High Risk Of Fatality Research Articles

Characteristics of motor vehicle crashes and fatality risk among drivers with epilepsy.

Among motor vehicle crashes (MVCs), little is known about whether the characteristics and collision features involving drivers with epilepsy differ from those involving drivers without any history of epilepsy. We assessed MVC features and the effect of epilepsy diagnosis on the risk of severe crash-related injuries among drivers. A total of 33 174 MVC events among people with epilepsy (PWE) and 663 480 MVC events of age- and sex-matched non-PWE (1:20) were selected. Crash-related features that involved drivers with and without epilepsy were compared, including driver eligibility, medical history of comorbidities and medications, road and environmental conditions, and accident causes. Cox and logistic regression analyses were used to examine the risks of fatality and severe injury among drivers with and without epilepsy. PWE involved in MVCs were more likely to have lower socioeconomic status, comorbidities, scooter drivers without a qualified driver's license, driving under the influence of alcohol, and be involved in single-vehicle accidents than non-PWE. Drivers with epilepsy also had a higher risk of fatality within 30 days of MVC, with an adjusted hazard ratio (aHR) of 1.37 (95% confidence interval [CI], 1.20-1.57) and a higher risk of hospital admission within 3 days after MVC (aHR, 1.33; 95% CI, 1.29-1.38) compared to that of non-PWE. The characteristics of MVCs of drivers with epilepsy were distinct from those of non-affected drivers. And higher fatality and injury rates were observed among drivers with epilepsy, which should be considered in further policymaking regarding safe driving of PWE.

Cardiomyopathy characterizing and heart failure risk predicting by echocardiography and pathoanatomy in aged male mice.

Correlation between echocardiographic and pathoanatomic variables and their prognostic value in murine cardiomyopathy models remain unknown. Using echocardiography, morphometrics, and survival monitoring, we characterized transgenic (TG) mice with dilated cardiomyopathy due to cardiac overexpression of β2-adrenoceptors focusing on predicting heart failure (HF) risk and HF mortality. In 12-month-old non-TG and TG mice, echocardiography was performed to determine left ventricular (LV) dimensions (d), wall thickness (h), and fractional shortening (FS). Animals were monitored for 3 months for survival. Organ weights and pathological events indicating left HF were determined. TG mice (n = 76) had reduced FS and enlarged LV, and 79% died of HF or likely arrhythmias during the follow-up period while all non-TG mice (n = 26) survived. These mice with left HF also had pulmonary congestion and hypertrophy/dilatation of the right ventricle (RV). Weights of lungs, RV, and atria were intercorrelated (r = 0.79-0.83) and also negatively correlated with FS × (h/d) index (r = -0.502 to -0.609). By FS × (h/d) tertiles, TG mice of low tertiles were identified with the highest mortality (96%) largely due to HF (76%). In conclusion, in aged cardiomyopathy mice a good correlation existed between echocardiographic and pathoanatomic variables. Echocardiography-derived LV function and remodeling were useful in identifying a subgroup of TG mice with a high risk of HF and HF fatality.

Haemorrhagic cholecystitis: a case report—focus on the optimal diagnosis and management algorithm

Haemorrhagic cholecystitis refers to an inflammatory process of the gallbladder, complicated by bleeding into the gallbladder or biliary system (haemobilia). Approximately 10–15% of adults have cholelithiasis, but most patients do not develop symptoms. Acute cholecystitis occurs in about 10% of symptomatic patients. Among the recognized complications of acute cholecystitis, the haemorrhagic form occurs uncommonly. Underlying risk factors include a bleeding diathesis or treatment with anticoagulants, aneurysm rupture of colecystic artery and trauma. It is often associated with cholelithiasis. The presenting feature is right upper quadrant pain, which is a dominant feature and may mimic non-haemorrhagic acute cholecystitis. Haemorrhagic cholecystitis is diagnosed by radiographic imaging. The first-choice exam is ultrasonography. However, ultrasound does not appear to be ideal for differentiating between acute and haemorrhagic cholecystitis. Computed tomography (CT) scan is the gold standard in the diagnosis of haemorrhagic cholecystitis. MRI may show breakdown products of blood and can be used to estimate the age of the haemorrhage. Surgical resection or embolization of a cystic artery pseudoaneurysm should be considered the treatment of choice, due to the high risk of fatality associated with this condition. We describe a case of haemorrhagic cholecystitis in an 80-year-old male with secondary haemophilia and cholelithiasis who presented to our department of radiology with right upper quadrant pain.

