Explore the vast range of titles available.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), have shown benefits in patient with heart failure (HF), however, adherence remains a significant issue: with only 60% of patients continuing usage beyond a year. This study aims to identify patients at risk of discontinuing SGLT2i and promote its judicious use to reduce hospitalizations and improve cardiovascular outcomes. Using the Korean National Health Insurance Service database, patients diagnosed with HF and diabetes mellitus (n = 1,665,565) between 2013 and 2018 were identified. Among them, 55,694 participants prescribed SGLT2i were enrolled. The primary endpoint included 1) all-cause mortality and 2) SGLT2i-related hospitalization, encompassing incidents such as ketoacidosis, acute kidney injury, urinary tract infections, fall-related fractures, and other unplanned hospitalizations. During the follow-up period (median: 2.3 years; range: 1.2–3.6 years), 8,463 participants reached the primary endpoint (25.5 for all-cause death and 39.4 for SGLT2i-related hospitalizations per 1,000 person-years). Independent risk factors for the primary endpoint in multivariate Cox regression and propensity-score matching analyses included age of ≥ 70 years, body mass index (BMI) <18.5 kg/m 2 , body weight <60 kg, anemia, chronic kidney disease, and the use of diuretics. Age (hazard ratio [HR] 1.45, 95% confidence interval [CI]: 1.36–1.54), BMI (HR 1.78, 95% CI: 1.29–2.45), body weight (HR 1.17, 95% CI: 1.09–1.26) and the use of furosemide (HR 1.45, 95% CI: 1.22–1.74) (all p <0.001) were consistent independent risk factors in the propensity score-matched cohort. Having three or more risk factors was associated with an adjusted HR that was 3.04 times higher than cases with no risk factor (95% CI: 2.83–3.28, p <0.001). Old age, low weight or BMI, and the use of diuretics are risk factors that hinder the continuous use of SGLT2i in diabetic patients with HF. Close monitoring for side effects is essential when prescribing SGLT2i, particularly for those with multiple risk factors.

Background There is a lack of data regarding outcomes of therapeutic hypothermia in patients with acute myocardial infarction (AMI) complicated by out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the effect of therapeutic hypothermia on clinical outcomes in comatose patients after percutaneous coronary intervention (PCI) for AMI following OHCA. Methods Using a prospective nationwide registry from 2016 to 2021, we selected 2925 patients with AMI who underwent emergency PCI among 182,508 OHCA cases. These patients were divided into groups receiving hypothermia treatment ( n  = 624) and those not receiving hypothermia treatment ( n  = 2301). The primary endpoint was in-hospital mortality, and secondary endpoints were mortality rate at 24 h and neurological outcomes at discharge. Results The hypothermia group showed a significantly lower rate of in-hospital mortality than the non-hypothermia group (odds ratio [OR] 0.71; 95% confidence interval [CI], 0.59–0.85; P  < 0.001). However, there was no significant difference in neurological outcomes at discharge between the two groups. Furthermore, quartile analysis of door-to-cooling (DtC) time, defined as the time from hospital arrival to initiation of hypothermia, demonstrated that a shorter DtC time was associated with a decreased risk of mortality and poor neurological outcomes (mortality: adjusted OR, 0.40; 95% CI, 0.30–0.54; P  < 0.001; poor neurological outcome: adjusted OR, 0.59; 95% CI, 0.45–0.77; P  < 0.001 for quartile 1 versus quartile 4). Conclusions Therapeutic hypothermia reduced the rate of in-hospital mortality in patients with AMI complicated by OHCA. Moreover, early initiation of hypothermia demonstrated a reduction in mortality and poor neurological outcomes. Pre-registered clinical trial number URL: http://clinicaltrials.gov . Unique identifier: NCT05724914. Condensed abstract In this large, government-controlled, nationwide, prospective real-world registry with AMI and complicated by OHCA, we demonstrated therapeutic hypothermia reduced the rate of in-hospital mortality, but it did not improve neurological outcomes at discharge. Our findings also showed that early initiation of hypothermia was significantly associated with reduced in-hospital mortality and poor neurological outcomes. The findings of this study suggest that therapeutic hypothermia reduces in-hospital mortality in patients with AMI complicated by OHCA . Early application of hypothermia should be considered as a potential means of improving neurological outcomes in patients with AMI-OHCA undergoing emergency PCI. Graphical Abstract

