Role of polymer template in crystal structure and photoactivity of Cu-TiO2 heterojunction nanostructures towards environmental remediation.

Exploring porous heterojunction nanomaterials as a photocatalyst for water depollution strategies towards environmental restoration is exceedingly difficult in the perspective of sustainable chemistry. Herein, we first report a porous Cu-TiO2 (TC40) heterojunction by using microphase separation of a novel penta-block copolymer (PLGA-PEO-PPO-PEO-PLGA) as a template through an evaporation induced self-assembly (EISA) method having nanorod-like particle shape. Furthermore, two types of photocatalyst were made with or without polymer template to clarify the function of that template precursor on the surface and morphology, as well as which variables are the most critical for a photocatalyst. TC40 heterojunction nanomaterial displayed higher BET surface area along with lower band gap value viz.2.98 eV compared to the other and these features make it a robust photocatalyst for wastewater treatment. In order to improve water quality, we have carried out experiments on the photodegradation of methyl orange (MO), highly toxic pollutants that cause health hazards and bioaccumulate in the environment. Our catalyst, TC40 exhibits the 100% photocatalytic efficiency towards MO dye degradation in 40 and 360 min at a rate constant of 0.104 ± 0.007 min-1 and 0.440 ± 0.03 h-1 under UV + Vis and visible light irradiation, respectively.

Triangular Resection Epicanthoplasty: A Novel Method of Minimizing Hypertrophic Scar After Medial Epicanthoplasty.

Medial epicanthoplasty is a crucial component in Asian cosmetic eyelid surgery. Conventional surgical methods have mandated wide undermining for the purpose of sufficient release. However, excessive undermining may result in hypertrophic scar or webbing deformities. To minimize undesirable results, the authors are proposing a novel approach. From March 2010 to December 2017, a triangular resection epicanthoplasty was performed in 421 Asian patients. The authors' procedure consists of triangular skin resection, the release of orbicularis oculi muscle and upper half medial epicanthal tendon, and dog ear correction. No complication regarding scarring or webbing was reported. The revision was performed in 18 cases where the patients wanted additional correction. The triangular resection epicanthoplasty offers both optimal results and minimal scar with relative simplicity.

Performance evaluation of deep learning models for the classification and identification of dental implants.

STATEMENT OF PROBLEM: Dental implant systems can be identified using image classification deep learning. However, investigations on the accuracy of classifying and identifying implant design through an object detection model are lacking. PURPOSE: The purpose of this study was to evaluate the performance of an object detection deep learning model for classifying the implant designs of 103 types of implants. MATERIAL AND METHODS: From panoramic radiographs, 14 037 implant images were extracted. Implant designs were subdivided into 10 classes in the coronal, 13 in the middle, and 10 in the apical third. Classes with fewer than 50 images were excluded from the training dataset. Among the images, 80% were used as training data, and the remaining 20% as test data; the data were generated 3 times for 3-fold cross-validation (implant datasets 1, 2, and 3). Versions 5 and 7 of you only look once (YOLO) algorithm were used to train the model, and the mean average precision (mAP) was evaluated. Subsequently, data augmentation was performed using image processing and a real-enhanced super-resolution generative adversarial network, and the accuracy was re-evaluated using YOLOv7. RESULTS: The mAP of YOLOv7 in the 3 datasets was 0.931, 0.984, and 0.884, respectively, which were higher than the mAP of YOLOv5. After image processing in implant dataset-1, the mAP improved to 0.986 and, with the real-enhanced super-resolution generative adversarial network, to 0.988 and 0.986 at magnification ×2 and ×4, respectively. CONCLUSIONS: The object detection model for classifying implant designs found a high accuracy for 26 classes. The mAP of the model differed depending on the type of algorithm, image processing process, and detailed implant design.

Multi-Domain Neumann Network with Sensitivity Maps for Parallel MRI Reconstruction.

MRI is an imaging technology that non-invasively obtains high-quality medical images for diagnosis. However, MRI has the major disadvantage of long scan times which cause patient discomfort and image artifacts. As one of the methods for reducing the long scan time of MRI, the parallel MRI method for reconstructing a high-fidelity MR image from under-sampled multi-coil k-space data is widely used. In this study, we propose a method to reconstruct a high-fidelity MR image from under-sampled multi-coil k-space data using deep-learning. The proposed multi-domain Neumann network with sensitivity maps (MDNNSM) is based on the Neumann network and uses a forward model including coil sensitivity maps for parallel MRI reconstruction. The MDNNSM consists of three main structures: the CNN-based sensitivity reconstruction block estimates coil sensitivity maps from multi-coil under-sampled k-space data; the recursive MR image reconstruction block reconstructs the MR image; and the skip connection accumulates each output and produces the final result. Experiments using the fastMRI T1-weighted brain image dataset were conducted at acceleration factors of 2, 4, and 8. Qualitative and quantitative experimental results show that the proposed MDNNSM method reconstructs MR images more accurately than other methods, including the generalized autocalibrating partially parallel acquisitions (GRAPPA) method and the original Neumann network.

