Habitat use of loggerhead (Caretta caretta) and green (Chelonia mydas) turtles at the northern limit of their distribution range of the Northwest Pacific Ocean

Verifying habitats, including the foraging and nesting areas for sea turtles, enables an understanding of their spatial ecology and successful planning of their conservation and management strategies. Recently, the observation frequency and bycatch of loggerhead (Caretta caretta) and green (Chelonia mydas) turtles have increased in the northern limit of their distribution range, in the northern part of the East China Sea and East (Japan) Sea. We conducted satellite tracking to investigate the habitat use of seven loggerhead and eight green turtles from June 2016 to August 2022 in this area, where little is known about their spatial ecology. We applied a 50 percent volume contour method to determine their main foraging areas and analyzed 6 environmental variables to characterize their habitats. Loggerhead turtles mainly stayed in and used the East China Sea as a foraging area during the tracking period, while two individuals among them also used the East Sea as a seasonal foraging area. Most green turtles also used the East China Sea as a foraging area, near South Korea and Japan, with one individual among them using the lower area of the East Sea as a seasonal foraging area. Notably, one green turtle traveled to Hainan Island in the South China Sea, a historical nesting area. Our results showed that the two sea turtle species included the East Sea as a seasonal foraging area, possibly owing to the abundance of food sources available, despite its relatively lower sea temperature. Considering that loggerhead and green sea turtles were observed using the northern part of the East China Sea and East Sea more frequently than previously known and that the sea temperature gradually increases due to climate change, conservation and management activities are required for sea turtles in these areas.

Diagnosis of osteochondral lesions of the talus on Dual-layer spectral detector CT arthrography: clinical feasibility of virtual noncontrast images

AIM

To compare the image quality of virtual noncontrast (VNC) and true noncontrast (TNC) CT images and to evaluate the clinical feasibility of VNC CT images for assessing osteochondral lesions of the talus (OLTs).

MATERIALS AND METHODS

Forty-five OLT patients who underwent ankle CT arthrography (CTA) using dual-layer spectral detector CT were enrolled. Reconstruction of VNC and three-dimensional volume rendering images was performed. Afterward, image noise, the signal-to-noise ratio (SNR), and the contrast-to-noise ratio (CNR) were measured. For the subjective evaluation, two board-certified musculoskeletal radiologists [R2-1] assessed spatial resolution, overall image quality, and lesion conspicuity. The accuracy rate for OLT grading was determined in 23 patients who underwent arthroscopic surgery.

RESULTS

While VNC images showed significantly less noise than TNC images, TNC images showed better SNRs and CNRs (p<.01). In the subjective analysis, TNC images showed better overall image quality (p<.001). For the 3D volume rendering images, VNC images scored significantly higher for lesion conspicuity (p<.001). The accuracy rates of CTA and CTA with VNC images for OLT grading were 79.2% and 83.3%, respectively. Regarding confidence level, when CTA and VNC images were evaluated together, the confidence level was significantly higher than that when only CTA images were evaluated (p<.001).

CONCLUSION

VNC imaging can provide better confidence level of OLT grading and evaluation of the integrity of the subchondral bone plate when combined with conventional CTA without additional radiation dose to the patient. In addition, VNC images-based 3D volume rendering reconstruction would be helpful for preoperative planning in OLT patients.

Experimental study on color and texture as cues for plastic debris ingestion by captive sea turtles

Sea turtles face considerable risks from ingesting marine debris. They are primarily visual feeders, so color may be important for identifying food suitability or enhancing prey detection. Here, we investigated the impacts of color and texture on foraging behavior in relation to plastic consumption. We experimentally assessed the influences of color and texture as attractors for sea turtles using edible jellyfish. The findings showed that the colors of objects significantly affected selective preferences, as evidenced by different behaviors by sea turtles in response to different colors. They exhibited diet-related selectivity toward colors similar to common aquarium food, and texture had a significant impact on complete ingestion. The results suggest that plastic resembling natural prey is more likely ingested. Also, sea turtles were attracted by the color yellow, suggesting that visually distinctive items can attract them. Our results provide fundamental knowledge, helping mitigate the effects of plastic pollution on wildlife.

Differential impact of planktonic and periphytic diatoms on aggregation and sinking of microplastics in a simulated marine environment

Aggregation between microalgae and microplastics (MPs) significantly influences the MPs distribution in marine environment. We investigated the effects of two diatoms, the planktonic Pseudo-nitzschia pungens and the periphytic Navicula sp., on the formation and sinking of aggregates when they were cultured with four different types of MPs: small and large polyethylene terephthalate (PET) fibers, and low-density and high-density polyethylene (PE) spheres. Navicula sp. formed aggregates with all MPs within one week, but P. pungens only formed aggregates with PE spheres after 9 weeks. The PE-Navicula sp. aggregates settled about 100 times faster than the PE-P. pungens aggregates (12.2 vs. 0.1 mm s-1), and this difference was most likely due to aggregate shape rather than size. Our findings indicate that the periphytic Navicula sp. had a greater effect on the settling of MPs than the planktonic P. pungens. These findings have implications for understanding the behavior of MPs in marine environments.

Occurrence and characteristics of microplastics in greywater from a research vessel

The discharge of greywater from ships, an uncounted sea-based source of microplastics (MPs), is a growing concern. Yet, empirical data on MPs from this source are currently limited. Here, the abundances and characteristics of MPs in greywater from a research vessel were investigated according to water usage type (e.g., galley, cabin, and laundry). The mean abundance of MPs was highest in greywater from the laundry (177,667 n/m3), followed by the cabins (133,833 n/m3) and galley (75,000 n/m3). However, no significant differences were found in the MP abundances among greywater types due to high variability of triplicate samples collected every five days. Fiber-type MPs accounted for 66% of the total MP abundance and fragment-type MPs for 34%. Microplastics in the size range of 100-200 μm exhibited the highest levels among size classes. The dominant polymer identified in all greywater samples was polyester (53%), followed by polypropylene (23%). Marine coating origin MPs (6%) were also observed in all types of greywater. The greywater generation rate during the cruise was 0.15 m3/person∙day. Annual MP emissions per person by the greywater discharge of the research vessel was estimated to be 4.1 × 106 n/person∙year (equivalent to 3.0 g/person∙year).

Intra-annual variation in microplastics in mussels (Mytilus galloprovincialis) inhabiting an urbanized bay of South Korea

This study investigated the presence of microplastics (MPs) in mussels from an urbanized bay in Korea, focusing on intra-annual variation. The average MP concentration was 0.36 ± 0.14 n/g w.w. (1.24 ± 0.56 n/individual). MPs were detected throughout the year with minor monthly variation and no significant monthly changes. Although there was no correlation between MP concentration in mussel and seawater, a positive relationship was observed when normalizing MPs to mussel's condition index (except for July). Polypropylene, polyethylene and acrylate polymer were dominant MPs, with high-density polymers comprising 59 % of the total. Most MPs were fragments and particles <200 μm. This study indicates that strict time restrictions for mussel sampling may not be necessary to assess MP levels in this bay. Additionally, considering MPs in seawater, biological conditions of mussel may be essential for understanding variations in MP levels in mussels. Including small MPs (<200 μm) and high-density polymers in MP assessment is recommended.

