Healthcare resource use and costs associated with the misdiagnosis of migraine.

OBJECTIVE: To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis. BACKGROUND: Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown. METHODS: This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the "misdiagnosed cohort." Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the "correctly diagnosed cohort." Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios. RESULTS: A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients. CONCLUSION: Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history.

Securing Infrared Communication in Nuclear Power Plants: Advanced Encryption for Infrared Sensor Networks.

This study enhances infrared communication security in nuclear power plants' secondary systems, addressing the risk of mechanical and cyber failures. A novel random address generator, employing an innovative S-box, was developed to secure IoT sensor data transmissions to gateway nodes, mitigating eavesdropping, interference, and replay attacks. We introduced a structured IR communication protocol, generating unique, encrypted addresses to prevent unauthorized access. Key-dependent S-boxes, based on a compound chaotic map system, significantly improved encryption, increasing data transmission randomness and uniqueness. Entropy analysis and reduced duplicated addresses confirmed the effectiveness of our method, with the Hash-CCM algorithm showing the highest entropy and fewest duplicates. Integrating advanced cryptographic techniques into IR systems significantly enhances nuclear power plants' security, contributing to the protection of critical infrastructure from cyber threats and ensuring operational integrity.

Automatic Weight Redistribution Ensemble Model Based on Transfer Learning to Use in Leak Detection for the Power Industry.

Creating an effective deep learning technique for accurately diagnosing leak signals across diverse environments is crucial for integrating artificial intelligence (AI) into the power plant industry. We propose an automatic weight redistribution ensemble model based on transfer learning (TL) for detecting leaks in diverse power plant environments, overcoming the challenges of site-specific AI methods. This innovative model processes time series acoustic data collected from multiple homogeneous sensors located at different positions into three-dimensional root-mean-square (RMS) and frequency volume features, enabling accurate leak detection. Utilizing a TL-driven, two-stage learning process, we first train residual-network-based models for each domain using these preprocessed features. Subsequently, these models are retrained in an ensemble for comprehensive leak detection across domains, with control weight ratios finely adjusted through a softmax score-based approach. The experiment results demonstrate that the proposed method effectively distinguishes low-level leaks and noise compared to existing techniques, even when the data available for model training are very limited.

Cloud Digital Forensics: Beyond Tools, Techniques, and Challenges.

Cloud computing technology is rapidly becoming ubiquitous and indispensable. However, its widespread adoption also exposes organizations and individuals to a broad spectrum of potential threats. Despite the multiple advantages the cloud offers, organizations remain cautious about migrating their data and applications to the cloud due to fears of data breaches and security compromises. In light of these concerns, this study has conducted an in-depth examination of a variety of articles to enhance the comprehension of the challenges related to safeguarding and fortifying data within the cloud environment. Furthermore, the research has scrutinized several well-documented data breaches, analyzing the financial consequences they inflicted. Additionally, it scrutinizes the distinctions between conventional digital forensics and the forensic procedures specific to cloud computing. As a result of this investigation, the study has concluded by proposing potential opportunities for further research in this critical domain. By doing so, it contributes to our collective understanding of the complex panorama of cloud data protection and security, while acknowledging the evolving nature of technology and the need for ongoing exploration and innovation in this field. This study also helps in understanding the compound annual growth rate (CAGR) of cloud digital forensics, which is found to be quite high at ≈16.53% from 2023 to 2031. Moreover, its market is expected to reach ≈USD 36.9 billion by the year 2031; presently, it is ≈USD 11.21 billion, which shows that there are great opportunities for investment in this area. This study also strategically addresses emerging challenges in cloud digital forensics, providing a comprehensive approach to navigating and overcoming the complexities associated with the evolving landscape of cloud computing.

Advances in mining and expressing microbial biosynthetic gene clusters.

