Magnetically responsive micro-clustered calcium phosphate-reinforced cell-laden microbead sodium alginate hydrogel for accelerated osteogenic tissue regeneration.

The rising prevalence of bone injuries has increased the demand for minimally invasive treatments. Microbead hydrogels, renowned for cell encapsulation, provide a versatile substrate for bone tissue regeneration. They deliver bioactive agents, support cell growth, and promote osteogenesis, aiding bone repair and regeneration. In this study, we synthesized superparamagnetic iron oxide nanoparticles (Sp) coated with a calcium phosphate layer (m-Sp), achieving a distinctive flower-like micro-cluster morphology. Subsequently, sodium alginate (SA) microbead hydrogels containing m-Sp (McSa@m-Sp) were fabricated using a dropping gelation strategy. McSa@m-Sp is magnetically targetable, enhance cross-linking, control degradation rates, and provide strong antibacterial activity. Encapsulation studies with MC3T3-E1 cells revealed enhanced viability and proliferation. These studies also indicated significantly elevated alkaline phosphatase (ALP) activity and mineralization in MC3T3-E1 cells, as confirmed by Alizarin Red S (ARS) and Von Kossa staining, along with increased collagen production within the McSa@m-Sp microbead hydrogels. Immunocytochemistry (ICC) and gene expression studies supported the osteoinductive potential of McSa@m-Sp, showing increased expression of osteogenic markers including RUNX-2, collagen-I, osteopontin, and osteocalcin. Thus, McSa@m-Sp microbead hydrogels offer a promising strategy for multifunctional scaffolds in bone tissue engineering.

Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks.

BACKGROUND: Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups METHODS: This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization. RESULTS: Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes. CONCLUSIONS: The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250).

Nanoscale Polishing Technique of Biomedical Grade NiTi Wire by Advanced MAF Process: Relationship between Surface Roughness and Bacterial Adhesion.

Nitinol (NiTi), an alloy of nickel and titanium, wires are an important biomedical material that has been used in catheter tubes, guidewires, stents, and other surgical instruments. As such wires are temporarily or permanently inserted inside the human body, their surfaces need to be smoothed and cleaned in order to prevent wear, friction, and adhesion of bacteria. In this study, NiTi wire samples of micro-scale diameters (i.e., Ø 200 µm and Ø 400 µm) were polished by an advanced magnetic abrasive finishing (MAF) process using a nanoscale polishing method. Furthermore, bacterial adhesion (i.e., Escherichia coli (E. coli), and Staphylococcus aureus (S. aureus)) to the initial and final surfaces of NiTi wires were investigated and compared in order to assess the impact of surface roughness on bacterial adhesion to the surfaces of NiTi wires. The finding revealed that the surfaces of NiTi wires were clean and smooth with a lack of particle impurities and toxic components on the final surface polished using the advanced MAF process. The surface roughness Ra values of the Ø 200 µm and Ø 400 µm NiTi wires were smoothly enhanced to 20 nm and 30 nm from the 140 nm and 280 nm initial surface roughness values. Importantly, polishing the surfaces of a biomedical material such as NiTi wire to nano-level roughness can significantly reduce bacterial adhesion on the surface by more than 83.48% in the case of S. aureus, while in the case of E. coli was more than 70.67%.

Polyvinylidene fluoride/silk fibroin-based bio-piezoelectric nanofibrous scaffolds for biomedical application.

Since the discovery that applying electrical stimulation can promote cell growth, proliferation, and tissue regeneration, research on bio-piezoelectric materials is being actively conducted. In this study, a composite material was prepared by mixing polyvinylidene fluoride (PVDF), a conventional piezoelectric polymer, and silk fibroin (SF), a natural piezoelectric material that recently attracting attention. These two polymers were fabricated into a composite fiber mat using electrospinning technology. To find optimal conditions, SF was added in various ratios to prepare electrospun PVDF/SF mats. The characteristics of these PVDF/SF composite mats were then analyzed through various evaluations and in vitro studies. It was confirmed that PVDF and SF were successfully mixed through scanning electron microscope images and structural analysis such as x-ray diffractometer and Fourier transform infrared. The results revealed that adding an appropriate amount of SF could improve the tensile strength, enhance cell proliferation rate, and generate a voltage similar to that of a conventional PVDF-only electrospinning mat. Such fabricated electrospun PVDF/SF composite mats are expected to be useful in the bio-piezoelectric field because they can maintain piezoelectricity while compensating for the shortcomings, such as low physical properties, of a PVDF electrospun mat.

