Purpose: This study investigated the effects of aroma inhalation on sleep quality, professional quality of life (QoL), and near-misses in medication errors during night shifts among emergency room nurses. Methods: A randomized crossover experimental design was used to determine the effects of this intervention. The research participants included 55 nurses (29 in group 1 and 26 in group 2) who worked as nurses in the emergency room at a tertiary general hospital in Chungcheongbuk-do, South Korea. Aroma inhalation was conducted on the night shift. Sleep quality, professional QoL, and near-misses in medication were measured before and after inhalation of the aroma. Data was analyzed using the independent t-test, the chi-square test, and a linear mixed-effects model. Results: The aroma treatment group had significantly better sleep quality than the non-treatment group (p < .010), and the sleep time on the third day of aroma treatment was longer than that of the non-treatment group (p = .008). However, there were no signs of improvement in professional QoL or near-misses in medication errors in response to aroma treatment. Conclusion Aroma inhalation effectively improved sleep quality and increased sleep duration in emergency room nurses. Therefore, aroma inhalation is suggested as an intervention to improve the sleep quality of emergency room nurses who work night shifts. Follow-up studies are needed to build a more robust evidence base to inform strategies for improving nurses' professional QoL and patient safety during medication management.

Purpose: This study aimed to assess the impact of aerobic exercise at different intensities over an eight-week period on the expression and activation of cortical synaptic proteins, with the potential to reduce anxiety and improve memory in young mice. Methods: Seven-week-old C57BL/6 mice were subjected to treadmill exercises at low (n = 10), moderate (n = 10), and high intensity (n = 10) for eight weeks. Behavioral assessments were conducted to evaluate anxiety and cognitive function. To explore the underlying mechanisms, we measured the phosphorylated levels of extracellular signal-regulated kinase (ERK), cyclic adenosine monophosphate response-binding protein (CREB), protein kinase (AKT), adenosine monophosphate activated protein kinase (AMPK), synapsin (S9, S549, S609), and PSD-95 in the cortex, as these are associated with synaptic strength. Additionally, the expression of doublecortin (DCX), a neurogenic factor, was analyzed in the hippocampus. Results: Exercise led to reductions in depressive and anxiety-related behaviors and elevated the levels of phosphorylated ERK, CREB, AKT, AMPK, synapsin (S9, S549, S609), and PSD-95 in the cortex of young mice. Furthermore, exercise increased DCX expression in the hippocampus. Moderate-intensity exercise yielded more pronounced effects than other intensities. Conclusion The findings of this research indicate that consistent moderate-intensity exercise increases synaptic strength and reduces depression and anxiety in young mice by activating multiple factors.

Epidemiological evidence has shown that diabetes is associated with overt heart failure (HF) and worse clinical outcomes. However, the presence of a distinct primary diabetic cardiomyopathy (DCM) has not been easy to prove because the association between diabetes and HF is confounded by hypertension, obesity, microvascular dysfunction, and autonomic neuropathy. In addition, the molecular mechanisms underlying DCM are not yet fully understood, DCM usually remains asymptomatic in the early stage, and no specific biomarkers have been identified. Nonetheless, several mechanistic associations at the systemic, cardiac, and cellular/molecular levels explain different aspects of myocardial dysfunction, including impaired cardiac relaxation, compliance, and contractility. In this review, we focus on recent clinical and preclinical advances in our understanding of the molecular mechanisms of DCM and the role of anti-hyperglycemic agents in preventing DCM beyond their glucose lowering effect.

Background/Aims: Fexuprazan, a novel potassium-competitive acid blocker, was developed for treating acid-related disorders. Pharmacokinetic and pharmacodynamic properties of fexuprazan, unlike those of proton pump inhibitors, are independent of food effect. This study aims to evaluate differences in efficacy and safety of fexuprazan in patients with erosive esophagitis (EE) according to the timing of dosing. Methods: In this multicenter, open-label noninferiority study, patients who had typical reflux symptoms with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg daily 30 minutes before or after meal. Treatment was completed after 2 weeks or 4 weeks when healing was endoscopically confirmed. The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy up to week 4. Safety endpoints included treatment-emergent adverse events (TEAEs). Results: In the prior-to-meal group (n = 89) and after-meal group (n = 86), 4-week EE healing rates were 98.77% and 100.00% (difference, 0.01%; 95% CI, –0.01% to 0.04%) and 2-week EE healing rates were 95.77% and 97.14% (difference, 0.01%; 95% CI, –0.05% to 0.07%), respectively. TEAEs were 9.78% and 8.70% in the prior-to-meal group and the after-meal group, respectively. Conclusions Non-inferiority analysis revealed that taking fexuprazan after meal was non-inferior to taking fexuprazan before meals in patients with EE. The frequency of adverse events was similar between the 2 study groups. The drug is safe and effective for healing EE regardless of the timing of dosing.