Natural products (NPs) especially the secondary metabolites originated from microbes exhibit great importance in biomedical, industrial and agricultural applications. However, mining biosynthetic gene clusters (BGCs) to produce novel NPs has been hindered owing that a large population of environmental microbes are unculturable. In the past decade, strategies to explore BGCs directly from (meta)genomes have been established along with the fast development of high-throughput sequencing technologies and the powerful bioinformatics data-processing tools, which greatly expedited the exploitations of novel BGCs from unculturable microbes including the extremophilic microbes. In this review, we firstly summarized the popular bioinformatics tools and databases available to mine novel BGCs from (meta)genomes based on either pure cultures or pristine environmental samples. Noticeably, approaches rooted from machine learning and deep learning with focuses on the prediction of ribosomally synthesized and post-translationally modified peptides (RiPPs) were dramatically increased in recent years. Moreover, synthetic biology techniques to express the novel BGCs in culturable native microbes or heterologous hosts were introduced. This working pipeline including the discovery and biosynthesis of novel NPs will greatly advance the exploitations of the abundant but unexplored microbial BGCs.

Occurrence and characteristics of microplastics in fish of the Han River, South Korea: Factors affecting microplastic abundance in fish.

This study examined the abundance of microplastics (MPs) in 106 fish from 22 species inhabiting three sites of the Han River, South Korea. In total, 1753 MPs from 106 fish samples were identified with an average abundance of 15.60 ± 13.45 MPs per individual fish (MPs indiv-1) in the North Han River, 16.35 ± 12.32 MPs indiv-1 in the South Han River, and 20.14 ± 10.01 MPs indiv-1 in downstream of the Han River, indicating that the fish in the downstream of the Han River was the most contaminated by MPs. The dominant size of MPs detected in fish ranged between 0.1 and 0.2 mm, and the most common polymer types found in fish were polypropylene (PP) (≥40%) and polyethylene (PE) (≥23%), followed by polytetrafluoroethylene (PTFE) (≥16%) at all sampling locations. A significant correlation was observed between the log-transformed number of MPs with log-transformed fish length (p < 0.01) and with log-transformed fish weight (p < 0.01). The Kruskal-Wallis test disclosed a significant difference in the number of MPs among the feeding habits (p < 0.01), indicating that omnivorous and insectivorous fish contained more MPs than carnivorous and herbivorous fish. In addition, fish habitat result showed that pelagic fish contained a higher level of MPs than demersal fish, but no significant differences in the number of MPs among fish habitats were observed (p > 0.05).

Luteolin-3'-O-Phosphate Inhibits Lipopolysaccharide-Induced Inflammatory Responses by Regulating NF-κB/MAPK Cascade Signaling in RAW 264.7 Cells.

Luteolin (LT), present in most plants, has potent anti-inflammatory properties both in vitro and in vivo. Furthermore, some of its derivatives, such as luteolin-7-O-glucoside, also exhibit anti-inflammatory activity. However, the molecular mechanisms underlying luteolin-3'-O-phosphate (LTP)-mediated immune regulation are not fully understood. In this paper, we compared the anti-inflammatory properties of LT and LTP and analyzed their molecular mechanisms of action; we obtained LTP via the biorenovation of LT. We investigated the anti-inflammatory activities of LT and LTP in macrophage RAW 264.7 cells. We confirmed from previously reported literature that LT inhibits the production of nitric oxide and prostaglandin E2, as well as the expression of inducible NO synthetase and cyclooxygenase-2. In addition, expressions of inflammatory genes and mediators, such as tumor necrosis factor-α, interleukin-6, and interleukin-1ß, were suppressed. LTP showed anti-inflammatory activity similar to LT, but better anti-inflammatory activity in all the experiments, while also inhibiting mitogen-activated protein kinase and nuclear factor-kappa B more effectively than LT. At a concentration of 10 µM, LTP showed differences of 2.1 to 44.5% in the activity compared to LT; it also showed higher anti-inflammatory activity. Our findings suggest that LTP has stronger anti-inflammatory activity than LT.

Prunetin 4'-O-Phosphate, a Novel Compound, in RAW 264.7 Macrophages Exerts Anti-Inflammatory Activity via Suppression of MAP Kinases and the NFκB Pathway.

