Effect of Combination Therapy with Ezetimibe and Statins versus Statin Monotherapy on Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: Lipid-lowering agents such as ezetimibe are recommended in uncontrolled hyperlipidemia for primary and secondary prevention of cardiovascular disease. Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis and a predictor of cardiovascular and cerebral events. The effects of ezetimibe on CIMT have been inconsistently reported. The aim of this meta-analysis is to compare the effects of ezetimibe/statin and statin alone therapies on CIMT reduction. Materials and Methods: The PubMed, Embase, and Cochrane library databases were searched for randomized controlled trials (RCTs) published prior to 26 January 2023 with the MeSH keywords 'Ezetimibe' and 'Carotid Intima-Media Thickness'. The results were presented as standard mean difference (SMD) with 95% confidence intervals using the random-effect model method, and heterogeneity was assessed. Subgroup, meta-regression, and sensitivity analyses were conducted. Results: Five RCTs with 642 participants were included. CIMT reduction was not significantly different between the ezetimibe/statin and statin alone groups. However, in subgroup analyses, CIMT in the ezetimibe/statin group was significantly reduced in patients with non-familial hypercholesterolemia (SMD: -0.34 mm and p = 0.002) and in patients with secondary prevention (SMD: -0.38 mm and p = 0.002). The low-density lipoprotein cholesterol level was significantly reduced in the ezetimibe/statin group (SMD: -0.58 mg/dL and p < 0.001). Conclusions: The effect of ezetimibe on CIMT reduction was shown in non-familial hypercholesterolemia and secondary prevention. These results suggest that the efficacy of ezetimibe may vary with potential CIMT reduction benefits in certain subpopulations.

Human Gait Recognition: A Single Stream Optimal Deep Learning Features Fusion.

Human Gait Recognition (HGR) is a biometric technique that has been utilized for security purposes for the last decade. The performance of gait recognition can be influenced by various factors such as wearing clothes, carrying a bag, and the walking surfaces. Furthermore, identification from differing views is a significant difficulty in HGR. Many techniques have been introduced in the literature for HGR using conventional and deep learning techniques. However, the traditional methods are not suitable for large datasets. Therefore, a new framework is proposed for human gait recognition using deep learning and best feature selection. The proposed framework includes data augmentation, feature extraction, feature selection, feature fusion, and classification. In the augmentation step, three flip operations were used. In the feature extraction step, two pre-trained models were employed, Inception-ResNet-V2 and NASNet Mobile. Both models were fine-tuned and trained using transfer learning on the CASIA B gait dataset. The features of the selected deep models were optimized using a modified three-step whale optimization algorithm and the best features were chosen. The selected best features were fused using the modified mean absolute deviation extended serial fusion (MDeSF) approach. Then, the final classification was performed using several classification algorithms. The experimental process was conducted on the entire CASIA B dataset and achieved an average accuracy of 89.0. Comparison with existing techniques showed an improvement in accuracy, recall rate, and computational time.

Polyphenol-enriched fraction of Vaccinium uliginosum L. protects selenite-induced cataract formation in the lens of Sprague-Dawley rat pups.