Annual incidence and prevalence of obesity in childhood and young adulthood based on a 30-year longitudinal population-based cohort study in Korea: the Kangwha study.

PURPOSE: Childhood obesity is a major global issue that causes a variety of health problems and high social costs. Many previous studies have investigated childhood obesity using cross-sectional data, but few longitudinal cohort studies have been performed, especially in the Korean population. METHODS: We analyzed the incidence and prevalence of obesity and overweight in a Korean prospective cohort study of children that were followed-up from age 7 to age 36. The study eventually recruited a total of 1216 participants, with 16 follow-up surveys over 30 years (1986-2017). RESULTS: The annual incidence of obesity showed a small peak (2.1%) at age 13 when the cohort entered middle school, but a rapid increase (6.4%) when participants reached the age of 20. The prevalence of obesity and overweight at age 8 was 0.8% and 0.9%, respectively, and increased rapidly from age 12 (obesity 2.2%, overweight 4.6%), reaching 9.5% and 15.9%, respectively, at age 20. The prevalence of obesity and overweight was consistently higher in girls than in boys during the childhood period, but this trend reversed in adulthood. CONCLUSIONS: Incidence and prevalence of obesity and overweight increased markedly after the final grades of elementary school in females, but after adolescence in males.

Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI).Methods and Results:As a post hoc analysis of the SMART-DATE trial, effects of ≥12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the ≥12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of ≥12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; Pinteraction=0.718). In addition, ≥12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; Pinteraction=0.885) patients. CONCLUSIONS: Compared with 6-month DAPT, ≥12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.

Clinical Usefulness of PRECISE-DAPT Score for Predicting Bleeding Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: An Analysis From the SMART-DATE Randomized Trial.

BACKGROUND: Although the current guidelines endorse the PRECISE-DAPT score (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) to inform clinical decisions regarding duration of DAPT in patients undergoing percutaneous coronary intervention, use of the PRECISE-DAPT score to guide duration of DAPT has not been properly validated by randomized trials focused on the population with acute coronary syndrome. This study aimed to evaluate the usefulness of the PRECISE-DAPT score for predicting future bleeding and ischemic events and to compare clinical outcomes of short-term and long-term DAPT duration according to the PRECISE-DAPT score in patients with acute coronary syndrome. METHODS: This was a substudy of the SMART-DATE trial (6- Versus 12-Month or Longer Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome), in which patients with acute coronary syndrome undergoing percutaneous coronary intervention were randomly assigned to either 6- (n=1357) or 12-month or longer DAPT (n=1355). Major bleeding (Bleeding Academic Research Consortium type 3-5) and ischemic (myocardial infarction, stent thrombosis, or ischemic stroke) events at 18 months after the index procedure were compared between the 6- and 12-month or longer DAPT groups, according to PRECISE-DAPT score. RESULTS: The PRECISE-DAPT score was moderately effective at predicting bleeding events (area under the curve, 0.754 [95% CI, 0.655-0.854]; P<0.001). In patients with nonhigh PRECISE-DAPT score (<25, n=1967 [72.5%]), 6-month DAPT was associated with higher ischemic risk (2.7% versus 1.3%; HR, 2.01 [95% CI, 1.03-3.91]; P=0.040; absolute risk difference, +1.3%; P=0.035) with similar bleeding risk (0.4% versus 0.3%; HR, 2.00 [95% CI, 0.37-10.94]; P=0.422; absolute risk difference, +0.2%; P=0.498), compared with 12-month or longer DAPT. Among patients with high PRECISE-DAPT score (≥25, n=745 [27.5%]), 6-month DAPT presented a similar ischemic risk (4.8% versus 3.4%; HR, 1.43 [95% CI, 0.68-2.98], P=0.348; absolute risk difference, +1.5%; P=0.327) but significantly reduced major bleeding risk (0.6% versus 2.3%; HR, 0.25 [95% CI, 0.05-1.17]; P=0.079; absolute risk difference, -1.7%; P=0.045). CONCLUSIONS: Consistent with current guidelines, determination of the duration of DAPT according to PRECISE-DAPT score could improve the clinical outcomes in patients with acute coronary syndrome after percutaneous coronary intervention with current-generation drug-eluting stents. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01701453.

Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke.

BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 µm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-µg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95% CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.

Age-differential association between serum uric acid and incident hypertension.

Increasing evidence suggests a positive association between the serum uric acid (SUA) level and incident hypertension. However, the association has been inconsistent based on age, sex, body mass index, and lipid profiles. Thus, we investigated whether there is an interaction between SUA and other risk factors on incident hypertension in the Korean general population. In this study, 808 participants aged 40-79 years were included. They were free of hypertension and major cardiovascular disease at baseline. Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or use of antihypertensive medication. To investigate whether the association between SUA and incident hypertension is modified by other risk factors for hypertension, a generalized linear model and Z test were used. During the mean follow-up of 3.3 years, 11.5% of men and 10.7% of women developed hypertension. The association between SUA and incident hypertension was inconsistent according to participant age (p for interaction = 0.009). The association between SUA level and incident hypertension was positively significant among people aged < 55 years (relative risk 1.74 per 1.0 mg/dL of SUA; p = 0.002), but there was no significant association among people aged ≥ 55 years (p = 0.894). In a secondary analysis, the SUA level was not associated with an increase in SBP, but positively associated with DBP. We observed an age-differential association between SUA level and incident hypertension among Koreans. An increased SUA level can be a trigger for hypertension through early vascular changes in the middle-aged population.

Association of appendicular skeletal muscle mass with carotid intima-media thickness according to body mass index in Korean adults.

OBJECTIVES: The combined effects of obesity and appendicular skeletal muscle (ASM) on atherosclerosis, especially in middleaged populations, remain poorly understood. This cross-sectional study investigated the effects of ASM on carotid intima-media thickness (IMT) according to body mass index (BMI) in middle-aged Korean adults. METHODS: Herein, 595 men and 1,274 women aged 30-64 years completed questionnaires and underwent health examinations as part of the Cardiovascular and Metabolic Disease Etiology Research Center cohort. ASM was measured via bioelectrical impedance analysis and adjusted for weight (ASM/Wt). IMT was assessed using B-mode ultrasonography; highest quartile of IMT was defined as gender-specific top quartile of the IMT values. Higher BMIs was defined as a BMI over 25.0 kg/m2 . RESULTS: Compared to the highest ASM/Wt quartile, the lowest ASM/Wt quartile was significantly associated with highest quartile of IMT in men with lower BMIs (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.09 to 7.13), but not in those with higher BMIs (aOR, 0.59; 95% CI, 0.24 to 1.91). In women, there was no significant association of low skeletal muscle mass with highest quartile of IMT, regardless of BMI. CONCLUSIONS: Low appendicular skeletal muscle mass is associated with carotid arterial wall thickening in men with lower BMIs, but not in men with higher BMIs. Our findings suggest that the risk of atherosclerosis may be low in middle-aged Korean men with appropriate body weight and skeletal muscle mass maintenance.

Triglyceride to high density lipoprotein cholesterol ratio among adolescents is associated with adult hypertension: the Kangwha study.

BACKGROUND: The triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio associated with hypertension in adults. However, whether the TG/HDL-C ratio in adolescents predicts future hypertension remains unclear. Here, we evaluated the prospective association between the TG/HDL-C ratio in adolescents and hypertension in early adulthood. METHODS: The Kangwha Study is an ongoing prospective cohort study that has tracked the blood pressure of first grade elementary school students since 1986. We followed up 272 participants who completed health examinations at the age of 16 and 35 years. We excluded 27 participants with adolescent hypertension, defined as those whose blood pressures were above the age- and sex-specific 95th percentiles of the Korean population, and finally analysed 245 participants. We defined high and low TG/HDL-C ratio groups according to the age- and sex-specific 75th percentile of the TG/HDL-C ratio (1.04 for boys and 0.81 for girls) of the Korean population. Adult hypertension was defined by a systolic/diastolic blood pressure ≥ 140/90 mmHg or by taking antihypertensive medication at the age of 35 years. Logistic regression analysis was performed to evaluate the association between adolescent TG/HDL-C ratio and adult hypertension after adjusting for age at follow-up, sex, baseline systolic blood pressure, waist circumference, and total cholesterol and fasting glucose levels. RESULTS: During the 20-year follow-up, 11 (18.3%) individuals developed hypertension in the high TG/HDL-C ratio group and 10 (5.4%) individuals developed hypertension in the low TG/HDL-C ratio group. The adjusted odds ratio for incident hypertension in the high TG/HDL-C ratio group, compared with the low TG/HDL-C ratio group, was 3.40 (95% confidence interval 1.24-9.31). CONCLUSIONS: High TG/HDL-C ratio in adolescence is associated with hypertension in early adulthood.

