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Background Paragangliomas are tumors that arise from extra-adrenal chromaffin cells. Herein, we present a rare case of a functional paraganglioma in the posterior mediastinum. Case presentation A 36-year-old man presented with paroxysms of chest pain and headache. At presentation, the patient’s blood pressure was 190/120 mmHg. Chest computed tomography and magnetic resonance imaging revealed a left paravertebral mass in the posterior mediastinum. 123 I-metaiodobenzylguanidine scanning revealed focally high tracer uptake in the left paravertebral area. The metanephrine level in the urine was elevated, confirming a rare, catecholamine-producing, functional paraganglioma in the posterior mediastinum. Before surgery, the patient was prepared by orally administering α- and β-adrenergic blockers. The mass was then resected via a lateral thoracotomy. The metanephrine level in urine was normal 24 h after surgery. Conclusions Paragangliomas in the posterior mediastinum are very rare, but more than half of all cases are functional. The associated symptoms are curable with complete resection, and long-term follow-up for recurrence is important.

Excessive smartphone use is a phenomenon related to maladaptive smartphone use, leading to negative consequences. This study set out with the aim of assessing the effects of excessive smartphone use on behavioral and neural responses during facial emotional processing. We examined 25 excessive smartphone users and 27 normal control users using functional MRI during facial emotion processing and investigated Behavioral Inhibition System/Behavioral Activation System (BIS/BAS). The excessive smartphone use group (SP) showed neural deactivation in the dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC) during the presentation of an angry face and emotional transition compared to that of the normal control group (NC). Additionally, the SP revealed neural deactivation of the superior temporal sulcus and temporo-parietal junction related to social interaction during emotional transition compared to the NC. We found that BAS-Reward Responsiveness level was correlated with behavioral responses during repeated happy faces related to emotional reward in SP compared to NC. It can thus be suggested that excessive smartphone use is likely to fail on cognitive control during emotional processing, and this impairment might be influenced on emotional processing related to social interaction.

There are little direct comparative evidences of strategies between ≥50% and the absolute target goal of low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml for the patients who underwent percutaneous coronary intervention (PCI). This study aimed to investigate the clinical impact of different strategies between 2 groups of patients who underwent PCI. A total of 3,104 patients with previous PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The study population was stratified into 2 groups based on whether the LDL-C level was <55 mg/100 ml at the 1-year mark or not. Furthermore, the 50% reduction rate of LDL-C was also categorized based on whether it had decreased by ≥50% from the initial LDL-C level at the 1-year mark. The primary end point was 3-year major adverse cardiovascular events (MACEs) which were defined as a composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization, hospitalization for heart failure, or nonfatal stroke. There was no significant difference between the LDL <55 mg/100 ml group and the LDL ≥55 mg/100 ml group in the risk of MACEs (hazard ratio 1.06, 95% confidence interval 0.81 to 1.38, p = 0.690) after propensity score matching. However, the group that achieved ≥50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACEs in the subgroup of LDL-C level ≥55 mg/100 ml (hazard ratio 0.41, 95% confidence interval 0.19 to 0.89, p = 0.025) compared with the group with <50% reduction of LDL-C. In all patients, the achievement rate of target LDL-C <55 mg/100 ml and more than 50% reduction from baseline was 17.2%. In conclusion, guideline-directed management strategy of ≥50% reduction of LDL-C from the baseline will be needed to reduce the incidence of MACEs in patients with LDL-C ≥55 mg/100 ml who underwent PCI. Additional efforts to increase the target goal achievement rate of LDL-C are warranted.

Background Sodium‐glucose co‐transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real‐world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM). Hypothesis A difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes. Methods From 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all‐cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3‐year period. Results Propensity‐score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73–2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all‐cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE. Conclusions Dapagliflozin and empagliflozin showed no significant difference of real‐world clinical cardiovascular outcomes in patients with DM over a 3‐year period. Further large randomized clinical trials will be warranted for better evaluation. Comparative study on dapagliflozin and empagliflozin showed similar 3‐year cardiovascular outcomes in patients with diabetes mellitus. DM, diabetes mellitus; MACE, major adverse cardiovascular events; PS, propensity‐score; SGLT2, sodium‐glucose co‐transporter 2.

