Background and Objectives: Clinical characteristics and outcomes in acute heart failure (AHF) vary by phenotype. We assessed phenotype-specific features, treatment patterns, and outcomes in a nationwide Korean cohort. Methods: The Korean Heart Failure III registry prospectively enrolled 7,351 AHF admissions at 47 hospitals. Among 6,777 patients with available left ventricular ejection fraction (EF), phenotypes were defined as heart failure with reduced EF (HFrEF, ≤40%), mildly reduced EF (HFmrEF,41–49%), or preserved EF (HFpEF, ≥50%). The primary endpoint was a 12-month composite of all-cause death or heart transplantation, evaluated from index admission and, among hospital survivors, from discharge. We used inverse probability weighting (multinomial generalized boosted models with stabilized, trimmed weights) and weighted Cox proportional-hazards models to estimate hazard ratios (HRs). Results: Phenotype distribution was 58.9% HFrEF, 13.6% HFmrEF, and 27.5% HFpEF. Crude 12-month composite rates from index admission were 13.4% (HFrEF), 12.7% (HFmrEF), and 16.8% (HFpEF). After weighting, from index admission, HFmrEF (HR, 0.892; 95% confidence interval [CI], 0.731–1.088) and HFpEF (HR, 1.101; 95% CI, 0.939–1.291) did not differ from HFrEF; from discharge, HFpEF had modestly higher risk (HR, 1.207; 95% CI, 1.008–1.445) whereas HFmrEF did not (HR, 1.039; 95% CI, 0.844–1.279). Hyponatremia and chronic kidney disease were consistent adverse markers, while angiotensin-converting enzyme inhibitor/ angiotensin II receptor blocker use at discharge was protective. Conclusions Across the EF spectrum, phenotypes showed distinct profiles and risk. Postdischarge risk was modestly higher in HFpEF, supporting phenotype-tailored care and systematic discharge optimization in Korean patients with AHF.

A case of a 51-year-old male presented with leukocytosis, lymphocytosis, and splenomegaly. Comprehensive diagnostic evaluations, including cytomorphology, flow cytometric immunophenotyping, and splenic pathology, confirmed the diagnosis of splenic diffuse red pulp small B-cell lymphoma (SDRPL). The patient tested was positive for TP53 mutation and demonstrated poor response to various chemotherapy regimens. During follow-up, the patient′s condition deteriorated. PET-CT revealed multiple metabolically active lymph nodes throughout the body. Peripheral blood smear revealed abnormal lymphocytes, which suggests potential high-grade transformation. Pathological examination of axillary lymph nodes indicated lymphoma cell infiltration, with positive expression of BCL-2, BCL-6, and C-MYC. Subsequent treatment with Zanubrutinib+Obinutuzumab+Bendamustine yielded suboptimal results. Chimeric antigen receptor T-cell immunotherapy (CAR-T) was subsequently administered, and after 9 months, minimal residual disease (MRD) evaluation was negative. SDRPL is a rare indolent B-cell lymphoma, and its diagnosis relies on splenic pathology. The abnormal lymphocytes exhibit characteristic villous projections, and monitoring morphological changes during follow-up can indicate disease progression, providing a basis for selecting appropriate treatment strategies.

A case of a 51-year-old male presented with leukocytosis, lymphocytosis, and splenomegaly. Comprehensive diagnostic evaluations, including cytomorphology, flow cytometric immunophenotyping, and splenic pathology, confirmed the diagnosis of splenic diffuse red pulp small B-cell lymphoma (SDRPL). The patient tested was positive for TP53 mutation and demonstrated poor response to various chemotherapy regimens. During follow-up, the patient′s condition deteriorated. PET-CT revealed multiple metabolically active lymph nodes throughout the body. Peripheral blood smear revealed abnormal lymphocytes, which suggests potential high-grade transformation. Pathological examination of axillary lymph nodes indicated lymphoma cell infiltration, with positive expression of BCL-2, BCL-6, and C-MYC. Subsequent treatment with Zanubrutinib+Obinutuzumab+Bendamustine yielded suboptimal results. Chimeric antigen receptor T-cell immunotherapy (CAR-T) was subsequently administered, and after 9 months, minimal residual disease (MRD) evaluation was negative. SDRPL is a rare indolent B-cell lymphoma, and its diagnosis relies on splenic pathology. The abnormal lymphocytes exhibit characteristic villous projections, and monitoring morphological changes during follow-up can indicate disease progression, providing a basis for selecting appropriate treatment strategies.

Conjugate upward and downward gaze palsy related to unilateral midbrain infarction is a rare neurological symptom, as there were few reported cases worldwide. Here, we report a case of 55-year-old male patient presenting with conjugate vertical gaze palsy. In this case, diffusion-weighted magnetic resonance images demonstrated a localized infarction in the right rostral midbrain.

Conjugate upward and downward gaze palsy related to unilateral midbrain infarction is a rare neurological symptom, as there were few reported cases worldwide. Here, we report a case of 55-year-old male patient presenting with conjugate vertical gaze palsy. In this case, diffusion-weighted magnetic resonance images demonstrated a localized infarction in the right rostral midbrain.

