Comparison of the problem-solving performance of ChatGPT-3.5, ChatGPT-4, Bing Chat, and Bard for the Korean emergency medicine board examination question bank.

Large language models (LLMs) have been deployed in diverse fields, and the potential for their application in medicine has been explored through numerous studies. This study aimed to evaluate and compare the performance of ChatGPT-3.5, ChatGPT-4, Bing Chat, and Bard for the Emergency Medicine Board Examination question bank in the Korean language. Of the 2353 questions in the question bank, 150 questions were randomly selected, and 27 containing figures were excluded. Questions that required abilities such as analysis, creative thinking, evaluation, and synthesis were classified as higher-order questions, and those that required only recall, memory, and factual information in response were classified as lower-order questions. The answers and explanations obtained by inputting the 123 questions into the LLMs were analyzed and compared. ChatGPT-4 (75.6%) and Bing Chat (70.7%) showed higher correct response rates than ChatGPT-3.5 (56.9%) and Bard (51.2%). ChatGPT-4 showed the highest correct response rate for the higher-order questions at 76.5%, and Bard and Bing Chat showed the highest rate for the lower-order questions at 71.4%. The appropriateness of the explanation for the answer was significantly higher for ChatGPT-4 and Bing Chat than for ChatGPT-3.5 and Bard (75.6%, 68.3%, 52.8%, and 50.4%, respectively). ChatGPT-4 and Bing Chat outperformed ChatGPT-3.5 and Bard in answering a random selection of Emergency Medicine Board Examination questions in the Korean language.

In Vivo Monitoring of Glycerolipid Metabolism in Animal Nutrition Biomodel-Fed Smart-Farm Eggs.

Although many studies have examined the biochemical metabolic pathways by which an egg (egg yolk) lowers blood lipid levels, data on the molecular biological mechanisms that regulate and induce the partitioning of hepatic glycerolipids are missing. The aim of this study was to investigate in vivo monitoring in four study groups using an animal nutrition biomodel fitted with a jugular-vein cannula after egg yolk intake: CON (control group, oral administration of 1.0 g of saline), T1 (oral administration of 1.0 g of pork belly fat), T2 (oral administration of 1.0 g of smart-farm egg yolk), and T3 (oral administration of T1 and T2 alternately every week). The eggs induced significant and reciprocal changes in incorporating 14C lipids into the total glycerolipids and releasing 14CO2, thereby regulating esterification and accelerating oxidation in vivo. The eggs increased phospholipid secretion from the liver into the blood and decreased triacylglycerol secretion by regulating the multiple cleavage of fatty acyl-CoA moieties' fluxes. In conclusion, the results of the current study reveal the novel fact that eggs can lower blood lipids by lowering triacylglycerol secretion in the biochemical metabolic pathway of hepatic glycerolipid partitioning while simultaneously increasing phospholipid secretion and 14CO2 emission.

Impact of the Combination of Probiotics and Digital Poultry System on Behavior, Welfare Parameters, and Growth Performance in Broiler Chicken.

Recently, applied technology in the form of the combination of a probiotics and a digital poultry system, with the convergence of Information and Communications Technology and farm animals, has enabled a new strategy to overcome the livestock production crisis caused by climate change, while maintaining sustainable poultry farming in terms of care, feeding, and environmental management systems for poultry. The aim of this study was to investigate the biological mechanisms of animal behavioral welfare and production improvement using the combination of a probiotics and a digital poultry system in broiler chickens. A total of 400 one-day-old male broilers (ROSS 308) were randomly divided into four treatment groups, with five replicates each (20 birds/replicate pen) in a completely randomized design: control group with a conventional poultry system without probiotics (CON), conventional poultry system with 500 ppm of probiotics (CON500), digital poultry control system without probiotics (DPCS), and digital poultry system with 500 ppm of probiotics (DPS500). All experimental animals were reared for 35 days under the same standard environmental conditions. The experimental results indicated that the animal behavioral welfare, which includes drinking, eating, locomotion, grooming, and resting, in addition to foot pads, knee burns, plumage, and gait scores, as well as the growth performance of the broiler chickens, were improved by maintaining immune function and cecal microbiota balance via interaction between the combination of a probiotics and a digital poultry system. In conclusion, it was found that the combined system showed improved broiler growth performance and animal behavioral welfare. Thus, further studies of molecular biological mechanisms by the use of such a combined system to improve the nutritional composition and quality of chicken meats are recommended.

The S-S.M.A.R.T: A New Prognostic Tool for Patients with Suspected Sepsis in the Emergency Department.

