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The FeSe nematic phase has been the focus of recent research on iron-based superconductors (IBSs) due to its unusual properties, which are distinct from those of the pnictides. A series of theoretical/experimental studies were performed to determine the origin of the nematic phase. However, they yielded conflicting results and caused additional controversies. Here, we report the results of angle-resolved photoemission and X-ray absorption spectroscopy studies on FeSe detwinned by a piezo stack. We fully resolved band dispersions with orbital characters near the Brillouin zone (BZ) corner, and revealed an absence of any Fermi pocket at the Y point in the 1-Fe BZ. In addition, the occupation imbalance between dxz and dyz orbitals was the opposite of that of iron pnictides, consistent with the identified band characters. These results resolve issues associated with the FeSe nematic phase and shed light on the origin of the nematic phase in IBSs.

The superconducting transition temperature (TC) in a FeSe monolayer on SrTiO3 is enhanced up to 100 K (refs ,,,). High TC is also found in bulk iron chalcogenides with similar electronic structure to that of monolayer FeSe, which suggests that higher TC may be achieved through electron doping, pushing the Fermi surface (FS) topology towards leaving only electron pockets. Such an observation, however, has been limited to chalcogenides, and is in contrast to the iron pnictides, for which the maximum TC is achieved with both hole and electron pockets forming considerable FS nesting instability. Here, we report angle-resolved photoemission characterization revealing a monotonic increase of TC from 24 to 41.5 K upon surface doping on optimally doped Ba(Fe1-xCox)2As2. The doping changes the overall FS topology towards that of chalcogenides through a rigid downward band shift. Our findings suggest that higher electron doping and concomitant changes in FS topology are favourable conditions for the superconductivity, not only for iron chalcogenides, but also for iron pnictides.

Around 50% of the population harbour thyroid nodules on ultrasonography, up to 7% of which may be malignant irrespective of size. While fine-needle aspiration biopsy is reliable, subjecting every thyroid nodule to this procedure is not cost-effective. Hence, ultrasonography is used primarily to characterise thyroid nodules, whereas nodules that have suspicious features are subject to a fine-needle aspiration biopsy. The presence of microcalcifications, macrocalcifications, irregular margins, 'taller-than-wide' shape, marked hypoechogenicity and intrinsic vascularity are features that render a thyroid nodule suspicious for malignancy. Spongiform appearance and the presence of colloid plugs or purely cystic nodules are considered features of benignity. In this article, these aforementioned sonographic features of malignancy and benignity are pictorially illustrated and a basic approach to dealing with solitary and multiple thyroid nodules is highlighted. [ABSTRACT FROM AUTHOR]

Background: A significant proportion of individuals who have no symptoms of asthma or other respiratory diseases show bronchial hyperresponsiveness (BHR). BHR is usually assessed by measuring the provocative concentration of methacholine causing a 20% fall in FEV(1) (PC(20)). The percentage fall in FVC at the PC(20) (DeltaFVC) has been suggested to reflect maximal airway response and to be a more useful index of disease severity in asthma than PC(20). The aim of this study was to investigate whether asymptomatic BHR would differ from symptomatic BHR with regard to DeltaFVC.Methods: Methacholine bronchial challenge tests were conducted in children with no past or current symptoms of asthma, allergic rhinitis, or other respiratory diseases, who were identified among siblings of children with asthma. Forty-three children with asymptomatic BHR (PC(20) < 16 mg/mL) were recruited, and 43 children with mild asthma who were matched for age, sex, and PC(20) were selected (mild asthma group). The DeltaFVC on methacholine concentration-response curves was retrospectively analyzed in the two groups.Results: There were no differences in the frequency of atopy, blood eosinophil counts, serum IgE levels, and spirometric values between the asymptomatic BHR and mild asthma groups. Mean (+/- SD) DeltaFVC was significantly (p = 0.005) lower in the asymptomatic BHR group (14.5 +/- 3.6%) than in the mild asthma group (16.9 +/- 4.3%).Conclusions: Our results suggest that children with asymptomatic BHR have a lower level of maximal airway response than mild asthmatics with a similar degree of BHR. This may be a possible explanation for the lack of symptoms in subjects with asymptomatic BHR. [ABSTRACT FROM AUTHOR]

Background: Many children with asthma go into long-term clinical remission at adolescence, but bronchial hyperresponsiveness (BHR) persists in approximately one half of these subjects. BHR is usually assessed by measuring the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20). The percentage fall in FVC at the PC20 (deltaFVC) has been suggested to be a more useful index of disease severity in asthma than PC20.Study Objective: The aim of this study was to determine whether deltaFVC is higher in adolescents with symptomatic asthma than in those with clinical remission.Patients and Methods: Forty adolescents with symptomatic asthma and 80 adolescents with asthma remission underwent methacholine challenge testing. DeltaFVC and PC20 were measured on the methacholine dose-response curve.Results: The mean (95% confidence interval [CI]) deltaFVC (15.5% [95% CI, 14.1 to 16.9%]) in the symptomatic group (n = 40) was significantly higher (p = 0.017) than that (12.8% [95% CI, 11.5 to 14.1%]) in the BHR-positive (PC20 < 16 mg/mL) remission group (n = 44) or that (11.5% [95% CI, 10.2 to 12.8%]) of the BHR-negative remission group (n = 36), with no difference between the two latter groups (p = 0.581). No significant correlation was found between deltaFVC and PC20 in the symptomatic group (r = -0.156, p = 0.336) or in the whole remission group (r = -0.187, p = 0.097).Conclusions: Adolescents with symptomatic asthma had a higher deltaFVC than those with clinical remission, irrespective of the presence of BHR in the latter group. This finding suggests that deltaFVC may serve as an adjunct marker for differentiating between asthma persistence and remission during adolescence. [ABSTRACT FROM AUTHOR]

