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Background: Screening of variants, related to lipid metabolism in patients with extreme cholesterol levels, is a tool used to identify targets affecting cardiovascular outcomes. The aim of this study was to examine the prevalence and characteristics of rare and common variants of APOB and PCSK9 in Korean patients with extremely low low-density lipoprotein-cholesterol (LDL-C) levels. Methods: Among 13,545 participants enrolled in a cardiovascular genome cohort, 22 subjects, whose LDL-C levels without lipid-lowering agents were ≤1 percentile (48 mg/dL) of Korean population, were analyzed. Two target genes, APOB and PCSK9, were sequenced by targeted next-generation sequencing. Prediction of functional effects was conducted using SIFT, PolyPhen-2, and Mutation Taster, and matched against a public database of variants. Results: Eight rare variants of the two candidate genes (five in APOB and three in PCSK9) were found in nine subjects. Two subjects had more than two different rare variants of either gene (one subject in APOB and another subject in APOB/PCSK9). Conversely, 12 common variants (nine in APOB and three in PCSK9) were discovered in 21 subjects. Among all variants, six in APOB and three in PCSK9 were novel. Several variants previously reported functional, including c.C277T (p.R93C) and c.G2009A (p.G670E) of PCSK9, were found in our population. Conclusions: Rare variants of APOB or PCSK9 were identified in nine of the 22 study patients with extremely low LDL-C levels, whereas most of them had common variants of the two genes. The common novelty of variants suggested polymorphism of the two genes among them. Our results provide rare genetic information associated with this lipid phenotype in East Asian people. [ABSTRACT FROM AUTHOR]

Aims The Korean Acute Heart Failure registry ( KorAHF) aims to evaluate the clinical characteristics, management, hospital course, and long-term outcomes of patients hospitalized for acute heart failure syndrome ( AHFS) in Korea. Methods and results This is a prospective observational multicentre cohort study funded by the Korea National Institute of Health. Patients hospitalized for AHFS in 10 tertiary university hospitals across the country have been consecutively enrolled since March 2011. The study is expected to complete the scheduled enrolment of 5000 patients some time in 2014, and follow-up is planned through 2016. As of April 2012, the interim analysis of 2066 consecutive subjects was performed to understand the baseline characteristics of the population. The mean age was 69 ± 14 years; 55% were male; and 50% were de novo heart failure. The mean left ventricular ejection fraction ( LVEF) was 40 ± 18%. Ischaemia was both the leading cause (38%) and the most frequent aggravating factor (26%) of AHFS. ACE inhibitors/ ARBs and beta-blockers were prescribed at discharge in 65% and 51% of the patients, respectively. In-hospital mortality was 5.2%, and 0.9% of patients received urgent heart transplantation. Low blood pressure and azotaemia were the most important predictors of in-hospital mortality. The post-discharge 30-day and 180-day all-cause mortality were 1.2% and 9.2%, respectively. Conclusions Our analysis reveals that the prognosis of AHFS in Korea is poor and that there are specific features, including lower blood pressures at admission and lower rates of heart failure related to hypertension, compared with other registries. Adherence to current guidelines should be improved. [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]

Abstract: The issue of classroom management in the English as a foreign language (EFL) setting has not been addressed adequately despite teachers'' views of it as constituting one of their prioritized tasks. Among the aspects of classroom management, in particular, classroom discipline seems to warrant research focus because it contributes to “smooth and efficient teaching and learning in the lesson” (Ur, 1996, p. 270). The current study examined Korean elementary school EFL teachers'' language use for disciplinary purposes. Classroom interactions between two non-native English speaking EFL teachers and their respective students were observed in nine classes between March and June 2010, and audio-recorded. In addition, the teachers and students were interviewed in a semi-structured way. The results show that the teacher whose EFL proficiency level was high relied significantly more on the target language (TL) than on the first language (L1), while the low proficiency level teacher depended significantly more on L1 than on TL. The differences were found to be caused in complex ways by a number of factors. Based on the findings of the study, implications are suggested. [Copyright &y& Elsevier]

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]

