Background/Aims: Nocturnal acid reflux disrupts sleep and impairs quality of life. Proton pump inhibitors provide insufficient suppression of nocturnal acid secretion, whereas fexuprazan offers prolonged acid suppression. We compared the efficacy of fexuprazan and esomeprazole in controlling nocturnal reflux. Methods: In a randomized and crossover study, patients received fexuprazan or esomeprazole daily for 4 weeks, followed by a washout and crossover to the alternate medication for another 4 weeks, with a final washout completing the sequence. Severity (scores 0-10), frequency, sleep disturbance, and medication preferences were evaluated. Results: Thirty-nine patients were enrolled and randomized to receive either fexuprazan (n = 20) or esomeprazole (n = 19) first. After the first treatment, fexuprazan reduced severity from 7.5 ± 1.7 to 1.4 ± 1.7 (81.3% decrease), versus 7.8 ± 1.5 to 2.8 ± 1.9 (64.1% decrease) with esomeprazole (P = 0.012). In patients with severe symptoms (scores ≥ 7), fexuprazan led to significantly greater improvement than esomeprazole (P = 0.008). Following the first washout, the second crossover treatment resulted in greater improvement in symptom severity with fexuprazan (P = 0.001). During the second washout, nocturnal symptoms severity and frequencies were better controlled with fexuprazan than with esomeprazole (P = 0.005 and 0.019). Patients who switched from esomeprazole to fexuprazan preferred fexuprazan (P = 0.018). Conclusions Fexuprazan was more effective than esomeprazole in controlling nocturnal reflux symptom, particularly in patients with severe symptoms. Fexuprazan may offer a therapeutic advantage for patients with severe and persistent nocturnal reflux despite proton pump inhibitor therapy.

Purpose: The study was designed to evaluate the combined therapeutic effect of topical 2% rebamipide and 0.5% carboxymethylcellulose sodium (CMC) for managing dry eye following cataract surgery compared with 2% rebamipide monotherapy. Methods: We retrospectively analyzed medical records of patients who underwent cataract surgery and were diagnosed with dry eye one week postoperatively. Among these, patients who received combined therapy with 2% rebamipide and 0.5% carboxymethylcellulose (CMC) eye drops (combined therapy group), or 2% rebamipide alone (monotherapy group), for at least two months were included. Clinical data were collected at one and two months after surgery, including Schirmer’s test, tear break-up time (TBUT), ocular surface staining scores, tear film osmolarity, tear lipid layer thickness, and Ocular Surface Disease Index (OSDI) scores. Results: In the combined therapy group, we observed a significant improvement in Schirmer’s test, TBUT, and ocular surface staining scores at both one and two months post-surgery compared to baseline (1 month: p < 0.001, < 0.001, 0.005; 2 months: p < 0.001, respectively). OSDI remained unchanged throughout the entire follow-up period. The combined therapy group exhibited significantly longer Schirmer’s test results (p < 0.001, 0.003), longer TBUT (p = 0.022 at 1 month), and a lower ocular surface staining score (p < 0.001, respectively) compared to the monotherapy group. Conclusions Following cataract surgery, the combined use of rebamipide and CMC eye drops resulted in improvements in Schirmer’s test, TBUT, and ocular surface staining scores. This suggests that combination therapy may be a promising option for patients who do not achieve adequate relief with rebamipide eyedrops.

Background: We aimed to investigate the predictive values of plasma C-peptide levels and the continuous glucose monitoring (CGM)-defined coefficient of variation (CV) in risk prediction for hypoglycemia in Korean people with diabetes with normal and impaired kidney function. Methods: We analyzed data from 1,185 participants diagnosed with type 1 and type 2 diabetes who underwent blinded professional CGM between January 2009 and May 2021 at outpatient clinics. We explored correlations among CGM-defined CV, plasma C-peptide levels, and time below range at <70 and 54 mg/dL across different kidney function categories. Results: In patients with chronic kidney disease (CKD) stages 1–2 (n=934), 89.3% who had a random plasma C-peptide level higher than 600 pmol/L exhibited a CV of ≤36%. Among those in CKD stage 3 (n=161) with a random plasma C-peptide level exceeding 600 pmol/L, 66.7% showed a CV of ≤36%. In stages 4–5 of CKD (n=90), the correlation between random C-peptide levels and CV was not significant (r=–0.05, P=0.640), including cases with a CV greater than 36% despite very high random plasma C-peptide levels. Random plasma C-peptide levels and CGM-assessed CV significantly predicted hypoglycemia in CKD stages 1–2 and 1–5, respectively. Conclusion The established C-peptide criteria in Western populations are applicable to Korean people with diabetes for hypoglycemic risk prediction, unless kidney function is impaired equivalent to CKD stage 3–5. The CGM-defined CV is informative for hypoglycemic risk prediction regardless of kidney function.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder characterized by the presence of eosinophilic nuclear inclusions in neurons and somatic cells. It clinically manifests as cognitive decline, seizures, and autonomic dysfunction. A 44-year-old man presented with a transient visual field defect and hemiparesis. Based on characteristic imaging findings and pathological findings, NIID was suspected and diagnosed through genetic testing. This case emphasizes the importance of comprehensive clinical phenotype analysis and accurate genetic diagnosis.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.