BACKGROUND: In asthmatic subjects, not only airway sensitivity but maximal airway response are increased on the dose-response curve to methacholine, and peak expiratory flow (PEF) variability is closely related to airway hypersensitivity and maximal airway response. OBJECTIVE: The aims of this study were to compare the prevalence and the level of maximal response plateau between patients with cough-variant asthma (CVA) and those with classic asthma (CA), and to examine the relationship between airway hypersensitivity or maximal airway response and PEF variability in patients with CVA. METHODS: A high-dose methacholine inhalation test was performed on 83 patients with CVA and on 83 patients with CA matched for provocative concentration of methacholine causing a 20% fall in FEV1 (PC20). PEF was recorded in the morning and evening for 14 consecutive days in 78 CVA patients, and the amplitude percentage mean was used to express the diurnal PEF variation. RESULTS: Fifty-two CVA subjects (62.7%) but only 33 CA subjects (39.8%) showed a maximal response plateau. This difference was significant after correction by the Bonferroni method (corrected p = 0.024). Subjects in the CVA and CA groups showing a plateau had significantly different plateau levels (38.0 +/- 5.9% vs 42.9 +/- 3.9%, corrected p = 1.0 x 10(-4)). In patients with CVA, no significant relationship was found between PC20 and PEF variability. However, the absence of a maximal response plateau and a higher plateau level were associated with increased PEF variability. CONCLUSIONS: Maximal airway response may be an important confounder in the relationship between airway hypersensitivity and the clinical expression of asthma. The identification of a maximal response plateau and the level of this plateau in patients with CVA provide information relevant to PEF variability. [ABSTRACT FROM AUTHOR]

Background: The mechanisms responsible for bronchial hyperresponsiveness (BHR) in symptomatic asthma include genetic predisposition and airway inflammation, but the causes of BHR in adolescents with asthma remission are poorly understood. It has been shown that BHR in adolescents with asthma remission was not reduced by prolonged treatment with inhaled corticosteroids, in contrast to the BHR of symptomatic asthma.Objective: The aim of this study was to investigate whether family history of BHR may contribute to the persistence of BHR in asthma remission during adolescence.Methods: One hundred twenty-six adolescents with long-term asthma remission (neither symptoms nor any medication used during the previous 2 years) and their parents underwent a methacholine inhalation test. The provocative concentration of methacholine causing a 20% fall in FEV(1) (PC(20)) and the bronchial responsiveness (BR) index were calculated for each individual.Results: Sixty-nine adolescents (54.8%) were found to have persisting BHR (PC(20) < 18 mg/mL). The frequency of BHR and the BR index were significantly higher in parents (n = 138) of the BHR-persisting group (28.3% and 1.150 +/- 0.103, respectively [mean +/- 1 SD]) than in parents (n = 114) of BHR-nonpersisting group (16.7% [p = 0.030] and 1.124 +/- 0.088 [p = 0.029], respectively). Furthermore, adolescents (n = 56) with at least one BHR-positive parent were found to have a higher frequency of BHR (66.1% vs 45.7%, p = 0.023) and a higher BR index (1.244 +/- 0.090 vs 1.204 +/- 0.082, p = 0.011) than adolescents (n = 70) with non-BHR parents.Conclusion: Our results suggest that adolescents in asthma remission are more likely to have BHR when there is a family history of BHR. Further studies are needed to examine the possible involvement of genetic factors in the BHR of adolescents in asthma remission. [ABSTRACT FROM AUTHOR]

Study Objectives: Our current knowledge of pediatric bronchiolitis obliterans (BO) is based largely on a few small series of patients that were reported in the older literature. In these older cases, the mortality rate was high. This study was conducted to investigate the characteristics of pediatric BO cases in two different countries.Design: We extracted specific information regarding predisposing factors, symptoms and signs, diagnostic studies, treatment, and outcome from the medical records of 31 children who received diagnoses of BO at four university medical centers in Korea and the United States in the 1990s.Results: The large number of Asian children reflects a clustering of cases in Korea due to adenovirus and Mycoplasma pneumoniae epidemics. The characteristic diagnostic features of BO were present in 29 of 30 high-resolution CT (HRCT) studies. Seven of nine children who underwent biopsies had histologic confirmations of BO. In two patients whose biopsy results were nondiagnostic, the diagnosis was established by HRCT together with pulmonary function testing results that were consistent with nonreversible small airways obstruction. Fifteen children (48.4%) had evidence of hypoxemia. At present, all but one are alive. Patients with elevated severity-of-illness scores were observed to have increased likelihoods of lung transplantation or death.Conclusions: We conclude that BO has a good overall prognosis and that the mortality rate has declined over the past decade. This could be related primarily to the use of HRCT for accurate diagnosis and the availability of pediatric lung transplantation. BO cases in Korea were associated with infectious epidemics, whereas those in United States had variable predisposing factors. [ABSTRACT FROM AUTHOR]

This research addresses the rapid aging phenomenon prevalent in Asian societies, which has led to a significant increase in elderly individuals relocating to nursing homes due to health-related issues. This trend has resulted in social isolation and loneliness among the elderly, contributing to physical and mental ailments such as hypertension and cardiovascular diseases, as highlighted by the World Health Organization (WHO). To mitigate these issues, the research proposes leveraging technology, specifically the integration of robotics, to alleviate the caregiver shortage and enhance human interaction for the elderly. The novel approach involves developing a social robot designed to bridge the gap between humans and machines, combining knowledge from embedded systems, robotics, and essential soft skills for effective interaction. The authors found that this technological solution holds promise in addressing the caregiver shortage and improving the well-being of elderly individuals by reducing their sense of isolation, fostering better mental and physical health outcomes, and potentially transforming the landscape of elderly care through innovative technological applications. Future work includes expanding pilot studies and collaborating with healthcare institutions to further validate the effectiveness of the solution.

