External validation and update of the early detection rule for severe hyperkalemia among patients with symptomatic bradycardia.

OBJECTIVE: Chon et al. suggested a high prevalence of severe hyperkalemia (serum potassium ≥ 6.0 mEq/L with electrocardiographic [ECG] changes) among patients with symptomatic or extreme bradycardia. Despite the urgent need to detect and treat severe hyperkalemia, serum potassium result may be available too late and is often spuriously high. Meanwhile, the traditional, descriptive ECG findings of severe hyperkalemia have shown unsatisfactory diagnostic powers. To overcome these diagnostic problems, they outlined the following quantitative rules to facilitate its early detection: Maximum precordial T wave ≥ 8.5 mV (2), atrial fibrillation/junctional bradycardia (1), heart rate (HR) ≤ 42/min (1) with (original rule)/without (ECG-only rule) diltiazem medication (2), and diabetes mellitus (1). Here we report on our external validation of these rules and the resulting updates. METHODS: This retrospective, cross-sectional study included all adults with symptomatic (HR ≤ 50/min with syncope/pre-syncope/dizziness, altered mentality, chest pain, dyspnea, general weakness, oliguria, or shock) or extreme (HR ≤ 40/min) bradycardia who visited a university emergency department from 2014 to 2019. After validating the abovementioned rules externally, we selected risk factors of severe hyperkalemia among the ECG findings and easy-to-assess clinical variables by multiple logistic regression analysis. After modelling the updated 'ECG-only' and 'ECG-plus' indices, we internally validated the better of the two by bootstrapping with 1000 iterations. RESULTS: Among 455 symptomatic/extreme bradycardia cases (70.3 ± 13.1 years; 213 females [46.8%]), 70 (15.4%) had severe hyperkalemia. The previous ECG-only rule showed a c-statistic of 0.765 (95% CI: 0.706-0.825), Hosmer-Lemeshow test of p < 0.001, and a calibration slope of 0.719 (95% CI: 0.401-1.04). On updating, the ECG-plus index summing junctional bradycardia/atrial fibrillation (1), maximum precordial T wave≥8.0 mV (2), general weakness as the chief complaint (2), oxygen demand (1), and dialysis (2) outperformed the ECG-only index (c-statistic, 0.832; 95% CI, 0.785-0.880 vs. 0.764; 95% CI, 0.700-0.828; p = 0.011). On bootstrapping, the c-statistic was 0.832 (95% CI: 0.786-0.878). For scores ≥ 3 (positive likelihood ratio ≥ 5.0), the sensitivity and specificity were 0.514 and 0.901, respectively. For scores ≤ 1, negative likelihood ratio was ≤0.2. CONCLUSIONS: Previous rules showed less satisfactory calibration but fair discrimination to detect severe hyperkalemia in patients with symptomatic or extreme bradycardia. We propose the ECG-plus index as the optimum tool to facilitate its early detection.

Wide angle holographic video projection display.

Holographic projection displays provide high diffraction efficiency. However, they have a limited projection angle. This work proposes a holographic projection display with a wide angle, which gives an image of size 306mm×161mm at 700 mm and reduced speckle noise. The solution uses single Fourier lens imaging with a frequency filter and hologram generation utilizing complex coding and nonparaxial diffraction. The experiment was performed with a 4K phase-only spatial light modulator (SLM) to prove the high efficiency of the developed numerical tools. Optical reconstruction shows high resolution and high image quality achieved from a single frame. Hence, displaying video at a full frame rate of the SLM is possible.

Efficacy of tumbling in soy sauce marination of pork loins: effects of tumbling time and temperature.

