Background and Objectives: Beta-blockers (BBs) improve prognosis in heart failure (HF), which is mediated by lowering heart rate (HR). However, HR has no prognostic implication in atrial fibrillation (AF) and also BBs have not been shown to improve prognosis in heart failure with preserved ejection fraction (HFpEF) with AF. This study assessed the prognostic implication of BB in HFpEF with AF according to discharge HR. Methods: From the Korean Acute Heart Failure Registry, 687 patients with HFpEF and AF were selected. Study subjects were divided into 4 groups based on 75 beats per minute (bpm) of HR at discharge and whether or not they were treated with BB at discharge. Results: Of the 687 patients with HFpEF and AF, 128 (36.1%) were in low HR group and 121 (36.4%) were in high HR group among those treated with BB at discharge. In high HR group, HR at discharge was significantly faster in BB non-users (85.5±9.1 bpm vs. 89.2±12.5 bpm, p=0.005). In the Cox model, BB did not improve 60-day rehospitalization (hazard ratio, 0.93;95% confidence interval [95% CI], 0.35–2.47) or mortality (hazard ratio, 0.77; 95% CI, 0.22– 2.74) in low HR group. However, in high HR group, BB treatment at discharge was associated with 82% reduced 60-day HF rehospitalization (hazard ratio, 0.18; 95% CI, 0.04–0.81), but not with mortality (hazard ratio, 0.77; 95% CI, 0.20–2.98). Conclusions In HFpEF with AF, in patients with HR over 75 bpm at discharge, BB treatment at discharge was associated with a reduced 60-day rehospitalization rate.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

Background: This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea. Methods: A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocar‑ diographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical out‑ come was in-hospital mortality. Results: Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall inhospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regur‑ gitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037). Conclusions This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

Background: This report presents annual data from the surgical site infection (SSI) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2021 to June 2022. Methods: Surveillance of 20 surgeries (e.g., stomach, colon, rectal, gallbladder surgery, knee replacement, hip replacement, craniotomy, ventricular shunts, spinal fusion, laminectomy, cardiac artery bypass grafting - incision in the chest site only and incisions both the chest and donor site, cardiac, prostatectomy, abdominal hysterectomy, vaginal hysterectomy, appendectomy, thoracic, cesarean section, and head and neck surgeries) associated with SSI was performed between July 1, 2021, and June 30, 2022, according to the KONIS Manual 2020. Results: A total of 133,281 surgical cases were collected and 1,100 SSIs were identified, resulting in a SSI rate of 0.83%. The SSI rates for 30-day surveillance surgeries were 1.9% for stomach, 2.82% for colon, 1.88% for rectal, 0.29% for gallbladder, 0.25% for lumbar laminectomy, 0.33% for cesarean section, 0.67% for abdominal hysterectomy, 0.74% for vaginal hysterectomy, 0.23% for prostatectomy, 1.39% for appendectomy, and 0.06% for thoracic surgeries. Neck surgery could not be analyzed due to no reported cases. The SSI rates for the 90-day surveillance surgeries were 0.16% for knee replacement, 0.54% for hip replacement, 0.89% for spinal fusion, 0.70% for craniotomy, 0.92% for ventricular shunt, 1.13% for cardiac, 1.80% for cardiac artery bypass grafting (chest only incision), and 1.64% for cardiac artery bypass grafting (chest and leg incision) surgeries. In total, 608 strains were isolated and cultured from 1,286 infections. Conclusion Compared with the incidence of SSI (1.06%) in 2018, the overall incidence decreased, and most site-specific infection rates decreased or remained the same.

Background: Anemia is a common complication of chronic kidney disease (CKD). In patients with CKD-related anemia, an inverse relationship between vitamin D and hepcidin levels has been observed. Hepcidin is a key regulator of iron homeostasis, mediated via binding to ferroportin. The aim of this study was to investigate the effects of cholecalciferol and omega-3 fatty acids (FA) on hepcidin levels using 5/6 nephrectomized (Nx) rats. Methods: Male Sprague-Dawley rats were divided into five groups: sham control, 5/6 Nx, 5/6 Nx treated with cholecalciferol, 5/6 Nx treated with omega-3 FA, and 5/6 Nx treated with both cholecalciferol and omega-3 FA. We measured the hepcidin and ferroportin levels in the kidney and liver by enzyme-linked immunosorbent assays and Western blots. We evaluated hepcidin expression in the kidney by immunohistochemical staining. Results: Among the five groups, 5/6 Nx rats exhibited the worst kidney function. Compared with the sham controls, 5/6 Nx rats showed significantly increased serum hepcidin levels and decreased vitamin D levels. Supplementation with either omega-3 FA or cholecalciferol decreased hepcidin and increased vitamin D levels, with a concurrent improvement of anemia. Furthermore, 5/6 Nx rats treated with omega-3 FA/cholecalciferol showed decreased ferroportin and ferritin levels, while iron and total iron-binding capacity levels increased. Conclusions Treatment with a combination of cholecalciferol and omega-3 FA may improve anemia in a CKD rat model by decreasing hepcidin levels.

Background: This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea. Methods: A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocar‑ diographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical out‑ come was in-hospital mortality. Results: Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall inhospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regur‑ gitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037). Conclusions This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.