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Background: The DAPA-HF and DELIVER trials demonstrated the clinical benefits of dapagliflozin in heart failure (HF) patients across the entire ejection fraction (EF) spectrum. However, further investigation is needed for the real-world application of dapagliflozin in HF patients. This study examines the proportion of real-world HF patients eligible for dapagliflozin and evaluates the cost-effectiveness of adding dapagliflozin to current HF therapy. Methods: Data from the nationwide prospective registry, the Korean Acute Heart Failure (KorAHF) registry, were used to determine dapagliflozin eligibility based on the enrollment criteria of the DAPA-HF/DELIVER trials. A cost-utility analysis was conducted using a Markov model to assess the cost-effectiveness of dapagliflozin by comparing it to the standard of care. Results: Out of 5178 KorAHF patients, 48.7% met the enrollment criteria of the DAPA-HF/DELIVER trials, while 89.5% met the label criteria (US Food and Drug Administration, European Medicines Agency, and Korean Ministry of Food and Drug Safety). Eligibility was highest among HF patients with preserved EF (55.3% vs. HF with mildly reduced EF and HF with reduced EF 46.4%). Dapagliflozin proved to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 4557 US dollar (US$) per quality-adjusted life year, which falls below the US$18,182 willingness-to-pay threshold. The cost-effectiveness benefit was more pronounced in patients with a left ventricular EF (LVEF) ≤ 40% (ICER US$3279 for LVEF ≤ 40% vs. US$8383 for LVEF > 40%). Conclusions: Discrepancies in dapagliflozin eligibility were observed between real-world data and clinical trial results. The addition of dapagliflozin to HF therapy proved to be highly cost-effective across the entire EF spectrum. [ABSTRACT FROM AUTHOR]

Simple Summary: Around 248,530 newly diagnosed in 2021, prostate cancer has been the most frequently diagnosed cancer in the USA. Rapid decellularization preserving acellular tissues is essential for accurate treatment and regeneration in affected areas. Our study aimed to assess the safety and efficacy of high-frequency pulsed electric field (HF-PEF) in a beagle model for the treatment of prostate cancer. We confirmed that HF-PEF of 1800 V/cm, 100 μs width, 2 ms interval successfully decellularized the prostate tissue after 4 hours, and the tissues were almost regenerated in 28 days. IRE with HF-PEF has therapeutic potential to treat prostate cancer while minimizing damage to the surrounding tissues. Conventional irreversible electroporation (IRE) with low-frequency pulsed electric field (LF-PEF) is used to induce cell death; however, it has several disadvantages including a long procedure time and severe muscle contraction due to high-voltage electric field. This study investigates a novel IRE protocol with high-frequency pulsed electric field (HF-PEF) of 500 Hz repetition to ablate the prostate tissue in beagles for treatment of prostate cancer. A finite element analysis was performed to validate optimal electrical field strength for the procedure. In total, 12 beagles received HF-PEF of 500 Hz and were sacrificed at 4 h, 4 days, and 28 days (3 each). The remaining three beagles underwent sham procedure. The outcomes of HF-PEF were assessed by histological responses. HF-PEF successfully decellularized the prostate tissues 4 h after the treatment. The prostate glands, duct, and urethra were well preserved after IRE with HF-PEF. The ablated prostatic tissues were gradually regenerated and appeared similar to the original tissues 28 d after IRE with HF-PEF. Moreover, electrocardiography and hematology demonstrated that IRE with HF-PEF did not seriously affect the cardiac tissue. HF-PEF was effective and safe in the beagle prostate and effectively induced the ablation and gradually recovered with cellular regeneration. [ABSTRACT FROM AUTHOR]

