Risk factors for colorectal cancer in a fecal immunochemical test-positive group: The National Health Insurance Service-National Health Screening Cohort.

BACKGROUND AND AIM: Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long-term studies on subjects with FIT-positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT-positive patients using the National Health Insurance Service Bigdata database. METHODS: Among 1 737 633 individuals with a FIT screening result for CRC in 2009, 101 143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10 years (up to 2018) of these participants was investigated using the National Cancer Registry. RESULTS: Out of the 101 143 FIT-positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT-positive patients who underwent a second round of screening showed a 5-year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT-positive patients, the CRC incidence in the non-compliance group for the second round of screening was 2.8 times higher than that in the compliance group. CONCLUSIONS: In FIT-positive participants, non-compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT-positive patients to increase the rate of compliance with the second round of CRC screening.

Association between quantitative analysis of cerebral edema using CT imaging and neurological outcomes in cardiac arrest survivors.

BACKGROUND: To determine if the density distribution proportion of Hounsfield unit (HUdp) in head computed tomography (HCT) images can be used to quantitatively measure cerebral edema in survivors of out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective observational study included adult comatose OHCA survivors who underwent HCT within 6 h (first) and 72-96 h (second), all performed using the same CT scanner. Semi-automated quantitative analysis was used to identify differences in HUdp at specific HU ranges across the intracranial component based on neurological outcome. Cerebral edema was defined as the increased displacement of the sum of HUdp values (ΔHUdp) at a specific range between two HCT scans. Poor neurological outcome was defined as cerebral performance categories 3-5 at 6 months after OHCA. RESULTS: Twenty-three (42%) out of 55 patients had poor neurological outcome. Significant HUdp differences were observed between good and poor neurological outcomes in the second HCT scan at HU = 1-14, 23-35, and 39-56 (all P < 0.05). Only the ΔHUdp = 23-35 range showed a significant increase and correlation in the poor neurological outcome group (4.90 vs. -0.72, P < 0.001) with the sum of decreases in the other two ranges (r = 0.97, P < 0.001). Multivariate logistic regression analysis demonstrated a significant association between ΔHUdp = 23-35 range and poor neurological outcomes (adjusted OR, 1.12; 95% CI: 1.02-1.24; P = 0.02). CONCLUSION: In this cohort study, the increased displacement in ΔHUdp = 23-35 range is independently associated with poor neurological outcome and provides a quantitative assessment of cerebral edema formation in OHCA survivors.

Quantitative analysis of early apparent diffusion coefficient values from MRIs for predicting neurological prognosis in survivors of out-of-hospital cardiac arrest: an observational study.

BACKGROUND: This study aimed to quantitatively analyse ultra-early brain diffusion-weighted magnetic resonance imaging (DW-MRI) findings to determine the apparent diffusion coefficient (ADC) threshold associated with neurological outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective study included adult survivors of comatose OHCA who underwent DW-MRI imaging scans using a 3-T MRI scanner within 6 h of the return of spontaneous circulation (ROSC). We investigated the association between neurological outcomes and ADC values obtained through voxel-based analysis on DW-MRI. Additionally, we constructed multivariable logistic regression models with pupillary light reflex (PLR), serum neuron-specific enolase (NSE), and ADC values as independent variables to predict poor neurological outcomes. The primary outcome was poor neurological outcome 6 months after ROSC, determined by the Cerebral Performance Category 3-5. RESULTS: Overall, 131 patients (26% female) were analysed, of whom 74 (57%) showed poor neurological outcomes. The group with a poor neurological outcome had lower mean whole brain ADC values (739.1 vs. 787.1 × 10-6 mm/s) and higher percentages of voxels with ADC below threshold in all ranges (250-1150) (all P < 0.001). The mean whole brain ADC values (area under the receiver operating characteristic curve [AUC] 0.83) and the percentage of voxels with ADC below 600 (AUC 0.81) had the highest sensitivity of 51% (95% confidence interval [CI] 39.4-63.1; cut-off value ≤ 739.2 × 10-6 mm2/s and > 17.2%, respectively) when the false positive rate (FPR) was 0%. In the multivariable model, which also included PLR, NSE, and mean whole brain ADC values, poor neurological outcome was predicted with the highest accuracy (AUC 0.91; 51% sensitivity). This model showed more accurate prediction and sensitivity at an FPR of 0% than did the combination of PLR and NSE (AUC 0.86; 30% sensitivity; P = 0.03). CONCLUSIONS: In this cohort study, early voxel-based quantitative ADC analysis after ROSC was associated with poor neurological outcomes 6 months after cardiac arrest. The mean whole brain ADC value demonstrated the highest sensitivity when the FPR was 0%, and including it in the multivariable model improved the prediction of poor neurological outcomes.

