Background: Patients with septic shock frequently require tracheal intubation in the emergency department (ED). However, the criteria for tracheal intubation are subjective, based on physician experience, or require serial evaluations over relatively long intervals to make accurate predictions, which might not be feasible in the ED. We used supervised learning approaches and features routinely available during the initial stages of evaluation and resuscitation to stratify the risks of tracheal intubation within a 24-hour time window. Methods: We retrospectively analyzed the data of patients diagnosed with septic shock based on the SEPSIS-3 criteria across 21 university hospital EDs in the Republic of Korea. A principal component analysis revealed a complex, non-linear decision boundary with respect to the application of tracheal intubation within a 24-hour time window. Stratified five-fold cross validation and a grid search were used with extreme gradient boost. Shapley values were calculated to explain feature importance and preferences. Results: In total, data for 4,762 patients were analyzed; within that population, 1,486 (31%) were intubated within a 24-hour window, and 3,276 (69%) were not. The area under the receiver operating characteristic curve and F1 scores for intubation within a 24-hour window were 0.829 (95% CI, 0.801–0.878) and 0.654 (95% CI, 0.627–0.681), respectively. The Shapley values identified lactate level after initial fluids, suspected lung infection, initial pH, Sequential Organ Failure Assessment score at enrollment, and respiratory rate at enrollment as important features for prediction. Conclusions An extreme gradient boosting machine can moderately discriminate whether intubation is warranted within 24 hours of the recognition of septic shock in the ED.

Purpose: The purpose of this study was to determine the effects of ankle dorsiflexion, neutral, and plantarflexion on lower extremity muscle activity and break point angle (BPA) during Nordic hamstring exercises. Methods: Twenty-four members of a college soccer club (age, 21.68±2.39 years; height, 175.63±4.76 cm; weight, 71.88±6.29 kg) were recruited to participate in the experiment, and all subjects were measured three times in triplicate for Nordic hamstrings at three different ankle angles with all subjects in one group. Surface electromyography equipment (miniDTS, Noraxon Inc.) was used to acquire 3 seconds of muscle activity data at the starting point (90°) during exercise, and motion analysis software (Kinovea version 0.9.5, Kinovea) was used to collect kinematic data at the point where knee strike angular velocity exceeded 30°/sec for BPA data acquisition. Results: The results of this study, lower extremity muscle activity was not significantly different in the three variants of Nordic hamstring exercises, but BPA was significantly lower in the dorsiflexion position (60.28°±6.35°) compared to the neutral position (65.32°±6.35°) and plantarflexion position (63.82°±7.01°) (p＜ 0.001). Conclusion These results suggest that the dorsi flexion position of the ankle during Nordic hamstring exercises allows the body to maintain the position for a longer period of time against eccentric forces in situations where the body is moving forward. This suggests that the ankle dorsi flexion position can be used as a position for effective Nordic hamstring exercises in amateur soccer players.

Background and Objectives: The popliteal artery is generally regarded as a “no-stent zone.”Limited data are available on the outcomes of drug-coated balloons (DCBs) for popliteal artery disease. This study aimed to evaluate the 12-month clinical outcomes among patients who received DCB treatment for atherosclerotic popliteal artery disease. Methods: This prospective, multicenter registry study enrolled 100 patients from 7 Korean endovascular centers who underwent endovascular therapy using IN.PACT DCB (Medtronic) for symptomatic atherosclerotic popliteal artery disease. The primary endpoint was 12-month clinical primary patency and the secondary endpoint was clinically driven target lesion revascularization (TLR)–free rate. Results: The mean age of the study cohort was 65.7±10.8 years, and 77% of enrolled patients were men. The mean lesion length was 93.7±53.7 mm, and total occlusions were present in 45% of patients. Technical success was achieved in all patients. Combined atherectomy was performed in 17% and provisional stenting was required in 11%. Out of the enrolled patients, 91 patients completed the 12-month follow-up. Clinical primary patency and TLR-free survival rates at 12 months were 76.0% and 87.2%, respectively. A multivariate Cox regression analysis identified female and longer lesion length as the significant independent predictors of loss of patency. Conclusions DCB treatment yielded favorable 12-month clinical primary patency and TLRfree survival outcomes in patients with popliteal artery disease.

