CRISPR-Cas9 and beyond: identifying target genes for developing disease-resistant plants

Throughout the history of crop domestication, desirable traits have been selected in agricultural products. However, such selection often leads to crops and vegetables with weaker vitality and viability than their wild ancestors when exposed to adverse environmental conditions. Considering the increasing human population and climate change challenges, it is crucial to enhance crop quality and quantity. Accordingly, the identification and utilization of diverse genetic resources are imperative for developing disease-resistant plants that can withstand unexpected epidemics of plant diseases. In this review, we provide a brief overview of recent progress in genome-editing technologies, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (Cas9) technologies. In particular, we classify disease-resistant mutants of Arabidopsis thaliana and several crop plants based on the roles or functions of the mutated genes in plant immunity and suggest potential target genes for molecular breeding of genome-edited disease-resistant plants. Genome-editing technologies are resilient tools for sustainable development and promising solutions for coping with climate change and population increases.

Patient-physician interaction education in Korea: a systematic review

Patient-physician interaction (PPI) is an important area in medical education, but in-depth discussions on the content of the outcome of patient-doctor education are rare. Therefore, in this study, we will systematically analyze the research on PPI education in Korea. In this study, papers searched with keywords related to PPI education from Korea's academic journal service were targeted according to a systematic literature analysis method. The scope of the study was to include papers published in academic journals that are candidates for Korea Citation Index registration, excluding dissertations, research reports, posters, conference presentations, books, and internet materials. The content included papers targeting medical education and medical school students was set as the range. As a result of the analysis, although communication between PPI has many positive effects in the PPI in medical education at medical schools, obstacles do occur, and various ways to overcome them were suggested. Therefore, although medical interview training between patients and doctors in medical schools is necessary, it was analyzed as being based on overseas research or lacking in specific content. The core of PPI education appears to be medical interviews, and it seems necessary to discuss whether empathy or patient-centered medical care are appropriate as the main principles of PPI education in Korea. Therefore, education on the patient-doctor relationship is an important element in medical humanities and medical humanities education, and it is expected that research and education on this will progress more actively.

Examination of medical students' opinions on multimedia learning materials according to social cues: focusing on sound principles

PURPOSE

Although interest in various forms of learning media is increasing due to the coronavirus disease 2019 (COVID-19) pandemic there is relatively little research on influencing student motivation by intervening in cognitive processing. The purpose of this study was to present the optimal form of learning materials provided to medical students.

METHODS

This study provided learning materials in class at a level according to social cues (script, video [artificial intelligence (AI) voice], video [professor voice]) based on the principle of voices among the principles of personalization, voices, image, and embodiment of social cues in multimedia learning, and surveyed students' opinions.

RESULTS

There was no statistically significant difference according to social clues in satisfaction and learning help, but both appeared in the order of silent videos containing the professor's voice, followed by videos containing the AI voice.

CONCLUSION

This study is significant in that there is no research on the impact of student motivation on the provision of learning materials for medical school education in Korea, and we hope that it will help provide learning materials for self-directed learning of medical students in the post-COVID-19.

Improved survival in COVID-19 related sepsis and ARDS treated with a unique "triple therapy" including therapeutic plasma exchange: A single center retrospective analysis

BACKGROUND

Throughout the COVID-19 pandemic, the mortality of critically ill patients remained high. Our group developed a treatment regimen targeting sepsis and ARDS which we labeled "triple therapy" consisting of (1) corticosteroids, (2) therapeutic plasma exchange (TPE), and (3) timely intubation with lung protective ventilation. Our propensity analysis assesses the impact of triple therapy on survival in COVID-19 patients with sepsis and ARDS.

METHODS

Retrospective propensity analysis comparing triple therapy to no triple therapy in adult critically ill COVID-19 patients admitted to the Intensive Care Unit at Lexington Medical Center from 1 March 2020 through 31 October 2021.

RESULTS

Eight hundred and fifty-one patients were admitted with COVID-19 and 53 clinical and laboratory variables were analyzed. Multivariable analysis revealed that triple therapy was associated with increased survival (OR: 1.91; P = .008). Two propensity score-adjusted models demonstrated an increased likelihood of survival in patients receiving triple therapy. Patients with thrombocytopenia were among those most likely to experience increased survival if they received early triple therapy. Decreased survival was observed with endotracheal intubation ≥7 days from hospital admission (P < .001) and there was a trend toward decreased survival if TPE was initiated ≥6 days from hospital admission (P = .091).

CONCLUSION

Our analysis shows that early triple therapy, defined as high-dose methylprednisolone, TPE, and timely invasive mechanical ventilation within the first 96 hours of admission, may improve survival in critically ill septic patients with ARDS secondary to COVID-19 infection. Further studies are needed to define specific phenotypes and characteristics that will identify those patients most likely to benefit.

Vacancies in growing habitats promote the evolution of cooperation

We study evolutionary game dynamics in a growing habitat with vacancies. Fitness is determined by the global effect of the environment and a local prisoner's dilemma among neighbors. We study population growth on a one-dimensional lattice and analyze how the environment affects evolutionary competition. As the environment becomes harsh, an absorbing phase transition from growing populations to extinction occurs. The transition point depends on which strategies are present in the population. In particular, we find a 'cooperative window' in parameter space, where only cooperators can survive. A mutant defector in a cooperative community might briefly proliferate, but over time naturally occurring vacancies separate cooperators from defectors, thereby driving defectors to extinction. Our model reveals that vacancies provide a strong boost for cooperation by spatial selection.

Mortality Risk Factors in Pediatric Onco-Critical Care Patients and Machine Learning Derived Early Onco-Critical Care Phenotypes in a Retrospective Cohort

OBJECTIVES

To use supervised and unsupervised statistical methodology to determine risk factors associated with mortality in critically ill pediatric oncology patients to identify patient phenotypes of interest for future prospective study.

DESIGN

This retrospective cohort study included nonsurgical pediatric critical care admissions from January 2017 to December 2018. We determined the prevalence of multiple organ failure (MOF), ICU mortality, and associated factors. Consensus k-means clustering analysis was performed using 35 bedside admission variables for early, onco-critical care phenotype development.

SETTING

Single critical care unit in a subspeciality pediatric hospital.

INTERVENTION

None.

PATIENTS

There were 364 critical care admissions in 324 patients with underlying malignancy, hematopoietic cell transplant, or immunodeficiency reviewed.

MEASUREMENTS

Prevalence of multiple organ failure, ICU mortality, determination of early onco-critical care phenotypes.

