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Objectives: This study aimed to compare the predictive performance of the Korean Triage and Acuity Scale (KTAS) and the National Early Warning Score (NEWS) for serious adverse events (SAEs), including mortality and intensive care unit (ICU) admission, during emergency department (ED) stay. We also evaluated whether combining the two systems improves prediction accuracy. Methods: This retrospective study included adult patients (≥19 years) who presented to a university-affiliated ED between October and December 2024. KTAS and NEWS were assessed simultaneously at triage. NEWS2 was calculated retrospectively based on routinely documented vital signs and medical history without performing routine arterial blood gas analysis. The primary outcome was the occurrence of SAE during the ED stay. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and logistic regression models were used to identify independent associations. Results: A total of 4216 patients were analyzed, of whom 255 (6.0%) experienced SAEs. All three scores—KTAS, NEWS and NEWS2—were independently associated with the occurrence of SAEs. The AUCs for KTAS, NEWS and NEWS2 were 0.75 (95% CI, 0.74–0.76), 0.73 (95% CI, 0.71–0.74) and 0.73 (95% CI, 0.71–0.74), respectively. Combining KTAS with NEWS or NEWS2 significantly improved predictive accuracy (AUC 0.81, 95% CI 0.79–0.82; p < 0.001). Conclusions: Both KTAS and NEWS/NEWS2 reliably predicted in-ED adverse outcomes, and their combination further enhanced prognostic performance. Integrating physiology-based early warning scores with structured triage systems may help identify high-risk ED patients earlier and optimize resource allocation.

It has been reported that valproic acid (VPA) combined with therapeutic hypothermia can improve survival and neurologic outcomes in a rat asphyxial cardiac arrest model. However, neuroprotective mechanisms of such combined treatment of valproic acid with hypothermia remains unclear. We hypothesized that epigenetic regulation of HSP70 by histone acetylation could increase HSP70-mediated neuroprotection suppressed under hypothermia. Male Sprague-Dawley rats that achieved return of spontaneous circulation (ROSC) from asphyxial cardiac arrest were randomized to four groups: normothermia (37°C ± 1°C), hypothermia (33°C ± 1°C), normothermia + VPA (300 mg/kg IV initiated 5 minutes post-ROSC and infused over 20 min), and hypothermia + VPA. Three hours after ROSC, acetyl-histone H3 was highly expressed in VPA-administered groups (normothermia + VPA, hypothermia + VPA). Four hours after ROSC, HSP70 mRNA expression levels were significantly higher in normothermic groups (normothermia, normothermia + VPA) than in hypothermic groups (hypothermia, hypothermia + VPA). The hypothermia + VPA group showed significantly higher HSP70 mRNA expression than the hypothermia group. Similarly, at five hours after ROSC, HSP70 protein levels were significantly higher in normothermic groups than in hypothermic groups. HSP70 levels were significantly higher in the hypothermia + VPA group than in the hypothermia group. Only the hypothermia + VPA group showed significantly attenuated cleaved caspase-9 levels than the normothermia group. Hypothermia can attenuate the expression of HSP70 at transcriptional level. However, VPA administration can induce hyperacetylation of histone H3, leading to epigenetic transcriptional activation of HSP70 even in a hypothermic status. Combining VPA treatment with hypothermia may compensate for reduced activation of HSP70-mediated anti-apoptotic pathway.

BackgroundParicalcitol is known to attenuate ischemic-reperfusion injury of various organs. However, it is not known whether paricalcitol prevents neuronal injury after global cerebral ischemia. The purpose of this study is to investigate the neuroprotective effect of paricalcitol in a rat model of transient global cerebral ischemia.MethodsThis is a prospective, randomized experimental study. Male Sprague-Dawley rats that survived 10 min of four-vessel occlusion were randomly assigned to two treatment groups: one group was treated with paricalcitol 1 μg/kg IP, and the other was given an equivalent volume of normal saline IP. Drugs were administered at 5 min, 1 day, 2 days, and 3 days after ischemia. Neurologic function was assessed at 2 h, 1 day, 2 days, 3 days, and 4 days after ischemia. We tested motor function 3 days after ischemia using the rotarod test. Also, we tested memory function 4 days after ischemia using the passive avoidance test. We assessed neuronal degeneration in the hippocampus of surviving rats 4 days after ischemia.ResultsEight rats were allocated to each group. No significant differences were found between the groups in terms of survival rate, motor coordination, or memory function. The neurological function score 2-h post-ischemia was significantly higher in the paricalcitol group (p = 0.04). Neuronal degeneration was significantly less in the paricalcitol group compared with the control group (p = 0.01).ConclusionsParicalcitol significantly attenuated neuronal injury in the hippocampus. Although motor coordination, memory function, and survival rate were not significantly improved by paricalcitol treatment in this study, paricalcitol remains a potential neuroprotective drug after global cerebral ischemia.

Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival. This prospective observational study and retrospective review included adult out-of-hospital cardiac arrest survivors who were treated by hypothermia-targeted temperature management. Serum NGAL was assessed at 0, 24, 48, and 72h after return of spontaneous circulation. The primary outcome was poor outcome at six months after cardiac arrest, defined as cerebral performance category score of 3–5. The secondary outcome was six-month mortality. In total, 76 patients were analyzed. The patients with poor outcomes showed significantly higher NGAL levels at 24, 48 and 72h after cardiac arrest than the patients with good outcomes. Long-term survival rates were significantly lower in the high-NGAL group than in the low-NGAL group at each time point. Subgroup analysis of patients who survived 72h showed that only serum NGAL 72h after cardiac arrest had prognostic value for long-term outcomes (area under the receiver operating characteristic curve=0.72; p=0.02). Post-cardiac arrest serum NGAL is associated with long-term outcomes and survival; particularly, three days post-cardiac arrest is the optimal time point for predicting long-term outcomes. However, the predictive power of NGAL is unsatisfactory, and it should be regarded as an additional prognostic modality.

Background To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM). Methods This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3–5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis. Results Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%, p  < 0.001) and 6-month outcomes (89.2% vs. 73.0%, p  = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c > 6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c > 6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26–15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41–12.40, p < 0.001). Conclusions This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.

Background: To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM). Methods: This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3-5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis. Results: Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%, p < 0.001) and 6-month outcomes (89.2% vs. 73.0%, p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c >6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c >6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26-15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41-12.40, p < 0.001). Conclusions: This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.

Antiplatelet drugs are effective in preventing recurrence of atherosclerosis in type 2 diabetes (T2D) patients. However, the efficacy and usefulness of antiplatelet drugs on the progression of carotid intima-media thickness (IMT), a marker for evaluating early atherosclerotic vascular disease, has not been analyzed. We conducted a prospective, randomized, open, 36-month trial comparing cilostazol vs. aspirin. A total of 415 T2D patients (age range 38–83 years; 206 females) without macrovascular complications were randomized to either an aspirin (100 mg/day) or cilostazol (200 mg/day) treatment. Patients underwent B-mode ultrasonography annually to assess the IMT and serum levels of inflammatory markers were measured before and after each treatment. Potential confounders were statistically adjusted, and included lipid profiles, HbA1c, body mass index, waist circumference, anti-hypertensive and statin medications. The decrease in mean left, maximum left, mean right and maximum right IMT were significantly greater with cilostazol compared with aspirin (− 0.094 ± 0.186 mm vs. 0.006 ± 0.220 mm, p  < 0.001; − 0.080 ± 0.214 mm vs. 0.040 ± 0.264 mm, p  < 0.001; − 0.064 ± 0.183 mm vs. 0.004 ± 0.203 mm, p  = 0.015; − 0.058 ± 0.225 mm vs. 0.023 ± 0.248 mm, p  = 0.022, respectively). And these differences remained significant after adjustment of potential confounders. Compared with aspirin, cilostazol treatment was associated with significantly increased HDL cholesterol ( p  = 0.039) and 25-hydroxy vitamin D levels ( p  = 0.001). Cilostazol treatment was associated with significantly lowered IMT in T2D patients compared to aspirin, independent of conventional cardiovascular risk factors. Cilostazol may inhibit plaque formation and have beneficial effects on atherosclerosis through vasodilatory and antiplatelet effects.