Introduction: With the advent of endovascular thrombectomy (ET), patients with acute ischaemic strokes (AIS) with large vessel occlusion (LVO) have seen vast improvements in treatment outcomes. Left ventricular diastolic dysfunction (LVDD) has been shown to herald poorer prognosis in conditions such as myocardial infarction. However, whether LVDD is related to functional recovery and outcomes in ischaemic stroke remains unclear. We studied LVDD for possible relation with clinical outcomes in patients with LVO AIS who underwent ET., Methods: We studied a retrospective cohort of 261 LVO AIS patients who had undergone ET at a single comprehensive stroke centre and correlated LVDD to short-term mortality (in-hospital death) as well as good functional recovery defined as modified Rankin Scale of 0-2 at 3 months., Results: The study population had a mean age of 65-years-old and were predominantly male (54.8%). All of the patients underwent ET with 206 (78.9%) achieving successful reperfusion. Despite this, 25 (9.6%) patients demised during the hospital admission and 149 (57.1%) did not have good function recovery at 3 months. LVDD was present in 82 (31.4%) patients and this finding indicated poorer outcomes in terms of functional recovery at 3 months (OR 2.18, 95% CI 1.04-4.54, p = 0.038) but was not associated with increased in-hospital mortality (OR 2.18, 95% CI 0.60-7.99, p = 0.240) after adjusting for various confounders., Conclusion: In addition to conventional echocardiographic indices such as left ventricular ejection fraction, LVDD may portend poorer outcomes after ET, and this relationship should be investigated further.

There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270). Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients., Competing Interests: CONFLICT OF INTEREST STATEMENT: None declared., (© Chonnam Medical Journal, 2024.)

Objective: To directly compare the 90-day outcomes of patients with symptomatic intracranial atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD), and ICAD with concomitant ECAD., Methods: From 2017-2021, patients who had (1) a transient ischemic attack or ischemic stroke within 30 days of admission as evaluated by a stroke neurologist and (2) ipsilateral ICAD and/or ECAD were prospectively enrolled. The cohort was divided into three groups: ICAD, ECAD, and ICAD with concomitant ECAD. The primary outcome assessed was 90-day ischemic stroke recurrence. Secondary outcomes included 90-day myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE, including cardiovascular death, nonfatal MI, and/or nonfatal ischemic stroke)., Results: Of 371 patients included in the analysis, 240 (64.7%) patients had ICAD only, 93 (25.0%) patients had ECAD only, and 38 (10.3%) patients had ICAD with concomitant ECAD. On multivariate time-to-event analysis adjusting for potential confounders and with ICAD as the reference comparator, the risk of 90-day clinical outcomes was highest among patients with ICAD and concomitant ECAD, with adjusted hazard ratios of 4.54 (95% CI=1.45, 14.2; p = 0.006), 9.32 (95% CI=1.58, 54.8; p = 0.014), and 8.52 (95% CI=3.54, 20.5; p < 0.001) for 90-day ischemic stroke, MI, and MACE, respectively., Conclusions: Patients with ICAD and concomitant ECAD have a poorer prognosis and are at significantly higher risk for 90-day ischemic stroke, MI, and MACE. Further research should focus on the evaluation of coronary atherosclerotic disease and more intensive medical therapy in this population., Competing Interests: Declaration of Competing Interest Not applicable., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: To study the effects of rotator cuff tear size, operation time, and the use of anticoagulant on blood loss in elderly patients undergoing arthroscopic rotator cuff surgery., Methods: Patients aged older than 65 years who underwent arthroscopic rotator cuff repair with subacromial decompression at our hospital from January 2015 to December 2021 were identified. We measured hemoglobin levels preoperatively, postoperatively, and 7 days after surgery. First, subjects were divided according to the operation time (group I, <90 minutes; group II, <120 minutes; group III <150 minutes; and group IV, >150 minutes). Second, we classified the subjects by the size of the rotator cuff tear (group A, <3 cm; group B, <5 cm; and group C, >5 cm). Lastly, we categorized the subjects into 2 groups according to the use of anticoagulant medication., Results: A total of 566 patients were included. The mean hemoglobin (Hgb) levels were 13.8 ± 1.4 g/dL preoperatively, 13.2 ± 1.4 g/dL postoperatively, and 12.8 ± 1.3 g/dL 7 days after surgery, and the differences among them were statistically significant ( P < .001). The Hgb level changes 7 days after surgery showed a significant decrease in the group with a longer operation time, and the Hgb loss increased from group 1 to group 4 ( P < .001). They did not show any difference in the Hgb levels among the groups according to the size of a cuff tear preoperatively, postoperatively, and 7 days after surgery. The subjects with anticoagulant use showed more decrease in Hgb levels between immediately after the surgery and 7 days after the surgery ( P  = .031). Still, both groups did not show a statistical difference in the Hgb level 7 days after surgery ( P  = .115)., Conclusions: In this study, blood loss after arthroscopic rotator cuff repair in elderly patients was greater than expected. Bleeding increased in elderly patients who had longer surgical times or were taking anticoagulant medications after surgery. Tear size was not associated with a decrease in Hgb levels., Level of Evidence: Level III, retrospective comparative study., (© 2023 The Authors.)

Background: This study aimed to estimate the ratio of the anterior and posterior gaps before surgery that can minimize the posterior tibial slope (PTS) change through preoperative radiography, and to confirm whether the use of the block helps maintain the PTS during open wedge high tibial osteotomy (OWHTO)., Methods: Patients who underwent OWHTO between 2015 and 2018 were included. To measure optimal anterior gap (AG) and posterior gap (PG) ratio, hinge to medial tibial tuberosity length (HTL), total osteotomy length (TOL), and PTS were measured using knee AP X-ray. Real AG and PG were measured using postoperative knee computed tomography. Use of the block was also confirmed., Results: Total 107 knees (95 patients) were included. The average ratio between HTL and TOL was 70.9%. The average ratio AG: PG was 72.9%. PTS increased significantly from 10.2° to 11.2° postoperatively (p = 0.006). When the difference in HTL: TOL and AG: PG, and the amount of PTS change were analyzed using linear regression, there was a statistically significant correlation (correlation coefficient: - 25.9; p < 0.001). There was no difference in AG: PG according to the use of the block (p = 0.882)., Conclusion: In OWHTO, PTS change can be minimized by estimating the ratio of the AG and PG using radiographs, and is was approximately 70%. If the ratio is increased by 10% from the predicted value, the PTS increases by approximately 2.6°. Using a block during OWHTO did not have a considerable advantage in terms of PTS maintenance compared to the group not using a block., Level of Evidence: Level IV., (© 2023. The Author(s).)

