Background: Recent landmark trials have shown that several pharmacologic therapies improve outcomes in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF), leading to updates in heart failure (HF) management guidelines. However, real-world adherence to guideline-directed medical therapy (GDMT) in these populations remains uncertain. This study evaluated GDMT prescription patterns in patients with HFmrEF or HFpEF based on the 2022 Korean Heart Failure Society guidelines. Methods: This single-center observational study included patients newly diagnosed with HF between January and December 2023, identified using International Classification of Diseases codes. Patients without recent echocardiographic or N-terminal pro–brain natriuretic peptide data, those with reduced ejection fraction, or those with end-stage renal disease were excluded. Electronic medical records were reviewed to assess GDMT prescription rates. Results: Among 615 patients (mean age, 68.9 years; 52.4% female), 568 had HFpEF and 47 had HFmrEF. Common comorbidities included hypertension (75.5%), diabetes mellitus (50.9%), ischemic heart disease (43.7%), and chronic kidney disease (22.6%). Overall prescription rates were 73.3% for renin–angiotensin system inhibitors, 83.7% for beta-blockers, 41.1% for mineralocorticoid receptor antagonists (MRAs), and 42.9% for sodium–glucose cotransporter 2 inhibitors (SGLT2is). SGLT2i use was significantly higher in patients with diabetes than in those without (71.6% vs. 13.2%; p<0.001). Angiotensin receptor–neprilysin inhibitors and MRAs were more frequently prescribed in HFmrEF than HFpEF. Beta-blocker use was lower in patients aged ≥75 years. Conclusions A substantial gap persists between guideline recommendations and real-world GDMT use in patients with HFmrEF and HFpEF, particularly for SGLT2is. Multicenter studies are warranted to further characterize and address this treatment gap.

Small intestinal bacterial overgrowth (SIBO) can partly explain irritable bowel syndrome (IBS), and rifaximin has been observed to improve abdominal symptoms in nonconstipated IBS patients. However, there are few reports on the association of the rifaximin treatment periods with the results of a lactulose breath test (LBT). Therefore, we performed a retrospective review of patient charts to investigate the relation between the rifaximin treatment periods with LBT results in nonconstipated IBS patients. We also evaluated the time to achieve a symptomatic improvement in the IBS patients as compared to the changes in the LBT. We reviewed the charts for patients who showed IBS symptoms with documented positive results for LBT during their initial visit and who had a follow-up LBT after treatment with rifaximin. The LBT values were compared to the subjects' symptom scores. A total of 102 subjects had a follow-up LBT to assess LBT normalization. The subjects were divided into groups according to treatment periods of 4 weeks (n = 36), 8 weeks (n = 43), and 12 weeks (n = 23). The groups with a longer treatment exhibited an increase in the hydrogen gas value at 90 min and its sum during 90 min at the initial LBT. There were significant differences in hydrogen gas value at 90 min and in its sum during 90 min at the initial LBT between the groups treated for 4 and 12 weeks. The most significant treatment response was observed during the first 4 weeks for all treatment groups. Symptomatic improvement occurred earlier than LBT normalization in the treatment period over 4 weeks. The results indicate that different rifaximin treatment periods are needed in accordance with LBT levels to effectively eradicate SIBO.
Biomarkers/analysis ; Breath Tests/*methods ; Constipation ; Drug Administration Schedule ; Drug Monitoring/*methods ; Female ; Gastrointestinal Agents/administration & dosage ; Humans ; Irritable Bowel Syndrome/*diagnosis/*drug therapy ; Lactulose/*analysis ; Male ; Middle Aged ; Reproducibility of Results ; Rifamycins/*administration & dosage ; Sensitivity and Specificity ; Treatment Outcome

Within the vertebrate nervous system, myelination is required for the normal function of neurons by facilitating the rapid conduction of action potentials along axons. Oligodendrocytes are glial cells which myelinate axons in the central nervous system. Disruption of myelination and remyelination failure can cause human diseases such as multiple sclerosis. Despite the importance of myelination, the molecular basis of oligodendrocyte differentiation and myelination are still poorly understood. To understand the molecular mechanisms which regulate oligodendrocyte differentiation and myelination, novel genes were identified using a microarray analysis. The analysis used oligodendrocyte lineage cells isolated from transgenic zebrafish expressing fluorescent proteins in the oligodendrocyte lineage cells. Seven genes not previously known to be involved in oligodendrocyte differentiation were identified, and their expression during oligodendrocyte development was validated.
Action Potentials ; Axons ; Central Nervous System ; Humans ; Mass Screening ; Microarray Analysis ; Multiple Sclerosis ; Myelin Sheath ; Nervous System ; Neuroglia ; Neurons ; Oligodendroglia ; Proteins ; Vertebrates ; Zebrafish