The objectives of this study were to determine the effects of tumbling time on the processing characteristics of soy sauce marinated pork loins, and to compare its efficacy at two different tumbling temperatures. In experiment I, pork loins (M. longissimus thoracis et lumborum) were pumped to 115% (w/w) of original sample weight with soy sauce solution (75%, w/w) and tumbled for 0, 1, 3, and 5 h. In experiment II, the soy sauce pumped pork loins were tumbled at two different temperatures (- 1 and 4 °C) for 4 h. The pH, color characteristics, water-holding capacity, protein solubility, and shear force of pork loins tumbled with soy sauce marinade were determined. An increase in tumbling time increased the cooked pH and yellowness of soy sauce marinated pork loins (p < 0.05). Protein solubility, particularly that of total and salt-soluble proteins, increased with increasing tumbling time (p < 0.05), and a tumbling time of at least 3 h may guarantee excellent water-holding capacity and shear force. In addition, low tumbling temperature of - 1 °C could positively contribute to the improvement of water-holding capacity and shear force of soy sauce marinated pork loins. In conclusion, this current study indicates that the efficacy of tumbling in soy sauce marination of pork loins is affected by tumbling time and temperature, moreover, tumbling at - 1 °C for at least 3 h could be an effective method in the experimental operating condition.

Effect of chicken skin on the quality characteristics of semi-dried restructured jerky.

The objective of this study was to evaluate the effect of skin on the textural properties of semi-dried jerky produced with different acid treatments. Jerky was prepared with no skin (control) or with 1, 3, or 5% chicken skin. After hand mixing (for 3 min) and tumbling (for 30 min) to distribute the curing ingredients, the cured meats were dried for 180 min at 55°C, for 180 min at 65°C, and finally for 60 min at 75°C. The presence of skin was shown to result in a higher fat content, TBA value, and metmyoglobin due to the high fat content of the skin. In contrast, acid treatment decreased the TBA value and metmyoglobin in jerky relative to samples that were not subjected to acid treatment. The presence of skin also improved the moisture contents, processing yields, and mechanical tenderness.

Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma.

OBJECTIVE: Although papillary thyroid microcarcinoma (PTMC) has a favourable long-term prognosis, disease recurrence after initial treatment remains a problem and controversy exists regarding the role of radioactive iodine (RAI) ablation in PTMC. We performed this study to evaluate the effect of RAI ablation on disease recurrence in patients with PTMC. PATIENTS AND METHODS: Between 1994 and 2004, 2579 patients underwent thyroid surgery for thyroid cancer at Samsung Medical Center. Among these patients, 704 patients with PTMC presumed disease-free after initial treatment were followed up for disease recurrence (median, 64 months; range, 1-185 months). Patients with PTMC with microscopic extrathyroidal extension, cervical lymph node metastases or multifocality were considered to be in the intermediate-risk group for recurrence. RESULTS: Disease recurrence was found in six patients at a median of 29 months (range, 10-70 months) after initial treatment; all six patients with recurrent tumours had received RAI treatment after total thyroidectomy. Disease-related mortality was not observed, even after recurrence. Based on a Cox regression model considering the standardized inverse probability of treatment weight (IPTW) within each propensity score stratum of patients with a similar likelihood of having received RAI ablation, the likelihood ratio for recurrence did not differ between the RAI ablation group and no RAI group (P = 0·17). When we performed a subgroup analysis considering only patients with PTMC at intermediate-risk for recurrence, RAI ablation again did not have a significant effect on recurrence (P = 0·79). CONCLUSIONS: Radioactive iodine ablation after total thyroidectomy in low- and intermediate-risk patients with PTMC did not prevent recurrent tumours. Future randomized, controlled, multicenter prospective trials involving a larger sample of patients followed-up for a longer duration are warranted to confirm our findings.

Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer.