Welding, a key technology in the shipbuilding industry, is mostly performed by hand, owing to the complex structure and shape of production blocks. This manual welding requires a variety of working postures, which have become an important determinant of the worker’s workload and, consequently, assembly man-hours. Currently, major shipyards calculate welding man-hours by reflecting the welding factor, which is defined as the working time consumed in the welding process. A set of welding factors is known to be based on the accumulated experience in shipyards, whereas the verification or derivation process for these factors is not disclosed or available. This study proposed a method for quantitatively calculating work difficulty for welding positions based on the working posture in a process where the posture acts as an important variable. Standard welding positions reflecting the actual welding work at shipyards were established. A physiological assessment method was used to propose the physical welding factor by analyzing the measured muscle activity. The validity of the proposed method was verified by comparing the results of a musculoskeletal simulation package and shipyard welding factors. The proposed method can be readily applied to other fields in which workers’ physical activities are involved.

The proportion of welding work in total man-hours required for shipbuilding processes has been perceived to be significant, and welding man-hours are greatly affected by working posture. Continuous research has been conducted to identify the posture in welding by utilizing the relationship between man-hours and working posture. However, the results that reflect the effect of the welding posture on man-hours are not available. Although studies on posture recognition based on depth image analysis are being positively reviewed, welding operation has difficulties in image interpretation because an external obstacle caused by arcs exists. Therefore, any obstacle element must be removed in advance. This study proposes a method to acquire work postures using a low-cost RGB-D camera and recognize the welding position through image analysis. It removes obstacles that appear as depth holes in the depth image and restores the removed part to the desired state. The welder’s body joints are extracted, and a convolution neural network is used to determine the corresponding welding position. The restored image showed significantly improved recognition accuracy. The proposed method acquires, analyzes, and automates the recognition of welding positions in real-time. It can be applied to all areas where image interpretation is difficult due to obstacles.

Data on the clinical impact of beta-blockers (BBs) in patients with myocardial infarction (MI) who had non-reduced left ventricular ejection fraction (LVEF) after percutaneous coronary intervention are limited. From 2016 to 2020, we evaluated a cohort of 12,101 myocardial infarction patients with a non-reduced LVEF (≥40%) from the Korean Acute Myocardial Infarction Registry V. Patients were divided into two groups based on their BB (carvedilol, bisoprolol, or nebivolol) treatment at discharge: with beta-blocker treatment (BB,  = 9,468) and without beta-blocker treatment (non-BB,  = 2,633). The primary endpoint after discharge was the occurrence of patient-oriented composite endpoints (POCEs), including all-cause mortality, any MI, or any revascularization at 1-year follow-up. The median follow-up period was 353 days (interquartile range, 198-378 days). At 1-year follow-up, no significant differences were observed in the primary endpoint between the BB group and the non-BB group. Before propensity score (PS) matching, the POCE incidence was 3.1% in the BB group vs. 3.4% in the non-BB group [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.68-1.09,  = 0.225]. After PS matching, the POCE incidence remained similar between the two groups (3.7% vs. 3.4%, HR 1.01, 95% CI 0.76-1.35,  = 0.931). Individual outcomes, including all-cause mortality, myocardial infarction, and revascularization, also showed no significant differences between the two groups. Independent predictors of 1-year POCEs after discharge were age, chronic kidney disease, reduced LVEF, and multivessel disease. BB treatment in patients with acute MI and non-reduced LVEF was not associated with a significant reduction in cardiovascular outcomes at 1-year follow-up.

This study aimed to determine the impact of dysglycemia on myocardial injury and cardiac dysfunction in acute myocardial infarctions (AMIs). From 2005 to 2016, a total of 1,593 patients with AMIs who underwent percutaneous coronary intervention were enrolled. The patients were classified into five groups according to the admission glucose level: ≤80, 81 to 140, 141 to 200, 201 to 260, and ≥261 mg/dL. The clinical and echocardiographic parameters and 30-day mortality were analyzed. The peak troponin I and white blood cell levels had a positive linear relationship to the admission glucose level. The left ventricular ejection fraction had an inverted U-shape trend, and the E/E' ratio was U-shaped based on euglycemia. The 30-day mortality also increased as the admission glucose increased, and the cut-off value for predicting the mortality was 202.5 mg/dL. Dysglycemia, especially hyperglycemia, appears to be associated with myocardial injury and could be another adjunctive parameter for predicting mortality in patients with AMIs.

Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI-, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI-, P<0.001) but the level of CSS was higher (316.13±108.20 mPa in AMI+ and 286.80±85.34 mPa in AMI-, P=0.040) in the AMI+. The CSS was significantly related to the erythrocyte sedimentation rate (R²=0.497, P<0.001) and use of dipeptidyl peptidase-4 inhibitors (R²=0.574, P=0.048). Diabetics with AMI resulted in adverse hemorheologic changes with lower EI and higher CSS compared to diabetic subjects without AMI. Evaluation of the hemorheologic parameters may provide valuable supplementary information for managing patients with AMI and T2DM.