Clinical profile and treatment outcomes of idiopathic intracranial hypertension: a multicenter study from Korea.

BACKGROUND: Currently, there is a relative lack of detailed reports regarding clinical presentation and outcome of idiopathic intracranial hypertension in Asians. This study aims to describe the clinical features and treatment outcomes of Korean patients with idiopathic intracranial hypertension. METHODS: We prospectively recruited patients with idiopathic intracranial hypertension from one hospital and retrospectively analyzed the medical records of 11 hospitals in Korea. We collected data regarding preceding medical conditions or suspected medication exposure, headache phenotypes, other associated symptoms, detailed neuroimaging findings, treatments, and outcomes after 1-2 and 3-6 months of treatment. RESULTS: Fifty-nine (83.1% women) patients were included. The mean body mass index was 29.11 (standard deviation, 5.87) kg/m2; only 27 patients (45.8%) had a body mass index of ≥ 30 kg/m2. Fifty-one (86.4%) patients experienced headaches, patterns of which included chronic migraine (15/51 [29.4%]), episodic migraine (8/51 [15.7%]), probable migraine (4/51 [7.8%]), chronic tension-type headache (3/51 [5.9%]), episodic tension-type headache (2/51 [3.9%]), probable tension-type headache (2/51 [3.9%]), and unclassified (17/51 [33.3%]). Medication overuse headache was diagnosed in 4/51 (7.8%) patients. After 3-6 months of treatment, the intracranial pressure normalized in 8/32 (25.0%), improved in 17/32 (53.1%), no changed in 7/32 (21.9%), and worsened in none. Over the same period, headaches remitted or significantly improved by more than 50% in 24/39 patients (61.5%), improved less than 50% in 9/39 (23.1%), and persisted or worsened in 6/39 (15.4%) patients. CONCLUSION: Our findings suggest that the features of Asian patients with idiopathic intracranial hypertension may be atypical (i.e., less likely obese, less female predominance). A wide spectrum of headache phenotypes was observed. Medical treatment resulted in overall favorable short-term outcomes; however, the headaches did not improve in a small proportion of patients.

Trend of incidence rate of age-related diseases: results from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in Korea: a cross- sectional study.

BACKGROUND: This study aimed to identify and select age-related diseases (ARDs) in Korea, which is about to have a super-aged society, and to elucidate patterns in their incidence rates. METHODS: The National Health Insurance Service-National Sample Cohort, comprising 1 million health insurance and medical benefit beneficiaries in Korea from 2002 to 2019, was utilized. We selected 14 diseases with high disease burden and prevalence among Koreans from the 92 diseases defined in the Global Burden of Diseases, Injuries, and Risk Factors Study as ARDs. The annual incidence rate represented the number of patients newly diagnosed with an ARD each year from 2006 to 2019, excluding those with a history of ARD diagnosis from 2002 to 2005. The incidence rate by age was categorized into 10-year units based on age as of 2019. The number of patients with ARDs in each age group was used as the numerator, and the incidence rate for each age group was calculated with the age group as the denominator. RESULTS: Regarding the annual incidence rates of ARDs from 2006 to 2019, chronic obstructive pulmonary disease, congestive heart failure, and ischemic heart disease decreased annually, whereas dyslipidemia, chronic kidney disease, cataracts, hearing loss, and Parkinson's disease showed a significant increase. Hypertension, diabetes, cerebrovascular disease, osteoporosis, osteoarthritis, and age-related macular degeneration initially displayed a gradual decrease in incidence but exhibited a tendency to increase after 2015. Concerning age-specific incidence rates of ARDs, two types of curves emerged. The first type, characterized by an exponential increase with age, was exemplified by congestive heart failure. The second type, marked by an exponential increase peaking between ages 60 and 80, followed by stability or decrease, was observed in 13 ARDs, excluding congestive heart failure. However, hypertension, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and hearing loss in men belonged to the first type. CONCLUSIONS: From an epidemiological perspective, there are similar characteristics in age-specific ARDs that increase with age, reaching a peak followed by a plateau or decrease in Koreans.

Relationships among Symptoms, Disability, Type D Personality, and Quality of Life in Patients with Migraine: A Cross-Sectional Study in South Korea.