We aimed to evaluate the utility of left atrial reservoir strain (LASr) as a predictor of left ventricular (LV) filling pressure measured via catheterization in patients with sinus rhythm. This prospective study collected data including pre-atrial contraction (pre-A) pressure and LV end-diastolic pressure (LVEDP) from patients undergoing LV catheterization. Transthoracic echocardiography was performed within 24 h to assess LA strain. Patients with supraventricular tachycardia or acute coronary syndrome were excluded. From June 2021 to September 2022, 365 patients (mean age 61.7 ± 11.5 years, 25.5% female) were enrolled. Mean LASr was 28.7 ± 7.4%. LASr demonstrated good discrimination for predicting LV pre-A pressure ≥ 15 mmHg (0.754, 95% CI 0.641–0.820), being significantly better than that of LVEDP ≥ 16 mmHg (0.655, 95% CI 0.592–0.719) using a 24% cutoff ( p  = 0.021). Adding LASr to a model based on HFA-PEFF components improved diagnostic performance (continuous net reclassification index 0.404, 95% CI 0.037–0.807, p  = 0.032). In patients with indeterminate diastolic function, LASr ≥ 24% reclassified them as normal with 76.9% accuracy. When the 198 patients within the intermediate score group with LASr > 24% were reclassified as ‘HFpEF unlikely,’ 192 (97.0%) showed normal LV filling pressure. LASr is an independent predictor of LV filling pressure, especially LV pre-A pressure.

The standard 60-mg dose of fimasartan, a newly developed selective angiotensin II receptor blocker, is effective and safe for use in patients with mild to moderate hypertension. This study aimed to compare the efficacy and safety of low-dose (30 mg) fimasartan and placebo or valsartan (80 mg) for 8 weeks in patients with mild to moderate hypertension. In this randomized trial, 293 patients (219 men; mean age, 54.24 [9.77] years) with mild to moderate hypertension were enrolled. After randomization to receive 30-mg fimasartan (n = 115), placebo (n = 117), or 80-mg valsartan (n = 61), the treatment dose was kept constant without dose escalation for 8 weeks. The primary end point was improvement in sitting diastolic blood pressure (SiDBP) from baseline to 8 weeks that was compared between treatments with low-dose fimasartan and placebo. The secondary end point was the overall efficacy and safety of low-dose fimasartan compared with that of placebo or valsartan. At week 8, SiDBP changed by –9.93 (8.86) mm Hg in the fimasartan group and by –2.08 (9.47) mm Hg in the placebo group, which indicated significant antihypertensive efficacy (P < 0.0001). Efficacy was shown at week 4 as measured by SiDBP (–9.96 [7.73] vs –2.27 [7.85] mm Hg; P < 0.0001) or sitting systolic blood pressure (SiSBP) (–16.18 [14.44] vs –1.95 [13.48] mmHg; P < 0.0001) and at week 8 as determined by SiSBP (–15.35 [16.63] vs –2.30 [14.91] mm Hg; P < 0.0001). The fimasartan group exhibited more potent antihypertensive efficacy than the valsartan group both at week 4 (SiDBP, –9.96 [7.73] vs –6.53 [9.58] mm Hg [P = 0.0123]; SiSBP, –16.18 [14.4] vs –7.65 [12.89] mm Hg [P = 0.0002]) and at week 8 (SiDBP, –9.93 [8.86] vs –5.47 [8.96] mm Hg [P = 0.0021]; SiSBP, –15.35 [16.63] vs –7.49 [13.68] mm Hg [P = 0.0021]). Most treatment-emergent adverse events (TEAEs) were mild (89 of 95), and there were no serious TEAEs. The incidence of TEAEs was 19.1% in the fimasartan group, 22.6% in the placebo group, and 13.6% in the valsartan group, with no significant differences. Low-dose fimasartan (30 mg) was well tolerated during the study period with no significant TEAEs. Low-dose fimasartan had an effective blood pressure–lowering effect that was greater than that of 80-mg valsartan in patients with mild to moderate hypertension. ClinicalTrials.gov identifier: NCT01672476.

