An unusual case of carotidynia preceding recurrent ischemic stroke with carotid thrombosis in a patient with systemic lupus erythematosus.

Carotid artery thrombosis following carotidynia is an uncommon manifestation of systemic lupus erythematosus. We report the case of a woman without evidence of a lupus flare-up who presented with the unusual clinical course of ipsilateral carotidynia and recurrent ischemic stroke due to carotid thrombosis. To our knowledge, this is the first case of such an unusual manifestation in lupus and highlights distinctive challenges in the diagnosis and management of carotid artery thrombosis following carotidynia.

Presence of tophi is a predictive factor of arterial stiffness in patients with gout.

The objective of this study is to determine whether the presence of tophi could predict an increase in arterial stiffness. Between June 2017 and June 2018, the augmentation index (AI) was measured using SphygmoCor® for patients with gout who visited the Jeju National University Hospital in South Korea. Patients were divided into the following groups: group with tophi and group without tophi. Medical records, laboratory data, and AI were retrospectively analyzed. One hundred and twenty patients with gout or participated in the study, with most (96.7%) of the patients being male. The mean duration of the disease was 7.0 years. At the time of the examination, 99 patients (82.5%) were treated with a uric acid-lowering agent. Of the total patients, 24 (19.7%) had tophi. Patients with tophi were significantly older (60.2 ± 11.6 years vs. 53.8 ± 13.0 years, p = 0.031), had longer disease duration (13.0 ± 6.5 years vs 5.5 ± 5.4 years, p < 0.001), and higher AI@75 (28.7 ± 7.8 vs 20.9 ± 10.0, p = 0.001) than those without tophi. In the multiple linear regression analysis, tophi was shown to be a significant predictor of high AI (p = 0.040). The presence of tophi is a predictor of increased arterial stiffness in patients with gout. Therefore, more strict control of cardiovascular disease risk factors is needed in the treatment of patients with tophi.

Proline-Hinged α-Helical Peptides Sensitize Gram-Positive Antibiotics, Expanding Their Physicochemical Properties to Be Used as Gram-Negative Antibiotics.

The outer membrane (OM) of Gram-negative bacteria is the most difficult obstacle for small-molecule antibiotics to reach their targets in the cytosol. The molecular features of Gram-negative antibiotics required for passing through the OM are that they should be positively charged rather than neutral, flat rather than globular, less flexible, or more increased amphiphilic moment. Because of these specific molecular characteristics, developing Gram-negative antibiotics is difficult. We focused on sensitizer peptides to facilitate the passage of hydrophobic Gram-positive antibiotics through the OM. We explored ways of improving the sensitizing ability of proline-hinged α-helical peptides by adjusting their length, hydrophobicity, and N-terminal groups. A novel peptide, 1403, improves the potentiation of rifampicin in vitro and in vivo and potentiates most Gram-positive antibiotics. The "sensitizer" approach is more plausible than those that rely on conventional drug discovery methods concerning drug development costs and the development of drug resistance.

Prevalence of shoulder pain and its correlates in Jeju agricultural population: A retrospective cross-sectional study.

The aim of this study was to investigate the prevalence of shoulder pain and analyze its association with socio-demographic factors, agricultural work-related conditions, and biomechanical factors among farmers on Jeju Island. We utilized initial survey data from the Safety for Agricultural Injury of Farmers' cohort study involving adult farmers on Jeju Island. The presence and characteristics of shoulder pain, socio-demographics, agricultural work-related conditions, and biomechanical factors were assessed using semi-structured questionnaires. A total of 1206 participants were analyzed for prevalence and associated risk factors using frequency and multivariate logistic regression analyses. The overall prevalence of shoulder pain was 17%. Multivariate logistic regression analysis, adjusted for significant socio-demographic and agricultural work-related condition variables, revealed that stress level, type of farming, and experiencing an agricultural injury within the preceding year were significantly associated with shoulder pain (stress level: "occasional," adjusted odds ratio [aOR], 1.581; 95% confidence interval [CI], 1.079-2.318; "frequent," aOR, 1.964; 95% CI, 1.205-3.200; and "extreme," aOR, 2.999; 95% CI, 1.480-6.074 vs "rarely"; type of farming: "orchard," aOR, 0.82; 95% CI, 0.597-1.124; "livestock," aOR, 0.225; 95% CI, 0.079-0.641 vs "field"; and experienced an agricultural injury within the past year: "yes," aOR, 2.078; 95% CI, 1.269-3.405). In addition, 3 biomechanical factors significantly contributed to shoulder pain: activities requiring significant power such as shoveling, pickaxing, and hammering; repetitive use of a particular body part; and constant elevation of the arm above the head. The findings highlight the importance of postural education, injury prevention, and psychological support in managing shoulder pain among farmers.