BACKGROUND: Type D personality as a personality vulnerable to stress consists of negative affectivity and social inhibition, and it is related to symptoms and decreased quality of life in patients with chronic illness. AIM: This study aimed to explore the relationships among migraine symptoms, disability, type D personality, and quality of life in patients with migraine. METHODS: A convenience sample of 135 patients with migraine was collected at the neurologic outpatient clinics of two tertiary hospitals in South Korea. Frequency and severity of migraine symptoms, Migraine Disability Assessment, type D personality, and quality of life were investigated using a structured questionnaire. A descriptive cross-sectional design was used. RESULTS: Sixty-one (45.2%) were classified as type D personality. The intensity of the most severe migraine and Migraine Disability Assessment scores in subjects with type D personality were significantly higher than those in subjects without type D personality. In addition, the quality of life score of subjects with type D personality was significantly lower than in subjects without type D personality. The intensity of the migraine, Migraine Disability Assessment score, and type D personality were significant factors influencing quality of life on stepwise multiple regression analysis. CONCLUSIONS: Type D personality was related to migraine symptoms, disability, and quality of life in patients with migraine.

Predictive Model of Self-management in Patients With Stroke Based on the Information-Motivation-Behavioral Skills Model.

BACKGROUND: Patients who had a stroke are required to manage risk factors, and self-management for risk factor control in stroke is essential. Recent studies using the information-motivation-behavioral skills model reported that the model is effective for predicting and explaining self-management behavior in chronically ill patients. OBJECTIVES: This study aimed to develop and verify the predictive model of self-management based on the information-motivation-behavioral skills model in patients with stroke. METHODS: This was a descriptive, cross-sectional study; path analysis was conducted to develop and verify the hypothesized predictive model. We recruited 242 patients who had a stroke using convenience sampling from the neurological outpatient clinic. RESULTS: The model's fit indices were adequate. Stroke self-management knowledge, social support, and self-efficacy had a direct effect on stroke self-management, and stroke self-management knowledge and attitude and social support had an indirect effect on stroke self-management, mediated by self-efficacy. Stroke self-management knowledge and attitude, social support, and self-efficacy explained 27.5% of the total variance in stroke self-management. CONCLUSIONS: The information-motivation-behavioral skills model is potentially a predictive model for self-management for patients who had a stroke. Considering the level of stroke knowledge and attitude, social support, and self-efficacy together may help to understand the required level of self-management. In addition, using this model for the development of self-management interventions for patients who had a stroke could be a strategy for improving self-management in patients with stroke.

Effect of a Hospital-To-Home Transitional Intervention Based on an Interaction Model of Client Health Behavior for Adult Patients with Stroke.

To develop and identify the effectiveness of a hospital-to-home transitional intervention based on an interaction model of client health behavior in adult patients with stroke. A non-equivalent control group pretest-posttest. Thirty-eight patients participated (18=intervention, 20=control); the intervention group received 12 weeks of the intervention. The intervention influenced anxiety, disease severity, health behavior adherence, patient satisfaction, and quality of life in adult patients with stroke. Transitional programs have potential to improve the health behaviors of subjects, and community health nurses can assist in the implementation of these programs. Health behaviors and quality of life scores were significantly higher in the intervention group than in the control group; these findings support the need for continuity of nursing care during the transitional period for patients with stroke. Given the challenges faced by adult stroke patients after stroke, community nurses should pay attention to patients' transitional experiences.

De Novo Sphingolipid Biosynthesis in Atherosclerosis.

Atherosclerosis is the formation of fibrofatty lesions in the arterial wall, and this inflammatory state of the artery is the main cause of advanced pathological processes, including myocardial infarction and stroke. Dyslipidemic conditions with excess cholesterol accumulate within the arterial vessel wall and initiate atherogenic processes. Following vascular reaction and lipid accumulation, the vascular wall gradually thickens. Together with the occurrence of local inflammation, early atherosclerotic lesions lead to advanced pathophysiological events, plaque rupture, and thrombosis. Ceramide and sphingomyelin have emerged as major risk factors for atherosclerosis and coronary artery disease. Currently, the clinical association between de novo sphingolipid biosynthesis and coronary artery disease has been established. Furthermore, therapeutic strategies to modulate this pathway, especially those involving serine palmitoyltransferase and sphingomyelin synthase, against atherosclerosis, cancer, type 2 diabetes, and non-alcoholic fatty liver disease are actively under development. In this chapter, we focus on the relationship between de novo sphingolipid biosynthesis and coronary artery disease.

Influence of Type D Personality on Health Promoting Behaviours and Quality of Life in Stroke Patients: A Cross-Sectional Study in South Korea.

