Although WHO declared the end of the public health emergency for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), XBB lineages continue to evolve and emerge globally. In particular, XBB.1.5 and XBB.1.16 are raising concerns because of their high immune evasion, leading to apprehensions regarding vaccine efficacy reduction and potential reinfection. We aimed to investigate the COVID-19 outbreak in Korea and predict the likelihood of reinfection by testing neutralizing activity against live viruses from the S clade and 19 Omicron sublineages.We found a significant risk of infection with the currently prevalent XBB lineage for individuals who were either vaccinated early or infected during the initial Omicron outbreak. Vaccinated individuals were better equipped than unvaccinated individuals to produce neutralizing antibodies for other SARS-CoV-2 variants upon infection. Therefore, unvaccinated individuals do not easily develop neutralizing activity against other variants and face the highest risk of reinfection by the XBB lineage. Our study provides important information to facilitate the development of strategies for monitoring populations that would be the most susceptible to new COVID-19 outbreaks.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Background/Aims: Combination immunotherapy, exemplified by atezolizumab plus bevacizumab, has become the standard of care for inoperable hepatocellular carcinoma (HCC). However, the lack of predictive biomarkers and limited understanding of response mechanisms remain a challenge. Methods: Using data from the IMbrave150plus cohort, we applied an immune signature score (ISS) predictor to stratify HCC patients treated with atezolizumab plus bevacizumab or with sorafenib alone into potential high and low response groups. By applying multiple statistical approaches including a Bayesian covariate prediction algorithm, we refined the signature to 10 key genes (ISS10) for clinical use while maintaining similar predictive power to the full model. We further validated ISS10 in an independent HCC cohort treated with nivolumab plus ipilimumab. Results: The study identified a significant association between the ISS and treatment response. Among patients classified as high responders, those treated with the atezolizumab plus bevacizumab combination exhibited improved overall and progression-free survival as well as better objective response rate compared to those treated with sorafenib. We also observed a significant correlation between ISS10 and response to nivolumab plus ipilimumab treatment. Analysis of immune cell subpopulations revealed distinct characteristics associated with ISS subtypes. In particular, the ISS10 high subtype displayed a more favorable immune environment with higher proportions of antitumor macrophages and activated T-cells, potentially explaining its better response. Conclusions Our study suggests that ISS and ISS10 are promising predictive biomarkers for enhanced therapeutic outcomes in HCC patients undergoing combination immunotherapy. These markers are crucial for refining patient stratification and personalized treatment approaches to advance the effectiveness of standard-of-care regimens.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Background: To analyze the outcomes of clipping and coiling for ruptured intracranial aneurysms (RIAs) based on data from the National Health Insurance Service in South Korea, with a focus on variations according to region and hospital size. Methods: This study analyzed the one-year mortality rates for patients with RIAs who underwent clipping or coiling in 2018. Coiling was further categorized into non-stent assisted coiling (NSAC) and stent assisted coiling (SAC). Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs), or semi-general hospitals (sGHs) based on size. South Korea’s administrative districts were divided into 15 regions for analysis. Results: In 2018, there were 2,194 (33.1%) clipping procedures (TRGH, 985; GH, 827; sGH, 382) and 4,431 (66.9%) coiling procedures (TRGH, 1,642; GH, 2076; sGH, 713) performed for RIAs treatment. Among hospitals performing more than 20 treatments, the one-year mortality rates following clipping or coiling were 11.2% and 16.0%, respectively, with no significant difference observed. However, there was a significant difference in one-year mortality between NSAC and SAC (14.3% vs. 19.5%, P = 0.034), with clipping also showing significantly lower mortality compared to SAC (P = 0.019). No significant differences in other treatment modalities were observed according to hospital size, but clipping at TRGHs had significantly lower mortality than at GHs (P = 0.042). While no significant correlation was found between the number of treatments and outcomes at GHs, at TRGHs, a higher volume of clipping procedures was significantly associated with lower total mortality (P = 0.023) and mortality after clipping (P = 0.022). Conclusion Using Korea NHIS data, mortality rates for RIAs showed no significant variation by hospital size due to coiling’s prevalence. However, differences in clipping outcomes by hospital size and volume in TRGH highlight the need for national efforts to improve clipping skills and standardization. Additionally, the higher mortality rate with SAC emphasizes the importance of precise indications for its application.