Purpose: As the aging population is increasing, the incidence of age-related cataract is expected to increase globally. The surgical intervention, a treatment for cataract, still has complications and is limited to developed countries. In this study, we investigated whether the polyphenol-enriched fraction of Vaccinium uliginosum L. (FH) prevents cataract formation in Sprague-Dawley (SD) rat pups. Methods: Sixty rat pups were randomly divided into six groups: CTL, Se, FH40, FH80, FH120, and Cur80. The cataract was induced with subcutaneous injection of sodium selenite (18 µmol/kg bodyweight) on postnatal (P) day 10. All groups, except CTL, were injected with sodium selenite, and the FH40, FH80, and FH120 groups were given gastric intubation with FH40 mg/kg, 80 mg/kg, and 120 mg/kg on P9, P10, and P11. The Cur80 group was also given gastric intubation with curcumin 80 mg/kg on P9, P10, and P11. All rat pups were euthanized on P30. Results: Lens morphological analysis showed that FH dose-dependently inhibited cataract formation. In the Se group, soluble proteins were insolubilized, and the gene expression of the α-, ß-, and γ-crystallins was downregulated. However, FH treatment statistically significantly inhibited insolubilization of soluble proteins and downregulation of the gene expression of the α-, ß-, and γ-crystallins. In the Se group, the gene and protein levels of m-calpain were downregulated, which were attenuated with FH treatment. In addition, sodium selenite injection caused reduced antioxidant enzymes (superoxide dismutase (SOD) and glutathione peroxidase (GPx)), glutathione (GSH) depletion, and malondialdehyde (MDA) production in the lens. The administration of FH inhibited sodium selenite-induced oxidative stress in a dose-dependent manner. The mechanism of protection against oxidative stress by FH involves NF-E2-related factor (Nrf-2) and hemoxygenase-1 (HO-1). FH treatment inhibited decrease of Nrf-2 in the nucleus fraction and HO-1 in the cytosol fraction. Finally, the FH treatment protected poly (ADP)-ribose polymerase (PARP) from cleavage, determined with western blotting. Conclusions: FH showed a preventive effect against cataract formation by inhibiting m-calpain-mediated proteolysis and oxidative stress in the lens. These results suggest that FH could be a potential anticataract agent in age-related cataract.

Impact of sequential implementation of multimodal perioperative care pathways on colorectal surgical outcomes

Background: Standardized care protocols offer the potential to reduce postoperative complication rates. The purpose of this study was to determine whether there was an additive benefit associated with the sequential implementation of the evidence-based surgical site infection bundle (SSIB) and enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery in a community hospital. Methods: Patients at a single institution who underwent elective colorectal surgery between Apr. 1, 2011, and Dec. 31, 2015, were identified by means of American College of Surgeons National Surgical Quality Improvement Program data. Patients were stratified into 3 groups according to the protocol implementation dates: pre-SSIB/pre-ERAS (control), post-SSIB/pre-ERAS and post-SSIB/post-ERAS. Primary outcomes assessed were length of stay and wound complication rates. We used inverse proportional weighting to control for possible differences between the groups. Results: There were 368 patients included: 94 in the control group, 95 in the post-SSIB/pre-ERAS group and 179 in the post-SSIB/post-ERAS group. In the adjusted analyses, mean length of stay (control group 7.6 d, post-SSIB/post-ERAS group 5.5 d, p = 0.04) and overall wound complication rates (14.7% and 6.5%, respectively, p = 0.049) were reduced after sequential implementation of the protocols. Conclusion: Sequential implementation of quality-improvement initiatives yielded additive benefit for patients undergoing colorectal surgery in a community hospital, with a decrease in length of stay and wound complication rates. The amount of improvement attributable to either initiative is difficult to define as they were implemented sequentially. The improved outcomes were realized after the introduction of the ERAS protocol in adjusted analyses.

Contexte: Les protocoles de soins standardisés offrent la possibilité de réduire les taux de complications postopératoires. Le but de cette étude était de déterminer s'il y a un avantage additif associé à l'application séquentielle des protocoles fondés sur des données probantes SSIB (surgical site infection bundle) et ERAS (enhanced recovery after surgery) chez des patients soumis à une chirurgie colorectale dans un hôpital communautaire. Méthodes: Les patients d'un seul établissement ayant subi une chirurgie colorectale non urgente entre le 1er avril 2011 et le 31 décembre 2015 ont été recensés à partir des données du Programme national d'amélioration de la qualité chirurgicale de l'American College of Surgeons. Les patients ont été stratifiés en 3 groupes selon les dates d'application des protocoles : pré-SSIB/pré-ERAS (témoin), post-SSIB/pré-ERAS et post-SSIB/post-ERAS. Les paramètres principaux évalués étaient la durée du séjour hospitalier et les taux de complications de plaies. Nous avons utilisé une pondération proportionnelle inverse pour tenir compte des possibles différences entre les groupes. Résultats: Nous avons inclus 368 patients, 94 dans le groupe témoin, 95 dans le groupe post-SSIB/pré-ERAS et 179 dans le groupe post-SSIB/post-ERAS. Dans les analyses ajustées, la durée moyenne des séjours (groupe témoin 7,6 j, groupe post-SSIB/post-ERAS 5,5 j, p = 0,04) et les taux globaux de complications de plaies (14,7 % et 6,5 % respectivement, p = 0,049) ont diminué après l'application séquentielle des protocoles. Conclusion: L'application séquentielle des initiatives d'amélioration de la qualité a donné lieu à des bienfaits additifs chez les patients soumis à une chirurgie colorectale dans un hôpital communautaire, avec abrègement du séjour hospitalier et diminution du taux de complications de plaies. Le degré d'amélioration attribuable à chacune des initiatives est difficile à préciser puisqu'elles ont été appliquées séquentiellement. L'amélioration des paramètres a été obtenue après l'introduction du protocole ERAS dans des analyses ajustées.