MAIN RESULTS

ICU mortality was 5.2% and was increased in those with MOF (18.4% MOF, 1.7% single organ failure [SOF], 0.6% no organ failure; p ≤ 0.0001). Prevalence of MOF was 23.9%. Significantly increased ICU mortality risk was associated with day 1 MOF (hazards ratio [HR] 2.27; 95% CI, 1.10-6.82; p = 0.03), MOF during ICU admission (HR 4.16; 95% CI, 1.09-15.86; p = 0.037), and with invasive mechanical ventilation requirement (IMV; HR 5.12; 95% CI, 1.31-19.94; p = 0.018). Four phenotypes were derived (PedOnc1-4). PedOnc1 and 2 represented patient groups with low mortality and SOF. PedOnc3 was enriched in patients with sepsis and MOF with mortality associated with liver and renal dysfunction. PedOnc4 had the highest frequency of ICU mortality and MOF characterized by acute respiratory failure requiring invasive mechanical ventilation at admission with neurologic dysfunction and/or severe sepsis. Notably, most of the mortality in PedOnc4 was early (i.e., within 72 hr of ICU admission).

CONCLUSIONS

Mortality was lower than previously reported in critically ill pediatric oncology patients and was associated with MOF and IMV. These findings were further validated and expanded by the four derived nonsynonymous computable phenotypes. Of particular interest for future prospective validation and correlative biological study was the PedOnc4 phenotype, which was composed of patients with hypoxic respiratory failure requiring IMV with sepsis and/or neurologic dysfunction at ICU admission.

Patterns and Longitudinal Changes in The Practice of Breast Cancer Radiotherapy in Korea: Korean Radiation Oncology Group 22-01

PURPOSE/OBJECTIVE(S)

To analyze contemporary practice patterns in breast cancer radiotherapy (RT) and to assess longitudinal changes therein over 5 years in Korea.

MATERIALS/METHODS

A nationwide survey was conducted among board-certified radiation oncologists in Korea by the Division for Breast Cancer of the Korean Radiation Oncology Group in March 2022. The survey consisted of 44 questions related to six domains: hypofractionated (HypoFx) whole breast RT, accelerated partial breast RT (APBI), regional nodal irradiation (RNI), RT for ductal carcinoma in situ (DCIS), postmastectomy RT (PMRT), and tumor bed boost.

RESULTS

In total, 70 radiation oncologists from 61 of 101 (60%) institutions participated in the survey. HypoFx RT was used by 62 respondents (89%), which has significantly increased from 36% in 2017. The HypoFx RT was commonly administered at 40-42.5 Gy in 15-16 fractions. APBI was used by 12 respondents (17%), which has increased from 5% in 2017. The use of RNI did not change significantly: ≥ pN2 (6%), ≥ pN1 (33%), and ≥ pN1 with pathological risk factors (61%). However, the indications for use of internal mammary lymph node (IMN) irradiation have expanded. In particular, the rates of routine treatment of IMN (11% from 6% in 2017) and treatment in cases of ≥ pN2 (27% from 14% in 2017) have doubled; however, the rate of treatment for only IMN involvement, identified on imaging, has decreased to 31% from 47% in 2017. With regard to DCIS, the use of hypoFx RT increased to 75% from 25%, and the rate of omission on of RT after breast-conserving surgery decreased to 38% from 48% in 2017. The use of hypoFx RT for PMRT also increased to 36% from 8% in 2017.

CONCLUSION

The adoption of HypoFx RT after breast-conserving surgery in invasive breast cancer and DCIS has increased significantly, whereas that for PMRT has increased moderately, compared to 2017. Further studies are required to determine the optimal use of RNI.

Spexin-based galanin receptor 2 agonist improves renal injury in mice with type 2 diabetes

The spexin-based GALR2 agonist (NS200) is a novel drug, which has shown antidepressant and anxiolytic action in a recent experimental study. In this study, we investigated the effects of NS200 on renal injury in an animal model of type 2 diabetes. Eight-week-old diabetic db/db mice were administered NS200 for 12 weeks. NS200 was intraperitoneally administered at a dose of 1.0 mg/kg/day. Metabolic parameters and structural and molecular changes in the kidneys were compared among the three groups: non-diabetic db/m control, db/db mice, and NS200-treated db/db mice. In db/db mice, NS200 administration did not impact the body weight, food and water intake, urinary volume, fasting blood glucose level, or HbA1c levels. Insulin and glucose tolerance were also unaffected by NS200 treatment. However, NS200 improved urinary albumin excretion and glomerulosclerosis in diabetic kidneys. Activation of TGFβ1 and insulin signaling pathways, such as PI3 K /AKT/ERK, were inhibited by NS200. In conclusion, a spexin-based GALR2 agonist attenuated diabetic nephropathy by alleviating renal fibrosis in mice with type 2 diabetes. Spexin-based GALR2 agonists have considerable potential as novel treatment agents in diabetic nephropathy.

Hyperferritinemic sepsis, macrophage activation syndrome, and mortality in a pediatric research network: a causal inference analysis

BACKGROUND

One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network's objective was to obtain rationale for designing anti-inflammatory clinical trials targeting hyperferritinemic sepsis.

METHODS

We assessed differences in 32 cytokines, immune depression (low whole blood ex vivo TNF response to endotoxin) and thrombotic microangiopathy (low ADAMTS13 activity) biomarkers, seven viral DNAemias, and macrophage activation syndrome (MAS) defined by combined hepatobiliary dysfunction and disseminated intravascular coagulation, and mortality in 117 children with hyperferritinemic sepsis (ferritin level > 500 ng/mL) compared to 280 children with sepsis without hyperferritinemia. Causal inference analysis of these 41 variables, MAS, and mortality was performed.

RESULTS

Mortality was increased in children with hyperferritinemic sepsis (27/117, 23% vs 16/280, 5.7%; Odds Ratio = 4.85, 95% CI [2.55-9.60]; z = 4.728; P-value < 0.0001). Hyperferritinemic sepsis had higher C-reactive protein, sCD163, IL-22, IL-18, IL-18 binding protein, MIG/CXCL9, IL-1β, IL-6, IL-8, IL-10, IL-17a, IFN-γ, IP10/CXCL10, MCP-1/CCL2, MIP-1α, MIP-1β, TNF, MCP-3, IL-2RA (sCD25), IL-16, M-CSF, and SCF levels; lower ADAMTS13 activity, sFasL, whole blood ex vivo TNF response to endotoxin, and TRAIL levels; more Adenovirus, BK virus, and multiple virus DNAemias; and more MAS (P-value < 0.05). Among these variables, only MCP-1/CCL2 (the monocyte chemoattractant protein), MAS, and ferritin levels were directly causally associated with mortality. MCP-1/CCL2 and hyperferritinemia showed direct causal association with depressed ex vivo whole blood TNF response to endotoxin. MCP-1/CCL2 was a mediator of MAS. MCP-1/CCL2 and MAS were mediators of hyperferritinemia.

CONCLUSIONS

These findings establish hyperferritinemic sepsis as a high-risk condition characterized by increased cytokinemia, viral DNAemia, thrombotic microangiopathy, immune depression, macrophage activation syndrome, and death. The causal analysis provides rationale for designing anti-inflammatory trials that reduce macrophage activation to improve survival and enhance infection clearance in pediatric hyperferritinemic sepsis.

The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial

BACKGROUND

While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored.

OBJECTIVE

In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress.

METHODS

We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period.

RESULTS

After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=-0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period.

