Medium-chain fatty acids (MCFAs) are mostly generated from dietary triglycerides and can penetrate the blood-brain barrier. Astrocytes in the brain use MCFAs as an alternative energy source. In addition, MCFAs have various regulatory and signaling functions in astrocytes. However, it is unclear how astrocytes sense and take up MCFAs. This study demonstrates that decanoic acid (DA; C10), a saturated MCFA and a ligand of G(αs) protein-coupled receptors (G(αs)-GPCRs), is a signaling molecule in energy metabolism in primary astrocytes. cAMP synthesis and lactate release were increased via a putative G(αs)-GPCR and transmembrane adenylyl cyclase upon short-term treatment with DA. By contrast, monoamine oxidase B-dependent gamma-aminobutyric acid (GABA) synthesis was increased in primary cortical and hypothalamic astrocytes upon long-term treatment with DA. Thus, astrocytes respond to DA by synthesizing cAMP and releasing lactate upon short-term treatment, and by synthesizing and releasing GABA upon long-term treatment, similar to reactive astrocytes. Our data suggest that astrocytes in the brain play crucial roles in lipid-sensing via GPCRs and modulate neuronal metabolism or activity by releasing lactate via astrocyte-neuron lactate shuttle or GABA to influence neighboring neurons.
Adenylyl Cyclases ; Animals ; Astrocytes* ; Blood-Brain Barrier ; Brain ; Energy Metabolism ; Fatty Acids ; gamma-Aminobutyric Acid* ; Lactic Acid* ; Metabolism ; Mice* ; Monoamine Oxidase ; Neurons ; Triglycerides

OBJECTIVE: Since 2018, the surviving sepsis campaign recommended one-hour bundle therapy in septic shock patients. On the other hand, evidence for the effectiveness of bundle therapy has not been established. The object of this study was to determine the prognostic value of one-hour bundle completion in septic shock patients. METHODS: This prospectively collected registry-based, retrospective observational study, between January 2016 and December 2018. A one-hour bundle in septic shock was defined by the serum lactate measurements, blood cultures, administration of antibiotics, and adequate fluid administration within one hour from emergency department admission. Eligible septic shock patients were included in the analysis, and the prognostic abilities of the completion of the one-hour bundle and each item were analyzed. The primary outcome was the 28-day mortality. RESULTS: The study included 381 patients, and the overall 28-day mortality was 24.7%. The overall one-hour bundle completion rate was 11.3%, and each completion rate of serum lactate measurement, blood cultures, administration of antibiotics, and adequate fluid administration were 85.8%, 74.3%, 19.4%, and 48.6%, respectively. On the other hand, overall bundle completion as well as each bundle were not associated with the 28-day mortality except for adequate fluid administration (odds ratio [OR], 0.67 [95% confidence interval (CI), 0.30–1.50]; OR, 1.33 [95% CI, 0.66–2.70]; OR, 1.50 [95% CI 0.85–2.64]; OR, 1.17 [95% CI 0.66–2.07]; and OR, 0.54 [95% CI, 0.34–0.87], respectively). Multivariate logistic regression analysis showed that adequate fluid administration was independently associated with the 28-day mortality (OR, 0.22 [95% CI, 0.09–0.55]; P=0.001). CONCLUSION In this study, most of the one-hour bundle completions were not associated with 28-day mortality. Although adequate fluid administration was associated with the 28-day mortality, multicenter interventional study will be needed to generalize this result.

PURPOSE: Non-benzodiazepine hypnotic drugs (including zolpidem) are associated with an increased risk of suicide and suicidal ideation. Considering the wide usage of zolpidem, this drug should be considered a possible etiology for stupor or coma in any patient exposed to this drug. However, there are no reports on zolpidem blood levels in emergency department patients in Korea. We therefore reviewed the analyzed data of a toxicology laboratory at one university affiliated hospital. METHODS: The sex, age, chief symptoms, suspiciousness of poisoning, and presumption of poison were analyzed from January 2018 to June 2019. The detection frequency and level of zolpidem in the patient blood were compared to the mental changes presented, which is the main consequence of zolpidem. RESULTS: A total of 229 toxicological analyses, requested to a toxicological laboratory at one university affiliated hospital, were reviewed. Among 229 patients, the mean age was 54.3±20.7 years old with 113 women and 116 men. 8.7% of patients have psychiatric illness and 39.7% were poisoned intentionally. The chief symptoms detected were: mental change 55.0%, gastrointestinal 14.4%, cardiovascular 10.5%, focal neurological 7.4%, respiratory 3.5%, none 8.7%, and unknown 0.4%. A request for detailed reports revealed that causative poisons were specified only in 20.1% cases. Zolpidem was detected in 22.3% cases (51/229), with median blood level 1.26 mg/L (interquartile 0.1, 5.06 mg/L) and urine 0.90 mg/L (interquartile 0.11, 5.6 mg/L). Furthermore, zolpidem was more frequently detected in toxicology analysis of patients where mental change was the primary symptom, as compared to other symptoms (32.5% vs. 9.7%, p<0.01). CONCLUSION This study reported the blood level of zolpidem in suspected poisoning patients admitted to the emergency department.

