Quadriplegia, Dysphagia and Ataxia Manifested in a Child With COVID-19 Related Acute Necrotizing Encephalopathy: A Case Report.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, presents primarily with respiratory symptoms. However, children with COVID-19 are usually asymptomatic or mild acute symptoms and also neurological manifestations have also been observed. We report the case of a 7-year-old girl who presented with high fever and altered mental status, leading to a diagnosis of COVID-19 and acute necrotizing encephalopathy (ANE). The patient received intensive medical care in the intensive care unit and subsequently underwent rehabilitation programs due to neurological functional sequelae. Neurological complications in COVID-19, including ANE, may result from potential viral nerve involvement, cytokine storms, and the blood-brain barrier disruption. Early rehabilitation plays a pivotal role in managing COVID-19-related neurological complications and enhancing patients' functional outcomes. Further research is essential to gain a better understanding of the mechanisms and treatment strategies for neurological manifestations in pediatric COVID-19 patients, particularly those with multisystem inflammatory syndrome in child.

Integrated Analysis of Transcriptome and Proteome of the Human Cornea and Aqueous Humor Reveal Novel Biomarkers for Corneal Endothelial Cell Dysfunction.

Earlier studies have reported that elevated protein levels in the aqueous humor (AH) are associated with corneal endothelial cell dysfunction (CECD), but the details of the underlying mechanism as well as specific biomarkers for CECD remain elusive. In the present study, we aimed to identify protein markers in AH directly associated with changes to corneal endothelial cells (CECs), as AH can be easily obtained for analysis. We carried out an in-depth proteomic analysis of patient-derived AH as well as transcriptomic analysis of CECs from the same patients with bullous keratopathy (BK) resulting from CECD. We first determined differentially expressed genes (DEGs) and differentially expressed proteins (DEPs) from CECs and AH in CECD, respectively. By combining transcriptomic and proteomic analyses, 13 shared upregulated markers and 22 shared downregulated markers were observed between DEGs and DEPs. Among these 35 candidates from biomarker profiling, three upregulated markers were finally verified via data-independent acquisition (DIA) proteomic analysis using additional individual AH samples, namely metallopeptidase inhibitor 1 (TIMP1), Fc fragment of IgG binding protein (FCGBP), and angiopoietin-related protein 7 (ANGPTL7). Furthermore, we confirmed these AH biomarkers for CECD using individual immunoassay validation. Conclusively, our findings may provide valuable insights into the disease process and identify biofluid markers for the assessment of CEC function during BK development.

Microlens array camera with variable apertures for single-shot high dynamic range (HDR) imaging.

We report a microlens array camera with variable apertures (MACVA) for high dynamic range (HDR) imaging by using microlens arrays with various sizes of apertures. The MACVA comprises variable apertures, microlens arrays, gap spacers, and a CMOS image sensor. The microlenses with variable apertures capture low dynamic range (LDR) images with different f-stops under single-shot exposure. The reconstructed HDR images clearly exhibit expanded dynamic ranges surpassing LDR images as well as high resolution without motion artifacts, comparable to the maximum MTF50 value observed among the LDR images. This compact camera provides, what we believe to be, a new perspective for various machine vision or mobile devices applications.

Pretreatment of rhesus monkeys with transdermal patches containing physostigmine and procyclidine: implications of the delivery system for the potential application against VX nerve agent intoxication in humans.

Physostigmine (Phs) is a reversible inhibitor of acetylcholinesterase (AChE) that penetrates the blood-brain barrier (BBB) and could be used to protect the central nervous system (CNS) against the effects of nerve agents. For prophylactic effectiveness, long, steady, and adequate inhibition of AChE activity by Phs is needed to broadly protect against the CNS effects of nerve agents. Here, we evaluated the efficacy of transdermal patches containing Phs and procyclidine (PC) as prophylactic agents. Patches (25 cm2) containing 4.4 mg Phs and 17.8 mg PC had a protective ratio of approximately 78.6-fold in rhesus monkeys challenged with VX nerve agent and given an antidote. Physiologically based pharmacokinetic model in conjunction with an indirect pharmacodynamic (PBPK/PD) was developed for Phs and scaled to rhesus monkeys. The model was able to reproduce the concentration profile and inhibitory effect on AChE of Phs in monkeys, as evidenced by correlation coefficients of 0.994 and 0.992 for 25 cm2 and 49 cm2 patches, respectively (i.e., kinetic data), and 0.989 and 0.968 for 25 cm2 and 49 cm2 patches, respectively (i.e., dynamic data). By extending the monkey PBPK/ PD model to humans, the effective human dose was predicted to be five applications of a 25 cm2 patch (i.e., 22 mg Phs), and two applications of a 49 cm2 patch (i.e., 17.4 mg Phs). Therefore, given that patch application of Phs in rhesus monkeys has a prolonged effect (namely, AChE inhibition of 19.6% for the 25 cm2 patch and 23.0% for the 49 cm2 patch) for up to 216 h, patch formulation of Phs may provide similar protection against nerve agent intoxication in humans.