What Are the Expected Findings on Follow-up Computed Tomography Angiogram in Post-traumatic Patients With Blunt Cerebrovascular Injury?

PURPOSE: Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating diagnosis. Our study establishes the temporal changes and findings on follow-up imaging. METHODS: For this retrospective, institutional review board-approved study, the hospital trauma registry was queried for all severely injured polytrauma patients who underwent computed tomography angiogram (CTA) scans in the emergency department between January 1, 2010, and December 31, 2016, with injury severity score ≥16, yielding 3747 patients. A total of 128 patients had a follow-up CTA for BCVI. The grade, location, and outcomes of injuries on follow-up imaging were studied. RESULTS: A vehicular collision was the most common mechanism of injury (75%). The majority of patients (61%) had a Glasgow Coma Scale of 10-15. Vertebral fractures were the most common associated injury (57%). The overall incidence of BCVI in our study population was 4.8%. On the initial CTA, 50% of injuries were grade 1, 25.4% were grade 2, 7% were grade 3, 17% were grade 4, and 0.6% were grade 5. For the different grades of injuries, improvement has been documented in 44% with complete healing in 34%, while 51% of injuries remained unchanged from the initial scan. Only 5% progressed to a higher-grade injury. Twelve patients developed strokes with an incidence of 9.4% in patients with a follow-up CTA. CONCLUSIONS: This study can help increase the awareness of radiologists about the evolution patterns of different grades of BCVIs on follow-up CTA for severely injured posttraumatic patients.

Secure Utilization of Beacons and UAVs in Emergency Response Systems for Building Fire Hazard.

An intelligent emergency system for hazard monitoring and building evacuation is a very important application area in Internet of Things (IoT) technology. Through the use of smart sensors, such a system can provide more vital and reliable information to first-responders and also reduce the incidents of false alarms. Several smart monitoring and warning systems do already exist, though they exhibit key weaknesses such as a limited monitoring coverage and security, which have not yet been sufficiently addressed. In this paper, we propose a monitoring and emergency response method for buildings by utilizing beacons and Unmanned Aerial Vehicles (UAVs) on an IoT security platform. In order to demonstrate the practicability of our method, we also implement a proof of concept prototype, which we call the UAV-EMOR (UAV-assisted Emergency Monitoring and Response) system. Our UAV-EMOR system provides the following novel features: (1) secure communications between UAVs, smart sensors, the control server and a smartphone app for security managers; (2) enhanced coordination between smart sensors and indoor/outdoor UAVs to expand real-time monitoring coverage; and (3) beacon-aided rescue and building evacuation.

Relationship between Pulse Pressure and Handgrip Strength in the Korean Population: A Nationwide Cross-Sectional Study.