Trend of incidence rate of age-related diseases: results from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in Korea: a cross- sectional study.

BACKGROUND: This study aimed to identify and select age-related diseases (ARDs) in Korea, which is about to have a super-aged society, and to elucidate patterns in their incidence rates. METHODS: The National Health Insurance Service-National Sample Cohort, comprising 1 million health insurance and medical benefit beneficiaries in Korea from 2002 to 2019, was utilized. We selected 14 diseases with high disease burden and prevalence among Koreans from the 92 diseases defined in the Global Burden of Diseases, Injuries, and Risk Factors Study as ARDs. The annual incidence rate represented the number of patients newly diagnosed with an ARD each year from 2006 to 2019, excluding those with a history of ARD diagnosis from 2002 to 2005. The incidence rate by age was categorized into 10-year units based on age as of 2019. The number of patients with ARDs in each age group was used as the numerator, and the incidence rate for each age group was calculated with the age group as the denominator. RESULTS: Regarding the annual incidence rates of ARDs from 2006 to 2019, chronic obstructive pulmonary disease, congestive heart failure, and ischemic heart disease decreased annually, whereas dyslipidemia, chronic kidney disease, cataracts, hearing loss, and Parkinson's disease showed a significant increase. Hypertension, diabetes, cerebrovascular disease, osteoporosis, osteoarthritis, and age-related macular degeneration initially displayed a gradual decrease in incidence but exhibited a tendency to increase after 2015. Concerning age-specific incidence rates of ARDs, two types of curves emerged. The first type, characterized by an exponential increase with age, was exemplified by congestive heart failure. The second type, marked by an exponential increase peaking between ages 60 and 80, followed by stability or decrease, was observed in 13 ARDs, excluding congestive heart failure. However, hypertension, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and hearing loss in men belonged to the first type. CONCLUSIONS: From an epidemiological perspective, there are similar characteristics in age-specific ARDs that increase with age, reaching a peak followed by a plateau or decrease in Koreans.

Effect of the lumbar stability exercise on the height difference between shoulders and range of motion in older adults.

[Purpose] The purpose of this study was to investigate the effect of the lumbar stability exercise on the range of motion (ROM) and height difference of the shoulder and to provide basic data to prevent musculoskeletal disorders for improvement of the quality of life of older adults. [Participants and Methods] Twenty older adults without musculoskeletal problems were divided into the lumbar stability exercise group and the passive upper arm exercise group and performed exercise for 30 minutes, 3 times a week for 5 weeks. The shoulder flexion, abduction, extension, and height difference between shoulders were measured. A paired t-test was applied for comparative analysis of data before and after exercise in both groups. [Results] In the lumbar stability exercise group, the shoulder flexion, abduction and height difference were significantly different. In the passive upper arm exercise group, the abduction was significantly different. [Conclusion] Since it was proved that the height difference and range of motion of shoulder are improved when the lumbar stability exercise is indirectly carried out without directly doing shoulder exercise, it is suggested that the lumbar stability exercise is strongly recommended for clinical uses to improve functions in older adults.