Spatial distribution and historical trend of microplastic pollution in sediments from enclosed bays of South Korea

Seafloor sediments are an important sink for microplastics (MPs), and the vertical profile of MP accumulation in a sediment core represents historical pollution trends. In this study, MP (20-5000 μm) pollution in surface sediments of urban, aquaculture, and environmental preservation sites in South Korea was evaluated, and the historical trend was investigated using age-dated core sediments from the urban and aquaculture sites. The abundance of MPs ranked in the order of urban, aquaculture, and environmental preservation sites. Polymer types were more diverse at the urban site compared to other sites, and expanded polystyrene was dominant in the aquaculture site. An increase in MP pollution and polymer types was observed from bottom to top of cores, and historical trends of MP pollution reflect local influences. Our results indicate that the characteristics of MPs are determined by human activities, and MP pollution should be addressed according to the characteristics of each site.

Fragmentation of nano- and microplastics from virgin- and additive-containing polypropylene by accelerated photooxidation

Plastic is ubiquitous in the environment, where it gradually weathers and fragments into nanoplastics (NPs) and microplastics (MPs); however, the weathering process and fragmentation rate are poorly understood. In this study, we quantitatively determined the abundances and size distributions of NPs and MPs produced from virgin polypropylene (PP) and additive-containing PP (PPa) sheets via photooxidation with water in a simulated sunlight chamber followed by vortexing. The fragmentation rate of PP and PPa were approximately 1.1 × 108 particles/cm2 and 1.0 × 108 particles/cm2, respectively, during 176 days of exposure in the chamber (corresponding to 2.7 years of exposure in an outdoor environment in the Republic of Korea). However, quadratic regression analysis of the relationship between total particles produced and exposure duration revealed that the PP fragmentation rate was faster than the PPa fragmentation rate after a sunlight exposure duration equivalent to 2.7 years. Furthermore, the mechanical stress of vortexing after photooxidation played an important role in the production of MPs; it had a smaller role in the production of NPs. The sizes of fragmented particles produced by photooxidation and mechanical stress followed a power law distribution, with a scaling exponent of α = 2.87 ± 0.15, which was similar to a three-dimensional fragmentation pattern. This study provides valuable insights into the weathering and fragmentation processes of plastics. Further studies on the environmental fate and impact of NP and MP production from plastic weathering and fragmentation, as well as the potential influence of plastic additives on these processes.

The effects of environmental Microplastic on wharf roach (Ligia exotica): A Multi-Omics approach

This is the first report to evaluate the potential effects of microplastics (MPs) on wild wharf roaches (Ligia exotica) in a shoreline habitant. L. exotica is an important plastic detritus consumer in coastal area. A survey was conducted from May to June in the years 2019 and 2020 in two South Korean nearshore sites: Nae-do (as MPs-uncontaminated) and Maemul-do (as MPs-contaminated). MPs (>20 μm in size) were detected highly in gastrointestinal tracts of the L. exotica from Maemul-do, at an average level of 50.56 particles/individual. They were detected in much lower levels in the L. exotica from Nae-do. at an average rate of 1.00 particles/individual. The polymer type and shape were dominated by expanded polystyrene (EPS, 93%) and fragment (99.9%) in L. exotica from Maemul-do. Especially, Hexabromocyclododecanes, brominated flame retardants added to EPS, have been detected highly in L. exotica from Maemul-do (630.86 ± 587.21 ng/g l. w.) than those of Nae-do (detection limit: 10.5 ng/g l. w). Genome-wide transcriptome profiling revealed altered expression of genes associated with fatty acid metabolic processes, the innate-immune response-activating system and vesicle cytoskeletal trafficking in L. exotica from Maemul-do. The activation of the p53 signaling pathway (which is related to proteasome, ER regulation and cell morphogenesis) is likely to be involved in the EPS-uptake of wild L. exotica. Four neurosteroids were also detected in head tissue, and cortisol and progesterone concentrations differed significantly in L. exotica from Maemul-do. Our findings also suggest that resident plastic detritus consumer might be a useful indicator organism for evaluating pollution and potential effects of environmental microplastics.

Anti-diabetic effect of quercetin in type 2 diabetes mellitus by regulating the microRNA-92b-3p/EGR1 axis

Insulin resistance (IR) is predominantly causal for type 2 diabetes mellitus (T2DM). To solve this problem, this study particularly determined the role of quercetin (Que) in controlling IR in T2DM mice. The T2DM mouse model was established, and given 20 mg/kg/d Que by gavage for 6 weeks, and the lentiviral vector that interfered with microRNA-92b-3p (miR-92b-3p) or early growth response 1 (EGR1) expression was injected into the tail vein of T2DM mice. Blood glucose homeostasis and histopathological changes in the pancreas were observed after the corresponding treatment. miR-92b-3p and EGR1 expressions were assessed in T2DM mice, as well as their interlink. In results we found that Que could improve IR and pancreatic histopathological changes in T2DM mice. Low miR-92b-3p and high EGR1 were expressed in T2DM mice, while Que could upregulate miR-92b-3p to target EGR1. Enhancing miR-92b-3p or reducing EGR1 could further improve IR and pancreatic histopathological changes in T2DM mice after Que administration. Nevertheless, silencing miR-92b-3p or overexpressing EGR1 contributed to the opposite results. We concluded that Que exerted anti-diabetic effects in T2DM mice by regulating the miR-92b-3p/EGR1 axis.

Microplastic emission characteristics of stormwater runoff in an urban area: Intra-event variability and influencing factors

Stormwater runoff is considered a major pathway for land-based microplastic transportation to aquatic environments. By applying time-weighted stormwater sampling at stormwater outlets from industrial and residential catchments, we investigated the emission characteristics and loads (number- and mass-based) of microplastics to aquatic environments through urban stormwater runoff during rainfall events. Microplastics were detected in stormwater runoff from industrial and residential areas in the concentration range of 68-568 n/L and 54-639 n/L, respectively. Polypropylene and polyethylene were found as major polymers accounting for around 60 % of total microplastics. The fragment was the dominant shape of microplastics, and the most common size class was 20-100 μm or 100-200 μm. The microplastic load emitted from industrial and residential areas were estimated to be 1.54-46.1 × 10⁸ and 0.63-28.5 × 10⁸ particles, respectively. The discharge characteristics of microplastics inter- and intra-event were affected by the land-use pattern and rainfall characteristics. The concentration of microplastics did not significantly differ between industrial and residential catchments, but the composition of polymer types reflected the land-use pattern. The microplastics in stormwater were more concentrated when the number of antecedent dry days (ADDs) was higher; the concentration of microplastics was generally peaked in the early stage of runoff and varied according to rainfall intensity during a rainfall event. The contamination level and load of microplastics were heavily affected by the total rainfall depth. Most microplastics were transported in the early stage of runoff (19-37 % of total runoff time), but the proportion of larger and heavier particles increased in the later period of runoff. The microplastic emission via stormwater runoff was significantly higher than that through the discharge of wastewater treatment plant effluent in the same area, implying that stormwater runoff is the dominant pathway for transporting microplastics to aquatic environments.

Plastic debris as a mobile source of additive chemicals in marine environments: In-situ evidence

Plastic debris can act as a source of hazardous chemicals in the ocean, but the significance of its role in the environment is not yet known. To address this question, a comprehensive field study of highly contaminated and non-contaminated islands was conducted. Comparison of the plastic additive hexabromocyclododecanes and ubiquitous contaminants polychlorinated biphenyls in marine invertebrates showed that the load of stranded plastics plays a significant role in the bioaccumulation of plastic additives in the marine debris-contaminated island. Fugacity analysis indicates that net flow of hexabromocyclododecanes occurred from plastics to environmental reservoirs. Additionally, significantly higher levels of antioxidants, 2,4-di-tert-butylphenol and butylated hydroxytoluene, was found in the marine invertebrates inhabiting the marine debris-contaminated island than those inhabiting the marine debris-noncontaminated island, but ultraviolet stabilizers did not show the regional difference. This study provides the first field evidence that the movement of plastic debris in the ocean drives the dispersal of plastic additives to pristine waters.

