Euglycemic diabetic ketoacidosis following traumatic brain injury.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors lower glucose levels by reducing glucose reabsorption in the kidneys, which can lead to ketogenesis. Euglycemic diabetic ketoacidosis (DKA) is a rare but potentially life-threatening complication of SGLT2 inhibitors that can be triggered by trauma. However, the absence of significant hyperglycemia can delay its diagnosis and treatment, which may lead to detrimental consequences. Herein, we report a case of euglycemic DKA following traumatic brain injury in a patient with type 2 diabetes who was taking an SGLT2 inhibitor. Delayed recognition of euglycemic DKA in this case led to progressive metabolic deterioration. This report emphasizes the importance of promptly suspecting, diagnosing, and treating euglycemic DKA in patients with traumatic injuries who exhibit high anion-gap metabolic acidosis, ketonuria, and glucosuria-even if they do not have significant hyperglycemia.

Intense Hydrochromic Photon Upconversion from Lead-Free 0D Metal Halides For Water Detection and Information Encryption.

Hydrochromic materials that change their luminescence color upon exposure to moisture have attracted considerable attention owing to their applications in sensing and information encryption. However, the existing materials lack high hydrochromic response and color tunability. This study reports the development of a new and bright 0D Cs3 GdCl6 metal halide as the host for hydrochromic photon upconversion in the form of polycrystals (PCs) and nanocrystals. Lanthanides co-doped cesium gadolinium chloride metal halides exhibit upconversion luminescence (UCL) in the visible-infrared region upon 980 nm laser excitation. In particular, PCs co-doped with Yb3+ and Er3+ exhibit hydrochromic UCL color change from green to red. These hydrochromic properties are quantitatively confirmed through the sensitive detection of water in tetrahydrofuran solvent via UCL color changes. This water-sensing probe exhibits excellent repeatability and is particularly suitable for real-time and long-term water monitoring. Furthermore, the hydrochromic UCL property is exploited for stimuli-responsive information encryption via cyphertexts. These findings will pave the way for the development of new hydrochromic upconverting materials for emerging applications, such as noncontact sensors, anti-counterfeiting, and information encryption.

Utilizing VO2 as a Hole Injection Layer for Efficient Charge Injection in Quantum Dot Light-Emitting Diodes Enables High Device Performance.

Quantum dot light-emitting diodes (QLEDs) are promising devices for display applications. Polyethylenedioxythiophene:polystyrene sulfonate (PEDOT:PSS) is a common hole injection layer (HIL) material in optoelectronic devices because of its high conductivity and high work function. Nevertheless, PEDOT:PSS-based QLEDs have a high energy barrier for hole injection, which results in low device efficiency. Therefore, a new strategy is needed to improve the device efficiency. Herein, we have demonstrated a bilayer-HIL using VO2 and a PEDOT:PSS-based QLED that exhibits an 18% external quantum efficiency (EQE), 78 cd/A current efficiency (CE), and 25,771 cd/m2 maximum luminance. In contrast, the PEDOT:PSS-based QLED exhibits an EQE of 13%, CE of 54 cd/A, and maximum luminance of 14,817 cd/m2. An increase in EQE was attributed to a reduction in the energy barrier between indium tin oxide (ITO) and PEDOT:PSS, caused by the insertion of a VO2 HIL. Therefore, our results could demonstrate that using a bilayer-HIL is effective in increasing the EQE in QLEDs.

Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis.