Importance: Although P2Y12 inhibitor monotherapy after a minimum period of dual antiplatelet therapy (DAPT) is a well-known way to reduce the risk of bleeding after percutaneous coronary intervention (PCI), data comparing long-term clinical outcomes between P2Y12 inhibitor monotherapy and extended DAPT in patients undergoing PCI have been unavailable., Objective: To identify the long-term safety and efficacy of P2Y12 inhibitor monotherapy following 3 months of DAPT after PCI., Design, Setting, and Participants: The Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy and Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE) trial was an open-label, noninferiority, randomized clinical trial, enrolling patients who underwent PCI with drug-eluting stent at 33 hospitals in Korea from March 2014 through July 2017. Clinical follow-up was extended to 3 years and completed in August 2020., Interventions: Patients were randomly assigned to either P2Y12 inhibitor monotherapy after 3 months of DAPT or DAPT for 12 months or longer., Main Outcomes and Measures: The primary end point was major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 3 years. The secondary end points included the components of the primary end point, bleeding (defined as Bleeding Academic Research Consortium [BARC] types 2-5), and major bleeding (BARC types 3-5)., Results: In total, 2993 patients were randomly assigned to receive P2Y12 inhibitor monotherapy after 3 months of DAPT (1495 patients [50%]; mean [SD] age, 64.6 [10.7] years; 1087 [72.7%] male) or prolonged DAPT (1498 patients [50%]; mean [SD] age, 64.6 [10.7] years; 1111 [74.2%] male) after PCI. At 3 years, the primary end point occurred in 87 individuals (6.3%) in the P2Y12 inhibitor monotherapy group and 83 (6.1%) in the prolonged DAPT group (hazard ratio [HR], 1.06 [95% CI, 0.79-1.44]; P = .69). P2Y12 inhibitor monotherapy significantly reduced the risk of bleeding (BARC types 2-5: 112 [3.2%] vs 44 [8.2%]; HR, 0.39 [95% CI, 0.28-0.55]; P < .001) and major bleeding (BARC types 3-5; 17 [1.2%] vs 31 [2.4%]; HR, 0.56 [95% CI, 0.31-0.99]; P = .048), compared with prolonged DAPT. The landmark analyses between 3 months and 3 years and per-protocol analyses showed consistent results., Conclusions and Relevance: Among patients who underwent PCI and completed 3-month DAPT, P2Y12 inhibitor monotherapy was associated with a lower risk of clinically relevant major bleeding than prolonged DAPT. Although the 3-year risk of ischemic cardiovascular events was comparable between the 2 groups, this result should be interpreted with caution owing to the limited number of events and sample size., Trial Registration: ClinicalTrials.gov Identifier: NCT02079194.

Purpose: Spinopelvic motion plays an important role in functional acetabular cup position after total hip arthroplasty (THA). Sacral slope (SS) has been a useful surrogate for spinopelvic motion. The present study aimed to investigate statistical characteristics of spinopelvic motion before and after THA using changes in SS in supine, standing, and sitting positions., Methods: A total of 76 patients (88 hips) were assessed. To classify spinopelvic mobility, defined as a change in SS from standing to sitting position (ΔSS stand/sit ), 10° ≤ ΔSS stand/sit  ≤ 30°, ΔSS stand/sit  < 10°, and ΔSS stand/sit  > 30° were considered normal, stiff, and hypermobile, respectively., Results: Over ± 7° changes in SS between before and one year after THA were observed in 39 (44.3%) hips in the sitting position, 19 (21.6%) hips in the supine position, seven (7.9%) in the standing position. Percentages of hips with stiff spinopelvic mobility (11.4% vs. 22.7%) and hypermobile spinopelvic mobility (23.9% vs. 12.5%) between before THA and one year after THA were significantly different (p = 0.034 and p = 0.016, McNemar's test). At one year after THA, 40.0% (4/10) of hips with stiff spinopelvic mobility and 57.1% (12/21) of hips with hypermobile spinopelvic mobility shifted to normal spinopelvic mobility., Conclusions: Change in SS between before THA and one year after THA had a high inter-subject variability especially in the sitting position. In addition, there was a distinct shift to normal spinopelvic mobility postoperatively in hips with stiff and hypermobile spinopelvic mobility pre-operatively., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

The degree of blood vessel stenosis significantly influences diabetic foot treatment. This study aimed to investigate the association between computed tomography angiography (CTA) stenosis and skin perfusion pressure (SPP), which are noninvasive vascular assessments used to evaluate diabetic foot wounds. Forty patients who reported diabetic foot wounds between November 2016 and December 2017 were included in the study. SPPand CTA were performed to evaluate the blood flow, and the rate of decrease in wound size was measured for the wounds corresponding to Meggitt-Wagner grade 1 at the first evaluation and 4-week intervals. The P value of the association between the degree of CTA stenosis and the SPP value was 0.915, and the P value of the association between CTA stenosis and decreasing rate of wound size was .235. There was no statistically significant association between SPP and the decreasing rate of wound size according to the degree of CTA stenosis. The association between SPP value and the decreasing rate of wound size was statistically significant (P < .05). The decreasing rate in diabetic foot wound size was significantly associated with SPP but not with CTA stenosis., Competing Interests: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Study Objective: To determine the feasibility of a double-blinded randomized, placebo-controlled study in determining the efficacy of antibiotic prophylaxis in preventing postoperative infections (POIs) in elective nonhysterectomy laparoscopic procedures for benign gynecologic conditions., Design: Double-blinded, randomized, placebo-controlled trial., Setting: University-affiliated tertiary referral hospital in Sydney, Australia., Patients: Women older than 18 years undergoing elective nonhysterectomy laparoscopic procedures for benign gynecologic conditions were eligible for the study and approached., Interventions: Before surgery, participants were randomized to receive either 2-g cephazolin or placebo (10-mL normal saline) administered by the anesthetist. Participants and other research staff were blinded to group allocation., Measurements and Main Results: The primary outcome was study feasibility measured by recruitment rates, compliance rates of drug administration, compliance rates of delivery, maintenance of double blinding, and follow-up rates. Secondary outcomes included rate of POIs, length of hospitalization, readmission to hospital, unscheduled presentations to healthcare facilities, and antibiotic-related reactions. Between February 2019 and March 2021, 170 patients were approached with 117 participants (68.8%) recruited and randomized. The study had a high compliance rate of trial drug delivery (95.7%) and a high follow-up rate (99.1%)., Conclusion: This pilot study has demonstrated feasibility of a large-scale study with a recruitment rate of 68% of patients approached and excellent trial drug delivery and follow-up rates. As anticipated, it is underpowered for identifying clinically significant findings for POI rates. A large-scale study is appropriate and essential to determine the health-related risks of antibiotic prophylaxis with an emphasis on antimicrobial stewardship. The sample size for a large-scale study is 1678 participants based on infection rates in this pilot study., (Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.)