Background: Sarcopenia is defined as the loss of muscle mass and strength and low physical performance, and it is closely related to the risk of cardiovascular disease and mortality. Pulse pressure (PP) is a biomarker of arterial stiffness and compliance. Elevated PP levels increase the risk of cardiovascular diseases and all-cause mortality. Nevertheless, the association between PP and sarcopenia has not yet been clearly established. Methods: Participant data were extracted from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2020. The study population was classified into three groups (PP < 40 mmHg, 40 mmHg ≤ PP < 60 mmHg, and PP ≥ 60 mmHg). PP was calculated by deducting the diastolic blood pressure from the systolic blood pressure. For handgrip strength, the maximum value measured with a grip dynamometer was adopted (weak handgrip strength: <28 kg for men, <18 kg for woman; normal handgrip strength: ≥28 kg for men, ≥18 kg for women). To determine the relationship between PP and the prevalence of weak handgrip strength, multiple logistic regression analysis was performed after adjusting for possible confounding factors. Results: The higher PP group had a higher age, body mass index; systolic blood pressure, prevalence of hypertension, diabetes, hyperlipidemia, and metabolic syndrome, and maximum handgrip strength. In all models, the prevalence of weak handgrip strength was significantly higher in the group with PP ≥ 60 mmHg compared to the control group (PP < 40 mmHg). Conclusions: Elevated PP was significantly associated with a higher prevalence of weak muscle strength. Thus, PP monitoring may be used to identify individuals at risk of sarcopenia and is helpful in improving health outcomes.

Association between Uric Acid Levels and the Consumption of Sugar-Sweetened Carbonated Beverages in the Korean Population: The 2016 Korea National Health and Nutrition Examination Survey.

Elevated uric acid levels are linked with obesity and diabetes. Existing research mainly examines the relationship between sugar-sweetened carbonated beverage (SSB) consumption and uric acid levels. This study explored the association between the quantity and frequency of SSB consumption and elevated uric acid levels in Korean adults. Data from 2881 participants aged 19-64 years (1066 men and 1815 women) in the 2016 Korea National Health and Nutrition Examination Survey were analyzed. Serum uric acid levels were categorized into quartiles, with the highest defined as high uric acid (men, ≥6.7 mg/dL; women, ≥4.8 mg/dL). SSB consumption was classified into quartiles (almost never, <1 cup (<200 mL), 1-3 cups (200-600 mL), ≥3 cups (≥600 mL)) and frequency into tertiles (almost never, ≤1/week, ≥2/week). Multivariate logistic regression assessed the association, with separate analyses for men and women. Increased daily SSB consumption and frequency were significantly associated with high uric acid levels in men but not in women. After adjusting for sociodemographic and health characteristics, consuming ≥3 cups (≥600 mL) of SSBs per day and SSBs ≥ 2/week were significantly associated with high serum uric acid levels in men, but this association was not observed in women. The study concludes that increased SSB intake is linked to elevated uric acid levels in Korean men, but not in women.

Association between Breakfast Consumption Frequency and Chronic Inflammation in Korean Adult Males: Korea National Health and Nutrition Examination Survey 2016-2018.

Background: Skipping breakfast is associated with an increased risk of chronic inflammatory diseases. This study aimed to examine the association between breakfast-eating habits and inflammation, using high-sensitivity C-reactive protein (hs-CRP) as a marker. Methods: A total of 4,000 Korean adult males with no history of myocardial infarction, angina, stroke, diabetes, rheumatoid arthritis, cancer, or current smoking were included. Data from the 2016-2018 Korea National Health and Nutrition Examination Survey were used for analysis. The frequency of breakfast consumption was assessed through a questionnaire item in the dietary survey section asking participants about their weekly breakfast consumption routines over the past year. Participants were categorized into two groups, namely "0-2 breakfasts per week" and "3-7 breakfasts per week"; hs-CRP concentrations were measured through blood tests. Results: Comparing between the "infrequent breakfast consumption (0-2 breakfasts per week)" and "frequent breakfast consumption (3-7 breakfasts per week)" groups, the mean hs-CRP was found to be significantly higher in the "infrequent breakfast consumption" group, even after adjusting for age, body mass index, physical activity, alcohol consumption, systolic blood pressure, blood pressure medication, fasting blood glucose, and triglycerides (mean hs-CRP: frequent breakfast consumption, 1.36±0.09 mg/L; infrequent breakfast consumption, 1.17±0.05 mg/L; P-value=0.036). Conclusion: Less frequent breakfast consumption was associated with elevated hs-CRP levels. Further large-scale studies incorporating adjusted measures of daily eating patterns as well as food quality and quantity are required for a deeper understanding of the role of breakfast in the primary prevention of chronic inflammatory diseases.