Background: The sepsis screening tool is essential because it enables the rapid identification of high-risk patients and facilitates prompt treatment. Quick Sequential Organ Failure Assessment (qSOFA) is a widely used screening tool for sepsis. However, it has limitations in predicting patient prognosis. We developed the S-S.M.A.R.T (sepsis evaluation with shock index, mental status, age, and ROX index on triage) and aimed at evaluating it as a screening tool for patients with suspected sepsis in the emergency department. Methods: We conducted a single-center retrospective chart review of patients with suspected sepsis in the emergency department. We compared the prognosis prediction abilities of the S-S.M.A.R.T and qSOFA scores in patients with suspected sepsis. The primary outcome was 7-day mortality, and the secondary outcomes included 30-day mortality and ICU admission. The receiver operating characteristic (ROC) curve analysis and the chi-square test were used. Results: In total, 401 patients were enrolled. The mean age of the patients was 72.2 ± 15.6 years, and 213 (53.1%) of them were female. The S-S.M.A.R.T had superior predictive ability for prognosis of patients with suspected sepsis compared to qSOFA (area under the ROC curve (AUC) of 0.789 vs. 0.699; p=0.02 for 7-day mortality, AUC of 0.786 vs. 0.681; p < 0.001 for 30-day mortality, AUC 0.758 vs 0.717; p=0.05 for ICU admission). Conclusion: The S-S.M.A.R.T can be useful in predicting the prognosis of patients with suspected sepsis in the emergency department.

Digital livestock systems and probiotic mixtures can improve the growth performance of swine by enhancing immune function, cecal bacteria, short-chain fatty acid, and nutrient digestibility.

In response to climate change, the use of digital livestock systems and probiotic mixtures as technological strategies to improve animal health and production is driving new innovations in the farm animal industry. However, there is little information available regarding the effects of digital livestock systems and probiotic mixtures (consisting of Bacillus subtillus, Streptomyces galilaeus, and Sphingobacteriaceae) on the growth performance of the growth-finishing swine. Thus, the objective of this study was to investigate the effects of digital livestock systems and probiotic mixtures on the immune function, cecal bacteria, short-chain fatty acids, nutrient digestibility, and growth performance of growth-finishing swine. A total of 64 crossbred male swine (Duroc × Landrace × Yorkshire, average body weight: 60.17 ± 1.25 kg) were randomly assigned to four treatment groups: CON (control group with a conventional livestock system without a probiotic mixture), CON0.4 (a conventional livestock system with a 0.4% probiotic mixture), DLSC (a digital livestock system without a probiotic mixture), and DLS0.4 (a digital livestock system with a 0.4% probiotic mixture). The swine were reared under standard environmental conditions until their average body weight reached 110 kg. The results indicated that the growth performance of the swine improved with an increase in nutrient digestibility and immune function via modulation of blood immune markers in the group with a digital livestock system compared to the CON group, although the growth performance of the swine was similar between the DLSC and CON0.4 groups. Moreover, the application of the digital livestock system and the probiotic mixture maintained higher levels of Lactobacillus and balanced short-chain fatty acid profiles compared to the CON group. These results suggest that a digital livestock system and a probiotic mixture can improve the growth performance of swine by enhancing their nutrient digestibility, improving their immune function, and maintaining balanced cecal bacteria and short-chain fatty acids. Therefore, this study provides insights into the application of digital livestock systems and probiotic mixtures as a climate change response strategy to improve swine production.

Molecular Mechanism for Hepatic Glycerolipid Partitioning of n-6/n-3 Fatty Acid Ratio in an Obese Animal Biomodels.