Lithium-Metal Batteries: From Fundamental Research to Industrialization.

Lithium-metal batteries (LMBs) are representative of post-lithium-ion batteries with the great promise of increasing the energy density drastically by utilizing the low operating voltage and high specific capacity of metallic lithium. LMBs currently stand at a point of transition at which the accumulation of knowledge from fundamental research is being translated into large-scale commercialization. This review summarizes the available strategies for addressing the intrinsic shortcomings of LMBs, such as the suppression of dendritic growth and parasitic reactions from the material to the electrode to the cell level. The discussion pertaining to the cell level includes efforts and concerns relating to scaling up established knowledge and expertise with the view of commercialization. This review intends to encourage researchers in both fundamental research institutions and industry to make a synergistic effort and share their views comprehensively to ensure that LMB technology continues to evolve in harmony to become a mature technology.

Gravity and magnetic anomalies of earthquake-prone areas in the southwestern Ulleung basin margin, East Sea (Sea of Japan).

Submarine earthquakes have increased in the southwestern Ulleung Basin adjacent to the Korean Peninsula. This study analyzed the gravitational and magnetic properties of the three earthquake-prone areas (Hupo Bank and offshore regions near Pohang and Ulsan) in the basin. The basin was affected by tensile and compressive stresses during the formation of the East Sea. The southern Hupo Bank and the Pohang offshore exhibited high gravity anomalies and strong magnetic anomalies. Hupo Bank was separated from the peninsula and earthquakes in this region have been influenced by crustal fractures that facilitated igneous activities during the formation of the basin. Dense volcanic rocks and seaward dipping reflectors along the Pohang coast and continental slope suggest magmatic activities during the formation of the East Sea. Comparatively, the Ulsan offshore, with a thick sedimentary layer, exhibited a slightly higher gravity anomaly than the surrounding area, but no significant differences in the magnetic anomaly. Sequential tensile and compressive stresses related to the creation of the basin produced complex tectonic structures in this region. The magnetic tilt derivative results suggest that earthquakes were located near magnetic source boundaries. The results show that it is important to monitor earthquake-prone areas with gravity and magnetic anomalies.

Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery.

Presepsin (PSP) is a viable biomarker for the detection of bacterial infection, but it lacks accuracy when acute kidney injury (AKI) develops. Herein, we evaluated the diagnostic and prognostic value of PSP in predicting postoperative sepsis after abdominal surgery respective to the degree of AKI. A total of 311 patients who underwent abdominal surgery and were admitted to a surgical intensive care unit were enrolled and classified into non-AKI, mild-AKI (stage 1, stage 2 and stage 3 without renal replacement therapy (RRT)) and severe-AKI (stage 3 with RRT) group, according to the Kidney Disease Improving Global Outcomes criteria. In each group, PSP and other biomarkers were statistically analyzed between non-sepsis and postoperative sepsis at the admission (T0), 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. In non-AKI and mild-AKI group, PSP levels were significantly higher in postoperative sepsis than non-sepsis group, whereas no difference was detected in the severe-AKI group. Cutoff values of PSP in the mild-AKI group for the prediction of postoperative sepsis were 544 pg/mL (AUC: 0.757, p < 0.001) at T0 and 458.5 pg/mL (AUC: 0.743, p < 0.001) at T1, significantly higher than in non-AKI group. In multivariate analysis, predictors of postoperative sepsis in the mild-AKI group were PSP at T2 (odds ratio (OR): 1.002, p = 0.044) and PSP at T3 (OR: 1.001, p = 0.049). PSP can be useful for predicting newly developed sepsis in patients with transient AKI after abdominal surgery with modified cutoff values.

The role of laparoscopic management in perforated gastric cancer.

