INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.

BACKGROUND: This cohort study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the middle-aged and older Japanese women and examine the relationship of these derivative patterns with onset of metabolic syndrome (MetS). METHODS: A total of 794 women (mean age: 56.2 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA) and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify participant groups based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with the onset of MetS after adjusting for age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline. RESULTS: Four distinct groups were identified: Group A had low levels of the AA variable; group B accumulated a certain number or more steps primarily through MVAA; group C accumulated a certain number or more steps primarily through LIAA; and group D had high level of the AA variables. Over the course of the 5-year follow-up period, 61 participants (7.7%) developed MetS. The multivariate-adjusted odds ratio (95% confidence interval) for onset of MetS in groups B, C, and D relative to group A were 0.416 (0.166-1.218), 0.451 (0.223-0.914), and 0.933 (0.365-2.382), respectively. Group C had a significantly lower odds ratio of MetS onset than group A. CONCLUSION AA patterns accumulating a certain number or more steps, regardless of the intensity of AA, may help reduce the risk of MetS compared to inactive AA patterns.
Humans ; Metabolic Syndrome/etiology* ; Female ; Middle Aged ; Japan/epidemiology* ; Aged ; Exercise ; Cohort Studies ; Accelerometry ; Risk Factors ; East Asian People

BACKGROUND: SARS-CoV-2 (COVID-19) is transmitted via infectious respiratory particles. Infectious respiratory particles are released when an infected person breathes, coughs, or speaks. Several studies have measured respiratory particle concentrations through focusing on activities such as breathing, coughing, and short speech. However, few studies have investigated the effect of speech duration. METHODS: This study aimed to clarify the effects of speech duration and volume on the respiratory particle concentration. Study participants were requested to speak at three voice volumes across five speech durations, generating 15 speech patterns. Participants spoke inside a clean booth where particle concentrations and voice volumes were measured and analyzed during speech. RESULTS: Our findings suggest that as speech duration increased, the aerosol number concentration also increased. Through focusing on individual differences, we considered there might be super-emitters who emit more aerosol particles than the average human. Two participants were identified as statistical outliers (aerosol number concentration, n = 1; mass concentration, n = 1). CONCLUSIONS Considering speech duration may improve our understanding of respiratory particle concentration dynamics. Two participants were identified as potential super-emitters.
Humans ; Male ; Speech/physiology* ; Adult ; Female ; COVID-19/transmission* ; Respiratory Aerosols and Droplets ; Voice ; SARS-CoV-2 ; Time Factors ; Young Adult ; Aerosols/analysis*

BACKGROUND: Exposure to methylmercury (MeHg) is predominantly attributed to consumption of marine products. However, the general population is exposed to low MeHg levels, which can induce chronic inflammation. Although some MeHg-related microRNAs (miRNAs) have been reported, their functions remain elusive. The objective of this study was to identify the miRNAs induced by low-level MeHg exposure in a human endothelial cell line (HAECs). This study aimed to determine the specific miRNAs induced by low-level MeHg exposure using a HAECs as a potential novel and sensitive biomarker. The roles of miRNAs in inflammatory processes have been examined. METHODS: Using HAECs, a miRNA microarray assay was performed to identify miRNAs with altered expression upon exposure to a non-cytotoxic MeHg level (0.1 and 1.5 µM). The expression patterns of interleukin-6 and -8, cyclooxygenase 2 (COX-2), RelB, and prostaglandin E₂ (PGE₂) were examined after transfection of the identified miRNAs with mimics/inhibitors. RESULTS: Although the microarray assay identified six MeHg-specific miRNAs, miR-3613-5p, upregulated by 0.1 and 1.5 µM MeHg exposures, demonstrated the best reproducibility in HAECs. Transfection with the miR-3613-5p mimic enhanced the MeHg-induced inflammatory responses, including PGE₂ and COX-2 protein levels, whereas the miR-3613-5p inhibitor suppressed these inflammatory responses. CONCLUSION This study observed that miR-3613-5p is induced by low-dose MeHg exposure, plays a crucial role in the inflammatory process, and could serve as a novel and sensitive biomarker for low-level MeHg exposure.
Methylmercury Compounds/adverse effects* ; Humans ; MicroRNAs/genetics* ; Endothelial Cells/metabolism* ; Inflammation/genetics* ; Cell Line ; Aorta/drug effects* ; Biomarkers/metabolism*

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice.Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Background: In the Latarjet procedure, the subscapularis is divided at the superior two-thirds junction. It has been believed that this subscapularis split approach resulted in better internal rotation strength rather than an L-shaped subscapularis tenotomy. However, there are few studies demonstrating the preserved function of the subscapularis after the Latarjet procedure. The aim of the present study was to clarify the subscapularis activity using positron emission tomography (PET) in patients after the Latarjet procedure. Methods: Six men who had undergone the Latarjet procedure were enrolled. The internal rotation exercise with elastic bands was performed with the arm at 0° and 90° of abduction. After the exercises, the patients had an intravenous injection of fluorine 18 fluorodeoxyglucose ( 18 F FDG). Each PET image was fused to the corresponding computed tomography image to calculate the standardized uptake value (SUV). The internal rotation muscle strength was measured by a dynamometer. Results: At 0° of abduction, the subscapularis SUVs of the involved side were significantly lower than those of the uninvolved side (p = 0.010), although there was no significant difference at 90° of abduction. The SUVs of the involved subscapularis were significantly lower at 0° of abduction than at 90° (p = 0.034). The internal rotation strength of the involved side was 81.1% ± 12.1% of the uninvolved side at 0° of abduction. Conclusions After the Latarjet procedure with the subscapularis split approach, subscapularis activity was well preserved at 90° of abduction. However, internal rotation strength was reduced by 19%.