Acute phlegmonous esophagitis presenting as chest pain: A case report.

RATIONALE: Acute phlegmonous esophagitis (APE) is bacterial infection of the submucosal and muscularis layers of the esophagus. APE is a rare but life-threatening disease, and few studies have reported it. PATIENT CONCERNS: A 63-year-old Korean woman was admitted to the emergency department complaining of chest pain. Contrast-enhanced computed tomography revealed diffuse esophageal wall thickening with low attenuation and paraesophageal fluid collection in the mediastinum. Esophagomyotomy, mediastinal abscess drainage with a right thoracotomy, and left 3-port video-assisted thoracoscopy were performed in the operating room. DIAGNOSES: Contrast-enhanced computed tomography revealed diffuse esophageal wall thickening with low attenuation and paraesophageal fluid collection in the mediastinum. INTERVENTIONS: Esophagomyotomy, mediastinal abscess drainage with a right thoracotomy, and left 3-port video-assisted thoracoscopy were performed in the operating room. OUTCOMES: The patient followed up through an outpatient visit 4 days later discharged. The patient progress was good, and she decided to visit the patient if she had pain afterwards. LESSONS: As APE is rare but deadly, strategies to identify APE in patients with chest pain or dysphagia are needed in emergency department.

Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS).

Objective: The primary objective of this study is to conduct a comparative analysis of telemedicine utilization patterns among adult populations residing in both rural and urban areas and evaluate the probability of telemedicine adoption among adults dwelling in both rural and urban areas amid the backdrop of the COVID-19 pandemic. Methods: Our study has attained sample populations (n = 279,260, National Weighted Estimates = 2,391,188,373) through the secondary analysis of the National Health Interview Survey (NHIS) for the year 2021. We examined the relationship between the rural, regional, and racial variables using chi-square tests and binary logistic regression associated with telemedicine use in our multivariable analysis. Results: Telemedicine use by population decreased with decreasing urbanization level, from 40.2% among adults living in large central metropolitan to 29.7% among adults living in rural area (p<0.0001). Regarding household income, adults with 400% or more of the federal poverty level (FPL) were significantly more likely to use telemedicine than adults with less than 100% of the FPL. Females were more likely than males to utilize telemedicine. In terms of region, adults living in the West were 1.25 times more likely to use telemedicine than adults living in the Northeast, and minority race/ethnicity groups (eg, Non-Hispanic Black, Hispanic, and other) are less likely to use the telemedicine rather than Non-Hispanic White. Conclusion: Health equity is attained when all demographic groups enjoy uniform access to healthcare services, but disparities emerge when there are discernible variations in access to treatment. Considering this study's findings, it becomes evident that the distinctions in poverty rates, median income levels, and healthcare utilization patterns across racial and regional lines may serve as indicators of potential health equity concerns.

Effect of Ampelopsis brevipedunculata (Maxim.) Trautv extract on a model of atopic dermatitis in HaCaT cells and mice.

Ampelopsis brevipedunculata (Maxim.) Trautv. has been used for a long time as a folk remedy. According to studies, it possesses anti-inflammatory, antioxidant, and antibacterial properties. However, its effects on atopic dermatitis (AD) are poorly studied. Thus, we investigated the therapeutic effect of A. brevipedunculata (Maxim.) Trautv. extract (ABE-M) on 2,4-dinitrochlorobenzene (DNCB)-induced AD. For in vitro analysis, keratinocytes cell lines (HaCaT cells) were used. To evaluate the gene and protein expression levels of cytokines and chemokines, TNF-α/IFN-γ-stimulated HaCaT cells were treated with ABE-M. The cells and the supernatant were collected, then gene and protein levels were analyzed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay analysis. For in vivo analysis, BALB/c mice (6 weeks) were randomly separated into five groups (n = 5). The mice were applied DNCB and phosphate-buffered saline, dexamethasone (DX) or ABE-M (50, 100, and 200 mg/kg) was orally administrated for 28 days. At the end, ear tissues and blood were collected for histological analysis and evaluation of cytokines and chemokines. In keratinocytes, ABE-M inhibited the protein and mRNA levels of chemokines, and cytokines exposed by TNF-α/IFN-γ. Similarly, the expression of chemokines was suppressed by ABE-M in AD animal model induced by DNCB and the level of pro-inflammatory cytokines was decreased in a dose-dependent manner. Our research indicates that ABE-M could be a candidate material that can be used to improve skin immunity enhancement, health, and beauty.

