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In 2015, a large outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred following a single patient exposure in an emergency room at the Samsung Medical Center, a tertiary-care hospital in Seoul, South Korea. We aimed to investigate the epidemiology of MERS-CoV outbreak in our hospital. We identified all patients and health-care workers who had been in the emergency room with the index case between May 27 and May 29, 2015. Patients were categorised on the basis of their exposure in the emergency room: in the same zone as the index case (group A), in different zones except for overlap at the registration area or the radiology suite (group B), and in different zones (group C). We documented cases of MERS-CoV infection, confirmed by real-time PCR testing of sputum samples. We analysed attack rates, incubation periods of the virus, and risk factors for transmission. 675 patients and 218 health-care workers were identified as contacts. MERS-CoV infection was confirmed in 82 individuals (33 patients, eight health-care workers, and 41 visitors). The attack rate was highest in group A (20% [23/117] vs 5% [3/58] in group B vs 1% [4/500] in group C; p<0·0001), and was 2% (5/218) in health-care workers. After excluding nine cases (because of inability to determine the date of symptom onset in six cases and lack of data from three visitors), the median incubation period was 7 days (range 2–17, IQR 5–10). The median incubation period was significantly shorter in group A than in group C (5 days [IQR 4–8] vs 11 days [6–12]; p<0·0001). There were no confirmed cases in patients and visitors who visited the emergency room on May 29 and who were exposed only to potentially contaminated environment without direct contact with the index case. The main risk factor for transmission of MERS-CoV was the location of exposure. Our results showed increased transmission potential of MERS-CoV from a single patient in an overcrowded emergency room and provide compelling evidence that health-care facilities worldwide need to be prepared for emerging infectious diseases. None.

زوجان عجوزان يعيشان في الفقر منذ سنوات طويلة، كل يوم يذهب الرجل لصيد السمك بينما تنشغل زوجته بأعمال النول. وذات يوم رمى الصياد شبكته ليصطاد بها سمكة ذهبية ناطقة، تتضرع السمكة للصياد كي يطلقها وتعده بأن تحقق له كل أمنياته إذا ما فعل ذلك. لكن الرجل يطلق سراحها من دون مقابل، مما يغضب زوجته العجوز التي تطلب منها مرة بعد مرة العودة إلى السمكة مع طلب جديد أكبر من السابق في كل مرة. جشع هذه المرأة لا يعرف الحدود: فبعد أن تصبح سيدة العالم تطلب أن تصبح سيدة البحار. ولكن هل كانت هذه السيدة جشعة دوماً أم أنها علقت في شباك الجشع؟ كان من الممكن أن تكون حياتها وحياة زوجها أكثر سعادة لو أنها رضيت بما قدمته السمكة الذهبية لهما لكنها أصرت على أن لا تتوقف عن الجشع. وحالة هذه السيدة تعبر عنها الأمواج التي تتبدل من كونها هادئة صافية إلى هادرة صاخبة، حتى تتحول إلى عاصفة تكاد تبتلع القارب. ربما شكل هذا نوعاً من الإنذار كي تتوقف العجوز عن جشعها.

Significance This study demonstrates that neuronal groups or ensembles, rather than individual neurons, are emergent functional units of cortical activity. We show that in the presence and absence of visual stimulation, cortical activity is dominated by coactive groups of neurons forming ensembles. These ensembles are flexible and cannot be accounted for by the independent firing properties of neurons in isolation. Intrinsically generated ensembles and stimulus-evoked ensembles are similar, with one main difference: Whereas intrinsic ensembles recur at random time intervals, visually evoked ensembles are time-locked to stimuli. We propose that visual stimuli recruit endogenously generated ensembles to represent visual attributes. The cortical microcircuit is built with recurrent excitatory connections, and it has long been suggested that the purpose of this design is to enable intrinsically driven reverberating activity. To understand the dynamics of neocortical intrinsic activity better, we performed two-photon calcium imaging of populations of neurons from the primary visual cortex of awake mice during visual stimulation and spontaneous activity. In both conditions, cortical activity is dominated by coactive groups of neurons, forming ensembles whose activation cannot be explained by the independent firing properties of their contributing neurons, considered in isolation. Moreover, individual neurons flexibly join multiple ensembles, vastly expanding the encoding potential of the circuit. Intriguingly, the same coactive ensembles can repeat spontaneously and in response to visual stimuli, indicating that stimulus-evoked responses arise from activating these intrinsic building blocks. Although the spatial properties of stimulus-driven and spontaneous ensembles are similar, spontaneous ensembles are active at random intervals, whereas visually evoked ensembles are time-locked to stimuli. We conclude that neuronal ensembles, built by the coactivation of flexible groups of neurons, are emergent functional units of cortical activity and propose that visual stimuli recruit intrinsically generated ensembles to represent visual attributes.