Background: frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT)., Objective: we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70 years., Methods: in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70 years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1-3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90 days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation., Results: a total of 198 patients were included. The mean age was 78.1 years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P = 0.002)., Conclusions: frailty was associated with poorer functional outcome at 90 days post-EVT in patients ≥ 70 years., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This retrospective cross-sectional study, which enrolled 124 normal tension glaucoma (NTG) eyes and 68 healthy eyes as the control, determined the association between central corneal thickness (CCT) and ocular parameters in NTG. CCT was measured using the Pentacam® system, optical coherence tomography angiography (OCT-A) was adopted to measure the peripapillary and macular area VDs, and spatial data were based on the Garway-Heath map as illustrated in OCT-A. Univariate and multivariate linear regressions were used to statistically analyze for associations between CCT and other factors. In this study, the mean age was similar for both the NTG and control groups. The mean CCT of the NTG group was significantly thinner than that of the control group (533.97 ± 33.11  µ m vs. 546.78 ± 38.21  µ m; p  = .022). Considering all the factors, CCT negatively correlated with visual field (VF) pattern standard deviation (univariate, p  = .045). To analyze structural and functional factors separately, we found a significant positive correlation between CCT and whole disc radial peripapillary capillary VD (VDRPC; multivariate, p  = .019). To analyze the relationship between all factors and sectoral changes in VDRPC, a significant positive correlation was observed between CCT and inferior temporal VDRPC (univariate, p  = .039) and inferior nasal VDRPC (VDRPC IN; univariate, p  = .048). In conclusion, this novel study shows that among NTG participants, a thinner cornea correlated with weaker biomechanical properties susceptible to optic nerve tissue displacement, especially in response to mild transient elevation of IOP, leads to compromised ocular microcirculation., Competing Interests: The authors report no conflicts of interest to declare., (Copyright © 2022 Lan-Hsin Chuang et al.)

Background: Although P2Y12 inhibitor monotherapy has emerged as a promising alternative for dual antiplatelet therapy (DAPT), there remains concern regarding the safety of clopidogrel monotherapy., Aims: We sought to investigate clinical outcomes of clopidogrel monotherapy in patients with and without on-treatment high platelet reactivity (HPR)., Methods: In the SMART-CHOICE study, three-month DAPT followed by P2Y12 inhibitor monotherapy was compared with 12-month DAPT in patients undergoing percutaneous coronary intervention. A platelet function test was performed for 833 patients with clopidogrel-based therapy. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: a composite of all-cause death, myocardial infarction, or stroke) at 12 months., Results: Overall, 108 (13.0%) patients had HPR on clopidogrel. Patients with HPR had a significantly higher rate of MACCE than patients without HPR (8.7% vs 1.5%, adjusted HR 3.036, 95% CI: 1.060-8.693, p=0.038). The treatment effect of clopidogrel monotherapy for the 12-month MACCE was not significantly different compared with DAPT among patients with HPR (8.0% vs 9.4%, adjusted HR 0.718, 95% CI: 0.189-2.737, p=0.628) and without HPR (2.2% vs 0.9%, adjusted HR 2.587, 95% CI: 0.684-9.779, p=0.161; adjusted p for interaction=0.170)., Conclusions: Clopidogrel monotherapy showed treatment effects comparable to DAPT for MACCE in patients with or without HPR. However, HPR was significantly associated with an increased risk of MACCE in clopidogrel-treated patients regardless of maintenance of aspirin., Clinical Trial Registration: Comparison Between P2Y12 Antagonist Monotherapy and Dual Antiplatelet Therapy After DES (SMART-CHOICE) (ClinicalTrials.gov: NCT02079194).

Background: Although ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown., Methods: A total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively., Results: After propensity score matching, ticagrelor had a higher incidence of in-hospital TIMI major bleeding than clopidogrel in all patients (odds ratio [OR], 1.683; 95% confidence interval [CI], 1.010-2.805; P = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374-8.714; P = 0.008). However, there was no significant difference in in-hospital TIMI major bleeding between ticagrelor and clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722-2.855; P = 0.303). No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups., Conclusions: The bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2021 The Korean Academy of Medical Sciences.)

Background: This study sought to investigate the prevalence and risk factors of periprosthetic occult acetabular fracture occurring during cementless acetabular cup insertion in patients undergoing primary total hip arthroplasty (THA) and to assess the clinical consequences of these fractures., Methods: A total of 232 hips (n = 205 patients) were included in this study. A periprosthetic occult acetabular fracture was defined as that which was unrecognised intraoperatively and was undetectable on post-operative radiographs yet was successfully diagnosed on post-operative computed tomography (CT) images. Clinical (age, sex, body mass index, and preoperative diagnosis) and surgical (additional screw fixation, cup rim size, and cup type) variables were analysed to identify risk factors for periprosthetic occult acetabular fracture., Results: Sixteen (6.9%) periprosthetic occult intraoperative acetabular fractures were identified. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. The superolateral wall (9/16 hips; 56.3%) was the most frequent location. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. Male sex was the only factor associated with an increased risk for periprosthetic occult intraoperative acetabular fracture (odds ratio for male versus female sex: 4.28; p = 0.04). There was no significant association between cup type and the occurrence of periprosthetic occult acetabular fracture. All 16 hips with periprosthetic occult intraoperative acetabular fracture were healed at the final follow-up visit without the requirement for any additional surgical interventions., Conclusion: The results of the current study suggest that periprosthetic occult acetabular fractures are common during press-fit acetabular cup insertion in primary THA. Surgeons should have a high index of suspicion and early CT imaging referral in male patients who present with unexplained early post-operative groin pain in primary THA using cementless acetabular cups., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS part of Springer Nature.)