Aminotransferase levels, body mass index, and the risk of diabetes: a prospective cohort study.

PURPOSE: To investigate whether the relationship between body mass index (BMI) and incident diabetes is modified by different alanine or aspartate aminotransferases (ALT or AST) levels. METHODS: We carried out an analysis of 6484 participants aged 40 years or older using data from the Korean Genome Epidemiology Study. The serum aminotransferase levels were stratified into low and high groups according to the median values and classified into three groups: both low, either high, and both high. To assess the association between BMI and incident diabetes according to the serum aminotransferase levels, multiple logistic regression models were used. RESULTS: In participants with high levels of both ALT and AST, compared with the first BMI quartile, the adjusted odds ratios for incident diabetes of the second, third, and fourth BMI quartiles were 1.72 (95% confidence interval, 0.84-3.55), 2.19 (1.11-4.33), and 3.08 (1.60-5.90), respectively (P trend < .001). In participants with either high ALT or AST, the adjusted odds ratios were 3.58 (1.23-10.41), 2.65 (0.90-7.76), and 5.28 (1.86-15.02), respectively (P trend = .005). However, in participants with both low ALT and AST levels, high BMI was not independently associated with the risk of incident diabetes. CONCLUSIONS: There was a strong association between BMI and incident diabetes among individuals with high aminotransferase levels, whereas no association was observed among those with low aminotransferase levels.

Association between dry eye symptoms and suicidal ideation in a Korean adult population.

PURPOSE: This study assessed the association of dry eyes with depression and suicidal ideation in a Korean adult population. METHODS: Data from 16408 participants (6972 men and 9436 women) aged ≥ 19 years included in the fifth Korea National Health and Nutrition Examination Survey, conducted from 2010-2012, were analyzed. For dry eyes, surveys of previous diagnosis of dry eye disease (DED) by an ophthalmologist and experience of subjective dry eye symptoms were separately used. Diagnosis of depression and suicidal ideation were obtained via responses to an interviewer-assisted questionnaire, and questions were asked in a closed-ended response format. Logistic regression was used to examine the associations between dry eyes, depression, and suicidal ideation. RESULTS: DED diagnosis exhibited an odds ratio (OR) of 1.32 (95% confidence interval [CI] 1.11-1.57) for depression and 1.24 (95% CI 1.05-1.48) for suicidal ideation compared to those without DED, after adjusting for sex, age, education, occupation, household income, body mass index, smoking behavior, alcohol consumption, physical activity, hypertension, diabetes, dyslipidemia, thyroid diseases, major cardiovascular disease, and cancer. Similarly, the adjusted OR (95% CI) of dry eye symptoms was 1.50 (95% CI 1.30-1.73) for depression and 1.47 (95% CI 1.27-1.70) for suicidal ideation. CONCLUSION: Our findings suggest that dry eyes (either DED diagnosis or dry eye symptoms) may be associated with the prevalence of depression and suicidal ideation in the Korean adult population.

6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial.

