Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

Background: Pulse pressure, reflecting arterial wall stiffness, is a cardiovascular disease risk factor but is highly variable. This study investigated the association of the pulse pressure index (PPI) with 10-year cardiovascular disease risk and its clinical utility by examining its correlations with diabetes mellitus (DM) and chronic kidney disease (CKD). Methods: This cross-sectional study included 3,604 hypertensive adults (30–79 years) from the 2019–2021 Korea National Health and Nutrition Examination Survey. We categorized PPI as <30, 30 to 40, 40 to 50, and ≥50. The Framingham risk score assessed 10-year cardiovascular disease risk, and multiple regressions analyzed its relationship with the PPI category. Binary logistic regressions evaluated the relationship between PPI, DM, and CKD. Results: Adjusted for other variables, higher PPI levels are associated with an increased 10-year cardiovascular disease risk (P<0.001). PPI ≥50 was associated with CKD, and all PPI groups, except <30, were associated with DM. Conclusion PPI predicts 10-year CVD risk and is associated with DM presence. PPI can be considered a risk factor for both cardiovascular disease and DM. Additionally, PPI ≥50 is associated with CKD.

According to recent evidence, ferroptosis is a major cell death mechanism in the pathogenesis of kidney injury and fibrosis.Despite the renoprotective effects of classical ferroptosis inhibitors, therapeutic approaches targeting kidney ferroptosis remain limited. In this study, we assessed the renoprotective effects of melatonin and zileuton as a novel therapeutic strategy against ferroptosis-mediated kidney injury and fibrosis. First, we identified RSL3-induced ferroptosis in renal tubular epithelial HK-2 and HKC-8 cells. Lipid peroxidation and cell death induced by RSL3 were synergistically mitigated by the combination of melatonin and zileuton. Combination treatment significantly downregulated the expression of ferroptosis-associated proteins, 4-HNE and HO-1, and upregulated the expression of GPX4. The expression levels of p-AKT and p-mTOR also increased, in addition to that of NRF2 in renal tubular epithelial cells. When melatonin (20 mg/kg) and zileuton (20 mg/kg) were administered to a unilateral ureteral obstruction (UUO) mouse model, the combination significantly reduced tubular injury and fibrosis by decreasing the expression of profibrotic markers, such as α-SMA and fibronectin. More importantly, the combination ameliorated the increase in 4-HNE levels and decreased GPX4 expression in UUO mice. Overall, the combination of melatonin and zileuton was found to effectively ameliorate ferroptosis-related kidney injury by upregulating the AKT/mTOR/ NRF2 signaling pathway, suggesting a promising therapeutic strategy for protection against ferroptosis-mediated kidney injury and fibrosis.

Background/Aims: Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019. Methods: The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions. Results: The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitison-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY. Conclusions Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs.SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.

BACKGROUND AND OBJECTIVES: The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases.SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. RESULTS: Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. CONCLUSION For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.

BACKGROUND AND OBJECTIVES: Dizzy patients with abnormal otolith function tests, despite a normal caloric response, are defined as having specific (isolated) otolith organ dysfunction. This study was performed to compare the differences in clinical presentation between isolated otolith dysfunction (iOD) patients with lab- and Sx-based iOD group and lab-based iOD symptoms. SUBJECTS AND METHODS: The medical records of 23 iOD patients with normal caloric response but abnormal cervical vestibular evoked myogenic potential (VEMP), ocular VEMP, or subjective visual vertical were reviewed. Non-spinning vertigo was considered as otolith-related symptoms. The patients’ age, onset of dizziness, Numeric Rating Scale on the severity of dizziness, and concomitant vestibular disorders were analyzed. RESULTS: Patients in the lab-based iOD group were significantly older than those in the lab- and Sx-based iOD group. Known vestibular disorders were significantly more common in the lab-based iOD group (83.3%) compared to the lab- and Sx-based iOD group (18.2%). Despite the normal caloric response, catch-up saccade was found in the video head impulse test in more than half (54.5%) of the lab-based iOD group patients. There was no catch-up saccade in the lab- and Sx-based iOD group. There were no significant differences in gender ratio, frequency of dizziness attacks, and duration of illness. CONCLUSIONS: We propose new definitions of definite iOD (lab- and Sx-based iOD) and probable iOD (lab- or Sx-based iOD). These new definitions may help researchers to identify patients who are more likely to have true iOD, and facilitate comparisons of results between different studies.
Dizziness ; Head Impulse Test ; Humans ; Medical Records ; Otolaryngology ; Otolithic Membrane ; Saccades ; Vertigo

BACKGROUND AND OBJECTIVES: The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases. SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. RESULTS: Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. CONCLUSION: For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.
Humans ; Mandibular Advancement ; Medical Records ; Methods ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea, Obstructive ; Snoring ; Visual Analog Scale