Humans and animals have a fundamental ability to use experiences and environmental information to organize behavior. It often happens that humans and animals make decisions and prepare actions under uncertain situations. Uncertainty would significantly affect the state of animals' minds, but may not be reflected in behavior. How to "read animals' mind state" under different situations is a challenge. Here, we report that neuronal activity in the medial prefrontal cortex (mPFC) of rats can reflect the environmental uncertainty when the task situation changes from certain to uncertain. Rats were trained to perform behavioral tasks under certain and uncertain situations. Under certain situations, rats were required to simply repeat two nose-poking actions that each triggered short auditory tone feedback (single-task situation). Whereas under the uncertain situation, the feedback could randomly be either the previous tone or a short musical rhythm. No additional action was required upon the music feedback, and the same secondary nose-poking action was required upon the tone feedback (dual-task situation); therefore, the coming task was uncertain before action initiation. We recorded single-unit activity from the mPFC when the rats were performing the tasks. We found that in the dual task, when uncertainty was introduced, many mPFC neurons were actively engaged in dealing with the uncertainty before the task initiation, suggesting that the rats could be aware of the task situation change and encode the information in the mPFC before the action of task initiation.
Animals ; Prefrontal Cortex/cytology* ; Uncertainty ; Neurons/physiology* ; Male ; Rats ; Rats, Long-Evans ; Action Potentials/physiology* ; Acoustic Stimulation

Objective To investigate the growth, development and health status of primary and secondary school students in Xinzhou District of Wuhan, and analyze the detection and change trend of common diseases in primary and secondary school students, and to provide a basis for relevant departments to formulate prevention and control measures of common diseases in students. Methods The monitoring data of common diseases and health influencing factors of primary and secondary school students in Xinzhou District from 2019 to 2022 were analyzed and compared according to different genders, different grades and ages. SPSS 20.0 software was used to analyze the data of detection rates of myopia, dental caries, obesity, malnutrition and abnormal spinal curvature. Results The overall detection rates of myopia, dental caries, malnutrition, obesity and abnormal spinal curvature were 57.00%, 58.45%, 4.60%, 14.91%, and 6.33%, respectively, in Xinzhou District from 2019 to 2022. The annual change rates were 7.22%, 15.10%, -2.72%, 13.29%, and 4.91%, respectively. The detection rates of myopia, dental caries, obesity and abnormal spinal curvature showed an increasing trend in each year (χ² ≥17.22, P<0.001). The detection rates of myopia and malnutrition increased with the increase of age and school level (both χ²≥42.37, P<0.001), while the opposite was true for the detection rates of dental caries and obesity (both χ²≥14.26, P<0.001). The detection rates of myopia and dental caries were higher in girls than in boys (both χ²≥33.66, P<0.001), while the detection rates of obesity and abnormal spinal curvature were higher in boys than in girls (both χ²≥8.22, P<0.005). The detection rates of myopia, dental caries, obesity and abnormal spinal curvature in 2019 were lower than those in 2020-2022 (χ²≥4.11, P<0.05), while the detection rates of malnutrition had decreased. Conclusion The growth, development and health status of primary and secondary school students in Xinzhou District are serious. The detection rate of common diseases such as myopia, dental caries, obesity and abnormal curvature of the spine is on the rise, which should be the focus of the surveillance work of common diseases in primary and secondary school students in the future, and comprehensive intervention measures are urgently needed to prevent and control these common diseases.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.

Background: We aimed to investigate the predictive values of plasma C-peptide levels and the continuous glucose monitoring (CGM)-defined coefficient of variation (CV) in risk prediction for hypoglycemia in Korean people with diabetes with normal and impaired kidney function. Methods: We analyzed data from 1,185 participants diagnosed with type 1 and type 2 diabetes who underwent blinded professional CGM between January 2009 and May 2021 at outpatient clinics. We explored correlations among CGM-defined CV, plasma C-peptide levels, and time below range at <70 and 54 mg/dL across different kidney function categories. Results: In patients with chronic kidney disease (CKD) stages 1–2 (n=934), 89.3% who had a random plasma C-peptide level higher than 600 pmol/L exhibited a CV of ≤36%. Among those in CKD stage 3 (n=161) with a random plasma C-peptide level exceeding 600 pmol/L, 66.7% showed a CV of ≤36%. In stages 4–5 of CKD (n=90), the correlation between random C-peptide levels and CV was not significant (r=–0.05, P=0.640), including cases with a CV greater than 36% despite very high random plasma C-peptide levels. Random plasma C-peptide levels and CGM-assessed CV significantly predicted hypoglycemia in CKD stages 1–2 and 1–5, respectively. Conclusion The established C-peptide criteria in Western populations are applicable to Korean people with diabetes for hypoglycemic risk prediction, unless kidney function is impaired equivalent to CKD stage 3–5. The CGM-defined CV is informative for hypoglycemic risk prediction regardless of kidney function.