Mortality Cases of Mushroom Poisoning with Russula subnigricans.

Mushroom poisoning is increasing worldwide, as well as the incidence of fatal mushroom poisoning. Several new syndromes associated with mushroom poisoning have been described in the literature. Notably, 1 of the newly identified mushroom poisonings is Russula subnigricans poisoning. R subnigricans can be classified as causing a delayed-onset rhabdomyolytic syndrome as patients with this severe poisoning present with severe rhabdomyolysis, acute kidney injury, and cardiomyopathy. However, there are only a few reports on the toxicity of R subnigricans. We recently treated 6 patients with R subnigricans mushroom poisoning, of whom 2 died. The 2 patients showed severe rhabdomyolysis, metabolic acidosis, acute renal failure, electrolyte imbalance, and irreversible shock, which caused their deaths. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown origin. In addition, in cases of mushroom poisoning with severe rhabdomyolysis, R subnigricans poisoning should be promptly identified.

Phenolic Compounds from the Fruits of Prunus davidiana (Rosaceae) and Their Antioxidant Activities.

This research was supported by Cooperative Research Program for Agriculture Science & Technology Development (Project No. PJ014204032019) and the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2020R1A6A3A01100042).

Comparison of blood flow between two mechanical compression devices using ultrasound: Animal trial.

BACKGROUND: During manual chest compression, maintaining accurate compression depth and consistency is a challenge. Therefore, mechanical chest compression devices(mCCDs) have been increasingly incorporated in clinical practice. Evaluation and comparison of the efficacy of these devices is critical for extensive clinical application. Hence, this study compared the cardiopulmonary resuscitation(CPR) efficiency of two chest compression devices, LUCAS™ 3(Physio-Control, Redmond, USA) and Easy Pulse (Schiller Medizintechnik GMBH, Feldkirchen, Germany), in terms of blood flow using ultrasonography(USG) in a swine model. METHODS: A swine model was used to compare two mCCDs, LUCAS™ 3 and Easy Pulse. Cardiac arrest was induced by injecting potassium chloride(KCl) solution in eight male mongrel pigs and the animals were randomly divided into two groups. Mechanical CPR was provided to two groups using LUCAS™ 3(LUCAS™ 3 group) and Easy Pulse(Easy Pulse group). USG was used to measure hemodynamic parameters including femoral peak systolic velocity(PSV) and femoral artery diameters(diameter during systole and diastole). Blood flow rate was calculated by multiplying the PSV and cross-sectional area of the femoral artery during systole. The end-tidal carbon dioxide(EtCo2), chest compression depth was measured. Systolic blood pressure, mean blood pressure, and diastolic blood pressure were also measured using an arterial catheter. RESULTS: The chest compression depth was much deeper in LUCAS™ 3 group than Easy Pulse group(LUCAS™ 3: 6.80 cm; Easy Pulse: 3.279 cm, p < 0.001). However, EtCo2 was lower in the LUCAS™ 3 group(LUCAS™ 3: 19.8 mmHg; Easy Pulse: 33.4 mmHg, p < 0.001). The PSV was higher in the LUCAS™ 3 group(LUCAS™ 3: 67.6 cm s-1; Easy Pulse: 55.0 cm s-1, p < 0.001), while the systolic(LUCAS™ 3: 1.5 cm; Easy Pulse: 2.0 cm, p < 0.001) and diastolic diameters were larger in the Easy Pulse group(LUCAS™ 3: 0.4; Easy Pulse: 0.8 cm, p < 0.001). The femoral flood flow rate was also lower in the LUCAS™ 3 group(LUCAS™ 3: 32.55 cm3/s; Easy Pulse: 61.35 cm3/s, p < 0.001). CONCLUSION: The Easy Pulse had a shallower compression depth and slower PSV but had a wider systolic diameter in the femoral artery as compared to that in LUCAS™ 3. Blood flow and EtCo2 were higher in the easy pulse group probably because of the wider diameter. Therefore, an easy pulse may create and maintain more effective intrathoracic pressure.