Characteristics and Trends of Pediatric Trauma in Jeju Island, South Korea: A Community Level Serial Cross-sectional study.

Objective: This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments (EDs) on Jeju Island. Method: Employing a community-level serial cross-sectional analysis, we targeted pediatric patients aged 18 years or younger who visited EDs for injuries over a ten-year period. The data, sourced from the Jeju Injury Surveillance System (JISS), facilitated a comprehensive examination of injury characteristics and epidemiological trends. This included an evaluation of the annual incidence and overall trends in pediatric injury cases. Results: The study found toddlers (42.5% of cases) to be the most frequently injured age group. Males were more prone to injuries, with a male-to-female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in Summer, evenings and weekends. Most incidents occurred at home, predominantly accidental in nature, with adolescents more likely to require EMS services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized, while self-harm/suicide and assault/violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents. Conclusion: The study underscores the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and times, to effectively mitigate pediatric trauma on Jeju Island.

A retrospective observational study of the appropriate starting dose of febuxostat in patients with gout.

BACKGROUND/AIMS: The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period. METHODS: We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020. RESULTS: Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly during the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack. CONCLUSION: Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.

Functional outcomes and length of stay with early and high-intensity rehabilitation after simultaneous bilateral total knee arthroplasty.

BACKGROUND: Length of stay and functional outcomes after total knee arthroplasty (TKA) are related to the timing and intensity of post-operative rehabilitation. OBJECTIVE: To determine the effectiveness of early and high-intensity rehabilitation after simultaneous bilateral TKA. METHODS: Prospective cohort data of 156 patients (11 men and 145 women; average age 72.0 ± 5.6 years) who underwent simultaneous bilateral primary TKA were analyzed. The intervention group (n= 82) underwent a high-intensity rehabilitation (phase II) after early postoperative standard rehabilitation (phase I) between June 2019 and May 2021. The control group (n= 74) underwent a lower-intensity rehabilitation (phase II) after phase I rehabilitation between July 2017 and May 2019. The timed up-and-go (TUG) test, timed stair climbing test (SCT), 6-minute walk test, isometric knee extensor and flexor strength of both knees, knee flexion and extension range of motion, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and functional levels, and the EuroQol five-dimension questionnaire were assessed preoperatively and 6 weeks after TKA. RESULTS: The average length of hospital stay was shortened by 5.7 days (p< 0.001). Phase II rehabilitation started earlier in the intervention group than in the control group (7.7 ± 1.3 vs 13.5 ± 2.0, p< 0.001). Compared with the control group, the intervention group showed significant improvements in the measures of mobility (WOMAC-function and SCT) and strength (isometric strength of both knee extensors and flexors) 6 weeks after TKA by statistically controlling for age and preoperative functional status. CONCLUSION: This study demonstrated that early and high-intensity rehabilitation could achieve functional improvement and shorten the length of hospital stay.

A case report of critical ischemic stroke in moyamoya-like vasculopathy accompanied by systemic lupus erythematosus.

