Unique multidisciplinary approach in living donor liver transplantation to achieve total physiological revascularization in a patient with complete occlusion of portal vein system with combined chronic and sub-acute thrombosis.

Patients receiving liver transplantation in a setting of complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis (Yerdel grade 4) experience lower outcomes after surgery; prognosis is independently influenced by the portal flow reconstruction technique, showing better outcomes in physiological surgical strategies. We describe a case of living donor liver transplantation in which the patient could not receive common physiological reconstructions pre-operatively due to multiple small collaterals and extensive thrombosis down to 1st branches of SMV. We performed thrombo-endo-venectomy of the portal vein and SMV first, but acute thrombosis developed recurrently even with interposition venous homograft between peri-choledochal collateral vein and proximal recipient portal vein. Immediate after surgery, intervention radiologist performed stenting insertion into 3 stenotic points. Through multidisciplinary approach, complete physiologic recanalization was obtained with normal liver function.

Better Prediction of Clinical Outcome with Estimated Glomerular Filtration Rate by CKD-EPI 2021.

BACKGROUND: While the real-world impact of estimated glomerular filtration rate (eGFR) equation change on clinical outcome in a longitudinal cohort setting is limited, external valuation of equation performance should be performed in different population cohorts. This study aimed to compare differential impacts of eGFR values, calculated by 5 equations in a Korean patient population, on clinical outcomes. METHODS: This retrospective longitudinal follow-up cohort study analyzed 23 246 participants with standardized creatinine/cystatin C assay-based laboratory results. The primary exposure was baseline eGFR calculated by 5 different equations including the recently developed 2021 race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Clinical outcomes including all-cause mortality, renal replacement therapy, and albuminuria were analyzed to estimate the hazard ratio of the eGFR on clinical outcomes. RESULTS: Among the 5 equations, CKD-EPI 2021 with creatinine and cystatin C (CKD-EPI 2021-CrCys) showed an earlier increase in hazard ratios for all clinical outcomes, while CKD-EPI 2012 with cystatin C showed a higher hazard ratio for all-cause mortality at low eGFR. Replacing CKD-EPI 2012 with CKD-EPI 2021-CrCys, 5.4% of patients with mortality and 3.3% of patients who received renal replacement therapy were reclassified to a lower risk stage. CONCLUSIONS: The 2021 CKD-EPI equations were acceptable in a Korean population, with better predictive power for clinical outcomes when compared to previous equations. The updated race-free factors for eGFR calculation improved identification of patients at risk for clinical outcomes.

Development of optimal indoor air disinfection and ventilation protocols for airborne infectious diseases.

Since the COVID-19 pandemic, there has been persistent emphasis on the importance of indoor air disinfection and ventilation in isolation units in the hospital environment. Nevertheless, no optimal and concrete disinfection protocol has been proposed to inactivate the viruses as quickly as possible. In this study, we experimentally evaluated various ventilation and disinfection protocols based on the combination of negative-pressure ventilation, ultraviolet (UV) light illumination, and Hypochlorous acid (HOCl) spray against three active virus species in a 3.5 cubic meters isolation unit. This small-size unit has gained attention during the pandemic due to the high demand for compact mobile laboratory systems capable of rapid disease diagnosis. In accordance with the WHO laboratory biosafety guidance, which states that all enclosed units where diagnostic work is conducted must ensure proper ventilation and disinfection activities, we aim to propose virus removal protocols for units compact enough to be installed within a van or deployed outdoor. The results confirmed the superiority (in terms of virus removal rate and time required) of the virus removal methods in the order of UV light, ventilation, and HOCl spray. Ultimately, we propose two optimal protocols: (i) UV light alone for three minutes, and (ii) UV light with ventilation for three minutes, followed by one-minute ventilation only. The time span of three minutes in the latter protocol is based on the clinical practice such that the medical staffs have a sufficient time to process the samples taken in transition to next patient to care.

Clinical Significance of Grade A Small-for-size Syndrome After Living Donor Liver Transplantation Utilizing the New Definition of Diagnostic Criteria: An International Multicenter Study.