The n-6/n-3 metabolic pathway associated with hepatic glycerolipid portioning plays a key role in preventing obesity. In this nutrition metabolism study, we used in vivo monitoring techniques with 40 obese male Sprague-Dawley strain rats attached with jugular-vein cannula after obesity was induced by a high-fat diet to determine the molecular mechanism associated with hepatic glycerolipid partitioning involving the n-6/n-3 metabolic pathway. Rats were randomly assigned to four groups (10 animals per group), including one control group (CON, n-6/n-3 of 71:1) and three treatment groups (n-6/n-3 of 4:1, 15:1 and 30:1). They were fed with experimental diets for 60 days. Incorporation rates of [14C]-labeling lipid into glycerolipid in the liver were 28.87−37.03% in treatment groups fed with diets containing an n-6/n-3 ratio of 4:1, 15:1 and 30:1, which were significantly (p < 0.05) lower than that in the CON (40.01%). However, 14CO2 emission % of absorbed dose showed the opposite trend. It was significantly (p < 0.05) higher in a treatment groups (n-6/n-3 of 4:1, 15:1 and 30:1, 30.35−45.08%) than in CON (27.71%). Regarding the metabolic distribution of glycerolipid to blood from livers, phospholipid/total glycerolipid (%) was significantly (p < 0.05) lower in CON at 11.04% than in treatment groups at 18.15% to 25.15%. Moreover, 14CO2/[14C]-total glycerolipid (%) was significantly (p < 0.05) higher in treatment groups at 44.16−78.50% than in CON at 39.50%. Metabolic distribution of fatty acyl moieties flux for oxidation and glycerolipid synthesis in the liver were significantly (p < 0.05) better in order of 4:1 > 15:1 > 30:1 than in the CON. Our data demonstrate that n-6/n-3 of 4:1 could help prevent obesity by controlling the mechanism of hepatic partitioning through oxidation and esterification of glycerolipid in an obese animal biomodel.

Vulnerable individuals and changes in suicidal behaviour during the COVID-19 pandemic in Korea.

BACKGROUND: The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions. AIMS: We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic. METHOD: We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods. RESULTS: In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients' rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11-13) v. 13 (interquartile range: 12-14), P < 0.001). CONCLUSIONS: Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.

Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19.

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

Peroxisome Metabolism Contributes to PIEZO2-Mediated Mechanical Allodynia.

Mutations in the peroxisomal half-transporter ABCD1 cause X-linked adrenoleukodystrophy, resulting in elevated very long-chain fatty acids (VLCFA), progressive neurodegeneration and an associated pain syndrome that is poorly understood. In the nervous system of mice, we found ABCD1 expression to be highest in dorsal root ganglia (DRG), with satellite glial cells (SGCs) displaying higher expression than neurons. We subsequently examined sensory behavior and DRG pathophysiology in mice deficient in ABCD1 compared to wild-type mice. Beginning at 8 months of age, Abcd1-/y mice developed persistent mechanical allodynia. DRG had a greater number of IB4-positive nociceptive neurons expressing PIEZO2, the mechanosensitive ion channel. Blocking PIEZO2 partially rescued the mechanical allodynia. Beyond affecting neurons, ABCD1 deficiency impacted SGCs, as demonstrated by high levels of VLCFA, increased glial fibrillary acidic protein (GFAP), as well as genes disrupting neuron-SGC connectivity. These findings suggest that lack of the peroxisomal half-transporter ABCD1 leads to PIEZO2-mediated mechanical allodynia as well as SGC dysfunction. Given the known supportive role of SGCs to neurons, this elucidates a novel mechanism underlying pain in X-linked adrenoleukodystrophy.

Commencing one-handed chest compressions while activating emergency medical system using a handheld mobile device in lone-rescuer basic life support: a randomised cross-over simulation study.

INTRODUCTION: In conventional basic life support (c-BLS), a lone rescuer is recommended to start chest compressions (CCs) after activating the emergency medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs while calling for help using a handheld cellular phone with the other free hand. This study aimed to compare the quality of BLS between c-BLS and m-BLS. METHODS: This was a simulation study performed with a randomised cross-over controlled trial design. A total of 108 university students were finally enrolled. After training for both c-BLS and m-BLS, participants performed a 3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over order. The paired mean difference with SE between c-BLS and m-BLS was assessed using paired t-test. RESULTS: The m-BLS had reduced lag time before the initiation of CCs (with a mean estimated paired difference (SE) of -35.0 (90.4) s) (p<0.001). For CC, a significant increase in compression fraction and a higher number of CCs with correct depth were observed in m-BLS (with a mean estimated paired difference (SE) of 16.2% (0.6) and 26.9% (3.3), respectively) (all p<0.001). However, no significant paired difference was observed in the hand position, compression rate and interruption time. For ventilation, the mean tidal volumes did not differ. However, the number of breaths with correct tidal volume was higher in m-BLS than in c-BLS. CONCLUSION: In simulated lone-rescuer BLS, the m-BLS could deliver significantly earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary resuscitation.

Prognostic value of red blood cell distribution width in predicting 3-month functional outcome of patients undergoing thrombolysis treatment for acute ischemic stroke.

ABSTRACT: This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6.A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214-5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761-0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score.Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.

Molecular and functional characterization of detrusor PDGFRα positive cells in spinal cord injury-induced detrusor overactivity.