Background and Objectives: The K-ELUVIA study aimed to investigate the clinical effectiveness and safety of Eluvia™, a polymer-coated, paclitaxel-eluting stent, for femoropopliteal artery disease using data from a prospective Korean multicenter registry. Methods: A total of 105 patients with femoropopliteal artery disease who received endovascular treatment (EVT) with Eluvia™ stents at 7 Korean sites were enrolled in a prospective cohort and followed for 2 years. The primary endpoint was the 2-year clinical patency. The secondary endpoint was 2-year freedom from clinically driven target lesion revascularization (TLR). Results: Mean patient age was 68.2±10.4 years, and most patients (82.7%) were male. Mean lesion length was 168.3±117.6 mm. Chronic total occlusion was found in 57.7% of patients.Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) type C or D lesions were present in 46.1% of patients. Procedural success was achieved in 99.0% of patients. The clinical patency rate was 84.4% at 1 year after EVT and 76.3% at 2 years post-EVT. The freedom from TLR rate was 89.1% at 1 year after EVT and 79.1% at 2 years post-EVT. Chronic total occlusion (hazard ratio [HR], 3.53; 95% confidence interval [CI], 1.08–11.67; p=0.039) and smaller mean stent diameter (HR, 0.40; 95% CI, 0.16– 0.98; p=0.044) were identified as independent predictors of loss of clinical patency at 2 years. Conclusions The K-ELUVIA study demonstrated favorable 2-year clinical effectiveness and safety outcomes of Eluvia stent for femoropopliteal artery lesions in real-world practice.

Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap’s vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.

Purpose: The purpose of this study was to determine the effects of ankle dorsiflexion, neutral, and plantarflexion on lower extremity muscle activity and break point angle (BPA) during Nordic hamstring exercises. Methods: Twenty-four members of a college soccer club (age, 21.68±2.39 years; height, 175.63±4.76 cm; weight, 71.88±6.29 kg) were recruited to participate in the experiment, and all subjects were measured three times in triplicate for Nordic hamstrings at three different ankle angles with all subjects in one group. Surface electromyography equipment (miniDTS, Noraxon Inc.) was used to acquire 3 seconds of muscle activity data at the starting point (90°) during exercise, and motion analysis software (Kinovea version 0.9.5, Kinovea) was used to collect kinematic data at the point where knee strike angular velocity exceeded 30°/sec for BPA data acquisition. Results: The results of this study, lower extremity muscle activity was not significantly different in the three variants of Nordic hamstring exercises, but BPA was significantly lower in the dorsiflexion position (60.28°±6.35°) compared to the neutral position (65.32°±6.35°) and plantarflexion position (63.82°±7.01°) (p＜ 0.001). Conclusion These results suggest that the dorsi flexion position of the ankle during Nordic hamstring exercises allows the body to maintain the position for a longer period of time against eccentric forces in situations where the body is moving forward. This suggests that the ankle dorsi flexion position can be used as a position for effective Nordic hamstring exercises in amateur soccer players.

Background and Objectives: The popliteal artery is generally regarded as a “no-stent zone.”Limited data are available on the outcomes of drug-coated balloons (DCBs) for popliteal artery disease. This study aimed to evaluate the 12-month clinical outcomes among patients who received DCB treatment for atherosclerotic popliteal artery disease. Methods: This prospective, multicenter registry study enrolled 100 patients from 7 Korean endovascular centers who underwent endovascular therapy using IN.PACT DCB (Medtronic) for symptomatic atherosclerotic popliteal artery disease. The primary endpoint was 12-month clinical primary patency and the secondary endpoint was clinically driven target lesion revascularization (TLR)–free rate. Results: The mean age of the study cohort was 65.7±10.8 years, and 77% of enrolled patients were men. The mean lesion length was 93.7±53.7 mm, and total occlusions were present in 45% of patients. Technical success was achieved in all patients. Combined atherectomy was performed in 17% and provisional stenting was required in 11%. Out of the enrolled patients, 91 patients completed the 12-month follow-up. Clinical primary patency and TLR-free survival rates at 12 months were 76.0% and 87.2%, respectively. A multivariate Cox regression analysis identified female and longer lesion length as the significant independent predictors of loss of patency. Conclusions DCB treatment yielded favorable 12-month clinical primary patency and TLRfree survival outcomes in patients with popliteal artery disease.

