Objective: This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required. Methods: An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed. Results: PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator. Conclusion PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.

Background and Objectives: Several real-world studies have been done in patients with nonvalvular atrial fibrillation (NVAF); however, information on its safety profile in patients with renal impairment is limited. XARENAL, a real-world study, aimed to prospectively investigate the safety profile of rivaroxaban in patients with NVAF with renal impairment (creatinine clearance [CrCl], 15–49 mL/min). Methods: XARENAL is an observational single-arm cohort study in renal impairment NVAF patients. Patients were followed up approximately every 3 months for 1 year or until 30 days following early discontinuation. The primary endpoint was major bleeding events. All adverse events, symptomatic thromboembolic events, treatment duration, and renal function change from baseline were the secondary endpoints. Results: XARENAL included 888 patients from 29 study sites. Overall, 713 (80.3%) had moderate renal impairment (CrCl, 30–49 mL/min), and 175 (19.7%) had severe renal impairment (CrCl, 15–29 mL/min) with a mean estimated glomerular filtration rate (eGFR) of 45.2±13.0 mL/min/1.73 m 2 . The mean risk scores were 3.3±1.4 and 1.7±0.9 for CHA 2 DS 2 -VASc score and HAS-BLED score, respectively. An incidence proportion of 5.6% (6.2 events per 100 patient-years) developed major bleeding; however, fatal bleeding occurred in 0.5% (0.5 events per 100 patient-years). The mean change in the eGFR was 2.22±26.47 mL/min/1.73 m 2 per year. Conclusions XARENAL observed no meaningful differences in major bleeding events from other previous findings as well as renal function changes in rivaroxaban-treated NVAF patients with renal impairment, which is considered to be acceptable in clinical practice.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background and Objectives: Cigarette smoking is a major risk factor for atherosclerosis.Nicotine, a crucial constituent of tobacco, contributes to atherosclerosis development and progression. However, evidence of the association between nicotine and neointima formation is limited. We aimed to evaluate whether nicotine enhances neointimal hyperplasia in the native epicardial coronary arteries of pigs after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods: After coronary angiography (CAG) and quantitative coronary angiography (QCA), we implanted 20 DES into 20 pigs allocated to 2 groups: no-nicotine (n=10) and nicotine (n=10) groups. Post-PCI CAG and QCA were performed immediately. Follow-up CAG, QCA, optical coherence tomography (OCT), and histopathological analyses were performed 2 months post-PCI. Results: Despite intergroup similarities in the baseline QCA findings, OCT analysis showed that the nicotine group had a smaller mean stent and lumen areas, a larger mean neointimal area, greater percent area stenosis, and higher peri-strut fibrin and inflammation scores than the no-nicotine group. In immunofluorescence analysis, the nicotine group displayed higher expression of CD68 and α-smooth muscle actin but lower CD31 expression than the no-nicotine group. Conclusions Nicotine inhibited re-endothelialization and promoted inflammation and NIH after PCI with DES in a porcine model.

Background/Aims: The Korean guidelines for Helicobacter pylori treatment were revised in 2020, however, the extent of adherence to these guidelines in clinical practice remains unclear. Herein, we initiated a prospective, nationwide, multicenter registry study in 2021 to evaluate the current management of H.pylori infection in Korea. Methods: This interim report describes the adherence to the revised guidelines and their impact on firstline eradication rates. Data on patient demographics, diagnoses, treatments, and eradication outcomes were collected using a web-based electronic case report form. Results: A total of 7,261 patients from 66 hospitals who received first-line treatment were analyzed.The modified intention-to-treat eradication rate for first-line treatment was 81.0%, with 80.4% of the prescriptions adhering to the revised guidelines. The most commonly prescribed regimen was the 14-day clarithromycin-based triple therapy (CTT; 42.0%), followed by tailored therapy (TT; 21.2%), 7-day CTT (14.1%), and 10-day concomitant therapy (CT; 10.1%). Time-trend analysis demonstrated significant increases in guideline adherence and the use of 10-day CT and TT, along with a decrease in the use of 7-day CTT (all p<0.001). Multivariate logistic regression analysis revealed that guideline adherence was significantly associated with first-line eradication success (odds ratio, 2.03; 95% confidence interval, 1.61 to 2.56; p<0.001). Conclusions The revised guidelines for the treatment of H. pylori infection have been increasingly adopted in routine clinical practice in Korea, which may have contributed to improved first-line eradication rates. Notably, the 14-day CTT, 10-day CT, and TT regimens are emerging as the preferred first-line treatment options among Korean physicians.