BACKGROUND: New diagnostic criteria have recently been established to classify small-for-size syndrome (SFSS) after living donor liver transplantation into 3 groups based on severity. This study aimed to evaluate the clinical impact of grade A SFSS and identify the mortality risk. METHODS: We collected data from 406 patients diagnosed with grade A SFSS after living donor liver transplantation. Grade A SFSS is characterized by total bilirubin >5 mg/dL on postoperative day (POD) 7 or total bilirubin >5 mg/dL or ascites >1 L/d on POD 14. After propensity score matching, 193 patients were categorized into the up-trend group, down-trend group, and ascites group, with 43 patients (22.3%) in the up-trend group (total bilirubin on POD 7 < POD 14), 107 patients (55.4%) in the down-trend group (total bilirubin on POD 7 > POD 14), and 43 patients (22.3%) in the ascites group (only satisfying ascites criteria). RESULTS: There was no significant difference in survival between patients with grade A SFSS and those without SFSS (P = 0.152). The up-trend group showed a higher 90-d mortality rate than the down-trend and ascites groups (P = 0.025). The 1-y survival rate differed significantly between the groups (87.6%, 91.9%, and 97.7%, respectively; P = 0.044). The independent risk factors for survival were up-trend of total bilirubin, recipient age (65 y and older), model for end-stage liver disease score (≥30), and ABO incompatibility. Patients with ≥2 risk factors had worse survival rates than those with none and only 1 risk factor (P < 0.001). CONCLUSIONS: Although the survival rate was comparable between the grade A SFSS and non-SFSS cohorts, the up-trend group showed worse survival. Aggressive interventions should be considered for up-trend patients with risk factors.

Effects of hard- and/or soft-tissue grafting with early implant placement: Histomorphometric outcomes of an exploratory study in canines.

OBJECTIVE: To histomorphometrically determine the effects of hard- and/or soft-tissue augmentation by applying the early implant placement protocol. MATERIALS AND METHODS: The distal roots of the maxillary second and third premolars were extracted in 10 mongrel dogs. After 1 month, early implant placement was performed in the distal roots, resulting in buccal dehiscence defects. Four treatments were then randomly applied: (1) guided bone regeneration (GBR), (2) connective tissue grafting (CTG), (3) simultaneous GBR and CTG (GBR + CTG) and (4) no further treatment (control). Healing abutments were connected to all implants to allow non-submerged healing. At 4 and 16 weeks, tissue sections were harvested and histomorphometric analyses were performed. RESULTS: Group GBR presented the largest total tissue thickness at 4 weeks, but underwent a greater remodelling compared with the other groups between 4 and 16 weeks. At 16 weeks, the overall tissue thickness was largest in group GBR + CTG. This group was also the most favourable in terms of the level of the margo mucosae and the presence of mineralized tissue at the coronal level. Group CTG demonstrated a stable tissue thickness over time, with a larger thickness at 16 weeks compared with group GBR. CONCLUSION: Simultaneous CTG and GBR resulted in the most-favourable tissue thickness when applying the early implant placement protocol.

Explainable artificial intelligence on safe balance and its major determinants in stroke patients.

This study develops explainable artificial intelligence for predicting safe balance using hospital data, including clinical, neurophysiological, and diffusion tensor imaging properties. Retrospective data from 92 first-time stroke patients from January 2016 to June 2023 was analysed. The dependent variables were independent mobility scores, i.e., Berg Balance Scales with 0 (45 or below) vs. 1 (above 45) measured after three and six months, respectively. Twenty-nine predictors were included. Random forest variable importance was employed for identifying significant predictors of the Berg Balance Scale and testing its associations with the predictors, including Berg Balance Scale after one month and corticospinal tract diffusion tensor imaging properties. Shapley Additive Explanation values were calculated to analyse the directions of these associations. The random forest registered a higher or similar area under the curve compared to logistic regression, i.e., 91% vs. 87% (Berg Balance Scale after three months), 92% vs. 92% (Berg Balance Scale after six months). Based on random forest variable importance values and rankings: (1) Berg Balance Scale after three months has strong associations with Berg Balance Scale after one month, Fugl-Meyer assessment scale, ipsilesional corticospinal tract fractional anisotropy, fractional anisotropy laterality index and age; (2) Berg Balance Scale after six months has strong relationships with Fugl-Meyer assessment scale, Berg Balance Scale after one month, ankle plantar flexion muscle strength, knee extension muscle strength and hip flexion muscle strength. These associations were positive in the SHAP summary plots. Including Berg Balance Scale after one month, Fugl-Meyer assessment scale or ipsilesional corticospinal tract fractional anisotropy in the random forest will increase the probability of Berg Balance Scale after three months being above 45 by 0.11, 0.08, or 0.08. In conclusion, safe balance after stroke strongly correlates with its initial motor function, Fugl-Meyer assessment scale, and ipsilesional corticospinal tract fractional anisotropy. Diffusion tensor imaging information aids in developing explainable artificial intelligence for predicting safe balance after stroke.

