Objective: This study evaluates the association between the initial fibrinogen levels and adverse outcomes in emergency department (ED) patients with primary postpartum hemorrhage (PPH). Methods: This retrospective observational study was performed between January 2004 and December 2021 in the ED of a university-affiliated tertiary referral center. Primary PPH patients with fibrinogen level assessments in the ED were included. Patients were classified into two groups: the adverse outcome group-defined as patients receiving massive transfusion (transfusion of ≥10 units of packed red blood cells within the initial 24 hours), uterine artery embolization or emergency hysterectomy, intensive care unit admission, and in-hospital mortality-and the non-adverse outcome group. Results: Of the 481 patients included in the study, 276 (57.4%) had adverse outcomes. The median fibrinogen level in patients with adverse outcomes was lower than in patients without adverse outcomes-149.5 mg/dL (range, 66.8-228.8) vs. 288.0 mg/dL (range, 215.0-349.0), respectively; P<0.001. The area under the receiver operating characteristic curve of the initial fibrinogen level for adverse outcomes was 0.811 (95% confidence interval, 0.773-0.849; P<0.001). The occurrence of adverse outcomes increased with decreasing fibrinogen levels (P<0.001). When the cutoff value of the initial fibrinogen level was 400 mg/dL, the sensitivity and negative predictive values for predicting adverse outcomes were 98.6% and 84.6%, respectively. When the cutoff value of the initial fibrinogen level was 100 mg/dL, the specificity and positive predictive values were 96.6% and 92.8%, respectively. Conclusion The initial fibrinogen levels on ED admission are associated with adverse outcomes.

Fungi act as important decomposers in the forest environment. They recycle essential nutrients, promote plant growth through mycorrhizal relationships, and act as food for small animals. Samples of 265 indigenous fungal species were collected from Mudeungsan National Park in 2020. These species were identified based on morphological, molecular, and phylogenetic analyses using the internal transcribed spacer (ITS), nuclear large subunit rRNA (LSU), and RNA polymerase II second largest subunit (rpb2) regions. Subsequently, seven species were identified as unrecorded species in Korea: Cordyceps cicadae, Dentocorticium bicolor, Hymenochaete nanospora, Physisporinus crataegi, Rigidoporus piceicola, Russula raoultii, and Scutellinia crinita. This study reveals their detailed macro- and microscopic morphological characteristics with phylogenetic trees to report them as unrecorded species in Korea.

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

Sporulated oocysts from the feces of infected cats with Toxoplasma gondii can cause detrimental disease in both humans and animals. To investigate the prevalence of feral cats that excrete T. gondii oocysts in the feces, we examined fecal samples of 563 feral cats over a 3-year period from 2009 to 2011. Oocysts of T. gondii excreted into the feces were found from 4 of 128 cats in 2009 (3.1%) and one of 228 (0.4%) in 2010 while none of the 207 cats in 2010 were found positive with oocysts in their feces, resulting in an overall prevalence rate of 0.89% (5/563) between 2009 and 2011. Among the 5 cats that tested positive with T. gondii oocysts, 4 of the cats were male and 1 was a female with an average body weight of 0.87 kg. Numerous tissue cysts of 60 μm in diameter with thin (<0.5 μm) cyst walls were found in the brain of one of the 5 cats on necropsy 2 months after the identification of oocysts in the feces. A PCR amplification of the T. gondii-like oocysts in the feces of the positive cats using the primer pairs Tox-5/Tox-8 and Hham34F/Hham3R confirmed the presence of T. gondii oocysts in the feces. This study provides a good indication of the risk assessment of feral cats in the transmission of T. gondii to humans in Korea.
Animals ; Body Weight ; Brain ; Cats ; Feces ; Female ; Humans ; Korea ; Male ; Oocysts ; Polymerase Chain Reaction ; Prevalence ; Risk Assessment ; Toxoplasma