Beneficial effects of modulated electro-hyperthermia during neoadjuvant treatment for locally advanced rectal cancer.

PURPOSE: Modulated electro-hyperthermia (mEHT) may enhance the tumor response, although the effectiveness of combined neoadjuvant therapy remains unclear. Therefore, we investigated the role of mEHT with neoadjuvant therapy for locally advanced rectal cancer. MATERIALS AND METHODS: Clinical data were analyzed for 120 patients who received neoadjuvant treatment for locally advanced rectal cancer (T3/4 or N+, M0) from May 2012 to December 2017. Capecitabine or 5-fluorouracil was administered along with radiotherapy. Patients were categorized into mEHT group (62 patients) and non-mEHT group (58 patients) depending on whether mEHT was added. Surgery was performed 6-8 weeks after the end of radiotherapy. RESULTS: The median age was 59 years (range, 33-83). The median radiation dose was significantly less for mEHT group (40 Gy) than for non-mEHT group (50.4 Gy). In mEHT group, 80.7% showed down-staging compared with 67.2% in non-mEHT group. For large tumors of more than 65 cm³ (mean), improved tumor regression was observed in 31.6% of mEHT group compared with 0% of non-mEHT group (p = .024). The gastrointestinal toxicity rate of mEHT group was 64.5%, which was found to be statistically significantly less than 87.9% of non-mEHT group (p = .010). The 2-year disease-free survival was 96% for mEHT group and 79% for non-mEHT group (p = .054). CONCLUSION: The overall mEHT group had a comparable response and survival using less radiation dosing compared with standard care; the subgroup with large tumors showed improved efficacy for tumor regression after mEHT.

Fatty liver index and development of cardiovascular disease in Koreans without pre-existing myocardial infarction and ischemic stroke: a large population-based study.

BACKGROUND: Despite the known association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD), whether NAFLD predicts future CVD events, especially CVD mortality, remains uncertain. We evaluated the relationship between fatty liver index (FLI), a validated marker of NAFLD, and risk of major adverse cardiac events (MACEs) in a large population-based study. METHODS: We identified 3011,588 subjects in the Korean National Health Insurance System cohort without a history of CVD who underwent health examinations from 2009 to 2011. The primary endpoint was a composite of cardiovascular deaths, non-fatal myocardial infarction (MI), and ischemic stroke. A Cox proportional hazards regression analysis was performed to assess association between the FLI and the primary endpoint. RESULTS: During the median follow-up period of 6 years, there were 46,010 cases of MACEs (7148 cases of cardiovascular death, 16,574 of non-fatal MI, and 22,288 of ischemic stroke). There was a linear association between higher FLI values and higher incidence of the primary endpoint. In the multivariable models adjusted for factors, such as body weight and cholesterol levels, the hazard ratio for the primary endpoint comparing the highest vs. lowest quartiles of the FLI was 1.99 (95% confidence interval [CIs], 1.91-2.07). The corresponding hazard ratios (95% CIs) for cardiovascular death, non-fetal MI, and ischemic stroke were 1.98 (1.9-2.06), 2.16 (2.01-2.31), and 2.01 (1.90-2.13), respectively (p < 0.001). The results were similar when we performed stratified analyses by age, sex, use of dyslipidemia medication, obesity, diabetes, and hypertension. CONCLUSIONS: Our findings indicate that the FLI, which is a surrogate marker of NAFLD, has prognostic value for detecting individuals at higher risk for cardiovascular events.

Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study.

BACKGROUND: Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. METHODS: Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. RESULTS: Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130-139/80-89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130-139/80-89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130-139/80-89 mmHg and BP 120-129/70-79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130-139/80-89 mmHg at all ages. CONCLUSIONS: In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130-139/80-89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130-139/80-89 mmHg at the age of ≥ 70.

Triglyceride and glucose (TyG) index is an effective biomarker to identify severe acute pancreatitis.