(1) Background: Most factors that predict the in-hospital survival rate in patients with severe trauma are patient-related factors; environmental factors are not currently considered important. Predicting the severity of trauma using environmental factors could be a reliable and easy-to-use method. Therefore, the purpose of this study was to determine whether environmental factors affect the survival in patients with severe trauma. (2) Methods: Medical records of patients who activated trauma team in the single regional trauma center, from 2016 to 2020, were retrospectively analyzed. After exclusion of young patients (<19 years old), cases of mild trauma (ISS < 16), and non-preventable deaths (trauma and injury severity score <25%), a total of 1706 patients were included in the study. (3) Results: In the Cox proportional hazard regression analysis, older age, night compared with day, and high rainfall were identified as statistically significant environmental predictors of mortality due to severe trauma. The relationship between mortality and precipitation showed a linear relationship, while that between mortality and temperature showed an inverted U-shaped relationship. (4) Conclusions: Various environmental factors of trauma affect mortality in patients with severe trauma. In predicting the survival of patients with severe trauma, environmental factors are considered relatively less important, though they can be used effectively.

Recurrence Risk Evaluation in Patients with Papillary Thyroid Carcinoma: Multicenter Machine Learning Evaluation of Lymph Node Variables.

Background: Lymph node (LN)-related risk factors have been updated to predict long-term outcomes in patients with papillary thyroid carcinoma (PTC). However, those factors' analytic appropriateness and general applicability must be validated. This study aimed to assess LN-related risk factors, and suggest new LN-related risk categories. Methods: This multicenter observational cohort study included 1232 patients with PTC with N1 disease treated with a total thyroidectomy and neck dissection followed by radioactive iodine remnant ablation. Results: The median follow-up duration was 117 months. In the follow-up period, structural recurrence occurred in 225 patients (18.3%). Among LN-related variables, the presence of extranodal extension (p < 0.001), the maximal diameter of metastatic LN foci (p = 0.029), the number of retrieved LNs (p = 0.003), the number of metastatic LNs (p = 0.003), and the metastatic LN ratio (p < 0.001) were independent risk factors for structural recurrence. Since these factors showed a nonlinear association with the hazard ratio of recurrence-free survival (RFS) rates, we calculated their optimal cutoff values using the K-means clustering algorithm, selecting 0.2 cm and 1.1 cm for the maximal diameter of metastatic LN foci, 4 and 13 for the number of metastatic LN, and 0.28 and 0.58 for the metastatic LN ratio. The RFS curves of each subgroup classified by these newly determined cutoff values showed significant differences (p < 0.001). Each LN risk group also showed significantly different RFS rates from the others (p < 0.001). Conclusions: In PTC patients with an N1 classification, our novel LN-related risk estimates may help predict long-term outcomes and design postoperative management and follow-up strategies. After further validation studies based on independent datasets, these risk categories might be considered when redefining risk stratification or staging systems.

Restratification of Patients with Intermediate-Risk Papillary Thyroid Carcinoma.

BACKGROUND: Long-term management and follow-up strategies in patients with intermediate-risk papillary thyroid carcinoma (PTC) according to the American Thyroid Association (ATA) are still controversial due to the paucity of data on unique risk factors or a risk stratification system predictive of long-term outcomes. PATIENTS AND METHODS: This study included 649 patients with PTC who underwent an initial surgical treatment. Retrospectively enrolled patients were categorized according to the ATA risk stratification system. Intermediate-risk patients were further categorized into subgroups by the number of ATA intermediate risk factors. The recurrence-free survival (RFS) rates of these subgroups were compared with those of low- and high-risk patient groups. Additionally, the patients were classified according to their response to the initial therapy using the dynamic risk stratification (DRS) system, and the percentages of patients in each category were compared among the subgroups. RESULTS: The median follow-up period was 102 months. Structural recurrence occurred in 9.2% of all enrolled patients (60/649) and in 13.0% of intermediate-risk patients (40/308). Patients with two or more current intermediate risk factors had a poorer RFS than patients with only one risk factor (p < 0.001) and showed a comparable RFS to high-risk patients (p > 0.050). The percentages of patients with an excellent response category for DRS significantly decreased with an increase in the number of intermediate risk factors. CONCLUSION: Subclassification according to the number of intermediate risk factors may be useful to better predict the RFS and the response to initial therapy in patients with intermediate-risk PTC.

