Impact of the early phase of the COVID-19 pandemic on emergency department-to-intensive care unit admissions in Korea: an interrupted time-series analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic resulted in significant disruptions to critical care systems globally. However, research on the impact of the COVID-19 pandemic on intensive care unit (ICU) admissions via the emergency department (ED) is limited. Therefore, this study evaluated the changes in the number of ED-to-ICU admissions and clinical outcomes in the periods before and during the pandemic. METHODS: We identified all adult patients admitted to the ICU through level 1 or 2 EDs in Korea between February 2018 and January 2021. February 2020 was considered the onset point of the COVID-19 pandemic. The monthly changes in the number of ED-to-ICU admissions and the in-hospital mortality rates before and during the COVID-19 pandemic were evaluated using interrupted time-series analysis. RESULTS: Among the 555,793 adult ED-to-ICU admissions, the number of ED-to-ICU admissions during the pandemic decreased compared to that before the pandemic (step change, 0.916; 95% confidence interval [CI] 0.869-0.966], although the trend did not attain statistical significance (slope change, 0.997; 95% CI 0.991-1.003). The proportion of patients who arrived by emergency medical services, those transferred from other hospitals, and those with injuries declined significantly among the number of ED-to-ICU admissions during the pandemic. The proportion of in-hospital deaths significantly increased during the pandemic (step change, 1.054; 95% CI 1.003-1.108); however, the trend did not attain statistical significance (slope change, 1.001; 95% CI 0.996-1.007). Mortality rates in patients with an ED length of stay of ≥ 6 h until admission to the ICU rose abruptly following the onset of the pandemic (step change, 1.169; 95% CI 1.021-1.339). CONCLUSIONS: The COVID-19 pandemic significantly affected ED-to-ICU admission and in-hospital mortality rates in Korea. This study's findings have important implications for healthcare providers and policymakers planning the management of future outbreaks of infectious diseases. Strategies are needed to address the challenges posed by pandemics and improve the outcomes in critically ill patients.

Magnetically Actuated Trigger Transient Soft Actuators Comprising On-Demand Photo-Initiated and Thermo-Degradable Polypropylene Carbonate-Photo-Acid Generator.

Lifetime-reconfigurable soft robots have emerged as a new class of robots, emphasizing the unmet needs of futuristic sustainability and security. Trigger-transient materials that can both actuate and degrade on-demand are crucial for achieving life-reconfigurable soft robots. Here, we propose the use of transient and magnetically actuating materials that can decompose under ultraviolet light and heat, achieved by adding photo-acid generator (PAG) and magnetic particles (Sr-ferrite) to poly(propylene carbonate) (PPC). Chemical and thermal analyses reveal that the mechanism of PPC-PAG decomposition occurs through PPC backbone cleavage by the photo-induced acid. The self-assembled monolayer (SAM) encapsulation of Sr-ferrite preventing the interaction with the PAG allowed the transience of magnetic soft actuators. We demonstrate remotely controllable and degradable magnetic soft kirigami actuators using blocks with various magnetized directions. This study proposes novel approaches for fabricating lifetime-configurable magnetic soft actuators applicable to diverse environments and applications, such as enclosed/sealed spaces and security/military devices.

Posttraumatic Basal Ganglia Infarction by Lenticulostriate Artery Injury in Adult Patients: A Review.

Post-traumatic striatocapsular infarction (SCI) due to lenticulostriate artery (LSA) damage is rare. Most cases reported are in children. We discuss the pathogenesis and differential diagnosis of this kind of SCI after trauma in adult patients. The most common etiology of non-traumatic SCI are an embolism from the proximal artery, cardiogenic embolism, and atherosclerotic plaque in the proximal middle cerebral artery (MCA). However, injury of the LSA after trauma may lead to hemorrhagic infarction in the basal ganglia (BG). Post-traumatic SCI due to LSA damage might be associated with hemorrhage in the BG. The main locations of these lesions are the distal perfusion area of the LSA, similar to SCI due to intracranial atherosclerotic disease affecting the MCA. Vessel wall imaging, magnetic resonance angiography, and ultrahigh-resolution computed tomography can be used for differentiating the injury mechanism in SCI following a traumatic event.

Intracerebral Hemorrhage Caused by the Rupture of a Traumatic Pseudoaneurysm in the Middle Meningeal Artery.