Spatial distribution and temporal trends of classical and emerging persistent organic pollutants (POPs) in black-tailed gull (Larus crassirostris) eggs from Korea

This study monitored the spatiotemporal trends of persistent organic pollutants (POPs) contamination along the Korean coasts using eggs of the black-tailed gull, a resident bird that occupies a high trophic position in the marine food web. Black-tailed gull eggs were collected from three breeding islands located in the western (Seoman-do), southern (Hong-do), and eastern (Dok-do) seas of Korea during 2015-2019, and egg contents were analyzed for classical and emerging POPs. Among the target analytes, levels of emerging POPs such as brominated flame retardants (BFRs) and perfluoroalkyl acids (PFAAs) were significantly higher in eggs from Seoman-do than other islands. Global positioning system tracking data show that seagulls from Seoman-do traveled frequently to two neighboring major cities (Incheon and Seoul), indicating that the accumulation of BFRs and PFAAs in bird eggs is directly affected by the pollution characteristics of urban areas. Overall, the ratios of PFAA and BFR to the total POPs in eggs from the islands increased over time, while the proportion of classical POPs decreased. A shift from classical POPs to BFRs and PFAAs in seagull eggs was identified. Interestingly, perfluorooctanoic acid (PFOA), which exhibits limited bioaccumulation, was detected at higher levels in eggs from Seoman-do, indicating widespread use of PFOA and maternal transfer to seabird eggs. Continuous monitoring of PFAAs in marine environments of Korea is needed. This study demonstrates that monitoring of seabird eggs is effective for detecting spatial and temporal trends of POPs in the marine environment, and provides insights into emerging POPs such as PFAAs.

The fragmentation of nano- and microplastic particles from thermoplastics accelerated by simulated-sunlight-mediated photooxidation

The plastic debris that washes ashore and litters the shoreline often undergoes weathering under sunlight exposure, such that it fragments to form nanoplastics and microplastics, but the fragmentation rate for many thermoplastics is unknown. In this study, three major thermoplastics were exposed to simulated sunlight in an accelerated weathering chamber to evaluate the speed of photooxidation-induced fragmentation. The initiation of photooxidation-induced fragmentation extrapolated from the accelerated weathering chamber to real sunlight exposure in South Korea followed the order of PS (< 1 year) > PP (< 2 years) > LDPE (> 3 years). The surface cracks created by photooxidation were not directly reflected in the initiation of fragmentation of thermoplastics. The initiation of fragmentation was faster in PS than other polymers, but the total abundance of particles produced, and increasing ratio (exposure/non-exposure) were comparable or lower than those of PP. The increasing ratio pattern between nanoplastics and small microplastics of PP differed noticeably from other polymers. The initiation of nanoplastic and small-microplastic fragmentation determined in this study will be useful for the further estimation of secondary microplastic production by weathering and thus for decision-making regarding methods for the timely removal of plastic litter in the environment.

Towards a North Pacific Ocean long-term monitoring program for plastic pollution: A review and recommendations for plastic ingestion bioindicators

Marine debris is now a ubiquitous component of the Anthropocene global ocean. Plastic ingestion by marine wildlife was first reported in the 1960s and since that time, roughly one thousand marine species have been reported to consume this debris. This study focuses on plastic ingestion by marine invertebrates and vertebrates in the North Pacific Ocean. Specifically, we reviewed the scientific literature to assess the scope of the problem, identified key bioindicator species, and proposed guidelines for future monitoring of plastic debris in North Pacific marine ecosystems. Our meta-analysis confirmed that the North Pacific is among the most polluted ocean regions globally; roughly half of all fish and seabird specimens and more than three-quarters of sea turtles and bivalve specimens examined in this region had consumed plastic. While there are not enough standardized data to assess if these ingestion rates are changing, sampling standardization and reporting of methods are improving over time. Using a rubric-evaluation approach, we evaluated 352 species for their potential to serve as bioindicators of the prevalence of plastic pollution in the North Pacific. This analysis revealed a suite of 12 bioindicator species candidates which sample a variety of ecosystem components and cover a wide range of plastic size classes. Thus, we contend that these bioindicator candidates provide a key foundation for developing a comprehensive plastic monitoring program in the region. To enhance the utility of these bioindicators, we developed a framework for standardized data collection to minimize methodological variability across different studies and to facilitate the assessment of temporal trends over space and time. Tracking plastic ingestion by these bioindicators will help to assess the effectiveness of mitigation actions in the region, a critical step to evaluate progress towards sustainability and improved ocean health in the 21st century.

Underwater hidden microplastic hotspots: Historical ocean dumping sites

Three ocean dumping sites located in the Yellow Sea (YS) and East Sea (ES) of South Korea have accumulated terrestrial waste from 1988 to 2015. Most of this waste comprised industrial wastewater and sewage sludge, which are sources of microplastics. In this study, we investigated the spatiotemporal distribution and characteristics of microplastics in surface and core sediments of the YS, South Sea (SS) and ES, including at dumping sites (YDP and EDP). The mean abundance of microplastics in surface sediments was ranked in order of EDP (59,457 ± 49,130 particles/kg d.w.), ES (5,047 ± 9,404 particles/kg d.w.), YDP (3,965 ± 3,213 particles/kg d.w.), SS (314 ± 488 particles/kg d.w.) and YS (288 ± 400 particles/kg d.w.). EDP and YDP showed about 14- and 12-fold higher microplastic abundances, and more diverse polymer compositions, than the ES and YS, respectively. The historical trend of microplastic pollution in age-dated core sediments from EDP and YDP aligned well with the amount of historical ocean dumping. As the level of ocean dumping has gradually reduced since 2006, and was finally banned in 2015, the microplastic abundance decreased accordingly. Interestingly, spherical polystyrene (PS) primary microplastic was the dominant type in EDP sediments (78%) and other surface sediments in the ES (52%). More than 60 million tons of sewage and wastewater sludge were dumped at EDP, and extremely high abundances of up to 130,000 particles/kg d.w. were observed in EDP surface sediments. PS primary microplastics were continuously present in the EDP and ES sediment cores in the dumping period and are suspected to have originated from industrial wastewater sludge. The particle transportation model results showed that PS was dispersed throughout the ES during ocean dumping. In addition, deep circulation can contribute to the dispersion of particles after sinking. These results indicate that ocean dumping sites represent an underwater hotspot and source of microplastics in seafloor sediments.

Identification of novel polar aryl hydrocarbon receptor agonists accumulated in liver of black-tailed gulls in Korea using advanced effect-directed analysis

Although bioaccumulation of persistent organic pollutants in seabirds has been examined, few studies have been conducted to identify previously unidentified substances. Here, aryl hydrocarbon receptor (AhR) agonists were identified in livers of black-tailed gulls from South Korea using effect-directed analysis combined with full-scan screening analysis. Significant AhR-mediated potencies were observed in the polar fractions of liver extracts using H4IIE-luc bioassay. Eight known polar AhR agonists accounted for 11-20% of the total AhR-mediated potencies in the polar fractions; hydrocortisone and rutaecarpine were the major contributors. Twenty-two AhR agonist candidates in the polar fractions were identified using liquid chromatography-quadrupole time-of-flight mass spectrometry during a six-step selection process. Of these, [10]-gingerol, angelicin, corticosterone, eupatilin, etofenprox, oxadixyl, and tretinoin were identified as novel AhR agonists. The contribution to potencies increased with inclusion of novel AhR agonists (27-52%); corticosterone and [10]-gingerol contributed significantly. Quantitative structure-activity relationship suggested that the novel AhR agonists have other potential toxic effects, including carcinogenicity and mutagenicity. Polar AhR agonists have been used for pharmaceuticals and pesticides. Some novel AhR agonists have log K_OW > 2 and log K_OA ≥ 6, which indicates that these compounds can be biomagnified in air-breathing organisms, such as seabirds.

COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use.

MATERIALS AND METHODS

We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

RESULTS

Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19.

CONCLUSIONS

AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.

Continuing perioperative estrogen therapy does not increase venous thromboembolic events in transgender patients: a systematic review and meta-analysis

OBJECTIVE

The aim of this study is to compare the risk of venous thromboembolic events (VTE) between patients suspending and continuing estrogen therapy perioperatively, in male to female gender-affirming surgery (vaginoplasty).

MATERIALS AND METHODS

The authors conducted a systematic review and meta-analysis of existing research on male to female gender-affirming study, which compared the risk of VTE among the usage of estrogen perioperatively.

RESULTS

A total of 209 studies were identified as potentially eligible among PubMed, Embase, and Cochrane library databases. Among the studies, 191 studies were excluded due to their abstract inappropriateness. Out of the remaining 18 studies, only 3 articles were eligible and were finally included. Meta-analysis was performed and showed odds ratio of 0.77 (95% CI: 0.04, 14.01).

CONCLUSIONS

Perioperative estrogen therapy does not increase VTE risk on male to female gender-affirming surgery. Therefore, estrogen therapy may be continued perioperatively in vaginoplasty. More prospective studies are needed.

What type of plastic do sea turtles in Korean waters mainly ingest? Quantity, shape, color, size, polymer composition, and original usage

Globally, sea turtles are at high risk of ingesting plastic. However, research on plastic ingestion by sea turtles in East Asia is scant, and no quantitative or qualitative investigation has been conducted in Korean waters. This study examined the plastic ingestion of sea turtles stranded, floating, or incidentally captured in Korean waters between 2012 and 2018. The quantity, shape, color, size, polymer type, and original usage of plastic debris (>1 mm) ingested by sea turtles were analyzed after being sorted from the gastrointestinal tracts of 34 turtles (21 loggerheads (Caretta caretta), 9 green turtles (Chelonia mydas), 2 leatherbacks (Dermochelys coriacea), and 2 olive ridleys (Lepidochelys olivacea)). The ingestion frequencies of greens, loggerheads, olive ridleys, and leatherbacks were 100%, 81%, 50%, and 50%, respectively. The mean amount of plastic ingested was 108 ± 253 mg/kg (38 ± 61 n/ind.). The ingested debris tended to be films and fibers (>80%), light in color (white and transparent; 65%), and light polymers (polyethylene, polypropylene, polypropylene [poly (ethylene:propylene)], expanded polystyrene; 93%). The original uses were identified for 187 pieces; single-use plastics (e.g., plastic bag and packaging) and fishing and aquaculture items (e.g., twine and net) were found to dominate. Green turtles (264 ± 433 mg/kg) ingested significantly higher amounts of plastic than loggerheads (72.8 ± 156 mg/kg). Green turtles ingested mostly fibers (51%), such as rope, twine, and net, while loggerheads ingested largely films (61%), such as plastic bags and packaging. Interspecies differences in quantities and shapes of ingested debris may be related to their distinct feeding habits and geographical range of movement. The present study demonstrates that sea turtles foraging in Korean waters are considerably affected by marine plastic debris, and indicates that proper waste management of single-use plastics and fishing gears is urgently needed to mitigate the damage that plastic debris causes to marine wildlife.

Levels and profiles of perfluorinated alkyl acids in liver tissues of birds with different habitat types and trophic levels from an urbanized coastal region of South Korea

Contamination status and characteristics of perfluorinated alkyl acids (PFAAs) including perfluorinated carboxylic acids (PFCAs) and perfluorinated sulfonic acids (PFSAs) was examined using liver tissue of birds - black-tailed gulls (Larus crassirostris), domestic pigeons (Columba livia var. domestica), pacific loons (Gavia pacifica), herons (Ardea cinerea), and egrets (Egretta garzetta and Ardea alba) - with different trophic levels, habitat types and migratory behaviors from an industrialized coastal region of South Korea. A wide range of PFAAs (1.09 ng/g to 1060 ng/g; median = 52.6 ng/g) were detected in bird livers from the Korean coasts with high detection frequency. Accumulation features of PFAAs in birds indicated that primarily trophic position and secondly habitat type influence the levels and composition of PFAAs, e.g., relatively high PFAA levels and high composition of odd-numbered long carbon chain PFCAs (perfluoroundecanoic acid (PFUnDA) and perfluorotridecanoic acid (PFTriDA)) and PFOS in higher trophic and marine birds. The prevalence of long carbon chain (≥14) PFCAs likely implies a wide use of fluorotelomer-based substances in Korea. Interspecies comparison in the accumulation profile of persistent organic pollutants (including polychlorinated biphenyls (PCBs), organochlorine pesticides, polybrominated diphenylethers (PBDEs), and PFAAs) reveals relatively high load of PFAAs in inland (pigeons) and estuarine (egrets/herons) species compared to marine bird species, indicating wide use of PFAAs in the terrestrial environment.

A comparison of spectroscopic analysis methods for microplastics: Manual, semi-automated, and automated Fourier transform infrared and Raman techniques

This study was conducted to establish the best practice for microplastic analysis by reducing the time demand and human bias and comparing the characteristics of μ-FTIR and Raman techniques. A manual analysis, semi-automated method, and fully automatic identification method were compared. Fully automated identification took the shortest time to analyze a whole filter paper (Ø25 mm), but its false positive identification rate was 80 ± 15%. The semi-automated analysis using spectrum profiling was suitable for all aspects of microplastic analysis. It was less time consuming than the manual analysis (manual: 6.1 ± 0.8 h, semi-automated: 4.0 ± 0.6 h), and 22 ± 12% more microplastic particles were detected using the semi-automated method compared to the manual analysis due to the reduction in false negative results. Raman microscopy was suitable for small microplastic (>5 μm) identification, although the Raman analysis took nine times longer than the semi-automated analysis.

Suicide associated with COVID-19 infection: an immunological point of view

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide.

MATERIALS AND METHODS

We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients.

RESULTS

Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed.

CONCLUSIONS

COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy for advanced EGFR-mutated non-small cell lung cancer: systematic review and meta-analysis

OBJECTIVE

It is controversial whether there is efficacy or safety benefit of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced EGFR-mutated non-small cell lung cancer (NSCLC) compared to standard chemotherapy. We aim to assess the efficacy and safety of EGFR-TKIs compared to other chemotherapeutics in EGFR-mutated NSCLC.

MATERIALS AND METHODS

Up to April 27th, 2020, PubMed, Embase, Medline, Scopus, Cochrane library, and ClinicalTrials.gov were searched for articles or trials meeting the inclusion criteria. After filtering, 230 eligible studies were initially identified. Data extraction followed PRISMA and included outcomes were progression-free survival (PFS), overall survival (OS), and severe adverse events (SAEs). Direct and indirect meta-analyses were generated in the context of log-linear mixed-effects models, with fixed effects for each relative comparison and random effects for each study.

RESULTS

The results showed that EGFR-TKI therapy had improved PFS with a hazard ratio (HR) of 0.40 (95% CI: 0.36-0.44, p<0.001) compared to standard chemotherapy. Nevertheless, the EGFR-TKIs showed no benefit on OS (HR: 0.96, 95% CI: 0.83-1.10, p=0.556). In the analysis of adverse events, EGFR-TKIs had fewer SAEs than standard chemotherapy (HR: 0.29, 95% CI: 0.26-0.33, p<0.001).