OBJECTIVES: Acceleration plethysmograms (APGs) are obtained by taking the second derivative of photoplethysmograms (PPGs) and are noninvasive circulatory signals related to risk factors for atherosclerosis with age. There has been growing interest in the development of mobile devices to collect and analyze PPG single features for ambulatory health monitoring. The present study aimed to extract a new feature from the morphologies of APG and PPG signals to classify the dominant indices related to the pulsatile volume of blood in tissue according to age. METHODS: Ten APG and 14 PPG indices were simultaneously extracted. All indices were compared via Pearson correlation coefficients (r) and a regression analysis. We introduced a combined index extracted from both the PPG and APG indices defined as the inflection point area plus the d_peak (IPAD). The participants included 93 healthy adults aged 36–86 years with a mean ± standard deviation age of 57.43 ± 11.99 years. RESULTS: The d_peak and age index for the APG indices were significantly correlated with age (r = −0.408, p < 0.0001 and r = 0.296, p = 0.0039, respectively). Only the A1 time for PPG indices was moderately correlated with age (r = −0.247, p = 0.017). The stiffness index, including individual height information, was not related to age (r = −0.031, p = 0.7713). However, the combined IPAD index was significantly more correlated with age (r = 0.56, p < 0.001) than the other indices. CONCLUSIONS: The proposed index outperformed the other 24 indices for evaluating vascular aging. We suggest that the IPAD is a significant factor related to the clinical information embedded in the PPG waveform.
Acceleration* ; Adult ; Aging* ; Atherosclerosis ; Humans ; Photoplethysmography ; Risk Factors ; Vascular Stiffness

The morphological optimization of Trichoderma harzianum was carried out using several surfactants to achieve increased cellulase production. Addition of the surfactants to the culture medium successfully modified the fungal morphology from an aggregated form to a dispersed form. Optimization of the fungal morphology increased cellulase activity up to 177%. The morphologically optimized conditions enhanced the accessibility of the fungus to substrates and thus promoted cellulase production.
Cellulase ; Fungi ; Surface-Active Agents ; Trichoderma*

PURPOSE: Acute pyelonephritis (APN) usually presents as a mild disease. However, it has been shown to cause substantial morbidity and mortality on occasion. Therefore, it is important to distinguish between the complicated and uncomplicated APN. The purpose of this study was to determine the clinical significance of bilateral APN compared with unilateral APN in the emergency department (ED). METHODS: We analyzed the data of 303 consecutive patients with APN who underwent a abdominal computed tomography (CT) examination in the ED from January 2012 to December 2014. We compared the clinical presentation, progress, and outcomes between the unilateral and bilateral APNs that were identified on the CT scan. RESULTS: Of these 303 patients, 110 patients (36.3%) were confirmed as bilateral APN by the CT. The proportion of male was higher in the bilateral APN group (20.0% vs. 10.9%, p=0.029). Moreover, patients in the bilateral group visited the ED post symptom onset (6.5±7.8 vs. 3.6±3.1, p<0.001). However, symptom, sign, laboratory test, and CT findings were not statistically different between the two groups. In addition, severity, resistant pathogen, and outcomes such as occurrence of septic shock, hospital days, and mortality were also not different. CONCLUSION: This study suggests that bilateral APN, as determined by a CT, does not have clinical significance compared with unilateral APN.
Emergency Service, Hospital ; Humans ; Male ; Mortality ; Prognosis* ; Pyelonephritis* ; Shock, Septic ; Tomography, X-Ray Computed

PURPOSE: Deep vein thrombosis (DVT) is a risk factor of pulmonary thromboembolism (PTE), however it is not clear who should be evaluated for a PTE and a DVT at the same time. The purpose of this study is to determine the clinical characteristics of PTE in patients with DVT who visited the emergency department (ED). METHODS: This was a retrospective cohort study of ED patients who visited with DVT and were simultaneously evaluated for a PTE from January 2012 to December 2013. We compared clinical characteristics between non-PTE and PTE patients with confirmed DVT in the ED. RESULTS: Of these 166 patients, 96 patients (57.8%) were confirmed PTE by computed tomography. In multivariate analysis, patients with PTE had more systemic neoplasm (OR 2.03, 95% CI 1.04-3.93, p=0.037) and right heart strain pattern in electrocardiography (OR 5.29, 95% CI 1.71-16.36, p=0.004) than patients without PTE. Femoral DVT was more likely in the non-PTE group (87.1% vs. 65.6%, p=0.002) and popliteal DVT was more likely in the PTE group (62.9% vs. 80.2%, p=0.013). However the number of DVT sites including both femoral and popliteal vein was not statistically different. CONCLUSION: In patients with systemic neoplasm or right heart strain patterns in electrocardiography, simultaneous PTE evaluation may be required in patients with DVT.
Cohort Studies ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart ; Humans ; Multidetector Computed Tomography ; Multivariate Analysis ; Popliteal Vein ; Pulmonary Embolism* ; Retrospective Studies ; Risk Factors ; Thromboembolism ; Venous Thrombosis*

