This case report investigates the effects of semi-occluded vocal tract exercises (SOVTEs) on voice improvement in elderly female patients with presbyphonia. Elderly female patients with presbyphonia commonly present with symptoms such as hoarseness, decreased vocal intensity, and phonatory difficulties. These symptoms are often associated with age-related vocal fold atrophy, leading to compensatory muscle tension and inefficient phonation, which necessitate targeted therapeutic interventions. In this study, two elderly female patients, aged 73 years and 71 years, participated in a voice therapy program centered on SOVTEs designed to promote vocal fold vibration efficiency and reduce compensatory tension. Case 1 underwent five therapy sessions, while Case 2 completed sixteen sessions. Pre- and post-treatment voice assessments revealed notable improvements in vocal quality, suggesting that SOVTEs may be an effective therapeutic approach for managing presbyphonia in elderly women.

This case report investigates the effects of semi-occluded vocal tract exercises (SOVTEs) on voice improvement in elderly female patients with presbyphonia. Elderly female patients with presbyphonia commonly present with symptoms such as hoarseness, decreased vocal intensity, and phonatory difficulties. These symptoms are often associated with age-related vocal fold atrophy, leading to compensatory muscle tension and inefficient phonation, which necessitate targeted therapeutic interventions. In this study, two elderly female patients, aged 73 years and 71 years, participated in a voice therapy program centered on SOVTEs designed to promote vocal fold vibration efficiency and reduce compensatory tension. Case 1 underwent five therapy sessions, while Case 2 completed sixteen sessions. Pre- and post-treatment voice assessments revealed notable improvements in vocal quality, suggesting that SOVTEs may be an effective therapeutic approach for managing presbyphonia in elderly women.

This case report investigates the effects of semi-occluded vocal tract exercises (SOVTEs) on voice improvement in elderly female patients with presbyphonia. Elderly female patients with presbyphonia commonly present with symptoms such as hoarseness, decreased vocal intensity, and phonatory difficulties. These symptoms are often associated with age-related vocal fold atrophy, leading to compensatory muscle tension and inefficient phonation, which necessitate targeted therapeutic interventions. In this study, two elderly female patients, aged 73 years and 71 years, participated in a voice therapy program centered on SOVTEs designed to promote vocal fold vibration efficiency and reduce compensatory tension. Case 1 underwent five therapy sessions, while Case 2 completed sixteen sessions. Pre- and post-treatment voice assessments revealed notable improvements in vocal quality, suggesting that SOVTEs may be an effective therapeutic approach for managing presbyphonia in elderly women.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Objectives: Sepsis is a leading global cause of mortality, and predicting its outcomes is vital for improving patient care. This study explored the capabilities of ChatGPT, a state-of-the-art natural language processing model, in predicting in-hospital mortality for sepsis patients. Methods: This study utilized data from the Korean Sepsis Alliance (KSA) database, collected between 2019 and 2021, focusing on adult intensive care unit (ICU) patients and aiming to determine whether ChatGPT could predict all-cause mortality after ICU admission at 7 and 30 days. Structured prompts enabled ChatGPT to engage in in-context learning, with the number of patient examples varying from zero to six. The predictive capabilities of ChatGPT-3.5-turbo and ChatGPT-4 were then compared against a gradient boosting model (GBM) using various performance metrics. Results: From the KSA database, 4,786 patients formed the 7-day mortality prediction dataset, of whom 718 died, and 4,025 patients formed the 30-day dataset, with 1,368 deaths. Age and clinical markers (e.g., Sequential Organ Failure Assessment score and lactic acid levels) showed significant differences between survivors and non-survivors in both datasets. For 7-day mortality predictions, the area under the receiver operating characteristic curve (AUROC) was 0.70–0.83 for GPT-4, 0.51–0.70 for GPT-3.5, and 0.79 for GBM. The AUROC for 30-day mortality was 0.51–0.59 for GPT-4, 0.47–0.57 for GPT-3.5, and 0.76 for GBM. Zero-shot predictions using GPT-4 for mortality from ICU admission to day 30 showed AUROCs from the mid-0.60s to 0.75 for GPT-4 and mainly from 0.47 to 0.63 for GPT-3.5. Conclusions GPT-4 demonstrated potential in predicting short-term in-hospital mortality, although its performance varied across different evaluation metrics.

Background: s/Aims: Calcium is a preventive factor for colorectal cancer, which develops from colorectal adenoma. This study aimed to investigate the association between dietary calcium intake and prevalence of colorectal adenoma among Korean adults. Methods: Overall, 612 participants aged ≥ 20 years who underwent gastrointestinal endoscopy at 8 medical centers from 2021 to 2023 were included. Dietary calcium intake was assessed using a food frequency questionnaire and was energy-adjusted using the residual model. Multivariate logistic regression models were used to calculate for the odds ratios (ORs) and 95% confidence intervals (CIs). The associations between dietary calcium intake and colorectal adenoma prevalence were also assessed according to the anatomic subsites and adenoma status (advanced or nonadvanced). Results: Among the 612 participants, 269 were diagnosed with colorectal adenoma (170 men and 99 women). With respect to the gender-specific association, low dietary calcium intake was associated with higher prevalence of colorectal adenoma among men (ORs [95% CIs]: 2.13 [0.50– 9.00] for < 250 mg/day; 3.53 [1.06–11.76], 250 to < 350 mg/day; and 1.84 [0.63–5.35], 350 to < 650 mg/day, compared to ≥ 650 mg/day of dietary calcium [p for trend = 0.07]). Similar association was observed among women, but neither the association nor trend was statistically significant (p for trend = 0.59). These inverse associations remained similar for distal colon/rectal adenoma among women and advanced adenoma among men. Conclusions Low dietary calcium intake was associated with high colorectal adenoma prevalence, particularly among men. Given the limited number of studies among Asian populations, our findings should be replicated in other Asian groups.

