The pathophysiological mechanism of cardiovascular disease in patients with chronic kidney disease (CKD) is complicated. Mediation analysis is an important statistical tool for gaining insight into the complex mechanisms of exposure-outcome effects. We investigated the potential mediating role of the left ventricular mass index (LVMI) on the association between fluid balance (overhydration/extracellular water, OH/ECW) and left ventricular diastolic function (E/e´ ratio) in patients with CKD not yet on dialysis. Methods: Bioimpedance spectroscopy, echocardiography, and laboratory evaluations were performed on 425 consecutive patients on the same day. The patients were classified into two groups according to the estimated glomerular filtration rate corresponding to CKD stages 3 and 5. Mediation analysis was performed using the PROCESS macro and bootstrapping methods. Results: OH/ECW and LVMI were positively correlated with the E/e´ ratio in both the CKD stages 3 and five groups. In CKD stage 5, there was a statistically significant association between OH/ECW and LVMI, whereas no correlation was observed in CKD stage 3. In the mediation analysis, LVMI positively mediated the relationship between OH/ECW and E/e´ ratio when controlling for confounders in patients with CKD stage 5 (B = 2.602; Boot 95% confidence interval, 1.313–4.076). Conclusion: In our analysis, the indirect effect of mediators was significant in patients with advanced CKD. Therefore, our study suggests that further research on several other risk factors may be needed to determine the underlying mechanisms of association between the associated factors in all CKD stages.

Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir for 12 weeks in HCV-infected Korean adults. Methods: This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir–velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir–velpatasvir–voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. Results: Of 53 participants receiving sofosbuvir–velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir–velpatasvir–voxilaprevir achieved SVR 12. Overall, sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. Conclusions: Treatment with sofosbuvir–velpatasvir or sofosbuvir–velpatasvir–voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.

Objective: T1 mapping provides valuable information regarding cardiomyopathies. Manual drawing is time consuming and prone to subjective errors. Therefore, this study aimed to test a DL algorithm for the automated measurement of native T1 and extracellular volume (ECV) fractions in cardiac magnetic resonance (CMR) imaging with a temporally separated dataset. Materials and Methods: CMR images obtained for 95 participants (mean age ± standard deviation, 54.5 ± 15.2 years), including 36 left ventricular hypertrophy (12 hypertrophic cardiomyopathy, 12 Fabry disease, and 12 amyloidosis), 32 dilated cardiomyopathy, and 27 healthy volunteers, were included. A commercial deep learning (DL) algorithm based on 2D U-net (Myomics-T1 software, version 1.0.0) was used for the automated analysis of T1 maps. Four radiologists, as study readers, performed manual analysis. The reference standard was the consensus result of the manual analysis by two additional expert readers. The segmentation performance of the DL algorithm and the correlation and agreement between the automated measurement and the reference standard were assessed. Interobserver agreement among the four radiologists was analyzed. Results: DL successfully segmented the myocardium in 99.3% of slices in the native T1 map and 89.8% of slices in the post-T1 map with Dice similarity coefficients of 0.86 ± 0.05 and 0.74 ± 0.17, respectively. Native T1 and ECV showed strong correlation and agreement between DL and the reference: for T1, r = 0.967 (95% confidence interval [CI], 0.951–0.978) and bias of 9.5 msec (95% limits of agreement [LOA], -23.6–42.6 msec); for ECV, r = 0.987 (95% CI, 0.980–0.991) and bias of 0.7% (95% LOA, -2.8%–4.2%) on per-subject basis. Agreements between DL and each of the four radiologists were excellent (intraclass correlation coefficient [ICC] of 0.98–0.99 for both native T1 and ECV), comparable to the pairwise agreement between the radiologists (ICC of 0.97–1.00 and 0.99–1.00 for native T1 and ECV, respectively). Conclusion The DL algorithm allowed automated T1 and ECV measurements comparable to those of radiologists.

PURPOSE: We investigate biases in the assessments of left ventricular function (LVF), by compressed sensing (CS)-cine magnetic resonance imaging (MRI). MATERIALS AND METHODS: Cardiovascular cine images with short axis view, were obtained for 8 volunteers without CS. LVFs were assessed with subsampled data, with compression factors (CF) of 2, 3, 4, and 8. A semi-automatic segmentation program was used, for the assessment. The assessments by 3 CS methods (ITSC, FOCUSS, and view sharing (VS)), were compared to those without CS. Bland-Altman analysis and paired t-test were used, for comparison. In addition, real-time CS-cine imaging was also performed, with CF of 2, 3, 4, and 8 for the same volunteers. Assessments of LVF were similarly made, for CS data. A fixed compensation technique is suggested, to reduce the bias. RESULTS: The assessment of LVF by CS-cine, includes bias and random noise. Bias appeared much larger than random noise. Median of end-diastolic volume (EDV) with CS-cine (ITSC or FOCUSS) appeared −1.4% to −7.1% smaller, compared to that of standard cine, depending on CF from (2 to 8). End-systolic volume (ESV) appeared +1.6% to +14.3% larger, stroke volume (SV), −2.4% to −16.4% smaller, and ejection fraction (EF), −1.1% to −9.2% smaller, with P < 0.05. Bias was reduced from −5.6% to −1.8% for EF, by compensation applied to real-time CS-cine (CF = 8). CONCLUSION: Loss of temporal resolution by adopting missing data from nearby cardiac frames, causes an underestimation for EDV, and an overestimation for ESV, resulting in underestimations for SV and EF. The bias is not random. Thus it should be removed or reduced for better diagnosis. A fixed compensation is suggested, to reduce bias in the assessment of LVF.
Bias (Epidemiology) ; Compensation and Redress ; Diagnosis ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine ; Noise ; Stroke Volume ; Ventricular Function, Left ; Volunteers