Hematomas caused by the rupture of a pseudoaneurysm in the middle meningeal artery (MMA) after trauma usually present as epidural hematomas. Intracerebral hemorrhage (ICH) is extremely rare. We reviewed ICH due to the rupture of MMA pseudoaneurysms. We found that in cases of acute ICH, a pseudoaneurysm was attached to the outer surface of the dura mater and associated with dura tear. In patients with acute ICH, the intraoperative rupture of a pseudoaneurysm developed just after bone flap removal. In cases of delayed ICH, pseudoaneurysms adhered to the inner surface of the dura mater. In patients with delayed ICH, the intraoperative rupture of a pseudoaneurysm developed during dura opening and hematoma removal. In situations of dura tear after trauma, the rupture of pseudoaneurysms might lead to ICH via a dura tear. Pseudoaneurysms that develop in the MMA after trauma may exert pressure and result in the thinning of the dura mater. In this case, pseudoaneurysms will adhere to the inner surface of the dura mater after several days or weeks. ICH might develop through both acute and delayed mechanisms following the development of pseudoaneurysms in the MMA. Clinicians should pay attention to the timing of such ruptures during operations for both acute and delayed ICH.

Lifetime-configurable soft robots via photodegradable silicone elastomer composites.

Developing soft robots that can control their own life cycle and degrade on-demand while maintaining hyperelasticity is a notable research challenge. On-demand degradable soft robots, which conserve their original functionality during operation and rapidly degrade under specific external stimulation, present the opportunity to self-direct the disappearance of temporary robots. This study proposes soft robots and materials that exhibit excellent mechanical stretchability and can degrade under ultraviolet light by mixing a fluoride-generating diphenyliodonium hexafluorophosphate with a silicone resin. Spectroscopic analysis revealed the mechanism of Si─O─Si backbone cleavage using fluoride ion (F-) and thermal analysis indicated accelerated decomposition at elevated temperatures. In addition, we demonstrated a robotics application by fabricating electronics integrated gaiting robot and a fully closed-loop trigger disintegration robot for autonomous, application-oriented functionalities. This study provides a simple yet novel strategy for designing life cycle mimicking soft robotics that can be applied to reduce soft robotics waste, explore hazardous areas, and ensure hardware security with on-demand destructive material platforms.

Evaluation of a Hydrophobic Coating Agent Based on Cellulose Nanofiber and Alkyl Ketone Dimer.

In this study, we report on the development and testing of hydrophobic coatings using cellulose fibers. The developed hydrophobic coating agent secured hydrophobic performance over 120°. In addition, a pencil hardness test, rapid chloride ion penetration test, and carbonation test were conducted, and it was confirmed that concrete durability could be improved. We believe that this study will promote the research and development of hydrophobic coatings in the future.

Comparison of the Prediction of Effective Moment of Inertia of FRP Rebar-Reinforced Concrete by an Optimization Algorithm.

FRP (fiber-reinforced polymer)-reinforced concrete members have larger deflection than reinforced concrete members because of the low modulus of elasticity of the FRP bar. In this paper, we proposed a new effective moment of inertia equation to predict the deflection of FRP-reinforced concrete members based on the harmony search algorithm. The harmony search algorithm is used to optimize a function that minimizes the error between the deflection value of the experimental result and the deflection value expected from the specimen's specifications. In the experimental part, four GFRP (Glass Fiber-Reinforced Polymer)- and BFRP (Basalt Fiber-Reinforced Polymer)-reinforced concrete slab specimens were manufactured and tested. FRP-reinforced concrete slabs were reinforced with GFRP and BFRP rebars on spiral rib surfaces. The effects of the FRP reinforcement ratio and balanced reinforcement ratio (ρf/ρfb), the moment of inertia of the transformed cracked section and the gross moment of inertia (Icr/Ig), and the cracking moment and the maximum service load moment (Mcr/Ma) on the effective moment of inertia have been considered. The experimental results and predicted results of the flexural testing of concrete slabs reinforced with FRP rebars were compared, and the experimental results were in good agreement with the calculated values using the proposed effective moment of inertia equation.

Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea.

BACKGROUND: Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). METHODS: We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. RESULTS: Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9-6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16-1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. CONCLUSIONS: In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.

Design exploration and comparative analysis of tail shape of tri-wheel-based stair-climbing robotic platform.

Stair climbing is one of the most important capabilities of mobile robots. Therefore, stair-climbing mobile robots have become a field of study and diverse stair-climbing mobile robots have been developed. Although tri-wheel-based stair-climbing robotic platforms were developed to overcome the challenges posed by stair climbing, they have shown limitations such as impact during locomotion and damage owing to friction with the nosing of the stairs. In this study, several tail mechanisms were proposed and designed to solve the limitations of tri-wheel-based stair-climbing robots. A comparative analysis of the tail mechanisms was performed through dynamic simulations based on various performance indices. It was observed that the tail mechanism improved the stability and stair-climbing performance of the tri-wheel-based stair-climbing robots. The experimental verification confirmed the reliability of the comparative analysis results based on the simulation. These findings can be used to design mobile stair-climbing robots.

