Background: The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort. Methods: We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups. Results: The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001). Conclusions The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Purpose: We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years. Materials and Methods: We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores. Results: During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479–3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95%CI: 1.141–5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance. Conclusion The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

Objective: Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors. Methods: We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed. Results: A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18–1.79; p = 0.336). Conclusion SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Objective: Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors. Methods: We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed. Results: A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18–1.79; p = 0.336). Conclusion SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: To assess the safety and effectiveness of high-density light-emitting diode (LED) irradiation therapy in patients with hand osteoarthritis (OA) and compare the pre- and post-intervention symptoms. Methods: Twenty-three patients with hand OA underwent eight sessions of high-density LED irradiation therapy directed at the five most painful areas in the finger joints. Each session lasted for 18 minutes; and the sessions were conducted twice a week, for 4 weeks. We evaluated the degree of pain using the visual analogue scale, ring size, and passive range of motion (flexion+extension) for two most painful joints from the baseline to post-therapy (weeks 4 and 6). Results: High-density LED irradiation therapy significantly reduced the pain posttreatment compared with that observed at the baseline (p<0.001). Although improvements were observed in ring size and joint range of motion at 4 and 6 weeks, they were not statistically significant (p>0.05). No adverse events were observed. Conclusion We examined the safety and effectiveness of high-density LED irradiation therapy in reducing pain and hand swelling and improving joint mobility in patients with hand OA. These results suggest that high-density LED irradiation therapy has the potential to be an important strategy for managing hand OA.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.