Comparison of maximum strength, proprioceptive, dynamic balance, maximum joint angle between two groups classified through the ankle instability instrument.

[Purpose] The purpose of this study is to figure out the information obtainable from ankle instability instrument (AII) survey among various factors related to the ankle instability. [Participants and Methods] This study targeted on 34 participants, divided the participants into stability group and instability group based on AII survey results, and measured the maximum isometric contraction, proprioception, dynamic balance, and maximum joint angles. The independent t-test was used. [Results] The maximum isometric contraction showed significance in the plantar flexion while the proprioceptive sense showed significance in both dorsiflexion and plantar flexion. The dynamic balanced showed significance in the anterior direction while the maximum joint angles showed significance in the dorsiflexion. [Conclusion] According to the results, the participants who were classified as ankle instability patients based on AII survey results involved problems in the maximum isometric contraction, proprioception, dynamic balance, and maximum joint angles.

Comparison of maximum strength, proprioceptive, dynamic balance, maximum joint angle of stability and instability ankle by Cumberland Ankle Instability Tool.

[Purpose] The purpose of this study was to investigate the factors of ankle instability by using Cumberland ankle instability tool (CAIT), which have been frequently used as ankle instability tools. The participants were divided into the normal ankle group and the instability ankle group. Maximum strength, proprioception, dynamic balance and maximum rage of joint motion were compared in order to find out factors of instability in the questionnaires. [Participants and Methods] A total of 44 participants were classified into the control (CON) group and the chronic ankle instability (CAI) group according to questionnaire types. Muscle strength, proprioception, dynamic balance and maximum joint angle were measured. The independent t-test was used. [Results] In the case of maximum ankle strength, it showed significance in CON group and CAI group ankle dorsiflexion and plantarflexion. In proprioception, it showed significance in CON group and CAI group. In dynamic balance, it showed significance in anterior (ANT) direction of the CON group and CAI group. Maximum joint angle produced significance in dorsiflexion of CON group and CAI group. [Conclusion] Information on maximum strength, proprioception, dynamic balance of anterior direction, and maximum joint angle of dorsiflexion is available through questionnaire CAIT.

Differences of quadriceps activity during inline lunge by using FMS assessment.

[Purpose] This study assessed the exercise capacity of healthy adults while performing the inline lunge exercise by using Functional Movement Screen (FMS). Compared the difference in muscle activity of the quadriceps according to the exercise capacity. [Participants and Methods] Thirty two healthy participants (12 males, 20 females) participated in this study. The surface electromyography (sEMG) was used to measure the electrical activities for the vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL) of quadriceps. [Results] Both groups had significant difference when sitting up and getting up during the inline lunge. In scores 3 group, vastus medialis showed higher muscle activity than vastus lateralis. On contrary, in scores 2 group, vastus lateralis had higher muscle activity than vastus medialis. [Conclusion] Therefore, this study suggests that inline lunge can help to strengthen the quadriceps effectively by showing the difference of quadriceps activity according to exercise capacity.

Morphological advantages of endoscopic treatment in obstructive chronic pancreatitis.