Although socioeconomic status (SES) is considered a risk factor for cardio-cerebrovascular diseases (CCVDs), few studies have examined this association. In this cross-sectional study, we aimed to assess the prevalence and trends of CCVDs across different SES groups over a 12-year period in a representative Korean population. We analysed 47 745 economically active adults aged ≥30 and <65 years from 97 622 patients in the Korean National Health and Nutrition Examination Survey (2007-18), where a new independent sample of the population was examined each year. We categorised the participants into four groups based on education level and income. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CCVD, including angina, myocardial infarction, and stroke, was analysed at four-year intervals. Average age, urban residence, white-collar occupation, and body mass index >30 increased, whereas CCVD prevalence did not change significantly (P = 0.410) over the study period. Low education (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04-1.47, P < 0.001) and low income (OR = 1.14; 95% CI = 1.02-1.28, P = 0.017) were significant determinants of CCVD in addition to existing traditional risk factors. CCVD prevalence was significantly higher in both the low-education and low-income groups compared to the high-education and high-income groups every four years, with no significant change in this gap over the study period (P = 0.239). Despite the increase in the elderly population and the prevalence of obesity, the incidence of CCVDs in Korea has remained unchanged. Individuals with low education or low income had a significantly higher prevalence of CCVD, with the lowest SES group, defined by both low education and low income, consistently having the highest prevalence of CCVDs.

Although amlodipine is recommended as the first‐line therapy for the treatment of hypertension, its use is limited by its potential side effects. S‐amlodipine is expected to be able to minimize side effects of amlodipine with a similar antihypertensive effect by removing the malicious R‐chiral form. However, sustainable blood pressure control with S‐amlodipine has not been well established yet. The purpose of the current study was to evaluate ambulatory blood pressure (ABP) profiles before and after a 12‐week treatment of S‐amlodipine. Patients received once‐daily S‐amlodipine 2.5 or 5 mg. ABP during 24 hr and office blood pressure were measured at baseline and after the 12‐week treatment. Primary endpoints were changes of systolic and diastolic 24 hr ABP. After 12‐week S‐amlodipine treatment, mean systolic ABP (‐15.1 ± 16.2 mmHg, p < .001) and diastolic ABP (‐8.9 ± 9.8 mmHg, p < .001) were decreased significantly. Both daytime and night‐time mean systolic BP and diastolic BP were also significantly decreased after the 12‐week treatment. Global trough‐to‐peak ratio and smoothness index after 12‐week S‐amlodipine treatment were .75 and .79 for SBP and .65 and .61 for DBP, respectively. Age ≥65 years (hazard ratio [HR]: 3.13; 95% confidence interval [CI]: 1.67–14.3) and nonalcohol drinking (HR: 3.09; 95% CI: 1.34–7.17) were independent clinical factors for target ABP achievement. Adverse drug reactions (ADR) were developed in 16 (6.4%) patients, including two (.8%) cases of peripheral edema. In conclusion, this study demonstrated the efficacy and safety of S‐amlodipine in patients with uncontrolled essential hypertension.