BACKGROUND: Early diagnosis of severe acute pancreatitis (AP) is important to reduce morbidity and mortality. We investigated the association between the triglyceride and glucose index (TyG index) and the prognosis of severe AP (SAP). METHODS: The TyG index was calculated as: ln [fasting triglycerides (mg/dL) x fasting plasma glucose (mg/dL)]/2. Multivariable logistic regression analyses were used to investigate the independent association between the TyG index and the severity of AP. RESULTS: In this study, 373 patients with AP were recruited from three hospitals. The TyG index was higher in the SAP group than in the non-SAP group. Further, the TyG index was higher than in patients admitted to an intensive care unit and those who died of AP. The TyG index was an independent predictive factor for SAP (odds ratio 7.14, 95% confidence interval 2.80-18.19). The area under the curve increased significantly, from 0.738 to 0.830, after adding the TyG index to a predictive SAP model. CONCLUSIONS: Our findings suggest that the TyG index is an independent prognostic factor in patients with AP and could be used as a simple prognostic indicator for SAP.

Procalcitonin as a diagnostic marker for sepsis/septic shock in the emergency department; a study based on Sepsis-3 definition.

INTRODUCTION: The recent definition of sepsis was modified based on a scoring system focused on organ failure (Sepsis-3). It would be a time-consuming process to detect the sepsis patient using Sepsis-3. Procalcitonin (PCT) is a well-known biomarker for diagnosing sepsis/septic shock and monitoring the efficacy of treatment. We conducted a study to verify the predictability of PCT for diagnosing sepsis based on Sepsis-3 definition. MATERIALS & METHODS: This is a retrospective cohort study. The patients whose PCT was measured on the emergency department (ED) arrival and had final diagnosis related infection were enrolled. The patients were categorized by infection, sepsis, or septic shock followed by Sepsis-3 definition. "Pre-septic shock" was defined when a patient was initially diagnosed with sepsis, following which his/her mean arterial blood pressure decreased to under 65 mmHg refractory to fluid resuscitation and there was need for vasopressor use during ED admission. Receiver operating characteristics (ROC) curve and area under the curve (AUC) analysis were performed to verify sensitivity and specificity of PCT. RESULTS: 866 patients were enrolled in the final analysis. There are 287 cases of infection, 470 cases of sepsis, and 109 cases of septic shock. An optimal cutoff value for diagnosing sepsis was 0.41 ng/dL (sensitivity: 74.8% and specificity: 63.8%; AUC: 0745), septic shock was 4.7 ng/dL (sensitivity: 66.1% and specificity: 79.0%; AUC: 0.784), and "pre-septic shock" was 2.48 ng/dL (sensitivity: 72.8%, specificity: 72.8%, AUC: 0.781), respectively. CONCLUSION: PCT is a reliable biomarker to predict sepsis or septic shock according to the Sepsis-3 definitions.

Metabolic Syndrome Severity Score in Korean Adults: Analysis of the 2010-2015 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Continuous metabolic syndrome (MS) severity scores that can track metabolic risk in individuals over time have been developed for Western populations. The present study aimed to develop gender- and age-specific equations for MS severity scores in Korean adults. METHODS: Using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) IV (2010-2012) and VI (2013-2015), we performed a confirmatory factor analysis of single MS factor that allowed for differential loadings across groups to generate gender- and age-specific, continuous MS severity scores. Then, we validated this equation in a different dataset of Korean adults. RESULTS: In confirmatory analysis, waist circumference had the highest factor loading, indicating that waist circumference had the strongest correlation with MS among Korean adults. Lower factor loadings (< 0.4) among Korean adults aged 40-59 years were noted for systolic blood pressure and fasting glucose. MS severity score values were significantly correlated with metabolic parameters, including high-sensitivity C-reactive-protein, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Furthermore, MS severity scores well predicted traditional MS according to receiver operating characteristic analysis in a validation dataset (KNHANES VII). In a longitudinal cohort dataset, participants diagnosed with Adult Treatment Program III (ATP-III) MS after an initial assessment had progressively higher baseline MS severity scores in relationship to their time until ATP-III MS diagnosis. CONCLUSION: The new MS severity score equations for Korean adults proposed in this study provide a clinically-accessible continuous measure of MS for potential use in identifying adults at higher risk for MS-related diseases and following changes within individuals over time.

High Sensitive pH Sensor Based on AlInN/GaN Heterostructure Transistor.