Correlation between the Injury Site and Trauma Mechanism in Severely Injured Patients with Blunt Trauma.

Background: In patients with severe injury, predicting the injury site without using advanced diagnostic modalities can help formulate a diagnosis and treatment plan based on the suspected injury site. Objectives: This study aimed to determine the correlation between the injury site and trauma mechanism in severely injured patients with blunt trauma. Methods: We retrospectively analyzed the clinical characteristics-including age, sex, date of emergency room (ER) visit, time of injury, trauma mechanism (car accident, motorcycle accident, bicycle accident, pedestrian accident, fall, slipping and rolling down, crush injury, assault, and others), final diagnosis, injury severity score, abbreviated injury scale (AIS) score, and injury site-of 1,245 patients in a tertiary trauma center. Results: There was a strong correlation between certain injury sites and specific trauma mechanisms. In particular, most trauma mechanisms were associated with injury to the head and neck, as well as the chest, with a combined frequency of >40.0%. Moreover, when using one-way analysis of variance and Bonferroni's post hoc tests, there were significant differences in AIS scores 1, 3, 4, and 5 for each trauma mechanism. Conclusion: Generally, when patients with severe injury present to the ER, the injury site can be predicted upon initial assessment based on the trauma mechanism. Based on our study, the injury site predicted by a specific mechanism should be checked repeatedly and additionally through physical examination and imaging tools. This can reduce misdiagnosis and help with accurate diagnosis and treatment.

Optimal cutoff values of primary tumour size to better predict long-term outcomes in patients with papillary thyroid carcinoma undergoing total thyroidectomy: A preliminary study using restricted cubic spline analysis.

OBJECTIVE: Primary tumour size (PTS) is known to be a significant prognostic factor in patients with papillary thyroid carcinoma (PTC) undergoing thyroidectomy. Although cutoff values of 2 and 4 cm are widely used in surgical extent decision and long-term outcomes predictions, the effectiveness of arbitrary cutoff values in stratifying patients for target outcomes is questionable. This study aimed to determine new optimal cutoffs of PTS. DESIGN, PATIENT AND MEASUREMENTS: Patients (n = 529) with PTC who underwent total thyroidectomy were retrospectively reviewed. After risk factor analysis for structural recurrence, the optimal cutoffs of PTS were automatically calculated using restricted cubic spline analysis and X-tile software. Subgroups were classified based on the newly determined cutoff values. Both the recurrence-free survival (RFS) and the proportion of patients in each response-to-therapy category, using the dynamic risk stratification system (DRS), were compared between the subgroups. RESULTS: PTS was confirmed as an independent risk factor for structural recurrence. The optimal cutoff values were calculated as 1.4 and 3.0 cm. The subgroups stratified using these newly determined cutoffs showed significantly different RFS and DRS based on the response to initial therapy, but the subgroups classified using the cutoffs of 2 and 4 cm did not. CONCLUSIONS: The newly determined cutoff values of PTS may be useful in better stratifying patients with PTC undergoing thyroidectomy for target outcomes and can be considered as a new definition in staging and risk stratification systems.

Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years.

PURPOSE: Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. METHODS: The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. RESULTS: Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. CONCLUSION: When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota's fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.

Determination of the radiologic findings for predicting failure of conservative management with observation for blunt renal injury patients: A single-centre experience over 13 years.