Combining 2'-fucosyllactose and galactooligosaccharides exerts anti-inflammatory effects and promotes gut health.

This study investigated the potential of 2'-Fucosyllactose (2'-FL) and galactooligosaccharides (GOS) combinations as a novel and cost-effective substitute for human milk oligosaccharides (HMOs) in promoting gut health and reducing inflammation. In vitro studies using Caco-2 cells showed that 2'-FL and GOS combinations (H1: GOS:2'-FL ratio of 1.8:1; H2: ratio of 3.6:1) reduced lipopolysaccharide-induced inflammation by decreasing pro-inflammatory markers, while individual treatments had no significant effects. In a mouse model of dextran sulfate sodium (DSS)-induced colitis, combined 2'-FL and GOS supplementation alleviated symptoms, improved gut permeability, and enhanced intestinal structure, with the GH1 group (H1 combo with DSS) being the most effective. 2'-FL and GOS combinations also enhanced short-chain fatty acid production in infant fecal batch fermentation and mouse fecal analysis, with GH1 showing the most promising results. GH1 supplementation altered gut microbiota in mice with DSS-induced colitis, promoting microbial diversity and a more balanced Firmicutes to Bacteroidota ratio. Infant formula products (IFPs) containing 2'-FL and GOS combinations (IFP2: 174 mg GOS and 95 mg 2'-FL per 14 g serving, 1.8:1 ratio; IFP3: 174 mg GOS and 48 mg 2'-FL per 14 g serving, 3.6:1 ratio) demonstrated gastrointestinal protective and anti-inflammatory properties in a coculture model of Caco-2 and THP-1 cells. These findings suggest that 2'-FL and GOS combinations have potential applications in advanced infant formulas and supplements to promote gut health and reduce inflammation.

Efficacy and safety evaluation of imidafenacin administered twice daily for continency recovery following radical prostatectomy in prostate cancer patients: Prospective open-label case-controlled randomized trial.

PURPOSE: This study aims to prospectively analyze the effects of anticholinergic therapy using imidafenacin on detrusor overactivity occurring after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS: Patients were followed-up at outpatient visits 2-4 weeks post-surgery (visit 2) to confirm the presence of urinary incontinence. Those confirmed with urinary incontinence were randomly assigned in a 1:1 ratio to the anticholinergic medication group (imidafenacin 0.1 mg twice daily) or the control group. Patients were followed-up at 1, 3, and 6 months post-surgery for observational assessments, including the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). RESULTS: A total of 49 patients (25 in the treatment group and 24 in the control group) were randomized for the study. There were no differences observed between the groups in terms of age, comorbidities, prostate size, or pathological staging. According to the IPSS questionnaire results, there was no statistically significant difference between the medication and control groups (p=0.161). However, when comparing storage and voiding symptoms separately, there was a statistically significant improvement in storage symptom scores (p=0.012). OABSS also revealed statistically significant improvement in symptoms from 3 months post-surgery (p=0.005), which persisted until 6 months post-surgery (IPSS storage: p=0.023, OABSS: p=0.013). CONCLUSIONS: In the case of urinary incontinence that occurs after RARP, even if the function of the intrinsic sphincter is sufficiently preserved, if urinary incontinence persists due to changes in the bladder, pharmacological therapy using imidafenacin can be beneficial in managing urinary incontinence.