Technical developments in multidetector computed tomography (CT) have increased the number of detector rows on the z-axis, and 16-cm wide-area-coverage CT scanners have enabled volumetric scanning of the entire heart. Beyond coronary arterial imaging, such innovations offer several advantages during clinical imaging in the cardiothoracic area. The wide-detector CT scanner markedly reduces the image acquisition time to less than 1 second for coronary CT angiography, thereby decreasing the volume of contrast material and radiation dose required for the examination. It also eliminates stair-step artifacts, allowing robust improvements in myocardial function and perfusion imaging. Additionally, new imaging techniques for the cardiothoracic area, including subtraction imaging and free-breathing scans, have been developed and further improved by using the wide-detector CT scanner. This article investigates the technical developments in wide-detector CT scanners, summarizes their clinical applications in the cardiothoracic area, and provides a review of the recent literature.

Cancer-related fatigue (CRF) affects therapeutic compliance and clinical outcomes including recurrence and mortality. This study aimed to comprehensively and comparatively assess the severity-based prevalence of CRF. From two public databases (PubMed and Cochrane Library), we extracted data containing information on both prevalence and severity of fatigue in cancer patients through December 2021. We conducted a meta-analysis to produce point estimates using random effects models. Subgroup analyses were used to assess the prevalence and severity by the organ/system tumor development, treatment phase, therapeutic type, sex and assessment method. A total of 151 data (57 studies, 34,310 participants, 11,805 males and 22,505 females) were selected, which indicated 43.0% (95% CI 39.2–47.2) of fatigue prevalence. The total CRF prevalence including ‘mild’ level of fatigue was 70.7% (95% CI 60.6–83.3 from 37 data). The prevalence of ‘severe’ fatigue significantly varied by organ/system types of cancer origin (highest in brain tumors 39.7% vs. lowest in gynecologic tumors 3.9%) and treatment phase likely 15.9% (95% CI 8.1–31.3) before treatment, 33.8% (95% CI 27.7–41.2) ongoing treatment, and 24.1% (95% CI 18.6–31.2) after treatment. Chemotherapy (33.1%) induced approximately 1.5-fold higher prevalence for ‘severe’ CRF than surgery (22.0%) and radiotherapy (24.2%). The self-reported data for ‘severe’ CRF was 20-fold higher than those assessed by physicians (23.6% vs. 1.6%). Female patients exhibited a 1.4-fold higher prevalence of ‘severe’ fatigue compared to males. The present data showed quantitative feature of the prevalence and severity of CRF based on the cancer- or treatment-related factors, sex, and perspective of patient versus physician. In the context of the medical impact of CRF, our results provide a comparative reference to oncologists or health care providers making patient-specific decision.

Currently available therapeutic options for non-insulin-dependent diabetes mellitus, such as dietary modification, oral hypoglycemics, and insulin, have limitations of their own. Many natural products and herbal medicines have been recommended for the treatment of diabetes. The present paper reviews medicinal plants that have shown experimental or clinical antidiabetic activity and that have been used in traditional systems of medicine; the review also covers natural products (active natural components and crude extracts) isolated from the medicinal plants and reported during 2001 to 2005. Many kinds of natural products, such as terpenoids, alkaloids, flavonoids, phenolics, and some others, have shown antidiabetic potential. Particularly, schulzeines A, B, and C, radicamines A and B, 2,5-imino-1,2,5-trideoxy-L-glucitol, -homofuconojirimycin, myrciacitrin IV, dehydrotrametenolic acid, corosolic acid (Glucosol™), 4-(α-rhamnopyranosyl)ellagic acid, and 1,2,3,4,6- pentagalloylglucose have shown significant antidiabetic activities. Among active medicinal herbs, Momordica charantia L. (Cucurbitaceae), Pterocarpus marsupium Roxb. (Leguminoceae), and Trigonella foenum graecum L. (Leguminosae) have been reported as beneficial for treatment of type 2 diabetes.