Aims Increased red cell distribution width (RDW) is a poor prognostic factor in patients with heart failure (HF). However, only a few large‐scale studies have identified the clinical utility of RDW after adjusting for covariates affecting RDW. Methods and results From January 2010 to April 2021, we retrospectively enrolled patients diagnosed with HF from three referral hospitals with available RDW data (taken within 3 months of HF diagnosis) using an integrated clinical data system. Patients with an ejection fraction (EF) < 50% or HFA‐PEFF (Heart Failure Association Pre‐test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology) score ≥ 2 without severe valvular heart disease or coronary revascularization were enrolled. The primary endpoint was all‐cause mortality, and cardiovascular mortality was also collected. Multivariable Cox regression analysis and stabilized inverse probability of treatment weighting (IPTW) were used to identify any association between RDW and all‐cause death by balancing covariates or compounding factors. The global χ2 score was calculated and discrimination analysis was performed to evaluate the incremental value of RDW in predicting prognosis. Among the 6599 participants enrolled in this study, 1256 (19.0%) cases of all‐cause death occurred, and the median duration of follow‐up was 887 (interquartile range 351–1589) days. Elevated RDW at the initial diagnosis was associated with poor prognosis [cumulative incidence: 819 (30.2%) vs. 437 (11.2%), relative risk 1.58, 95% confidence interval (CI) 1.51–1.67, log‐rank P < 0.001]. Multivariable Cox analysis showed that elevated RDW was a poor prognostic factor for the primary endpoint [hazard ratio (HR) 1.11, 95% CI 1.06–1.16, P < 0.001], independent of clinical risk factors, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), and EF, which was concordant with the stabilized IPTW (HR 1.29, 95% CI 1.10–1.49, P < 0.001). Adding RDW to model composed of traditional risk factors, NT‐proBNP, and echocardiographic parameters showed incremental prognostic value for predicting poor prognosis (area under the receiver operating characteristic curve, 0.799–0.826; P < 0.001). Conclusions Increased RDW at the time of diagnosis is associated with poor prognosis in patients with HF, independent of clinical risk factors, such as NT‐proBNP, and echocardiographic parameters. Therefore, RDW may aid in the management of these patients beyond traditional risk factors.

It has been found that there is a gap between service need and utilization in the mental health field in South Korea. This study examined factors that facilitate help- seeking attitudes toward mental health services among South Koreans. Specifically, this study aimed to investigate whether stigma tolerance and family, friends, and societal support/sanction associated with one’s seeking psychological help were facilitating factors that promoted one’s attitudes toward seeking professional psychological help. Participants were 324 South Korean adults living in South Korea (114 males and 210 females; ages range from 19 to 70 years old, M = 39.95, SD = 12.601). Measures that were used in the study included: 1) Attitudes Toward Seeking Professional Psychological Help Scale—Short (ATSPPH-S); 2) Stigma Tolerance Scale (STS); 3) Family, Friends, and Societal Support Scale (FFSS); and 4) Stigma Scale for Receiving Psychological Help (SSRPH). Results of the hierarchical regression analyses revealed that higher levels of stigma tolerance and family and friends support/sanction of receiving professional psychological help predicted more positive attitudes toward seeking help. Neither the mediation nor the moderation analyses produced any significant results. Results of post- hoc mediation analyses indicated that family support and friends support mediated the relationship between stigma tolerance and help-seeking attitudes. In sum, these findings suggest that stigma tolerance and family and friends support/sanction are factors that facilitate Korean’s attitudes toward seeking professional psychological help.

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

Dominant intermediate Charcot-Marie-Tooth disease type C（DI-CMTC） is a dominantly inherited neuropathy that has been classified primarily based on motor conduction velocity tests but is now known to involve axonal and demyelination features.DI-CMTC is linked to tyrosyl-t RNA synthetase（YARS）-associated neuropathies,which are caused by E196 K and G41 R missense mutations and a single de novo deletion（153-156 del VKQV）.It is well-established that these YARS mutations induce neuronal dysfunction,morphological symptoms involving axonal degeneration,and impaired motor performance.The present study is the first to describe a novel mouse model of YARS-mutation-induced neuropathy involving a neuron-specific promoter with a deleted mitochondrial targeting sequence that inhibits the expression of YARS protein in the mitochondria.An adenovirus vector system and in vivo techniques were utilized to express YARS fusion proteins with a Flag-tag in the spinal cord,peripheral axons,and dorsal root ganglia.Following transfection of YARS-expressing viruses,the distributions of wild-type（WT） YARS and E196 K mutant proteins were compared in all expressed regions; G41 R was not expressed.The proportion of Flag/green fluorescent protein（GFP） double-positive signaling in the E196 K mutant-type mice did not significantly differ from that of WT mice in dorsal root ganglion neurons.All adenovirus genes,and even the empty vector without the YARS gene,exhibited GFP-positive signaling in the ventral horn of the spinal cord because GFP in an adenovirus vector is driven by a cytomegalovirus promoter.The present study demonstrated that anatomical differences in tissue can lead to dissimilar expressions of YARS genes.Thus,use of this novel animal model will provide data regarding distributional defects between mutant and WT genes in neurons,the DICMTC phenotype,and potential treatment approaches for this disease.