PURPOSE: Most blunt renal injuries (BRIs) are managed conservatively without complications. Because conservative management with observation (CMO) is widely conducted, failed CMO is frequent. Clarifying the role and indication of CMO is important to manage BRI patients. Therefore, this study was conducted to analyse factors related to failed CMO. METHODS: BRI patients (aged >13 years) who were admitted via the emergency department in Wonju Severance Christian Hospital were analysed retrospectively between January 2008 and July 2020. Patient characteristics, including clinical data, laboratory findings, transfusion requirements, injury grade, initial CT findings, length of hospital stay, intensive care unit stay, and mortality, were investigated for all enrolled patients. RESULTS: Kidney injury grade ≥ 4, perinephric haematoma rim distance (PHD), length of main laceration, intravascular contrast extravasation (ICE), Gerota's fascia discontinuity, multiple lacerations, dissociated renal fragment and complexity of laceration were statistically significantly different between the successful CMO and failed CMO groups in the comparative analysis. The multivariate analysis showed that perinephric haematoma rim distance [odds ratio (OR) 1.44 [95% confidence interval (CI) 1.09 - 1.90], p = 0.011] and ICE [OR 7.41 (95% CI 2.20 - 24.99), p = 0.001] were mutually independent risk factors associated with failed CMO. When the ROC curve of PHD and ICE was generated to predict the failure of CMO, the area under the curve (AUC) was 0.884 (95% CI, 0.826 - 0.942), p < 0.001), and the optimal cut-off value for PHD was 2.9 cm, and for ICE was presence of ICE on CT [sensitivity: 90.5% (95% CI, 0.70 - 0.99), specificity: 78.0% (95% CI, 0.73 - 0.83)]. CONCLUSION: PHD and ICE may be useful factors to predict failed CMO for BRI patients. PHD > 2.9 cm and the presence of ICE may indicate who will require invasive procedures. Close observation is wise for patients with these risk factors.

Inter- and Intra-Molecular Organocatalysis of SN2 Fluorination by Crown Ether: Kinetics and Quantum Chemical Analysis.

We present the intra- and inter-molecular organocatalysis of SN2 fluorination using CsF by crown ether to estimate the efficacy of the promoter and to elucidate the reaction mechanism. The yields of intramolecular SN2 fluorination of the veratrole substrates are measured to be very small (<1% in 12 h) in the absence of crown ether promoters, whereas the SN2 fluorination of the substrate possessing a crown ether unit proceeds to near completion (~99%) in 12 h. We also studied the efficacy of intermolecular rate acceleration by an independent promoter 18-crown-6 for comparison. We find that the fluorinating yield of a veratrole substrate (leaving group = -OMs) in the presence of 18-crown-6 follows the almost identical kinetic course as that of intramolecular SN2 fluorination, indicating the mechanistic similarity of intra- and inter-molecular organocatalysis of the crown ether for SN2 fluorination. The calculated relative Gibbs free energies of activation for these reactions, in which the crown ether units act as Lewis base promoters for SN2 fluorination, are in excellent agreement with the experimentally measured yields of fluorination. The role of the metal salt CsF is briefly discussed in terms of whether it reacts as a contact ion pair or as a "free" nucleophile F-.

Soft, thin skin-mounted power management systems and their use in wireless thermography.

Power supply represents a critical challenge in the development of body-integrated electronic technologies. Although recent research establishes an impressive variety of options in energy storage (batteries and supercapacitors) and generation (triboelectric, piezoelectric, thermoelectric, and photovoltaic devices), the modest electrical performance and/or the absence of soft, biocompatible mechanical properties limit their practical use. The results presented here form the basis of soft, skin-compatible means for efficient photovoltaic generation and high-capacity storage of electrical power using dual-junction, compound semiconductor solar cells and chip-scale, rechargeable lithium-ion batteries, respectively. Miniaturized components, deformable interconnects, optimized array layouts, and dual-composition elastomer substrates, superstrates, and encapsulation layers represent key features. Systematic studies of the materials and mechanics identify optimized designs, including unusual configurations that exploit a folded, multilayer construct to improve the functional density without adversely affecting the soft, stretchable characteristics. System-level examples exploit such technologies in fully wireless sensors for precision skin thermography, with capabilities in continuous data logging and local processing, validated through demonstrations on volunteer subjects in various realistic scenarios.