PM2.5 chemical components are associated with in-hospital case fatality among acute myocardial infarction patients in China

Recent studies have linked the cardiovascular events with the exposure to ambient fine particulate matter (PM2.5); however, the impact of PM2.5 chemical components on acute myocardial infarction (AMI) case fatality remains poorly understood. To address this gap, we included 178,340 hospitalised patients with AMI utilising the inpatient discharge database from Sichuan, Shanxi, Guangxi, and Guangdong, China spanning 2014–2019. We evaluated exposure to PM2.5 and its components (black carbon (BC), organic matter (OM), sulphate (SO42−), nitrate (NO3−), and ammonium (NH4+)) using bilinear interpolation based on the patient’s residential address. We used mixed-effects logistic regression models to investigate the associations of PM2.5 and its five components with in-hospital AMI case fatality. Per interquartile range (IQR) increment in short-term exposure (7-day average) to overall PM2.5 (odds ratio (OR): 1.086, 95 % confidence interval (CI): 1.045–1.128), SO42−(1.063, 1.024–1.104), BC (1.055, 1.023–1.089), OM (1.052, 1.019–1.086, and NO3− (1.045, 1.003–1.089) were significantly associated with high risk of in-hospital AMI case fatality. The ORs per IQR increment in long-term exposure (annual average) were 1.323 (95 % CI: 1.255–1.394) for PM2.5, followed by BC (1.271, 1.210–1.335), OM (1.243, 1.188–1.300), SO42− (1.212, 1.157–1.270), NO3− (1.116, 1.075–1.159), and NH4+ (1.068, 1.031–1.106). Our study suggests that PM2.5 chemical components might be important risk factors for in-hospital AMI case fatality, highlighting the importance of targeted reduction of PM2.5 emissions, particularly BC, OM, and SO42−.

High-affinity monoclonal antibodies against the porcine epidemic diarrhea virus S1 protein

The porcine epidemic diarrhea virus (PEDV) infection inflicted substantial economic losses upon the global pig-breeding industry. This pathogen can infect all pigs and poses a particularly high fatality risk for suckling piglets. The S1 subunit of spike protein is a crucial target protein for inducing the particularly neutralizing antibodies that can intercept the virus-host interaction and neutralize virus infectivity. In the present study, the HEK293F eukaryotic expression system was successfully utilized to express and produce recombinant S1 protein. Through quantitative analysis, five monoclonal antibodies (mAbs) specifically targeting the recombinant S1 protein of PEDV were developed and subsequently evaluated using enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IFA), and flow cytometry assay (FCA). The results indicate that all five mAbs belong to the IgG1 isotype, and their half-maximal effective concentration (EC50) values measured at 84.77, 7.42, 0.89, 14.64, and 7.86 pM. All these five mAbs can be utilized in ELISA, FCA, and IFA for the detection of PEDV infection. MAb 5-F9 exhibits the highest sensitivity to detect as low as 0.3125 ng/mL of recombinant PEDV-S1 protein in ELISA, while only 0.096 ng/mL of mAb 5-F9 is required to detect PEDV in FCA. The results from antigen epitope analysis indicated that mAb 8-G2 is the sole antibody capable of recognizing linear epitopes. In conclusion, this study has yielded a highly immunogenic S1 protein and five high-affinity mAbs specifically targeting the S1 protein. These findings have significant implications for early detection of PEDV infection and provide a solid foundation for further investigation into studying virus-host interactions.

Case Report: Managing the Coinfection of Cerebral Malaria and Dengue in the Intensive Care Unit