Sufficient physical activity (PA) is highly recommended to improve the prognosis after stroke. However, there have been only a few studies evaluating the changes in PA level after stroke. We aimed to identify the changes in PA level between before and after stroke, and to determine the association between PA and adverse outcomes. This observational, retrospective cohort study was performed using the Nationwide Health Insurance Service (NHIS) database in South Korea. Subjects between the ages of 20 to 80 years, who had a first-ever ischemic stroke from 2010 to 2013, were included. Subjects were divided into either the "sufficient" or "insufficient" subgroups, depending on the result of the self-reported PA questionnaire. Adverse outcomes, including all-cause mortality, stroke recurrence, and myocardial infarction (MI), were collected from a post-stroke health checkup to 2017. Of the 34,243 subjects with ischemic stroke, only 21.24% had sufficient PA level after stroke. Among those with insufficient PA level, only 17.34% improved their PA level after stroke. Subjects with sufficient PA level after stroke, regardless of their PA level prior to stroke, showed a lower risk of composite adverse outcomes (adjusted Hazard Ratio [HR], 95% CI: 0.85, 0.80–0.90). Subjects who went from insufficient to sufficient PA level (HR 0.87, 95% CI: 0.81–0.93) showed a significantly lower risk of composite adverse outcomes. Achieving a sufficient PA level after ischemic stroke appears to significantly reduce major adverse events. Further effort is needed to promote the PA level after ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Self-care behaviours are important to improve health outcomes in patients with heart failure. However, little is known about the factors related to the subdimensions of self-care behaviours in these patients. Aims: To identify the factors associated with the subdimensions of self-care behaviours among South Korean patients with heart failure. Methods: The participants in this cross-sectional descriptive study conducted between October 2016 and January 2017 were 178 patients with heart failure. Self-care behaviours were measured using the EHFScB-9, which has three subdimensions: autonomy-based adherence; provider-directed adherence; and consulting behaviours. Demographic characteristics, experience of heart failure education, physical function, patient health questionnaire-9, Pittsburgh sleep quality index and self-care confidence were also measured. Descriptive statistics and multiple linear regression analysis were conducted. Results: The mean age was 62 ± 12 years, and 37% were women. Younger age (P =0.023), no experience of heart failure education (P =0.039), poor physical function (P =0.003), poor sleep quality (P =0.037) and lower self-care confidence (P =0.001) were significantly associated with poor autonomy-based adherence. Being employed (P =0.042), poor sleep quality (P =0.042) and lower levels of self-care confidence (P =0.001) were associated with poor provider-directed adherence. Younger age (P =0.001) and lower self-care confidence (P =0.001) were associated with lower engagement in consulting behaviours. Conclusion: The three subdimensions of self-care behaviours were associated with different psychosocial factors, necessitating the development of tailored interventions and educational materials based on unique self-care behaviour patterns in patients with heart failure. [ABSTRACT FROM AUTHOR]

Objective To summarize the causes, treatment and prognosis of severe epistaxis after transnasal endoscopic skull base surgery. Methods and Results There were 12 patients with delayed severe epistaxis after transnasal endoscopic skull base surgery from February 2007 to January 2018. Surgical methods included endoscopic electrocoagulation hemostasis in 7 cases (7/12), DSA - assisted endoscopic electrocoagulation hemostasis in one case (1/12), DSA - assisted superselective arterial embolization in 3 cases (3/12), and DSA - assisted superselective arterial embolization combined with endoscopic electrocoagulation hemostasis in one case (1/12). Successful hemostasis occurred in 11 cases, and one case died. Patients were followed up for (17.21 ± 3.42) months without epistaxis recurrence. Conclusions Epistaxis mainly occurs over 7 to 14 d after transnasal endoscopic skull base surgery. The choice of operation methods is related to the location of bleeding and responsible artery. Endoscopic electrocoagulation hemostasis is an effective method without serious complications. Patients with internal carotid artery (ICA) pseudoaneurysms can be cured by endoscopic electrocoagulation hemostasis plus arterial embolization. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms and vitamin D deficiency predict cardiac events in heart failure patients, but whether vitamin D supplements are associated with depressive symptoms and cardiac events in heart failure patients remains unknown. Purpose: The purpose of this study was to compare the association of vitamin D supplement use with depressive symptoms and cardiac events in heart failure patients with mild or moderate to severe depressive symptoms. Methods: A total of 177 heart failure patients with depressive symptoms (Patient Health Questionnaire-9 score ≥5) completed a three-day food diary to determine dietary vitamin D deficiency. Patients were split into four groups by dietary vitamin D adequacy versus deficiency and vitamin D supplement use versus non-use. The Patient Health Questionnaire-9 was used to reassess depressive symptoms at six months. Data on cardiac events for up to one year and vitamin D supplement use were obtained from patient interview and medical record review. Hierarchical linear and Cox regressions were used for data analysis. Results: Sixty-six patients (37.3%) had dietary vitamin D deficiency and 80 (45.2%) used vitamin D supplements. In patients with moderate to severe depressive symptoms, the group with dietary vitamin D deficiency and no supplements had the highest Patient Health Questionnaire-9 score at six months (β=0.542, p<0.001) and shortest cardiac event-free survival (p<0.001) among the four groups, the group with dietary vitamin D deficiency and no supplements didn’t have the highest Patient Health Questionnaire-9 score at six months and shortest cardiac event-free survival in patients with mild depressive symptoms. Conclusions: Vitamin D supplements predicted lower depressive symptoms and reduced cardiac events for patients with moderate to severe depressive symptoms. Vitamin D deficiency was associated with higher risk of shorter cardiac event-free survival in heart failure patients regardless of vitamin D supplementation. [ABSTRACT FROM AUTHOR]