Fabrication of complex 3-dimensional patterned structures on a ∼10 nm scale from a single master pattern by secondary sputtering lithography.

We describe a highly efficient method for fabricating a variety of complex 3D nano-patterns from a single master pattern using secondary sputtering lithography, which is a 10 nm scale patterning method that we have developed. A rapid etching rate in the bottom part of the PS pillar during the RIE process can produce various nanostructure shapes and the PS residual layer thickness can influence various feature dimensions, due to the controlled RIE time leading to different PS layer thicknesses. This technique provides a highly effective method for producing various complex 3D patterns from a single master pattern. Thus, this method can serve as a new procedure for the cost-effective mass production of complex nanoscale patterns with high resolution.

Microsolvation of lysine by water: computational study of stabilized zwitterion.

We present calculations for Lys-(H(2)O)(n) (n = 2, 3) to examine the effects of microsolvating water on the relative stability of the zwitterionic vs canonical forms of Lys. We calculate the structures, energies, and Gibbs free energies of the conformers at the B3LYP/6-311++G(d,p), wB97XD/6-311++G(d,p), and MP2/aug-cc-pvdz levels of theory, finding that three water molecules are required to stabilize the Lys zwitterion. By calculating the barriers of the canonical ↔ zwitterionic pathways of Lys-(H(2)O)(3) conformers, we suggest that both forms of Lys-(H(2)O)(3) may be observed in low temperature gas phase.

Effects of bioconjugation on the structures and electronic spectra of CdSe: density functional theory study of CdSe-adenine complexes.

We present density functional theory (DFT) and time-dependent DFT (TD-DFT) study of the structures and electronic spectra of small CdSe nanocluster-adenine complexes Cd(n)Se(n)-adenine (n = 3, 6, 10, 13). We examine the changes in the geometries and excitation spectra of the nanoclusters induced by DNA base-binding. By comparing the results calculated for the bare (Cd(n)Se(n)), hydrogen-passivated (Cd(n)Se(n)H(2n)), as well as the corresponding adenine (Ade)-bound clusters (Cd(n)Se(n)-Ade, Cd(n)Se(n)H(2n)-Ade, Cd(n)Se(n)H(2n-2)-Ade), we find that binding with Ade slightly blue-shifts (up to 0.18 eV) the electronic excitations of bare nanoclusters but strongly red-shifts (<1.2 eV) those of hydrogen-passivated nanoclusters. Natural bond orbital analysis shows that the LUMO of Cd(n)Se(n)H(2n)-Ade is a pi* orbital located on the purine ring.

A mechanistic study of S(N)2 reaction in a diol solvent.

We present calculations for the mechanism of S(N)2 reactions in ethylene glycol, focusing on the role of two protic functional groups (-OH) in the solvent molecule. We find that some hydroxyl groups act as Lewis base to interact with the cation, whereas others affect the reaction as Lewis acid to the nucleophile. We predict that the nucleophile (F-) reacts as an ion pair rather than as a solvent-separated ion when metal cation (Cs+) is used as a counterion. The overall influence of ethylene glycol manifests itself as the reaction barrier (E(double dagger) = 20.0, G(353K)(double dagger) = 21.5 kcal/mol) that is a bit smaller than that in tert-butyl alcohol, which proved to be a very efficient solvent for S(N)2 reactions [Kim, D. W., et al. J. Am. Chem. Soc. 2006, 128, 16394]. We therefore show that a small protic solvent such as ethylene glycol may be as efficient as a bulky alcohol for S(N)2 reactions.

Arginine zwitterion is more stable than the canonical form when solvated by a water molecule.

We present calculations for the Arg-H2O system and predict that the zwitterionic Arg is thermodynamically more stable than the canonical form in the gas phase under the influence of a single water molecule because of the strongly basic guanidine side chain. Canonical conformers of Arg-H2O are found to isomerize to the zwitterionic forms via a small barrier (approximately 6 kcal/mol).