CONCLUSIONS

Engagement in a mobile app-based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481.

Emergence of Inequality in Income and Wealth Dynamics

Increasing wealth inequality is a significant global issue that demands attention. While the distribution of wealth varies across countries based on their economic stages, there is a universal trend observed in the distribution function. Typically, regions with lower wealth values exhibit an exponential distribution, while regions with higher wealth values demonstrate a power-law distribution. In this review, we introduce measures that effectively capture wealth inequality and examine wealth distribution functions within the wealth exchange model. Drawing inspiration from the field of econophysics, wealth exchange resulting from economic activities is likened to a kinetic model, where molecules collide and exchange energy. Within this framework, two agents exchange a specific amount of wealth. As we delve into the analysis, we investigate the impact of various factors such as tax collection, debt allowance, and savings on the wealth distribution function when wealth is exchanged. These factors play a crucial role in shaping the dynamics of wealth distribution.

Clinical Sensitivity of the (1-3)-β-D-glucan Test for Predicting Candidemia

The sensitivity of the (1-3)-β-D-glucan (BDG) diagnostic test for candidemia varies in different clinical settings, and its usefulness in early diagnosis of candidemia is suboptimal. We evaluated the sensitivity of the test for early candidemia prediction. All adult patients with culture-proven candidemia who underwent a serum Goldstream Fungus (1-3)-β-D-Glucan Test within seven days prior to candidemia onset at a tertiary referral hospital between January 2017 and May 2021 were included. Any-positive BDG results within seven days prior to candidemia onset were obtained in 38 out of 93 (40.9%) patients. The positive rate increased when the test was performed near the day of candidemia onset (P=0.04) but reached only 52% on the day of candidemia onset. We observed no significant differences between BDG-positive and -negative groups in terms of underlying disease, risk factors for candidemia, clinical presentation, origin of candidemia, and 30-day mortality. Candida albicans was significantly associated with positive BDG results than with all-negative BDG results (P=0.04). The Goldstream BDG test is unreliable for candidemia prediction because of its low sensitivity. Negative BDG results in patients with a high risk of invasive candidiasis should be interpreted with caution.

Invasion and interaction determine population composition in an open evolving ecological system

It is well-known that interactions between species determine the population composition in an ecosystem. Conventional studies have focused on fixed population structures to reveal how interactions shape population compositions. However, interaction structures are not fixed but change over time due to invasions. Thus, invasion and interaction play an important role in shaping communities. Despite its importance, however, the interplay between invasion and interaction has not been well explored. Here, we investigate how invasion affects the population composition with interactions in open evolving ecological systems considering generalized Lotka-Volterra-type dynamics. Our results show that the system has two distinct regimes. One is characterized by low diversity with abrupt changes of dominant species in time, appearing when the interaction between species is strong and invasion slowly occurs. On the other hand, frequent invasions can induce higher diversity with slow changes in abundances despite strong interactions. It is because invasion happens before the system reaches its equilibrium, which drags the system from its equilibrium all the time. All species have similar abundances in this regime, which implies that fast invasion induces regime shift. Therefore, whether invasion or interaction dominates determines the population composition.

Prediction of Amyloid β-Positivity with both MRI Parameters and Cognitive Function Using Machine Learning

Purpose

To investigate the MRI markers for the prediction of amyloid β (Aβ)-positivity in mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to evaluate the differences in MRI markers between Aβ-positive (Aβ [+]) and -negative groups using the machine learning (ML) method.

Materials and Methods

This study included 139 patients with MCI and AD who underwent amyloid PET-CT and brain MRI. Patients were divided into Aβ (+) (n = 84) and Aβ-negative (n = 55) groups. Visual analysis was performed with the Fazekas scale of white matter hyperintensity (WMH) and cerebral microbleeds (CMB) scores. The WMH volume and regional brain volume were quantitatively measured. The multivariable logistic regression and ML using support vector machine, and logistic regression were used to identify the best MRI predictors of Aβ-positivity.

Results

The Fazekas scale of WMH (p = 0.02) and CMB scores (p = 0.04) were higher in Aβ (+). The volumes of hippocampus, entorhinal cortex, and precuneus were smaller in Aβ (+) (p < 0.05). The third ventricle volume was larger in Aβ (+) (p = 0.002). The logistic regression of ML showed a good accuracy (81.1%) with mini-mental state examination (MMSE) and regional brain volumes.

Conclusion

The application of ML using the MMSE, third ventricle, and hippocampal volume is helpful in predicting Aβ-positivity with a good accuracy.

Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes

BACKGROUND

Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes.

OBJECTIVE

To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes.

MATERIALS AND METHODS

For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen.

RESULTS

The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group.

CONCLUSION

Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.

Evaluation research in Korean medical education: a systematic review

The purpose of this study aims to analyze research trends related to 'evaluation' in Korean medical education through a systematic review. This study used a systematic review method, which is a research methodology for research trends and 'literature analysis.' Researchers searched the Korean journal literature published until the end of December 2020 in the Korean research database with keywords related to medicine and evaluation. Thus, 5,205 cases were identified. Based on these data, 143 papers were selected through a logical screening process, requiring 1 month to complete the data search and analysis process. In terms of publications, medical journals overwhelmingly outnumbered nonmedical journals until 2015; however, after 2016, the number of papers published in nonmedical journals increased, and the number of published papers was similar to that of medical journals. In terms of evaluation-related research, research on student and program evaluations has been very active compared to that on accreditation. As the number of evaluation studies has gradually decreased over the past 10 years, preparing a plan to revitalize them in Korean medical education is necessary. Considering that the role of evaluation in education has been emphasized in recent years, research on reestablishing the concept of evaluation; developing evaluation indicators; analyzing the status of student evaluation, program evaluation, and accreditation; and deriving measures to improve medical education through evaluation is required.

The relationship between electronic health literacy and individual factors among adults with chronic pain: A cross-sectional study

Introduction: Chronic pain requires individuals to develop self-management skills that rely on health literacy and, more recently, eHealth literacy. Very few studies have investigated potential predictors of eHealth literacy in chronic pain patients. Therefore, the purpose of this study is to explore potential predictors of eHealth literacy among individual characteristics and pain-related clinical factors, as a preliminary step to understanding the multi-variable relationships that could be examined in a larger study. Methods: A cross-sectional online survey was distributed to adults living in the United States with various chronic pain conditions using Amazon’s Mechanical Turk. A convenience sample of 196 participants was recruited. The independent variables of interest regarding their relationship with eHealth literacy (dependent variable) included demographics, health literacy, chronic pain severity, pain attitudes and coping skills. Chi square tests of association, and independent samples t-tests were used to examine the bivariate relationships. Results: The majority of the sample suffered from chronic pain for more than 2 years with 48% suffering from chronic back pain. Most of the sample (n=184, 93.9%) had high eHealth literacy. Significant relationships were found between eHealth literacy and the following variables: marital status, education level, and age, as well as health literacy, chronic pain interference with activities and chronic pain attitudes. These warrant further exploration in a larger study using logistic regression. Conclusions: our findings provide new information on the relationship between eHealth literacy levels, pain-related individual factors such as attitudes toward pain, and clinical outcomes, i.e., pain interference with physical and psychological function. Although further research is needed to investigate eHealth literacy predictors and mediators, these findings promote the evidence-based development and evaluation of interventions enhancing eHealth literacy skills, as well as self-management skills of chronic pain patients.