Background: In response to the COVID-19 pandemic in Australia, restrictions to elective surgeries were implemented nationwide., Aims: To investigate the response to these restrictions in elective gynaecological and In vitro fertilisation (IVF) procedures during the first wave of the COVID-19 pandemic., Materials and Methods: We analysed the Medicare Item Reports for the number of elective gynaecological (labioplasty, vulvoplasty; prolapse and continence; operative hysteroscopy; hysterectomy; fertility) and IVF procedures claimed in Australia between January-June 2020 and compared these to January-June 2019., Results: The number of included gynaecological and IVF procedures performed in January-June 2020 decreased by -13.71% and -12.56%, respectively, compared to January-June 2019. The greatest reductions were in May 2020 (gynaecology -43.71%; IVF -51.63% compared to May 2019), while April 2020 reported decreases of -37.69% and -31.42% in gynaecological and IVF procedures, respectively. In April 2020, 1963 IVF cycle initiations (-45.20% compared to April 2019), 2453 oocyte retrievals (-26.99%) and 3136 embryo transfers (-22.95%) were billed. The procedures with greatest paired monthly decrease were prolapse and continence surgeries in April (676 procedures; -51.85%) and May 2020 (704 procedures; -60.05%), and oocyte retrievals in May 2020 (1637 procedures; -56.70%)., Conclusions: While we observed a decrease in procedural volumes, elective gynaecological and IVF procedures continued in considerable numbers during the restricted timeframes. In the event of future overwhelming biological threat, careful consideration must be given to more effective measures of limiting access for non-emergency procedures to conserve essential resources and reduce risk to both the public and healthcare staff., (© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: To compare P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) with 12-month DAPT according to the type of P2Y12 inhibitor in patients undergoing percutaneous coronary intervention (PCI)., Methods: The Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE) randomised trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT. In this trial, 2993 patients undergoing successful PCI with drug-eluting stent were enrolled in Korea. As a prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT versus 12-month DAPT were compared among patients receiving clopidogrel and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel), respectively. The primary endpoint was a composite of all-cause death, myocardial infarction or stroke at 12 months after the index procedure., Results: Among 2993 patients (mean age 64 years), 58.2% presented with acute coronary syndrome. Clopidogrel was prescribed in 2312 patients (77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no significant differences in the primary endpoint between the P2Y12 inhibitor monotherapy group and the DAPT group among patients receiving clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR: 3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT showed consistent treatment effects across various subgroups for the primary endpoint. Among patients receiving potent P2Y12 inhibitors, the rate of bleeding (Bleeding Academic Research Consortium types 2- 5) was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03)., Conclusions: Compared with 12-month DAPT, clopidogrel monotherapy after 3-month DAPT showed comparable cardiovascular outcomes in patients undergoing PCI., Trial Registration Number: NCT02079194., Competing Interests: Competing interests: J-YH reports receiving grants from Abbott Vascular, Boston Scientific, Biotronik, Korean Society of Interventional Cardiology, and Medtronic; and speaker’s fees from AstraZeneca, Daiichi Sankyo and Sanofi-Aventis. H-CG reports receiving research grants from Abbott Vascular, Boston Scientific and Medtronic; and speaker’s fees from Abbott Vascular, Boston Scientific and Medtronic. All other authors declare that they have no conflicts of interest., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

From November to December 2020, the third wave of COVID-19 cases in Korea is ongoing. The government increased Seoul's social distancing to the 2.5 level, and the number of confirmed cases is increasing daily. Due to a shortage of hospital beds, treatment is difficult. Furthermore, gatherings at the end of the year and the beginning of next year are expected to worsen the effects. The purpose of this paper is to emphasize the importance of prediction timing rather than prediction of the number of confirmed cases. Thus, in this study, five groups were set according to minimum, maximum, and high variability. Through empirical data analysis, the groups were subdivided into a total of 19 cases. The cumulative number of COVID-19 confirmed cases is predicted using the auto regressive integrated moving average (ARIMA) model and compared with the actual number of confirmed cases. Through group and case-by-case prediction, forecasts can accurately determine decreasing and increasing trends. To prevent further spread of COVID-19, urgent and strong government restrictions are needed. This study will help the government and the Korea Disease Control and Prevention Agency (KDCA) to respond systematically to a future surge in confirmed cases.

Understanding characteristic energy scales is a fundamentally important issue in the study of strongly correlated systems. In multiband systems, an energy scale is affected not only by the effective Coulomb interaction but also by the Hund's coupling. Direct observation of such energy scale has been elusive so far in spite of extensive studies. Here, we report the observation of a kink structure in the low energy dispersion of NiS 2-x Se x and its characteristic evolution with x, by using angle resolved photoemission spectroscopy. Dynamical mean field theory calculation combined with density functional theory confirms that this kink originates from Hund's coupling. We find that the abrupt deviation from the Fermi liquid behavior in the electron self-energy results in the kink feature at low energy scale and that the kink is directly related to the coherence-incoherence crossover temperature scale. Our results mark the direct observation of the evolution of the characteristic temperature scale via kink features in the spectral function, which is the hallmark of Hund's physics in the multiorbital system.