CONCLUSIONS

Our systemic review indicates that EGFR-TKI therapy has improved PFS, and reduced SAEs compared to standard chemotherapy in advanced EGFR-mutated NSCLC.

Evaluating the fate of hexabromocyclododecanes in the coastal environment: Fugacity analysis using field data

Abundant use of plastic materials has increased the amount of microplastics (MPs) and related hazardous chemicals in the marine environment. Hexabromocyclododecanes (HBCDs), brominated flame retardants added to expanded polystyrene (EPS), have been detected in biotic and abiotic samples. In this study, the partition constants of HBCDs between plastics and seawater (K_Psw) were determined. Fugacities of HBCDs in EPS, seawater, sediment, and mussels were obtained to determine the directions of the diffusive flux. The fugacities in EPS (f_EPS) were greater than those in seawater (f_sw), sediment (f_sed), and mussels (f_swmussel-EPS and f_mussel-rock) by three orders of magnitude, indicating that EPS plastics are a significant source of HBCDs. The f_mussel-rock of α-HBCD in rock mussels was greater than f_sw by factors of 1.7, whereas the f_mussel-rock of γ-HBCD was smaller than f_sw by factors of 16, indicating the bioisomerization from γ-to α-HBCD. The relatively constant concentration ratio of β-HBCD to the total HBCDs indicated that β-HBCD is a sufficient tracer for determining the diffusive flux. The f_sed values of HBCDs were greater than f_sw by factors of 17-28, implying a probable advective vertical flow of HBCDs from the EPS plastics, which requires further investigation.

Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses

OBJECTIVE

Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available.

MATERIALS AND METHODS

We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval.

RESULTS

A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers.

CONCLUSIONS

Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.

Prevalence of small high-density microplastics in the continental shelf and deep sea waters of East Asia

Microplastics are widely distributed throughout aquatic environments. Information about the vertical distribution and fate of microplastics in seawater remains limited. To elucidate the vertical distribution of microplastics, three to six vertical water column layers were sampled based on the thermocline depth, from which the vertical distribution and characteristics of microplastics larger than 20 μm were investigated in continental shelf and deep-sea waters around South Korea. In addition, microplastics incorporated into marine aggregates (aggregated fraction) were investigated to determine the contribution of aggregates to vertical transport of microplastics. The abundance of microplastics was in the range of 15-9,400 particles/m³. No consistent trend was observed in the overall vertical profiles. The size, shape and polymer compositions of microplastics at each station were generally comparable throughout the water column. Unexpectedly, high-density (HD; > 1.02 g/cm³) polymers accounted for an average of 73% of total microplastics. As polymer density increased, the proportion of microplastics less than 100 μm in size increased. HD polymers also accounted for 68% of the aerosol samples collected together with water samples. Due to the relatively high proportion of HD polymers in far-offshore waters, high-density solution should be used to extract microplastics, even from surface seawaters. The aggregated fraction accounted for 0-28.6% (average, 3.4%) of total microplastics. Marine aggregates are considered an important mechanism of transport for microplastics less dense than seawater to the deep-water column, but they showed lower proportions than expected in continental shelf and deep-sea waters around South Korea.

Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses

OBJECTIVE

Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases.

MATERIALS AND METHODS

We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval.

RESULTS

We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant.

CONCLUSIONS

Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.

Impact of polyethylene terephthalate microfiber length on cellular responses in the Mediterranean mussel Mytilus galloprovincialis

Many studies have investigated the toxic effects of microplastics in marine organisms, but most studied nano-sized round microplastics at high concentrations and were not environmentally relevant. To understand the cellular toxicity of polyethylene terephthalate microfibers (PET-MFs) by length (50 and 100 μm), Mediterranean mussels (Mytilus galloprovincialis) were exposed to environmental (0.5 μg/L) and high (100 mg/L) MF concentrations for four days. Short PET-MFs accumulated in the lower intestinal organs of the mussels, but long PET-MFs were only observed in the upper intestinal organs. Both sized PET-MFs affected necrosis, DNA damage, reactive oxygen species, nitric oxide, and acetylcholinesterase (AChE) activity. Significant MF length-dependent effects occurred at environmentally relevant concentrations for DNA damage (100 μm MFs) and AChE activity (50 μm MFs). However, length effects disappeared at the higher exposure concentration. The current study provides potentially sensitive indicators to detect MFs exposure and the ecotoxicological implications of MFs in marine ecosystems.

Data analysis scheme for correcting general misalignments of an optics configuration for a voltage measurement system based on the Pockels electro-optic effect

Having a sub-ns response time and not requiring physical contacts to the measurement points, a voltage measurement system based on the Pockels electro-optic effect, referred to as a PE (Pockels effect)-based voltmeter, is widely used for pulsed high voltage devices such as accelerators and X-pinch systems. To correct for the misalignment of a Pockels cell and the transmittance ratio of a beam splitter, a polar-coordinate-based data analysis scheme has been proposed. This scheme also overcomes a limitation on the measurable range of a PE-based voltmeter without ambiguity and can measure the half-wave voltage of a Pockels cell. We present an improved polar-coordinate-based data analysis scheme using an ellipse fitting method, which can correct for misalignments of all the optics components of a PE-based voltmeter while keeping the advantages of the previous scheme. We show the results of the improved data analysis scheme for measuring a slowly modulated voltage up to approximately 5 kV in about 30 s and a pulsed high voltage up to 7 kV with a rise time of less than 20 ns.

Ecological risk assessment of microplastics in coastal, shelf, and deep sea waters with a consideration of environmentally relevant size and shape

This study assessed the ecological risk posed by microplastics in surface and subsurface seawaters in coastal, continental shelf, and deep-sea areas of South Korea. The target microplastics for risk assessment were specified as only non-spherical type microplastics in the size range 20-300 μm, because this type was predominantly observed in our study areas, and adverse biological effects have previously been reported. Exposure data for non-spherical microplastics were obtained from a previous study or were measured for microplastics of sizes down to 20 μm. A predicted no-effect concentration (PNEC) of 12 particles/L was derived by employing a species sensitivity distribution approach. Then the results were compared to the in situ observed concentrations at each site. The detected microplastic concentrations did not exceed the derived PNEC, i.e., the current pollution levels of fragment and fiber microplastics in the size range 20-300 μm would not pose a significant threat to the marine ecosystem in South Korea. However, predictions are that microplastic pollution will increase to 50-fold by 2100 at the current rates, and in this scenario, the microplastic concentration is expected to far exceed the derived PNEC values for marine ecosystems. It is therefore urgent to take precautionary actions to prevent a further increase in microplastic concentrations in these environments.

Nationwide monitoring of microplastics in bivalves from the coastal environment of Korea

Bivalves are useful bioindicators of microplastic contamination in the marine environment for several reasons, such as extensive filter feeding activity, broad geographical distribution, and limited movement capability. This study conducted a nationwide monitoring of microplastic pollution along the Korean coasts using filter-feeding bivalves (including oyster, mussel, and Manila clam) as bioindicators to identify the national contamination level and characteristics of microplastics. Seawater sample was collected from the same sampling stations of oyster and mussel for comparison. Microplastics were widely distributed in both coastal bivalves and waters with mean concentrations of 0.33 ± 0.23 n/g (1.21 ± 0.68 n/individual) in oyster/mussel, 0.43 ± 0.32 n/g (2.19 ± 1.20 n/individual) in Manila clam, and 1400 ± 560 n/m³ in seawater. Despite the lack of significant relationship in the abundance of microplastics, their dominant features such as size, shape, color and polymer type were similar between bivalves and seawater. Fragments (69% for oyster/mussel, 72% for Manila clam, and 77% for seawater), particles smaller than 300 μm (96% for oyster/mussel, 83% for Manila clam, and 84% for seawater) and colorless (79% for oyster/mussel, 85% for Manila clam, 75% for seawater) were the dominant shape, size and color, respectively. The major polymer types were polypropylene, polyethylene, and polyester. The microplastic level in bivalves was relatively high in urbanized areas with a wide diversity of polymer types compared with those in non-urbanized areas, and the proportion of polystyrene in the Korean samples was abundant compared with other regions due to wide use of polystyrene products in Korea. Our result suggests that microplastic contamination is widespread in the Korean coastal environment, and bivalves can reflect the microplastic pollution characteristics of the surrounding waters where they live.

