New prognostic scoring system for mortality in idiopathic pulmonary fibrosis by modifying the gender, age, and physiology model with desaturation during the six-minute walk test

BackgroundIdiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD) with variable and heterogeneous clinical course. The GAP (gender, age, and physiology) model had been used to predict mortality in patients with IPF, but does not contain exercise capacity. Therefore, our aim in this study was to develop new prognostic scoring system in the Korea IPF Cohort (KICO) registry.Materials and methodsThis is a retrospective study of Korean patients with IPF in KICO registry from June 2016 to August 2021. We developed new scoring system (the GAP6) based on the GAP model adding nadir saturation of percutaneous oxygen (SpO2) during six-minute walk test (6MWT) in the KICO registry and compared the efficacy of the GAP and the GAP6 model.ResultsAmong 2,412 patients in KICO registry, 966 patients were enrolled. The GAP6 model showed significant prognostic value for mortality between each stage [HR Stage II vs. Stage I = 2.89 (95% CI = 2.38–3.51), HR Stage III vs. Stage II = 2.68 (95% CI = 1.60–4.51)]. In comparison the model performance with area under curve (AUC) using receiver operating characteristic (ROC) curve analysis, the GAP6 model showed a significant improvement for predicting mortality than the GAP model (AUC the GAP vs. the GAP6, 0.646 vs. 0.671, p < 0.0019). Also, the C-index values slightly improved from 0.674 to 0.691 for mortality.ConclusionThe GAP6 model adding nadir SpO2 during 6WMT for an indicator of functional capacity improves prediction ability with C-index and AUC. Additional multinational study is needed to confirm these finding and validate the applicability and accuracy of this risk assessment system

Association of Plasma Level of TNF-Related Apoptosis-Inducing Ligand with Severity and Outcome of Sepsis

Recent studies have suggested that TNF-related apoptosis-inducing ligand (TRAIL) is associated with mortality in sepsis, possibly through necroptosis. The objective of this study was to analyze the association between the plasma level of TRAIL and sepsis severity and outcomes. Furthermore, the plasma level of TRAIL was compared to that of receptor-interacting protein kinase-3 (RIPK3), a key executor of necroptosis, to identify any correlation between TRAIL and necroptosis. Plasma levels of TRAIL and RIPK3 from consecutively enrolled critically ill patients were measured by ELISA. Of 190 study patients, 59 (31.1%) and 84 (44.2%) patients were diagnosed with sepsis and septic shock, respectively. There was a trend of decreased plasma level of TRAIL across the control, sepsis, and septic shock groups. For 143 patients with sepsis, patients with low plasma TRAIL were more likely to have septic shock and higher SAPS3 and SOFA scores. However, no difference in 28-day and 90-day mortalities was observed between the two groups. The plasma level of TRAIL was inversely associated with RIPK3 in patients with sepsis. Plasma levels of TRAIL increased over time on days three and seven, and were inversely associated with sepsis severity and RIPK3 level, but not with mortality

Dynamic Channel Coordination Schemes for IEEE 802.11p/1609 Vehicular Networks: A Survey

IEEE 802.11p/1609-based vehicular networks utilize a multichannel architecture to support vehicle-to-vehicle and vehicle-to-infrastructure communications. In the multi-channel architecture, the available channels in the 5 GHz spectrum are divided into one control channel (CCH) and multiple service channels (SCHs). Multiple SCHs are defined for nonsafety data transfer, while the CCH is used to broadcast safety messages called beacons and control messages (i.e., service advertisement messages). According to the channel coordination scheme, a radio interface alternately switches between the CCH and a specific SCH. The intervals during which a radio interface stays tuned to the CCH and SCH are called CCH and SCH intervals, respectively. Both intervals are set to a fixed value (i.e., 50 ms) in the standard. However, since the fixed-length intervals cannot be effective for dynamically changing traffic load, some dynamic interval division protocols have been recently proposed to support the dynamic adjustment of the CCH/SCH intervals for improving channel utilization. In this paper, we therefore provide a survey of dynamic interval division protocols for VANETs, discuss the advantages and disadvantages of them, and define some open issues and possible directions of future research