Background Cardiac resynchronization therapy (CRT) is an important therapy in patients with heart failure (HF) and dyssynchrony. We performed the present study to elucidate clinical factors associated with cardiac vein accessibility. Methods In 255 consecutive patients (age, 48.7 ± 19.4 years; male, 126), cardiac venography was performed during CRT implantation or an electrophysiological study. We measured the diameters and the proximal branching angles of the lateral cardiac and posterior ventricular veins. Easy accessibility of the cardiac vein was defined as a lumen diameter ≥1.6 mm with an angle of ≥90°. We compared baseline characteristics between patients with and without easily accessible cardiac veins. We compared cardiac vein accessibility between patients with and without HF, including ischemic and nonischemic HF, and between males and females. Results In 189 (74.1%) patients, the cardiac veins were easily accessible. The cardiac veins were more easily accessible in patients with HF (n = 75) compared with patients without HF (n = 180; 89.3% and 67.8%, respectively; P < 0.001). The cardiac veins were more easily accessible in patients with nonischemic HF (n = 56) compared with patients with ischemic HF (n = 19; 96.4% and 68.4%, respectively; P = 0.003). The cardiac veins were more easily accessible in females compared with males (79.8% and 68.3%, respectively; P = 0.035). Conclusions Accessing the cardiac veins for CRT implantation was difficult in ∼10% of patients with HF. Cardiac vein accessibility was high in patients with nonischemic HF and in females. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. This prospective study included 31 patients who underwent slanted lateral rectus recession for intermittent exotropia with convergence insufficiency between June 2010 and June 2012. Following parameters were recorded and analyzed: patient sex, age, preoperative and postoperative near and distance ocular alignment, and changes in stereopsis. The mean age of the patients was 9.2 years. The preoperative mean deviation angle was 32.4 PD at distance and 43.4 PD at near. After 6 months, slanted lateral rectus recession reduced the deviation angles to 2 PD at distance and 3.4 PD at near. In addition, the mean difference between distance and near deviation angles was significantly reduced from 11 PD to 1.4 PD at 6 months postoperatively. Slanted lateral rectus recession for intermittent exotropia with convergence insufficiency in children successfully reduced the distance and near exodeviations and the near-distance difference without increasing the risk of long-term postoperative esotropia or diplopia. [ABSTRACT FROM AUTHOR]