BACKGROUND: Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population. METHODS: We did a randomised, open-label, non-inferiority trial at 31 centres in South Korea. Patients were eligible if they had unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction, and underwent percutaneous coronary intervention. Enrolled patients were randomly assigned, via a web-based system by computer-generated block randomisation, to either the 6-month DAPT group or to the 12-month or longer DAPT group, with stratification by site, clinical presentation, and diabetes. Assessors were masked to treatment allocation. The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke at 18 months after the index procedure in the intention-to-treat population. Secondary endpoints were the individual components of the primary endpoint; definite or probable stent thrombosis as defined by the Academic Research Consortium; and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding at 18 months after the index procedure. The primary endpoint was also analysed per protocol. This trial is registered with ClinicalTrials.gov, number NCT01701453. FINDINGS: Between Sept 5, 2012, and Dec 31, 2015, we randomly assigned 2712 patients; 1357 to the 6-month DAPT group and 1355 to the 12-month or longer DAPT group. Clopidogrel was used as a P2Y12 inhibitor for DAPT in 1082 (79·7%) patients in the 6-month DAPT group and in 1109 (81·8%) patients in the 12-month or longer DAPT group. The primary endpoint occurred in 63 patients in the 6-month DAPT group and in 56 patients in the 12-month or longer DAPT group (cumulative event rate 4·7% vs 4·2%; absolute risk difference 0·5%; upper limit of one-sided 95% CI 1·8%; pnon-inferiority=0·03 with a predefined non-inferiority margin of 2·0%). Although all-cause mortality did not differ significantly between the 6-month DAPT group and the 12-month or longer DAPT group (35 [2·6%] patients vs 39 [2·9%]; hazard ratio [HR] 0·90 [95% CI 0·57-1·42]; p=0·90) and neither did stroke (11 [0·8%] patients vs 12 [0·9%]; 0·92 [0·41-2·08]; p=0·84), myocardial infarction occurred more frequently in the 6-month DAPT group than in the 12-month or longer DAPT group (24 [1·8%] patients vs ten [0·8%]; 2·41 [1·15-5·05]; p=0·02). 15 (1·1%) patients had stent thrombosis in the 6-month DAPT group compared with ten (0·7%) in the 12-month or longer DAPT group (HR 1·50 [95% CI 0·68-3·35]; p=0·32). The rate of BARC type 2-5 bleeding was 2·7% (35 patients) in the 6-month DAPT group and 3·9% (51 patients) in the 12-month or longer DAPT group (HR 0·69 [95% CI 0·45-1·05]; p=0·09). Results from the per-protocol analysis were similar to those from the intention-to-treat analysis. INTERPRETATION: The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care. FUNDING: Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors Inc, and Dong-A ST.

Sex difference in the effect of the fasting serum glucose level on the risk of coronary heart disease.

OBJECTIVE: Diabetic women have a greater relative risk of coronary heart disease than diabetic men. However, the sex difference in the effect of fasting serum glucose levels below the diabetic range on the risk of coronary heart disease is unclear. We investigated whether the association between nondiabetic blood glucose levels and the incident risk of coronary heart disease is different between men and women. METHODS: The fasting serum glucose levels and other cardiovascular risk factors at baseline were measured in 159,702 subjects (100,144 men and 59,558 women). Primary outcomes were hospital admission and death due to coronary heart disease during the 11-year follow-up. RESULTS: The risk for coronary heart disease in women significantly increased with impaired fasting glucose levels (≥110mg/dL) compared to normal glucose levels (<100mg/dL), whereas the risk for coronary heart disease in men was significantly increased at a diabetic glucose range (≥126mg/dL). Women had a higher hazard ratio of coronary heart disease associated with the fasting serum glucose level than men (p for interaction with sex=0.021). CONCLUSIONS: The stronger effect of the fasting serum glucose levels on the risk of coronary heart disease in women than in men was significant from a prediabetic range (≥110mg/dL).

The 23-year tracking of blood lipids from adolescence to adulthood in Korea: the Kangwha study.