Abstract: Background: The number of hypertensive patients achieving treatment targets is not ideal with therapies that engage a single mechanism of action, and combination therapies using different mechanisms of action can increase drug efficacy in a synergistic way. Objective: This noninferiority study compared the clinical efficacy and safety profile of fixed-dose combination of amlodipine/losartan 5/50 mg and amlodipine 10 mg monotherapy in essential hypertensive patients who respond poorly to amlodipine 5 mg monotherapy. Methods: This was a double-blind, multicenter, randomized trial of hypertensive patients (N = 185) aged ≥18 years taking amlodipine 5 mg during the run-in treatment period but failed to achieve sitting diastolic blood pressure (DBP) <90 mm Hg. After randomization into the amlodipine/losartan 5/50 mg fixed-dose combination group (n = 92) and the amlodipine 10 mg monotherapy group (n = 93), treatment was maintained without dose escalation for 8 weeks. The noninferiority margin was prespecified as 4 mm Hg after 8 weeks of treatment for the difference of the average change in DBP between treatments. The primary efficacy evaluation of noninferiority was tested using a confidence interval approach with a 97.5% 1-sided lower confidence limit using the average difference in DBP measured at baseline and 8 weeks. Results: After 8 weeks, the DBP of both groups decreased from baseline by 8.9 (6.1) and 9.4 (7.5) mm Hg, respectively (difference = −0.5 [6.9] mm Hg, 95% CI: −2.5 to 1.5). Secondary end points of reductions in DBP after 4 weeks (−8.1 [6.7] vs −9.9 [7.3] mm Hg, difference = −1.8 mm Hg, 95% CI: −3.9 to 0.2) and sitting systolic blood pressure after 4 (−10.2 [11.8] vs −12.8 [10.2] mm Hg, difference = −2.6 mm Hg, 95% CI: −5.9 to 0.6) and 8 weeks (−12.2 [11.0] vs −13.4 [11.3] mm Hg, difference = −1.2 mmHg, 95% CI: −4.4 to 2.1) were comparable between the 2 treatment groups. There were 38 adverse events in 20 patients (21.7%) in the amlodipine/losartan 5/50 mg fixed-dose combination group and 31 in 24 patients (26.1%) in the amlodipine 10 mg monotherapy group; most were mild. There were 7 adverse events in 6 patients (6.5%) related to treatment in the fixed-dose combination group and 13 in 10 patients (10.9%) in the monotherapy group (P = 0.30). Conclusions: Fixed-dose combination amlodipine/losartan 5/50 mg was not inferior in terms of reductions in DBP after 8 weeks of treatment and had comparable safety profile to amlodipine 10 mg in patients who did not respond to amlodipine 5 mg monotherapy. ClinicalTrials.gov identifier: NCT00940667. [Copyright &y& Elsevier]

Background: The association between vascular endothelial growth factor (VEGF), soluble fms-like tyrosine kinase 1 (sFlt-1), and coronary artery disease (CAD) was investigated. Methods: We enrolled 112 hypertensive patients with proven CAD and 112 hypertensive controls matched for age and gender. The severity of CAD was assessed by the most severe clinical presentation of CAD in patients’ history and by the number of diseased vessels. Results: Vascular endothelial growth factor level was lower, whereas sFlt-1 level was higher in the CAD group compared to the controls. Diabetes mellitus (P = .001), smoking (P = .004), and higher sFlt-1 level (P = .01) were independently associated with CAD. Younger age (P = .02), smoking (P = .049), and higher VEGF levels (P = .02) were independently associated with a history of myocardial infarction (MI), whereas higher sFlt-1 level (P = .01) was independently associated with multivessel disease. Conclusion: Plasma sFlt-1 levels are positively associated with the presence of CAD and are associated with angiographical severity of CAD. [ABSTRACT FROM PUBLISHER]

Abstract: The discharge of perfluorinated compounds (PFCs) was investigated for 15 wastewater treatment plants (WWTPs), comprising 25% of total domestic wastewater and 23% of total industrial wastewater produced in Korea. PFCs concentrations in influent, effluent, and sludge were greater in industrial wastewater than in the majority of domestic wastewater. Individual PFCs were found to have differing industrial sources, with perfluorocarboxylates used in fabric/textiles, paper-mill, and dyeing industries, and perfluoroalkylsulfonates occurring in oil/chemical and metal-plating/processing industries. Total WWTP-derived national discharge loads were calculated based on the average concentrations in effluents and the total volume of wastewaters produced in Korea. The average WWTP-derived national discharge loads of individual PFCs were 0.04–0.61ton/year, with 63% of perfluorooctanoate being from domestic wastewater, and 75% of perfluorooctanesulfonate being from industrial wastewater. These estimates accounted for the majority of national emissions, based on measurements in major river mouths, indicating the major contribution of WWTPs to PFC occurrence in Korean aquatic environments. Both the per capita emission factor (μg/capita/day) for domestic discharge, and area-normalized national discharge loads (g/capita/km2/day) for all wastewaters were several factors lower in Korea than in Japan or Europe, which is consistent with the lower levels of human exposure to PFCs in Korea. [Copyright &y& Elsevier]

Background Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. Methods and results The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level < 135 mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥ 50% and LVEF ≤ 40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4 ± 4.7 mmol/L vs. HFpEF: 137.5 ± 5.0 mmol/L, P = 0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P < 0.001), in HFrEF (13.1% vs. 4.9%, P < 0.001), and in HFpEF (6.0% vs. 1.9%, P < 0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24–1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84–1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. Conclusions Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF. [ABSTRACT FROM AUTHOR]

Highlights: [•] The C. annuum materials have included all varieties of this species in Korea. [•] We obtained a clearer phylogenetic tree of paprika varieties based on the nrDNA ITS region. [•] Twenty-six paprika varieties are grouped according to sequence variation and length. [•] Phylogenetic result shows close relations with fruit colour of paprika variety. [•] This work provides a basis for further paprika breeding. [Copyright &y& Elsevier]