Russula subnigricans Poisoning Causes Severe Rhabdomyolysis That Could be Misdiagnosed as Non-ST Segment Elevation Myocardial Infarction.

Mushroom poisoning and subsequently the number of patients visiting emergency rooms are increasing, as well as the proportion of fatal mushroom poisonings. Myocytic mushroom poisoning is one of the new clinical classifications. This report documents the course of a family with Russula subnigricans poisoning complicated by severe rhabdomyolysis, including a case that was misdiagnosed as myocardial infarction. A 64-y-old man visited our hospital with symptoms including substernal chest discomfort, nausea, vomiting, and myalgia, lasting for 12 h. His laboratory tests showed elevated serum high-sensitive troponin I. He was diagnosed with non-ST segment elevation myocardial infarction. After that, 2 family members who ate mushrooms together were transferred from a local emergency room with the diagnosis of rhabdomyolysis. Consequently, rhabdomyolysis due to mushroom poisoning was diagnosed. They were hospitalized in the intensive care unit. After admission, conservative management, including primary fluid resuscitation, was performed, and the patients were discharged without complications. R subnigricans poisoning was revealed after investigation and should be considered in mushroom poisoning with rhabdomyolysis. Early recognition and intensive supportive care are important for mushroom poisoning patients.

The Role of Individual-Level Factors in Rural Mortality Disparities.

Introduction: The role of individual risk factors in the rural‒urban mortality disparity is poorly understood. The purpose of this study was to explore the role of individual-level demographics and health behaviors on the association between rural residence and the risk of mortality. Methods: Cancer Prevention Study-II participants provided updated addresses throughout the study period. Rural‒Urban Commuting Area codes were assigned to participants' geocoded addresses as a time-varying exposure. Cox proportional hazards regression was used to estimate hazard ratios and 95% CIs for mortality associated with Rural‒Urban Commuting Area groups. Results: After adjustment for age and sex, residents of rural areas/small towns had a small but statistically significant elevated risk of all-cause mortality compared with metropolitan residents (hazard ratio=1.04; 95% CI=1.01, 1.06). Adjustment for additional covariates attenuated the association entirely (hazard ratio=0.99; 95% CI=0.97, 1.01). Individually, adjustment for education (hazard ratio=0.99; 95% CI=0.97, 1.01), alcohol use (hazard ratio=1.01; 95% CI=0.99, 1.04), and moderate-to-vigorous intensity aerobic physical activity (hazard ratio=1.00; 95% CI=0.97, 1.02) eliminated the elevated risk. Conclusions: The elevated risk of death for rural compared with that for metropolitan residents appeared to be largely explained by individual-level demographics and health behaviors. If replicated in other subpopulations, these results suggest that modifiable factors may play an important role in reducing the rural mortality disparity.

The State of Research on Faith Community Nursing in Public Health Interventions: Results from a Systematic Review.

Though faith community nurses (FCNs) serve many roles in churches and communities, little is known about their roles or effectiveness in public health interventions. This systematic review summarizes the literature on recent faith community nursing interventions, examining trends, evaluating rigor, and proposing future research directions. Articles were downloaded from PubMed and CINAHL, and 24 studies were included. Interventions addressed various health outcomes. The FCNs participated in research by recruiting participants, developing study measures, and implementing programs. Results reported mainly process evaluation and provided few outcomes. Better evaluation is needed to understand the effectiveness of FCNs in public health research.