OBJECTIVE: Epidemiological studies have demonstrated that excess weight increases the risk of thyroid cancer. However, the associations between excess weight and prognostic factors for thyroid cancer are uncertain. We evaluated the relationships between body mass index (BMI) and clinico-pathological features and outcomes of papillary thyroid cancer (PTC). PATIENTS AND METHODS: Retrospective analysis of 2057 patients with PTC was performed. Patients were grouped according to BMI (underweight, normal weight, overweight and obesity)-based World Health Organization standardized categories. Logistic regression models were used to assess the relationships between BMI and clinico-pathological features of PTC. A Cox proportional hazards model was used to examine the association between BMI and disease recurrence. RESULTS: A 5-kg/m(2) increase in BMI was associated with PTC tumours larger than 1 cm [odds ratio (OR) 1.31, P < 0.001], with microscopic extrathyroidal invasion (OR 1.23, P = 0.006), and with advanced tumour-node-metastasis (TNM) stage (OR, 1.30, P = 0.003), which is independent of confounding variables such as gender, age, serum TSH, total cholesterol and fasting glucose level. The multivariate-adjusted OR [95% confidence intervals (CI)] in the overweight (25.0-29.9 kg/m(2)) and obese (BMI ≥ 30) groups for tumours larger than 1 cm were 1.41 (1.10-1.81) and 2.17 (1.23-3.82), respectively, compared to the normal weight group (BMI 18.5-24.9). The multivariate-adjusted OR (95% CI) for microscopic extrathyroidal extension in the obesity group was 1.88 (1.06-3.32), and the OR for advanced TNM stage in the overweight group was 1.35 (1.02-1.79) compared to the normal weight group. During follow-up (median, 84 month; range, 1-185), 43 patients (2.1%) experienced recurrence. There were no significant differences in recurrence of PTCs among BMI groups. CONCLUSIONS: Higher BMI was strongly associated with larger tumour size, extrathyroidal invasion and advanced TNM stage of PTCs. However, there was no difference in recurrence rate among BMI groups. This study suggests that excess weight is associated with aggressive features of PTCs. Further studies with long-term follow-up are needed to confirm this finding.

Food memory test to evaluate memory function.

Purpose: To evaluate cognitive function with ease at bedside, we developed a novel neurologic exam called the "food memory test (FMT)" and evaluated its validity for use in clinical practice. Methods: In this prospective study in a neurology clinic, we asked patients about what they had eaten for the soup and main dish at the last meal [FMT1] and the second-to-last meal [FMT2]. If they answered correctly for both the soup and main dish, they received a "pass" score. If they did not answer or chose the wrong food, they received a "fail" score. We also performed conventional cognitive function tests for comparison. Results: A total of 27 patients was enrolled, and 12 (44.4%) passed the FMT1 test. FMT1 has a strong correlation with conventional memory function tests, including time-place orientation, three-word recall, the Seoul Verbal Learning Test, and the Rey Complex Figure Test . FMT1 was not correlated with a depression score or with frontal lobe function tests. FMT2 showed less significant correlation with conventional memory tests. Conclusion: These results suggest that FMT1 is a reliable bedside test to evaluate recent memory. Clinical application of FMT in daily clinical practice is warranted.

Characteristics of low-fat meat emulsion systems with pork fat replaced by vegetable oils and rice bran fiber.

The effects of vegetable oils prepared from olive, corn, soybean, canola, or grape seed, and rice bran fiber on the composition and rheological properties of meat batters were studied. Pork fat at 30% in the control was partially replaced by one of the vegetable oils at 10% in addition to reducing the pork fat to 10%. The chemical composition, cooking characteristics, texture properties, and viscosity of low-fat meat batters were analyzed. The moisture, protein, ash content, uncooked and cooked pH values, b(∗)-value, hardness, cohesiveness, gumminess, chewiness, and viscosity of meat batters with vegetable oil and rice bran fiber were all higher than the control. In addition, batters supplemented with vegetable oil and rice bran fiber had lower cooking loss and better emulsion stability. Low-fat meat batters with reduced pork fat content (10%) and 10% vegetable oil plus rice bran fiber had improved characteristics relative to the regular fat control.

Relationship between the antioxidant capacity of soy sauces and its impact on lipid oxidation of beef patties.

The aim of this study was to determine the relationship between in vitro antioxidant capacity of soy sauces and its impact on lipid oxidation in raw and cooked beef patties during 10 days of refrigerated storage. Three commercial soy sauces were used: industrially fermented soy sauce (IS), traditionally fermented Korean soy sauce (KS), and mixed soy sauce (MS). In vitro antioxidant capacity, KS showed the highest total phenol content, whereas IS and MS had a higher Fe2+ chelating activity than KS (P < .05). Heat treatment decreased total phenol content but increased Fe2+ chelating activity of soy sauces (P < .001). In both raw and cooked beef patties, the addition of IS or MS caused a lower 2-thiobarbituric acid reactive substances (TBARS) level than KS throughout the overall storage period (P < .05). This preliminary study suggests that the Fe2+ chelating activity of soy sauce may be one of the major mechanisms in preventing lipid oxidation in meat products.