Conclusion: Facial nerve dehiscence (FND) and ossicular injury occurred more frequently in patients with cholesteatomatous than non-cholesteatomatous otitis media. Objective: FND and ossicular injury commonly occur intraoperatively in patients with otitis media, both with and without cholesteatoma. This study was designed to analyze differences in FND and ossicular injury between patients with cholesteatomatous and non-cholesteatomatous otitis media. Methods: Patients who underwent tympanomastoidectomy due to otitis media from January 2010 to July 2012 were analyzed retrospectively. Clinical features (age, sex, bacteria, and severity of preoperative hearing loss) and intraoperative findings (FND and state of ossicular injury) were compared in patients with cholesteatomatous and non-cholesteatomatous otitis media. Results: Of 212 patients with otitis media, 148 (69.8%) had non-cholesteatomatous and 64 (30.2%) had cholesteatomatous otitis media. Of these groups, 88.6% and 88%, respectively, had positive bacterial cultures. Facial nerve dehiscence was detected in 41 patients (27.7%) with non-cholesteatomatous and 41 (64.0%) with cholesteatomatous otitis media. Dehiscence of the tympanic segment was most frequently observed in both groups. Ossicular injury was detected in 52 (35.1%) and 51 patients (78.1%), respectively. Erosion was most frequent in the incus, followed by the stapes and malleus. [ABSTRACT FROM AUTHOR]

Conclusion: The increased expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs indicates that these pattern recognition receptors are involved in the pathogenesis of cholesteatoma. Objective: Changes in expression of pattern recognition receptors may be associated with immune responses in patients with cholesteatoma. We therefore assessed the levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs associated with innate immune responses in patients with cholesteatoma. Methods: Cholesteatoma specimens were collected from 23 patients diagnosed with acquired cholesteatoma from August 2010 to July 2012. The posterior auricular skin of each patient was used as control. The levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNA were assessed quantitatively using real-time RT-PCR and correlated with sex, hearing level, the presence of bacteria, and the need for repeat surgery. Results: The levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs were significantly higher in cholesteatoma than in control skin samples ( p < 0.05 each). However, mRNA abundance was not associated with patient sex, hearing level, presence of bacteria or history of reoperation ( p > 0.05 each). [ABSTRACT FROM AUTHOR]

Aim Poor health-related quality of life ( HRQOL) in patients with chronic heart failure ( CHF) may be one of the most common predictors of mortality and rehospitalization. This study was conducted to identify factors affecting HRQOL in Korean patients with CHF using two HRQOL measurements. Methods The study included a sample of 114 patients. HRQOL was measured by the Minnesota Living with Heart Failure Questionnaire ( MLHFQ) and the World Health Organization's Quality of Life Instrument - Short Version ( WHOQOL-BREF). Multiple regression analyses were performed to analyze the relationship between the factors and HRQOL. Results Significant correlations were found between MLHFQ and WHOQOL-BREF in total and component scores, with the two exceptions of WHOQOL-BREF psychological and MLHFQ physical or total. The perceived economic status, functional status, and sex were factors identified as having an effect on HRQOL. Conclusion The MLHFQ was better able to differentiate sex, comorbidity, and functional status. Further studies are needed to implement cost-effective nursing interventions for patients with CHF to improve their HRQOL. [ABSTRACT FROM AUTHOR]

Conclusions: Staphylococcus species were the most common bacterial isolates from patients with otitis media with effusion (OME). Unexpectedly, however, there was no difference in the identity or antibiotic resistance of bacteria isolated from patients with recurrent and non-recurrent OME. Objectives: Antibiotic resistance has increased due to indiscriminate overuse and misuse of antibiotics. Bacterial strains isolated from patients with recurrent OME seem to be more pathogenic and more resistant to antibiotics than strains isolated from patients with non-recurrent OME. The aim of this study was to evaluate the differences in identity and antibiotic sensitivity profiles of bacterial strains isolated from patients with recurrent and non-recurrent OME. Methods: We collected 900 middle ear fluid (MEF) samples from 654 pediatric patients who underwent ventilation tube insertion due to OME, then compared the identity and antibiotic sensitivity profiles of bacterial strains. Recurrent OME was defined as a requirement for ventilation tube reinsertion after tube extrusion. Results: There was no difference in the identity of bacterial isolates from patients with non-recurrent and recurrent OME regardless of the number of ventilation tubes inserted. Antibiotic sensitivity tests showed that the two groups differed in sensitivity to penicillin and erythromycin, but not to other antibiotics. [ABSTRACT FROM AUTHOR]