The AlInN/GaN high-electron-mobility-transistor (HEMT) indicates better performances compared with the traditional AlGaN/GaN HEMTs. The present work investigated the pH sensor functionality of an analogous HEMT AlInN/GaN device with an open gate. It was shown that the Al0.83In0.17N/GaN device demonstrates excellent pH sense functionality in aqueous solutions, exhibiting higher sensitivity (−30.83 μA/pH for AlInN/GaN and −4.6 μA/pH for AlGaN/GaN) and a faster response time, lower degradation and good stability with respect to the AlGaN/GaN device, which is attributed to higher two-dimensional electron gas (2DEG) density and a thinner barrier layer in Al0.83In0.17N/GaN owning to lattice matching. On the other hand, the open gate geometry was found to affect the pH sensitivity obviously. Properly increasing the width and shortening the length of the open gate area could enhance the sensitivity. However, when the open gate width is too larger or too small, the pH sensitivity would be suppressed conversely. Designing an optimal ratio of the width to the length is important for achieving high sensitivity. This work suggests that the AlInN/GaN-based 2DEG carrier modulated devices would be good candidates for high-performance pH sensors and other related applications.

Managing Vascular Pedicle Exposure in Free Tissue Transfer Using a Reprocessed Micronized Dermal Substitute in Lower Extremity Reconstructions.

Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.

Effects of 4-week downhill treadmill walking on the vertebral angle and postural muscle activity in participants with thoracic kyphosis and forward head posture: A comparative longitudinal study.

BACKGROUND: Maintaining correct posture and optimal spine function has become an important issue due to the increased use of computers and smartphones. OBJECTIVE: To investigate the effect of a 4-week downhill treadmill exercise (DTWE) program on participants with thoracic kyphosis and forward head posture (FHP). METHODS: Twenty-eight male participants were randomly assigned to the DTWE (n= 14) or standard treadmill walking exercise (STWE) (n= 14) group. They performed 30-minute exercise three times a week for 4 weeks. The vertebral angle was measured using a three-dimensional (3D) motion analysis system. Surface electromyography (EMG) was performed to record muscle activity in the thoracic erector spinae (TES), sternocleidomastoid muscle (SCM), and cervical erector spinae (CES). RESULTS: The DTWE group showed significant increases in the craniovertebral angle (CVA) and TES EMG activity and significant decreases in the thoracic kyphosis angle and SCM and CES EMG activity compared with those shown by the STWE group following the intervention (p< 0.05). However, lumbar lordosis or pelvic tilt angles did not differ significantly between the groups after the intervention (p> 0.05). CONCLUSIONS: DTWE can be effective in reducing thoracic kyphosis and FHP without causing compensatory movements of the lumbar spine and pelvis.

Improvement of Dynamic On-Resistance in GaN-Based Devices with a High-Quality In Situ SiN Passivation Layer.

In this paper, we compared the characteristics of normally-on/off AlGaN/GaN MISHEMTs passivated by an in situ/ex situ SiN layer. The devices passivated by the in situ SiN layer revealed enhanced DC characteristics, such as the drain current of 595 mA/mm (normally-on) and 175 mA/mm (normally-off) with the high on/off current ratio of ~107, respectively, compared with those of the devices passivated by the ex situ SiN layer. The MISHEMTs passivated by the in situ SiN layer also exhibited a much lower increase of dynamic on-resistance (RON) of 4.1% for the normally-on device and 12.8% for the normally-off device, respectively. Furthermore, the breakdown characteristics are greatly improved by employing the in situ SiN passivation layer, suggesting that the in situ SiN passivation layer can remarkably not only suppress the surface-trapping effects, but also decrease the off-state leakage current in the GaN-based power devices.

Relative importance of potential risk factors for dementia in patients with hypertension.

Patients with hypertension are at higher risk for dementia than the general population. We sought to understand the relative importance of various risk factors in the development of dementia among patients with hypertension. This population-based cohort study used data from the Korean National Insurance Service database. Using the Cox proportional hazard model, R2 values for each potential risk factor were calculated to test the relative importance of risk factors for the development of dementia. Eligible individuals were adults 40 to 79 years of age with hypertension and without a history of stroke and dementia between 2007 and 2009. A total of 650,476 individuals (mean age, 60 ± 11 years) with hypertension were included in the analyses. During a mean follow-up of 9.5 years (±2.8 years), 57,112 cases of dementia were observed. The three strongest predictors of dementia were age, comorbidity burden (assessed using the Charlson Comorbidity Index), and female sex (R2 values, 0.0504, 0.0023, and 0.0022, respectively). The next strongest risk factors were physical inactivity, smoking, alcohol consumption, and obesity (R2 values, 0.00070, 0.00024, 0.00021, and 0.00020, respectively). Across all age groups, physical inactivity was an important risk factor for dementia occurrence. In summary, controlling and preventing comorbidities are of utmost importance to prevent dementia in patients with hypertension. More efforts should be taken to encourage physical activity among patients with hypertension across all age groups. Furthermore, smoking cessation, avoiding and limiting alcohol consumption, and maintaining an appropriate body weight are urged to prevent dementia.