Trauma-induced capillary leak syndrome after penetrating chest injury: Manifestation of massive ascites and pulmonary secretions aggravated by transfusion.

Trauma with prolonged shock can cause systemic capillary leak syndrome regardless of the site of injury and a transfusion can aggravate it. The systemic capillary leak induces both an abdominal compartment syndrome and pulmonary edema, and a transfusion can aggra-vate these sequelae within hours. In our case, 21-year-old man with a penetrating injury in his left thorax experienced delay in rescue and definitive surgery. To manage life-threatening shock, massive blood transfusion and crystalloids had been infused. Cardiopulmonary cerebral resuscitations were performed 2 times during the surgery. Massive amount of pulmonary secretions emitted from his airways with severe hypoxia along with development of massive ascites causing abdominal compartment syndrome, while the surgery was underway. After temporary abdominal closure, he was moved to the intensive care unit and underwent venovenous extracorporeal membranous oxygenation. He recovered without any notable complications. It is important to prevent and correct the shock rapidly by appropriate rescue, controlling the source and infusing less amount of crystalloid and transfusion.

Controlling of lattice strains for crack-free and strong ferroelectric barium titanate films by post-thermal treatment.

In this study, we experimentally demonstrate fabrication of ultra-smooth and crystalline barium titanate (BTO) films on magnesium oxide (MgO) substrates by engineering lattice strain and crystal structure via thermal treatment. We observe that oxygen-depleted deposition allows growth of highly strained BTO films on MgO substrates with crack-free surface. In addition, post-thermal treatment relaxes strain, resulting in an enhancement of ferroelectricity. Surface roughening of the BTO films caused by recrystallization during post-thermal treatment is controlled by chemical-mechanical polishing (CMP) to retain their initial ultra-smooth surfaces. From Raman spectroscopy, reciprocal space map (RSM), and capacitance-voltage (C-V) curve measurements, we confirm that the ferroelectricity of BTO films strongly depend on the relaxation of lattice strain and the phase transition from a-axis to c-axis oriented crystal structure.

Modified (-)-gallocatechin gallate-enriched green tea extract rescues age-related cognitive deficits by restoring hippocampal synaptic plasticity.

Aging leads to cognitive impairments characterized by reduced hippocampal functions that are associated with impairment of long-term potentiation of CA1 synapses. Here, we assessed the safety and efficacy of modified (-)-gallocatechin gallate (GCG)-enriched green tea extract (HTP-GTE) in ameliorating the cognitive dysfunctions in late middle-aged murine model. We developed a novel HTP-GTE that was enriched with GCG via epimerization that involved heating. We compared the effects of oral administrations of conventional green tea and HTP-GTE in young and aged male C57/BL6 mice, and examined the changes in the hippocampal functions related to aging process. The functional outcome was assessed by the electrophysiological experiments to measure the long-term potentiation (LTP). HTP-GTE improved the age-related cognitive impairments via restoring long-term synaptic plasticity. We also identified that GCG was the main active component responsible for the HTP-GTE effect. The main molecular pathway in ameliorating the age-related cognitive dysfunctions involved protein kinase A (PKA) which was shown to be modulated by HTP-GTE. Thus, HTP-GTE has a therapeutic potential as a dietary supplement which may aid to rescue the impaired cognitive functions at the early phase of aging process through the modulation of LTP threshold.

Comparison between Multiple Regression Analysis, Polynomial Regression Analysis, and an Artificial Neural Network for Tensile Strength Prediction of BFRP and GFRP.

In this study, multiple regression analysis (MRA) and polynomial regression analysis (PRA), which are traditional statistical methods, were applied to analyze factors affecting the tensile strength of basalt and glass fiber-reinforced polymers (FRPs) exposed to alkaline environments and predict the tensile strength degradation. The MRA and PRA are methods of estimating functions using statistical techniques, but there are disadvantages in the scalability of the model because they are limited by experimental results. Therefore, recently, highly scalable artificial neural networks (ANN) have been studied to analyze complex relationships. In this study, the prediction performance was evaluated in comparison to the MRA, PRA, and ANN. Tensile strength tests were conducted after exposure for 50, 100, and 200 days in alkaline environments at 20, 40, and 60 °C. The tensile strength was set as the dependent variable, with the temperature (TP), the exposure day (ED), and the diameter (D) as independent variables. The MRA and PRA results showed that the TP was the most influential factor in the tensile strength degradation of FRPs, followed by the exposure time (ED) and diameter (D). The ANN method provided the best correlation between predictions and experimental values, with the lowest error and error rate. The PRA method applied to the response surface method outperformed the MRA method, which is most commonly used. These results demonstrate that ANN can be the most efficient model for predicting the durability of FRPs.