FIBTEM Improves the Sensitivity of Hyperfibrinolysis Detection in Severe Trauma Patients: A Retrospective Study Using Thromboelastometry.

Rotational thromboelastometry (ROTEM) can only detect high-degree hyperfibrinolysis (HF), despite being frequently used in trauma patients. We investigated whether considering FIBTEM HF (the presence of maximal lysis (ML) > 15%) could increase ROTEM-based HF detection's sensitivity. This observational cohort study was performed at a level 1 trauma centre. Trauma patients with an Injury Severity Score (ISS) > 15 who underwent ROTEM in the emergency department between 2016 and 2017 were included. EXTEM HF was defined as ML > 15% in EXTEM. We compared mortality rates between EXTEM HF, FIBTEM HF, and non-HF patient groups. Overall, 402 patients were included, of whom 45% were men (mean age, 52.5 years; mean ISS, 27). The EXTEM HF (n = 37), FIBTEM HF (n = 132), and non-HF (n = 233) groups had mortality rates of 81.1%, 22.3%, and 10.3%, respectively. The twofold difference in mortality rates between the FIBTEM HF and non-HF groups remained statistically significant after Bonferroni correction (P = 0.01). On multivariable Cox regression analysis, FIBTEM HF was independently associated with in-hospital mortality (adjusted hazard ratio 2.15, 95% confidence interval 1.21-3.84, P = 0.009). Here, trauma patients with FIBTEM HF had significantly higher mortality rates than those without HF. FIBTEM be a valuable diagnostic method to improve HF detection's sensitivity in trauma patients.

Palliative care knowledge, information sources, and beliefs: Results of a national survey of adults in the USA.

OBJECTIVE: Despite its established benefits, palliative care (PC) is not well known among patients and family/caregivers. From a nationally representative survey, we sought to assess the following associated with PC: knowledge, knowledge sources, and beliefs. METHODS: Data were drawn from the Health Information National Trends Study (HINTS 5 Cycle 2), a cross-sectional, survey of non-institutionalized adults aged 18+ years in the USA. Data were weighted and assessed by proportional comparison and multivariable logistic regression. RESULTS: A total of 3504 respondents were identified, and approximately 29% knew about PC. In the adjusted model, less PC knowledge was associated with: lower age (those aged <50), male gender, lower education (

Compressive optic neuropathy secondary to Ewing sarcoma in the paranasal sinus: A case report.

RATIONALE: Ewing sarcoma localized in the paranasal sinuses, compressing the optic nerve, is very rare, with no prior case reports PATIENT CONCERNS:: A 68-year-old woman presented with decreased visual acuity in her left eye and paresthesia of the left face. Brain magnetic resonance imaging showed heterogeneously enhancing mass in the left paranasal sinuses with adjacent bone destruction, extending to the extraocular muscles and optic nerve of the left orbit. A biopsy of the nasal cavity confirmed Ewing sarcoma. DIAGNOSIS: Compressive optic neuropathy secondary to Ewing sarcoma in the paranasal sinuses. INTERVENTION: Neoadjuvant chemotherapy and radiotherapy were performed. OUTCOMES: Resolution of the tumor and increased visual acuity and field of the left eye. LESSONS: Primary head and neck Ewing sarcoma can lead to compressive optic neuropathy, but the tumor responded well to the chemotherapy. Early diagnosis and immediate treatment by close cooperation between the ophthalmologist and oncologist can prevent from permanent visual loss.

Recent Trends in Cost-Related Medication Nonadherence Among Cancer Survivors in the United States.