Association between E-Cigarette Smoking and Insulin Resistance Using the Triglyceride-Glucose Index in Korean Adults: Korea National Health and Nutrition Examination Survey.

Background: Insulin resistance contributes to the development of cardiovascular disease and type 2 diabetes mellitus. Smoking leads to an increase in triglyceride levels, which, in turn, increases insulin resistance. Although the number of e-cigarette users has increased in recent years, few studies have investigated the association between ecigarette use and insulin resistance. Therefore, this study aimed to determine the association between e-cigarette use and insulin resistance using the triglyceride-glucose (TyG) index in Korean adults. Methods: This study included 4,404 healthy adults aged ≥20 years who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2020. Participants were categorized as never-smokers or ecigarette users, and the TyG index was categorized into low- and high-TyG index groups according to the median value (9.22). A logistic regression analysis was performed to determine the association between e-cigarette smoking and insulin resistance. Results: E-cigarette users had a higher TyG index than never smokers (e-cigarette: mean=3.95; never: mean=9.18; P<0.001). The e-cigarette users had a higher risk of being in the high TyG index group than never-smokers (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.03-1.84). In the subgroup analysis stratified by sex, age, and body mass index, a higher OR for a high TyG index was observed in men (OR, 1.46; 95% CI, 1.03-2.08) and individuals aged 60 years or older (OR, 3.74; 95% CI, 1.14-12.30). Conclusion: Our findings suggest that e-cigarette use is significantly associated with insulin resistance.

Atherosclerotic Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection is a nontraumatic, noniatrogenic intimal tearing of the coronary artery in patients without atherosclerotic coronary disease. We present 3 unique cases of patients with spontaneous coronary artery dissection and atherosclerotic coronary artery disease. (Level of Difficulty: Intermediate.).

Weight loss maintenance after bariatric surgery.

Metabolic and bariatric surgery (MBS) is an effective treatment for patients with morbid obesity and its comorbidities. However, many patients experience weight regain (WR) after achieving their nadir weight. Establishing the definition of WR is challenging as postoperative WR has various definitions. Risk factors for WR after MBS include anatomical, racial, hormonal, metabolic, behavioral, and psychological factors, and evaluating such factors preoperatively is necessary. Long-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is multi-factorial. Although lifestyle interventions that focus on appropriate dietary education, physical activity education or interventions, and behavioral psychological interventions are suggested, more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are lacking. Anti-obesity drugs can be used to prevent and manage patients with WR after MBS; however, more research is needed to determine the timing, duration, and type of anti-obesity drugs used to prevent WR.

Association between pulse pressure and low muscle mass in Korean adults: A nationwide cross-sectional study.

Sarcopenia is characterized by a loss of muscle mass and strength and is associated with a high risk of cardiovascular events and increased mortality. Pulse pressure (PP) serves as a marker for changes in heart structure and function, as well as arterial stiffness. A high PP also increases the risk of cardiovascular disease and all-cause mortality. However, the relationship between PP and sarcopenia is poorly understood. We used the data of participants of the Korea National Health and Nutrition Examination Survey (KNHANES) of 2008 to 2011. Participants were divided into a control group (PP < 40 mm Hg) and a high-PP group (PP ≥ 40 mm Hg). PP was calculated by subtracting the diastolic blood pressure (DBP) from the systolic blood pressure (SBP), and the low muscle index was assessed using appendicular skeletal muscle mass (ASM) normalized by body mass index (BMI). Multiple logistic regression analyses were performed to examine the association between PP and the prevalence of low muscle mass, adjusting for potential confounders. The high-PP group had a higher age, SBP, DBP, and prevalence of hypertension, diabetes and hyperlipidemia than the control group. The high-PP group had a higher prevalence of low muscle mass than the control group in all models. A high PP is significantly associated with a higher prevalence of low muscle mass. Therefore, PP monitoring may help identify individuals at risk of sarcopenia and guide interventions to improve health outcomes.