Background This study sought to investigate the safety of 3-month dual antiplatelet therapy (DAPT) in patients receiving ultrathin sirolimus-eluting stents with biodegradable polymer (Orsiro). Methods and Results The SMART-CHOICE (Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Anti- platelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents) randomized trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT in 2993 patients undergoing percutaneous coronary intervention. The present analysis was a prespecified subgroup analysis for patients receiving Orsiro stents. As a post hoc analysis, comparisons between Orsiro and everolimus-eluting stents were also done among patients receiving 3-month DAPT. Of 972 patients receiving Orsiro stents, 481 patients were randomly assigned to 3-month DAPT and 491 to 12-month DAPT. At 12 months, the target vessel failure, defined as a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization, occurred in 8 patients (1.7%) in the 3-month DAPT group and in 14 patients (2.9%) in the 12-month DAPT group (hazard ratio [HR], 0.58; 95% CI, 0.24-1.39; P =0.22). In whole population who were randomly assigned to receive 3-month DAPT (n=1495), there was no significant difference in the target vessel failure between the Orsiro group and the everolimus-eluting stent group (n=1014) (1.7% versus 1.8%; HR, 0.96; 95% CI, 0.41-2.22; P =0.92). Conclusions In patients receiving Orsiro stents, clinical outcomes at 1 year were similar between the 3-month DAPT followed by P2Y12 inhibitor monotherapy and 12-month DAPT strategies. With 3-month DAPT, there was no significant difference in target vessel failure between Orsiro and everolimus-eluting stents. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02079194.

Background: It remains unclear whether P2Y12 monotherapy, especially clopidogrel, following short-duration dual antiplatelet therapy (DAPT) is associated with favorable outcomes in patients undergoing complex percutaneous coronary intervention (PCI). Therefore, this study analyzed the efficacy and safety of P2Y12 inhibitor monotherapy, mostly clopidogrel (78%), in complex PCI following short-term DAPT., Methods: The post-hoc analysis of the SMART-CHOICE trial involving 2,993 patients included 498 cases of complex PCIs, defined by at least one of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with ≥ 2 stents implanted, and a total stent length of ≥ 60 mm. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as the composite of all-cause death, myocardial infarction, and stroke. The primary safety endpoint included bleeding, defined as Bleeding Academic Research Consortium (BARC) types 2 to 5., Results: Complex PCI group had a higher risk of MACCE (4.0% vs. 2.3%, hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.05-2.89, p = 0.033) and a similar risk of BARC types 2-5 bleeding (2.6% vs. 2.6%, HR = 1.02, 95% CI: 0.56-1.86, p = 0.939) compared with those without complex PCIs. Patients undergoing complex PCIs, followed by P2Y12 inhibitor monotherapy and 12 months of DAPT exhibited similar rates of MACCE (3.8% vs. 4.2%, HR = 0.92, 95% CI: 0.38-2.21, p = 0.853)., Conclusions: P2Y12 inhibitor monotherapy, mostly clopidogrel, following 3 months of DAPT did not increase ischemic events in patients with complex PCIs.

Purpose: To investigate the epidemiologic characteristics of microbial keratitis and its overall burden on the health care system in Taiwan., Design: Retrospective, population-based study., Methods: We conducted a study using claims data in the Taiwan National Health Insurance Research Database in 2000-2013, employing diagnoses, drugs, and procedure codes to define diseases and procedures. Participants were classified into groups according to the requirement of hospitalization and surgical intervention. The main outcome measures were incidence, risk factors, predictive factors for hospitalization and surgical intervention, and health care expenditure., Results: A total of 2,071 patients were included. The overall incidence significantly increased from 8.4 in 2000 to 20.2 per 100,000 person-years in 2013. The peak age range of incidence was between 18 and 40 years, but the peak age group for health care expenditures was those older than 65 years. A total of 704 patients (33.99%) had analyzable risk factors, of which the top 3 were diabetes mellitus (DM, 11.52%), eye trauma (10.55%), and dry eye (8.72%). Older patients, those using steroid and antiglaucoma agents, and those with ocular and systemic diseases were susceptible to further hospitalization and surgical intervention for the treatment of microbial keratitis., Conclusions: In Taiwan, DM, eye trauma, and dry eye were key predisposing factors for microbial keratitis. Older patients (>40 years) accounted for approximately 80% of health care expenditure for the management of infectious keratitis. Special care may be required for older patients with medication-related risk factors and ocular and systemic comorbidities because they are likely to have severe diseases leading to hospitalization and surgical interventions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes., Materials and Methods: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination., Results: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes., Conclusion: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To evaluate prognostic factors in young patients with central retinal vein occlusion (CRVO)., Methods: Retrospective case series. CRVO patients aged ≤ 50 and follow-up ≥ 6 months were enrolled. The best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 3 months, 6 months, and last visit were documented. Severity of retinopathy was graded by comparing to standard photos. Prognostic factors associated with visual outcome at 6 months were evaluated by multiple linear regression models., Results: A total of 73 eyes from 69 patients with mean age 37.6 ± 8.5 were enrolled. Forty-seven (68%) patients were male. The mean follow-up duration was 25.9 ± 23.0 months. LogMAR BCVA improved from 0.979 ± 0.785 at baseline to 0.594 ± 0.748 at the 6 months (p < 0.001) and CRT improved from 475 ± 222 μm to 299 ± 104 μm (p < 0.001). Forty-eight (66%) eyes required anti-vascular endothelial growth factor (anti-VEGF) treatment. The mean number of injections was 2.25 ± 1.41 in the first 6 months and 75% of eyes received ≦ 3 injections during the clinical course. The baseline BCVA (coefficient 0.518, p < 0.001), grade of retinal hemorrhage (coefficient 0.230, p = 0.006), grade of retinal venous engorgement (coefficient 0.238, p = 0.011), grade of optic disc edema (coefficient - 0.226, p = 0.005), and diabetes mellitus (coefficient 0.264, p = 0.047) were the independent factors associated with visual outcome at 6 months., Conclusions: Baseline clinical features are useful for the prediction of visual outcome at 6 months in young CRVO patients.

This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS).In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded.Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106).OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.

