Longitudinal analysis of mucosa-associated invariant T cells in sepsis reveals their early numerical decline with prognostic implications and a progressive loss of antimicrobial functions.

Sepsis-elicited immunosuppression elevates the risk of secondary infections. We used a clinically relevant mouse model and serial peripheral blood samples from patients to assess the antimicrobial activities of mucosa-associated invariant T (MAIT) cells in sepsis. Hepatic and splenic MAIT cells from B6-MAITCAST mice displayed increased CD69 expression and a robust interferon-γ (IFNγ) production capacity shortly after sublethal cecal ligation and puncture, but not at a late timepoint. Peripheral blood MAIT cell frequencies were reduced in septic patients at the time of intensive care unit (ICU) admission, and more dramatically so among nonsurvivors, suggesting the predictive usefulness of early MAIT cell enumeration. In addition, at ICU admission, MAIT cells from sepsis survivors launched stronger IFNγ responses to several bacterial species compared with those from patients who subsequently died of sepsis. Of note, while low human leukocyte antigen (HLA)-DR+ monocyte frequencies, widely regarded as a surrogate indicator of sepsis-induced immunosuppression, were gradually corrected, the numerical insufficiency of MAIT cells was not resolved over time, and their CD69 expression continued to decline. MAIT cell responses to bacterial pathogens, a major histocompatibility complex-related protein 1 (MR1) ligand, and interleukin (IL)-12 and IL-18 were also progressively lost during sepsis and did not recover by the time of ICU/hospital discharge. We propose that MAIT cell dysfunctions contribute to post-sepsis immunosuppression.

Rapid and Rigorous IL-17A Production by a Distinct Subpopulation of Effector Memory T Lymphocytes Constitutes a Novel Mechanism of Toxic Shock Syndrome Immunopathology.

Toxic shock syndrome (TSS) is caused by staphylococcal and streptococcal superantigens (SAgs) that provoke a swift hyperinflammatory response typified by a cytokine storm. The precipitous decline in the host's clinical status and the lack of targeted therapies for TSS emphasize the need to identify key players of the storm's initial wave. Using a humanized mouse model of TSS and human cells, we herein demonstrate that SAgs elicit in vitro and in vivo IL-17A responses within hours. SAg-triggered human IL-17A production was characterized by remarkably high mRNA stability for this cytokine. A distinct subpopulation of CD4+ effector memory T (TEM) cells that secrete IL-17A, but not IFN-γ, was responsible for early IL-17A production. We found mouse "TEM-17" cells to be enriched within the intestinal epithelium and among lamina propria lymphocytes. Furthermore, interfering with IL-17A receptor signaling in human PBMCs attenuated the expression of numerous inflammatory mediators implicated in the TSS-associated cytokine storm. IL-17A receptor blockade also abrogated the secondary effect of SAg-stimulated PBMCs on human dermal fibroblasts as judged by C/EBP δ expression. Finally, the early IL-17A response to SAgs was pathogenic because in vivo neutralization of IL-17A in humanized mice ameliorated hepatic and intestinal damage and reduced mortality. Together, our findings identify CD4+ TEM cells as a key effector of TSS and reveal a novel role for IL-17A in TSS immunopathogenesis. Our work thus elucidates a pathogenic, as opposed to protective, role for IL-17A during Gram-positive bacterial infections. Accordingly, the IL-17-IL-17R axis may provide an attractive target for the management of SAg-mediated illnesses.

Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis.

OBJECTIVES: We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. DESIGN: The design was a systematic review and meta-analysis. DATA SOURCES: We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms "post-dural puncture headache," "spinal anesthesia," "epidural anesthesia," and "bed rest" to identify reports discussing the effectiveness of bed rest in preventing post-dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. RESULTS: The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. CONCLUSION: This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.

Publication Delay of Korean Medical Journals.

Publication lag is a determinant to journal efficiency that was not yet studied concerning Korean medical journals. To measure publication lag, we investigated the publication timestamps of 4,762 articles published by 10 Korean medical journals indexed in Scopus database, randomly selected from the KoreaMed Synapse since 2013. The total publication lag was 246.5 (Q1, Q3; 178.0, 347.0) days. The overall acceptance lag was 102.0 (65.0, 149.0) days. The overall lead lag was 123.0 (63.0, 236.0) days. The year of publication did not significantly affect the acceptance lag (P = 0.640), supposedly shortening it by about 1.4 (97.5% confidence interval [CI], ?5.2 to 8.0) days/year, while the date affected the lead lag (P = 0.028), shortening it by about 12.9 (1.3 to 24.5) days/year. The Korean medical journals have reduced the total publication delay entirely by means of reducing the lead lag, not by reducing the acceptance lag.