Utilization of End-of-Life Care Rooms by Patients Who Died in a Single Hospice Unit at a National University Hospital in South Korea.

Purpose: For the dignity of patients nearing the end of their lives, it is essential to provide end-of-life (EoL) care in a separate, dedicated space. This study investigated the utilization of specialized rooms for dying patients within a hospice unit. Methods: This retrospective study examined patients who died in a single hospice unit between January 1, 2017, and December 31, 2021. Utilizing medical records, we analyzed the circumstances surrounding death, the employment of specialized rooms for terminally ill patients, and the characteristics of those who received EoL care in a shared room. Results: During the 1,825-day survey period, deaths occurred on 632 days, and 799 patients died. Of these patients, 496 (62.1%) received EoL care in a dedicated room. The average duration of using this dedicated space was 1.08 days. Meanwhile, 188 patients (23.5%) died in a shared room. Logistic regression analysis revealed that a longer stay in the hospice unit was associated with a lower risk of receiving EoL care in a shared room (odds ratio [OR]=0.98, 95% confidence interval [CI] 0.97~0.99; P=0.002). Furthermore, a higher number of deaths on the day a patient died was associated with a greater risk of receiving EoL care in a shared room (OR=1.66, 95% CI 1.33~2.08; P<0.001). Conclusion: To ensure that more patients receive EoL care for an adequate duration in a private setting, additional research is necessary to increase the number of dedicated rooms and incorporate them into the hospice unit at an early stage.

Association between weekend catch-up sleep and hyperuricemia with insufficient sleep in postmenopausal Korean women: a nationwide cross-sectional study.

OBJECTIVE: Hyperuricemia is associated with metabolic and cardiovascular diseases and mortality. Efforts to lower the risk of hyperuricemia in various ways are needed as the prevalence of these diseases increases in postmenopausal women. Studies have shown that one of these methods is associated with adequate sleep duration, which is related to a low risk of hyperuricemia. Considering that it is difficult for people to get enough sleep in modern society, this study hypothesized that weekend catch-up sleep could be an alternative. To our knowledge, no past study has investigated the relation between weekend catch-up sleep and hyperuricemia in postmenopausal women. Hence, the aim of this research was to estimate the relation between weekend catch-up sleep and hyperuricemia with insufficient sleep in postmenopausal women during weekday or workday. METHODS: This study included 1,877 participants extracted from the Korea National Health and Nutrition Examination Survey VII. The study population was divided into weekend catch-up sleep and non-weekend catch-up sleep groups. Odds ratios with 95% confidence intervals were derived using multiple logistic regression analysis. RESULTS: Weekend catch-up sleep had a significantly lower prevalence of hyperuricemia after adjusting for confounders (odds ratio, 0.758 [95% confidence interval, 0.576-0.997]). In a subgroup analysis, weekend catch-up sleep of 1 to 2 hours was significantly correlated with a lower prevalence of hyperuricemia after adjusting for confounders (odds ratio: 0.522 [95% confidence interval, 0.323-0.845]). CONCLUSIONS: Weekend catch-up sleep had a decreased prevalence of hyperuricemia in postmenopausal women with sleep deprivation.

Association between Sleep Duration and Presbycusis in Korean Adults: Korea National Health and Nutrition Examination Survey.

BACKGROUND: Sleep duration is associated with hearing loss, especially presbycusis, which is the most common type of hearing loss; however, there is limited evidence regarding this association among the Korean population. We aimed to determine the relationship between sleep duration and high-frequency hearing loss in Korean adults aged ≥40 years. METHODS: We examined 5,547 Korean adults aged ≥40 years who completed audiometric tests and questionnaires regarding sleep duration during the 2010-2012 cycle of the Korea National Health and Nutrition Examination Survey. Mild presbycusis was defined as >25 decibels (dB) and <40 dB, whereas moderate-to-severe presbycusis was defined as >40 dB pure tone averages at high frequencies (3,000, 4,000, and 6,000 Hz) for both ears. Additionally, the sleep duration was divided into quartiles. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression after adjusting for covariates. RESULTS: The prevalence of presbycusis in South Korean adults was 62.1%, of which 61.4% showed moderate to severe presbycusis. The incidence of moderate-to-severe, but not mild, presbycusis showed a significant positive correlation with sleep duration. CONCLUSION: Our findings suggest that sleep duration is associated with the prevalence of presbycusis.

