Exosome-like extracellular vesicles (ELVs) contain biomolecules that have potential as diagnostic biomarkers, such as proteins, micro-RNAs (miRNAs), and lipids. However, it is difficult to enrich ELVs consistently with high yield and purity from clinical samples, which hampers the development of ELV biomarkers. This is particularly true for miRNAs in protein-rich plasma. Hence, we modified ELV isolation protocols of three commercially available polymer-precipitation-based kits using proteinase K (PK) treatment to quantify ELV-associated miRNAs in human plasma. We compared the yield, purity, and characteristics of enriched plasma ELVs, and measured the relative quantity of three selected miRNAs (miR-30c, miR-126, and miR-192) in ELVs using six human plasma samples. Compared with the original protocols, we demonstrated that ELVs can be isolated with PK treatment with high purity (i.e., lack of non-exosomal proteins and homogeneous size of vesicles) and yield (i.e., abundancy of exosomal markers), which were dependent on kits. Using the kit with the highest purity and yield with PK treatment, we successfully quantified ELV miRNAs (levels of 45%–65% in total plasma) with acceptable variability. Collectively, ELV enrichment using the modified easy-to-use method appears suitable for the analysis of miRNAs, although its clinical applicability needs to be confirmed in larger clinical studies.

Irisin is a myokine with potential anti-obesity properties that has been suggested to increase energy expenditure in obese patients. However, there is limited clinical information on the biology of irisin in humans, especially in morbidly obese patients undergoing bariatric surgery. We aimed to assess the association of circulating irisin concentrations with weight loss in obese patients undergoing bariatric surgery. This was a pilot, single-centre, longitudinal observational study. We recruited 25 morbidly obese subjects who underwent Roux-en-Y gastric bypass surgery (RYGBP), and blood samples from 12 patients were taken to measure serum irisin concentrations before, and one and nine months after surgery. Their clinical characteristics were measured for one year. The preoperative serum irisin concentration (mean 1.01 ± 0.23 μg/mL, range 0.73–1.49) changed bidirectionally one month after RYGBP. The mean concentration at nine months was 1.11 ± 0.15 μg/mL (range 0.92–1.35). Eight patients had elevated irisin levels compared with their preoperative values, but four did not. Elevations of irisin levels nine months, but not one month, after surgery, were associated with lower preoperative levels (p = 0.016) and worse weight reduction rates (p = 0.006 for the percentage excess weight loss and p = 0.032 for changes in body mass index). The preoperative serum irisin concentrations were significantly correlated with the percentage of excess weight loss for one year (R² = 0.612; p = 0.04) in our study. Our results suggest that preoperative circulating irisin concentrations may be at least in part associated with a weight loss effect of bariatric surgery in morbidly obese patients. Further large-scale clinical studies are needed to ratify these findings.

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar.

Objective We aimed to investigate the characteristics of frequent emergency department (ED) users in Korea.Methods We analyzed the Korea Health Panel Study data of a sampled population from the 2005 Population Census of Korea data, and adults (age ≥18 years) who visited the ED at least once a year between 2014 and 2017 were included in the study. People who visited three or more times a year were classified as frequent users. We compared demographic, socioeconomic, and health-related factors between nonfrequent and frequent users. We used a multivariable logistic regression analysis to determine factors related to frequent ED visits. We also compared the characteristics of ED use in both nonfrequent and frequent users.Results A total of 5,090 panels were included, comprising 6,853 visits. Frequent users were 333 (6.5% of all panels), and their ED visits were 1,364 (19.9% of all ED visits). In the multivariable regression analysis, medical aid coverage (adjusted odds ratio [aOR] of the National Health Service coverage, 0.55; 95% confidence interval [CI], 0.40–0.75), unemployment (aOR of employment, 0.72; 95% CI, 0.56–0.91), prior ward admission in a year (aOR, 2.14; 95% CI, 1.67–2.75), and frequent outpatient department use (aOR, 1.72; 95% CI, 1.35–2.20) were associated with frequent use. Moreover, frequent users visited the ED of public hospitals more often than than nonfrequent users (19.2% vs. 9.8%). Medical problems rather than injury/poisoning were the more common reasons for visiting the ED (84.5% vs. 71.2%).Conclusion We found that frequent ED users were likely to be those with socioeconomic disadvantage or with high demand for medical service. Based on this study, further studies on interventions to reduce frequent ED use are required for better ED services.