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.

OBJECTIVES: In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals. METHODS: We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; n=6,017, 64.8% male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%. RESULTS: Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers. CONCLUSIONS This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.

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.

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.

Purpose: This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer. Methods: This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires. Results: In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group. Conclusion LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

OBJECTIVES: In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals. METHODS: We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; n=6,017, 64.8% male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%. RESULTS: Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers. CONCLUSIONS This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.

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.