A study on the mental health of students at a medical school during COVID-19 outbreak: a retrospective study

Background

In this study, the degree of anxiety, depression, and stress caused by coronavirus disease 2019 (COVID-19) was identified, as well as the need for psychological prevention measures among medical students in the Daegu region that was designated the first special disaster area due to the spread of COVID-19.

Methods

The subjects of this study were 318 medical students in Daegu who voluntarily participated in an online test using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised Korean version. As a result of the test, risk students received immediate telephone counseling, and the effect of this telephone counseling was analyzed.

Results

There were no differences in depression, anxiety, or stress according to gender and grade. As a result of immediate telephone counseling for risk students, significant differences were found in depression, anxiety, and stress, and the counseling was found to be effective.

Conclusion

For medical students who are easily exposed to stress, the importance of psychological prevention measures and effectiveness of non-face-to-face counseling should be recognized. In the field of medical education, we must do our best to build a system that can be used immediately at the appropriate time for these programs.

Exploring medical students' perception of non-face-to-face theory and face-to-face laboratory classes during COVID-19 pandemic: focusing on anatomy course

PURPOSE

This study investigated students' perceptions of non-face-to-face theory classes and face-to-face laboratory classes conducted in anatomy courses at medical schools during the coronavirus disease 2019 pandemic.

METHODS

This study utilized a questionnaire to assess self-reported academic achievement level, satisfaction with non-face-to-face theory classes, satisfaction with face-to-face laboratory classes, and self-directed learning level, and conducted difference verification and regression analysis for 51 students who took anatomy courses from the fall semester of 2020 to the spring semester of 2021.

RESULTS

The group with a high self-reported academic achievement level was more satisfied with the non-face-to-face theory classes than the group with a low self-reported academic achievement level. The group with a high self-reported academic achievement level had a higher self-directed learning level than the group with a low self-reported academic achievement level. In addition, it was found that the higher the self-directed learning level, the higher the satisfaction with non-face-to-face theory classes.

CONCLUSION

These results suggest that to enhance satisfaction with non-face-to-face theory classes in an anatomy course, a favorable class environment that can increase the self-directed learning level is needed. In particular, careful concern is required when designing non-face-to-face classes for students with a low self-reported academic achievement.

Effect of dedifferentiation on noise propagation in cellular hierarchy

Many fast renewing tissues have a hierarchical structure. Tissue-specific stem cells are at the root of this cellular hierarchy, which give rive to a whole range of specialized cells via cellular differentiation. However, increasing evidence shows that the hierarchical structure can be broken due to cellular dedifferentiation in which cells at differentiated stages can revert to the stem cell stage. Dedifferentiation has significant impacts on many aspects of hierarchical tissues. Here we investigate the effect of dedifferentiation on noise propagation by developing a stochastic model composed of different cell types. The moment equations are derived, via which we systematically investigate how the noise in the cell number is changed by dedifferentiation. Our results suggest that dedifferentiation have different effects on the noises in the numbers of stem cells and nonstem cells. Specifically, the noise in the number of stem cells is significantly reduced by increasing dedifferentiation probability. Due to the dual effect of dedifferentiation on nonstem cells, however, more complex changes could happen to the noise in the number of nonstem cells by increasing dedifferentiation probability. Furthermore, it is found that even though dedifferentiation could turn part of the noise propagation process into a noise-amplifying step, it is very unlikely to turn the entire process into a noise-amplifying cascade.

Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes

BACKGROUND

Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes.

OBJECTIVE

To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes.

MATERIALS AND METHODS

For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen.

RESULTS

The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group.

CONCLUSION

Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.

Long-term bidirectional association between asthma and attention deficit hyperactivity disorder: A big data cohort study

BACKGROUND

Previous studies have argued that attention deficit hyperactivity disorder (ADHD) is associated with asthma. However, reliable evidence to verify this association has not yet been reported.

OBJECTIVES

To investigate the bidirectional association between asthma and ADHD through a 12-year big data cohort study.

METHODS

The independent variable group was extracted from 3.5 million individuals randomly sampled by the National Health Insurance Service (NHIS). In Study 1, the incidence of ADHD according to asthma was evaluated, while in Study 2, the incidence of asthma according to ADHD was analyzed. Propensity score (PS) matching with several variables was used to obtain a control group.

MEASUREMENTS AND MAIN RESULTS

In Study 1, the asthma group included 131,937 individuals and the non-asthma group included 131,937 individuals. The adjusted hazard ratio (aHR) for ADHD in the asthma group was 1.17 [95% confidence interval (CI): 1.11-1.23]. In subgroup analysis, the aHRs for ADHD of individuals in the subgroups male sex, 0-5 years old, 6-10 years old, atopic dermatitis, allergic rhinitis, Charlson comorbidity index (CCI) 1, and CCI > 2 were significant (aHR: 2.83, 1.70, 1.79, 1.09, 1.15, 1.06, and 1.49, respectively). In Study 2, ADHD was found to significantly affect asthma in all age groups (aHRs of the subgroups 0∼60 and 0∼17 years old were 1.10 and 1.09, respectively). In the 0∼17 years old subgroup, the association of ADHD with asthma was greater with younger age (aHRs of the subgroups 0∼5 and 6∼10 years old were 2.53 and 1.54, respectively).

CONCLUSION

From long-term follow-up, the incidence of ADHD was 1.17 times higher in the asthma group than in the control group. The incidence of asthma was 1.10 times higher in the ADHD group than in the control group. Asthma and ADHD have a bidirectional relationship, and childhood asthma and ADHD should be rigorously managed.

Evolution of irreversible somatic differentiation

A key innovation emerging in complex animals is irreversible somatic differentiation: daughters of a vegetative cell perform a vegetative function as well, thus, forming a somatic lineage that can no longer be directly involved in reproduction. Primitive species use a different strategy: vegetative and reproductive tasks are separated in time rather than in space. Starting from such a strategy, how is it possible to evolve life forms which use some of their cells exclusively for vegetative functions? Here, we develop an evolutionary model of development of a simple multicellular organism and find that three components are necessary for the evolution of irreversible somatic differentiation: (i) costly cell differentiation, (ii) vegetative cells that significantly improve the organism’s performance even if present in small numbers, and (iii) large enough organism size. Our findings demonstrate how an egalitarian development typical for loose cell colonies can evolve into germ-soma differentiation dominating metazoans.

Prediction of radiation-related cardiotoxicity using F-18 FDG PET in non-small-cell lung cancer

Background

Radiation-related cardiotoxicity has been refocused nowadays as the follow-up was increased amomg the patients with advanced lung cancer. The early recognition of the occult cardiotoxicity enables the early intervention preventing clinically significant cardiac events or worsening of severity.