Moyamoya-like vasculopathy (MMV) is a rare, chronic, progressive cerebrovascular disorder characterized by stenosis or occlusion of the terminal portion of the bilateral internal carotid arteries and development of abnormal collateral vessels at the base of the brain. This disorder develops in association with various systemic diseases and conditions, including neurofibromatosis type 1, Down syndrome, thyroid disease, radiation therapy, and autoimmune disease. We report a case of a 51-year-old female patient with low-activity systemic lupus erythematosus (SLE) who had a sudden onset of global aphasia and right hemiplegia. Three months previous, she had been on antiplatelet medication due to a single transient ischemic attack. Brain magnetic resonance imaging demonstrated a massive infarct of the left middle cerebral artery territory. Conventional angiography showed complete occlusion of the left middle cerebral artery with poor development of basal collateral vessels. This case demonstrates that a patient with underlying autoimmune disease such as SLE accompanied by MMV should be considered vulnerable to ischemic stroke.

Significant enhancement in radical-scavenging activity of curcuminoids conferred by acetoxy substituent at the central methylene carbon.

For a compound to be a radical-trapping antioxidant, the antioxidant-derived radical must be sufficiently inert to molecular oxygen as this would generate harmful chain-propagating peroxyl radicals. Curcumin has a unique structure with phenolic hydroxyl group as well as ß-diketone moiety in the same molecule, both of which are able to donate electrons to free radicals. However, due to the reactivity toward molecular oxygen, the carbon-centered radical derived from ß-diketone moiety do not serve as radical-trapping antioxidants. In this study, we reasoned that stabilization of the carbon-centered radical through substitution with an electron-withdrawing group would enhance the radical-scavenging antioxidative activity of the resulting curcuminoids. Thus, various substituents (methyl, allyl, methoxy, xanthate, and acetoxy) covering broad spectrum of the polar substituent effect were introduced to the central methylene position of both phenolic and non-phenolic curcuminoids. With the free phenolic hydroxyl groups present, the methylene-substituent did not exert significant effect on the antioxidant activity of the curcuminoids (EC(50)=23.2-30.3 µM) with the exception of the acetoxy-substituted derivative (EC(50)=8.7 µM) which showed more potent activity than curcumin (EC(50)=22.6 µM). When substituted to the non-phenolic curcumin scaffold, however, the methylene-substituent enhanced antioxidant activity of the otherwise inactive curcuminoids in the increasing order of methyl

Prognostic Factors for Radiographic Progression in Patients with Seronegative Rheumatoid Arthritis.

(1) Background: It has long been suggested that seronegative rheumatoid arthritis (RA) represents a clinical entity quite distinct from that of seropositive. However, analytical studies of seronegative RA dedicated to clinical outcomes regarding radiographic progression and related risk factors are scarce. The aim of this study is to evaluate radiographic outcome and prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (2) Methods: Subjects included RA patients reported as seronegative for both rheumatoid factor and anti-citrullinated protein antibody, who were treated at Jeju National University Hospital in South Korea between 2003 and 2016, including follow-up of at least 2 years. All patients fulfilled 1987 ACA or 2010 ACR/EULAR RA criteria. Radiographic progression was measured by yearly change in the Sharp van der Heijde (SvdH) score during follow-up periods. Medical records, laboratory and radiographic data were retrospectively analyzed, and linear regression analysis was performed to evaluate prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (3) Results: In total, 116 patients with seronegative RA were observed and 43 (37.1%) patients demonstrated radiographic damage during follow-up period. Mean age at diagnosis was 48 years and 86 (74.1%) patients were female. Symptom duration at diagnosis was 1.3 years and mean follow-up duration was 5.2 years. Patients with radiographic damage at diagnosis were 14 (12.1%) and mean SvdH score was 6.8 at diagnosis. Radiographic damage and SvdH at diagnosis significantly correlated with radiographic progression in patients with seronegative RA after adjusting age, sex, symptom duration, number of active synovitis, and CRP at diagnosis (ß-coefficient 6.5 ± 1.84; p = 0.001 and ß-coefficient 0.12 ± 0.02; p < 0.001, respectively). (4) Conclusions: This study determined that radiographic damage and SvdH at diagnosis were predictive factors in progression of radiographic damage in patients with seronegative rheumatoid arthritis. A large comparative study dedicated to this issue in seronegative RA is required.

A Hierarchical Metal Nanowire Network Structure for Durable, Cost-Effective, Stretchable, and Breathable Electronics.