Efficacy and safety of fermented Prunus mume vinegar on fatigue improvement in adults with unexplained fatigue: A randomized controlled trial.

Background: The accumulation of fatigue leads to reduced physical, emotional, psychological, and social functions. Objectives: Fermented Prunus mume vinegar (PV) improves fatigue in animals; however, studies in humans have not been conducted. We aimed to examine the effects and safety of consuming fermented PV for 8 weeks on fatigue indices in adults with unexplained fatigue while considering the placebo effect. Methods: A randomized, double-blind, placebo-controlled trial was conducted in adults of >19 years, who were diagnosed with unexplained fatigue for at least 1 month. Eighty participants were randomly assigned to receive daily 70 mL of fermented PV (2.56 mg/g, chlorogenic acid, and 15.3 mg/g, citric acid) or a placebo for 8 weeks. At baseline and 4 and 8 weeks after treatment, the participants were visited for blood tests (liver enzyme, glucose, creatinine, lactate, malondialdehyde [MDA], and creatine kinase [CK]) and questionnaires (Fatigue Severity Scale [FSS], fatigue visual analog scale [VAS], Beck Depression Inventory [BDI], the Korean version of the Brief Encounter Psychosocial Instrument [BEPSI-K], EQ-5D-3L, and EQ-VAS]). Results: Fermented PV supplementation for 8 weeks did not remarkably improve the fatigue indices when compared to placebo. Additionally, differences in fatigue VAS, BDI, BEPSI-K, EQ-5D-3L, EQ-VAS, lactate, CK, and MDA concentrations between the groups were not observed. However, FSS had positively correlated with fatigue VAS, BDI, and BEPSI-K, whereas it was negatively correlated with EQ-5D-3L and EQ-VAS at the baseline and 8 weeks. None of the participants reported adverse events. Conclusion: The efficacy of fermented PV did not exceed the efficacy of placebo in adults with unexplained fatigue. Clinical trial registration: [ClinicalTrials.gov], identifier [NCT04319692].

Histoplasma capsulatum culture-negative prosthetic valve endocarditis presenting as a cystic mass.

A 58-year-old immunocompetent patient with previous prosthetic valve presented with chest pain, constitutional symptoms and septic shock. Blood cultures and transthoracic echocardiogram were negative, but the patient was initiated on broad spectrum antibiotics due to high clinical suspicions of infective endocarditis. The patient received a transoesophageal echocardiogram revealing a cystic bioprosthetic valve lesion. Culture-negative endocarditis workup identified active disseminated histoplasmosis with likely Histoplasma endocarditis. A multidisciplinary discussion was held, and the patient was deemed high-risk for a third re-do open heart surgery. He was treated medically with anti-fungal treatment with good clinical recovery.

Biomarkers in metabolic syndrome.

Metabolic syndrome (MetS) is a global health challenge characterized as a group of risk factors for developing atherosclerotic cardiovascular disease. Although visceral adipose tissue, adipocyte dysfunction, chronic low-grade inflammation, and insulin resistance are fundamental to MetS, the exact biochemical mechanisms underlying this disease state remain unclear. Numerous biomarkers, however, have been proposed to improve our understanding of its complex pathophysiology and facilitate diagnosis. This review examines these biomarkers and clarifies their potential roles in the pathogenesis, diagnosis, prediction, progression, and severity of MetS and MetS-related disorders.

The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer.

OBJECTIVE: Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS. METHODS: This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle. RESULTS: PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA. CONCLUSION: The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.