Biorenovation, a microbial enzyme-assisted degradation process of precursor compounds, is an effective approach to unraveling the potential bioactive properties of the derived compounds. In this study, we obtained a new compound, prunetin 4'-O-phosphate (P4P), through the biorenovation of prunetin (PRN), and investigated its anti-inflammatory effects in lipopolysaccharide (LPS)-treated RAW 264.7 macrophage cells. The anti-inflammatory effect of P4P was evaluated by measuring the production of prostaglandin-E2 (PGE2), nitric oxide (NO), which is an inflammation-inducing factor, and related cytokines such as tumor necrosis factor-α (TNFα), interleukin-1ß (IL1ß), and interleukin-6 (IL6). The findings demonstrated that P4P was non-toxic to cells, and its inhibition of the secretion of NO-as well as pro-inflammatory cytokines-was concentration-dependent. A simultaneous reduction in the protein expression level of pro-inflammatory proteins such as cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) was observed. Moreover, the phosphorylation of mitogen-activated protein kinases (MAPKs) such as extracellular signal-regulated kinases (ERKs), c-Jun N-terminal kinase (JNK), p38 MAPK (p38), and nuclear factor kappa B (NFκB) was downregulated. To conclude, we report that biorenovation-based phosphorylation of PRN improved its anti-inflammatory activity. Cell-based in vitro assays further confirmed that P4P could be applied in the development of anti-inflammatory therapeutics.

Development of water quality criteria for arsenic to protect aquatic life based on species sensitivity distribution.

Arsenic is a hazardous environmental pollutant widely distributed globally. Arsenic toxicity is well known and it is regulated by many countries in terms of managing water quality and protecting aquatic organisms. Unfortunately, water quality criterion (WQC) to protect aquatic organisms has not been introduced in Korea yet. Thus, it is of great importance and necessity to introduce WQC to protect aquatic organisms from arsenic, as WQC play a significant role in protecting aquatic ecosystems from pollutants. Therefore, the purpose of this study is to derive arsenic water quality criterion for aquatic life in Korea. Arsenic acute toxicity tests were performed with 10 Korean native aquatic species, which belong to 7 different taxonomic groups. Based on the results of acute toxicity test and additional toxicity data from literature, the species sensitivity distribution (SSD) method was used in ecological risk assessment. The arsenic concentration of 95% protection level for aquatic life was 0.229 mg L-1 in this study. An assessment factor 3 and a background concentration 0.0004 mg L-1 were applied to the concentration value in consideration of the uncertainty of the data and the amount of arsenic natural generation. Consequently, the WQC value derived for arsenic was found to be 0.077 mg L-1. These results will serve as reference values to establish water quality criterion for the protection of aquatic life in Korea.

Separate development of the maxilla and mandible is controlled by regional signaling of the maxillomandibular junction during avian development.

BACKGROUND: Syngnathia is a congenital craniofacial disorder characterized by bony or soft tissue fusion of upper and lower jaws. Previous studies suggested some causative signals, such as Foxc1 or Bmp4, cause the disruption of maxillomandibular identity, but their location and the interactive signals involved remain unexplored. We wanted to examine the embryonic origin of syngnathia based on the assumption that it may be located at the separation between the maxillary and mandibular processes. This region, known as the maxillomandibular junction (MMJ), is involved in segregation of cranial neural crest-derived mesenchyme into the presumptive upper and lower jaws. RESULTS: Here we investigated the role of Fgf, Bmp, and retinoid signaling during development of MMJ in chicken embryos. By changing the levels of these signals with bead implants, we induced syngnathia with microstomia on the treated side, which showed increased Barx1 and neural cell adhesion molecule (NCAM) expression. Redistribution of proliferating cells was also observed at the proximal region to maxillary and mandibular arch around MMJ. CONCLUSIONS: We propose that interactive molecular signaling by Fgfs, Bmps, and retinoids around MMJ is required for normal separation of the maxilla and mandible, as well as the proper positioning of beak commissure during early facial morphogenesis. Developmental Dynamics 246:28-40, 2017. © 2016 Wiley Periodicals, Inc.

Effects of gyrokinesis exercise on the gait pattern of female patients with chronic low back pain.