Conjugate upward and downward gaze palsy related to unilateral midbrain infarction is a rare neurological symptom, as there were few reported cases worldwide. Here, we report a case of 55-year-old male patient presenting with conjugate vertical gaze palsy. In this case, diffusion-weighted magnetic resonance images demonstrated a localized infarction in the right rostral midbrain.

Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection. Methods: We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively. Results: Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110–115, 115–120, and 120–125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24–1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66–0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor. Conclusion: In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

Objective: Recent studies highlighted the triple-network model which illustrated the interactions among three large-scale networks including salience network (SN). The functional magnetic resonance imaging used in this study was designed to investigate the characteristics of three large-scale networks associated with the thought-action fusion (TAF) in patients with obsessive-compulsive disorder (OCD) using power spectral density (PSD) analysis. Methods: This study included 32 OCD patients and 38 age-matched healthy controls (HC). The TAF task was modified from the experiment of Rassin. PSD from time courses in large-scale networks of each subject was measured to compare between the groups for both TAF and resting state. Results: In SN, OCD reported lower power in the low-frequency domain of SN compared to HC using the two-sample t test during the TAF task (t = −2.395, p = 0.019) but not in the resting state. The PSD in the low-frequency domain of the SN had a significant negative correlation with state score in the guilty inventory (r = −0.361, p = 0.042) in OCD patients. Conclusion This study suggests that OCD patients showed reduced SN power which can be prominent in a certain situation, such as TAF. In addition, the PSD alterations in SN cause difficulty in processing ambiguous emotional cues in social situations, and the difficulty can be connected with a negative feeling (e.g., guilt).

Objective: Thought-action fusion (TAF), one of the most-studied dysfunctional beliefs in obsessive-compulsive disorder, represents an individual’s belief that his/her thoughts directly influence events. TAF belief types are divided into personal thoughts relating to positive (positive TAF) and negative outcomes (negative TAF). However, the neural mechanisms underlying both aspects of the TAF response remain elusive. Methods: This functional magnetic resonance imaging study aimed to investigate the neural circuits related to positive and negative TAF and their relationships with psychological measures. Thirty-one healthy male volunteers participated in a modified TAF task wherein they were asked to read the name of a close person embedded in positive statements (PS) or negative statements (NS). Results: Conjunction analysis revealed activation of the fusiform and lingual gyri, midcingulate and superior medial frontal gyri, inferior orbitofrontal gyrus, and temporoparietal junction. The NS ＞ PS comparison showed additional activation in the precuneus and medial prefrontal cortex, superior frontal gyrus, insula, globus pallidus, thalamus, and midbrain. Precuneus activity was associated with the TAF score among these areas. Moreover, activity in the inferior orbitofrontal gyrus, insula, superior, middle and medial frontal gyri, globus pallidus, inferior parietal lobule, and precuneus was associated with dimensional obsessive-compulsive scores. In contrast, the PS ＞ NS comparison revealed no significant activation. Conclusion These results suggest that negative TAF, relative to positive TAF, recruits additional regions for self-referential processing, salience, and habitual responding, which may contribute to the activation of the belief that a negative thought increases the probability of that negative outcome.

Background: Copeptin is secreted in equimolar amounts as arginine vasopressin, main hormone regulating body fluid homeostasis. A recent study reported a copeptin-based classification of osmoregulatory defects in syndromes of inappropriate antidiuresis that may aid in prediction of therapeutic success. We investigated usefulness of copeptin for differentiating etiologies of hyponatremia and predicting efficacy and safety of hypertonic saline treatment in hyponatremic patients. Methods: We performed a multicenter, prospective cohort study of 100 inpatients with symptomatic hyponatremia (corrected serum sodium [sNa] ≤ 125 mmol/L) treated with hypertonic saline. Copeptin levels were measured at baseline and 24 hours after treatment initiation, and patients were classified as being below or above median of copeptin at baseline or at 24 hours, respectively. Correlations between target, under correction, and overcorrection rates of sNa within 24 hours/24–48 hours and copeptin levels at baseline/24 hours were analyzed. Results: Mean sNa and median copeptin levels were 117.9 and 16.9 pmol/L, respectively. Ratio of copeptin-to-urine sodium allowed for an improved differentiation among some (insufficient effective circulatory volume), but not all hyponatremia etiologic subgroups. Patients with below-median copeptin levels at baseline achieved a higher target correction rate in 6/24 hours (odds ratio [OR], 2.97; p = 0.02/OR, 6.21; p = 0.006). Patients with below-median copeptin levels 24 hours after treatment showed a higher overcorrection rate in next 24 hours (OR, 18.00, p = 0.02). Conclusion There is a limited diagnostic utility of copeptin for differential diagnosis of hyponatremia. However, copeptin might be useful for predicting responses to hypertonic saline treatment in hyponatremic patients.