Background: Dengue and malaria are the two most common arthropod-borne illnesses, but cases of multiple infections are extremely uncommon. The mortality rate for individuals with dengue and malaria was higher than the death rate for those with malaria alone.Case: An intubated 53-year-old male was referred from a class B hospital because of severe malaria with suspected cerebral malaria, dengue fever (day-11), septic shock and acute kidney injury. His initial laboratory investigation showed increasing pattern of WBC, thrombocyte, anemia, peripheral blood smear normochromic normocytic erythrocyte, poikilocytosis (ovalocytes (+), teardrop cells (+)), normoblasts (+), presence of Plasmodium malariae trophozoite and schizont stage parasites, positive result of IgM and IgG anti dengue, increased liver function test, increased BUN and creatinine serum levels, hyperbilirubinemia, hypoalbuminemia, and normal result of blood gas analysis. On the sixth day of ICU admission, the patient gradually regained consciousness with appropriate responsiveness and showed clinical improvement. The patient was discharged after one month of hospital care with the last peripheral blood smear showing no parasites detected.Discussion: Mono-infection with malaria and dengue, two mosquito-borne diseases endemic to tropical and subtropical regions, often carries a high risk of fatality. The risk becomes even more pronounced when co-infection occurs. The early diagnosis and management in the ICU are crucial for cases of coinfection involving cerebral malaria and dengue. The primary focus is on both definitive and supportive therapies.Conclusion: The prognosis for coinfection of cerebral malaria and dengue is generally poor, but in this case, the patient showed improvement and was able to be discharged without any sequelae.

Rare Emergency Case of Bowel Ischaemia as a Result of Diabetic Ketoacidosis Complication: A Case Report and Literature Review of an Unusual Entity

Introduction and Importance: Diabetic ketoacidosis (DKA) is a life-threatening situation that if inadequately managed, is related to high fatality risk. It is associated with mesenteric ischaemia that necessitates early detection and intervention to enhance the prognosis for mesenteric ischaemia. Case Presentation: A 58-year-old male patient presented to our hospital with severe generalized abdominal pain, vomiting, and polyurea. On admission, he was newly diagnosed with diabetes mellitus type II (DM II) which is complicated by DKA. Days later, his abdominal pain worsened, and bowel obstruction was confirmed by both X-ray and ultrasonography of the abdomen. Due to the deterioration in the patient’s clinical condition, an emergent diagnostic laparoscopy was decided which was followed by an open laparotomy with bowel resection of the detected dilated and ischaemic bowel loops. The resected specimens, including small bowel and peritoneal wall mass, were sent for histopathological studies. Three re-look laparotomies were also performed, and the postoperative period was uneventful. Clinical Discussion: Intestinal ischaemia is a rare complication of DKA. Bowel ischaemia can be either occlusive or nonocclusive mesenteric types. It is clinically manifested by abdominal symptoms in diabetic patients. Evaluation is mainly by abdominal computed tomography (CT) and the main treatment approach is laparoscopy and/or laparotomy in combination with resection of the affected bowel loops. Conclusion: In our case report, we document an additional unusual case of intestinal ischaemia and necrosis as a DKA consequence, in a recently diagnosed DM II patient, as one of the few non-occlusive mesenteric ischaemia causes.

Prevalence and impact of long COVID-19 among patients with diabetes and cardiovascular diseases in Bangladesh.

Co-prevalence of long-COVID-19, cardiovascular diseases and diabetes is one of the major health challenges of the pandemic worldwide. Studies on long-COVID-19 and associated health outcomes are absent in Bangladesh. The main aim of this study was to determine the prevalence and impact of long-COVID-19 on preexisting diabetes and cardiovascular diseases (CVD) on health outcomes among patients in Bangladesh. We collected data from 3,250 participants in Bangladesh, retrospectively. Multivariable logistic regression model was used to determine the odds ratio between independent and dependent variables. Kaplan-Meier survival curve was used to determine the cumulative survival. COVID-19 was detected among 73.4% (2,385 of 3,250) participants. Acute long-COVID-19 was detected among 28.4% (678 of 2,385) and chronic long-COVID-19 among 71.6% (1,707 of 2,385) patients. CVD and diabetes were found among 32%, and 24% patients, respectively. Mortality rate was 18% (585 of 3,250) among the participants. Co-prevalence of CVD, diabetes and COVID-19 was involved in majority of fatality (95%). Fever (97%), dry cough (87%) and loss of taste and smell (85%) were the most prevalent symptoms. Patients with co-prevalence of CVD, diabetes and COVID-19 had higher risk of fatality (OR: 3.65, 95% CI, 2.79-4.24). Co-prevalence of CVD, diabetes and chronic long-COVID-19 were detected among 11.9% patients. Risk of hospitalization and fatality reduced significantly among the vaccinated. This is one of the early studies on long-COVID-19 in Bangladesh.

