Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.

Viral load and the duration of viral shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are important determinants of the transmission of coronavirus disease 2019.In this study, we examined the effects of viral doses on the lung and spleen of K18-hACE2 transgenic mice by temporal histological and transcriptional analyses. Approximately, 1×105 plaque-forming units (PFU) of SARS-CoV-2 induced strong host responses in the lungs from 2 days post inoculation (dpi) which did not recover until the mice died, whereas responses to the virus were obvious at 5 days, recovering to the basal state by 14 dpi at 1×102 PFU. Further, flow cytometry showed that number of CD8+ T cells continuously increased in 1×102 PFU-virusinfected lungs from 2 dpi, but not in 1×105 PFU-virus-infected lungs. In spleens, responses to the virus were prominent from 2 dpi, and number of B cells was significantly decreased at 1×105PFU; however, 1×102 PFU of virus induced very weak responses from 2 dpi which recovered by 10 dpi. Although the defense responses returned to normal and the mice survived, lung histology showed evidence of fibrosis, suggesting sequelae of SARS-CoV-2 infection. Our findings indicate that specific effectors of the immune response in the lung and spleen were either increased or depleted in response to doses of SARS-CoV-2. This study demonstrated that the response of local and systemic immune effectors to a viral infection varies with viral dose, which either exacerbates the severity of the infection or accelerates its elimination.

Lactase non-persistence (LNP), one of the causes of lactose intolerance, is related to lactase gene associated single nucleotide polymorphisms (SNPs). Since the frequency of LNP varies by ethnic group and country, the research to reveal the presence or absence of LNP for specific people has been conducted worldwide. However, in East Asia, the study of lactase gene associated SNPs have not been sufficiently examined so far using ancient human specimens from archaeological sites. In our study of Joseon period human remains (n=14), we successfully revealed genetic information of lactase gene associated SNPs (rs1679771596, rs41525747, rs4988236, rs4988235, rs41380347, rs869051967, rs145946881 and rs182549), further confirming that as for eight SNPs, the pre-modern Korean people had a lactase non-persistent genotype. Our report contributes to the establishment of LNP associated SNP analysis technique that can be useful in forthcoming studies on human bones and mummy samples from East Asian archaeological sites.

Background: The Omicron variant has become the most prevalent SARS-CoV-2 variant. Omicron is known to induce milder lesions compared to the original Wuhan strain. Fatal infection of the Wuhan strain into the brain has been well documented in COVID-19 mouse models and human COVID-19 cases, but apparent infections into the brain by Omicron have not been reported in human adult cases or animal models. In this study, we investigated whether Omicron could spread to the brain using K18-hACE2 mice susceptible to SARS-CoV-2 infection. Results: K18-hACE2 mice were intranasally infected with 1 × 105 PFU of the original Wuhan strain and the Omicron variant of SARS-CoV-2. A follow-up was conducted 7 days post infection. All Wuhan-infected mice showed > 20% body weight loss, defined as the lethal condition, whereas two out of five Omicron-infected mice (40%) lost > 20% body weight. Histopathological analysis based on H&E staining revealed inflammatory responses in the brains of these two Omicron-infected mice. Immunostaining analysis of viral nucleocapsid protein revealed severe infection of neuron cells in the brains of these two Omicron-infected mice. Lymphoid depletion and apoptosis were observed in the spleen of Omicron-infected mice with brain infection. Conclusion Lethal conditions, such as severe body weight loss and encephalopathy, can occur in Omicron-infected K18-hACE2 mice. Our study reports, for the first time, that Omicron can induce brain infection with lymphoid depletion in the mouse COVID-19 model.

Objective: A prolonged length of stay in the emergency department (EDLOS) is known to be associated with poorer outcomes in critically ill patients. However, this has not been proven in patients who visit the emergency department (ED) due to acute heart failure (AHF). We aimed to find out whether prolonged EDLOS is associated with major in-hospital complications in patients with AHF. Methods: This is a retrospective cohort study of AHF patients who were admitted to intensive care units (ICU) via the ED of a single academic hospital from January 2015 to December 2019. We divided the patients into two groups: EDLOS <24 hours and EDLOS≥24 hours. The primary outcome was major in-hospital complications, which included in-hospital death, application of continuous renal replacement therapy, or extracorporeal membrane oxygenation treatment. Secondary outcomes included in-hospital death, prolonged ICU stay (≥10 days), and prolonged hospital stay (≥14 days) excluding ED stay. Results: A total of 265 patients were enrolled. Of these 163 patients stayed in the ED for over 24 hours. The multivariable logistic analysis demonstrated that EDLOS ≥24 hours was independently associated with major in-hospital complications (odds ratio [OR], 3.296; 95% confidence interval [CI], 1.291-8.413; P=0.013). Analysis of the secondary outcomes showed that EDLOS ≥24 hours was associated with in-hospital death (OR, 2.607; 95% CI, 1.005-6.759; P=0.049) and prolonged hospital stay ≥14 days (OR, 2.458; 95% CI, 1.303-4.636; P=0.006). Conclusion Our study showed that in patients with AHF who visited ED and were admitted to the ICU, prolonged EDLOS was associated with major in-hospital complications.