[Purpose] The purpose of the present study was to use kinematic variables to identify the effects of 8/weeks' performance of a gyrokinesis exercise on the gait pattern of females with chronic low back pain. [Subjects] The subjects of the present study were females in their late 20s to mid 30s who were chronic back pain patients. [Methods] A 3-D motion analysis system was used to measure the changes in their gait patterns between pre and post-gyrokintic exercise. The SPSS 21.0 statistics program was used to perform the paired t-test, to compare the gait patterns of pre-post-gyrokinesis exercise. [Results] In the gait analysis, pre-post-gyrokinesis exercise gait patterns showed statistically significant differences in right and left step length, stride length, right-left step widths, and stride speed. [Conclusion] Gait pattern analysis revealed increases in step length, stride length, and stride speed along with a decrease in step width after 8 weeks of gyrokinesis exercise, demonstrating it improved gait pattern.

Neuroanatomical mechanism on the effect of distraction in working memory maintenance in patients with schizophrenia.

This study utilized functional magnetic resonance imaging (fMRI) to discriminate brain activation patterns associated with the effect of distraction during working memory (WM) maintenance for human faces in healthy controls and patients with schizophrenia. Event-related fMRI data were obtained while the subjects performed WM maintenance in a delayed-response WM task with task-irrelevant distracters. Compared with healthy controls, patients showed significantly decreased activities in the superior frontal gyrus, dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex, anterior cingulate cortex, inferior parietal gyrus, and fusiform gyrus during the delayed-response WM task with human face distracters. The blood-oxygen-level-dependent signal changes in the DLPFC were negatively correlated with both of the scores of the Positive Subscale and General Psychopathology Subscale under the Positive and Negative Syndrome Scale during the WM maintenance for the human faces in the patients. This study will be helpful in understanding the neural mechanisms in the general impairment of the inhibition control in schizophrenia.

The effects of wobble board training on the eyes open and closed static balance ability of adolescents with down syndrome.

[Purpose] The aim of the present study was to examine the influence of wobble board training on static balance, with and without vision, of adolescents with Down syndrome (DS). [Subjects] Ten adolescents with DS were recruited for this study. [Methods] Participants performed quiet standing with their eyes open and closed, pre- and post-wobble board training. During quiet standing, the center of pressure (COP) data was recorded using a force plate. To assess the static balance ability of the participants, the 95% confidence ellipse area of COP was calculated. The paired t-test was used to compare the 95% confidence ellipse area of COP between the eyes open and closed conditions, and between pre- and post-training. [Results] Although there was no significant difference in the 95% confidence ellipse area of COP between with and without vision, the 95% confidence ellipse area of COP decreased significantly after wobble board training. [Conclusion] These findings suggest that wobble board training is an effective at improving the static balance ability of adolescents with DS.

Effect of physical activity on free fatty acids, insulin resistance, and blood pressure in obese older women.

PURPOSE: Obesity is characterized by a progressive increase in body fat accompanied by insulin resistance (IR) and elevated blood pressure (BP), and presents significant health risks, particularly in aged individuals. This study aimed to evaluate the effects of physical activity (PA) on free fatty acid (FFA) levels, IR, and BP in obese older women. METHODS: Twenty-three participants were randomly assigned to either the control group (CON, n = 11) or the physical activity group (PA, n = 12). The PA group was provided with a target of achieving >7,000 steps/day for 5 days each week. Body composition, FFA levels, IR, and BP were measured at pre- and post- of the 12-week intervention. RESULTS: The analysis revealed a statistically significant interaction between FFA (p < 0.01), IR (p < 0.01), and SBP (p < 0.001). FFA (p < 0.5), IR (p < 0.5), and systolic blood pressure (SBP) (p < 0.01) were significantly decreased in the PA group compared to those in the CON group, which showed no significant changes in FFA, IR, and SBP. CONCLUSION: PA significantly decreased FFA, IR, and SBP in older women with obesity. Therefore, PA is an effective intervention for the prevention and management of obesity and cardiovascular diseases in obese older women.

Postoperative atrial fibrillation is associated with long-term morbidity and mortality in older adults: Analysis from the SWEDEHEART Registry.