BACKGROUND: and study aims: Chronic pancreatitis is associated with recurrent or persistent abdominal pain over the course of the disease. Ductal hypertension showing obstructed and dilated pancreatic duct has been suggested as a major factor in the mechanism of pain in chronic pancreatitis. Many studies investigating pain relief after endoscopic treatment of pancreatic duct (PD) are available, but the number of studies regarding the morphological changes to pancreas such as changes in PD caliber, pancreatic parenchyma, and especially pancreatic volume is far fewer. As such, we analyzed the changes of ductal caliber and parenchymal volume after endoscopic treatment of PD in patients with obstructive chronic pancreatitis. PATIENTS AND METHODS: In this retrospective study, we compared two groups of patients with obstructive chronic pancreatitis that either received endoscopic management of PD or conservative treatment without such endoscopic management. After we obtained age, sex, etiology of chronic pancreatitis, diabetic status, smoking and alcohol abuse status from the database, we compared the incidence for changes in pancreatic parenchymal volume and PD caliber between two groups. RESULT: In our study population, total of 480 patients was diagnosed with chronic pancreatitis between January 2006 and December 2016, and 166 (34.5%) of these patients were diagnosed with obstructive chronic pancreatitis with obstructed and dilated PD. After reviewing the population with the exclusion criteria, 71 patients were available for the final analysis. 28 of those patient received endoscopic treatment of pancreatic duct and 43 received conservative treatment without any endoscopic treatment of PD. Statistical analysis with Cox proportional hazards models showed that diabetes and endoscopic PD management were significant predictors for progression of PD caliber and in pancreatic parenchyma, and that only PD management influenced the pancreatic volume loss. CONCLUSION: Endoscopic management of PD in obstructive chronic pancreatitis have advantages on morphologic change such as pancreatic volume loss and progression of PD caliber in long follow-up period.

Effect of abdominal drawing-in maneuver with prone hip extension on muscle activation of posterior oblique sling in normal adults.

[Purpose] There have been many studies on ipsilateral erector spinae in regard of prone hip extension (PHE). However, mediating methods have been focusing on the reinforcement of gluteus. Hereupon, this study is intended to identify how an increase of abdominal drawing-in maneuver influences on posterior oblique sling (POS) and suggest a mediating method to effectively reinforce them. [Participants and Methods] This study has been conducted on normal male (10) and female (10), and participants were asked to prove PHE exercise and abdominal drawing-in maneuver prone hip extension exercise (ADIM PHE). Surface electromyography (EMG) was recorded from the contralateral latissimus dorsi, ipsilateral erector spinae, ipsilateral gluteus maximus, and ipsilateral biceps femoris. A pared t-test was used to compare muscle activity POS. [Results] EMG activity of the contralateral latissimus dorsi, ipsilateral gluteus maximus was significantly greater performed ADIM PHE than PHE. As for ipsilateral erector spinae muscle, ipsilateral biceps femoris activation was lower in ADIM PHE than PHE. [Conclusion] According to the results of this study, abdominal drawing-in maneuver seems to be an important factor that influences on muscular activation of POS.

Influence of muscle activation of posterior oblique sling from changes in activation of gluteus maximus from exercise of prone hip extension of normal adult male and female.

[Purpose] There have been many study ipsilateral erector spinae in regard of prone hip extension (PHE). However, mediating methods have been focusing on the reinforcement of gluteus. Hereupon, this study is intended to identify how an increase of gluteus maximus influences on posterior oblique sling (POS) and suggest a mediating method to effectively reinforce them. This study shows the seclective POS strength exercise. [Participants and Methods] This study has been conducted on normal male (13) and female (13), and participants were asked to proceed PHE exercise and prone hip extension with hip abduction with knee flexion (PHEAKF). Surface electromyography (EMG) was recorded from the contralateral latissimus dorsi, contralateral erector spinae, ipsilateral erector spinae, ipsilateral gluteus maximus, and ipsilateral biceps femoris. A paried t-test was used to compare muscle activity POS. [Results] EMG activity of the contralateral latissimus dorsi, ipsilateral erector spinae, and ipsilateral gluteus maximus was significantly greater performed PHEAKF than PHE. As for ipsilateral biceps femoris, muscle activation was lower in PHEAKF than PHE. [Conclusions] According to the results of this study, increase in muscular activation from the direction of muscular fiber and posterior oblique sling seems to be an important factor that influencontralateral crector spinae on muscular activation of POS.

A graphitic edge plane rich meso-porous carbon anode for alkaline water electrolysis.