This study explores how COVID-19-induced stress (CID) influences organizational trust, job satisfaction, self-esteem, and commitment in tourism and hospitality organizations. A total of 427 tourism affiliated employees in South Korea participated in an online survey. Using structural equation modelling (SEM), the proposed conceptual model reveals that CID stress in tourism/hospitality employees is negatively related to organizational trust, job satisfaction, and self-esteem which, in turn, is positively related to organizational commitment. CID stress also indirectly affects organizational commitment. The findings have significant strategic implications for tourism and hospitality organizations‒specifically, the provision of instrumental resources (e.g., safety glasses, latex gloves, hand sanitizers, facial masks) to alleviate their employees’ work-related stress during pandemics.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major risk factor for liver cirrhosis, yet effective prevention or treatment strategies remain limited. To address this, we utilized a signature-based in silico drug repositioning approach to identify potential therapeutics for MASLD that may reduce the risk of cirrhosis. We analyzed gene expression datasets to identify differentially expressed genes (DEGs) in MASLD and matched them to candidate drugs using L1000CDS2. We further validated potential drugs by cross-referencing with prescription data from the Korea National Health Insurance Service (NHIS). Participants who underwent health screenings between 2013 and 2014 were included. MASLD was diagnosed in individuals with hepatic steatosis (fatty liver index ≥60) and at least one cardiometabolic risk factor. We identified 11 drug candidates and analyzed 49,555 MASLD patients (mean age: 63.0 years, SD: 8.6). Atenolol (SHR: 0.81; 95% CI: 0.72-0.92; P < 0.001), isosorbide dinitrate (SHR: 0.82; 95% CI: 0.73-0.93; P = 0.001), and valsartan (SHR: 0.52; 95% CI: 0.45-0.60; P < 0.001) were associated with a reduced risk of cirrhosis. Conversely, amlodipine-based combinations (SHR: 1.24; 95% CI: 1.11-1.39; P < 0.001), torasemide (SHR: 1.39; 95% CI: 1.24-1.56; P < 0.001), and valsartan-based combinations (SHR: 1.22; 95% CI: 1.09-1.37; P < 0.001) were linked to an increased risk. Our findings suggest that antihypertensive drugs such as atenolol and isosorbide dinitrate may protect MASLD patients from cirrhosis, providing valuable insights for clinical applications and treatment strategies. This study is limited to drugs registered in the Korean NHIS, potentially excluding other relevant candidates. Additionally, the absence of dietary and genetic data in the NHIS database may introduce residual confounding. Lastly, as the study population consists solely of Korean adults, the findings may not be generalizable to other populations.

There is growing recognition of the importance of rehabilitation through immediate and long-term follow-up, and neonatal intensive care unit (NICU) aftercare is emerging as an important field to consider rehabilitation services. An increasing number of children born are admitted to the NICU with complications commonly related to low birth weight, premature birth, and development of underlying diseases. Early initiation of rehabilitation services in the NICU has become more common and includes therapies relating to feeding tube removal and pulmonary breathing. We investigated the patterns of rehabilitation utilization (rehabilitation frequency, moving to an area for rehabilitation treatment) and medical expenses based on NICU hospitalization history. Data from the Korean National Health Insurance Service Database over a span of ten years were reviewed, with an observation period of 3 years after the first rehabilitation session. The newborns were divided into two groups: 16,626 in the NICU group and the non-NICU group, matched 1:1 based on NICU hospitalization history. The number of rehabilitation treatments in the non-NICU group was significantly higher over the two years following the initial rehabilitation session ( p  < 0.05). In contrast, the total medical expenses during the 6 months following the initial rehabilitation session were more than six times higher in the NICU group (KRW 1,868,516 vs. 11,348,940, p  < 0.0001). The NICU group showed significantly more discrepancies between their residence and the first rehabilitation treatment area (9.5% vs. 13.4%, p  < 0.001). Results indicate that the amount of rehabilitation sessions and access to rehabilitation for individuals with a NICU history is lower compared to those without a NICU history. Therefore, national support is needed to revitalize rehabilitation procedures and reduce medical expenses in the NICU group, and further studies should focus on novel methods to revitalize NICU rehabilitation.