Background and Objectives: The K-ELUVIA study aimed to investigate the clinical effectiveness and safety of Eluvia™, a polymer-coated, paclitaxel-eluting stent, for femoropopliteal artery disease using data from a prospective Korean multicenter registry. Methods: A total of 105 patients with femoropopliteal artery disease who received endovascular treatment (EVT) with Eluvia™ stents at 7 Korean sites were enrolled in a prospective cohort and followed for 2 years. The primary endpoint was the 2-year clinical patency. The secondary endpoint was 2-year freedom from clinically driven target lesion revascularization (TLR). Results: Mean patient age was 68.2±10.4 years, and most patients (82.7%) were male. Mean lesion length was 168.3±117.6 mm. Chronic total occlusion was found in 57.7% of patients.Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) type C or D lesions were present in 46.1% of patients. Procedural success was achieved in 99.0% of patients. The clinical patency rate was 84.4% at 1 year after EVT and 76.3% at 2 years post-EVT. The freedom from TLR rate was 89.1% at 1 year after EVT and 79.1% at 2 years post-EVT. Chronic total occlusion (hazard ratio [HR], 3.53; 95% confidence interval [CI], 1.08–11.67; p=0.039) and smaller mean stent diameter (HR, 0.40; 95% CI, 0.16– 0.98; p=0.044) were identified as independent predictors of loss of clinical patency at 2 years. Conclusions The K-ELUVIA study demonstrated favorable 2-year clinical effectiveness and safety outcomes of Eluvia stent for femoropopliteal artery lesions in real-world practice.

Purpose: The purpose of this study was to determine the effects of ankle dorsiflexion, neutral, and plantarflexion on lower extremity muscle activity and break point angle (BPA) during Nordic hamstring exercises. Methods: Twenty-four members of a college soccer club (age, 21.68±2.39 years; height, 175.63±4.76 cm; weight, 71.88±6.29 kg) were recruited to participate in the experiment, and all subjects were measured three times in triplicate for Nordic hamstrings at three different ankle angles with all subjects in one group. Surface electromyography equipment (miniDTS, Noraxon Inc.) was used to acquire 3 seconds of muscle activity data at the starting point (90°) during exercise, and motion analysis software (Kinovea version 0.9.5, Kinovea) was used to collect kinematic data at the point where knee strike angular velocity exceeded 30°/sec for BPA data acquisition. Results: The results of this study, lower extremity muscle activity was not significantly different in the three variants of Nordic hamstring exercises, but BPA was significantly lower in the dorsiflexion position (60.28°±6.35°) compared to the neutral position (65.32°±6.35°) and plantarflexion position (63.82°±7.01°) (p＜ 0.001). Conclusion These results suggest that the dorsi flexion position of the ankle during Nordic hamstring exercises allows the body to maintain the position for a longer period of time against eccentric forces in situations where the body is moving forward. This suggests that the ankle dorsi flexion position can be used as a position for effective Nordic hamstring exercises in amateur soccer players.

Background and Objectives: The popliteal artery is generally regarded as a “no-stent zone.”Limited data are available on the outcomes of drug-coated balloons (DCBs) for popliteal artery disease. This study aimed to evaluate the 12-month clinical outcomes among patients who received DCB treatment for atherosclerotic popliteal artery disease. Methods: This prospective, multicenter registry study enrolled 100 patients from 7 Korean endovascular centers who underwent endovascular therapy using IN.PACT DCB (Medtronic) for symptomatic atherosclerotic popliteal artery disease. The primary endpoint was 12-month clinical primary patency and the secondary endpoint was clinically driven target lesion revascularization (TLR)–free rate. Results: The mean age of the study cohort was 65.7±10.8 years, and 77% of enrolled patients were men. The mean lesion length was 93.7±53.7 mm, and total occlusions were present in 45% of patients. Technical success was achieved in all patients. Combined atherectomy was performed in 17% and provisional stenting was required in 11%. Out of the enrolled patients, 91 patients completed the 12-month follow-up. Clinical primary patency and TLR-free survival rates at 12 months were 76.0% and 87.2%, respectively. A multivariate Cox regression analysis identified female and longer lesion length as the significant independent predictors of loss of patency. Conclusions DCB treatment yielded favorable 12-month clinical primary patency and TLRfree survival outcomes in patients with popliteal artery disease.