Purpose

We aim to search whether the F-18 fluorodeoxyglucose positron emission tomography (FDG PET) performed immediately after radiotherapy could predict the late cardiac events.

Methods

We retrospectively enrolled 133 patients with locally advanced, unresectable stage III NSCLC who underwent F-18 fluorodeoxyglucose positron emission tomography (FDG PET) immediately after CCRT for the response evaluation and survived at least for 6 months. Heart was recontoured according to the RTOG 0617 secondary analysis atlas for the dose volume analysis. Standardized uptake values (SUV) of the left ventricular myocardium were measured on FDG PET images. The patients were regularly followed up for the disease progression and complications. The primary end-point was the cardiac events grade ≥2 based on the Common Terminology Criteria for Adverse Events (version 5.0).

Results

FDG PET was performed at median interval of 11 days after CCRT. Fourty-two patients experienced cardiotoxicity during a median follow-up of 47 months (range, 12 – 123 months). In univariable analysis, mean heart dose, maximum SUV of the left ventricle (LV SUVmax), white blood cell count, and diabetes were associated with the risk of cardiotoxicity. In multivariable analysis, only higher mean heart dose (&gt;11.1 Gy, hazard ratio 3.930 [95% confidence interval 1.933–7.988]; p=0.0002) and higher LV SUVmax (&gt;12.84, 2.189 [1.162–4.124]; p=0.0152) were independently associated with increased risk of cardiotoxicity. In subgroup analyses, LV SUVmax remained predictive of cardiotoxicity among those with higher mean heart dose, but not among those with lower mean heart dose.

Conclusion

Early FDG PET after CCRT for NSCLC could predict the late cardiac events, especially in patients with high dose cardiac irradiation.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant of the Basic Science Research Program through the National Research Foundation funded by the Ministry of Education, Republic of Korea (Principal Investigator: Sang-Geon Cho)

Stochastic resonance of abundance fluctuations and mean time to extinction in an ecological community

Periodic environmental changes are commonly observed in nature from the amount of daylight to seasonal temperature. These changes usually affect individuals' death or birth rates, dragging the system from its previous stable states. When the fluctuation of abundance is amplified due to such changes, extinction of species may be accelerated. To see this effect, we examine how the abundance and the mean time to extinction respond to the periodic environmental changes. We consider a population wherein two species coexist together implemented by three rules-birth, spontaneous death, and death from competitions. As the interspecific interaction strength is varied, we observe the resonance behavior in both fluctuations of abundances and the mean time to extinction. Our result suggests that neither too high nor too low competition rates make the system more susceptible to environmental changes.

Surface Activity and Emulsifying Effect of Non-Toxic Starch Nanocrystal

The purpose of this study is to investigate the surface activity of starch nanocrystals (SNC), material derived from starch, and confirm their usefulness as a surfactant. In order to evaluate the surface activity, the surface tension change of suspended SNC solution via the Wilhelmy plate method was measured and the values were compared with various synthetic surfactants. The effect of SNC as emulsifier was evaluated on emulsion formation and physical stability. The surface tension of the SNC-dispersed solution was decreased while its concentration was increased. When the 5.0% (w/v) of SNC was added, the surface tension was decreased from 70.3 to 49.5 mN/m. It was confirmed that the physical stability of the emulsion prepared by adding the SNC was improved compared to that of surface inactivity material (PEG 400). The phase separation was observed within 1 hour after preparation of the emulsion containing PEG 400, but the emulsion containing SNC was stable for 5 hours or more. To summarize this study, SNC, a natural-derived and non-toxic material, exhibits sufficient surface activity, thereby confirming the possibility of being applied to the food and pharmaceutical industry.

Cadmium phytoavailability from 1976 through 2016: Changes in soil amended with phosphate fertilizer and compost

This study aimed to determine cadmium (Cd) accumulation in arable soil, changes in Cd extractability and relevant soil properties, and Cd uptake by rice plants after long-term (50 years) application of phosphate (P) fertilizer and compost. A long-term field experiment was performed with rice crops from 1967 to 2016. Treatments included nitrogen and potassium fertilization (NK), nitrogen, phosphate, and potassium fertilization (NPK), nitrogen, phosphate, and potassium fertilization with compost application (NPK + compost), and control. Total Cd concentration in soil amended with NPK and NPK + compost continuously increased from 110 μg kg^-1 up to 232 μg kg^-1 from 1976 to 2016 but remained unchanged in control soil and soil amended with only NK. Plant-available Cd concentration in soil increased with year for all treatments, likely as a result of relevant changes in soil chemical properties. Cd concentrations in rice harvested in 2017 treated with NPK or NPK + compost were 212 μg Cd kg^-1 and 223 μg Cd kg^-1, respectively. These values exceed the maximum permissible level (200 μg Cd kg^-1) established by the Ministry of Food and Drug Safety of Korea.

How sequence populations persist inside bacterial genomes

Compared to their eukaryotic counterparts, bacterial genomes are small and contain extremely tightly packed genes. Repetitive sequences are rare but not completely absent. One of the most common repeat families is REPINs. REPINs can replicate in the host genome and form populations that persist for millions of years. Here, we model the interactions of these intragenomic sequence populations with the bacterial host. We first confirm well-established results, in the presence and absence of horizontal gene transfer (hgt) sequence populations either expand until they drive the host to extinction or the sequence population gets purged from the genome. We then show that a sequence population can be stably maintained, when each individual sequence provides a benefit that decreases with increasing sequence population size. Maintaining a sequence population of stable size also requires the replication of the sequence population to be costly to the host, otherwise the sequence population size will increase indefinitely. Surprisingly, in regimes with high hgt rates, the benefit conferred by the sequence population does not have to exceed the damage it causes to its host. Our analyses provide a plausible scenario for the persistence of sequence populations in bacterial genomes. We also hypothesize a limited biologically relevant parameter range for the provided benefit, which can be tested in future experiments.

The Impact of Androgen Receptor and Histone Deacetylase 1 Expression on the Prognosis of Ductal Carcinoma In Situ

Purpose

Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS.

Methods

RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases.

Results

Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < -1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC - 1.35, p < 0.001, and HDAC1: log 2-FC - 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24-20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04-9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC.

Conclusion

Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.

Screening of Integrin Heterodimers Expressed Functionally on the Undifferentiated Spermatogonial Stem Cells in the Outbred ICR Mice

Background and Objectives

Outbred mice are widely used in toxicology, pharmacology, and fundamental biomedical research. However, there have been no reports of in vitro culture systems for spermatogonial stem cells (SSCs) derived from these mice.

Methods

As a step towards constructing a non-cellular niche supporting the in vitro maintenance of outbred mouse SSC self-renewal, we systematically investigated the types of integrin heterodimers that are expressed transcriptionally, translationally, and functionally in SSCs derived from Imprinting Control Region (ICR) mice.

