Purpose: Improvement of left ventricular (LV) diastolic dysfunction (DD) is known to be a good prognostic factor in patients with heart failure with reduced ejection fraction (EF). In the present study, we investigated the predisposing risk factors affecting the reversibility of LV diastolic filling pattern (DFP) in patients with preserved EF. Materials and Methods: A total of 600 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. We compared their index and follow-up echocardiography findings and determined the predisposing risk factor affecting the reversibility of LVDFP. Results: Comparing the index and follow-up echocardiography findings showed that 379 (63%) patients had improved to normal or impaired relaxation LVDFP (improved group) and 221 (37%) patients had maintained or worsened LVDFP (unimproved group).The incidence of paroxysmal atrial fibrillation (PAF) was significantly higher in the unimproved group than in the improved group (4.7% vs. 9.5%, p=0.026). After adjustment for relevant clinical risk factors of diastolic dysfunction, PAF was determined to be an independent predisposing risk factor for the unimproved LVDFP (odds ratio: 2.10, 95% confidence interval: 1.06–4.15, p=0.033).Among the parameters of diastolic dysfunction in follow-up echocardiography, the left atrial volume index, mean E/A ratio, and E/e' were significantly improved in patients without PAF but remained in patients with PAF. Conclusion We identified that PAF was an independent predisposing risk factor of the unimproved LVDFP in patients with pseudonormal LVDFP and preserved EF. Therefore, early detection and management of PAF might be required in patients with LVDD and preserved EF to prevent adverse cardiovascular events.

Purpose: This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea. Materials and Methods: The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values. Results: There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863. Conclusion The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.

Purpose: Food freshness may influence the healthy eating choices of consumers. This study aimed to examine whether self-reported market food freshness moderates the relationships between the three major constructs of the theory of planned behavior (TPB) and the intention for healthy eating among Chinese adults. Methods: A cross-sectional online survey was conducted in 2019 among 408 Chinese adults aged 18–64 years residing in Shanghai and parts of the Anhui Province, using a previously validated questionnaire. Structural equation modeling was applied to examine the moderating effects of market food freshness. Results: Based on a single subjective measure, 42.9% of the participants perceived market food freshness as low, and 57.1% perceived it as high. In the unconstrained model, perceived behavioral control (PBC) showed positive relationships with both short-term and long-term intentions for healthy eating (p < 0.001). Among participants reporting lower market food freshness, the relationship between PBC and short-term intention remained significant (p < 0.001), and the relationship between short-term and long-term intentions became significant (p = 0.042). However, among participants reporting higher market food freshness, PBC maintained significant relationships with short-term (p < 0.001) and longterm (p = 0.028) intentions, and the relationship between subjective norms and short-term intention became significant (p = 0.013). The moderating effect of market food freshness was significant (p < 0.001). Conclusion Market food freshness may moderate the relationships between the TPB constructs and the intentions for healthy eating in Chinese adults. These findings highlight the importance of developing tailored, region-specific strategies to enhance healthy eating behaviors among the Chinese population, accounting for disparities in resource availability and contextual differences. Further research should examine the underlying mechanisms driving regional variations in these associations.

Purpose: This study aimed to evaluate the dietary quality and nutritional status of Chinese adults and investigate the factors related to dietary scores using the Nutrition Quotient (NQ) developed for Korean adults. Methods: An online questionnaire survey including the NQ was administered to 424 Chinese adults residing in Shanghai and parts of the Anhui Province. Multiple linear regression analyses were conducted to identify factors related to NQ scores. Results: The mean NQ scores were as follows: balance (35.9), diversity (61.0), moderation (77.1), and dietary behavior (49.4), with an overall average NQ score of 57.2. Subjects were categorized into three levels of NQ: high 40.1%, middle 43.6%, and low 16.3%. After adjusting for confounding variables, multiple linear regression analyses revealed that age was positively associated with the total and subcomponent NQ scores, while the frequency of eating out was negatively associated with the same. Living alone was negatively related to balance, but positively related to diversity. Singles had lower diversity scores. Compared to the residents of second- or third-tier cities, those living in the countryside or village areas had lower balance scores, whereas the inhabitants of first-tier cities had lower moderation scores but higher dietary behavior scores. Female participants scored lower on dietary behavior. Age and eating out emerged as significant factors related to NQ items. Conclusion Applying the Korean adult NQ to Chinese adults revealed relatively low balance scores, indicating a need for tailored assessment tools and educational programs to enhance the dietary quality and nutritional status among Chinese adults. Further research is warranted to explore the determinants of low dietary balance scores in this population.

