Assessment of Instability in Thoracolumbar Burst Fractures Using a New Bone Scan Scoring System.

Background and Objectives: Unstable thoracolumbar burst fractures require surgical management as they can result in neurological deficits if left untreated. This study aimed to evaluate whether a new bone scan scoring system could accurately assess instability in thoracolumbar burst fractures. Materials and Methods: Fifty-two patients with thoracolumbar burst fractures who underwent bone scans and magnetic resonance imaging prior to surgery between January 2015 and August 2017 at Ulsan University Hospital were selected for inclusion. Instability was determined by clinical assessment and imaging, and the Thoracolumbar Injury Classification and Severity score was determined. Bone scans were visually evaluated using a new bone scan scoring system. Bone scan findings of vertebral body (BB) and posterior column (BP) were scored separately and were summed to produce BTS {BTS (total score) = BB (body score, 5 points) + BP (posterior score, 2 points)}. The diagnostic performance of the scoring system for identifying unstable then thoracolumbar burst fractures were assessed. Results: Of the 52 thoracolumbar burst fractures, 34 (65.4%) were unstable and 31 (59.6%) had a Thoracolumbar Injury Classification and Severity score ≥ 5. The diagnostic performance of using BTS ≥ 4 to identify unstable thoracolumbar burst fractures and those with a Thoracolumbar Injury Classification and Severity score ≥ 5 was as follows: sensitivity, 61.8% and 58.1%; specificity, 94.4% and 81.0%; positive predictive value, 95.5% and 81.8%; and negative predictive value, 56.7% and 56.7%, respectively. Conclusions: The proposed bone scan scoring system has a high specificity and positive predictive value for identifying thoracolumbar burst fractures that are unstable or have a Thoracolumbar Injury Classification and Severity score ≥ 5. This scoring system may help to inform decisions regarding surgical management.

Health risk assessment and source apportionment of PM2.5-bound toxic elements in the industrial city of Siheung, Korea.

The emission sources and their health risks of fine particulate matter (PM2.5) in Siheung, Republic of Korea, were investigated as a middle-sized industrial city. To identify the PM2.5 sources with error estimation, a positive matrix factorization model was conducted using daily mean speciated data from November 16, 2019, to October 2, 2020 (95 samples, 22 chemical species). As a result, 10 sources were identified: secondary nitrate (24.3%), secondary sulfate (18.8%), traffic (18.8%), combustion for heating (12.6%), biomass burning (11.8%), coal combustion (3.6%), heavy oil industry (1.8%), smelting industry (4.0%), sea salts (2.7%), and soil (1.7%). Based on the source apportionment results, health risks by inhalation of PM2.5 were assessed for each source using the concentration of toxic elements portioned. The estimated cumulative carcinogenic health risks from the coal combustion, heavy oil industry, and traffic sources exceeded the benchmark, 1E-06. Similarly, carcinogenic health risks from exposure to As and Cr exceeded 1E-05 and 1E-06, respectively, needing a risk reduction plan. The non-carcinogenic risk was smaller than the hazard index of one, implying low potential for adverse health effects. The probable locations of sources with relatively higher carcinogenic risks were tracked. In this study, health risk assessment was performed on the elements for which mass concentration and toxicity information were available; however, future research needs to reflect the toxicity of organic compounds, elemental carbon, and PM2.5 itself.

Three-dimensional assessment of the anterior and inferior loop of the inferior alveolar nerve using computed tomography images in patients with and without mandibular asymmetry.

BACKGROUND: The purpose of this study was to investigate the differences in configuration and dimensions of the anterior loop of the inferior alveolar nerve (ALIAN) in patients with and without mandibular asymmetry. METHOD: Preoperative computed tomography images of patients who had undergone orthognathic surgery from January 2016 to December 2018 at a single institution were analyzed. Subjects were classified into two groups as "Asymmetry group" and "Symmetry group". The distance from the most anterior and most inferior points of the ALIAN (IANant and IANinf) to the vertical and horizontal reference planes were measured (dAnt and dInf). The distance from IANant and IANinf to the mental foramen were also calculated (dAnt_MF and dInf_MF). The length of the mandibular body and symphysis area were measured. All measurements were analyzed using 3D analysis software. RESULTS: There were 57 total eligible subjects. In the Asymmetry group, dAnt and dAnt_MF on the non-deviated side were significantly longer than the deviated side (p < 0.001). dInf_MF on the non-deviated side was also significantly longer than the deviated side (p = 0.001). Mandibular body length was significantly longer on the non-deviated side (p < 0.001). There was no significant difference in length in the symphysis area (p = 0.623). In the Symmetry group, there was no difference between the left and right sides for all variables. CONCLUSION: In asymmetric patients, there is a difference tendency in the ALIAN between the deviated and non-deviated sides. In patients with mandibular asymmetry, this should be considered during surgery in the anterior mandible.

