Chl) degradation typically occurs during leaf senescence. To date, many Chl catabolic enzymes have been identified and shown to interact with light harvesting complex II to form a Chl degradation complex in senescing chloroplasts; this complex might metabolically channel phototoxic Chl catabolic intermediates to prevent oxidative damage to cells. The Chl catabolic enzyme 7-hydroxymethyl Chl a reductase (HCAR) converts 7-hydroxymethyl Chl a (7-HMC a) to Chl a. The rice (Oryza sativa) genome contains a single HCAR homolog (OsHCAR), but its exact role remains unknown. Here, we show that an oshcar knockout mutant exhibits persistent green leaves during both dark-induced and natural senescence, and accumulates 7-HMC a and pheophorbide a (Pheo a) in green leaf blades. Interestingly, both rice and Arabidopsis hcar mutants exhibit severe cell death at the vegetative stage; this cell death largely occurs in a light intensity-dependent manner. In addition, 7-HMC a treatment led to the generation of singlet oxygen (1O2) in Arabidopsis and rice protoplasts in the light. Under herbicide-induced oxidative stress conditions, leaf necrosis was more severe in hcar plants than in wild type, and HCAR-overexpressing plants were more tolerant to reactive oxygen species than wild type. Therefore, in addition to functioning in the conversion of 7-HMC a to Chl a in senescent leaves, HCAR may play a critical role in protecting plants from high light-induced damage by preventing the accumulation of 7-HMC a and Pheo a in developing and mature leaves at the vegetative stage.

Associations between religiosity and anxiety, depressive symptoms, and well-being in Korean adults living with epilepsy

PURPOSE

Religiosity can be important in the everyday life of persons with epilepsy (PWE). How PWE live with religiosity can be influenced by their cultural background. We determined whether religiosity is associated with anxiety, depressive symptoms, and well-being in Korean adults with epilepsy.

METHODS

This multicenter cross-sectional study was conducted in the outpatient clinics of five university hospitals in Korea. Religiosity was assessed using the five-item Duke University Religion Index (DUREL). The WHO-Five Well-Being Index (WHO-5) and Hospital Anxiety Depression Scale were used. The participants were categorized into three subgroups bounded by the 33rd and 66th percentiles of their DUREL scores.

RESULTS

Of a total of 226 participants, 61.1% declared that they had religious affiliation. The median DUREL score was 11 (interquartile ranges 6, 18). All three subscales of the DUREL were significantly related to WHO-5 (p<0.01). Non-organizational religious activities such as prayer and meditation were also inversely related to anxiety (p<0.05) and depressive symptoms (p<0.01). After controlling for confounding variables, anxiety and depressive symptoms were more extensive in the low religiosity subgroup than in the high or no religiosity subgroup (p<0.01) and well-being was higher in the high or low religiosity subgroup than in the no religiosity subgroup (p<0.05).

CONCLUSIONS

Religiosity is significantly associated with anxiety, depressive symptoms, and well-being in Korean adults with epilepsy.