The Methodological Quality of Systematic Reviews and Meta-Analyses on the Effectiveness of Non-pharmacological Cancer Pain Management.

This study used the Assessment of Multiple Systematic Reviews (AMSTAR) to determine how the quality of methodologies in systematic reviews (SRs) and meta-analyses (MAs) impacts the effectiveness of nonpharmacological cancer pain management. The authors searched 11 electronic databases for published and unpublished studies (in English and Korean) on SRs and MAs relating to "cancer" and "pain management" that were released prior to May 7, 2014. The findings from 17 SRs and MAs were scored for quality using AMSTAR and coded by management type and value of effect size. Only one article was deemed high quality; five were considered to be of low quality. The mean score was 5.47 (SD = 2.03), indicating moderate quality. Among the items we tested via AMSTAR, zero studies stated whether they have a conflict of interest in their covered studies, but every study established the research question and inclusion criteria before constructing the review. Rigorous assessment of nonpharmacological cancer pain management using AMSTAR might contribute to healthcare providers making more informed clinical decisions when it comes to handling pain. Based on the finding, researchers should abide by reporting guidelines for SRs and MAs to ensure that research is more rigorously synthesized.

Improving the classification accuracy for IR spectroscopic diagnosis of stomach and colon malignancy using non-linear spectral feature extraction methods.

Non-linear feature extraction methods, neighborhood preserving embedding (NPE) and supervised NPE (SNPE), were employed to effectively represent the IR spectral features of stomach and colon biopsy tissues for classification, and improve the classification accuracy for diagnosis of malignancy. The motivation was to utilize the NPE and SNPE's capability of capturing non-linear spectral behaviors by simultaneously preserving local relationships in order that minute spectral differences among classes would be effectively recognized. NPE and SNPE derive an optimal embedding feature such that the local neighborhood structure can be preserved in reduced spaces (variables). The IR spectra collected from stomach and colon tissues were represented by several new variables through NPE and SNPE, and also by using the principal component analysis (PCA). Then, the feature-extracted variables were subsequently classified into normal, adenoma and cancer tissues by using both k-nearest neighbor (k-NN) and support vector machine (SVM), and the resulting accuracies were compared with each other. In both cases, the combination of SNPE-SVM provided the best classification performance, and the accuracy was substantially improved compared to when PCA-SVM was used. Overall results demonstrate that NPE and SNPE could be potential feature-representation strategies useful in biomedical diagnosis based on vibrational spectroscopy where effective recognition of minute spectral differences is critical.

Discovering spatiotemporal usage patterns of a bike-sharing system by type of pass: a case study from Seoul.

Determining bike-sharing usage patterns and their explanatory factors on demand is essential for the effective and efficient operation of bike-sharing systems (BSSs). Most BSSs provide different passes that vary with the period of use. However, studies investigating the differences in usage patterns are rare compared to studies conducted at the system level, even though explanatory factors depending on the type of pass may cause different characteristics in terms of usage patterns. This study explores the differences in the usage patterns of BSSs and the impact of explanatory factors on the demand depending on the type of pass. Various machine learning techniques, including clustering, regression, and classification, are used, in addition to basic statistical analysis. As observed, long-term season passes of over six months are mainly used for transportation (especially commuting), whereas one-day or short-term season passes seem to be used more for leisure than for other purposes. Furthermore, differences in the purpose of bike rentals seem to cause differences in usage patterns and variations in demand over time and space. This study improves ther understanding of the usage patterns that appear differently for each pass type, and provides insights into the efficient operation of BSSs in urban areas. Supplementary Information: The online version contains supplementary material available at 10.1007/s11116-023-10371-7.

Investigation on changes in the usage patterns of Seoul Bike usage patterns owing to COVID-19 according to pass type.

Human mobility has been significantly impacted by varying degrees of social distancing and stay-at-home directives that have been implemented in many countries to prevent the spread of COVID-19; this effect was observed regardless of the mode of transportation. Several studies have indicated that bike-sharing is a relatively safe option in terms of COVID-19 infection, and more resilient than public transportation. However, previous studies on the effects of COVID-19 on bike-sharing, rarely considered the type of pass in their investigation of the pandemic-induced changes in usage patterns of shared bikes. To overcome this limitation, this study used trip records obtained from Seoul Bike to investigate the changes in usage patterns of shared bikes during the COVID-19 pandemic. The spatiotemporal usage patterns were characterized in this study based on the type of pass. Additionally, using t-tests and k-means clustering, we discovered significant factors that influenced changes in one-day pass usage rates and temporal usage patterns at the station level. Finally, we constructed spatial regression models to estimate changes in bike rentals caused by COVID-19 based on pass type. The findings provided a comprehensive understanding of how bike-sharing usage varies depending on pass type, which is closely related to shared bikes trip purposes.