암보험약관의 문제점과 개선방안

Cancer, identified as the leading cause of death in South Korea, not only carries a high risk of fatality upon onset but also imposes significant economic burdens, including treatment expenses and costs for maintaining daily life. As a result, the number of individuals choosing cancer insurance to mitigate this risk is steadily rising. Since the introduction of cancer insurance in South Korea in 1980, numerous intense insurance disputes have emerged. In response, insurance companies have repeatedly revised their cancer insurance policy terms through court rulings and regulatory improvement orders.
 In 2011, insurance companies revised the cancer insurance policy terms by introducing the “Primary Site Criteria”. According to this provision, in cases where thyroid cancer (C73) and secondary lymph node cancer (C77) are diagnosed, the primary cancer - in this case, thyroid cancer (C73) - is considered the basis for insurance benefit payouts.
 In situations where decisions from lower courts and financial dispute resolution committees are unclear, insurance companies revised the primary site criteria once again in January 2021 and expanded the examples illustrating the application of this criterion within the explanation section. For example, if stomach cancer (C16) metastasizes to the brain and results in a diagnosis of brain cancer (C79.3), it is categorized as stomach cancer for insurance coverage purposes. Similarly, if breast cancer (C50) metastasizes to the lungs and is diagnosed as lung cancer (C78.0), it is classified as breast cancer. This serves as a basis to provide reduced insurance benefits compared to the final diagnosed cancer.
 Should insurers fail to convincingly demonstrate a rational basis for distinguishing cancer insurance benefits based on whether the cancer originated primarily or secondarily in the same location, such actions should be deemed an unjust limitation on the rights of insurance consumers.
 While insurance policy terms can be unilaterally drafted and implemented by insurers based on the principle of private autonomy, any clauses contradicting the principle of utmost good faith - which mandates that terms and conditions should be drafted fairly and in line with the reasonable expectations and legitimate interests of the contracting parties without compromising fairness - are inevitably subject to judicial oversight.
 This paper critically analyzes insurers' arguments regarding the “Primary Site Criteria” within cancer insurance policy terms and sheds light on the issues at hand. The research results are as follows: It is advisable to eliminate the current “Primary Site Criteria” in the existing cancer insurance policy terms and instead transition to a payment structure for cancer insurance benefits based on the final condition or stage of the patient (insured). Moreover, in cases where a diagnosis of advanced cancer (general cancer or high treatment cost cancer) follows an early-stage cancer diagnosis benefit, it is in line with the reasonable expectations of insurance consumers to introduce a provision that ensures payment of the difference between the respective diagnosis benefits.

Unsolved mystery, the etiology of acute pancreatitis after liver resection: a case report and literature review

Link of Video Abstract: https://youtu.be/WQnJQwwYcHcIntroduction: After liver resection, pancreatitis is a well-known yet uncommon consequence. The actual cause is unclear, and the postoperative condition may mask the clinical symptoms. When a patient unexpectedly worsens after surgery, postoperative pancreatitis should always be taken into consideration due to its high fatality risk. After liver resection, we present our patient with acute pancreatitis. The paper was written using certain hypotheses. First, the surgeon should be aware of the possibility of pancreatitis following liver surgery, which is not included in the literature as a side effect of liver surgery. The second step is to increase our knowledge and develop measures to reduce the risk of acute pancreatitis following liver surgery. Case Description: We present here a case of acute pancreatitis following liver resection surgery from our institution, and we strongly suspect that the results of our postoperative white bile leak test contributed to this. According to the literature analysis, this test is risk-free and won't have a materially detrimental impact on the patient. Keep in mind the white test rule, which suggested things like focus and spooling following the test. Conclusion: The white test is effective for identifying bile leakage following liver resection, however, we do not advise frequent use of this test since there is a chance that it can trigger acute pancreatitis, which can have a substantial negative impact on the patient's morbidity or death. The precise process is still a mystery and will require further experimental research.

