This case report details a 23-year-old female with Down syndrome who suffered from acute respiratory failure due to severe obstructive sleep apnea syndrome and accompanying pulmonary arterial hypertension (PAH). The patient presented with obesity, adenotonsillar hypertrophy, and craniofacial anomalies commonly seen in Down syndrome, predisposing her to sleep-disordered breathing. Upon intensive care unit admission, she exhibited cardiomegaly, bilateral pulmonary edema, and right ventricular dysfunction. Polysomnography revealed severe sleep apnea with an apnea-hypopnea index of 108.7/hr. Treatment modalities included noninvasive positive pressure ventilation, diuretics, antibiotics, and positive airway pressure (PAP) devices to manage hypercapnia, pulmonary edema, and sleep apnea. PAH, a recognized complication of untreated sleep apnea, contributed to right ventricular dysfunction. A multidisciplinary approach was vital, with long-term management centered on continuous PAP therapy and comprehensive obesity management. This case underscores the intricate interplay between Down syndrome, sleep apnea, and PAH, highlighting the significance of early recognition and coordinated intervention in individuals with Down syndrome to enhance overall outcomes and quality of life.

Background: There are many models for predicting diabetes mellitus (DM), but their clinical implication remains vague. Therefore, we aimed to create various DM prediction models using easily accessible health screening test parameters. Methods: Two sets of variables were used to develop eight DM prediction models. One set comprised 62 easily accessible examination results of commonly used variables from a tertiary university hospital. The second set comprised 27 of the 62 variables included in the national routine health checkups. Gradient boosting and random forest algorithms were used to develop the models. Internal validation was performed using the stratified 10-fold cross-validation method. Results: The area under the receiver operating characteristic curve (ROC-AUC) for the 62-variable DM model making 12-month predictions for subjects without diabetes was the largest (0.928) among those of the eight DM prediction models. The ROC-AUC dropped by more than 0.04 when training with the simplified 27-variable set but still showed fairly good performance with ROC-AUCs between 0.842 and 0.880. The accuracy was up to 11.5% higher (from 0.807 to 0.714) when fasting glucose was included. Conclusion We created easily applicable diabetes prediction models that deliver good performance using parameters commonly assessed during tertiary university hospital and national routine health checkups. We plan to perform prospective external validation, hoping that the developed DM prediction models will be widely used in clinical practice.

Silica nanoparticles, which are applicable in many industrial fields, have been reported to induce cellular changes such as cytotoxicity in various cells and fibrosis in lungs. Because the immune system is the primary targeting organ reacting to internalized exogenous nanoparticles, we tried to figure out the immunostimulatory effect of silica nanoparticles in macrophages using differently sized silica nanoparticles. Using U937 cells we assessed cytotoxicity by CCK-8 assay, ROS generation by CM-H2DCFDA, intracellular Ca++ levels by staining with Fluo4-AM and IL-8 production by ELISA. At non-toxic concentration, the intracellular Ca++ level has increased immediately after exposure to 15 nm particles, not to larger particles. ROS generation was detected significantly in response to 15 nm particles. However, all three different sizes of silica nanoparticles induced IL-8 production. 15 nm silica nanoparticles are more stimulatory than larger particles in cytotoxicity, intracellular Ca++ increase and ROS generation. But IL-8 production was induced to same levels with 50 or 100 nm particles. Therefore, IL-8 production induced by silica nanoparticles may be dependent on other mechanisms rather than intracellular Ca++ increase and ROS generation.
Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Immune System ; Interleukin-8 ; Lung ; Macrophages ; Nanoparticles ; Silicon Dioxide ; Sincalide ; U937 Cells

In modern medicine the resistance to conventional antibiotics is becoming a serious concern due to high instances of mortality. Several metallic nanoparticles are suggested as promising anti-microbial agents against multidrug-resistant bacteria and some viruses. Among the nanoparticles mentioned, we review the recent finding which demonstrate the impact of silver nanoparticles on antimicrobial activities and recommend them as a potential candidate for restraining infections.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria ; History, Modern 1601- ; Metal Nanoparticles ; Nanoparticles ; Silver