Objectives: Postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia. The association of POAF with negative short-term outcomes after cardiac surgery is well understood; however, the association of POAF with long-term morbidity and mortality is not well described. We compared the risk of long-term clinical outcomes (up to 9 years postdischarge) in patients with and without POAF following open-chest cardiac surgery. Methods: This observational, retrospective cohort study used data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) Swedish Cardiac Surgery Registry and National Board of Health and Welfare. Patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019 were included. Clinical outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression. Results: A total of 30,870 patients with a mean age of 69.2 years were included in the study (no POAF, n = 20,734; POAF, n = 10,136). The median follow-up was 4.6 years. After adjustment, POAF was associated with a significantly higher risk of recurrent atrial fibrillation (hazard ratio [HR], 2.30; 95% CI, 2.21-2.41), heart failure (HR, 1.17; 95% CI, 1.10-1.25), chronic kidney disease (HR, 1.15; 95% CI, 1.07-1.24), all-cause mortality (HR, 1.11; 95% CI, 1.04-1.18), and cardiovascular mortality (HR, 1.16; 95% CI, 1.06-1.26). POAF was also associated with a numerically higher risk of ischemic stroke and major bleed, but these findings were not statistically significant after adjustment. Conclusions: These data provide further insight into the long-term clinical outcomes associated with POAF in patients undergoing cardiac surgery.

Melanin Inhibitory Effect of Tuber himalayense Isolated in Incheon, Korea.

There has been a growing interest in skin beauty and antimelanogenic products. Melanogenesis is the process of melanin synthesis whereby melanocytes are activated by UV light or hormone stimulation to produce melanin. Melanogenesis is mediated by several enzymes, such as tyrosinase (TYR), microphthalmia-associated transcription factor (MITF), tyrosinase-related protein-1 (TRP-1), and TRP-2. In this study, we investigated the effect of Tuber himalayense extract on melanin synthesis in α-melanocyte-stimulating hormone (α-MSH)-treated B16F10 melanoma cells. We confirmed that T. himalayense extract was not toxic to α-MSH-treated B16F10 melanoma cells and exhibited a significant inhibitory effect on melanin synthesis at concentrations of 25, 50, and 100 µg/ml. Additionally, the T. himalayense extract inhibited melanin, TRP-1, TRP-2, tyrosinase, and MITF, which are enzymes involved in melanin synthesis, in a concentration-dependent manner. Furthermore, T. himalayense extract inhibited the mitogen-activated protein kinase (MAPK) pathways, such as extracellular signal-regulated kinase-1/2 (ERK), c-Jun N-terminal kinase (JNK), and p38. Therefore, we hypothesized that various components of T. himalayense extract affect multiple factors involved in melanogenesis in B16F10 cells. Our results indicate that T. himalayense extract could potentially be used as a new material for preparing whitening cosmetics.

Influence of walking with talus taping on the ankle dorsiflexion passive range of motion.

[Purpose] This study investigated the effects of walking with talus taping on the ankle dorsiflexion passive range of motion (DF PROM) in individuals with limited ankle DF PROM. [Subjects] Fifteen ankles with limited DF PROM were examined. [Methods] After rigid strapping tape was applied to the ankles from the talus to the calcaneus, progressing posteriorly and inferiorly, the subjects walked on a walkway for 10 min. Using a goniometer, the ankle DF PROM was measured with the knee extended before and after walking with talus taping. The difference in ankle DF PROM between before and after walking with talus taping was analyzed using the paired t-test. [Results] The ankle DF PROM was significantly increased after walking with talus taping. [Conclusion] Our findings indicate that walking with talus taping is effective for increasing the ankle DF PROM in individuals with limited ankle DF PROM.

Healthcare resource utilization and costs for patients with postoperative atrial fibrillation in the United States.

BACKGROUND: Postoperative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery. POAF is associated with increased hospitalization costs, but its long-term economic burden is not well defined. OBJECTIVE: To assess 30-day and 1-year incremental healthcare resource utilization (HRU) and costs associated with POAF in the United States (US). METHODS: This retrospective cohort study used claims data from the IBM Watson MarketScan database. A cohort of US adults aged 55--90 years who underwent open-heart surgery between 1 January 2017 and 31 December 2018 was used to compare patients who experienced POAF versus patients who did not (controls). The outcomes of interest were incremental HRU and costs, which were assessed during the index hospitalization and 30-day and 1-year postdischarge time periods. Inverse probability weighting was used to adjust for differences in baseline characteristics. RESULTS: A total of 8,020 patients met the study inclusion criteria with 5,765 patients in the control cohort (mean age, 63.4 years) and 2,255 patients in the POAF cohort (mean age, 65.8 years). After adjustment, patients with POAF had an index hospitalization that was 1.9 days longer (99% CI, 1.3-2.4 days; p < 0.001) and cost $13,919 more (99% CI, $2,828-$25,011; p < 0.001) than for patients without POAF. POAF patients also had significantly higher HRU at 30 days and 1-year postdischarge with incremental costs of $4,649 (99% CI, $1,479-$7,819; p < 0.001) and $10,671 (99% CI, $2,407-$18,935; p < 0.001), respectively. CONCLUSION: POAF following open-heart surgery poses a significant economic burden up to 1 year postdischarge.