Identification of 130 Dental Implant Types Using Ensemble Deep Learning.

Purpose: To evaluate the accuracy and clinical usability of an identification model using ensemble deep learning for 130 dental implant types. Materials and Methods: A total of 28,112 panoramic radiographs were obtained from 30 domestic and foreign dental clinics. From these panoramic radiographs, 45,909 implant fixture images were extracted and labeled based on electronic medical records. Dental implants were classified into 130 types according to the manufacturer, the manufacturer's implant system, and the diameter and length of the implant fixture. Regions of interest were manually cropped, and data augmentation was performed. According to the minimum number of images collected per implant type, the datasets were classified into three sets: an overall total of 130 and two subsets that consisted of 79 and 58 types. EfficientNet and Res2Next algorithms were used for image classification in deep learning. After testing the performance of the two models, the ensemble learning technique was applied to improve accuracy. The top-1 accuracy, top-5 accuracy, precision, recall, and F1 scores were calculated according to algorithms and datasets. Results: For the 130 types, the top-1 accuracy, top-5 accuracy, precision, recall, and F1 scores were 75.27, 95.02, 78.84, 75.27, and 74.89, respectively. In all cases, the ensemble model performed better than EfficientNet and Res2Next. When using the ensemble model, the accuracy increased as the number of types decreased. Conclusion: The ensemble deep learning model for the identification of 130 types of dental implants showed higher accuracy than the existing algorithms. To further improve the performance and clinical usability of the model, images with higher quality and fine-tuned algorithms optimized for implant identification are required.

Hemostatic efficacy of a flowable collagen-thrombin matrix during coronary artery bypass grafting: a double-blind randomized controlled trial.

BACKGROUND: Flowable hemostatic agents have the advantage of being able to be applied to irregular wound surfaces and difficult to reach areas. We sought to compare the effectiveness and safety of the flowable hemostatic sealants Collastat® (collagen hemostatic matrix, [CHM]) and Floseal® (gelatin hemostatic matrix, [GHM]) during off-pump coronary artery bypass (OPCAB). METHODS: In this prospective, double-blind, randomized controlled trial, 160 patients undergoing elective OPCAB surgery were enrolled between March 2018 and February 2020. After primary suture of the aortocoronary anastomosis, an area of hemorrhage was identified, and patients received either CHM or GHM (n = 80, each). Study endpoints were the following: proportion of successful intraoperative hemostasis and time required for hemostasis overall postoperative bleeding, proportion of transfusion of blood products, and surgical revision for bleeding. RESULTS: Of the total patients, 23% were female, and the mean age was 63 years (range 42-81 years). Successful hemostasis proportion within 5 min was achieved for 78 patients (97.5%) in the GHM group, compared to 80 patients (100%) in the CHM group (non-inferiority p = 0.006). Two patients receiving GHM required surgical revision to achieve hemostasis. There were no differences in the mean time required to obtain hemostasis [GHM vs. CHM, mean 1.49 (SD 0.94) vs. 1.35 (0.60) min, p = 0.272], as confirmed by time-to-event analysis (p = 0.605). The two groups had similar amounts of mediastinal drainage for 24 h postoperatively [538.5 (229.1) vs. 494.7 (190.0) ml, p = 0.298]. The CHM group required less packed red blood cells, fresh frozen plasma, and platelets for transfusion than the GHM group (0.5 vs. 0.7 units per patient, p = 0.047; 17.5% vs. 25.0%, p = 0.034; 7.5% vs. 15.0%, p = 0.032; respectively). CONCLUSIONS: CHM was associated with a lower need for FFP and platelet transfusions. Thus, CHM is a safe and effective alternative to GHM. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04310150.

Clinical implications of cardiac troponin-I in patients with hypertensive crisis visiting the emergency department.