Objective: The efficacy and safety of nebivolol in patients with hypertension is well established, but its effect in Asian patients with essential hypertension in the real world has not been studied., Methods: Adult South Korean patients with essential hypertension, with or without comorbidities, were enrolled to participate in this prospective, single-arm, open, observational study; 3011 patients received nebivolol either as monotherapy or add-on therapy. Changes in SBP, DBP and heart rate (HR) at 12 and 24 weeks were evaluated. Subgroup analysis for BP changes in newly diagnosed (de novo) patients and those receiving other antihypertensives at study entry were also conducted., Results: Nebivolol significantly decreased mean SBP and DBP at 12 and 24 weeks compared with baseline (P < 0.0001). A significant reduction in HR was also observed at 12 and 24 weeks (P < 0.0001). The reductions of SBP and DBP were notably greater when nebivolol was used as monotherapy in de novo patients (P < 0.0001) and as add-on therapy to existing antihypertensives (angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors and calcium channel blockers; P < 0.0001). Majority of the reported adverse events were mild; the most common adverse events were dizziness (1.3%), headache (1.0%) and dyspnea (0.9%)., Conclusion: Despite the limitations associated with observational studies, this real-world study in Asian patients with essential hypertension with and without comorbidities, demonstrated the efficacy and safety of once daily nebivolol, either as monotherapy or add-on therapy., Clinical Trial Registration Number: NCT03847350.SDC Callout: Video Abstract, http://links.lww.com/HJH/B172.

Background and Objectives: The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI., Methods: Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed., Results: The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes., Conclusions: In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2020. The Korean Society of Cardiology.)

Background and Objectives: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD., Methods: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months., Results: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE., Conclusions: Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2019. The Korean Society of Cardiology.)

Importance: Data on P2Y12 inhibitor monotherapy after short-duration dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention are limited., Objective: To determine whether P2Y12 inhibitor monotherapy after 3 months of DAPT is noninferior to 12 months of DAPT in patients undergoing PCI., Design, Setting, and Participants: The SMART-CHOICE trial was an open-label, noninferiority, randomized study that was conducted in 33 hospitals in Korea and included 2993 patients undergoing PCI with drug-eluting stents. Enrollment began March 18, 2014, and follow-up was completed July 19, 2018., Interventions: Patients were randomly assigned to receive aspirin plus a P2Y12 inhibitor for 3 months and thereafter P2Y12 inhibitor alone (n = 1495) or DAPT for 12 months (n = 1498)., Main Outcomes and Measures: The primary end point was major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure. Secondary end points included the components of the primary end point and bleeding defined as Bleeding Academic Research Consortium type 2 to 5. The noninferiority margin was 1.8%., Results: Among 2993 patients who were randomized (mean age, 64 years; 795 women [26.6%]), 2912 (97.3%) completed the trial. Adherence to the study protocol was 79.3% of the P2Y12 inhibitor monotherapy group and 95.2% of the DAPT group. At 12 months, major adverse cardiac and cerebrovascular events occurred in 42 patients in the P2Y12 inhibitor monotherapy group and in 36 patients in the DAPT group (2.9% vs 2.5%; difference, 0.4% [1-sided 95% CI, -∞% to 1.3%]; P = .007 for noninferiority). There were no significant differences in all-cause death (21 [1.4%] vs 18 [1.2%]; hazard ratio [HR], 1.18; 95% CI, 0.63-2.21; P = .61), myocardial infarction (11 [0.8%] vs 17 [1.2%]; HR, 0.66; 95% CI, 0.31-1.40; P = .28), or stroke (11 [0.8%] vs 5 [0.3%]; HR, 2.23; 95% CI, 0.78-6.43; P = .14) between the 2 groups. The rate of bleeding was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (2.0% vs 3.4%; HR, 0.58; 95% CI, 0.36-0.92; P = .02)., Conclusions and Relevance: Among patients undergoing percutaneous coronary intervention, P2Y12 inhibitor monotherapy after 3 months of DAPT compared with prolonged DAPT resulted in noninferior rates of major adverse cardiac and cerebrovascular events. Because of limitations in the study population and adherence, further research is needed in other populations., Trial Registration: ClinicalTrials.gov Identifier: NCT02079194.

Purpose: Prenatal maternal stress affects offspring's atopic dermatitis (AD) development, which is thought to be mediated by the oxidative stress. We aimed to evaluate the difference in leukocyte telomere length (LTL), a marker for exposure to oxidative stress, according to the prenatal stress exposure and the later AD development., Methods: From a birth cohort (the COhort for Childhood Origin of Asthma and allergic diseases) that had displayed a good epidemiologic association between the exposure to prenatal stress and AD development in the offspring, we selected 68 pairs of samples from 4 subject groups based on the level of prenatal maternal stress and later AD development. The LTL was measured from both cord blood and 1-year peripheral blood, and their LTLs were compared between subject groups. Finally, the proportion of AD development was examined in the subject groups that are reclassified based on subjects' exposure to prenatal stress and there LTL., Results: Cord-blood LTL was shorter in prenatally stressed infants than in unstressed ones ( P = 0.026), which difference was still significant when subjects became 1 year old ( P = 0.008). LTL of cord blood, as well as one of the 1-year peripheral blood, was not different according to later AD development at 1 year ( P = 0.915 and 0.174, respectively). Shorter LTL made no increase in the proportion of later AD development in either prenatally high-stressed or low-stressed groups ( P = 1.000 and 0.473, respectively)., Conclusions: Cord-blood LTL may reflect subjects' exposure to maternal prenatal stress. However, the LTL shortening is not a risk factor of increasing AD development until the age of 1, and a longer investigation may be necessary for validation. Currently, the results doubt the role of LTL shortening as a marker for risk assessment tool for the prenatal stress associated with AD development in the offspring., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2019 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Purpose: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide., Methods: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma., Results: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered "taking as prescribed" was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups ( P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was "Easy" or "Very easy" to use ( P < 0.001). "Method of administration" was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration ( i.e. , "Frequency of administration")., Conclusions: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2019 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.)