Characteristics of fever and response to antipyretic therapy in military personnel with adenovirus-positive community-acquired pneumonia

BACKGROUND: In 2014, an outbreak of adenoviral pneumonia occurred in the Korean military training center. However, there are limited data on the characteristics of the fever and its response to antipyretic therapy in immunocompetent adults with adenovirus-positive community-acquired pneumonia (CAP). METHODS: The medical records of the patients who were admitted to the Armed Forces Chuncheon Hospital for the treatment of CAP between January 2014 and December 2016 were retrospectively analyzed. The patients were divided into three groups, namely, the adenovirus-positive (Adv) group, the adenovirus-negative (Non-Adv) group and the unknown pathogen group, according to the results of a polymerase chain reaction (PCR) test and sputum culture used to measure adenovirus and other bacteria or viruses in respiratory specimens. We evaluated and compared the demographics, clinicolaboratory findings and radiological findings upon admission between the two groups. RESULTS: Out of the 251 military personnel with CAP during the study periods, 67 were classified into the Adv group, while 134 were classified into the Non-Adv group and 50 were classified into the unknown pathogen group. The patients in the Adv group had a longer duration of fever after admission (3.2 ± 1.6 vs. 1.9 ± 1.2 vs. 2.2 ± 1.5 days, P = 0.018) and symptom onset (5.8 ± 2.2 vs. 3.9 ± 2.5 vs. 3.7 ± 2.0 days, P = 0.006) than patients in the Non-Adv and unknown pathogen groups, respectively. The patients in the Adv group had a higher mean temperature at admission (37.8 ± 0.3 vs. 37.3 ± 0.3 vs. 37.3 ± 0.3, P = 0.005), and more patients were observed over 40 and 39 to 40(14.9% vs. 2.2% vs. 4.0%, 35.8% vs. 3.7% vs. 6.0%, P <  0.001) than those in the Non-Adv and unknown pathogen groups, respectively. The Adv group more commonly had no response or exhibited adverse events after antipyretic treatment compared to the Non-Adv group (17.9% vs. 1.5%, 35.0% vs. 4.3%, P <  0.001, P = 0.05, respectively). In addition, the time from admission to overall clinical stabilization was significantly longer in the patients in the Adv group than in those in the Non-Adv group (4.3 ± 2.8 vs. 2.9 ± 1.8 days, P = 0.034, respectively). Furthermore, no significant difference in the length of hospital stay was observed between the two groups, and no patient died in either group. CONCLUSION: In this study, Adv-positive CAP in immunocompetent military personnel patients had distinct fever characteristics and responses to antipyretic treatment

A scalable multi-sink gradient-based routing protocol for traffic load balancing

Abstract Wireless sensor networks have been assumed to consist of a single sink and multiple sensor nodes which do not have mobility. In these networks, sensor nodes near the sink dissipate their energy so fast due to their many-to-one traffic pattern, and finally they die early. This uneven energy depletion phenomenon known as the hot spot problem becomes more serious as the number of sensor nodes (i.e., their scale) increases. Recently, multi-sink wireless sensor networks have been envisioned to solve the hot spot problem. Gradient routing protocols are known to be appropriate for the networks in that network traffic is evenly distributed to multiple sinks to prolong network lifetime and they are scalable. Each node maintains its gradient representing the direction toward a neighbor node to reach one of the sinks. In particular, existing protocols allow a sensor node to construct its gradient using the cumulative traffic load of a path for load balancing. However, they have a critical drawback that a sensor node cannot efficiently avoid using the path with the most overloaded node. Hence, this paper introduces a new Gradient routing protocol for LOad-BALancing (GLOBAL) with a new gradient model to maximize network lifetime. The proposed gradient model considers both of the cumulative path load and the traffic load of the most overloaded node over the path in calculating each node's gradient value. Therefore, packets are forwarded over the least-loaded path, which avoids the most overloaded node. In addition, it is known that assigning a unique address to each sensor node causes much communication overhead. Since the overhead increases as the network scales, routing protocols using an address to indicate the receiver in forwarding a packet are not scalable. Thus, GLOBAL also includes an addressing-free data forwarding strategy. Through ns-2 simulation, we verify that GLOBAL achieves better performance than the shortest path routing and load-aware gradient routing ones.</p