PURPOSE: Perforated gastric cancer is an extremely rare condition and usually presents in advanced stage with poor prognosis. Surgical strategies are still controversial regarding the extent to which complete resection or primary repair is performed and the application of laparoscopic techniques. We aim to determine the role of laparoscopic 2-stage approach in perforated gastric cancer. METHODS: Among 2,318 gastric cancers in Yeouido St. Mary's Hospital from January 1990 to December 2017, 20 patients with perforated gastric cancer were enrolled, and 5 patients underwent 2-stage gastrectomy consisting of primary closure on perforation followed by curative gastrectomy. Clinicopathological features, surgical outcomes, and survival analysis were evaluated. RESULTS: Two-stage approach for perforated gastric cancer was all performed by laparoscopic approach except 1 patient who needed paraaortic lymph node dissection (LND). Those were first treated on peritonitis with laparoscopic primary closure with or without Foley gastrostomy. Compared to 1-stage gastrectomy, more D2 LND was performed (60.0% vs. 100.0%, P = 0.260) and retrieved lymph nodes were significantly higher (median [range]: 17.0 [12.0-27.0] vs. 33.0 [26.5-43.5], P = 0.019]. Two patients of stage II and 3 patients of stage III were included in the 2-stage gastrectomy group. During the 38 months of median follow-up period, there were 8 and 1 recurrence among 1-stage and 2-stage gastrectomies, respectively. Except for 1 patient, 4 other 2-stage patients survived around 5 years without recurrence (5-year disease-free survival, 80%). CONCLUSION: Laparoscopic 2-stage surgery for perforated gastric cancer is safe and might increase the curability of gastrectomy with extended LND.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole.

PURPOSE: To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. METHODS: The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. RESULTS: Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. CONCLUSIONS: Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Effect of Ag doping on Pd/Ag-CeO2 catalysts for CO and C3H6 oxidation.

To achieve high fuel efficiency and low emission in automobiles, it is necessary to develop highly active diesel oxidation catalysts (DOCs). Pd/CeO2 catalysts have been widely used as active catalysts for CO and C3H6 oxidation reactions. Additionally, Ag has been reported to enhance the oxygen storage capacity (OSC) of CeO2, which contributes to the oxidation ability of Pd/CeO2. In this study, Pd/Ag-CeO2 catalysts were used for CO and C3H6 oxidation reactions. When CeO2 was doped with appropriate amounts of Ag, reducibility and CO desorption rate were increased, which confirmed the high OSCs of Ag-doped catalysts. However, Ag particles were formed and the Ce3+/Ce4+ ratio decreased when CeO2 was doped with excess amounts of Ag. In addition, reduced Pd (Pd0), which is an active species for C3H6 oxidation, was formed and maintained even under oxidative reaction conditions. Since the removal of C3H6 is important for the oxidation of CO and C3H6, the catalyst with the highest Pd0 fraction (Pd/0.1Ag-CeO2 and Pd/0.3Ag-CeO2) presented improved catalytic activity. Consequently, the optimal amount of Ag enhanced the OSC of Pd/Ag-CeO2 catalysts and formed active Pd0 species under oxidative conditions, which resulted in the excellent catalytic activity of Pd/Ag-CeO2 for the CO and C3H6 oxidation reaction.

Effects of La incorporation in catalytic activity of Ag/La-CeO2 catalysts for soot oxidation.

Owing to strengthened regulations toward vehicle emissions, the use of diesel particulate filter technology to reduce particulate matter emissions has attracted significant attention. To achieve low temperature oxidation of particulate matter, numerous studies on Ag/CeO2 catalysts for soot oxidation have been reported. Herein, Ag/La-CeO2 catalysts with different La contents are synthesized and compared to analyze the effect of La. Hydrogen temperature programmed reduction analysis confirms that the reducibility increases with an increase in the La content in La-CeO2. X-ray photoelectron spectroscopy and Raman analysis confirm an increase of oxygen vacancies with La doping. Accordingly, the soot oxidation performances estimated by temperature programmed oxidation experiments increase with La doping. However, the catalytic activity of Ag/La-CeO2 exhibits a volcano trend. When an appropriate amount of La is incorporated in Ag/CeO2, peroxide generation and reducibility improve, thereby enhancing the soot oxidation performance. Conversely, the catalytic activities gradually decrease with excess La-doping. Scanning transmission electron microscopy analysis and density functional theory calculations confirm that excess amounts of La induce the sintering of Ag particles, which lead to the degradation of peroxide generation and reducibility of the catalysts. Consequently, an optimal amount of La incorporation on Ag/La-CeO2 results in the best soot oxidation performance.

Which prognostic factors are important for long-term outcomes in symptomatic obstructive colon cancer? A multi-institutional retrospective cohort study.

Purpose: The prognostic factors in obstructive colon cancer have not been clearly identified. We aimed to identify the prognostic factor to establish optimal treatment strategy in obstructive colon cancer. Methods: Patients who underwent surgery for primary colon cancer in stages II and III with symptomatic obstruction from 2004 to 2010 in six hospitals were retrospectively collected. Clinicopathological and surgical outcomes were compared between stent insertion and emergent surgery group. Multiple regression analysis and survival curve analysis were used to identify the prognostic factors in symptomatic obstructive colon cancer. Results: Among 210 patients, 168 patients (80.0%) underwent stent insertion followed by surgery and 42 patients (20.0%) underwent emergent surgery. Laparoscopic approach (55.4% vs. 23.8%, p < 0.001) and adequate lymph node (LN) harvest (≥12) (93.5% vs. 69.0%, p < 0.001) were significantly higher in stent insertion group. In multiple regression analysis, emergent surgery (hazard ratio [HR], 2.153; 95% confidence interval [CI], 1.031-4.495), vascular invasion (HR, 6.257; 95% CI, 2.784-14.061), and omitting adjuvant chemotherapy (HR, 3.107; 95% CI, 1.394-6.925) were independent poor prognostic factors in 5-year overall survival, and N stage (N1 HR, 3.095; 95% CI, 1.316-7.284; N2 HR, 4.156; 95% CI, 1.671-10.333) was the only poor prognostic factor in 5-year disease-free survival. Conclusion: In symptomatic obstructive colon cancer, emergent surgery, N stage, vascular invasion, and omission of adjuvant chemotherapy were independent poor prognostic factors. Stent insertion is suggested as the initial treatment for symptomatic obstructive colon cancer, and adjuvant chemotherapy is recommended, especially when vascular invasion or LN metastasis is confirmed.

Roles of noble metals (M = Ag, Au, Pd, Pt and Rh) on CeO2 in enhancing activity toward soot oxidation: Active oxygen species and DFT calculations.

The effects of noble metal (M = Ag, Au, Pd, Pt, and Rh) on CeO2 in enhancing the activity toward soot oxidation were studied through experimental methods and density functional theory (DFT) calculations. Each noble metal (3 mol.%) was supported on CeO2 (M/CeO2) and the properties of the catalysts were verified by XRD, HRTEM, N2 physisorption, CO chemisorption, XPS, and H2-TPR results. The noble metal was highly dispersed over CeO2, except for Au due to the sintering of Au, and the reducibility of the catalysts was greatly improved according to degree of the interaction between each noble metal and CeO2. The activities of M/CeO2 catalysts for soot oxidation were better than that of CeO2, and followed the order Rh/CeO2 > Ag/CeO2 > Pt/CeO2 > Au/CeO2 > Pd/CeO2 > CeO2. Moreover, our DFT calculations showed that vacancy formation energy was gradually lowered in the following order: CeO2 > Pd4/CeO2 > Pt4/CeO2 > Au4/CeO2 = Ag4/CeO2 > Rh4/CeO2, which was similar order with experimental activity. In addition, the electronic states of the p and f orbitals of CeO2 were studied to compare with the occupied Ce 4f electrons, which affect the redox property. Rh/CeO2 and Ag/CeO2 showed the improved soot oxidation activity, with an enhanced ability to generate oxygen vacancy formation and oxygen adsorption and increased electron transfer. Consequently, the experimental and DFT calculation results revealed the roles of noble metals on ceria with respect to catalytic activity.

Bacillus subtilis spore vaccines displaying protective antigen induce functional antibodies and protective potency.

BACKGROUND: Bacillus anthracis is the causative agent of anthrax, a disease of both humans and various animal species, and can be used as a bioterror agent. Effective vaccines are available, but those could benefit from improvements, including increasing the immunity duration, reducing the shot frequency and adverse reactions. In addition, more sophisticated antigen delivery and potentiation systems are urgently required. The protective antigen (PA), one of three major virulence factors associated with anthrax was displayed on the surface of Bacillus subtilis spores, which is a vaccine production host and delivery vector with several advantages such as a low production cost, straightforward administration as it is safe for human consumption and the particulate adjuvanticity. Mice were immunized orally (PO), intranasally (IN), sublingually (SL) or intraperitoneally (IP) with the PA displaying probiotic spore vaccine. Clinical observation, serological analysis and challenge experiment were conducted to investigate the safety and efficacy of the vaccine. RESULTS: A/J mice immunized with the PA spore vaccine via PO, IN, SL, and IP were observed to have increased levels of active antibody titer, isotype profiles and toxin neutralizing antibody in sera, and IgA in saliva. The immunized mice were demonstrated to raise protective immunity against the challenge with lethal B. anthracis spores. CONCLUSIONS: In this study, we developed a B. subtilis spore vaccine that displays the PA on its surface and showed that the PA-displaying spore vaccine was able to confer active immunity to a murine model based on the results of antibody isotype titration, mucosal antibody identification, and a lethal challenge experiment.