The clinical significance of simple endoscopic scoring of patients with rectal cancer after concurrent chemoradiotherapy.

BACKGROUND: Neoadjuvant concurrent chemoradiotherapy (CCRT) is an effective treatment option for patients with rectal cancer. In this study, we investigated the clinical efficacy of simple endoscopic scoring of patients with rectal cancer after CCRT. METHODS: Between July 2008 and October 2015, medical records including endoscopic imaging from 41 patients with rectal cancer who received CCRT were retrospectively reviewed. Two expert gastroenterologists reviewed the endoscopic images and assigned scores from 0-3 according to post-CCRT findings. The scoring criteria were as follows: 0= scar without marginal elevation; 1= clean-based ulcer without marginal elevation; 2= clean-based ulcer with marginal elevation; 3= non-clean-based ulcer. We evaluated image scores to predict long-term outcomes using Kaplan-Meier curves and Cox regression models. RESULTS: The median follow-up duration was 55 months (interquartile range: 35-76 months). Patients with a low score (≤2) had a 17.2% recurrence rate, whereas patients with a high score [3] had a 50.0% recurrence rate. Patients with a low score had longer disease-free survival (DFS) than those with a high score in log-rank test (P=0.026). In multivariate Cox regression analysis, a high score was a significant predictor of poor DFS in patients with rectal cancer after CCRT treatment (hazard ratio =4.89, 95% confidence interval: 1.11-21.50, P=0.036). CONCLUSIONS: This simple endoscopic scoring approach is helpful for predicting prognosis of patients with rectal cancer after treatment with CCRT.

The Clinical Significance of Microsatellite Instability in Patients with Right-sided Colorectal Cancer.

BACKGROUND/AIMS: Colorectal cancer (CRC) with microsatellite instability (MSI) has a better prognosis than CRC with microsatellite stable (MSS). Recent studies have reported biological differences according to tumor location in CRC. In this study, we investigated the clinical significance of MSI in patients with right-sided CRC. METHODS: The medical records of 1,009 CRC patients diagnosed at our institute between October 2004 and December 2016 with MSI test results were retrospectively reviewed. The long-term outcomes of CRC patients with MSI were assessed with respect to tumor location using Kaplan-Meier curves and Cox regression models. RESULTS: The median follow-up duration for all 1,009 study subjects was 25 months (interquartile range, 15-38). One hundred twenty-four of the study subjects had MSI (12.3%) and 250 had right-sided CRC (24.8%). The patients with MSI and right-sided CRC had better disease-free survival (DFS) than those with MSS as determined by the log-rank test (p=0.013), and this result was significant in females (p=0.035) but not in males with right-sided CRC. Multivariate Cox regression analysis showed MSS significantly predicted poor DFS in patients with right-sided CRC (hazard ratio 3.97, 95% CI 1.30-12.15, p=0.016) and in female patients (hazard ratio 4.69, 95% CI 1.03-21.36, p=0.045). CONCLUSIONS: The study shows MSI is a useful predictor of DFS in patients with right-sided CRC, especially in female patients.

Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?

Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

Nitrite scavenging impact of fermented soy sauce in vitro and in a pork sausage model.

The objective of this study was to determine nitrite scavenging activity of fermented soy sauce in vitro and in a pork sausage model. In vitro nitrite scavenging activity (pH 6.0) of fermented soy sauce (10 mg/mL) was 13.2%. Within selected concentrations (10-100 mg/mL), in vitro nitrite scavenging activity and total phenol content of fermented soy sauce were highly dose-dependent (P < 0.001). In pork sausage model containing 120 mg/kg of NaNO2, fermented soy sauce resulted in significantly lower residual nitrite content (35.28 mg/kg) compared to only NaNO2 addition (40.12 mg/kg) at initial storage. During 4 weeks of cold storage, however, fermented soy sauce showed little effect on the residual nitrite content. This study indicates that fermented soy sauce could initially contribute to reduce residual nitrite content, and the nitrite scavenging impact of fermented soy sauce was less effective in the pork sausage model than in vitro evaluation.

Effects of pork/beef levels and various casings on quality properties of semi-dried jerky.

The aim of this study was to investigate the effects of pork/beef levels and the casings on the quality properties of semi-dried jerky. The pork/beef levels in the four test formulations were as follows: T-1 (pork: beef=100:0), T-2 (95:5), T-3 (90:10), and T-4 (80:20). After tumbling for 30min with curing solution, the cured meats were stuffed into natural sheep casings, collagen casings, or cellulose casings, and then dried. The restructured jerky with cellulose casing had the lowest water content and the highest protein content, with no significant differences between various formulations. There were no significant differences among all formulations with regard to pH and total microbial counts, and jerky with cellulose casing had the lowest value of water activity. The processing yields of jerky made from the T-3 formulation were not significantly different with the various casings. The shear force of jerky with cellulose casing was lower than with other casings, and the metmyoglobin contents were more than 85% in all formulations. With regard to sensory properties, jerky made with the T-3 formulation and cellulose casings rated most favorable in evaluations than other treatments.

Prediction of Thin-Walled Areas of Unruptured Cerebral Aneurysms through Comparison of Normalized Hemodynamic Parameters and Intraoperative Images.

OBJECT: Rupture of a cerebral aneurysm occurs mainly in a thin-walled area (TWA). Prediction of TWAs would help to assess the risk of rupture and select appropriate treatment strategy. There are several limitations of current prediction techniques for TWAs. To predict TWAs more accurately, HP should be normalized to minimize the influence of analysis conditions, and the effectiveness of normalized, combined hemodynamic parameters (CHPs) should be investigated with help of the quantitative color analysis of intraoperative images. METHODS: A total of 21 unruptured cerebral aneurysms in 19 patients were analyzed. A normalized CHP was newly suggested as a weighted average of normalized wall shear stress (WSS) and normalized oscillatory shear index (OSI). Delta E from International Commission on Illumination was used to more objectively quantify color differences in intraoperative images. RESULTS: CFD analysis results indicated that WSS and OSI were more predictive of TWAs than pressure (P<.001, P=.187, P=.970, respectively); these two parameters were selected to define the normalized CHP. The normalized CHP became more statistically significant (P<.001) as the weighting factor of normalized WSS increased and that of normalized OSI decreased. Locations with high CHP values corresponded well to those with high Delta E values (P<.001). Predicted TWAs based on the normalized CHP showed a relatively good agreement with intraoperative images (17 in 21 cases, 81.0%). CONCLUSION: 100% weighting on the normalized WSS produced the most statistically significant result. The normalization scheme for WSS and OSI suggested in this work was validated using quantitative color analyses, rather than subjective judgments, of intraoperative images, and it might be clinically useful for predicting TWAs of unruptured cerebral aneurysms. The normalization scheme would also be integrated into further fluid-structure interaction analysis for more reliable estimation of the risk of aneurysm rupture.

Reliability verification of vehicle speed estimate method in forensic videos.

In various types of traffic accidents, including car-to-car crash, vehicle-pedestrian collision, and hit-and-run accident, driver overspeed is one of the critical issues of traffic accident analysis. Hence, analysis of vehicle speed at the moment of accident is necessary. The present article proposes a vehicle speed estimate method (VSEM) applying a virtual plane and a virtual reference line to a forensic video. The reliability of the VSEM was verified by comparing the results obtained by applying the VSEM to videos from a test vehicle driving with a global positioning system (GPS)-based Vbox speed. The VSEM verified by these procedures was applied to real traffic accident examples to evaluate the usability of the VSEM.

Activating P2X7 Receptors Increases Proliferation of Human Pancreatic Cancer Cells via ERK1/2 and JNK.