BACKGROUND: Several studies have examined tracking pattern of blood lipids level during long follow-up periods in Western countries. However, there have been few such studies in Asian populations. METHODS: The Kangwha Study is a community-based prospective cohort study that started in 1986 on Kangwha Island, South Korea. A total of 432 participants (47% men) were enrolled in the study, during which serum total cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol levels were measured for each participant at least once during adolescence (12-16 years of age) and again at least once during adulthood (25-35 years of age). The tracking patterns of the blood lipid levels were determined using Spearman correlation coefficients and tracking coefficients from generalized estimating equations. RESULTS: The Spearman correlation coefficients between lipid measurements ranged from 0.12 to 0.73 depending on the lipid profile and measurement time interval; all were significant (p < 0.05). The magnitude of the coefficients tended to decrease as the time interval increased. When adjusted for age, sex, body mass index, and blood pressure, the tracking coefficients were 0.58 (95% confidence interval [CI]: 0.54-0.63) for total cholesterol, 0.39 (95% CI: 0.31-0.48) for triglycerides, and 0.51 (95% CI: 0.47-0.56) for HDL cholesterol. In a subgroup analysis by sex, the tracking coefficients were higher for women than for men, except for HDL cholesterol. CONCLUSIONS: The tracking patterns of blood lipids from adolescence to adulthood were notable. This study supports the importance of measuring lipids during adolescence for identifying high-risk individuals.

Performance-Based Animation Using Constraints for Virtual Object Manipulation.

Optical motion-capture systems can be used to animate characters in real time based on human demonstrations. However, most approaches do not consider the detailed finger movements necessary for object manipulation. The proposed online motion-capture framework encourages natural motions by automatically guiding the avatar's motion toward the desired behavior based on a set of captured reference motions for the same behavior. The proposed motion controller imitates the user's finger and body gestures to enable performance-based animation of human avatars that can manipulate virtual objects in real time.

Association between Mean Corpuscular Hemoglobin Concentration and Future Depressive Symptoms in Women.

Insufficient hemoglobin and depression share several symptoms and often occur in the same patients. Here, we sought to clarify their relationship by investigating two indices of oxygenation at the tissue level: mean corpuscular hemoglobin concentration (MCHC) and hemoglobin level. We hypothesized that MCHC would be more informative than hemoglobin levels. This prospective, longitudinal, community-based study included 337 participants (108 men and 229 women; age range, 38-87 years) who received evaluations of MCHC, hemoglobin levels and depressive symptom scores (DSS) during baseline and follow-up examinations, which were performed in 2008-2011 and 2010-2012, respectively. MCHC and hemoglobin levels were measured as part of complete blood counts, while DSS was evaluated using the Beck Depression Inventory. Associations were analyzed using linear regression. We found a statistically significant association between baseline MCHC and follow-up DSS (ß = -0.69, p = 0.026), which remained statistically significant after controlling for potential confounders (ß = -0.71, p = 0.011). Further, when we analyzed the relationship separately for men and women, we observed that it remained stable for women before (ß = -1.00, p = 0.014) and after (ß = -1.09, p = 0.003) adjusting for confounders. The stable association indicates that MCHC may be superior to hemoglobin level as a prognostic factor for future depressive symptoms in women. MCHC is easy to measure and low MCHC is usually treatable. Therefore, screening and intervention efforts could be targeted at women with low MCHC, who appear to have elevated risks of developing depressive symptoms.

Association between changes in systolic blood pressure and incident diabetes in a community-based cohort study in Korea.

An association between hypertension and diabetes has been reported; however, the temporal relationship of blood pressure changes and incident diabetes has not been fully investigated in the general population. We examined whether increasing blood pressure is associated with the risk of developing diabetes among community-dwelling Korean adults. This study included 2225 participants (859 men and 1366 women) aged 27-87 years from the Korean Genome Epidemiology Study. The participants were free of diabetes and cardiovascular disease at baseline. Incident diabetes was defined as fasting blood glucose⩾126 mg dl-1 or hemoglobin a1c ⩾6.5% (48 mmol mol-1) at follow-up examination and/or a physician's diagnosis of diabetes during the follow-up period. The effects of the baseline level and change in blood pressure on the risk of incident diabetes were assessed by multivariate logistic regression analysis. During the mean follow-up of 2.6 years, new-onset diabetes was observed in 5.0% (43/859) of the men and 3.4% (47/1366) of the women. In the multivariate model, the baseline systolic blood pressure was not significantly associated with incident diabetes (adjusted odds ratio 0.93 per 10 mmHg, P=0.747). However, an increase in systolic blood pressure during the follow-up period was independently associated with incident diabetes (adjusted odds ratio 5.53 per 5 mmHg per year, P=0.002) after adjusting for the baseline blood pressure and other potential confounders. Increasing blood pressure, but not a high baseline blood pressure, was independently associated with the risk of diabetes in Korean adults.