Urealess NOx Reduction by Carbon Monoxide in Simulated Lean-Burn Exhausts.

The lean NOx aftertreatment is one of the major barriers to the widespread adoption of advanced combustion powertrains for the reduction of both greenhouse gases and toxic exhausts. Urea/SCR, selective catalytic reduction of NOx by NH3 generated through urea decomposition, is commonly regarded as the best way to reduce NOx in low temperature lean exhaust. However, the urea/SCR system has inherent drawbacks, i.e., periodic refill of the aqueous urea solution and a complicated hardware system. Here, we demonstrated a state-of-the-art catalyst that is extremely selective and efficient for reducing NOx, primarily with the most abundant reductant, CO, particularly in the presence of O2 (>5%) at low temperature. Under temperatures lower than 250 °C, IrRu/Al2O3 catalysts achieved higher NOx conversion by CO only than a commercial Cu-based urea/SCR catalyst employing NH3 as a primary reductant. Furthermore, the IrRu catalyst revealed high thermal stability and SO2 tolerance, which are very important factors for real world applications.

Correlation Analysis between Ocular Surface Parameters with Subjective Symptom Severity in Dry Eye Disease.

PURPOSE: To evaluate the clinical symptoms of patients with dry eyes, based on the ocular surface disease index (OSDI) and analyze the relationship between OSDI and various ocular surface parameters. METHODS: This was a retrospective study that included 45 eyes of 45 dry eye patients who visited the Seoul Nune Eye Hospital from August 2017 to December 2017. The patients were assessed by non-invasive keratography for the first break-up time, lipid layer thickness (LLT), tear osmolarity, tear matrix metalloproteinase-9 immunoassay as well as with the conventional Schirmer I test and fluorescein break-up time. The patient's symptoms were evaluated by the OSDI questionnaires and correlations were analyzed based on the parameters described above. RESULTS: There were significant negative correlations between OSDI and non-invasive keratography for the first break-up time (p = 0.038, r = -0.330), and LLT (p = 0.005, r = -0.426). However, there were no significant correlations between OSDI and fluorescein break-up time, Schirmer I score, and tear osmolarity (p = 0.173, 0.575, and 0.844 respectively). OSDI was not significantly different between matrix metalloproteinase-9 positive and negative groups (p = 0.768). CONCLUSIONS: Non-invasive examinations such as non-invasive keratograph break-up time and interferometry of LLT can be efficient tools for evaluating dry eye symptoms.

Usefulness of Optical Coherence Tomography Angiography in the Differential Diagnosis Between Superior Segmental Optic Hypoplasia and Normal-tension Glaucoma.

PURPOSE: The differential diagnosis of superior segmental optic hypoplasia (SSOH) and normal-tension glaucoma (NTG) is an issue in the ophthalmologic field. To date, several modalities have been developed to solve this issue; however, no standard methods have been established. Recently, optical coherence tomography angiography (OCTA) has been introduced to better evaluate the volumetric angiography images. Therefore, in this study, we investigated the usefulness of OCTA in differentiating between SSOH and NTG. MATERIALS AND METHODS: In this retrospective study, we included 26 patients with SSOH who had definite visual field defects and 40 patients with NTG who had only inferior visual field defects. Age, sex, intraocular pressure, refractive error, retinal nerve fiber layer thickness, and visual field defects were compared between the groups. In addition, we analyzed and compared the peripapillary vessel density (VD) measured on OCTA between the groups. The area under the receiver operating characteristic curves were obtained for each parameter. RESULTS: On Cirrus HD-OCT, the retinal nerve fiber layer in patients with SSOH was thinner in the superonasal segment and thicker in the superotemporal segment compared with patients with NTG. In the analysis of OCTA, the peripapillary VD of the superonasal segment was significantly lower in the SSOH group than in the NTG group, while it was significantly higher in the superotemporal segment in the SSOH group than in the NTG group. The optimal superonasal-to-superotemporal ratio cutoff was 0.8828, with a sensitivity of 95% and specificity of 92.3%, for the diagnosis of SSOH (area under the receiver operating characteristic curve=0.962). CONCLUSIONS: Our findings suggest that the superonasal-to-superotemporal VD ratio measured on OCTA may be used to distinguish between SSOH and NTG. However, further large-scale studies are required to verify our findings.