Relative importance of aqueous leachate versus particle ingestion as uptake routes for microplastic additives (hexabromocyclododecane) to mussels

Microplastic pollution is emerging as a global environmental issue, and its potential for transferring hazardous chemicals to aquatic organisms is gaining attention. Studies have investigated the transfer of chemicals, mainly sorbed chemicals, through ingestion of microplastics by organisms, but limited information is available regarding chemical additives and uptake via the aqueous route through plastic leaching. In this study, we compared two bioaccumulation pathways of the additive hexabromocyclododecane (HBCD) by exposing mussels (Mytilus galloprovincialis) to two different sizes of expanded polystyrene (EPS): inedible size (4.2-5.5 mm) for leachate uptake and edible size (20-770 μm) for particle ingestion and leachate uptake. Over 10 days, the HBCD concentration increased significantly in mussels in the EPS exposure groups, indicating that EPS microplastic acts as a source of HBCD to mussels. The concentration and isomeric profiles of HBCD in mussels show that uptake through the aqueous phase is a more significant pathway for bioaccumulation of HBCD from EPS to mussels than particle ingestion. HBCD levels measured in EPS, leachate and exposed mussels from this study are environmentally relevant concentration. The fate and effects of chemical additives leached from plastic debris in ecosystem requires further investigation, as it may affect numerous environments and organisms through the aqueous phase.

Risk factors of COVID-19 mortality: a systematic review of current literature and lessons from recent retracted articles

OBJECTIVE

Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight.

MATERIALS AND METHODS

We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers.

RESULTS

Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91).

CONCLUSIONS

When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.

Clinical characteristics and mortality of patients with hematologic malignancies and COVID-19: a systematic review

OBJECTIVE

Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we comprehensively reviewed existing literature and analyzed clinical characteristics and mortality of patients with hematologic malignancies and COVID-19.

MATERIALS AND METHODS

Through searching PubMed until June 03, 2020, we identified 16 relevant case studies (33 cases) from a total of 45 studies that have reported on patients with COVID-19 and hematologic malignancies. We investigated the clinical and laboratory characteristics including type of hematologic malignancies, initial symptoms, laboratory findings, and clinical outcomes. Then, we compared those characteristics and outcomes of patients with hematologic malignancies and COVID-19 to the general population infected with COVID-19.

RESULTS

The median age was 66-year-old. Chronic lymphocytic leukemia was the most common type of hematologic malignancy (39.4%). Fever was the most common symptom (75.9%). Most patients had normal leukocyte counts (55.6%), lymphocytosis (45.4%), and normal platelet counts (68.8%). In comparison to patients with COVID-19 without underlying hematologic malignancies, dyspnea was more prevalent (45.0 vs. 24.9%, p=0.025). Leukocytosis (38.9 vs. 9.8%, p=0.001), lymphocytosis (45.4 vs. 8.2%, p=0.001), and thrombocytopenia (31.3 vs. 11.4%, p=0.036) were significantly more prevalent and lymphopenia (18.2 vs. 57.4%, p=0.012) less prevalent in patients with hematologic malignancies. There were no clinical and laboratory characteristics predicting mortality in patients with hematologic malignancies. Mortality was much higher in patients with hematologic malignancies compared to those without this condition (40.0 vs. 3.6%, p<0.001).

CONCLUSIONS

Co-occurrence of hematologic malignancies and COVID-19 is rare. However, due to the high mortality rate from COVID-19 in this vulnerable population, further investigation on tailored treatment and management is required.

Rapid Production of Micro- and Nanoplastics by Fragmentation of Expanded Polystyrene Exposed to Sunlight

Expanded polystyrene (EPS) is a common plastic marine debris found in oceans worldwide. The unique "foamed" structure of EPS, which is composed of thin layers, is more vulnerable to fragmentation than bulk plastics. However, the production rate of micro- and nanoplastics by the fragmentation of EPS following sunlight exposure remains largely unknown. Here, we determined the fragmentation rate and weight loss of EPS in an outdoor weathering experiment that ran for 24 months. It took only 1 month for the weight of an EPS box to decline by 5% due to photodegradation, and approximately 6.7 × 10⁷ micro- and nanoparticles/cm² could be produced at a latitude of 34 °N. These results indicate that macro EPS debris can continually produce a massive number of particles within a relatively short exposure duration. The findings provide useful information to inform policymakers how rapidly to remove "likely fragmented" plastic litter from the environment.

Psychoacoustics and neurophysiological auditory processing in patients with Charcot-Marie-Tooth disease types 1A and 2A

BACKGROUND AND PURPOSE

Hidden hearing loss has been reported in patients with Charcot-Marie-Tooth (CMT) disease; however, the auditory-processing deficits have not been widely explored. We investigated the psychoacoustic and neurophysiological aspects of auditory processing in patients with CMT disease type 1A (CMT1A) and type 2A (CMT2A).

METHODS

A total of 43 patients with CMT1A and 15 patients with CMT2A were prospectively enrolled. All patients with CMT disease had normal sound-detection ability by using pure-tone audiometry. Spectral-ripple discrimination, temporal modulation detection and auditory frequency-following response were compared between CMT1A, CMT2A and control groups.

RESULTS

Although all participants had normal audiograms, patients with CMT disease had difficulty understanding speech in noise. The psychoacoustic auditory processing was somewhat different depending on the underlying pathophysiology of CMT disease. Patients with CMT1A had degraded auditory temporal and spectral processing. Patients with CMT2A had no reduced spectral resolution, but they showed further reduced temporal resolution than the patients with CMT1A. The amplitudes of the frequency-following response were reduced in patients with CMT1A and CMT2A, but the neural timing remained relatively intact.

CONCLUSIONS

When we first assessed the neural representation to speech at the brainstem level, the grand average brainstem responses were reduced in both patients with CMT1A and CMT2A compared with healthy controls. As the psychoacoustic aspects of auditory dysfunctions in CMT1A and CMT2A were somewhat different, it is necessary to consider future auditory rehabilitation methods based on their pathophysiology.

Spatial distribution of microplastic in the surface waters along the coast of Korea

We examined the spatial distribution and local characteristics of microplastics (0.33-5 mm) in surface water from six semi-enclosed bays and two coastal waters in Korea. Surveys were conducted in July from 2015 to 2017 using a Manta trawl. The mean abundance of total microplastics ranged from 1.12-4.74 particles/m³ among sites; the microplastics were mostly expanded polystyrene (EPS), paint particles, fragments and fibers. The mean microplastic abundance (2.85 particles/m³) in urban areas was about 1.5 times higher than in rural areas (1.86 particles/m³) (p < 0.05). EPS dominated at rural sites, while fragments, paint particles, and fibers were relatively more dominant in urban areas. The different types and quantities of microplastic particles indicated that the region-specific occurrence of microplastics is likely to be related to differences in human activities between urban and rural areas, even though fibers were distributed throughout the study area.