Volume accommodation occurs via a novel mechanism involving interstitial cells in detrusor muscles. The interstitial cells in the bladder are PDGFRα+, and they restrain the excitability of smooth muscle at low levels and prevents the development of transient contractions (TCs). A common clinical manifestation of spinal cord injury (SCI)-induced bladder dysfunction is detrusor overactivity (DO). Although a myogenic origin of DO after SCI has been suggested, a mechanism for development of SCI-induced DO has not been determined. In this study we hypothesized that SCI-induced DO is related to loss of function in the regulatory mechanism provided by PDGFRα+ cells. Our results showed that transcriptional expression of Pdgfra and Kcnn3 was decreased after SCI. Proteins encoded by these genes also decreased after SCI, and a reduction in PDGFRα+ cell density was also documented. Loss of PDGFRα+ cells was due to apoptosis. TCs in ex vivo bladders during filling increased dramatically after SCI, and this was related to the loss of regulation provided by SK channels, as we observed decreased sensitivity to apamin. These findings show that damage to the mechanism restraining muscle contraction during bladder filling that is provided by PDGFRα+ cells is causative in the development of DO after SCI.

Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study.

BACKGROUND: A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries. PURPOSE: To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA). MATERIAL AND METHODS: The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively. RESULTS: The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781-121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis. CONCLUSION: A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.

Utility of a Modified Oropharyngeal Airway for Performing Tracheal Intubation Using a Fiberoptic Bronchoscope and Video Stylet: A Randomized Crossover Trial Using a Manikin.

PURPOSE: The purpose of this study was to assess if a modified airway (MA), developed by the authors, would act as a guide and improve the performance of intubation when used with a video stylet (VS) or fiberoptic bronchoscope (FOB) for endotracheal intubation. METHODS: This randomized crossover simulation study using manikins was conducted with 36 novice operators. Time to complete intubation, time to see the glottis, and success rate of intubation of each device were measured and compared with or without use of MA. RESULTS: For intubation using FOB with MA, the median time to complete intubation significantly reduced from 46 to 31 seconds with a medium effect size (p=0.004, r = 0.483), and the median time to see the glottis significantly reduced from 7 to 5 seconds with a medium effect size (p=0.032, r = 0.357). The overall success rate was not statistically different between FOB with MA (33/36, 91.7%) and FOB alone (31/36, 86.1%); however, the cumulative success rate over time for FOB with MA was higher than that for FOB alone (p=0.333). For intubation using VS, there were no differences in the time to see the glottis and time to complete intubation between VS with MA and VS alone (p=0.065 and p=0.926, respectively), and the cumulative success rate was not statistically significant (p=0.594). CONCLUSION: Adjunct use of MA helped reduce time to complete intubation in FOB, but not in VS. If an inexperienced operator uses FOB, it would be helpful to use MA as an adjunct device.

Case of cardiac arrest due to carbon dioxide poisoning following an explosion of a carbon dioxide tank.

Carbon dioxide is widely used for a variety of purposes. As it is a normal constituent of air, the public generally regards it as safe. Although low concentrations of carbon dioxide are not harmful to human beings, high concentrations are toxic, and can cause serious harm, including cardiac arrest. Only a limited number of cases of carbon dioxide intoxication have been reported in Korea, and they have all been mild, with no cases of cardiac arrest following acute exposure to high concentrations of carbon dioxide, reported previously. We describe a case of carbon dioxide poisoning following an explosion of a carbon dioxide tank, which led to cardiac arrest in a 66-year-old patient. This cardiac arrest could have been avoided if the patient was fully aware of the hazardous effects and serious consequences of exposure to high concentrations of carbon dioxide.

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department.

Background: Serum lactate is a useful biomarker for prediction of mortality in critically ill patients. The purpose of this study was to identify if serum lactate could be used as a biomarker for predicting mortality in patients with subarachnoid hemorrhage (SAH) in the emergency department. Methods: This retrospective study enrolled 189 patients. Baseline demographic data and clinical characteristics of patients were obtained from medical record review. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of variables for mortality prediction in SAH. Results: Using multivariate logistic regression analysis, age [OR 1.05; 95% confidence interval (CI) 1.00-1.10; p = 0.037], Hunt and Hess scale score (OR 3.29; 95% CI 1.62-6.70; p = 0.001), serum lactate level (OR 1.33; 95% CI 1.03-1.74; p = 0.032), and serum glucose level (OR 1.01; 95% CI 1.00-1.02; p = 0.049) predicted overall mortality in SAH. The area under the ROC curve (AUC) value for the use of serum lactate level to predict mortality in SAH was 0.815 (95% CI 0.753-0.868) (p < 0.001). Conclusion: Serum lactate may be a useful biomarker for the early prediction of mortality in SAH patients in the emergency department.