OBJECTIVE: To investigate the accuracy of model-based iterative reconstruction (MIR) for volume measurement of part-solid nodules (PSNs) and solid nodules (SNs) in comparison with filtered back projection (FBP) or hybrid iterative reconstruction (HIR) at various radiation dose settings. MATERIALS AND METHODS: CT scanning was performed for eight different diameters of PSNs and SNs placed in the phantom at five radiation dose levels (120 kVp/100 mAs, 120 kVp/50 mAs, 120 kVp/20 mAs, 120 kVp/10 mAs, and 80 kVp/10 mAs). Each CT scan was reconstructed using FBP, HIR, or MIR with three different image definitions (body routine level 1 [IMR-R1], body soft tissue level 1 [IMR-ST1], and sharp plus level 1 [IMR-SP1]; Philips Healthcare). The SN and PSN volumes including each solid/ground-glass opacity portion were measured semi-automatically, after which absolute percentage measurement errors (APEs) of the measured volumes were calculated. Image noise was calculated to assess the image quality. RESULTS: Across all nodules and dose settings, the APEs were significantly lower in MIR than in FBP and HIR (all p < 0.01). The APEs of the smallest inner solid portion of the PSNs (3 mm) and SNs (3 mm) were the lowest when MIR (IMR-R1 and IMR-ST1) was used for reconstruction for all radiation dose settings. (IMR-R1 and IMR-ST1 at 120 kVp/100 mAs, 1.06 ± 1.36 and 8.75 ± 3.96, p < 0.001; at 120 kVp/50 mAs, 1.95 ± 1.56 and 5.61 ± 0.85, p = 0.002; at 120 kVp/20 mAs, 2.88 ± 3.68 and 5.75 ± 1.95, p = 0.001; at 120 kVp/10 mAs, 5.57 ± 6.26 and 6.32 ± 2.91, p = 0.091; at 80 kVp/10 mAs, 5.84 ± 1.96 and 6.90 ± 3.31, p = 0.632). Image noise was significantly lower in MIR than in FBP and HIR for all radiation dose settings (120 kVp/100 mAs, 3.22 ± 0.66; 120 kVp/50 mAs, 4.19 ± 1.37; 120 kVp/20 mAs, 5.49 ± 1.16; 120 kVp/10 mAs, 6.88 ± 1.91; 80 kVp/10 mAs, 12.49 ± 6.14; all p < 0.001). CONCLUSION: MIR was the most accurate algorithm for volume measurements of both PSNs and SNs in comparison with FBP and HIR at low-dose as well as standard-dose settings. Specifically, MIR was effective in the volume measurement of the smallest PSNs and SNs.
Hominidae ; Humans ; Lung Neoplasms ; Multidetector Computed Tomography ; Noise ; Phantoms, Imaging ; Radiation Dosage ; Thorax ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the accuracy of emphysema volume (EV) and airway measurements (AMs) produced by various iterative reconstruction (IR) algorithms and virtual monoenergetic images (VME) at both low- and standard-dose settings. MATERIALS AND METHODS: Computed tomography (CT) images were obtained on phantom at both low- (30 mAs at 120 kVp) and standard-doses (100 mAs at 120 kVp). Each CT scan was reconstructed using filtered back projection, hybrid IR (iDose4; Philips Healthcare), model-based IR (IMR-R1, IMR-ST1, IMR-SP1; Philips Healthcare), and VME at 70 keV (VME70). The EV of each air column and wall area percentage (WA%) of each airway tube were measured in all algorithms. Absolute percentage measurement errors of EV (APEvol) and AM (APEWA%) were then calculated. RESULTS: Emphysema volume was most accurately measured in IMR-R1 (APEvol in low-dose, 0.053 ± 0.002; APEvol in standard-dose, 0.047 ± 0.003; all p < 0.001) and AM was the most accurate in IMR-SP1 on both low- and standard-doses CT (APEWA% in low-dose, 0.067 ± 0.002; APEWA% in standard-dose, 0.06 ± 0.003; all p < 0.001). There were no significant differences in the APEvol of IMR-R1 between low- and standard-doses (all p > 0.05). VME70 showed a significantly higher APEvol than iDose4, IMR-R1, and IMR-ST1 (all p < 0.004). VME70 also showed a significantly higher APEWA% compared with the other algorithms (all p < 0.001). CONCLUSION: IMR was the most accurate technique for measurement of both EV and airway wall thickness. However, VME70 did not show a significantly better accuracy compared with other algorithms.
Emphysema* ; Tomography, X-Ray Computed

We report a case of disseminated Mycobacterium intracellulare infection in a 31-year-old man who had been diagnosed as having dermatomyositis and systemic lupus erythematosus 3-years prior. The patient developed a left pleural effusion M. intracellulare was repeatedly isolated from the pleural fluid. After antimycobacterial treatment, the patient's pleural effusion resolved, but a left knee joint effusion developed newly and M. intracellulare was cultured from the joint fluid. At present, the patient has been taking antimycobacterial medication for 15 months but his left knee joint fluid remains positive for M. intracellulare. To our knowledge, this is the second reported case of disseminated NTM infection in a non-HIV infected patient in Korea.
Adult ; Arthritis ; Dermatomyositis ; Humans ; Immunocompromised Host ; Joints ; Knee Joint ; Korea ; Lupus Erythematosus, Systemic ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection ; Pleural Effusion