Beyond the Rhythm: In Silico Identification of Key Genes and Therapeutic Targets in Atrial Fibrillation.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia worldwide and is characterized by a high risk of thromboembolism, ischemic stroke, and fatality. The precise molecular mechanisms of AF pathogenesis remain unclear. The purpose of this study was to use bioinformatics tools to identify novel key genes in AF, provide deeper insights into the molecular pathogenesis of AF, and uncover potential therapeutic targets. Four publicly available raw RNA-Seq datasets obtained through the ENA Browser, as well as proteomic analysis results, both derived from atrial tissues, were used in this analysis. Differential gene expression analysis was performed and cross-validated with proteomics results to identify common genes/proteins between them. A functional enrichment pathway analysis was performed. Cross-validation analysis revealed five differentially expressed genes, namely FGL2, IGFBP5, NNMT, PLA2G2A, and TNC, in patients with AF compared with those with sinus rhythm (SR). These genes play crucial roles in various cardiovascular functions and may be part of the molecular signature of AF. Furthermore, functional enrichment analysis revealed several pathways related to the extracellular matrix, inflammation, and structural remodeling. This study highlighted five key genes that constitute promising candidates for further experimental exploration as biomarkers as well as therapeutic targets for AF.

Characteristics of fatal occupational injuries in migrant workers in South Korea: A machine learning study

ObjectiveAnalysis of occupational injuries is essential for developing preventive strategies. However, few studies have evaluated severe occupational injuries in migrant workers from the perspective of gender. Therefore, using a new analytical method, this study was performed to identify gender-specific characteristics associated with fatal occupational injuries among migrant workers; the interactions between these factors, were also analyzed. In addition, we compared the utility of explainable artificial intelligence (XAI) using SHapley Additive exPlanations (SHAP) with logistic regression (LR) and discuss caveats regarding its use. Materials and methodsWe analyzed national statistics for occupational injuries among migrant workers (n = 67,576) in South Korea between January 1, 2007, and September 30, 2018. We applied an extreme gradient boosting model and developed SHAP and LR models for comparison. ResultsWe found clear gender differences in fatal occupational injuries among migrant workers, with males in the same occupation having a higher risk of death than females. These gender differences suggest the need for gender-specific occupational injury prevention interventions for migrant workers to reduce the mortality rate. Occupation was a significant predictor of death among female migrant workers only, with care jobs having the highest fatality risk. The occupational fatality risk of female workers would not have been identified without the performance of detailed job-specific analyses stratified by gender. The major advantages of SHAP identified in the present study were the automatic identification and analysis of interactions, ability to determine the relative contributions of each feature, and high overall performance. The major caveat when using SHAP is that causality cannot be established. ConclusionDetailed job-specific analyses stratified by gender, and interventions considering the gender of migrant workers, are necessary to reduce occupational fatality rates. The XAI approach should be considered as a complementary analytical method for epidemiological studies, as it overcomes the limitations of traditional statistical analyses.

US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020

(JAMA. 2022;328:2159–2161) Drug overdose deaths have significantly increased in the last few years. Many factors have been proposed to explain this increase in the general population, but research is lacking in more specific populations, such as pregnant and postpartum women. This population is at high risk of fatality from overdose, but trends have not been assessed recently. This study aimed to understand changes in drug overdose deaths in pregnant or postpartum individuals, both drug-specific deaths and all deaths before and during the COVID-19 pandemic.

The Application of Theory of Planned Behaviour in Pedestrian Safety: A Literature Approach

Road accidents among pedestrian become an important issue that needs to be mitigated due to high injuries and fatalities cases. Pedestrian is a weakest group of people compared to the drivers because they are not fully protected. The accidents involving pedestrian may occur due to their own negative crossing behaviour. This study is purposely to identify the effectiveness of theory of planned behaviour (TPB) in predicting pedestrian behaviour. TPB has three main constructs which are attitudes, subjective norms and perceived behavioural control that significant to behavioural intention. Some studies used extended TPB by adding other constructs such as moral norms, perceived risk, conformity tendency, perceived severity, and past behaviour to predict pedestrian behaviour more accurately. This study used a literature approach where some of the previous studies are examined and the results of the studies are being analysed using descriptive analysis. The results show that TPB is suitable to predict pedestrian behaviour because the constructs are significant and comply with its fit. This study also shows that pedestrian behaviours are differ according to their age and gender. Most of previous studied states that young people tends to perform risky behaviours compared to old people. Children pedestrian are more vulnerable and have a high tendency to involve in road accidents and have a high fatality risk. Men are more risk-taking compared to women and men have high tendency to violate road regulations and exposed to injuries and fatality while women have more positive crossing behaviour.

