Toward tunable dynamic repression using CRISPRi

CRISPR interference (CRISPRi) is widely utilized for regulation of target gene expression by repressing transcription. Simple design rules for the single guide RNA (sgRNA) and multiplexity won this method immense popularity. However, quantitative control of the expression levels at varying degrees in a dynamic manner using CRISPRi has been regarded difficult. To deal with this limitation, Fontana et al. modulated the expression levels of the components of CRISPRi, the deactivated Cas9 (dCas9), and the sgRNAs, using various constitutive or inducible promoters (Fontana et al., Biotechnol. J. 2018, 13, 1800069). They found that the expression level of sgRNA is the key to controlling CRISPRi. Modulation of sgRNA expression levels enabled quantitative tuning of the CRISPRi-regulated gene expression level. This approach is expected to be easily applied to diverse applications owing to its simplicity compared to the conventional approaches that modified target sequence or changed the expression level of dCas9.110Ysciescopu

The Occurrence of a Thyroid Storm in a Patient with Recurrent Refractory Peptic Ulcer: A Case Report

A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient’s initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery

New Concept of a Surgical Hospitalist: Early Experience of Managing the Admission, Critical Care, Trauma Surgery Team

The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019–2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

Purpose This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients. Methods The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed. Results Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013). Conclusion Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG

Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection

Purpose Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection. Methods This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection. Results Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032–4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049–0.515, p = 0.002) as independent risk factors for PICC-associated infection. Conclusion The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection

Risk Factors Associated with 30-day Mortality in Patients with Postoperative Acute Kidney Injury Who Underwent Continuous Renal Replacement Therapy in the Intensive Care Unit

Purpose To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT). Methods Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted. Results There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality. Conclusion Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered