Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications. Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO2), and sleep position proportions. These were compared across different OSA severity levels—mild, moderate, and severe—to assess differences between the POSA and non-POSA groups. Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO2 of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%). Conclusion Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications. Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO2), and sleep position proportions. These were compared across different OSA severity levels—mild, moderate, and severe—to assess differences between the POSA and non-POSA groups. Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO2 of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%). Conclusion Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications. Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO2), and sleep position proportions. These were compared across different OSA severity levels—mild, moderate, and severe—to assess differences between the POSA and non-POSA groups. Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO2 of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%). Conclusion Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by fat accumulation in the liver. MASLD encompasses both steatosis and MASH. Since MASH can lead to cirrhosis and liver cancer, steatosis and MASH must be distinguished during patient treatment. Here, we investigate the genomes, epigenomes, and transcriptomes of MASLD patients to identify signature gene set for more accurate tracking of MASLD progression. Methods: Biopsy-tissue and blood samples from patients with 134 MASLD, comprising 60 steatosis and 74 MASH patients were performed omics analysis. SVM learning algorithm were used to calculate most predictive features. Linear regression was applied to find signature gene set that distinguish the stage of MASLD and to validate their application into independent cohort of MASLD. Results: After performing WGS, WES, WGBS, and total RNA-seq on 134 biopsy samples from confirmed MASLD patients, we provided 1,955 MASLD-associated features, out of 3,176 somatic variant callings, 58 DMRs, and 1,393 DEGs that track MASLD progression. Then, we used a SVM learning algorithm to analyze the data and select the most predictive features. Using linear regression, we identified a signature gene set capable of differentiating the various stages of MASLD and verified it in different independent cohorts of MASLD and a liver cancer cohort. Conclusions We identified a signature gene set (i.e., CAPG, HYAL3, WIPI1, TREM2, SPP1, and RNASE6) with strong potential as a panel of diagnostic genes of MASLD-associated disease.

Background: Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. Objective: This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. Methods: We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. Results: The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. Conclusion No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.

Background: Patients with atopic dermatitis (AD) have an impaired quality of life (QoL). To our knowledge, impairments in mental health status and health-related QoL (HRQoL) have not yet been evaluated in adult-onset and child-onset AD in a large-scale study. Objective: This study compared the mental health status and HRQoL (using the EuroQoL [EQ] five-dimensional [5D] questionnaire) in child-onset AD and adult-onset AD to those in normal controls. Methods: We used nationwide, population-based, cross-sectional data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2013. We performed multiple logistic regression analyses with adjustments for age, sex, body mass index, income, education level, drinking status, current smoking, regular exercise, diabetes mellitus, hypertension, and dyslipidemia, and analyzed odds ratios (OR) for factors associated with impaired QoL. Results: The OR for strong psychological stress, depressed mood, and suicidal ideation were significantly increased in adult-onset AD patients compared to in normal controls.In addition, the OR (95% confidence interval [CI]) values for the EQ-5D questionnaire responses (for physical activity, self-control, daily activities, pain/discomfort, and anxiety/ depression) were significantly high in adult-onset AD compared to in normal controls after adjustments for covariates. However, patients with child-onset AD showed a significantly increased OR (95% CI) only for problems in pain/discomfort in the EQ-5D questionnaire. Conclusion Adult-onset AD patients suffer from impaired HRQoL and significant mental problems compared to normal controls. Dermatologists should focus not only on the clinical phenotype but also patients’ psychological health status to ensure a better treatment outcome.

Purpose: The purpose of this paper is to study the epidemiologic series of Tsutsugamushi disease (TD), also known as scrub typhus in the Republic of Korea (Korea) and Japan. Methods: We investigated raw data of TD outbreaks from the National Notifiable Disease Surveillance System of the Korea Diseases Control and Prevention Agency in Korea, and the National Institute of Infectious Diseases in Japan, 2016 to 2020. Results: There were 36,785 cases of TD with a cumulative infectious rate (CIR) of 14.3 per 100,000 populations in Korea from 2016 to 2020. During the same period in Japan, there were 2,350 cases with a CIR of 0.4. When compared, Korea was much higher than that in Japan (P<0.01). In Korea, more females (60.2% of total cases) were infected than males (39.8%), while there was a significant difference between males (58.8%) and females (41.2%) in Japan, respectively (P<0.01). Conclusion These differences in TD risk factors reflect differences of vectors/hosts, climate, and geographical and cultural characteristics between the two countries. The surveillance of TD, primarily a zoonotic disease, should be continued in order to obtain a better understanding of its current status. Moreover, guidelines for the prevention of TD, and its control measures should be more established.

Objective: To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data. Methods: This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted. Results: No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003). Conclusion The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.

Background: and Purpose: Blood pressure (BP) control is strongly recommended, but BP control rate has not been well studied in patients with stroke. We evaluated the BP control rate with fimasartan-based antihypertensive therapy initiated in patients with recent cerebral ischemia. Methods: This multicenter, prospective, single-arm trial involved 27 centers in South Korea. Key inclusion criteria were recent cerebral ischemia within 90 days and high BP [systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg]. BP lowering was initiated with fimasartan. BP management during the follow-up was at the discretion of the responsible investigators. The primary endpoint was the target BP goal achievement rate (<140/90 mm Hg) at 24 weeks. Key secondary endpoints included achieved BP and BP changes at each visit, and clinical events (ClinicalTrials.gov Identifier: NCT03231293). Results: Of 1,035 patients enrolled, 1,026 were included in the safety analysis, and 951 in the efficacy analysis. Their mean age was 64.1 years, 33% were female, the median time interval from onset to enrollment was 10 days, and the baseline SBP and DBP were 162.3±16.0 and 92.2±12.4 mm Hg (mean±SD). During the study period, 55.5% of patients were maintained on fimasartan monotherapy, and 44.5% received antihypertensive therapies other than fimasartan monotherapy at at least one visit. The target BP goal achievement rate at 24-week was 67.3% (48.6% at 4-week and 61.4% at 12-week). The mean BP was 139.0/81.8±18.3/11.7, 133.8/79.2±16.4/11.0, and 132.8/78.5±15.6/10.9 mm Hg at 4-, 12-, and 24-week. The treatment-emergent adverse event rate was 5.4%, including one serious adverse event. Conclusions Fimasartan-based BP lowering achieved the target BP in two-thirds of patients at 24 weeks, and was generally well tolerated.