A close relationship between microplastic contamination and coastal area use pattern

Human activity is thought to affect the abundance and contamination characteristics of microplastics (MPs) in the environment, which may in turn affect aquatic species. However, few studies have examined the impact of coastal area use pattern on characteristics of MPs in coastal regions. In this study, we investigated MP contamination of abiotic matrices (seawater and sediment) and biotic matrices (bivalves and polychaetes) in three coastal regions characterized by different types of human activity, covering urban, aquafarm, and rural areas. MP abundance was higher in sediment from the urban site than in that from the rural site, but similar to that from the aquafarm site. In the abiotic matrices, different MP polymer compositions were observed among the three sites. Diverse polymers were found in marine matrices from the urban site, implying diverse MP sources in highly populated and industrialized areas. Polystyrene was more abundant in the aquafarm site, reflecting the wide use of expanded polystyrene aquaculture buoys. Polypropylene was more abundant at the rural site, probably due to the use of polypropylene ropes and nets in fishing activity. MP accumulation profiles in marine invertebrates showed trends similar to those exhibited by abiotic matrices, reflecting coastal area use patterns. These results indicate that marine MPs are generated from both land- and marine-based sources, and that the abiotic and biotic marine matrices reflect the MP characteristics.

Photosynthesis enhancement in four marine microalgal species exposed to expanded polystyrene leachate

Due to its widespread use, large amounts of expanded polystyrene (EPS) have been released into the marine environment, where it is broken down into small pieces with large surface areas. As such, chemical additives may be released into the environment, which can affect marine organisms; however, studies of the effects of such additives are lacking. We assessed the effects of leachate from EPS on the photosynthetic activities of four microalgal species (Dunaliella salina, Scenedesmus rubescens, Chlorella saccharophila, and Stichococcus bacillaris). They were exposed to EPS leachate for seven days and their photosynthetic activities were analyzed based on seven parameters. Overall, leachate exposure increased photosynthetic activity in all four species, albeit to different degrees and showing slightly different trends among the seven parameters. Based on chemical analysis, hexabromocyclododecane concentrations were higher in small-fragment leachate, whereas UV326 concentrations were higher in low-concentration-large-sphere leachate; bisphenol-A and total organic carbon showed no major differences among leachates. Thus, we speculate that exposure to trace chemicals influenced microalgal photosynthesis and overall growth. These results support further investigation of the impacts of plastic debris and chemical additives on marine ecosystems and organisms.

Evaluation of microplastic toxicity in accordance with different sizes and exposure times in the marine copepod Tigriopus japonicus

The indiscriminate use of plastic has greatly increased microplastic contamination risk in the marine environment. Microplastics can affect all marine life via the food web, from primary producers (e.g., microalgae) to final consumers (e.g., carnivorous fish). Thus, several studies have attempted to evaluate microplastic toxicity, but information about the underlying mechanisms of their effect is limited. Therefore, in this study, we examined multiple factors that could contribute to microplastic-induced toxicity. We investigated the potential molecular effects of microplastic size and exposure time. We exposed the marine copepod Tigriopus japonicus to 50 nm and 10 μm polystyrene microbeads. We found that both size and exposure time increased intracellular levels of reactive oxygen species. In addition, antioxidant-related gene expression was modulated and antioxidant enzyme activities were changed significantly. The results of this study provide important insights into the molecular mechanisms of microplastic-induced toxicity in a marine organism.

Spatiotemporal distribution and annual load of microplastics in the Nakdong River, South Korea

Although rivers represent an important pathway for the transport of microplastics to the oceans, research on riverine microplastics is limited compared to the marine environment. Hence, we investigated the spatiotemporal distribution of microplastics in the Nakdong River down to 20 μm in size and characterized them using Fourier transform infrared spectroscopy in surface and mid waters and sediment. The mean (±standard deviation) abundance of microplastic in the Nakdong River was in the range of 293 ± 83 (upstream, February 2017) to 4760 ± 5242 (downstream, August 2017) particles/m³ in water, and 1970 ± 62 particles/kg in sediment. The abundance of microplastics was about three times higher in surface than mid waters in the downstream area. Polypropylene and polyester accounted for 41.8% and 23.1% of microplastics in the water, respectively, whereas about 50% in the sediment was composed of polypropylene and polyethylene. Microplastics smaller than 300 μm in size accounted for 74% in the water and 81% in sediment, and the distribution peaked in the 50-150 μm size range. Based on these results, we estimated the annual load of microplastics carried by the Nakdong River in 2017 to be 5.4-11 trillion by number and 53.3-118 tons by weight. The proportions of the total load transported through surface water and the water column were 8% and 92%, respectively. In addition, the microplastic load was concentrated in the wet season, which makes up 71% in number and 81% in weight. These results indicate that it is necessary to reflect seasonal variation and sample both in the surface water and water column to estimate microplastic transport. Without considering these factors, the annual load of microplastics may be overestimated or underestimated.

Intraoperative Management to Prevent Cardiac Collapse in a Patient With a Recurrent, Large-volume Pericardial Effusion and Paroxysmal Atrial Fibrillation During Liver Transplantation: A Case Report

BACKGROUND

Pericardial effusion is a common feature of end-stage liver disease. In this case report we describe the intraoperative management of recurrent pericardial effusion, without re-pericardiocentesis, to prevent circulatory collapse during a critical surgical time-point; that is, during manipulation of the major vessels and graft reperfusion.

METHODS

A 47-year-old woman with hepatitis B was scheduled to undergo deceased donor liver transplantation (LT). A large pericardial effusion was preoperatively identified using transthoracic echocardiography (TTE). The patient also had paroxysmal atrial fibrillation. Two days before surgery, preemptive pericardiocentesis was performed and the 1150-mL effusion was drained. Intraoperatively, recurrence of the large pericardial effusion was identified using transesophageal echocardiography (TEE). During inferior vena cava manipulation, the surgeon consulted the anesthesiologist to evaluate the hemodynamic changes in the patient. After 3 attempts, the transplant team was able to determine the most appropriate anastomosis site, defined as that with the least impact on cardiac function. To prevent the development of severe postreperfusion syndrome, 10% MgSO₄ (2 g) was gradually infused 20 minutes before portal vein declamping, and immediately before graft reperfusion a 100-μg bolus of epinephrine was administered.

RESULTS

During graft reperfusion, there was no evidence of heart chamber collapse or flow disturbance, as seen on the TEE findings. Postoperatively, the patient recovered completely and was discharged from the hospital. Six months after surgery, there was no sign of pericardial effusion on follow-up TTE.

CONCLUSION

Our intraoperative strategy may prevent cardiac collapse in patients with pericardial effusion detected during LT. Intraoperative TEE plays an important role in guiding hemodynamic management.

Abundance and characteristics of microplastics in market bivalves from South Korea

Microplastic contamination in marine organisms is a growing environmental issue with implications for seafood safety. Among marine organisms, shellfish are considered to be an important route of human exposure to microplastics because they filter a large volume of seawater while feeding and, thus, accumulate microplastics from seawater; furthermore, they are consumed whole, without gut removal. In this study, a market survey was carried out to understand microplastic contamination in domestic bivalves sold in fishery markets in three major cities of South Korea. Four popular bivalve species, oyster (Crassostrea gigas), mussel (Mytilus edulis), Manila clam (Tapes philippinarum) and scallop (Patinopecten yessoensis), were selected as monitoring species, which together account for 79-84% of total shellfish consumption in Korea. The mean concentration of microplastics in these four species was 0.15 ± 0.20 n/g and 0.97 ± 0.74 n/individual. Fragments and particles smaller than 300 μm were dominant shape and size, accounting for 76% and 65% of total microplastics, respectively. Polyethylene (PE), polypropylene (PP), polystyrene (PS), and polyester were the major polymer types. Interestingly, differing polymer compositions were observed according to the culture methods and habitat characteristics of each species. PS was found in high proportions in oysters and mussels cultured in the upper layer of the water column, while the proportions decreased and those of polyester increased in Manila clams and scallops that were cultured in intertidal sediments or the middle and bottom layers of the water column. The annual dietary intake of microplastics by the Korean population via shellfish consumption was estimated as 212 n/person·year. Our results suggested that microplastic pollution is widespread in commercial bivalves and we recommend a systematic and integrative market-basket survey to clarify the current status of human exposure to microplastics.