Diabetes and impaired fasting glucose are associated with incidence of cerebro-/cardio-vascular diseases. This study hypothesized that fasting glycemic status may reflect cerebrovascular risk in non-diabetic Koreans. Fasting glycemic status, lipid profiles, oxidative stress, and inflammation markers were measured in non-diabetic subjects (healthy controls, n = 112 and stroke n = 41). Systolic blood pressure, fasting glucose, glycated hemoglobin (HbA1C), triglycerides, high sensitivity C-reactive protein (hs-CPR), interleukin-6, and tumor necrosis factor-alpha were higher, and high density lipoprotein (HDL)-cholesterols were lower in patients with stroke than healthy controls. Fasting glucose positively correlated with hs-CRP, interleukin-6, tumor necrosis factor-alpha, oxidized low density lipoprotein (LDL) and malondialdehyde. The significances continued or at least turned to a trend after adjustments for confounding factors. Multiple regression analyses revealed that fasting glucose was mainly associated with cerebrovascular risk (beta'-coefficient = 0.284, p < 0.0001) together with age, systolic blood pressure, total cholesterol, hs-CRP, body mass index, dietary poly unsaturated fatty acid/saturated fatty acid (PUFA/SFA), and HbA1C (r2 = 0.634, p = 0.044). The subjects were subdivided by their fasting glucose levels [normal fasting glucose: 70-99 mg/dL, n = 91 [NFG-control] and n = 27 [NFG-stroke]; higher fasting glucose: 100-125 mg/dL, n = 21 [HFG-control] and n = 14 [HFG-stroke]). In both controls and stroke patients, HFG groups show higher triglyceride, total- and LDL-cholesterol and lower HDL-cholesterol than NFG groups. Control-HFG group showed significantly higher levels of oxidative stress and inflammation than control-NFG group. Stroke-HFG group also showed significantly higher inflammatory levels than stroke-NFG group, moreover the highest among the groups. Additionally, stroke-NFG group consumed higher PUFA/SFA than stroke-HFG group. Fasting glucose may be a useful indicator for cerebrovascular risk in non-diabetic individuals which may be mediated by oxidative stress and inflammation status.
Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Cholesterol ; Fasting* ; Glucose* ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Inflammation* ; Interleukin-6 ; Lipoproteins ; Malondialdehyde ; Oxidative Stress* ; Stroke ; Triglycerides ; Tumor Necrosis Factor-alpha

OBJECTIVES: Recent studies have emphasized the potential information embedded in peripheral fingertip photoplethysmogram (PPG) signals for the assessment of arterial wall stiffening during aging. For the discrimination of arterial stiffness with age, the brachial-ankle pulse wave velocity (baPWV) has been widely used in clinical applications. The second derivative of the PPG (acceleration photoplethysmogram [APG]) has been reported to correlate with the presence of atherosclerotic disorders. In this study, we investigated the association among age, the baPWV, and the APG and found a new aging index reflecting arterial stiffness for a healthcare device. METHODS: The APG and the baPWV were simultaneously applied to assess the accuracy of the APG in measuring arterial stiffness in association with age. A preamplifier and motion artifact removal algorithm were newly developed to obtain a high quality PPG signal. In total, 168 subjects with a mean +/- SD age of 58.1 +/- 12.6 years were followed for two months to obtain a set of complete data using baPWV and APG analysis. RESULTS: The baPWV and the B ratio of the APG indices were correlated significantly with age (r = 0.6685, p < 0.0001 and r = -0.4025, p < 0.0001, respectively). A regression analysis revealed that the c and d peaks were independent of age (r = -0.3553, p < 0.0001 and r = -0.3191, p < 0.0001, respectively). CONCLUSIONS: We determined the B ratio, which represents an improved aging index and suggest that the APG may provide qualitatively similar information for arterial stiffness.
Aging* ; Artifacts ; Delivery of Health Care* ; Discrimination (Psychology) ; Photoplethysmography* ; Pulse Wave Analysis* ; Vascular Stiffness