Polymer nanofiber-based porous structures ("breathable devices") have been developed for breathable epidermal electrodes, piezoelectric nanogenerators, temperature sensors, and strain sensors, but their applications are limited because increasing the porosity reduces device robustness. Herein, we report an approach to produce ultradurable, cost-effective breathable electronics using a hierarchical metal nanowire network and an optimized photonic sintering process. Photonic sintering significantly reduces the sheet resistance (16.25 to 6.32 Ω sq-1) and is 40% more effective than conventional thermal annealing (sheet resistance: 12.99 Ω sq-1). The mechanical durability of the sintered (648.9 Ω sq-1) sample is notably improved compared to that of the untreated (disconnected) and annealed (19.1 kΩ sq-1) samples after 10,000 deformation cycles at 40% tensile strain. The sintered sample exhibits ∼29 times less change in electrical performance compared to the thermally annealed sample. This approach will lead to the development of affordable and ultradurable commercial breathable electronics.

All-Organic, Solution-Processed, Extremely Conformal, Mechanically Biocompatible, and Breathable Epidermal Electrodes.

Conformal integration of an epidermal device with the skin, as well as sweat and air permeability, are crucial to reduce stress on biological tissues. Nanofiber-based porous mesh structures (breathable devices) are commonly utilized to prevent skin problems. Noble metals are normally deposited on nanomesh substrates to form breathable electrodes. However, these are expensive and require high-vacuum processes involving time-consuming multistep procedures. Organic materials are suitable alternatives that can be simply processed in solution. We report a simple, cost-effective, mechanically biocompatible, and breathable organic epidermal electrode for biometric devices. Poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) is sprayed on a nanofiber-mesh structure, treated using only heat and water to enhance its biocompatibility and conductivity, and used as the electrode. The treatment is accomplished using an autoclave, simultaneously reducing the electrical resistance and sterilizing the electrode for practical use. This research can lead to affordable and biocompatible epidermal electrodes with improved suitability for various biomedical applications.

Prevalence of Low Back Pain and Associated Risk Factors among Farmers in Jeju.

BACKGROUND: We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population. METHODS: We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors. RESULTS: In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck. CONCLUSIONS: Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Enhancing the conductivity of PEDOT:PSS films for biomedical applications via hydrothermal treatment.

This paper reports a new biocompatible conductivity enhancement of poly (3,4-ethylenedioxythiophene):poly (styrene sulfonate) (PEDOT:PSS) films for biomedical applications. Conductivity of PEDOT:PSS layer was reproducibly from 0.495 to 125.367 S cm-1 by hydrothermal (HT) treatment. The HT treatment employs water (relative humidity > 80%) and heat (temperature > 61 °C) instead of organic solvent doping and post-treatments, which can leave undesirable residue. The treatment can be performed using the sterilizing conditions of an autoclave. Additionally, it is possible to simultaneously reduce the electrical resistance, and sterilize the electrode for practical use. The key to conductivity enhancement was the structural rearrangement of PEDOT:PSS, which was determined using atomic force microscopy, X-ray diffraction, Raman spectroscopy, X-ray photoelectron spectroscopy, and ultraviolet-visible spectroscopy. It was found that PEDOT inter-bridging occurred as a result of the structural rearrangement. Therefore, the conductivity increased on account of the continuous conductive pathways of the PEDOT chains. To test the biocompatible enhancement technique for biomedical applications, certain demonstrations, such as the monitoring of joint movements and skin temperature, and measuring electrocardiogram signals were conducted with the hydrothermal-treated PEDOT:PSS electrode. This simple, biocompatible treatment exhibited significant potential for use in other biomedical applications as well.

Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea.

BACKGROUND: This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea. METHODS: We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea. RESULTS: A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of <6 h (short sleep), 6-8 h (normal sleep), and >8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07-5.77). CONCLUSION: Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea.