OBJECTIVES: Type D personality is vulnerable to stress and is associated with high symptom severity, unhealthy behaviors, and low quality of life (QoL) in patients with chronic diseases. This study aimed to identify the influence of type D personality on health promoting behaviors and QoL in patients with ischemic stroke in South Korea. MATERIALS AND METHODS: A descriptive, cross-sectional design was used. This study collected data from a convenience sample of 170 patients with ischemic stroke. Demographic and clinical characteristics, health promoting behaviors, and QoL were compared between the type D personality group and the non-type D group. Stepwise multiple regression analysis was performed to identify factors influencing patients' QoL. RESULTS: Of the 170 subjects, 39 (22.9%) were classified as having type D personality. Type D personality was associated with higher National Institutes of Health Stroke Scale scores at admission and discharge, higher modified Rankin Scale (mRS) scores at 3 months after stroke, lower scores for health promoting behaviors, and lower QoL. Regression analysis showed that mRS score 3 months after stroke was the most significant factor influencing QoL, followed by health promoting behaviors, type D personality, speech deficits, and family income. CONCLUSIONS: Type D personality should be considered together with health promoting behaviors and QoL in patients with ischemic stroke. Interventions considering type D personality may be helpful in improving health promoting behavior and QoL for the stroke patients.

Post-Stroke Fatigue May Be Associated with the Promoter Region of a Monoamine Oxidase A Gene Polymorphism.

BACKGROUND: Post-stroke fatigue (PSF) is a common sequela of stroke. Despite reports of serotonergic involvement in the etiology of PSF, the potential contribution of serotonergic genes in the development of PSF needs to be investigated. METHODS: A total of 373 patients, who experienced ischemic stroke for PSF, were evaluated 3 months after the stroke. PSF was assessed using the Fatigue Severity Scale. The genomic DNA collected and stored in a -70°C freezer was genotyped for 6 polymorphisms in genes associated with serotonin synthesis (tryptophan hydroxylase 1 (TPH1) A218C, TPH2 rs10879355, and TPH2 rs4641528), transport (the promoter region of the serotonin transporter protein), and catabolism (the 30-bp functional variable number tandem repeat) polymorphism in the promoter region of monoamine oxidase A (MAO-A). RESULTS: Among the 373 patients, 164 (44%) had PSF. All patients were ethnic Koreans. Of the 6 polymorphisms examined, only one marker, that is, low-activity MAO-A was associated with PSF (p < 0.05) in female patients. Multiple logistic regression analyses showed that post-stroke depression (PSD; 95% CI 1.561-14.323, p = 0.006) and low MAO-A activity (95% CI 0.166-0.722, p = 0.005) were factors associated with PSF in female patients, whereas only PSD (95% CI 5.511-65.269, p = 0.000) was associated with PSF in male patients. CONCLUSIONS: Our findings suggest that PSF may be associated with a genetic polymorphism involving MAO-A, at least in female stroke patients.

Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review.

BACKGROUND AND PURPOSE: We investigated clinical and radiological characteristics of ischemic stroke patients with Takotsubo-like myocardial dysfunction. METHODS: From multicenter stroke registry database, ischemic stroke patients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo-like myocardial dysfunction with those without and further performed systematic literature review on those with Takotsubo cardiomyopathy. RESULTS: This study included 23 patients (0.42%). The mean age was 70.7±13.9 years, with predominance of women (73.9%) and typical pattern of Takotsubo-like myocardial dysfunction (91.3%). They were associated with short-term poor functional outcomes, including high mortality, neurological deterioration, and functional status at discharge, compared with those without (39.1% versus 2.4%, 47.8% versus 7.4%; and median [interquartile range], 5 [5-6] versus 3 [2-4]; all P<0.001). They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review. CONCLUSION: Stroke patients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.

Medical security and catastrophic health expenditures among households containing persons with disabilities in Korea: a longitudinal population-based study.

BACKGROUND: Although persons with disabilities need access to comprehensive and consistent healthcare services, a significant number of the poor with disabilities do not receive Medical-Aid due to the conditions of eligibility. We aimed to compare the financial burden of healthcare services between two groups of poor persons with disabilities: those not enrolled in Medical-Aid and Medical-Aid enrollees. METHODS: This study used the 1st-8th data (2008-2014 year) of Panel Survey of Employment for the Disabled (PSED) conducted by the Korea Employment Agency for the Disabled. We classified adults who did not exceed 100 % of the poverty level into two groups (N = 3,010). The first group consisted of enrollees in Medical-Aid (n = 1,259) and the second group comprised those not enrolled in Medical-Aid (n = 1,325). We applied generalized estimating equations (GEEs) to assess the independent effect of enrollment in Medical-Aid on catastrophic health expenditures (CHE). RESULTS: We found that about 4.2 % of the poor not enrolled in the Medical-Aid experienced CHE and the poor not enrolled in Medical-Aid were 2.1 times more likely to experience CHE than Medical-Aid enrollees after applying multivariate models adjusted for several covariates. CONCLUSIONS: Given the additional expenses for treatment and rehabilitation caused by disability-related health problems, persons with disabilities are more likely to face barriers to needed medical services. Thus, policy makers need to expand the number of people receiving Medical-Aid by loosening the strict criteria for those with disabilities.