Uncertainty-based concentration estimation of chlortetracycline antibiotics in swine farms and risk probability assessment for agricultural application of manure.

Consideration of livestock farming practices is necessary for the reliable prediction of veterinary antibiotics concentrations in livestock manure and soil and characterization of their ecological risks. This study aims to predict concentrations of chlortetracycline (CTC) generated from slurry pit and evaluate its ecological risk in soil based on the European Medicine Agency guidelines by considering slurry pit farm practices such as cleaning water volume and those uncertainties. Additionally, sensitivity analysis was conducted on the exposure estimation of CTC in soil employing the Monte Carlo simulation. The predicted environmental concentrations of CTC in the slurry pit and soil were in a range of 0.54-5.64 mg/kgmanure and 3.42-67.59 µg/kgsoil, respectively, for a 90 % confidence level. The predicted ranges included the measured values reported in previous studies. The probability of risk quotient (RQ) exceeding one was estimated at 9.3 % based on the Monte Carlo simulation. The four most influential factors on the exposure to CTC in soil were identified as nitrogen in fertilizer/compost, cleaning water volume, ratio of sick pigs requiring antibiotics, and pit emptying cycles. The results indicate that the ecological risk of CTC in the soil is possible and can be controlled by slurry pit farm practices.

Assessment on landfill liners as the barrier against C60 nanoparticles.

Owing to the increasing usage of nanomaterials, it is imperative to assess their potential impacts on natural systems, and in particular, investigate if existing barriers can prevent nanomaterial emission in landfills because they will be disposed in landfills at the end of their useful lives. This study inspected the behavior of colloidal fullerene (nC60) in and around landfill liner materials. Sorption isotherm experiments using either natural soil or high density polyethylene geomembrane as sorbents showed that nC60 was readily removed by sorption to soil and precipitation, while there was no sorption to geomembrane. To investigate transport through soil, nC60 was injected into columns of compacted soil layers with a thickness of 3.3-4.2 cm and hydraulic conductivity <1 × 10-7 cm/s. The nanoparticles rarely passed through the layers owing to self-aggregation and/or screening by the soil layer. When they were detected in the effluent, breakthrough curves of an extraordinary shape were produced, which is presumably attributed to surface modification of collectors by deposited nC60. However, simulation using the obtained mass transport parameters showed that it is unlikely that nC60 from disposed C60-containing products would overcome compacted clay liners; therefore, its migration to the ambient environment would be negligible.

Assessment of Cognitive Impairment in a Mouse Model of High-Fat Diet-Induced Metabolic Stress with Touchscreen-Based Automated Battery System.

Obesity-related metabolic disorders can affect not only systemic health but also brain function. Recent studies have elucidated that amyloid beta deposition cannot satisfactorily explain the development of Alzheimer's disease (AD) and that dysregulation of glucose metabolism is a critical factor for the sporadic onset of non-genetic AD. Identifying the pathophysiology of AD due to changes in brain metabolism is crucial; however, it is limited in measuring changes in brain cognitive function due to metabolic changes in animal models. The touchscreen-based automated battery system, which is more accurate and less invasive than conventional behavioral test tools, is used to assess the cognition of mice with dysregulated metabolism. This system was introduced in humans to evaluate cognitive function and was recently back-translated in monkeys and rodents. We used outbred ICR mice fed on high-fat diet (HFD) and performed the paired associates learning (PAL) test to detect their visual memory and new learning ability loss as well as to assess memory impairment. The behavioral performance of the HFD mice was weaker than that of normal mice in the training but was not significantly associated with motivation. In the PAL test, the average number of trials completed and proportion of correct touches was significantly lower in HFD mice than in normal diet-fed mice. Our results reveal that HFD-induced metabolic dysregulation has detrimental effects on operant learning according to the percentage of correct responses in PAL. These findings establish that HFD-induced metabolic stress may have an effect in accelerating AD-like pathogenesis.

Cell signaling heterogeneity is modulated by both cell-intrinsic and -extrinsic mechanisms: An integrated approach to understanding targeted therapy.