Effects of clove bud oil on the physicochemical properties and oxidative stability of canola oil organogels structured by different beeswax contents.

The aim of this study was to investigate the utilization of clove bud oil as fat-soluble antioxidants for retarding lipid oxidation in organogels by structuring canola oil with beeswax at 5, 7.5, and 10% concentration under accelerated oxidation condition. Oil binding capacity and viscoelastic properties were increased with beeswax content, but were not nearly affected by the addition of clove bud oil. Organogel loaded with clove bud oil were found to be more effective in retarding lipid oxidation in high beeswax content systems, particularly evident in 10% beeswax samples. The addition of clove bud oil resulted in low levels of hyeoperxide and MDA, and protected against texture and color deterioration during the storage period. Additionally, the Pearson correlation between lipid oxidation indices and parameters of texture and color has been found to exhibit a limited association, with the exception of the a* and b* values, which show a strong correlation.

Effect of ultrasound-assisted treatment on meat tenderization for elderly individuals.

This study evaluated the effect of ultrasound using papain and sodium bicarbonate (SC) on meat tenderness to achieve the desired texture for elderly individuals. Meats were immersed in distilled water (DW) or papain (PI), ultrasonically treated with papain (UPI), or ultrasonically treated with papain and SC (UPIS). Response surface methodology was used to optimize the processing conditions with the lowest hardness, and the optimal conditions were determined as follows: 400 U/mL papain, ultrasonic for 30 min, and 4% SC. Hardness, color, and myofibrillar fragmentation index (MFI) were investigated. The hardness followed the order of DW (22.50 N), PI (18.62 N), UPI (12.08 N), and UPIS (7.16 N), and UPIS showed the highest MFI. Papain and SC affected the color of the meat. Overall, ultrasound-assisted treatment using papain and SC resulted in hardness levels of less than 7.8 N, which can be easily compressed by low tongue pressure.

Cyanide profiling in stone fruit syrups: A comparative study of distillation techniques, a novel derivatization method, and cyanide composition in Maesil (Prunus Mume) syrup.

Cyanide ion was derivatized with o-phthalaldehyde and 3-mercaptopropionic acid for high-performance liquid chromatography-diode array detector analysis. The structure was elucidated using nuclear magnetic resonance spectroscopy and ultra-high performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. Method validation was conducted for three distillation methods to analyze cyanogenic glycosides, cyanohydrins, and free cyanide in fruit syrup. Acid-aided distillation only detected free cyanide, while direct distillation detected both free cyanide and cyanohydrins, and enzyme-aided distillation reflected all three types. These approaches were applied to stone fruit syrups in South Korean markets and households. Among tested, maesil (Prunus mume) syrup contained the highest amount of total cyanide, reaching a maximum of 21.9 mg/kg (cyanide ion equivalent), compared to other syrups. Investigation of cyanide composition changes during maesil syrup production revealed that free cyanide occupies the lowest proportion. Cyanogenic glycosides degraded gradually during aging, while cyanohydrins remained the majority after 12 months aging.

Enhanced Effects of ISA 207 Adjuvant via Intradermal Route in Foot-and-Mouth Disease Vaccine for Pigs.

In South Korea, a mandatory nation-wide foot-and-mouth disease (FMD) vaccination policy is in place. However, a major side effect of the current method of intramuscular (IM) administration of oil-adjuvanted FMD vaccines is the formation of granulomas in the muscles of pigs. To address this issue, we assessed the possible application of intradermal (ID) vaccination. Initially, we compared the serological immune response in specific pathogen-free pigs inoculated with FMD vaccines formulated with eight different adjuvants, administered twice at the neck site using a syringe with a needle via the ID route. Among the formulations (water-in-oil-in-water (W/O/W), oil-in-water (O/W), and polymer nanomaterials), ISA 207 of W/O/W was the most effective in inducing immunogenicity followed by ISA 201 of W/O/W. ISA 207 was further tested in formulations of different antigen doses (12 or 1.2 µg) delivered via both IM and ID routes. All four treatments successfully protected the pigs against FMD virus challenges. To assess the feasibility of the field application of the vaccines with ISA 207, we conducted ID vaccination of conventional pigs using a needle-free device, resulting in the detection of significant levels of neutralizing antibodies. ISA 207 was shown to be superior to ISA 201 in inducing immunogenicity via the ID route. In conclusion, ISA 207 could be a suitable adjuvant for ID vaccination in terms of vaccine efficacy for FMD, allowing for alternate use of ID vaccination and subsequent reduction in the incidences of granuloma formation in the field.

Exploring the Interplay: Obesity, Lipid Metabolism, and Clinical Manifestations in Atopic Dermatitis.

BACKGROUND: The interest toward the association between atopic dermatitis (AD) and obesity is increasing, yet the possibility of abnormal lipid metabolism has never been investigated before. OBJECTIVE: To identify the characteristics of patients with AD who are obese and analyze the serum lipid profiles of these patients. METHODS: This observational study included 167 patients diagnosed with AD and underwent evaluations for serum lipid panels between July 2017 and October 2017. The patients' body mass index was used to determine obesity and the serum lipid panels were analyzed between patients who are obese and non-obese. Also, the disease severity and subjective symptoms were evaluated and serum total immunoglobulin E (IgE) and specific IgE levels were assessed. RESULTS: Of the 167 patients with AD, there were 36 obese and 131 non-obese subjects. Obese patients were found to have a significantly higher disease severity, as well as higher serum triglyceride and low-density lipoprotein-cholesterol levels and lower high-density lipoprotein-cholesterol levels, which was most pronounced in adult males. Obesity AD patients also had a significantly higher serum total IgE, itch intensity score, and number of allergens sensitized. CONCLUSION: Patients with AD who are obese should be monitored for possible abnormalities in lipid metabolism. Obesity may be a factor that contributes to a higher disease severity of AD.

Analysis of volatile compounds and 5-hydroxymethylfurfural in fried chicken breast produced by air and deep-fat frying.

Two samples, simple-battered chicken (SBC) and normal-battered chicken (NBC), with different batters were deep-fat fried at various conditions and volatile compounds and 5-hydroxymethylfurfural (5-HMF) was analysed. The moisture content of the air-fried samples was significantly higher than that of the deep-fat fried samples in the same batter samples. A total of 72 volatile compounds (8 aldehydes, 15 monoterpenes, 12 sesquiterpenes, 2 terpene alcohols, 4 benzenes, 13 pyrazines, 2 pyridines, 6 furans, 5 alcohols, 2 pyrroles, and 3 others) were detected in fried chicken breast, and air-fried SBC possessed the highest total amount of volatile compounds. Furthermore, 5-HMF was exclusively detected in NBC samples; in particular, 1.27 ± 0.06 and 0.41 ± 0.02 µg/mL were detected in deep- and air-fried NBC, respectively. This study indicates the potential of air frying to reduce the formation of 5-HMF while maintaining quality characteristics, suggesting the need for further study on other hazardous compounds.

Impact of different organic acids on heat-moisture treated potato starch for enhancing prebiotic potential.

This research verified the in vitro digestive properties of potato starch modified with citric acid (CA), malic acid (MA), and tartaric acid (TA), and evaluated its prebiotic potential. The resistant starch (RS) content in CA- or MA-modified starch was greater than that in native starch. Furthermore, after cooking, all modified starches exhibited an increase in RS content by 2.3 to 3.3 times compared to native starch, which has a 29.81% RS content, demonstrating high thermal stability. Probiotic bacteria demonstrated increased viability, raiging form 6.38-6.85 log CFU/mL, when cultured with modified starch, in contrast to 4.48 log CFU/mL with glucose. During animal testing, modified starches consistently improved gastrointestinal transit, fecal moisture, and lipid levels. Notably, CA-, MA- or TA-modified starches promoted beneficial bacteria growth by providing short-chain fatty acids, with CA-modified starch proving to be the most potent.

Analysis of volatile compounds and α-dicarbonyl compounds in Arabica coffee soaked with various organic acids.