Conclusion: Contrary to our expectation, that the clinical characteristics of temporal bone fracture would differ in children and adults, we found that the two groups were similar. Objectives: Most studies of temporal bone fractures have been performed in adults. To our knowledge, no study has investigated differences in temporal bone fractures in children and adults. We therefore investigated differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients. Methods: The demographic and clinical characteristics were assessed in 32 children and 186 adults with temporal bone fractures. All patients underwent computed tomography of the temporal bone. Results: Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent in adults than in children (p < 0.05 each). [ABSTRACT FROM AUTHOR]

Aims and objectives. To assess the learning needs of patients with heart failure in Korea as this information is the cornerstone for developing a programme based on patients' learning needs. Background. Heart failure is a life-threatening event and a significant cause of morbidity and mortality in Korea. Cardiac educational programmes are intended to prevent the recurrence of heart failure and improve patients' quality of life. However, patients' information requests have historically not been well met by physicians and nurses in Korea. Design. A descriptive and exploratory study was designed. Methods. We recruited 121 patients with heart failure between the ages of 19-88 years. Self-report questionnaires, which included general characteristics, disease-related characteristics and the Heart Failure Patients' Learning Needs Inventory patient version, were used to gather data. Results. The only general characteristic that was significantly related to patients' learning needs was their occupation. No disease-related characteristics were related to learning needs. The overall mean learning needs score was 3·78. Conclusion. Patients' learning needs in Korea are lower than those typically seen in Western countries. Korean patients with heart failure had a low level of knowledge about heart failure and did not recognise the importance of being informed about their disease, which is why Korean patients with heart failure tend to depend on their physicians to make decisions related to their health management. These conditions can negatively affect clinical outcomes. Relevance to clinical practice. Although an educational programme for patients with heart failure should be based on the patients' learning needs, heart failure management and education programmes in Korea are not currently developed using a needs-based approach. Therefore, this study will provide a basis for encouraging Korean patients to obtain information about their disease and to guide professionals in developing heart failure management and education programmes. [ABSTRACT FROM AUTHOR]

Background: Angiotensin II receptor blockers (ARBs) play a key role in hypertension therapy. Recently, fimasartan, the ninth ARB, was developed, but its safety and efficacy have not been well established. Objective: The objective of this study was to determine whether age, sex, concomitant disease, and current antihypertensive medications affect the safety and efficacy of fimasartan in patients with arterial hypertension. Methods: This was a large-scale, open-label observational study to determine the safety and efficacy of fimasartan in patients with hypertension. Patients who were treated for more than 2 months with fimasartan (60 or 120 mg, once daily) were recruited, and the data were systematically collected using electronic case report forms. Written informed consent forms were obtained from all patients. Results: A total of 14,151 patients (50.7 % males; mean age 59 ± 12 years) were evaluated, of whom 37.9 % were never treated with fimasartan, 53.5 % were switched to fimasartan, and 8.5 % had fimasartan added to their treatment. Overall, fimasartan reduced systolic blood pressure (SBP) from 145.4 ± 18.1 to 126.8 ± 12.6 mmHg and diastolic blood pressure (DBP) from 88.7 ± 11.8 to 79.0 ± 8.7 mmHg (all p < 0.001). The pulse rate decreased from 74.4 ± 10.3 to 71.9 ± 9.2 beats/min in comparison with before treatment ( p < 0.001). The reductions were similar between sexes, age groups, and patients with and without co-morbidities, and were not dependent on prior or concomitant treatment with other antihypertensive drugs. Adverse events were reported in 3.31 % (treatment-emergent) and 2.35 % (drug-related) of patients; there were no dose differences for adverse events. The most frequent adverse events were dizziness (1.55 %) and headache (0.52 %); other adverse events were rare. The responder rate (DBP to <90 mmHg or a reduction of ≥10 mmHg) and the goal rate (combined SBP/DBP <140/90 mmHg) were 85.0 and 75.6 %, respectively. Global drug compliance was rated as excellent, very good, good, and poor in 68.1, 26.9, 3.4, and 1.7 % of patients, respectively. Conclusion: The safety, efficacy, and compliance of fimasartan were found to be excellent in a large patient population that included patients potentially at higher risk for adverse events. [ABSTRACT FROM AUTHOR]