Background: Worldwide, sepsis is the leading cause of death in hospitals. If mortality rates in patients with sepsis can be predicted early, medical resources can be allocated efficiently. We constructed machine learning (ML) models to predict the mortality of patients with sepsis in a hospital emergency department. Methods: This study prospectively collected nationwide data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Patients were enrolled from 19 hospitals between September 2019 and December 2020. For acquired data from 3,657 survivors and 1,455 deaths, six ML models (logistic regression, support vector machine, random forest, extreme gradient boosting [XGBoost], light gradient boosting machine, and categorical boosting [CatBoost]) were constructed using fivefold cross-validation to predict mortality. Through these models, 44 clinical variables measured on the day of admission were compared with six sequential organ failure assessment (SOFA) components (PaO 2 /FIO 2 [PF], platelets (PLT), bilirubin, cardiovascular, Glasgow Coma Scale score, and creatinine).The confidence interval (CI) was obtained by performing 10,000 repeated measurements via random sampling of the test dataset. All results were explained and interpreted using Shapley’s additive explanations (SHAP). Results: Of the 5,112 participants, CatBoost exhibited the highest area under the curve (AUC) of 0.800 (95% CI, 0.756–0.840) using clinical variables. Using the SOFA components for the same patient, XGBoost exhibited the highest AUC of 0.678 (95% CI, 0.626–0.730). As interpreted by SHAP, albumin, lactate, blood urea nitrogen, and international normalization ratio were determined to significantly affect the results. Additionally, PF and PLTs in the SOFA component significantly influenced the prediction results. Conclusion Newly established ML-based models achieved good prediction of mortality in patients with sepsis. Using several clinical variables acquired at the baseline can provide more accurate results for early predictions than using SOFA components. Additionally, the impact of each variable was identified.

Background: Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis. Methods: We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between lateonset sepsis and the primary outcome. Results: A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%).The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients.Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69–5.34).The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37–2.50).When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles (Pfor trend < 0.001). Conclusion Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days.

Purpose: Due to the shortage of lung donors relative to the number of patients waiting for lung transplantation (LTx), more than one-third of patients on the waitlist have died without receiving LTx in Korea. Therefore, the importance of fair and effective allocation policies has been emphasized. This study investigated the characteristics of the current urgency-based allocation system in Korea by simulating the Eurotransplant lung allocation score (ET-LAS) using a nationwide multi-institutional registry for LTx in Korea. Materials and Methods: This study used data from the Korean Organ Transplantation Registry (KOTRY), along with additional retrospective data for ET-LAS calculation. A total of 194 patients were included in this study between January 2015 and December 2019. The Korean urgency definition classifies an LTx candidate as having statuses 0–3 according to urgency. The ET-LAS was analyzed according to the Korean urgency status. Results: In total, 92 patients received lung transplants at status 0, 85 at status 1, and 17 at status 2/3. The ET-LAS showed a bimodal distribution with distinct peaks corresponding to status 0 and non-status 0. There was no significant difference in the ET-LAS among non-status 0 patients. In logistic and decision tree analyses, oxygen supplementation methods, particularly oxygen masks and high-flow nasal cannulas, were significantly associated with a high ET-LAS (≥50) among non-status 0 patients. Conclusion Simulation of the ET-LAS with KOTRY data showed that the Korean urgency definition may not allocate lungs by urgency, especially for patients in non-status 0; therefore, it needs to be revised.

Purpose: Although osimertinib is the standard-of-care treatment of epidermal growth factor receptor (EGFR) T790M mutation–positive non–small cell lung cancer, real-world evidence on the efficacy of osimertinib is not enough to reflect the complexity of the entire course of treatment. Herein, we report on the use of osimertinib in patients with EGFR T790M mutation–positive non–small cell lung cancer who had previously received EGFR tyrosine kinase inhibitor (TKI) treatment in Korea. Materials and Methods: Patients with confirmed EGFR T790M after disease progression of prior EGFR-TKI were enrolled and administered osimertinib 80 mg daily. The primary effectiveness outcome was progression-free survival, with time-to-treatment discontinuation, treatment and adverse effects leading to treatment discontinuation, and overall survival being the secondary endpoints. Results: A total of 558 individuals were enrolled, and 55.2% had investigator-assessed responses. The median progression-free survival was 14.2 months (95% confidence interval [CI], 13.0 to 16.4), and the median time-to-treatment discontinuation was 15.0 months (95% CI, 14.1 to 15.9). The median overall survival was 36.7 months (95% CI, 30.9 to not reached). The benefit with osimertinib was consistent regardless of the age, sex, smoking history, and primary EGFR mutation subtype. However, hepatic metastases at the time of diagnosis, the presence of plasma EGFR T790M, and the shorter duration of prior EGFR-TKI treatment were poor predictors of osimertinib treatment. Ten patients (1.8%), including three with pneumonitis, had to discontinue osimertinib due to severe adverse effects. Conclusion Osimertinib demonstrated its clinical effectiveness and survival benefit for EGFR T790M mutation–positive in Korean patients with no new safety signals.