BackgroundThe increasing number of products containing engineered nanomaterials (ENMs) has become a potential source for consumer exposure. Some manufacturers have not claimed that ENMs were used in products or others have claimed that their products used a nanotechnology without verifiable statements. This study aimed to identify the ENMs in consumer products advertising both \"ENMs-contained\" and \"Nanotechnology-based\".MethodsEight products advertising \"nanosilver (AgNP)-contained\" and four products just shown \"nanotechnology-based\" but specific constituents not labelled were tested. The size of nanoparticles in consumer products was identified using a particle size analyzer and a scanning electron microscope with an energy dispersive X-ray spectroscopy (SEM-EDX). An inductively-coupled plasma with a mass spectrometer (ICP-MS) was used to confirm the ingredients.ResultsThe 50 percentile particle size of \"AgNP-contained\" products was ranged 295-1,636 nm, and that of \"nanotechnology-based\" products was nano-sized (13-89 nm). The particle size of \"AgNP-contained\" products was nano-sized (15-78 nm) for single particles and 100-500 nm for aggregated or agglomerated particles. The particle size of \"nanotechnology-based\" labelled products was ranged 245-290 nm for single particles and 612-660 nm for aggregated or agglomerated particles. The AgNPs were confirmed using SEM-EDX for all \"AgNP-contained\" products and metallic ingredients (Ti/Mo/Mg/Na) were identified in \"nanotechnology-based\" products. The constituents measured with ICP-MS on some products were different to those of SEM-EDX. One \"AgNP-contained\" products did not contain the AgNP and the constituents of \"nanotechnology-based\" products did not match between EDX (Ti/Mo/Na/Ca) and ICP-MS (Mg/Mn/Zn/Fe/Cu).ConclusionWe confirmed that nanoparticles in dispersions were existed in aggregated/agglomerated status rather than single particle. These particles could be emitted in single nano-sized aerosols in the air during spraying. The constituents of some products did not match between analytical methods. To ensure the safety of the ENMs in consumer products, validated methods for identifying ENMs will be required.Acknowledgement This study was sponsored by the fund of National Institute of Environmental Research (NIER-SP2015-254), Republic of Korea in 2015.

IntroductionVarious chemicals are used as dispersion solvents in engineered nanomaterials (ENMs)-containing spray consumer products. During use, ENMs are emitted with the solvents into the air. The solvents evaporated during use could cause an interference when the ENMs are monitored. The purpose of this study was to compare the removal efficiencies of solvents by two thermodesorbers during the measurement of ENMs emitted in spraying products use.MethodsOne propellant type spray based on ethanol and the other one trigger type based on ethanol and propylene glycol monomethyl ether (PGME) were sprayed in an exposure chamber. A thermodesorber connected to a scanning mobility particle sizer (SMPS) was made up of a heating tube and an absorbent tube (Thermodesorber-1). In addition to thermodesorber-1, a silica gel tube was connected (Thermodesorber-2) and SMPS with no thermodesorber was tested as a control. Organic solvents were sampled with charcoal tubes at the inlets of the thremodesorbers and SMPS and analysed by GC-FID.ResultsDuring the use of propellant spray, the ethanol concentration was reduced greatly according to the thermodesorber use; 1,180 ppm of ethanol with no thremodesorber was reduced 40.2 ppm with the Thermodesorber-1 and 6.5 ppm with the Thermodesorber-2. Also, the concentration of solvents in trigger type spray with Thermodesorber-1 was decreased about 20 times (14.6 ppm) for ethanol and 17 times (2.0 ppm) for PGME compared to the concentrations measured with no thermodesorber (ethanol; 297.7 ppm, PGME; 34.5 ppm). The concentrations with the Thermodesorber-2 decreased to 7.62 ppm of ethanol and 0.45 ppm of PGME, respectively. The removal efficiency with Thermodesorber-1 was 95% for ethanol and 94% for PGME, while 97% for ethanol and 98% for PGME with Thermodesorber-2.ConclusionWe confirmed solvent removal efficiencies using thermodesober connecting real-time monitor and it showed good efficiencies for each solvent. The thermodesorber could help minimising the interference by solvents during aerosol monitoring.Acknowledgement This study was sponsored by the fund of National Institute of Environmental Research (NIER-SP2015-254), Republic of Korea in 2015.