TFEB-GDF15 axis protects against obesity and insulin resistance as a lysosomal stress response.

TFEB, a key regulator of lysosomal biogenesis and autophagy, is induced not only by nutritional deficiency but also by organelle stress. Here, we find that Tfeb and its downstream genes are upregulated together with lipofuscin accumulation in adipose tissue macrophages (ATMs) of obese mice or humans, suggestive of obesity-associated lysosomal dysfunction/stress in ATMs. Macrophage-specific TFEB-overexpressing mice display complete abrogation of diet-induced obesity, adipose tissue inflammation and insulin resistance, which is independent of autophagy, but dependent on TFEB-induced GDF15 expression. Palmitic acid induces Gdf15 expression through lysosomal Ca2+-mediated TFEB nuclear translocation in response to lysosomal stress. In contrast, mice fed a high-fat diet with macrophage-specific Tfeb deletion show aggravated adipose tissue inflammation and insulin resistance, accompanied by reduced GDF15 level. Finally, we observe activation of TFEB-GDF15 in ATMs of obese humans as a consequence of lysosomal stress. These findings highlight the importance of the TFEB-GDF15 axis as a lysosomal stress response in obesity or metabolic syndrome and as a promising therapeutic target for treatment of these conditions.

(-)-Gallocatechin gallate from green tea rescues cognitive impairment through restoring hippocampal silent synapses in post-menopausal depression.

Post-menopausal depression (PMD) is a common psychological disorder accompanied by a cognitive deficit, which is caused by a series of uncontrolled emotional disruptions by strong environmental stressors during menopause. To overcome PMD-induced cognitive deficit, Green tea has been suggested as a dietary supplement because of its ameliorating effect on cognitive dysfunction induced by normal aging or neurodegenerative syndromes; however, its clinical use to improve PMD-accompanied cognitive deficit is still limited due to the controversy for the active ingredients and ambiguous mechanism of its action. Here, we developed modified high-temperature-processed green tea extract (HTP-GTE), which showed lower neuronal toxicity than the conventional green tea extract (GTE). We also demonstrated that HTP-GTE administration prevented the development of learned helplessness (LH) in a rat post-menopausal model. Additionally, HTP-GTE improved LH-induced cognitive impairments simultaneously with rescued the long-term synaptic plasticity. This occurred via the restoration of silent synapse formation by increasing the hippocampal BDNF-tyrosine receptor kinase B pathway in the helpless ovariectomized (OVX) rats. Likewise, we also identified that (-)-gallocatechin gallate was the main contributor of the HTP-GTE effect. Our findings suggested that HTP-GTE has a potential as a preventive nutritional supplement to ameliorate cognitive dysfunctions associated with PMD.

Associations of physiologic myocardial 18F-FDG uptake with fasting duration, HbA1c, and regular exercise.

OBJECTIVE: The variability of physiologic 18F-FDG uptake in the myocardium has hampered the accurate evaluation of cardiac glucose metabolism. We investigated the effects of multiple factors, including fasting duration and physical activity, on the physiologic uptake of 18F-FDG by the myocardium in healthy participants. METHODS: A total of 446 participants (predominantly male, 91%) in a health screening program were included in this retrospective study. For the visual analysis of myocardial 18F-FDG uptake, the participants were categorized into three groups according to qualitative visual scales (QVS). For the quantitative analysis, the maximum SUV of the left ventricular myocardium was measured. RESULTS: Significant differences were observed in fasting duration (p < 0.001), SUVmax (p < 0.001), aspartate aminotransferase (AST) (p < 0.001), alanine aminotransferase (ALT) (p < 0.001), gamma-glutamyl transpeptidase (γ-GTP) (p = 0.001), and uric acid (p = 0.015) among the QVS groups. Participants who regularly exercised with vigorous activity (p = 0.032) and HbA1c > 6% (p = 0.005) showed significant association with myocardial FDG uptake in the Chi-squared test. The median value of fasting duration decreased significantly as the QVS of the myocardium increased. Twenty-nine of the 31 participants (93.5%) who fasted for 21.5 h or more showed a suppressed FDG uptake (mean SUVmax = 2.1). In multivariate logistic regression analysis, fasting duration (OR = 0.74, 95% CI 0.69-0.80, p < 0.001), HbA1c > 6% (OR = 0.29, 95% CI: 0.12 - 0.66, p = 0.004), uric acid (OR = 0.82, 95% CI 0.68-1.00, p = 0.049) and regular exercise with vigorous activity (OR = 1.75, 95% CI 1.13-2.70, p = 0.012) were significant factors for physiologic myocardial FDG uptake. CONCLUSIONS: Reduced physiologic 18F-FDG uptake of the myocardium was associated with longer fasting duration, higher level of HbA1c, and less frequency of regular exercise with vigorous activity. For the preparation of cardiac 18F-FDG PET, inclusion of longer fasting duration (more than 18 h) might be necessary for the adequate suppression of physiologic 18F-FDG myocardial uptake.