Background and purpose Identification of the center of the femoral head in the coronal plane is essential during total knee arthroplasty. We evaluated a new method for localization of the center of the hip, thereby detecting the neutral mechanical axis using inter-femoral head center distances (X) measured from a radiograph. Our proposed method was compared with 3 commonly used methods using landmarks that are estimated to be 2 finger-breaths medial to the anterosuperior iliac spine (method A), 2.5 cm perpendicular to the mid-inguinal point (method I), and 1.5 cm lateral to the femoral artery (method F). Methods 114 patients undergoing total knee arthroplasty were prospectively enrolled in the study. Four landmarks were marked and conventional anterior-posterior pelvic radiographs were taken. On the radiograph, the distance between the estimated FHC and the neutral mechanical axis was measured. Results The median value (mm) of the measured distance was 9 in A, 7 in I, 8.5 in F, and 5 in X. When an error of more than 3° from neutral alignment was defined as an outlier, 15% of measurements in A, 6% of measurements in I, 14% in F, and 2% in X would fall in the outlier zone. Interpretation The method detecting the neutral mechanical axis using inter-femoral head center distances (X) showed the least variability and the lowest percentage of outliers. [ABSTRACT FROM AUTHOR]

Fresh ginseng was fermented with Ganoderma lucidum mycelium (GL) in solid-state culture to enhance its immunomodulatory activity. When crude polysaccharide (FG-GL-CP) was fractionated from lyophilized fermented ginseng (FG-GL), FG-GL-CP showed significantly higher mitogenic, macrophage stimulating, and intestinal immune system modulating activity (1.52-, 1.52- and 1.46-fold, respectively) than those of crude polysaccharide from nonfermented ginseng (NG-CP, 1.36-, 1.37- and 1.32-fold) and G. lucidum mycelium alone (GL-CP, 1.48-, 1.40- and 1.31-fold). After FG-GL-CP was further fractionated into two active carbohydrate-rich fractions (FG-GL-CP-II and III) on DEAE-Sepharose CL-6B (Cl− form), the most active polysaccharide (FG-GL-CP-III-1) was purified as a single peak with a molecular weight of 71 kDa. FG-GL-CP-III-1 mainly consists of Ara, Man, Gal, and Glc (molar ratio: 0.85:1.00:0.81:0.76) in addition to a small amount of uronic acid. Methylation analysis indicates that FG-GL-CP-III-1 is composed mainly of terminal/4- or 5-linked Ara f, terminal/4-linked Man, terminal/3,6-branched Gal, and terminal/4-linked Glc. NaIO4 oxidation of FG-GL-CP-III significantly decreased its activity (64.0-79.2%). These results suggest that solid-state culture of ginseng with G. lucidum may enhance the immunomodulatory activity and that neutral polysaccharides containing Ara, Man, Gal, and Glc may be important for the activity of fermented ginseng. [ABSTRACT FROM AUTHOR]