Objectives: This study examined the association between oral health-related quality of life (OHRQoL), as assessed by the Geriatric Oral Health Assessment Index (GOHAI), and cardiovascular disease (CVD) outcomes among Korean older adults. Methods: Data from 5413 participants in the Korean Longitudinal Study of Aging were analyzed. GOHAI scores were categorized as either “poor” (<40) or “not poor” (≥40). Generalized estimating equation models were used to assess the relationship between GOHAI scores and CVD prevalence, with analyses stratified by sex. Results: Poor GOHAI score was significantly associated with elevated odds of CVD (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07 to 1.19; p<0.001). This association was stronger in female (OR, 1.36) compared to male (OR, 1.12). Poor oral health is indicative of systemic inflammation and age-related vulnerabilities, underscoring the utility of the GOHAI as an instrument for early identification of CVD risk. Conclusions Poor oral health, as measured by the GOHAI, is associated with an increased risk of CVD among older adults, especially female. These findings support the use of the GOHAI as a cost-effective screening tool for the early assessment of CVD risk. Further research is warranted to explore inflammatory biomarkers and sex-specific mechanisms that could inform targeted interventions.

Background: Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting. Methods: Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%. Results: A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0–32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups. Conclusions In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

Background: The stimulatory effects of caffeine contribute to poor sleep quality. However, the relationship between caffeinated beverages and sleep quality, considering frequency or types of caffeinated beverages, were not extensively studied. Methods: Data were collected from 160 urban workers (75 men [46.9%] aged 20–69 years; with an average age of 41.8±12.3 years) using a structured, self-administered online questionnaire. Sleep quality, time, satisfaction; types and frequency of caffeinated beverages (number of cups per week; Q1: 0 cup, Q4: 14 or more cups per week), demographics, and health behaviors were asked. Sleep quality were evaluated using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). Multiple regression analysis was conducted on the association between the frequency of caffeinated beverages consumption and sleep quality. Results: The most frequently consumed beverages were unsweetened coffee (22.8%) and the most common time for caffeine was between 12 pm to 5 pm (58.2%). The average sleep quality score based on the PSQI-K was 6.0±2.0 overall, 5.3±1.6 in Q1, and 6.6±2.2 in Q4 (frequent caffeinated beverage drinkers), indicating poorer sleep quality in Q4 (P=0.022). In Q1, 13.3% rated their sleep quality as ‘very good,’ while in Q4, only 2.5% gave the same rating. Poor sleep quality was significantly associated with the frequency of caffeinated beverages per week (β=0.232, P=0.004) and self-reported stress level (β=0.256, P=0.002). Conclusions Frequent consumption of caffeinated beverages appears to be associated with poor sleep quality among urban workers. While reducing caffeine intake may contribute to improvements in sleep quality as a health promoting behavior, this hypothesis requires validation through future studies employing personalized intervention approaches.

Basal cell adenocarcinoma, considered to be the malignant counterpart of basal cell adenoma, is a rare, low-grade malignant tumor of the salivary glands, accounting for 1-2% of salivary gland malignancies. It predominantly affects the parotid gland, while involvement of the minor salivary glands is exceptionally rare. This report presented a case of basal cell adenocarcinoma involving the left retromolar trigone in a 54-year-old woman. The initial provisional diagnosis suggested a benign or low-grade malignant salivary tumor. Advanced magnetic resonance imagingtechniques, including diffusion-weighted imaging and apparent diffusion coefficient analysis, aided in the preoperative prediction of malignancy, and an incisional biopsy confirmed the diagnosis of basal cell adenocarcinoma. This caseunderscored the challenge of distinguishing basal cell adenocarcinoma from benign salivary tumors, as clinical and imaging features often overlap. Surgical excision remains the primary treatment, yielding favorable outcomes;however, long-term follow-up is crucial due to the risk of recurrence.