Results

Among the genes encoding 25 integrin subunits, integrin α₁, α₅, α₆, α₉, α_V, and α_E, and integrin β₁ and β₅ had significantly higher transcriptional levels than the other subunits. Furthermore, at the translational level, integrin α₅, α₆, α₉, α_V, α_E, and β₁ were localized on the surface of SSCs, but integrin α₁ and β₅ not. Moreover, significantly stronger translational expression than integrin α₉ and α_E was observed in integrin α₅, α₆, α_V, and β₁. SSCs showed significantly increased adhesion to fibronectin, laminin, tenascin C and vitronectin, and functional blocking of integrin α₅β₁, α₆β₁, α₉β₁ or α_Vβ₁ significantly inhibited adhesion to these molecules.

Conclusions

We confirmed that integrin α₅β₁, α₆β₁, α₉β₁ and α_Vβ₁ actively function on the surface of undifferentiated SSCs derived from outbred ICR mice.

The birth of a bacterial tRNA gene by large-scale, tandem duplication events

Organisms differ in the types and numbers of tRNA genes that they carry. While the evolutionary mechanisms behind tRNA gene set evolution have been investigated theoretically and computationally, direct observations of tRNA gene set evolution remain rare. Here, we report the evolution of a tRNA gene set in laboratory populations of the bacterium Pseudomonas fluorescens SBW25. The growth defect caused by deleting the single-copy tRNA gene, serCGA, is rapidly compensated by large-scale (45–290 kb) duplications in the chromosome. Each duplication encompasses a second, compensatory tRNA gene (serTGA) and is associated with a rise in tRNA-Ser(UGA) in the mature tRNA pool. We postulate that tRNA-Ser(CGA) elimination increases the translational demand for tRNA-Ser(UGA), a pressure relieved by increasing serTGA copy number. This work demonstrates that tRNA gene sets can evolve through duplication of existing tRNA genes, a phenomenon that may contribute to the presence of multiple, identical tRNA gene copies within genomes.

Why is cyclic dominance so rare?

Natural populations can contain multiple types of coexisting individuals. How does natural selection maintain such diversity within and across populations? A popular theoretical basis for the maintenance of diversity is cyclic dominance, illustrated by the rock-paper-scissor game. However, it appears difficult to find cyclic dominance in nature. Why is this the case? Focusing on continuously produced novel mutations, we theoretically addressed the rareness of cyclic dominance. We developed a model of an evolving population and studied the formation of cyclic dominance. Our results showed that the chance for cyclic dominance to emerge is lower when the newly introduced type is similar to existing types compared to the introduction of an unrelated type. This suggests that cyclic dominance is more likely to evolve through the assembly of unrelated types whereas it rarely evolves within a community of similar types.

Localization of integrin heterodimer α9β1 on the surface of uterine endometrial stromal and epithelial cells in mice

Previously, we reported that endometrial stromal (ES) and endometrial epithelial (EE) cells did not attach to tenascin C, indicating the absence of active integrin α₉β₁ on the surface of mouse ES and EE cells. However, that study used recombinant tenascin C without fibronectin (FN) type III repeats interacting with integrin heterodimers. Therefore, we re-evaluated the presence of integrin α₉β₁ actively functioning on the surface of mouse ES and EE cells using full-length native tenascin C with FN type III repeats. The functionality of integrin α₉β₁ was confirmed using attachment and antibody inhibition assays. Both mouse ES and EE cells showed significantly increased adhesion to native tenascin C, and functional blocking of integrin α₉β₁ significantly inhibited adhesion to native tenascin C. These results demonstrate that the integrin α₉ and β₁ subunits function as active heterodimers on the plasma membrane of mouse ES and EE cells, respectively.

Screening of integrins localized on the surface of human epidermal melanocytes

In vivo, melanocytes occupy three-dimensional (3D) space. Nevertheless, most experiments involving melanocytes are performed in a two-dimensional microenvironment, resulting in difficulty obtaining accurate results. Therefore, it is necessary to construct an artificial in vivo-like 3D microenvironment. Here, as a step towards engineering a precisely defined acellular 3D microenvironment supporting the maintenance of human epidermal melanocytes (HEMs), we examined the types of integrin heterodimers that are expressed transcriptionally, translationally, and functionally in HEMs. Real-time PCR and fluorescent immunoassay analyses were used to elucidate the expression of integrin α and β subunit genes at the transcriptional and translational levels, respectively. The functionality of the presumed integrin heterodimers was confirmed using attachment and antibody-inhibition assays. Among the genes encoding 12 integrin subunits (α₁, α₂, α₃, α₄, α₅, α₆, α₇, α_V, β₁, β₃, β₅, and β₈) showing significantly higher transcription levels, proteins translated from the integrin α₂, α₄, α₅, β₁, β₃, and β₅ subunit genes were detected on the surface of HEMs. These HEMs showed significantly increased adhesion to collagen I, fibronectin, laminin, and vitronectin, and functional blockade of the integrin α₂ subunits significantly inhibited adhesion to collagen I, fibronectin, and laminin. In addition, there was no significant inhibition of the adhesion to fibronectin or vitronectin in HEMs with functional blockade of the integrin α₄, α₅, or α_V subunits. These results indicate that the active integrin α₂β₁ heterodimer and the inactive integrin α₄, α₅, α_V, β₃, and β₅ subunits are all localized on the surface of HEMs.

Development of a Gas Chromatography-Flame Ionization Method for the Detection and Quantification of 12 Flavoring Agents in Supplementary Feed

A flavoring agent is a compound that serves to add flavor with a pleasant scent and is used as a feed additive. Current flavor analysis methods include reflux pretreatment, titration, neutralization titration, and inversion; these are all analytical methods in which deviations and errors between experiments are generated. Titration methods are characterized by difficult selectivity analysis both for mixtures containing two or more types of flavoring agents and also for very low content samples. Current analysis methods are therefore particularly unsuitable for these sample types. Thus, more precise and accurate analysis of flavor agents is needed. This study intends to develop and verify a multi-component simultaneous analysis method that can accurately confirm the guaranteed content of 12 flavor agents of supplementary feeds distributed in the market, the goal being to establish a universally trusted method. Method validation was performed according to the International Conference on Harmonization (ICH) and International Union of Pure and Applied Chemistry (IUPAC) guidelines. Method

validation was performed in terms of linearity, sensitivity, selectivity, accuracy, and precision. The limits of detection (LOD) for the instrument employed in these experiments ranged from 0.44–4.77 mg/kg, and the limits of quantification (LOQ) ranged from 1.32–14.31 mg/kg. Average recoveries of the 12 flavoring agents ranged from 75.1–111.4%. Maximum %RSD values for intraday and interday peak area variation are 13.09% and 13.08%, respectively. A novel and simple method for detecting 12 flavoring agents in animal feed supplements using a gas chromatography-flame ionization detector (GC-FID) was developed.