BACKGROUND AND OBJECTIVES: The conventional transseptal transsphenoidal approach can inhibit visualization of the surgical field and may change the shape of external nose. We used the transseptal transsphenoidal technique to remove septal cartilage except the L strut via a modified Killian's incision and preserved the ‘key-stone area.’ The aim of this study was to verify the usefulness of this technique. SUBJECTS AND METHOD: Retrospective analysis was carried out on 42 pituitary tumor patients who received this technique by a single otolaryngologist from March 2005 to March 2012 at Kangbuk Samsung Hospital. RESULTS: The mean patient age at time of surgery was 52 years, and 41 cases were pituitary adenoma and 1 was Rathke's cleft cyst. Three patients had undergone prior surgery; of which 2 used a pterional approach and 1 a transsphenoidal approach. With regard to complication, there were 2 cases of CSF leakage and 5 cases of septal laceration. There were no cases of meningitis, deformity of external nose, septal perforation, anosmia, or sinusitis. In post operation follow up, 25 cases (59.5%) had no residual tumor, while 17 cases (40.5%) had residual tumor. CONCLUSION: This study reveals that transseptal transsphenoidal surgery with septal cartilage removal and a replacement technique for a pituitary tumor are effective, allow easy exposure, and result in a low complication rate.
Cartilage ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Lacerations ; Meningitis ; Methods ; Neoplasm, Residual ; Nose ; Olfaction Disorders ; Pituitary Neoplasms ; Retrospective Studies ; Sinusitis

Acute gastroenteritis is common infectious disease in community in adults. This work represents an update of ‘Clinical guideline for the diagnosis and treatment of gastrointestinal infections’ that was developed domestically in 2010. The recommendation of this guideline was developed regarding the following; epidemiological factors, test for diagnosis, the indications of empirical antibiotics, and modification of antibiotics after confirming pathogen. Ultimately, it is expected to decrease antibiotic misuse and prevent antibiotic resistance.

BACKGROUND: Acute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID. MATERIALS AND METHODS: This population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded. RESULTS: The study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 – 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%). CONCLUSION This study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.

No abstract available.
Anomia* ; Cognition Disorders* ; Hypoglycemia

Hypereosinophilic syndrome is a rare disorder involving the eosin concentration being elevated to more than 1500/µL in the peripheral blood for 6 months, and it causes various complications in the heart, skin, and nervous and respiratory systems. The simultaneous occurrence of neurological complications of hypereosinophilic syndrome is rare. Here we report a patient with hypereosinophilic syndrome who suffered from acute cerebral infarction and peripheral neuropathy during the same period.
Cerebral Infarction* ; Eosine Yellowish-(YS) ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Peripheral Nervous System Diseases* ; Respiratory System ; Skin

BACKGROUND AND OBJECTIVES: This trial evaluated the safety and efficacy of the Genoss drug-eluting coronary stent. METHODS: This study was a prospective, multicenter, randomized trial with a 1:1 ratio of Genoss drug-eluting stent (DES)™ and Promus Element™. Inclusion criteria were the presence of stable angina, unstable angina, or silent ischemia. Angiographic inclusion criteria were de novo coronary stenotic lesion with diameter stenosis >50%, reference vessel diameter of 2.5–4.0 mm, and lesion length ≤40 mm. The primary endpoint was in-stent late lumen loss at 9-month quantitative coronary angiography follow-up. Secondary endpoints were in-segment late lumen loss, binary restenosis rate, death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis during 9 months of follow-up. RESULTS: We enrolled 38 patients for the Genoss DES™ group and 39 patients for the Promus Element™ group. In-stent late lumen loss at 9 months was not significantly different between the 2 groups (0.11±0.25 vs. 0.16±0.43 mm, p=0.567). There was no MI or stent thrombosis in either group. The rates of death (2.6% vs. 0%, p=0.494), TLR (2.6% vs. 2.6%, p=1.000), and TVR (7.9% vs. 2.6%, p=0.358) at 9 months were not significantly different. CONCLUSION: This first-in-patient study of the Genoss DES™ stent showed excellent angiographic outcomes for in-stent late lumen loss and major adverse cardiac events over a 9-month follow-up.
Angina, Stable ; Angina, Unstable ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Ischemia ; Mortality ; Myocardial Infarction ; Polymers* ; Prospective Studies ; Sirolimus ; Stents* ; Thrombosis