There is growing interest in alkaline water electrolysis as a sustainable approach for producing hydrogen, but developing efficient and inexpensive catalysts for the oxygen evolution reaction, which can limit the operational efficiency of water electrolysis due to its considerable overpotential, is regarded as the most overriding challenge. Therefore, significant progress has been made in developing catalysts with transition metal and carbon materials as alternative catalysts. Here, we prepared cobalt containing carbon nanofibers via a facile route of electrospinning and pyrolysis, and metal leached carbon nanofibers were also prepared by subsequently leaching the metal. Despite metal leaching, the latter ones still show comparable activity and stability with iridium black in alkaline water electrolysis. After detailed physicochemical and electrochemical characterizations, we revealed that graphitic edge plane rich carbon is mainly responsible for the activity of our material rather than embedded metal species. In addition, the metal plays a role in forming the specific carbon structure along with improving graphitization based on the catalytic graphitization. This result indicates the importance of the graphitic edge plane and might be helpful to understand carbon anodes for alkaline water electrolysis.

Insights into an autonomously formed oxygen-evacuated Cu2O electrode for the selective production of C2H4 from CO2.

Electrochemical conversion of carbon dioxide (CO2) to small organic fuels (e.g. formate, methanol, ethylene, ethanol) is touted as one of the most promising approaches for solving the problems of climate change and energy security. In this study, we report the highly efficient electrochemical reduction of CO2 using cuprous oxide (Cu2O) electrodes to produce ethylene (C2H4) primarily. During CO2 electrolysis using electrodeposited Cu2O on a carbon electrode, we observe the transformation of a compact metal oxide layer to a metal oxide structure with oxygen vacant sites at the bulk region. In contrast to previous studies, our results clearly indicate that Cu2O remains at the surface of the catalyst and it efficiently catalyzes the conversion process of CO2 at low overpotential, exhibiting a high selective faradaic efficiency of over 20% towards C2H4 formation even in long-term electrolysis.

Quasi-perpetual discharge behaviour in p-type Ge-air batteries.

Metal-air batteries continue to become attractive energy storage and conversion systems due to their high energy and power densities, safer chemistries, and economic viability. Semiconductor-air batteries - a term we first define here as metal-air batteries that use semiconductor anodes such as silicon (Si) and germanium (Ge) - have been introduced in recent years as new high-energy battery chemistries. In this paper, we describe the excellent doping-dependent discharge kinetics of p-type Ge anodes in a semiconductor-air cell employing a gelled KOH electrolyte. Owing to its Fermi level, n-type Ge is expected to have lower redox potential and better electronic conductivity, which could potentially lead to a higher operating voltage and better discharge kinetics. Nonetheless, discharge measurements demonstrated that this prediction is only valid at the low current regime and breaks down at the high current density region. The p-type Ge behaves extremely better at elevated currents, evident from the higher voltage, more power available, and larger practical energy density from a very long discharge time, possibly arising from the high overpotential for surface passivation. A primary semiconductor-air battery, powered by a flat p-type Ge as a multi-electron anode, exhibited an unprecedented full discharge capacity of 1302.5 mA h gGe(-1) (88% anode utilization efficiency), the highest among semiconductor-air cells, notably better than new metal-air cells with three-dimensional and nanostructured anodes, and at least two folds higher than commercial Zn-air and Al-air cells. We therefore suggest that this study be extended to doped-Si anodes, in order to pave the way for a deeper understanding on the discharge phenomena in alkaline metal-air conversion cells with semiconductor anodes for specific niche applications in the future.

The influence of a fibrous carbon envelope on the formation of CoFe nanoparticles for durable electrocatalytic oxygen evolution.