Evolution of simple multicellular life cycles in dynamic environments

The mode of reproduction is a critical characteristic of any species, as it has a strong effect on its evolution. As any other trait, the reproduction mode is subject to natural selection and may adapt to the environment. When the environment varies over time, different reproduction modes could be optimal at different times. The natural response to a dynamic environment seems to be bet hedging, where multiple reproductive strategies are stochastically executed. Here, we develop a framework for the evolution of simple multicellular life cycles in a dynamic environment. We use a matrix population model of undifferentiated multicellular groups undergoing fragmentation and ask which mode maximizes the population growth rate. Counterintuitively, we find that natural selection in dynamic environments generally tends to promote deterministic, not stochastic, reproduction modes.

Association between body mass index and stroke severity in acute ischaemic stroke with non-valvular atrial fibrillation

BACKGROUND AND PURPOSE

The objective of this study was to investigate the association between body mass index (BMI) and both initial stroke severity at presentation and functional outcomes after acute ischaemic stroke (AIS) in patients with non-valvular atrial fibrillation (NVAF).

METHODS

Patients were categorized on the basis of their BMI into underweight (BMI <18.5, n = 111), normal (18.5 ≤ BMI <25, n = 1036) and overweight to obese (BMI ≥25, n = 472) groups. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and functional outcomes were assessed using the modified Rankin Scale score at discharge. The differences in stroke severity and functional outcomes were compared between groups using robust log-linear regression with a Poisson distribution and binary logistic regression analysis.

RESULTS

A total of 1619 AIS patients with NVAF from six hospitals were included. Compared with the NIHSS scores [median 5, interquartile range (IQR) 2-14] of normal-weight patients, the NIHSS scores (median 9, IQR 4-19) of underweight patients were more likely to be higher, whereas those of overweight to obese patients were lower (median 4, IQR 1-12) (P < 0.001). In terms of functional outcomes after stroke, underweight patients had a higher risk of poor functional outcomes (odds ratio 1.78, 95% confidence interval 1.09-2.56, P = 0.01) but overweight to obese patients had no significant difference in functional outcomes compared with normal-weight patients.

CONCLUSION

An inverse association was found between BMI and stroke severity in AIS patients with NVAF. This suggests the presence of an obesity paradox for short-term outcomes in patients with NVAF.

A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study

Background

Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools.

Objective

The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses.

Methods

We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions.

Results

A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value.

Conclusions

The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system.

Trial Registration

ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966

The Effect of a Virtual Reality-Based Intervention Program on Cognition in Older Adults with Mild Cognitive Impairment: A Randomized Control Trial

This study aimed to investigate the association between a virtual reality (VR) intervention program and cognitive, brain and physical functions in high-risk older adults. In a randomized controlled trial, we enrolled 68 individuals with mild cognitive impairment (MCI). The MCI diagnosis was based on medical evaluations through a clinical interview conducted by a dementia specialist. Cognitive assessments were performed by neuropsychologists according to standardized methods, including the Mini-Mental State Examination (MMSE) and frontal cognitive function: trail making test (TMT) A & B, and symbol digit substitute test (SDST). Resting state electroencephalogram (EEG) was measured in eyes open and eyes closed conditions for 5 minutes each, with a 19-channel wireless EEG device. The VR intervention program (3 times/week, 100 min each session) comprised four types of VR game-based content to improve the attention, memory and processing speed. Analysis of the subjects for group-time interactions revealed that the intervention group exhibited a significantly improved executive function and brain function at the resting state. Additionally, gait speed and mobility were also significantly improved between and after the follow-up. The VR-based training program improved cognitive and physical function in patients with MCI relative to controls. Encouraging patients to perform VR and game-based training may be beneficial to prevent cognitive decline.

Exercise Promotion and Distress Reduction Using a Mobile App-Based Community in Breast Cancer Survivors

Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired t-test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps (t = -3.5341; P = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week (p value <0.0001) and decreased DT scores by 0.77 per week (p value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 (p value <0.0001) and decrease in weekly DT by 0.73 (p value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Trial Registration: NCT03190720, NCT03072966.

β-Amyrin Ameliorates Alzheimer's Disease-Like Aberrant Synaptic Plasticity in the Mouse Hippocampus

Alzheimer's disease (AD) is a progressive and most frequently diagnosed neurodegenerative disorder. However, there is still no drug preventing the progress of this disorder. β-Amyrin, an ingredient of the surface wax of tomato fruit and dandelion coffee, is previously reported to ameliorate memory impairment induced by cholinergic dysfunction. Therefore, we tested whether β-amyrin can prevent AD-like pathology. β-Amyrin blocked amyloid β (Aβ)-induced long-term potentiation (LTP) impairment in the hippocampal slices. Moreover, β-amyrin improved Aβ-induced suppression of phosphatidylinositol-3-kinase (PI3K)/Akt signaling. LY294002, a PI3K inhibitor, blocked the effect of β-amyrin on Aβ-induced LTP impairment. In in vivo experiments, we observed that β-amyrin ameliorated object recognition memory deficit in Aβ-injected AD mice model. Moreover, neurogenesis impairments induced by Aβ was improved by β-amyrin treatment. Taken together, β-amyrin might be a good candidate of treatment or supplement for AD patients.

Comparison of the diagnostic performance of the 2017 and 2018 versions of LI-RADS for hepatocellular carcinoma on gadoxetic acid enhanced MRI

AIM

To compare the diagnostic performance of the 2017 (v2017) and 2018 versions (v2018) of the Liver Imaging-Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) and to evaluate the effect in v2018.

MATERIALS AND METHODS

Treatment-naive patients at high-risk for HCC who underwent Gd-EOB-MRI were included. The LI-RADS categories were assigned according to v2017 and v2018. The diagnostic performances were compared between v2017 and v2018 according to the size and combination of imaging features.

RESULTS

A total of 117 patients with 137 observations were identified, including 89 HCCs; 76.2% (64/84) of observations with threshold growth were re-classified as subthreshold growth when using v2018 instead of v2017. The final categories changed in nine (14%) cases. For the combination of LR-5/LR-5V, there were no significant differences in sensitivity and specificity between the two versions (sensitivity, 64% versus 58.4%; specificity, 87.5% versus 85.4%; all p>0.05). For the combination of LR-4 and LR-5/5V, the diagnostic performance of v2018 was inferior to that of v2017 when considering only major features (accuracy, 86.1% versus 80.3%, respectively; p=0.013), particularly in observations measuring 10-20 mm, but was comparable after adding the ancillary features (accuracy, 86.9% versus 86.1%, respectively; p=1.00).

CONCLUSION

In LI-RADS v2018, although a considerable number of observations re-classified subthreshold growth, changes in the assigned categories were insignificant; overall diagnostic performance was comparable to that of v2017, but v2018 might emphasise the value of ancillary features in combination with major features for determining the probability of HCC.