Intraoperative Management of a Patient With Impaired Cardiac Function Undergoing Simultaneous ABO-Compatible Liver and ABO-Incompatible Kidney Transplant From 2 Living Donors: A Case Report

BACKGROUND

Combined liver and kidney transplant is a very complex surgery. To date, there has been no report on the intraoperative management of patients with impaired cardiac function undergoing simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors.

CASE REPORT

A 60-year-old man underwent simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors because of IgA nephropathy and alcoholic liver cirrhosis. The preoperative cardiac findings revealed continuous aggravation, shown by large left atrial enlargement, severe left ventricular hypertrophy, a very prolonged QT interval, and a calcified left anterior descending coronary artery. Severe hypotension with very weak pulsation and severe bradycardia developed, with an irregular junctional rhythm noted immediately after the liver graft was reperfused. Although epinephrine was administered as a rescue drug, hemodynamics did not improve, and central venous pressure and mean pulmonary arterial pressure increased to potentially fatal levels. Emergency phlebotomy via the central line was performed. Thereafter, hypotension and bradycardia recovered gradually as the central venous pressure and mean pulmonary arterial pressure decreased. The irregular junctional rhythm returned to a sinus rhythm, but the QTc interval was slightly more prolonged. Because of poor cardiac capacity, the volume and rate of fluid infusion were increased aggressively to maintain appropriate kidney graft perfusion after confirming vigorous urine production of the graft.

CONCLUSIONS

A heart with impaired function due to both end-stage liver and kidney diseases may be less able to withstand surgical stress. Further study on cardiac dysfunction will be helpful for the management of patients undergoing complex transplant surgery.

Horizontal and Vertical Distribution of Microplastics in Korean Coastal Waters

This is the first survey to investigate the vertical distribution and composition of microplastics >20 μm at the surface (0-0.2 m; bulk sample) and in the water column (3-58 m depth; pump) of six semi-enclosed bays and two nearshore areas of South Korea. The average microplastic abundance of 41 stations at all sampling depths was 871 particles/m³, and the microplastic abundance near urban areas (1051 particles/m³) was significantly higher than that near rural areas (560 particles/m³). Although the average microplastic abundances in the midcolumn (423 particles/m³) and bottom water (394 particles/m³) were approximately 4 times lower than that of surface water (1736 particles/m³), microplastics prevailed throughout the water column in concentrations of 10-2000 particles/m³. The average sizes of fragment and fiber type microplastics were 197 and 752 μm, respectively. Although the polymer composition differed by depth depending on the particle size and density, polypropylene and polyethylene predominated throughout the water column regardless of their low density and particle size. Finally, the middle and bottom water samples contained higher abundances of microplastics than predicted by a model based on physical mixing, indicating that biological interactions also influence the downward movement of low-density microplastics.

Canavalia ensiformis-derived lectin inhibits biofilm formation of enterohemorrhagic Escherichia coli and Listeria monocytogenes

AIM

A lectin Concanavalin A (ConA) derived from Canavalia ensiformis (jack bean) exhibits high-binding affinity to carbohydrates on bacterial cell surfaces. The objective of this study was to inhibit the biofilm formation of the foodborne pathogens enterohemorrhagic Escherichia coli and Listeria monocytogenes using ConA prepared by a membrane-based extraction method.

METHODS AND RESULTS

ConA was extracted using a simple and inexpensive membrane method instead of a chromatography approach. The extracted ConA was effective in inhibiting biofilms of E. coli by 30-fold and L. monocytogenes by 140-fold. In addition, ConA decreased the swimming motility of enterohemorrhagic E. coli EDL933 (EHEC) by 37%, resulting in low biofilm formation, as ConA binding to the bacterial cell surfaces might cause a reduced capability to adhere due to low cellular motility. We confirmed that the extracted ConA contains active components at less than 10 kDa as well as ConA multimers (>30 kDa) that repress EHEC biofilms. Additionally, noncell-based mannose reduced the activity of ConA in inhibiting biofilms.

CONCLUSIONS

ConA extracted using the membrane-based method is active in inhibiting the biofilm formation by E. coli and L. monocytogenes via the mannose-binding affinity of ConA.

SIGNIFICANCE AND IMPACT OF THE STUDY

ConA can be used as a promising anti-adherent and antibiofilm agent in inhibiting biofilm formation by enterohemorrhagic E. coli and L. monocytogenes. The membrane-based extraction approach may be applied for the economic production of biologically active lectins.

Highly-Sensitive Refractive Index Sensing by Near-infrared Metatronic Nanocircuits

In this work, we present a highly-sensitive refractive index sensor based on metatronic nanocircuits operating at near-infrared spectral range. The structure is designed based on simple nanorod geometry and fabricated by nanopatterning of transparent conducting oxides. The functionality of these polarization dependent metatronic nanocircuits is enhanced by applying tunable response. This feature is investigated by depositing NH₂ (Amine) groups via plasma polymerization technique on top of indium-tin-oxide nanorods. The dielectric constant of Amine groups is a function of their thickness, which can be controlled by the RF power and the time duration of the applied plasma polymerization process. The resonance wavelengths of nanocircuits shift to higher wavelength, as the dielectric constant of the deposited material increases. An excellent agreement between the design and experimental results are obtained. Our metatronic based nanosensor offers a high-sensitive performance of 1587 nm/RIU with a satisfactory figure of merit for this class of sensors.

[A cohort study on body mass index and risk of all-cause mortality among hypertensive population]

Objective: To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods: All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results: Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m(2)<BMI<24.0 kg/m(2)) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m(2), 24-28 kg/m(2), and ≥28 kg/m(2)) were 0.83 (95%CI: 0.37-1.87), 0.81 (95%CI: 0.67-0.97), and 0.72 (95%CI: 0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion: Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon.

Abundance, composition, and distribution of microplastics larger than 20 μm in sand beaches of South Korea

To support microplastic management, the abundance, composition, and spatial distribution of microplastics on a national scale must be known. Hence, we studied the baseline level of microplastic pollution at 20 sandy beaches along the South Korean coast. All microplastic particles extracted from the sand samples were identified down to 20 μm in size using Fourier transform infrared spectroscopy. The abundances of large microplastics (L-MPs; 1-5 mm) and small microplastics (S-MPs; 0.02-1 mm) were in the range of 0-2088 n/m² and 1400-62800 n/m², respectively. Maximum microplastic abundance was in the size range of 100-150 μm, and particles smaller than 300 μm accounted for 81% of the total abundance. Expanded polystyrene (EPS) accounted for 95% of L-MPs, whereas S-MPs were predominantly composed of polyethylene (49%) and polypropylene (38%). The spatial distribution of L-MPs, excluding EPS, was significantly related to population, precipitation, proximity to a river mouth and abundance of macroplastic debris on beach. However, there were no relationships between S-MPs and other environmental and source-related factors, except for macroplastic debris and L-MPs excluding EPS. These results imply that S-MPs are mainly produced on beaches by weathering, whereas L-MPs other than EPS are mainly introduced from land-based sources and are also partly produced on beaches.