OBJECTIVES: The aim of this study was to investigate the effects of the activated P2X7 receptors on the proliferation and growth of human pancreatic cancer cells. METHODS: Proliferation was measured by incorporating bromodeoxyuridine into pancreatic cancer cells, MIA PaCa-2 and HPAC. Expression of P2 receptors and signal molecules was examined using quantitative reverse transcription/polymerase chain reaction and/or Western blot. Proliferative effects of the P2X7 receptors in vivo were examined using a xenotransplant model of pancreatic cancer cell lines. RESULTS: Incubating pancreatic cancer cells with adenosine triphosphate (ATP) and 2'(3')-O-(4-Benzoylbenzoyl)ATP resulted in a dose-dependent increase of cell proliferation. The P2 receptor antagonist, KN-62, and small interfering RNA against P2X7 receptors, significantly decreased the proliferative effects of ATP. The ATP-induced proliferation was mediated by protein kinase C, extracellular signal-regulated protein kinases 1 and 2 (ERK1/2), and c-Jun N-terminal kinase (JNK); specifically, ATP increased the phosphorylation of ERK1/2 and JNK. The expression of inducible nitric oxide synthase was decreased by P2X7 receptor activation. In a xenotransplant model, applying ATP significantly increased the growth of induced tumors. CONCLUSIONS: The P2X7 receptor activation by extracellular nucleotides increased proliferation and growth of human pancreatic cancer cells via ERK1/2 and JNK. This supports the pathophysiological role of P2X7 receptors in pancreatic disease and recovery.

Effects of Replacing Pork with Tuna Levels on the Quality Characteristics of Frankfurters.

The aim of this study was to evaluate the effects of pork and tuna levels on the quality characteristics of frankfurters and to establish a suitable percentage of added tuna. The levels of pork meat (PM) and yellow-fin tuna (YFT) in the test frankfurters were as follows: 100% PM (control), 90% PM+10% YFT (T1), 80% PM+20% YFT (T2), 70% PM+30% YFT (T3), 60% PM+40% YFT (T4), and 50% PM+50% YFT (T5). The pH of the frankfurter batters significantly decreased with increasing tuna levels, because the pH of the tuna is lower than that of the pork. The water holding capacity did not differ significantly in frankfurters containing up to 30% tuna, whereas that of the 40% tuna-containing frankfurter was significantly lower than the control. Cooking loss did not differ significantly. At up to 10% tuna, apparent viscosity did not differ significantly, whereas at 20% tuna, it was significantly lower than the control. Fat separation and total expressible fluid separation at up to 30% tuna did not differ from the control; however, when more than 30% was added, higher losses were observed. The hardness of frankfurters containing more than 40% tuna was lower than that of the control, but there was no significant difference in springiness. The overall acceptability of frankfurters manufactured with up to 30% tuna did not differ significantly from the control. These results suggest that the addition of 30% tuna does not affect the quality of frankfurters made from pork.

Rewritable full-color computer-generated holograms based on color-selective diffractive optical components including phase-change materials.

We propose rewritable full-color computer-generated holograms (CGHs) based on color-selective diffraction using the diffractive optical component with the resonant characteristic. The structure includes an ultrathin layer of phase-change material Ge2Sb2Te5 (GST) on which a spatial binary pattern of amorphous and crystalline states can be recorded. The CGH patterns can be easily erased and rewritten by the pulsed ultraviolet laser writing technique owing to the thermally reconfigurable characteristic of GST. We experimentally demonstrate that the fabricated CGH, having a fine pixel pitch of 2 µm and a size of 32.8 × 32.8 mm2, reconstructs the three-dimensional holographic images. In addition, the feasibility of the rewritable property is verified by erasing and rewriting part of the CGH.

Correction: Rewritable full-color computer-generated holograms based on color-selective diffractive optical components including phase-change materials.

Correction for 'Rewritable full-color computer-generated holograms based on color-selective diffractive optical components including phase-change materials' by Chi-Young Hwang et al., Nanoscale, 2018, DOI: 10.1039/c8nr04471f.