Coxiella burnetii infects humans and wild and domesticated animals. Although reported cases on Jeju Island, off the coast of South Korea, are rare, the region is considered to have a high potential for Q fever. We investigated the seroprevalence of antibodies to C. burnetii in 230 farmers living in ten rural areas on Jeju Island between January 2015 and December 2019. Blood samples were collected and examined for C. burnetii Phase I/II IgM and IgG antibodies. Trained researchers collected ticks from rural areas. Clone XCP-1 16S ribosomal RNA gene sequencing was performed to identify Coxiella species from the collected ticks. The overall seroprevalence of antibodies to C. burnetii in farmers was 35.7%. The seroprevalence was significantly higher in fruit farmers. Of the collected ticks, 5.4% (19/351) of the Haemaphysalis longicornis ticks harbored C. burnetti. A high seroprevalence of antibodies to C. burnetii was observed in this region of Jeju Island, confirming that C. burnetti is endemic. Physicians should thus consider Q fever in the differential diagnosis of patients that present with acute fever after participating in outdoor activities.

Cyr61 synthesis is induced by interleukin-6 and promotes migration and invasion of fibroblast-like synoviocytes in rheumatoid arthritis.

BACKGROUND: Interleukin-6 (IL-6) is involved in fibroblast-like synoviocyte (FLS) activation and promotes pannus formation and bone and cartilage destruction in rheumatoid arthritis (RA). Cysteine-rich 61 (Cyr61) protein regulates cell proliferation, migration, and differentiation. The aim of this study was to investigate the role of Cyr61 in RA-FLS migration and invasion after IL-6 stimulation. METHODS: Western blotting, immunohistochemistry, reverse transcription-polymerase chain reaction, and real time-polymerase chain reaction were used to examine protein and mRNA levels of Cyr61, matrix metalloproteinases (MMPs), and other signalling proteins. Knockdown of gene expression was performed with siRNA, and RNA sequencing was performed for differential gene analysis. Migration and invasion were assessed by wound healing and Boyden chamber assays. RESULTS: Cyr61 levels were elevated in FLSs from RA patients compared to those in osteoarthritis patients. Control and IL-6-treated FLSs showed differential gene expression. IL-6 stimulated protein synthesis of Cyr61, which was attenuated by the extracellular signal-related kinase 1/2 (ERK 1/2) inhibitor, PD98059, and knockdown of early growth response 3 (EGR3), but not of JUN. IL-6-induced Cyr61 protein synthesis increased expression of MMP2. Cyr61 promoted FLS migration and invasion in an autocrine manner. Knockdown of CYR61 and a neutralising antibody attenuated Cyr61 synthesis and IL-6-induced FLS migration. CONCLUSIONS: By modulating the ERK/EGR3 pathway, IL-6 stimulated Cyr61 production and in turn increased invasiveness of FLS. Our data suggest that Cyr61 might be a potential target to prevent the progression of joint damage in RA.

Breathable Nanomesh Humidity Sensor for Real-Time Skin Humidity Monitoring.

The importance of monitoring the condition of skin is increasing as its relevance to health is becoming more well understood. Inappropriate humidity levels can cause atopic dermatitis or hair loss. However, conventional film substrates used in electronic skin monitoring devices cause accumulation of sweat or gas between the device and biological tissue, leading to negative effects in long-term humidity measurements. Thus, real-time measurements of skin humidity over long periods are difficult using conventional film devices. Here, a breathable nanomesh humidity sensor that can monitor skin humidity for a long time is developed by using biocompatible materials such as gold, poly(vinyl alcohol), and Parylene C. The sensor presents excellent gas and sweat permeability and precisely detects the humidity level of an object for a long time. This study demonstrates the successful real-time detection of the humidity level from human skin and also detects the relative humidity of a plant surface over a prolonged period. This sensor is expected to have wide applicability for cultivating delicate plants as well as to reveal correlations between skin humidity and disease for biomedical applications.

Accurate, hysteresis-free temperature sensor for health monitoring using a magnetic sensor and pristine polymer.

Herein, a novel temperature sensor is proposed employing a planar Hall resistance (PHR) magnetic sensor, a magnet sheet, and an expanding polymer. It features a tunable temperature range, high linear sensitivity, accuracy, and cycling stability through 1000 cycles, and no thermal hysteresis. This new sensor is promising as a body temperature sensor.