PURPOSE: This study was conducted in order to analyze the dietary habits and food intake status according to the prevalence of depression in adults. METHODS: A total of 496 subjects, 224 men and 272 women aged 50 to 100 years were recruited from more than 13 cities in Korea. The questionnaires consisted of general characteristics, dietary life status, food intakes, the mean mini dietary assessment and satisfaction with food-related life questionnaire of the subjects to ask according to the degree of depression. Depression status was evaluated according to the Korean form of the Geriatric Depression Scale (K-GDS). RESULTS: All subjects were divided into depression or normal groups; the prevalence of depression was 13.8% (male) and 23.9% (female). People aged 65 or older were more likely to have higher prevalence of depression and to be bereaved. People in the depression group had poor appetite, almost never dined-out, and ate alone. The food intake of miscellaneous cereals, beans, tofu, chicken/duck meat, cabbage, carrot/amber, fungi, apple, pear, strawberry, grapes, and banana was significantly higher in the normal group compared with the depression group. In particular, significantly higher intake of vegetables and fruits was observed in the normal group. In addition, subjects in the depression group ate more fatty meat and were more dissatisfied with food-related life than those in the normal group. CONCLUSION: The results of this study imply that the prevalence of depression may affect the dietary habits, food intake, and dietary behaviors in the older adult population.
Adult* ; Appetite ; Brassica ; Edible Grain ; Depression* ; Eating ; Fabaceae ; Female ; Food Habits* ; Fragaria ; Fruit ; Fungi ; Humans ; Korea ; Male ; Meat ; Musa ; Prevalence ; Pyrus ; Surveys and Questionnaires ; Soy Foods ; Vegetables ; Vitis

Phagocytosis or endocytosis by macrophages is critical to the uptake of fine particles, including nanoparticles, in order to initiate toxic effects in cells. Here, our data enhance the understanding of the process of internalization of silver nanoparticles by macrophages. When macrophages were pre-treated with inhibitors to phagocytosis, caveolin-mediated endocytosis, or clathrin-mediated endocytosis, prior to exposure to silver nanoparticles, Interleukin-8 (IL-8) production was inhibited. Although cell death was not reduced, the inflammatory response by macrophages was compromised by phagocytosis and endocytosis inhibitors.
Cell Line ; Cell Survival/drug effects ; Endocytosis/*physiology ; Humans ; Interleukin-8/*metabolism ; Macrophages/drug effects/*metabolism ; Metal Nanoparticles/*chemistry ; Phagocytosis/*physiology ; Silver/*chemistry/pharmacology

Background: The coronavirus disease 2019 (COVID-19) has escalated to be a global threat to public health. Analysis of the use of radiology resources may render us insight regarding the public health behavior during pandemic. We measured the influence COVID-19 had on the use of radiology resources in terms of the number of examinations performed, and turnaround time for portable radiography. Methods: This study was conducted at a tertiary hospital located in area where the prevalence of COVID-19 infection was low (0.01%). We compared the number of radiology examinations 1) before pandemic (in 2019) vs. during peak of pandemic (January to March 2020), and 2) before pandemic vs. after the peak of pandemic (April to June 2020) via t-tests. We repeated similar analyses for subgroups as follows: gender, age, department (outpatient, inpatient, emergency, screening), body parts, and modality. We also performed a survey of radiologic technologists regarding the turnaround time and rate-limiting step of portable radiography for patients with and without suspicion or confirmation of COVID-19. Results: Although not statistically significant, the daily number of examinations during the peak of pandemic decreased by 9 percentage points (2,638 vs. 2,413; difference [95% CI], −225 [−489, 38]; P = 0.094). The percentage change was especially notable for children, emergency, and screening department (25, 19, and 44 percentage points, respectively). After the peak of the pandemic, the number of examinations increased back to near the prepandemic level (2,638 vs. 2,588; −50 [−317, 218]; P = 0.71). The turnaround time for portable radiography tended to be longer for patients with suspicion or confirmation of COVID-19, with donning personal protective equipment being the major rate-limiting step. Conclusion The number of examinations decreased during the pandemic, reflecting the tendency of the public to refrain from seeking medical care even in a community of low infection risk. Nevertheless, burden of healthcare providers may not have decreased as much, considering longer turnaround time required for COVID-19 related examinations.

Objective: We compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization. Materials and Methods: A total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups. Results: In the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively (p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable. Conclusion The use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.