Comparison of the Estimation Methods from Acute to Chronic Biotic Ligand Model-Based Predicted No-Effect Concentrations for Nickel in Freshwater Species.

Biotic ligand models (BLMs) and the sensitivities of indigenous species are used to assess the environmental risk considering the bioavailability of metals, such as nickel. However, the BLM-based acute-to-chronic ratio (ACR) is required if the predicted no-effect concentration (PNEC) cannot be derived from the chronic species sensitivity distribution (SSD). The applicability of the ACR approach for estimating BLM-based PNEC for nickel from acute toxicity data was evaluated in the present study. The BLM-based acute SSD for nickel was built using the sensitivities of 21 indigenous species and different taxon-specific BLMs for each taxonomic group. To predict the acute sensitivity of invertebrates, the chronic crustacean nickel BLM with pH effect term, which can account for nickel toxicity at high pH levels, was used. This was used instead of the existing acute BLM for crustacean, which has too narrow a pH range to cover the pH dependency of toxicity. The final BLM-based ACR of nickel, determined within a factor of 1.53 from the species-specific acute and chronic sensitivities of the six species, was more reliable than the typical ACR estimated within a factor of 1.84. A linear relationship (r2 = 0.95) was observed between the PNECs using BLM-based ACR and the PNECs derived from the BLM-based chronic SSD of the European Union Risk Assessment Reports. In conclusion, the BLM-based PNEC for nickel could be derived using the ACR approach, unlike when copper BLM was applied. The BLM-based ACR for nickel is the first result calculated by directly comparing acute and chronic species sensitivities, and will contribute to the application of BLM-based risk assessment in broader ecoregions. Environ Toxicol Chem 2023;42:914-927. © 2023 SETAC.

Risk Factors for Reoperation Following Radical Gastrectomy in Gastric Cancer Patients.

BACKGROUND: Reoperation due to elective surgery complications is very mentally, physically, and economically detrimental to patients. This study investigated the potential risk factors associated with early reoperation after radical gastrectomy in gastric cancer patients and included an in-depth analysis of these risk factors. METHODS: This retrospective study reviewed 1568 patients with gastric cancer. Grade 3 or greater complications were defined as severe. Any factors related to reoperation after radical gastrectomy were analyzed in patients with severe local complications. RESULTS: Among 1537 patients undergoing radical gastrectomy, 115 (7.5%) patients had severe postoperative complications, 98 (6.38%) of whom experienced severe local complications. The most common local complication was anastomotic leakage (31, 2.02%), followed by intra-abdominal abscess (30, 1.95%), pancreatic leakage (22, 1.43%), duodenal stump leakage (18, 1.17%), intra-abdominal bleeding (12, .78%), intraluminal bleeding (8, .52%), small bowel obstruction (5, .32%), and chyle leakage (3, .19%). Of these patients, 26 (1.69%) underwent reoperation, and 6 (.39%) died. In the univariate analysis of clinical factors related to reoperation, intra-abdominal bleeding and small bowel obstruction were risk factors for reoperation, and intra-abdominal bleeding (odds ratio [OR] = 9.57, confidence interval [CI] = 2.65-40.20, P < .001) and small bowel obstruction (OR = 19.14, CI = 2.60-390.13, P = .011) were independent risk factors associated with reoperation in the multivariate analysis. CONCLUSION: Intra-abdominal bleeding and small bowel obstruction are independent risk factors for reoperation following radical gastrectomy. Patients with postoperative intra-abdominal bleeding and small bowel obstruction need to be warned about reoperation.