Agriculture Sensor-Cloud Infrastructure and Routing Protocol in the Physical Sensor Network Layer

Nowadays, wireless sensor networks (WSNs) are used in a variety of areas. However, it is difficult to efficiently manage a large number of sensor nodes and their sensing data owing to the limitations of WSNs. Particularly, in agricultural applications, a WSN installed in a specific region is used for multiple services (i.e., greenhouse environment monitoring and control). However, the network resources (i.e., channel, battery, etc.) are currently being utilized for redundant operations requested from multiple service users owing to the lack of an efficient system for managing large WSN data. In this paper, we propose an agriculture sensor-cloud infrastructure (ASCI) to effectively provide various agricultural services using WSNs. In addition, we propose hierarchical source routing (HSR), aggregation gradient routing (AGR), and a priority-based data transmission technique in order to allow packets to be delivered to the destination fast and reliably in large-scale WSNs

Plasma Mitochondrial DNA and Necroptosis as Prognostic Indicators in Critically Ill Patients with Sepsis

Mitochondrial DNA (mtDNA) has been identified as a biomarker for predicting sepsis mortality. Although preclinical studies suggested that necroptosis could explain the mechanistic link of mtDNA in sepsis, this is not yet evident in patients with sepsis. This study evaluated the association between mtDNA and essential necroptosis mediators in prospectively enrolled patients with sepsis. Plasma mtDNA copy number was measured using quantitative PCR assay and necroptosis mediators, including receptor-interacting protein kinase-3 (RIPK3), mixed lineage domain-like pseudokinase (MLKL), and high-mobility group box 1 (HMGB1), were measured by ELISA. Receiver operating characteristic (ROC) analysis was conducted to evaluate the predictive ability of mtDNA copy number as a predictor of hospital mortality. Among the 142 patients with sepsis, the mtDNA copy number was significantly higher in non-survivors than in survivors (median, 4040 copies/&micro;L vs. 2585 copies/&micro;L; p &lt; 0.001), and the area under the ROC curve was 0.73 (95% CI, 0.64&ndash;0.82) for the relationship between mtDNA and hospital mortality. Furthermore, the correlation between mtDNA copy number and each necroptosis mediator was excellent (p &lt; 0.001 for all): RIPK3 (r = 0.803), MLKL (r = 0.897), and HMGB1 (r = 0.603). The plasma mtDNA copy number was highly correlated with essential necroptosis mediators, suggesting that mtDNA propagates necroptosis and increases sepsis mortality

Prospective Study of Proton Therapy for Lung Cancer Patients with Poor Lung Function or Pulmonary Fibrosis

PBT has a unique depth–dose curve with a Bragg peak that enables one to reduce the dose to normal lung tissue. We prospectively enrolled 54 patients with non-small cell lung cancer treated with definitive PBT. The inclusion criteria were forced expiratory volume in 1 s (FEV1) ≤ 1.0 L or FEV1 ≤ 50% of predicted or diffusing capacity of the lungs for carbon monoxide (DLco) ≤ 50%, or pulmonary fibrosis. The primary endpoint was grade ≥ 3 pulmonary toxicity, and secondary endpoints were changes in pulmonary function and quality of life. The median age was 71.5 years (range, 57–87). Fifteen (27.8%) and fourteen (25.9%) patients had IPF and combined pulmonary fibrosis and emphysema, respectively. The median predicted forced vital capacity (FVC), FEV1, and DLco were 77% (range, 42–104%), 66% (range, 31–117%), and 46% (range, 23–94%), respectively. During the follow-up (median, 14.7 months), seven (13.0%) patients experienced grade ≥ 3 pulmonary toxicity. Seven months after the completion of PBT, patients with IPF or non-IPF interstitial lung disease (ILD) experienced a decrease in the FVC but the decrease in DLco was not significant. Under careful monitoring by pulmonologists, PBT could be a useful treatment modality for lung cancer patients with poor lung function or pulmonary fibrosis