BACKGROUND: Cancer survivors avoid necessary medications due to costs. OBJECTIVE: To estimate the prevalence of cost-related medication non-adherence (CRN) by age and insurance status over a number of years in a national sample of U.S. cancer survivors. METHODS: Using the 1999-2012 National Health Interview Survey, we examined the prevalence and correlates of self-reported CRN, that is, patient-reported inability to afford prescribed medications within the past 12 months, resulting in nonadherence among cancer survivors. Descriptive statistics and multivariate logistic regression models were used to identify time trends in CRN among cancer survivors. RESULTS: In a nationally representative sample of 20,517 cancer survivors from 1999 to 2012, 1,788 (8.7%) survivors reported CRN, representing approximately 436,498 individuals nationally. CRN increased significantly from 11.8% (1999-2005) to 16.9% (2006-2012) among younger cancer survivors (P < 0.001). Among young cancer survivors (aged 45-64 years), the uninsurance rate was higher for those reporting CRN in the years 2006-2012 (48.5%) than in the earlier period (42.5%; P = 0.043). Among older cancer survivors, insurance coverage through Medicare only was lower for individuals reporting CRN in the years 2006-2012 (5.8%) than in the earlier period (7.8%; P = 0.0210). In adjusted models, younger cancer survivors without health insurance were more likely to report CRN than those with supplemental private insurance with Medicare, and older cancer survivors with Medicare only were more likely to report CRN than those with supplemental private insurance with Medicare. CONCLUSIONS: Increasing trends in CRN were evident among younger cancer survivors. DISCLOSURES: No external funding was received for this work. The authors have no conflicts of interest to report. Study concept and design were contributed by Lee, along with Khan and Salloum. Lee collected the data, and data interpretation was performed by Lee, Khan, and Salloum. The manuscript was written primarily by Lee, with assistance from Khan and Salloum, and revised by Lee, Khan, and Salloum.

Association of Demographic and Socioeconomic Factors With Risk Factors for Chronic Kidney Disease.

OBJECTIVES: The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD). METHODS: We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007-2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR <60 mL/min/1.73 m(2), and 1304 of the 45 208 individuals included in the KNHANES were found to have CKD by this definition. The outcome variable was whether individual subjects adhered to the CKD prevention and management guidelines recommended by the Korea Centers for Disease Control and Prevention. The guidelines suggest that individuals maintain a normal weight, abstain from alcohol consumption and smoking, manage diabetes and hypertension, and engage in regular exercise in order to prevent and manage CKD. RESULTS: This study found that individuals with CKD were more likely to be obese and have hypertension or diabetes than individuals without CKD. In particular, male and less-educated CKD patients were less likely to adhere to the guidelines. CONCLUSIONS: Although the prevalence of CKD, as indicated by the KNHANES data, decreased from 2007 to 2013, the prevalence of most risk factors associated with CKD fluctuated over the same time period. Since a variety of demographic and socioeconomic factors are related to the successful implementation of guidelines for preventing and managing CKD, individually tailored prevention activities should be developed.

Choroidal Maps in Different Types of Macular Edema in Branch Retinal Vein Occlusion Using Swept-Source Optical Coherence Tomography.

PURPOSE: To compare choroidal thickness maps of different types of macular edema secondary to branch retinal vein occlusion (BRVO) using swept-source optical coherence tomography (SS OCT). DESIGN: Retrospective cross-sectional study. METHODS: We generated choroidal thickness maps of 55 eyes of 55 patients with BRVO using the macular volumetric raster scan protocol of the SS OCT. The enrolled eyes were classified into 4 types of macular edema according to the captured OCT images: no macular edema (nME, 13 eyes), cystoid macular edema (CME, 15 eyes), serous retinal detachment (SRD, 12 eyes), and mixed type (CME + SRD, 15 eyes). The data from normal fellow eyes served as the control. Statistical analysis was performed to compare choroidal thickness maps according to the type of macular edema. RESULTS: The mean choroidal thicknesses in the control, nME, CME, SRD, and mixed-type groups were 205.77 ± 41.65 µm, 211.56 ± 46.34 µm, 214.30 ± 49.21 µm, 249.18 ± 43.51 µm, and 248.05 ± 49.51 µm, respectively. No statistical difference in choroidal thickness was observed among the nME, CME, and control groups, while the SRD and mixed groups showed larger choroidal thickness values than the control group (P < .001). No topographic feature in the choroidal thickness was observed to vary according to the location of BRVO. CONCLUSIONS: The results suggest the choroidal thickness in BRVO varies according to the type of macular edema. Among the macular edema groups, choroidal thickness was significantly increased in eyes with SRD relative to those without SRD, which suggests that increased choroidal thickness may influence the development of SRD in BRVO.