Purpose: Triage tools play a vital role in classifying the severity of children in emergency departments (EDs). We investigated the association between the Korean Triage and Acuity Scale (KTAS) and severity of dyspnea in the ED. Methods: We conducted a retrospective study of children aged 3-14 years with dyspnea who visited the ED from January 2015 through December 2021. They were divided into severe (KTAS level 1-3) and non-severe (KTAS level 4-5) groups. Between the groups, we compared the clinical characteristics, including age, sex, associated symptoms, vital signs, route of visit, treatment at ED, and outcomes. Results: Among a total of 468 children with dyspnea, 267 and 201 were assigned to the severe and non-severe groups, respectively. The severe group had higher frequencies of fever (21.7% vs. 13.9%; P = 0.031), cough (53.2% vs. 43.3%; P = 0.034), systemic steroids (42.3% vs. 25.9%; P < 0.001), intravenous fluids (47.6% vs. 25.4%; P < 0.001), oxygen therapy (16.5% vs. 6.5%; P = 0.001), inotropics (4.1% vs. 1.0%; P = 0.042), and hospitalization (24.7% vs. 11.9%; P = 0.002). The severe group also showed a higher mean heart rate, respiratory rate, and temperature, and lower mean oxygen saturation (all Ps < 0.001). Among these findings, fever, heart rate, respiratory rate, temperature, intravenous fluids, oxygen therapy, inotropics, and hospitalization remained significantly different between the groups after defining the severe group as a KTAS level 1-2. Conclusion This study shows the association between KTAS and severity of dyspnea in the ED. Therefore, KTAS may reflect not only the initial clinical conditions but also emergency measures and outcomes in children with dyspnea who visit EDs.

Background: As the number of large-scale studies involving multiple organizations producing data has steadily increased, an integrated system for a common interoperable format is needed. In response to the coronavirus disease 2019 (COVID-19) pandemic, a number of global efforts are underway to develop vaccines and therapeutics. We are therefore observing an explosion in the proliferation of COVID-19 data, and interoperability is highly requested in multiple institutions participating simultaneously in COVID-19 pandemic research. Results: In this study, a laboratory information management system (LIMS) approach has been adopted to systemically manage various COVID-19 non-clinical trial data, including mortality, clinical signs, body weight, body temperature, organ weights, viral titer (viral replication and viral RNA), and multiorgan histopathology, from multiple institutions based on a web interface. The main aim of the implemented system is to integrate, standardize, and organize data collected from laboratories in multiple institutes for COVID-19 non-clinical efficacy testings. Six animal biosafety level 3 institutions proved the feasibility of our system. Substantial benefits were shown by maximizing collaborative high-quality non-clinical research. Conclusions This LIMS platform can be used for future outbreaks, leading to accelerated medical product development through the systematic management of extensive data from non-clinical animal studies.

Objective: The frequency of penetrating neck injuries has gradually increased with the development of industry and the rising crime rates. There have been few studies with penetrating neck injuries reported in Korea. Thus, we analyzed clinical factors that could differentiate between superficial and deep injuries in patients with penetrating neck injuries. Methods: We investigated the medical records of 90 patients with penetrating neck injuries who visited the emergency department between January 2010 and March 2020. To identify the degree of injuries, we compared age, sex, onset and arrival time, onset-to-arrival time, initial vital signs, Glasgow Coma Scale, Revised Trauma Score, cause, mechanism, location and number of injuries, anatomical zone, alcohol intake and psychiatric history were classified as early clinical factors. Results: Among 90 patients, 51 had superficial injuries, and 39 had deep injuries. The early clinical factors showing statistically significant differences were the Glasgow Coma Scale, Revised Trauma Score, cause of injury and anatomical zones. As the Glasgow Coma Scale increased by 1 point, deep injuries decreased by 0.807 times compared to superficial injuries. Homicidal injuries were 3.233 times deeper than suicidal injuries. Conclusion If the Glasgow Coma Scale is low or the cause of injury is homicide, the possibility of a deep penetrating injury is high. Therefore, it is important to treat the patient carefully, considering these factors.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

This study performed the forensic anthropological sex estimation of Koreans in a non-metric way by reconstructing three-dimensional (3D) computed tomography (CT) images of skulls. The skull CT images used in this study were 100 (51 males, 49 females), and all CT images were taken with a slice thickness of 0.75 mm and then reconstructed into 3D images using the MIMICS 23.0 program. Using the reconstructed 3D image, measurements were repeated twice. The sex determination was male if the 4 point to 5 point was relatively more in five landmarks, and female if the points of 1 to 2 were relatively more. Results of the study show that, 88 of the 100 cases matched the actual sex. Among the 12 discrepant cases, ten cases were mismatched with the actual sex even though the estimation and repeated estimation readout of sexestimating were the same. Two cases, were “unknown,” showing different sexes in the first and repeated estimations. In conclusion, this study indicated that a forensic anthropological analysis from 3D images provided accurate point information on the landmarks of skulls, showing as high an accuracy as the sex estimation method using real bones. The ten cases of sex mismatch, except the two “Unknown” cases, are considered to be errors that did not consider differences in population groups. In further studies, further establishing a nonmetric, specifically Korean methods to increase the accuracy and reliability of sex estimation is need.