Association Between ß-Blockers and Outcome of Coronary Artery Bypass Grafting: Before and After 1 Year.

BACKGROUND: We evaluated the long-term outcomes of coronary artery bypass grafting (CABG) according to ß-blocker therapy using landmark analysis. Although ß-blockers have been shown to improve outcomes for ischemic heart disease, the long-term effects and optimal treatment duration of use after CABG remain unknown. METHODS: From January 2001 to December 2014, 5382 CABG patients were stratified into 2 groups according to ß-blocker therapy at discharge (ß-blocker group: 3677 [68.3%], no ß-blocker group: 1705 [31.7%]). RESULTS: The primary outcome was all-cause death during 48 months of follow-up. Using propensity score-matched analysis, ß-blocker therapy was associated with all-cause death during the 48-month follow-up (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.41-0.95; P = .03). The landmark analysis demonstrated that the effect of ß-blockers on all-cause death was particularly significant within the first 12 months of therapy (HR, 0.37; 95% CI, 0.19-0.80; P = .01) but not after 12 months (HR, 0.92; 95% CI, 0.56-1.53; P = .77). CONCLUSIONS: The benefits of postdischarge ß-blockers may be limited to 1 year after CABG, but further studies are required to confirm this finding.

Trauma Versus Nontrauma Intensive Care Unit Nursing: A Workload Comparison.

BACKGROUND: Trauma centers with dedicated trauma intensive care units (TICUs) have recently been developed in South Korea. It is hypothesized that TICU nurse staffing is driven not only by the number of patients but also by the work intensity. This study aims to compare nursing workload characteristics between TICUs and non-TICUs. METHODS: A 1-year retrospective study was performed in one TICU and five non-TICUs in a single trauma center from September 2014 to August 2015. Demographic data were collected along with nursing workload characteristics using the Workload Management System of Critical Care Nurses (WMSCN) score. RESULTS: A total of 332 trauma patients in the TICU and 2,346 nontrauma patients in non-TICUs were studied. TICU patients were younger (49.27 vs. 60.44, p < .001) and more frequently male (75.6% vs. 24.4%, p < .001). The most common admission reasons were motor vehicle crash (38.6%) and cardiovascular conditions (24.9%). Both intensive care unit and hospital length of stay were longer in TICU patients (12.72 vs. 5.43, p < .001; and 35.61 vs. 18.16, p < .001), whereas the mortality rates in the TICU were lower (11.1% vs. 15.1%, p < .001). Total WMSCN scores were significantly higher in the TICU (115.99 vs. 110.19; p < .001). CONCLUSIONS: This study found that nursing workload or work intensity was significantly higher in the TICU than in non-TICUs. Further multicenter studies using objective medical severity scores are warranted.

Triethoxysilane-derived SiOx-assisted structural reinforcement of Si/carbon nanotube composite for lithium-ion battery.

Herein, triethoxysilane-derived SiOx is used as a robust adhesive anchor to bind Si nanoparticles (NPs) and carbon nanotubes (CNTs) to prepare a structurally reinforced Si/CNT microsphere composite. The chemical reaction between the silanol groups of triethoxysilane with the hydroxyl groups on the Si surface and acid-treated CNTs induce strong chemical bonds between the Si NPs and CNTs and among neighboring CNTs, facilitating electron-conduction pathways and structural integrity of the composite, even under severe stress/strain. Thus, the structurally reinforced Si/CNT/SiOx microsphere composite exhibits superior cyclability: ∼88% of its initial capacity of 1112 mA h g-1 is retained after 100 cycles at 0.5 A g-1. Moreover, the Si/CNT/SiOx composite exhibits a negligible change in electrode thickness after 100 cycles. The stable electrochemical behavior and negligible change in the electrode thickness are attributed to the maintenance of the electron-conduction pathways and structural integrity of the Si/CNT/SiOx composite, enabled by the binding of neighboring CNTs with the SiOx anchor.