Integrins expressed on the surface of human endometrial stromal cells derived from a female patient experiencing spontaneous abortion

Here, as a basic study in revealing the correlation between extracellular matrix components and spontaneous abortion, we defined the types of integrins expressed on the surface of endometrial stromal (ES) cells retrieved from the uterus of a patient experiencing spontaneous abortion. For these, the types of integrin subunits in the ES cells retrieved from a woman with spontaneous abortion were identified at the transcriptional and translational levels, and functional assay was conducted for confirming the combinations of integrin α and β subunits. Among the genes encoding 25 integrin subunits, significantly high transcription was seen in integrins α₁, α₂, α₃, α₄, α₅, α_V, β₁, β₃, and β₅. Translation of integrins α₁, α₃, α₅, α_V, and β₁ on the cell surface was detected in almost all ES cells, whereas integrins α₂, α₄, β₃, and β₄ were expressed translationally only in some ES cells. Subsequently, ES cells showed significantly increased adhesion to collagen I, laminin, fibronectin, and vitronectin, and functional blocking of integrin α₁, α₃, α₅, and α_V significantly inhibited adhesion to these molecules. These results demonstrated that active heterodimers composed of integrins α₁β₁, α₃β₁, α₅β₁, and α_Vβ₁ were co-localized on the surface of ES cells derived from a patient experiencing spontaneous abortion.

Recombinant FNIII9-10-derived extracellular signaling effects on the physiology of dermal fibroblasts during in vitro culture

Previous reports showed that fibronectin (FN) was effective in stimulating the recovery of damaged dermis. However, native FN has multifunctional domains transmitting beneficial as well as unbeneficial signals to dermal tissue cells through the mediation of integrin heterodimers. The use of a functional domain [FN type III9-10 fragments (FNIII9-10)] providing beneficial effects on the physiology of dermal tissue cells would enhance an in vitro culture system for dermal fibroblasts (DFs). We therefore investigated the FNIII9-10-derived extracellular signaling effect on the physiology of DFs during in vitro culture. Recombinant FNIII9-10 proteins were constructed and their functionality was determined by observing the adhesion of adult human DFs (aHDFs) to recombinant FNIII9-10 and of low adhesion integrin α₅β₁- and α_vβ₃-blocked aHDFs to recombinant FNIII9-10. Cellular proliferation, morphology, and senescence were measured and compared in the aHDFs cultured on native FN and recombinant FNIII9-10 for short or long periods. The results show that recombinant FNIII9-10-derived extracellular signaling stimulated increased proliferation of aHDF (both in short- and long-term cultures) and inhibited the generation of morphological abnormalities (in short- and long-term cultures) and cellular senescence (long-term culture) when compared with native FN-derived extracellular signaling. Our results suggest that, instead of native FN, recombinant FNIII9-10 better enhanced the in vitro culture of aHDFs while diminishing the adverse effects associated with the use of human-derived materials.

Evolution of cooperation driven by self-recommendation

Cooperators increase the fitness of others at a cost to themselves. Thus cooperation should not be favored by natural selection in a well-mixed population. It challenges the evolutionists since cooperation is widespread. Information spreading has been revealed to play a key role in the emergence of cooperation. Individuals, however, are typically assumed to be passive in the information spreading. Here we assume that individuals self-recommend themselves to those that are about to have new neighbors. Individuals with higher tendencies of self-recommendation are likely to have more neighbors. In this way, individuals are active to spread the information. We analytically obtain a critical cost-to-benefit ratio, below which cooperation emerges. It reveals quantitatively how eloquent cooperators have to be compared with defectors to ensure that cooperation takes over the population. It also indicates that individuals need to be open enough to the self-recommendation to enhance cooperation level. In addition, the critical cost-to-benefit ratio represents the viscosity of the population, measuring how close cooperators are to each other. Our results highlight the role self-recommendation plays in cooperation.

The effect of low body mass index on the development of chronic obstructive pulmonary disease and mortality

BACKGROUND

Sarcopenia may worsen disease progression and lead to poor outcomes in chronic obstructive pulmonary disease (COPD).

OBJECTIVES

We aimed to determine the effect of BMI on the development of COPD and mortality.

METHODS

We enrolled 437 584 participants registered in the physical health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003, and we defined COPD diagnosis based on the ICD-10 code and prescribed medication. BMI (kg m^-2 ) classified them to five groups (low BMI < 18.5, normal BMI 18.5-23, overweight 23-25, obesity 25-30, severe obesity ≥30) at baseline.

RESULTS

Participants in the low BMI group had a significantly higher rate of COPD development for 13 years (7.6%) than those in other groups (3.4-4.1%, P < 0.0001). Amongst never or light smokers, COPD development in the low BMI group (5.6-6.7%) was significantly higher than that in other groups (2.8-4.7%). Similarly, amongst participants with a smoking history of ≥30 years, COPD development in the low BMI group (20.1%) was higher than those in other groups (8.4-12.4%). On multivariable analysis, normal or higher than normal body weight was significantly protective against the development of COPD (hazard ratio [HR], 0.609-0.739,) compared to low BMI. COPD-free-survival (HR, 0.491-0.622) and overall survival (HR, 0.440-0.585) were also better in them compared to those with low BMI (all P < 0.0001).

CONCLUSIONS

Low BMI is an important risk factor for COPD development and mortality. Maintaining adequate body weight may reduce the risk for COPD development and mortality.

P671Impacts of echocardiography-defined pulmonary hypertension on clinical outcome in patients with multiple myeloma

Background

Pulmonary hypertension (PH) is a rarely reported complication of multiple myeloma (MM). PH of MM is usually mild to moderate and can be secondary to a variety of conditions, including left ventricular dysfunction, diastolic dysfunction, chronic heart failure, treatment-related toxicity, thrombophilic condition and precapillary involvement. However, only few reports regarding PH in MM incidence and prognosis exist up to now.

Purpose

The purpose of this study was to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on clinical outcome in patients with MM.

Methods

A total of 277 MM patients was included and divided into 2 groups–those non-pulmonary hypertension (PH) or those with PH, based on the results of the transthoracic echocardiography (TTE); PH group (n=143, 60.9±9.2 years, 68 males) versus non-PH group (n=134, 55.9±11.5 years, 72 males). We analyzed propensity score matching and multiple imputation method were used to deal with the missing data in echocardiographic characteristics.

Results

During the follow-up period (median 618 days), all-cause death occurred in 79 (28.5%) patients and 41 patients (14.8%) died from cardiovascular causes (including acute decompensated heart failure, fatal MI, sudden cardiac arrest). In the Kaplan-Meier survival analysis of crude population and propensity-matched population, cumulative overall survival and cardiovascular death (CVD)-free survival were significantly lower in the PH group than in the non-PH group (p<0.001). In propensity-matched population, estimated pulmonary artery pressure >35mmHg in TTE, congestive heart failure, and DM were significant independent predictors of all-cause death.

KM curves in MM stratified by PH

Conclusion

This study demonstrates that the presence of PH, congestive heart failure, and DM is an independent prognostic factor for all-cause death in MM patients with MM. These results highlight the risk associated cardiovascular disease in MM patients and emphasize that management strategies that prevent deterioration of cardiac function are essential.

An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study

Background

Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors.

Objective

The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors.

Methods

In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis.

Results

A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level.

Conclusions

Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants’ distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors.

Trial Registration

ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966