Co oxides are known to be active and stable alternative anode electrocatalysts possessing the potential to replace the best performing but most expensive Ir and Ru oxides in alkaline water electrolysis. Of late, Co oxides loaded on various carbon supports have been reported as a way to outperform Ir or Ru catalysts by improving the utilization efficiency. In this study, we introduce Co and Fe nanoparticles embedded carbon nanofibers (CoFe-CNFs), fabricated through electrospinning and pyrolysis of a polymer mixed with Co and Fe precursors. This method is a facile route for simultaneously making Co and Fe nanoparticles as well as the stable accommodation of the CoFe nanoparticles in the carbon support. We demonstrate the potential of the CoFe-CNFs as active and stable electrocatalysts for the oxygen evolution reaction (OER) in alkaline media. We conducted detailed physico-chemical characterizations to elucidate the effect of the CNFs on the OER activity and stability of the CoFe-CNFs. It is suggested that the CNFs are a medium in which OER-active CoFe alloy nanoparticles are formed homogeneously, and that carbon layers surrounding the nanoparticles are beneficial to the stability of the CoFe-CNFs in the OER.

Risk of incident chronic kidney disease among patients with urolithiasis: a nationwide longitudinal cohort study.

Background: Urolithiasis has been infrequently implicated to have a causal association with chronic kidney disease (CKD). Recently, several studies have demonstrated the relationship between urolithiasis and CKD. However, the generalizability of their results is limited. This study aimed to investigate the association between urolithiasis and the risk of incident CKD. Methods: This longitudinal cohort study used the National Health Insurance Service data, including 219 570 Korean adults with incident urolithiasis requiring procedural interventions and without prior kidney disease and 219 570 age- and sex-matched controls without urolithiasis between 1 January 2002 and 31 December 2020. Primary outcome was the development of CKD, defined by an estimated glomerular filtration rate <60 ml/min/1.73 m2 for at least two consecutive measurements at least 90 days apart. The risk for incident CKD was further examined using the outcome defined by newly occurring diagnostic codes indicating CKD. Results: Over a mean follow-up of 6 years, 12 338 (2.8%) primary outcome events of CKD were observed (incidence rate 4.6/1000 person-years). Per multivariable Cox analysis, urolithiasis was associated with a higher risk of incident CKD [adjusted hazard ratio 1.41 (95% confidence interval 1.36-1.46)]. This association remained consistent across all clinically relevant subgroups and when the CKD outcome was defined based on the diagnostic codes in the sensitivity analysis. Conclusions: In this large national cohort study, patients with urolithiasis were associated with a higher risk of incident CKD than those without urolithiasis. Further studies are warranted to establish the benefits of preventing urolithiasis in reducing CKD development.

NKCC1 in Neonatal Cochlear Support Cells Reloads Ions Necessary for Cochlear Spontaneous Activity.

In the auditory system, the spontaneous activity of cochlear inner hair cells (IHCs) is initiated by the release of ATP from inner supporting cells (ISCs). This ATP release sets off a cascade, activating purinergic autoreceptors, opening of Ca2+-activated Cl- channel TMEM16A, Cl- efflux and osmotic cell shrinkage. Then, the shrunken ISCs efficiently regain their original volume, suggesting the existence of mechanisms for refilling Cland K+, priming them for subsequent activity. This study explores the potential involvement of NKCCs (Na+-K+-Cl- cotransporters) and KCCs (K+-Cl- cotransporters) in ISC spontaneous activity, considering their capability to transport both Cl- and K+ ions across the cell membrane. Employing a combination of immunohistochemistry, pharmacological interventions, and shRNA experiment, we unveiled the pivotal role of NKCC1 in cochlear spontaneous activity. Immunohistochemistry revealed robust NKCC1 expression in ISCs, persisting until the 2nd postnatal week. Intriguingly, we observed a developmental shift in NKCC1 expression from ISCs to synaptophysin-positive efferent terminals at postnatal day 18, hinting at its potential involvement in modulating synaptic transmission during the post-hearing period. Experiments using bumetanide, a well-known NKCC inhibitor, supported the functional significance of NKCC1 in ISC spontaneous activity. Bumetanide significantly reduced the frequency of spontaneous extracellular potentials (sEP) and spontaneous optical changes (sOCs) in ISCs. NKCC1-shRNA experiments conducted in cultured cochlear tissues further supported these findings, demonstrating a substantial decrease in event frequency and area. Taken together, we revealed the role of NKCC1 in shaping the ISC spontaneous activity that govern auditory pathway development.