OBJECTIVES: Cardiac troponin-I (cTnI) is a representative marker of myocardial injury. Elevation of cTnI is frequently observed in patients with hypertensive crisis, but few studies have examined its prognostic significance in hypertensive crisis. We aimed to determine whether cTnI could predict all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED). METHODS: This observational study included patients aged ≥18 years who visited an ED between 2016 and 2019 for hypertensive crisis, defined as systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥110 mmHg. Among 6467 patients, 3938 who underwent a cTnI assay were analysed. RESULTS: Among the 3938 patients, 596 (15.1%) had cTnI levels above the 99th percentile upper reference limit (elevated cTnI >40 ng/L) and 600 (15.2%) had cTnI levels between the detection limit (≥10 ng/L) and the 99th percentile upper reference limit (detectable cTnI). The 3-year all-cause mortality in the elevated, detectable and undetectable cTnI groups were 41.6%, 36.5% and 12.8%, respectively. After adjusting for confounding variables, elevated cTnI patients (adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.61-2.52) and detectable cTnI patients (adjusted HR, 1.64; 95% CI, 1.32-2.04) showed a significantly higher risk of 3-year all-cause mortality than did patients with undetectable cTnI. CONCLUSIONS: In patients with hypertensive crisis, elevated cTnI levels provide useful prognostic information and permit the early identification of patients with an increased risk of death. Moreover, putatively normal but detectable cTnI levels also significantly correlated with a higher risk of all-cause mortality. Intensive treatment and follow-up strategies are needed for patients with hypertensive crisis with elevated and detectable cTnI levels.Key messagesCardiac troponin-I level was an independent prognostic factor for all-cause mortality in patients with hypertensive crisis.Detectable but normal range cardiac troponin-I, which was considered clinically insignificant, also had a prognostic impact on all-cause mortality comparable to elevated cardiac troponin-I levels.

Impact of underweight on 3-year all-cause mortality in patients with acute severe hypertension: a retrospective cohort study.

Body mass index (BMI) is used to measure body fat. We investigated the association between BMI and long-term clinical outcomes in patients with acute severe hypertension who visited the emergency department (ED). Cross-sectional study data were obtained from a single regional emergency medical center, including patients with elevated initial systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 100 mmHg. The patients were classified into five groups according to BMI level (underweight, normal, overweight, obese class I, II and III). Among 4867 patients who presented with acute severe hypertension at the ED, 935 (19.21%) died within 3-years. In particular, 140 (44.59%) patients in the underweight group died from any cause, which was the highest among the five groups, and there was a reverse J-shaped association between BMI and 3-year all-cause mortality. Underweight patients had a significantly increased risk of all-cause mortality by 1.55-fold during the 3-year follow-up. Rather, obesity was associated with a reduction in the 3-year all-cause mortality. Comorbidities, including chronic kidney disease and acute hypertension-mediated organ damage, were independent predictors of all-cause mortality in patients who were not underweight. Underweight contributes to worsening long-term clinical outcomes in patients with acute severe hypertension. Clinicians should consider BMI as one of the physical examination parameters in patients with acute severe hypertension, and management including lifestyle modifications such as diet control and exercise should be undertaken considering BMI and comorbidities.

Handgrip Strength Cutoff Value Among Korean Adolescents with Metabolic Syndrome Components: Korean National Health and Nutrition Examination Survey Data 2014-2017.

Abstract Objectives: To propose the cutoff value of handgrip strength (HGS) for each metabolic syndrome component in Korean adolescents. Methods: Total of 2303 adolescents (1226 boys and 1077 girls; age 10-18 years) who participated in the Korea National Health and Nutrition Examination Survey from 2014 to 2017. We used the International Diabetes Federation metabolic syndrome guideline for children to define metabolic syndrome. The highest HGS for both hands were recorded. The optimal HGS cutoff for predicting metabolic syndrome components was determined by receiver operating characteristic curve analysis. Results: Adolescents with metabolic syndrome components defined by each criterion had higher HGS, systolic blood pressure, waist circumference, body mass index, fasting glucose, cholesterol, triglyceride (TG), alanine aminotransferase, and aspartate aminotransferase compared with average participants' data. The cutoff value of HGS defining waist circumference, TG level, high-density lipoprotein, and blood pressure was 24, 21.5, 30.9, and 30.2, respectively. The cutoff value of HGS defining metabolic syndrome was 28.9. For HGS to body weight ratio, the cutoff value defining metabolic syndrome was 0.38. Conclusions: This study showed that cutoff values of HGS have relation with metabolic syndrome in adolescents. Although cutoff has been suggested, it may not be sufficient for clinical use. Additional data are need to be accumulated in actual clinical trials for more accurate cutoff HGS value.