Modified cardiovascular SOFA score in sepsis: development and internal and external validation

Background : The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. Methods : We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. Results : We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%). Conclusions : Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.National Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF2020R1A2C3004508) to Kyuseok Kim. National Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF2020R1F1A1052908) to Tae Gun Shin

Individual- and School-level Predictors of Latent Profiles of Bullying Victimization: Comparing South Korea and the United States

This cross-national research investigated nationally representative adolescents from South Korea and the United States, explored similarities and differences in latent profiles of bullying victimization between countries, and examined individual- and school-level variables that predict such latent profiles supported by the Social Disorganization Theory. The fourth-grade sample of the 2015 Trends in International Mathematics and Science Study from South Korea (N = 4,669) and the United States (N = 10,029) was used to conduct a latent profile analysis based on eight items of the bullying victimization questionnaire. Multilevel logistic regression was conducted using latent profiles as dependent variables. Independent variables include individual-level (material goods, school absence, academic interest, school belonging) and school-level (concentration of affluent families, school resources, the severity of delinquency, academic commitment) factors. More similarities existed than differences in the latent groups of bullying victimization between South Korea (rare, low-moderate, verbal-relational-physical, and multi-risk) and the United States (rare, low-moderate, verbal-relational, and multi-risk). Evidence for school-level variables as predictors of bullying victimization profiles was stronger for adolescents in the United States, with a concentration of affluent families and severity of delinquency being significant in four of the six models. For the South Korean sample, the severity of delinquency predicted bullying victimization in only one model. Examination of both individual- and school-level factors that predict unique bullying victimization experiences grounded in Social Disorganization Theory may be informative for addressing key areas of intervention-especially at the school-level context in which victimization primarily takes place and where anti-bullying intervention programs are often provided.N

Stabilization of the Distal Radioulnar Joint with or without Triangular Fibrocartilage Complex Tear by an External Wrist Band Brace: A Cadaveric Study

The purpose of this study was to investigate whether a watch-shaped external wrist band brace improves distal radioulnar joint (DRUJ) stability. Seven fresh cadaveric arms were used. Using a customized testing system, volar and dorsal translation forces were applied to the radius externally while the ulna was fixed. The test was performed with the forearm in neutral, 60° pronated, and 60° supinated positions, once without the brace and once with the brace applied. In each condition, the amount of translation was measured. Then, the triangular fibrocartilage complex (TFCC) was detached from the ulnar styloid process and the fovea ulnaris, and the same tests were performed again. Detachment of the TFCC significantly increased volar and dorsal translations in all forearm rotations compared to the intact condition (p p = 0.091). Brace application significantly reduced volar and dorsal translations in all forearm rotations both in intact specimens and in TFCC-detached specimens (p p = 0.101 and p = 0.131, respectively). With the brace applied, the TFCC-detached specimens showed no significant difference in volar or dorsal translation in all forearm rotations compared to the intact specimens (p > 0.05). The external wrist band brace improved DRUJ stability in both normal and TFCC-torn wrists and reduced the DRUJ instability caused by TFCC tear to a near-normal level

Male Infertility Associated with a Supernumerary Marker Chromosome

A marker chromosome (mar) is a structurally abnormal chromosome in which no part can be identified. The significance of a marker varies, depending on the material contained within the marker. Very few reports have been published of marker chromosomes associated with male infertility. Here, we report the case of an infertile man with a rare variant of a marker chromosome of a mos 47,XY,+mar[25]/46,XY[25] karyotype

Seasonal variations in gross weights of biochemical components of monthly mean-sized individuals of <i>Crassostrea gigas</i> in Geoje–Hansan Bay.

<p>(a) Proteins; (b) carbohydrates (CHO); (c) glycogen; and (d) lipids.</p

Gross energy budget of monthly mean-sized oyster individuals during the entire culturing period.

<p>Gross energy budget of monthly mean-sized oyster individuals during the entire culturing period.</p

Values for the intercept (<i>a</i>) and slope (<i>b</i>) in allometric equation <i>Y</i> = <i>aDW</i>^<i>b</i> between physiological rate (<i>Y</i>, J d⁻¹) and dry tissue weight (DW, g) of <i>Crassostrea gigas</i> during experimental period.

<p>Values for the intercept (<i>a</i>) and slope (<i>b</i>) in allometric equation <i>Y</i> = <i>aDW</i>^<i>b</i> between physiological rate (<i>Y</i>, J d⁻¹) and dry tissue weight (DW, g) of <i>Crassostrea gigas</i> during experimental period.</p