Direct Effects of Mifepristone on Mice Embryogenesis: An In Vitro Evaluation by Single-Embryo RNA Sequencing Analysis

The clinical use of mifepristone for medical abortions has been established in 1987 in France and since 2000 in the United States. Mifepristone has a limited medical period that lasts <9 weeks of gestation, and the incidence of mifepristone treatment failure increases with gestation time. Mifepristone functions as an antagonist for progesterone and glucocorticoid receptors. Studies have confirmed that mifepristone treatments can directly contribute to endometrium disability by interfering with the endometrial receptivity of the embryo, thus causing decidual endometrial degeneration. However, whether mifepristone efficacy directly affects embryo survival and growth is still an open question. Some women choose to continue their pregnancy after mifepristone treatment fails, and some women express regret and seek medically unapproved mifepristone antagonization with high doses of progesterone. These unapproved treatments raise the potential risk of embryonic fatality and developmental anomalies. Accordingly, in the present study, we collected mouse blastocysts ex vivo and treated implanted blastocysts with mifepristone for 24 h. The embryos were further cultured to day 8 in vitro to finish their growth in the early somite stage, and the embryos were then collected for RNA sequencing (control n = 3, mifepristone n = 3). When we performed a gene set enrichment analysis, our data indicated that mifepristone treatment considerably altered the cellular pathways of embryos in terms of viability, proliferation, and development. The data indicated that mifepristone was involved in hallmark gene sets of protein secretion, mTORC1, fatty acid metabolism, IL-2-STAT5 signaling, adipogenesis, peroxisome, glycolysis, E2F targets, and heme metabolism. The data further revealed that mifepristone interfered with normal embryonic development. In sum, our data suggest that continuing a pregnancy after mifepristone treatment fails is inappropriate and infeasible. The results of our study reveal a high risk of fetus fatality and developmental problems when pregnancies are continued after mifepristone treatment fails.

Gynecological Cancer Surgeries during COVID -19 Pandemic - An Experience from Tertiary Care Hospital of Pakistan

Background: Immunocompromised cancer patients stand high case fatality risk if encountered severe infection. This study aims to evaluate outcomes and complications of gynecological cancer surgeries performed during COVID-19 pandemic. Methods: A retrospective study conducted at Aga Khan University hospital, Pakistan. Patient’s medical records who underwent gynecologic cancer surgery or deferred between March-December 2020 were reviewed. Age, BMI, comorbid, COVID-19 status, clinical stage of disease and intraoperative data were collected. Post-operative complications per Clavien-Dindo classification i.e., Infection, thromboembolism, Urinary/bowel problems, and mortality within 30 days were noted. Statistical analysis performed using SPSS-19. Mean, SD ratios calculated for age and BMI. Frequency/percentages for priority levels and Categorical variables were equated using Chi square test. Results: Total 116 patients were included. Early-stage disease found in 64% patients. Surgical approach was laparotomy in 77.6%, including 48% complex surgeries. Prioritization based on BGCS framework, including 89% levels 2 and 11% level 3. PCR testing for all pre-operative patients initiated late in institute hence done in 77% however verbal screening performed in 90% patients. Two patients found COVID positive, so surgery delayed. Post operative complications of grade 1, grade 4a and grade 5 were observed in four patients. Twelve patients had clinical suspicion of COVID post operatively, 3 were found to be positive and one required ICU care. Conclusion: During pandemic, treatment provision posed challenge due to concern of infection to both patients and healthcare workers. However, with adequate preventive measures, cancer surgeries can be performed with low risk of severe complications and post-surgical COVID positivity. Keywords: COVID-19, Gynecology Oncology, Surgery, Guidelines

Linking the outer membrane composition of salmonella to protective antibody responses.

Invasive non-typhoidal Salmonella (iNTS) infection has a high risk of fatality. Currently, there is no licensed vaccine against iNTS, making creating an effective vaccine priority for regions where the rate of these infections is high. In particular, an ideal vaccine should be protective against multiple serovars of Salmonella. The correlation of the protective properties of antibodies raised against Salmonella with distinct types and lengths of O-antigen repeats and membrane proteins has not been thoroughly investigated yet, but experiments conducted on mice have revealed some important differences. We hypothesize that these differences can be explained by the physical structure of the bacterial outer envelope and the accessibility of proteinaceous epitopes to antibodies. To test this hypothesis, we modeled the outer membrane for two of the most common iNTS serovars, Salmonella enterica Enteritidis (SEn) and Typhimurium (STm), along with the outer membrane proteins OmpD and OmpA. We set up all-atomic molecular simulations (MD) for both proteins separately for the serotypes STm and SEn, and for LPS with different lengths of O4 and O9 O-Ag repeats, giving, overall, 20 systems for 1.5 microseconds each. From these MD simulations, we measured various quantities, including Solvent Accessible Surface Area (SASA) of extracellular loops of the proteins, root-mean-square fluctuation (RMSF) of the residues, and the protein to O-Ag contact area, in order to explain the molecular underpinnings of differential antibody responses being raised by distinct serotypes.