Efficacy of Amflow®, a Real-Time-Portable Feedback Device for Delivering Appropriate Ventilation in Critically Ill Patients: A Randomised, Controlled, Cross-Over Simulation Study.

OBJECTIVE: The aim of this study was to test whether Amflow® (a newly designed portable ventilation feedback device) can assist rescuers in delivering target tidal volume (V T) and respiration rate (RR) during self-inflating bag (SB) ventilations in various clinical scenarios. METHOD: This was a simulation study with a prospective cross-over design. A total of 40 trained participants who underwent training for SB ventilation were recruited. Using a SB with or without Amflow® alternately, participants delivered ventilations to test lungs connected to a gas flow analyser in each of three different scenarios: acute respiratory distress syndrome (ARDS; 315-385 ml ranges for 350 ml target V T, with 20 breaths/min); cardiopulmonary resuscitation (CPR; 450-550 ml ranges for 500 ml target V T with 10 breaths/min); and adult head trauma (630-770 ml ranges for 700 ml target V T with 15 breaths/min). RESULTS: The feedback group (SB with Amflow®) demonstrated a significantly higher percentage of delivering the appropriate V T ranges than the no-feedback group for both ARDS (58.6% versus 23.5%, respectively) and CPR (85.4% versus 41.0%, respectively) (all p < 0.05). However, there was no significant difference between the two groups in the percentage of delivering the appropriate V T ranges in head trauma patients (65.9% versus 68.3%, respectively; p=0.092). In all three scenarios, a higher percentage of target RR delivered was achieved in the feedback group (88.3%, 99.2%, and 96.3%, respectively) compared with the no-feedback group (5.8%, 12.5%, and 10.0%, respectively) (all p < 0.05). CONCLUSION: The Amflow® device could be useful for rescuers in delivering SB ventilation with appropriate V T and RR simultaneously in various critical situations, except for clinical cases that demand greater delivered V T.

In vivo monitoring of hepatic glycolipid distribution of n-6 ∕ n-3 in jugular-vein-cannulated rats as a nutritional research model for monogastric animal.

The metabolic distribution via blood from liver of glycerolipids by omega-6 to omega-3 fatty acid ( n -6  /   n -3) ratio in monogastric animal nutrition is very important. In vivo monitoring technique using jugular-vein-cannulated rats as a nutritional model for monogastric animal can yield important insights into animal nutrition. This study was conducted to determine the effect of different n -6  /   n -3 ratios ( 71 : 1 , 4 : 1 , 15 : 1 , 30 : 1 ) on metabolic distribution of glycerolipids newly synthesized and secreted in the liver of the rats and explore the mechanism involved. Regarding 14 CO 2 released from oxidation of glycerolipid metabolism, it was the highest (22.5 %) in groups with a n -6  /   n -3 ratio of 4 : 1 ( P < 0.05 ). The control group showed the highest total glycerolipid level, followed by the 30 : 1 , 15 : 1 , and 4 : 1 groups in order ( P < 0.05 ). When secreted triacylglycerol level of each group was compared with that of the control group, the 4 : 1 , 15 : 1 , and 30 : 1 groups were decreased by 36.3 %, 20.9 %, and 13.3 %, respectively ( P < 0.05 ). Regarding the distribution of phospholipid against total glycerolipid compared to the control group, the 4 : 1 , 15 : 1 , and 30 : 1 groups were 1.38, 1.29, and 1.17 times higher, respectively ( P < 0.05 ). In the comparison of 14 CO 2 emission against total glycerolipid compared with the control group, the 4 : 1 , 15 : 1 , and 30 : 1 groups were 1.61, 1.52, and 1.29 times higher, respectively ( P < 0.05 ). These results demonstrate that a dietary n -6  /   n -3 fatty acid ratio of 4 : 1 could significantly decrease harmful lipid levels in the blood by controlling the mechanism of metabolic distribution via blood from triglyceride and phospholipid newly synthesized in the liver of cannulated rat.

Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea.

BACKGROUND: In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak. METHODS: This is a case-cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact. RESULTS: The index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient. CONCLUSIONS: Our study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients. TRIAL REGISTRATION: NCT02605109 , date of registration: 11th November 2015.

Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator.

OBJECTIVE: Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA. METHODS: This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed. RESULTS: In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm3, P=0.020). The best cutoff platelet count was 195,000/mm3, and patients with platelet counts of <195,000/mm3 had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm3. CONCLUSION: Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.