Hypertension and dyslipidemia significantly contribute to cardiovascular disease development. Their coexistence poses challenges in managing multiple medications, influencing treatment adherence. This study aimed to assess the efficacy and safety of a combined treatment approach using a fixed-dose combination therapy. This multicenter, 8-week, randomized, double-blind, Phase IV trial was named Telmisartan/Amlodipine/Rosuvastatin from Samjin Pharmaceuticals and evaluated the efficacy and safety of fixed-dose combination treatment in patients with essential hypertension and dyslipidemia. They were randomly assigned to 2 fixed-dose combination therapy groups, telmisartan 40 mg/amlodipine 5 mg/rosuvastatin 10 mg (TEL/ALD/RSV) or amlodipine 5 mg/atorvastatin 10 mg (ALD/ATV) after washout/run-in period. The primary outcomes were the change in mean sitting systolic blood pressure and the percentage change of LDL-C after 8 weeks of medical treatment. Adverse drug reactions and events were assessed. Of a total of 304 patients who underwent screening, 252 were randomized to the TEL/ALD/RSV group (125 patients) and the ALD/ATV group (127 patients). The mean (SD) ages of the TEL/ALD/RSV group and the ALD/ATV group were 67.4 (11.3) and 68.2 (10.6) years, respectively (P = 0.563). The least-squares mean (SE) in mean sitting systolic blood pressure changes between the 2 groups were –16.27 (0.93) mm Hg in the TEL/ALD/RSV group, –6.85 (0.92) mm Hg in the ALD/ATV group (LSM difference = –9.42 mm Hg; 95% CI, –11.99 to –6.84; P <.001). For LDL-C level changes, a significant difference was noted between the 2 groups: –50.03% (1.18%) in the TEL/ALD/RSV group, –39.60% (1.17%) in the ALD/ATV group (LSM difference = –10.43%; 95% CI, –13.70 to –7.16; P <.001). No severe adverse events were observed. TEL/ALD/RSV proved to be more efficient than ALD/ATV in lowering blood pressure and reducing LDL-C levels among patients with hypertension and dyslipidemia, with no notable safety concerns. (Curr Ther Res Clin Exp. 2024; XX:XXX–XXX). ClinicalTrials.gov identifier: NCT03860220. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: Leg muscle strength (LMS) may be useful as a frailty index in patients with heart failure. However, LMS, until recently, has been indirectly estimated, and its prognostic value in acute heart failure syndrome (AHFS) is unclear. Therefore, we evaluated the prognostic value of direct LMS assessment and its relationship with proinflammatory mediators in patients with AHFS. Methods: We directly measured LMS at predischarge using a dynamometer in 110 prospectively and consecutively enrolled patients with AHFS (75 male; 60 ± 14 yr; mean ejection fraction, 29.9% ± 14.6%). The primary end point was cardiovascular (CV) events, defined as CV mortality, cardiac transplantation, or rehospitalization due to heart failure aggravation. Patients were divided into impaired and preserved LMS groups according to Contal and O'Quigley's method. Results: CV events occurred in 28 patients (25.5%) (including 5 CV deaths and 6 cardiac transplantations) during follow-up (median, 246 d; range = 11–888 d). Impaired LMS was associated with significantly higher levels of serum monokine induced by gamma interferon and poor clinical outcomes (P < 0.001). Multivariable Cox proportional hazard analysis (controlling for age, sex, body mass index, heart failure type, hemoglobin level, N-terminal pro-b-type natriuretic peptide level, and beta-blocker use) revealed LMS as an independent predictor of CV events (P = 0.017). Conclusion: Impaired LMS, which might be used as a marker of frailty, is associated with increased levels of a proinflammatory chemokine and independently predicts clinical outcomes in patients with AHFS. The direct measurement of LMS is simple and feasible and might have important implications for the risk stratification of patients with AHFS. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objectives: The aim of the study was to explore motivators for and barriers to exercise rehabilitation in hemodialysis patients and the barriers perceived by the hemodialysis center staff. Design: A cross-sectional study was performed in five hemodialysis centers using patient questionnaires designed for this study to evaluate the motivators for and barriers to exercise rehabilitation. Questionnaires were not yet validated. Results: Of the 471 recruited patients, 63.3% were willing to participant in exercise rehabilitation. The greatest motivators included improving quality of life (98.0%) and wanting to be healthier (98.0%). Perceived barriers included discomfort (59.0%), concerns regarding safety (36.7%), and disinterest (27.0%). Among these, unwillingness, disinterest, and having peripheral arterial disease were independent risk factors of lack of participation in exercise rehabilitation. The most common perceived barriers among the 90 employees that participated were lack of professional guidance and advice from rehabilitation therapists (93.1%), lack of exercise rehabilitation knowledge (86.2%), and lack of special exercise equipment (86.2%). Conclusions: Most patients were willing to exercise to improve their health and quality of life. Barriers to exercise rehabilitation included patient and staff factors. It is essential to establish a rehabilitation team within dialysis centers, including general staff and rehabilitation therapists. These centers require improved rehabilitation policies and access to specialized rehabilitation equipment. [ABSTRACT FROM AUTHOR]