In this study, volatile compounds and α-dicarbonyl compounds (α-DCs), such as glyoxal (GO), methylglyoxal (MGO), and diacetyl (DA), were analyzed in Arabica coffee prepared from Arabica green coffee beans presoaked in six organic acid solutions. The ratio of volatile compounds in samples was 18.06 to 0.6 (peak area of each peak/peak area of internal standard). Succinic acid pretreated Arabica had the highest concentration of volatile compounds, 128.9% higher than without pretreatment. The level of total α-DCs ranged from 12.90 to 100.32 µg/mL. Detected levels of GO, MGO, and DA ranged from 0.81 to 7.74, from 18.53 to 89.08, and from 0.43 to 6.74 µg/mL, respectively. Organic acid pretreatment increased the amounts of volatile compounds and lowered the concentrations of α-DCs compared to without pretreatment. The results obtained in this study would be useful for increasing the flavor of Arabica coffee and decreasing α-DCs. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-024-01592-2.

Data-Driven Iterative Learning Model Predictive Control With Self-Modified Prior Knowledge.

Iterative learning model predictive control (ILMPC) has become an excellent data-driven intelligent control strategy for digitized batch manufacturing, featured by the progressive improvement of tracking performance along trials, and the persistent rejection of stochastic disturbance along time. The point-to-point learning mechanism of existing ILMPC generally relies on identical operating conditions along trials to guarantee the integrity and accuracy of historical data. However, the variations of production requirements usually lead to trial-varying operating references and durations, resulting in incomplete and inaccurate historical information for the iterative learning of subsequent trials. To promote the adaptability and flexibility of ILMPCs with unconformable prior information, a data-driven self-modification scheme is originally embedded into ILMPC in this article to transfer the prior knowledge contained in the historical operating data into the form consistent with the condition of each current trial. The control actions are imitated along trials by an adaptive deep neural network (DNN), which is then utilized to generate reference control signals for iterative learning in each trial. For attenuating the influence of the considerable DNN approximation error in early trials with limited data accumulation, the 2-D optimization of ILMPC is performed under a tube control frame to ensure the time-domain bounded stability. Based on the intrinsic recursive feasibility and the guaranteed time-domain stability, the iteration-domain bounded convergence of the developed ILMPC system is theoretically validated. Simulations on the nonlinear injection molding process verify the superiority of the proposed method in adapting to significant changes in operating reference and duration.

Exploiting WEE1 kinase activity as FUS::DDIT3-dependent therapeutic vulnerability in myxoid liposarcoma.

PURPOSE: The pathognomonic FUS::DDIT3 fusion protein drives myxoid liposarcoma (MLS) tumorigenesis via aberrant transcriptional activation of oncogenic signaling. Since FUS::DDIT3 has so far not been pharmacologically tractable to selectively target MLS cells, this study investigated the functional role of the cell cycle regulator WEE1 as novel FUS::DDIT3­dependent therapeutic vulnerability in MLS. EXPERIMENTAL DESIGN: Immunohistochemical evaluation of the cell cycle regulator WEE1 was performed in a large cohort of MLS specimens. FUS::DDIT3 dependency and biological function of the G1/S cell cycle checkpoint were analyzed in a mesenchymal stem cell model and liposarcoma cell lines in vitro. WEE1 activity was modulated by RNAi­mediated knockdown and the small molecule inhibitor MK-1775 (Adavosertib). An established MLS cell line-based chicken chorioallantoic membrane model was employed for in vivo confirmation. RESULTS: We demonstrate that enhanced WEE1 pathway activity represents a hallmark of FUS::DDIT3­expressing cell lines as well as MLS tissue specimens and that WEE1 is required for MLS cellular survival in vitro and in vivo. Pharmacologic inhibition of WEE1 activity results in DNA damage accumulation and cell cycle progression forcing cells to undergo apoptotic cell death. In addition, our results uncover FUS::DDIT3-dependent WEE1 expression as an oncogenic survival mechanism to tolerate high proliferation and resulting replication stress in MLS. Fusion protein-driven G1/S cell cycle checkpoint deregulation via overactive Cyclin E/CDK2 complexes thereby contributes to enhanced WEE1 inhibitor sensitivity in MLS. CONCLUSIONS: Our preclinical study identifies WEE1-mediated replication stress tolerance as molecular vulnerability in FUS::DDIT3-driven MLS tumorigenesis that could represent a novel target for therapeutic intervention.