Purpose: This study aimed to develop a magnetic resonance imaging (MRI)–based radiomics model to predict high-risk pathologic features for lung adenocarcinoma: micropapillary and solid pattern (MPsol), spread through air space, and poorly differentiated patterns. Materials and Methods: As a prospective study, we screened clinical N0 lung cancer patients who were surgical candidates and had undergone both 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) and chest CT from August 2018 to January 2020. We recruited patients meeting our proposed imaging criteria indicating high-risk, that is, poorer prognosis of lung adenocarcinoma, using CT and FDG PET/CT. If possible, these patients underwent an MRI examination from which we extracted 77 radiomics features from T1-contrast-enhanced and T2-weighted images. Additionally, patient demographics, maximum standardized uptake value on FDG PET/CT, and the mean apparent diffusion coefficient value on diffusion-weighted image, were considered together to build prediction models for high-risk pathologic features. Results: Among 616 patients, 72 patients met the imaging criteria for high-risk lung cancer and underwent lung MRI. The magnetic resonance (MR)–eligible group showed a higher prevalence of nodal upstaging (29.2% vs. 4.2%, p < 0.001), vascular invasion (6.5% vs. 2.1%, p=0.011), high-grade pathologic features (p < 0.001), worse 4-year disease-free survival (p < 0.001) compared with non-MR-eligible group. The prediction power for MR-based radiomics model predicting high-risk pathologic features was good, with mean area under the receiver operating curve (AUC) value measuring 0.751-0.886 in test sets. Adding clinical variables increased the predictive performance for MPsol and the poorly differentiated pattern using the 2021 grading system (AUC, 0.860 and 0.907, respectively). Conclusion Our imaging criteria can effectively screen high-risk lung cancer patients and predict high-risk pathologic features by our MR-based prediction model using radiomics.

Objective: This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required. Methods: An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed. Results: PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator. Conclusion PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.

Objective: This study aimed to identify the factors contributing to post-traumatic growth (PTG) among nurses who experienced patient death during the coronavirus disease-2019 (COVID-19) pandemic and to evaluate the necessity of grief support is required. Methods: An online survey was conducted to assess the experiences of nurses at Ulsan University Hospital who lost patients during the past year of the pandemic. In total, 211 nurses were recruited. We obtained information on the participants’ demographic and clinical characteristics. For symptoms rating, we used the following scales: the Post-traumatic Growth Inventory (PTGI), Stress and Anxiety to Viral Epidemic-9 (SAVE-9), Patient Health Questionnaire (PHQ-9), Pandemic Grief Scale (PGS), and Utrecht Grief Rumination Scale (UGRS), and Grief Support in Healthcare Scale (GSHCS). Pearson’s correlation coefficients, linear regression, and mediation analysis were employed. Results: PTGI scores were significantly correlated with the SAVE-9 (r=0.31, p<0.01), PHQ-9 (r=0.31, p<0.01), PGS (r=0.28, p<0.01), UGRS (r=0.45, p<0.01), and GSHCS scores (r=0.46, p<0.01). The linear regression analysis revealed the factors significantly associated with PTGI scores: SAVE-9 (β=0.16, p=0.014), UGRS (β=0.29, p<0.001), and GSHCS (β=0.34, p<0.001). The mediation analysis revealed that nurses’ stress and anxiety about COVID-19 and grief rumination had a direct impact on PTG, with grief support serving as a significant mediator. Conclusion PTG was promoted by increases in the medical staff’s anxiety and stress related to COVID-19, grief rumination, and grief support. For the medical staff’s experience of bereavement to result in meaningful personal and professional growth, family members, colleagues, and other associates should provide thoughtful support.