Reassessment of the status of Streptomyces setonii and reclassification of Streptomyces fimicarius as a later synonym of Streptomyces setonii and Streptomyces albovinaceus as a later synonym of Streptomyces globisporus based on combined 16S rRNA/gyrB gene sequence analysis.

The 16S rRNA and gyrB genes of 22 Streptomyces strains belonging to the Streptomyces griseus cluster were sequenced, and their taxonomic positions were re-evaluated. For correct analysis, all of the publicly available sequences of the species were collected and compared with those obtained in this study. Species for which no consensus sequence could be identified were excluded from the phylogenetic analysis. The levels of 16S rRNA gene sequence similarity within the cluster ranged from 98.6 to 100% with a mean value of 99.6 ± 0.3%, and those of the gyrB gene ranged from 93.6 to 99.9% with a mean value of 96.3 ± 1.5%. The observed average nucleotide substitution rate of the gyrB gene was ten times higher than that of the 16S rRNA gene, showing a far higher degree of variation. Strains sharing 99.3% or more gyrB sequence similarity (corresponding to an evolutionary distance of 0.0073) always formed monophyletic groups in both trees. Through the combined analysis of the two genes, clear cases of synonymy could be identified and, according to the priority rule, the assertion of the status of Streptomyces setonii as a distinct species and the reclassification of Streptomyces fimicarius as a later synonym of S. setonii and Streptomyces albovinaceus as a later synonym of Streptomyces globisporus are proposed. Emended descriptions of S. setonii and S. globisporus are provided.

The effects of uncoated paper on skin moisture and transepidermal water loss in bedridden patients.

AIMS AND OBJECTIVES: The aims of this study were to measure skin moisture and transepidermal water loss after application of uncoated paper and to compare skin moisture and transepidermal water loss after use of uncoated paper and disposable underpads. STUDY DESIGN: The study was a cross-over, prospective, open-labeled, randomized trial. SAMPLE AND SETTING: Bedridden patients aged≥18 years at a medical center in Korea were included. Treatment order was randomly assigned using block randomization, with a block size of 4 and an assignment rate of one-by-one. METHODS: Skin moisture was measured using a Corneometer 825 and transepidermal water loss was measured using a Tewameter 300. RESULTS: Skin moisture after application of an uncoated paper was significantly lower than observed after application of a disposable underpad (mean 40.6 and SD 13.1 vs. mean 64.6 and SD 23.7, p<0.001). Transepidermal water loss also showed greater health scores after using uncoated paper (mean 11.1 and SD 5.7 g/m2/hour) than after applying a disposable underpad (mean 23.2 and SD 11.1 g/m2 /hour, p<0.001). There were no statistical between-group differences in room temperature, relative humidity, and body temperature. CONCLUSION: We found that uncoated paper was helpful in avoiding excessive moisture without adverse effects. RELEVANCE TO CLINICAL PRACTICE: As indicated by the results of this study, uncoated paper can be applied to bed-ridden patients who required incontinence care. Nurses may consider using uncoated paper as one of nursing methods in the routine care of bed-ridden patients for moisture control.

Semi-supervised distributed representations of documents for sentiment analysis.

Learning document representation is important in applying machine learning algorithms for sentiment analysis. Distributed representation learning models of words and documents, one of neural language models, have overcome some limits of vector space models such as bag-of-words model and have been utilized successively in many natural language processing tasks including sentiment analysis. However, because such models learn the embeddings only with a context-based objective, it is hard for embeddings to reflect the sentiment of texts. In this research, we address this problem by introducing a semi-supervised sentiment-discriminative objective using partial sentiment information of documents. Our method not only reflects the partial sentiment information, but also preserves local structures induced from original distributed representation learning objectives by considering only sentiment relationships between neighboring documents. Using real-world datasets, the proposed method has been validated by sentiment visualization and classification tasks. The visualization results of Amazon review datasets demonstrate the enhancement of the sentiment class separation when document representations of our proposed method are compared to other methods. Sentiment prediction from our representations also appears to be consistently superior to other representations in both Amazon and Yelp datasets. This work can be extended to develop effective document embeddings applied to other discriminative tasks.

Immunomodulatory effects of high-protein diet with resveratrol supplementation on radiation-induced acute-phase inflammation in rats.