During the last decade, our understanding of cancer cell signaling networks has significantly improved, leading to the development of various targeted therapies that have elicited profound but, unfortunately, short-lived responses. This is, in part, due to the fact that these targeted therapies ignore context and average out heterogeneity. Here, we present a mathematical framework that addresses the impact of signaling heterogeneity on targeted therapy outcomes. We employ a simplified oncogenic rat sarcoma (RAS)-driven mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase-protein kinase B (PI3K-AKT) signaling pathway in lung cancer as an experimental model system and develop a network model of the pathway. We measure how inhibition of the pathway modulates protein phosphorylation as well as cell viability under different microenvironmental conditions. Training the model on this data using Monte Carlo simulation results in a suite of in silico cells whose relative protein activities and cell viability match experimental observation. The calibrated model predicts distributional responses to kinase inhibitors and suggests drug resistance mechanisms that can be exploited in drug combination strategies. The suggested combination strategies are validated using in vitro experimental data. The validated in silico cells are further interrogated through an unsupervised clustering analysis and then integrated into a mathematical model of tumor growth in a homogeneous and resource-limited microenvironment. We assess posttreatment heterogeneity and predict vast differences across treatments with similar efficacy, further emphasizing that heterogeneity should modulate treatment strategies. The signaling model is also integrated into a hybrid cellular automata (HCA) model of tumor growth in a spatially heterogeneous microenvironment. As a proof of concept, we simulate tumor responses to targeted therapies in a spatially segregated tissue structure containing tumor and stroma (derived from patient tissue) and predict complex cell signaling responses that suggest a novel combination treatment strategy.

Isolated Syndesmosis Diastasis: Computed Tomography Scan Assessment With Arthroscopic Correlation.

PURPOSE: To investigate which method can predict tibiofibular diastasis more accurately among the tibiofibular interval at the ankle joint level or previous parameters taken 1 cm above the joint line. METHODS: An arthroscopic examination was performed in 78 consecutive patients with anterolateral ankle pain. Four different methods were performed to take measurements of the tibiofibular interval using an axial computed tomography (CT) scan under existing arthroscopic diagnosis. Three previously reported parameters were assessed at 1 cm above the joint level. In the first method, 2 measurements were obtained. The anterior measurement was the closest distance between the anterior border of the fibula and anterior tibial tubercle. The posterior measurement was the closest distance between the medial border of the fibula and posterior tibial tubercle. In the second method, an angle between the fibular axis and the line connecting the anterior and posterior tibial tubercle was measured. In the third method, the nearest distance between the line perpendicular to the line connecting the tubercles at the anterior tubercle of the distal tibia and the anterior-most margin of the fibula was measured. The fourth method, which was developed in this study, measured the narrowest tibiofibular distance at the joint level. Data were analyzed using Student's t-test and the receiver operating characteristic curve to make comparisons among 4 CT-based parameters. RESULTS: In the comparison between the patients with arthroscopic diastasis and without diastasis, the posterior parameter in the first method and the narrowest tibiofibular distance at the joint level in the fourth method showed a significant difference (P < .05) The areas under the receiver operating characteristic curve (AUCs) of the anterior and posterior parameter of the first method were 0.58 (95% confidence interval [CI], 0.43-0.73; P = .167) of anterior measurement and 0.6 (95% CI, 0.45-0.75; P = .029) of posterior measurement, respectively. The second and third methods presented AUCs of 0.59 (95% CI, 0.44-0.74; P = .458) and 0.48 (95% CI, 0.33-0.64; P = .987), respectively. The fourth method presented an AUC of 0.86 (95% CI, 0.75-0.94; P = .000). When the syndesmosis was measured at the joint level, 2 mm of syndesmosis interval as a cutoff value showed 76% of sensitivity and 81% of specificity. CONCLUSIONS: Syndesmosis assessment using an axial CT scan at the joint level best correlated with the arthroscopic examination. When there is more than 2 mm of widening in syndesmosis on the axial CT scan at the joint level, there is a high likelihood of diastasis of the distal tibiofibular syndesmosis in patients who are suspicious clinically to have acute or chronic syndesmosis lesion. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Forest-fire model as a supercritical dynamic model in financial systems.