Developmental toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin in artificially fertilized crucian carp (Carassius auratus) embryo.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a persistent bioaccumulative environmental contaminant that is an endocrine disruptor. Embryos of various fish species are responsive to TCDD and have been used as an alternative method to the acute toxicity test with juvenile and adult fish. The TCDD test has similar endpoints of developmental toxicity. However, their sensitivity and signs of TCDD-induced toxicity are different depending on fish species and its habit. Crucian carp (Carassius auratus) - the sentinel species for persistent organic pollutants and a common foodfish in China, Japan, and Korea - was used to identify the developmental toxicity of TCDD. We obtained the fertilized eggs from the artificial fertilization of crucian carp (97.45% success rate). Embryos at 3h post fertilization (hpf) were exposed to no vehicle, vehicle (dimethylsulfoxide, 0.1% v/v) or TCDD (0.128, 0.32, 0.8, 2 and 5 µg/L) for 1h and then fresh water was changed and aerated. Embryonic development and toxicity were monitored until 150 hpf. TCDD-exposed group showed no effects on embryo mortality and hatching rate from 6 to 126 hpf. On the other hand, the post-hatching mortality rate in TCDD-exposed group was increased in a dose-dependent manner, especially at high doses (0.8, 2 and 5 µg/L). The LD50 for larval mortality was calculated to 0.24 ng TCDD/g embryo. Pericardial edema was continuously observed in larvae of TCDD-exposed groups from hatching complete time (78 hpf), followed by the onset of yolk sac edema. Hemorrhage and edema showed a significant increase depending on exposure concentration and time. Expression of TCDD-related CYP1A genes was evaluated quantitatively. Embryo and larvae in TCDD-exposed groups displayed a significant increase of CYP1A gene expression. Overall, we defined TCDD-induced toxicity in artificially fertilized crucian carp embryo and these results suggest that crucian carp can be applied as an early life stage model of TCDD-induced toxicity.

Sequence and structure of Brassica rapa chromosome A3.

BACKGROUND: The species Brassica rapa includes important vegetable and oil crops. It also serves as an excellent model system to study polyploidy-related genome evolution because of its paleohexaploid ancestry and its close evolutionary relationships with Arabidopsis thaliana and other Brassica species with larger genomes. Therefore, its genome sequence will be used to accelerate both basic research on genome evolution and applied research across the cultivated Brassica species. RESULTS: We have determined and analyzed the sequence of B. rapa chromosome A3. We obtained 31.9 Mb of sequences, organized into nine contigs, which incorporated 348 overlapping BAC clones. Annotation revealed 7,058 protein-coding genes, with an average gene density of 4.6 kb per gene. Analysis of chromosome collinearity with the A. thaliana genome identified conserved synteny blocks encompassing the whole of the B. rapa chromosome A3 and sections of four A. thaliana chromosomes. The frequency of tandem duplication of genes differed between the conserved genome segments in B. rapa and A. thaliana, indicating differential rates of occurrence/retention of such duplicate copies of genes. Analysis of 'ancestral karyotype' genome building blocks enabled the development of a hypothetical model for the derivation of the B. rapa chromosome A3. CONCLUSIONS: We report the near-complete chromosome sequence from a dicotyledonous crop species. This provides an example of the complexity of genome evolution following polyploidy. The high degree of contiguity afforded by the clone-by-clone approach provides a benchmark for the performance of whole genome shotgun approaches presently being applied in B. rapa and other species with complex genomes.