Background and Objectives: Obstructive sleep apnea (OSA) has been associated with an increased risk of cancer in various organs. OSA is also linked to chronic inflammation in the biliary tract and pancreas, a well-established risk factor for carcinogenesis in these organs. However, its relationship with biliary tract and pancreatic cancers remains unclear and has been rarely investigated. Therefore, we aimed to evaluate whether OSA serves as an independent risk factor for these malignancies by analyzing a nationwide healthcare claims database in South Korea. Methods: A retrospective cohort study was conducted using the Korean National Health Insurance Service (KNHIS) database. Adults aged ≥20 years who were newly diagnosed with OSA (ICD-10: G47.30) between 2007 and 2014 were identified and propensity score-matched (1:5) with controls based on age, sex, and comorbidities. Individuals with pre-existing cancer diagnoses were excluded. The primary endpoints were the incidence of overall cancer, biliary tract cancer (C23–C24), and pancreatic cancer (C25). Cox proportional hazards regression models were used to calculate hazard ratios (HRs), adjusting for demographic and clinical factors. Results: A total of 1,191,444 individuals were included, comprising 198,574 patients diagnosed with OSA and 992,870 matched controls. OSA was associated with an increased overall cancer incidence (HR, 1.132; 95% confidence interval [CI], 1.097–1.169); however, it was not significantly associated with pancreatic cancer (HR, 0.941; 95% CI, 0.823–1.072) or biliary tract cancer (HR, 0.931; 95% CI, 0.751–1.142). Subgroup analyses stratified by sex and age revealed no statistically significant associations across these groups. Conclusion Our findings do not support OSA as an independent risk factor for biliary tract or pancreatic cancers.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Purpose: To describe a case of posterior scleritis accompanied by optic disc edema following the surgical removal of a traumatic intraocular foreign body.Case Summary: A 32-year-old man presented to the hospital after suspecting that a foreign body had entered his left eye while nailing. Slit lamp examination revealed a 2-mm corneal laceration, iris defect, and lens opacity. Lensectomy, vitrectomy, and intraocular foreign body removal were subsequently performed. A magnetic foreign body approximately 1 mm in diameter was extracted from the vitreous cavity. One week after surgery, during an outpatient visit, optic disc swelling and retinal vessel thickening were observed. Oral steroids were initiated and tapered over 2 months. After discontinuing the medication, the patient experienced acute ocular pain and severe ciliary body hyperemia, and B-scan imaging showed thickening of the posterior ocular coat. The diagnosis was posterior scleritis with optic disc swelling, and oral steroids were prescribed and tapered over 12 weeks. Following the secondary intraocular lens scleral fixation, no recurrence of posterior scleritis was noted. Conclusions Posterior scleritis should be considered in cases presenting with ocular pain, ciliary body hyperemia, or optic nerve swelling after intraocular foreign body removal surgery.

Purpose: To investigate the short-term outcomes of intravitreal injections of the ranibizumab biosimilar SB11 in patients with neovascular age-related macular degeneration (AMD). Methods: This retrospective comparative study assessed changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in patients diagnosed with neovascular AMD who received three monthly injections of SB11. The outcomes were compared to those of patients who received the same treatment using the ranibizumab originator. Within the SB11 group, comparisons were made between BCVA and CRT at diagnosis and after three injections. The proportion of patients with resolved subretinal fluid/intraretinal fluid was also evaluated. Results: The study included 46 eyes. In the SB11 group (n = 23), the average BCVA improved significantly from a baseline of logarithm of minimal angle of resolution 0.54 ± 0.42 to 0.40 ± 0.32 after three injections (p = 0.008). The average CRT decreased significantly from 447.4 ± 167.7 µm at baseline to 267.9 ± 66.9 µm after treatment (p < 0.001). Complete resolution of macular edema was observed in 19 eyes (82.7%). No significant differences were found in the degree of change in BCVA (p = 0.883) and CRT (p = 0.629) when compared to the ranibizumab originator group (n = 23). No complications such as intraocular inflammation or retinal detachment were noted. Conclusions Treatment with SB11 loading injections in neovascular AMD led to significant improvements in vision and reductions in macular thickness. The extent of improvement was comparable to that achieved with the ranibizumab originator and no severe complications were observed.

Objective: The frequency and severity of dog bite injuries were reported to increase during the coronavirus disease-19 (COVID-19) pandemic. This study examined the status of dog bite injuries in Korea and the changes during the COVID-19 pandemic. Methods: Patient information was obtained from in-depth research data on patients from January 1, 2019, to December 31, 2020, conducted by the Korea Centers for Disease Control and Prevention. The general characteristics, the situation and location at the time of the dog bite injury, severity, and the means of transport to the emergency department (ED) were evaluated, and the excess mortality ratio-adjusted injury severity score was determined to evaluate the severity. The differences between the pre-COVID pandemic (2019) and post-COVID pandemic (2020) were compared, and subgroups by age were also analyzed. Results: Under the COVID-19 pandemic, the number of patients decreased in all age groups. In contrast, the severity, especially in the under-19-year-old group, showed a slight but significant increase. In addition, dog bite injuries occurred most frequently in the home, particularly during the COVID-19 pandemic. Conclusion The severity of dog bites in those under the age of 19 was highest, which should be considered when setting more appropriate guidelines for the classification and treatment of dog-bite patients in an ED. Dog bite injuries occur most frequently during daily activity in the house. This tendency was further strengthened in the context of the COVID-19 pandemic.