Recently large-scale cascading failures in complex systems have garnered substantial attention. Such extreme events have been treated as an integral part of self-organized criticality (SOC). Recent empirical work has suggested that some extreme events systematically deviate from the SOC paradigm, requiring a different theoretical framework. We shed additional theoretical light on this possibility by studying financial crisis. We build our model of financial crisis on the well-known forest fire model in scale-free networks. Our analysis shows a nontrivial scaling feature indicating supercritical behavior, which is independent of system size. Extreme events in the supercritical state result from bursting of a fat bubble, seeds of which are sown by a protracted period of a benign financial environment with few shocks. Our findings suggest that policymakers can control the magnitude of financial meltdowns by keeping the economy operating within reasonable duration of a benign environment.

Field assessment of semi-aerobic condition and the methane correction factor for the semi-aerobic landfills provided by IPCC guidelines.

According to IPCC guidelines, a semi-aerobic landfill site produces one-half of the amount of CH4 produced by an equally-sized anaerobic landfill site. Therefore categorizing the landfill type is important on greenhouse gas inventories. In order to assess semi-aerobic condition in the sites and the MCF value for semi-aerobic landfill, landfill gas has been measured from vent pipes in five semi-aerobically designed landfills in South Korea. All of the five sites satisfied requirements of semi-aerobic landfills in 2006 IPCC guidelines. However, the ends of leachate collection pipes which are main entrance of air in the semi-aerobic landfill were closed in all five sites. The CH4/CO2 ratio in landfill gas, indicator of aerobic and anaerobic decomposition, ranged from 1.08 to 1.46 which is higher than the values (0.3-1.0) reported for semi-aerobic landfill sites and is rather close to those (1.0-2.0) for anaerobic landfill sites. The low CH4+CO2% in landfill gas implied air intrusion into the landfill. However, there was no evidence that air intrusion has caused by semi-aerobic design and operation. Therefore, the landfills investigated in this study are difficult to be classified as semi-aerobic landfills. Also MCF of 0.5 may significantly underestimate methane emissions compared to other researches. According to the carbon mass balance analyses, the higher MCF needs to be proposed for semi-aerobic landfills. Consequently, methane emission estimate should be based on field evaluation for the semi-aerobically designed landfills.

Compensation for occupational cancer.

The legal scope and criteria for occupational cancer in Korea was out of date. The aim of this study was to review the current criteria for occupational cancer and amend the existent criteria on the basis of recent scientific evidence. The scientific evidence and the legal list of occupational cancer were analyzed to identify the causes of occupational cancer on a global scale. The relationship between compensated occupational cancer cases and carcinogen exposure in Korea was examined. The factors associated with specific causes and target cancers were determined to produce additional criteria. Five-hundred and nineteen cases of 2,468 were awarded compensation for occupational cancer including lung, malignant mesothelioma, lymphohematopoietic, and liver cancers from January 2000 to October 2012. Between 1996 and 2005, benzene accounted for 84.4% of cases, and between 1999 and 2005, asbestos was associated with 62.3% of cases. Fourteen novel causative agents and 12 additional target cancers were identified and the final guidelines were amended to include 23 causative agents and 21 target cancers. This amendment of the criteria for occupational cancer represents the widest change in Korean history and is expected to improve the understanding of occupational cancer by providing an up-to-date and accurate reference guide.

Sheathless elasto-inertial particle focusing and continuous separation in a straight rectangular microchannel.

Particle focusing in planar geometries is essentially required in order to develop cost-effective lab-on-a-chips, such as cell counting and point-of-care (POC) devices. In this study, a novel method for sheathless particle focusing, called "Elasto-Inertial Particle Focusing", was demonstrated in a straight microchannel. The particles were notably aligned along the centerline of the straight channel under a pressure-driven flow without any additional external force or apparatus after the addition of an elasticity enhancer: PEO (poly(ethylene oxide)) (∼O(100) ppm). As theoretically predicted (elasticity number: El≈O(100)), multiple equilibrium positions (centerline and corners) were observed for the viscoelastic flow without inertia, whereas three-dimensional particle focusing only occurred when neither the elasticity nor the inertia was negligible. Therefore, the three-dimensional particle focusing mechanism was attributed to the synergetic combination of the elasticity and the inertia (elasticity number: El≈O(1-10)). Furthermore, from the size dependence of the elastic force upon particles, we demonstrated that a mixture of 5.9 and 2.4 µm particles was separated at the exit of the channel in viscoelastic flows. We expect that this method can contribute to develop the miniaturized flow cytometry and microdevices for cell and particle manipulation.