We hypothesized that a high-protein diet and/or resveratrol supplementation will improve acute inflammatory responses in rats after receiving experimental abdominal radiation treatment (ART). Based on our previous study, the period of 10 days after ART was used as an acute inflammation model. Rats were exposed to a radiation dose of 17.5 Gy and were supplied with a control (C), 30% high-protein diet (HP), resveratrol supplementation (RES), or HP with RES diet ([HP+RES]). At day 10 after ART, we measured profiles of lipids, proteins, and immune cells in blood. The levels of clusters of differentiating 4(+) (CD4(+)) cells and regulatory T cells, serum proinflammatory cytokines, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine were also measured. ART caused significant disturbances of lipid profiles by increasing triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), and decreasing high-density lipoprotein cholesterol. The proinflammatroy cytokine levels were also increased by ART. All the experimental diets (HP, RES, and [HP+RES]) significantly decreased levels of TG, monocytes, proinflammatory cytokines, and 8-OHdG, whereas the platelet counts were increased. In addition, the HP and [HP+RES] diets decreased the concentrations of plasma LDL-C and total cholesterol. Also, the HP and RES diets decreased regulatory T cells compared with those of the control diet in ART group. Further, the HP diet led to a significant recovery of white blood cell counts, as well as increased percentages of lymphocyte and decreased percentages of neutrophils. In summary, RES appeared to be significantly effective in minimizing radiation-induced damage to lipid metabolism and immune responses. Our study also demonstrated the importance of dietary protein intake in recovering from acute inflammation by radiation.

Availability of patient classification using clinical data.

OBJECTIVES: The aim of this study is examine the reliability and validity of the patient classification which is based on clinical data with comparing to nurse's check. METHOD: Nurse Experts estimated the content validity of extracting KPCS-1(Korea patient classification system for nurses Version 1) activities score from clinical data in storage of AMIS (Asan Medical Center information system). After verifying the content validity of extraction method from clinical data, two methods extracting KPCS-1 score (from clinical data vs. nurses' recording) were compared for 348 patients. RESULTS: This study demonstrated that extracting patient classification from clinical data is high value of validity (except 4 items excluded from this study), reliability between two methods extracting KPCS-1(from clinical data and nurses' recording) is high value (ICC=0.96, p<.001) and construct validity of two methods has similarity. CONCLUSIONS: It is believed that the patient classification system which is made from only clinical data without nurse's work burden is available. And 4 items which was excluded on KPCS-1 and examine area which had low level of reliability are needed to be amended.

Ceramide increases Fas-mediated apoptosis in glioblastoma cells through FLIP down-regulation.

Ceramide is a physiologic regulator of growth and differentiation in mammalian cells. In this study, the relationship between ceramide and FLICE inhibitory protein (FLIP) in the induction of apoptosis in glioblastoma cell lines was investigated. We found that LN215 cells were slightly more sensitive to Fas-mediated apoptosis than LN319 cells, which were more sensitive to ceramide than LN215 cells. FLIP was expressed in LN319 and LN215 cells constitutively, and this expression decreased with treatment of ceramide in LN215 cells, which might cause LN215 cells to be more sensitive to Fas-mediated apoptosis at lower level stimulation. In LN319 cells FLIP levels were not modified by ceramide treatment and the level of cell death induced by anti-Fas antibody was not affected. Our results suggest that FLIP may be down-regulated by low levels of ceramide in LN215 cells, which causes LN215 cells to be more sensitive to Fas-mediated apoptosis, whereas LN319 cells remain resistant.

Single-lung ventilation with a cuffed endotracheal tube in a child with a left mainstem bronchus disruption.

IMPLICATIONS: We report a case of management of ventilation during operative repair of a traumatic left mainstem bronchial disruption in a pediatric patient. With the use of a conventional cuffed endotracheal tube, with the cuff partially in the right mainstem bronchus and partially in the trachea, we successfully managed the case with single-lung ventilation.

Kocuria marina sp. nov., a novel actinobacterium isolated from marine sediment.

An actinobacterial strain was isolated from marine sediment taken from the Troitsa Bay of the Gulf of Peter the Great, East Siberian Sea, and subjected to a taxonomic investigation. The isolate, designated KMM 3905T, was Gram-positive, aerobic, non-motile and coccoid. The strain tolerated up to 15 % NaCl in growth media, although its presence was not essential for growth. Chemotaxonomic and phylogenetic properties of the strain were consistent with its classification in the genus Kocuria. The strain formed an independent phylogenetic line in the 16S rRNA gene tree encompassed by members of Kocuria. Comparison of phenotypic characteristics also supported its assignment to a novel species within Kocuria. The name Kocuria marina sp. nov. (type strain KMM 3905T = KCTC 9943T) is proposed for this halotolerant actinobacterium from the marine environment.