Angiotensin-(1–7) ameliorates sepsis-induced cardiomyopathy by alleviating inflammatory response and mitochondrial damage through the NF-κB and MAPK pathways

BackgroundThere is no available viable treatment for Sepsis-Induced Cardiomyopathy (SIC), a common sepsis complication with a higher fatality risk. The septic patients showed an abnormal activation of the renin angiotensin (Ang) aldosterone system (RAAS). However, it is not known how the Ang II and Ang-(1–7) affect SIC.MethodsPeripheral plasma was collected from the Healthy Control (HC) and septic patients and Ang II and Ang-(1–7) protein concentrations were measured. The in vitro and in vivo models of SIC were developed using Lipopolysaccharide (LPS) to preliminarily explore the relationship between the SIC state, Ang II, and Ang-(1–7) levels, along with the protective function of exogenous Ang-(1–7) on SIC.ResultsPeripheral plasma Ang II and the Ang II/Ang-(1–7) levels in SIC-affected patients were elevated compared to the levels in HC and non-SIC patients, however, the HC showed higher Ang-(1–7) levels. Furthermore, peripheral plasma Ang II, Ang II/Ang-(1–7), and Ang-(1–7) levels in SIC patients were significantly correlated with the degree of myocardial injury. Additionally, exogenous Ang-(1–7) can attenuate inflammatory response, reduce oxidative stress, maintain mitochondrial dynamics homeostasis, and alleviate mitochondrial structural and functional damage by inhibiting nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thus alleviating SIC.ConclusionsPlasma Ang-(1–7), Ang II, and Ang II/Ang-(1–7) levels were regarded as significant SIC biomarkers. In SIC, therapeutic targeting of RAAS, for example with Ang-(1–7), may exert protective roles against myocardial damage.

Integrative Effects between a Bubble and Seal Program and Workers’ Compliance to Health Advice on Successful COVID-19 Transmission Control in a Factory in Southern Thailand

Applying health measures to prevent COVID-19 transmission caused disruption of businesses. A practical plan to balance public health and business sustainability during the pandemic was needed. Herein, we describe a "Bubble and Seal" (B&S) program implemented in a frozen seafood factory in southern Thailand. We enrolled 1539 workers who lived in the factory dormitories. First, the workers who had a high fatality risk were triaged by RT-PCR tests, quarantined and treated if they had COVID-19. Newly diagnosed or suspected COVID-19 workers underwent the same practices. The non-quarantined workers were regulated to work and live in their groups without contact across the groups. Workers' personal hygiene and preventive measures were strongly stressed. Between the 6th and 9th weeks of the program, the post-COVID-19 infection status (PCIS) of all participants was evaluated by mass COVID-19 antibody or RT-PCR tests. Finally, 91.8% of the workers showed positive PCIS, which was above the number required for program exit. Although no workers had received a vaccination, there was only one case of severe COVID-19 pneumonia, and no evidence of COVID-19 spreading to the surrounding communities. Implementation of the B&S program and workers' adherence to health advice was the key to this success.

Association of Endothelial Protein C Receptor (EPCR) rs867186 Gene Polymorphism With Increased Levels of Soluble EPCR and High Risk of Severe Malaria and Fatality in Beninese Children.

The endothelial protein C receptor (EPCR)-rs867186 G allele has been linked to high plasma levels of soluble EPCR (sEPCR) and controversially associated with either susceptibility or resistance to severe and cerebral malaria. In this study, quantitative enzyme-linked immunosorbent assay and sequencing were used to assess sEPCR levels and EPCR-rs867186 polymorphism in blood samples from Beninese children with different clinical presentations of malaria. Our findings show that sEPCR levels were higher at hospital admission than during convalescence and that EPCR-rs867186 G allele was associated with increased sEPCR plasma levels, malaria severity, and mortality rate (P < .001, P = .03, and P = .04, respectively), suggesting a role of sEPCR in the pathogenesis of severe malaria.