Blood-brain barrier permeability for the first 24 hours in hypoxic-ischemic brain injury following cardiac arrest.

BACKGROUND: This study aimed to explore the changes in blood-brain barrier (BBB) permeability and intracranial pressure (ICP) for the first 24 h after the return of spontaneous circulation (ROSC) and their association with injury severity of cardiac arrest. METHODS: This prospective study analysed the BBB permeability assessed using the albumin quotient (Qa) and ICP every 2 h for the first 24 h after ROSC. The injury severity of cardiac arrest was assessed using Pittsburgh Cardiac Arrest Category (PCAC) scores. The primary outcome was the time course of changes in the BBB permeability and ICP for the first 24 h after ROSC and their association with injury severity (PCAC scores of 1-4). RESULTS: Qa and ICP were measured 274 and 197 times, respectively, in 32 enrolled patients. Overall, the BBB permeability increased progressively over time after ROSC, and then it increased significantly at 18 h after ROSC compared with the baseline. In contrast, the ICP revealed non-significant changes for the first 24 h after ROSC. The Qa in the PCAC 2 group was < 0.01, indicating normal or mild BBB disruption at all time points, whereas the PCAC 3 and 4 groups showed a significant increase in BBB permeability at 14 and 22 h, and 12 and 14 h after ROSC, respectively. CONCLUSION: BBB permeability increased progressively over time for the first 24 h after ROSC despite post-resuscitation care, whereas ICP did not change over time. BBB permeability has an individual pattern when stratified by injury severity.

Differences in Cerebral Metabolism between Moderate- and High-Severity Groups of Patients with Out-of-Hospital Cardiac Arrest Undergoing Target Temperature Management.

The aim of this study was to investigate the differences in cerebral metabolism and the prognostic value of cerebrospinal fluid (CSF) lactate 24 h after the return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). CSF lactate and pyruvate levels were measured immediately and every 2 h for 24 h after the ROSC. The distribution of cerebral mitochondrial dysfunction (MD) and cerebral ischemia was also evaluated. In the moderate-severity group, the absence of cerebral MD or ischemia was observed in six patients (40.0%) immediately after ROSC and in nine patients (60.0%) 24 h after the ROSC. In the high-severity group, the absence of cerebral MD or ischemia was observed in four patients (30.8%) immediately after ROSC and in three patients (23.1%) 24 h after the ROSC. The distribution of cerebral metabolism over time varied depending on the severity of the OHCA. The predictive value of CSF lactate levels for a poor neurological prognosis was better for patients in the moderate-severity group than for the overall patient cohort. Therefore, the severity in the patients with OHCA should be considered when studying cerebral metabolism or using CSF lactate as a prognostic tool.

Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care.

We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-arrest patients who underwent prognostic tests, including the gray-white-matter ratio (GWR-BG), the Glasgow Coma Scale motor (GCS-M) score before sedative administration, and the neuron-specific enolase (NSE) level measured at 24 h after the ROSC. We investigated the prognostic performances of the tests as single predictors and in various combination strategies. Classification and regression-tree analysis were used to provide a reliable model for the risk stratification. Out of all the patients, 55 (44.0%) had good outcomes. The NSE level showed the highest prognostic performance as a single prognostic test and provided improved specificities (>70%) and sensitivities (>98%) when used in combination strategies. Low NSE levels (≤32.1 ng/mL) and high GCS-M (≥4) scores identified good outcomes without misclassification. The overall accuracy for good outcomes was 81.8%. In comatose patients with low NSE levels or high GCS-M scores, the premature withdrawal of life-sustaining therapy should be avoided, thereby complying with the formal prognostication-strategy algorithm after at least 72 h from the ROSC.