Machine-learning model to predict the tacrolimus concentration and suggest optimal dose in liver transplantation recipients: a multicenter retrospective cohort study.

Titrating tacrolimus concentration in liver transplantation recipients remains a challenge in the early post-transplant period. This multicenter retrospective cohort study aimed to develop and validate a machine-learning algorithm to predict tacrolimus concentration. Data from 443 patients undergoing liver transplantation between 2017 and 2020 at an academic hospital in South Korea were collected to train machine-learning models. Long short-term memory (LSTM) and gradient-boosted regression tree (GBRT) models were developed using time-series doses and concentrations of tacrolimus with covariates of age, sex, weight, height, liver enzymes, total bilirubin, international normalized ratio, albumin, serum creatinine, and hematocrit. We conducted performance comparisons with linear regression and populational pharmacokinetic models, followed by external validation using the eICU Collaborative Research Database collected in the United States between 2014 and 2015. In the external validation, the LSTM outperformed the GBRT, linear regression, and populational pharmacokinetic models with median performance error (8.8%, 25.3%, 13.9%, and - 11.4%, respectively; P < 0.001) and median absolute performance error (22.3%, 33.1%, 26.8%, and 23.4%, respectively; P < 0.001). Dosing based on the LSTM model's suggestions achieved therapeutic concentrations more frequently on the chi-square test (P < 0.001). Patients who received doses outside the suggested range were associated with longer ICU stays by an average of 2.5 days (P = 0.042). In conclusion, machine learning models showed excellent performance in predicting tacrolimus concentration in liver transplantation recipients and can be useful for concentration titration in these patients.

Psychological Distress Trends and Effect of Media Exposure Among Community Residents After the Seoul Halloween Crowd Crush.

BACKGROUND: It is unclear how exposure to and perception of community trauma creates a mental health burden. This study aimed to examine the psychological distress trends among community residents in acute stress reaction, acute stress disorder, and post-traumatic stress disorder phases following the Seoul Halloween crowd crush. METHODS: A three-wave repeated cross-sectional survey was conducted with participants after the incident. Analysis of covariance (ANCOVA) with post hoc Bonferroni test was adopted to examine temporal changes in psychological distress and psychological outcomes resulting from media impacts. A two-way ANCOVA was adopted to examine the interaction effects of time and relevance to victims on psychological distress. RESULTS: A total of 807, 1,703, and 2,220 individuals participated in the three waves. Anxiety (estimated mean [standard error of the mean]: 2.28 [0.03] vs. 2.12 [0.02] vs. 2.03 [0.02]; P < 0.001), depression (2.22 [0.03] vs. 2.01 [0.02] vs. 1.90 [0.02]; P < 0.001), and anger (2.70 [0.03] vs. 2.66 [0.02] vs. 2.49 [0.02]; P < 0.001) gradually improved. However, sense of safety initially worsened and did not recover well (2.96 [0.03] vs. 2.75 [0.02] vs. 2.77 [0.02]; P < 0.001). The interaction effect of time and relevance to the victim were significant in depression (P for interaction = 0.049), anger (P for interaction = 0.016), and sense of safety (P for interaction = 0.004). Among participants unrelated to the victim, those exposed to graphics exhibited higher levels of anxiety (2.09 [0.02] vs. 1.87 [0.07]; P = 0.002), depression (1.99 [0.02] vs. 1.83 [0.07]; P = 0.020), and anger (2.71 [0.03] vs. 2.47 [0.08]; P = 0.003) at W2 and higher anger (2.49 [0.02] vs. 2.31 [0.06]; P = 0.005) at W3. CONCLUSION: Community residents indirectly exposed to trauma also experienced psychological distress in the early stages after the incident. A significant impact of media which might have served as a conduit for unfiltered graphics and rumors was also indicated.