Prestroke Antiplatelet Agents in First-Time Ischemic Stroke Are Related to Subtypes.

BACKGROUND: It is not well known whether prestroke antiplatelet agents (PAs) are associated with the subtypes of ischemic stroke. METHODS: We screened patients in a hospital-based stroke registry. Patients who were admitted with a diagnosis of first-time ischemic stroke within 5 days of symptom onset were included. Ischemic stroke subtypes were classified in accordance with the Trial of ORG 10172 in Acute Stroke Treatment classification based on stroke mechanism: large-artery atherosclerosis (LA), cardioembolism (CE), small vessel occlusion (SVO), other determined (OC) or undetermined causes (UC). Multinomial logistic regression analyses were performed to evaluate the effect of PA on stroke subtypes before and after propensity score matching. RESULTS: Among 3,025 patients, 748 (24.7%) were taking antiplatelet agents prior to stroke. After propensity score matching, 1,190 patients were ultimately included. The PA group was associated with strokes caused by SVO rather than LA in multinomial logistic regression of an unmatched dataset. However, multivariable analysis after propensity score matching demonstrated that PA use was associated with a higher probability of SVO and CE (OR 2.05, p < 0.001 and OR 1.62, p = 0.05, respectively) compared with LA. CONCLUSIONS: PAs were associated with specific index stroke subtypes.

Measuring melittin uptake into hydrogel nanoparticles with near-infrared single nanoparticle surface plasmon resonance microscopy.

This paper describes how changes in the refractive index of single hydrogel nanoparticles (HNPs) detected with near-infrared surface plasmon resonance microscopy (SPRM) can be used to monitor the uptake of therapeutic compounds for potential drug delivery applications. As a first example, SPRM is used to measure the specific uptake of the bioactive peptide melittin into N-isopropylacrylamide (NIPAm)-based HNPs. Point diffraction patterns in sequential real-time SPRM differential reflectivity images are counted to create digital adsorption binding curves of single 220 nm HNPs from picomolar nanoparticle solutions onto hydrophobic alkanethiol-modified gold surfaces. For each digital adsorption binding curve, the average single nanoparticle SPRM reflectivity response, ⟨Δ%RNP⟩, was measured. The value of ⟨Δ%RNP⟩ increased linearly from 1.04 ± 0.04 to 2.10 ± 0.10% when the melittin concentration in the HNP solution varied from zero to 2.5 µM. No change in the average HNP size in the presence of melittin is observed with dynamic light scattering measurements, and no increase in ⟨Δ%RNP⟩ is observed in the presence of either FLAG octapeptide or bovine serum albumin. Additional bulk fluorescence measurements of melittin uptake into HNPs are used to estimate that a 1% increase in ⟨Δ%RNP⟩ observed in SPRM corresponds to the incorporation of approximately 65000 molecules into each 220 nm HNP, corresponding to roughly 4% of its volume. The lowest detected amount of melittin loading into the 220 nm HNPs was an increase in ⟨Δ%RNP⟩ of 0.15%, corresponding to the absorption of 10000 molecules.

Statins improve survival in patients with cardioembolic stroke.

BACKGROUND AND PURPOSE: The objective of this study was to investigate the potential benefits of statin therapy on mortality and stroke recurrence after cardioembolic stroke. METHODS: In this retrospective observational study, we analyzed data from 535 patients with first-ever cardioembolic stroke. Patients were classified into nonstatin, low-potency statin, and high-potency statin groups. The primary outcomes were time to mortality and time to recurrent stroke. RESULTS: The mean duration of follow-up was 22.2 months. The cumulative mortality rate was 7% at the end of the first year and 10% at the end of the third year. Statin therapy was independently associated with reduced mortality (hazard ratio, 0.237; 95% confidence interval, 0.080-0.703 for nonstatin versus low-potency statin; hazard ratio, 0.158; 95% confidence interval, 0.037-0.686 for nonstatin versus high-potency statin). Statin treatment did not affect the incidence of recurrent stroke in patients with cardioembolic stroke. CONCLUSIONS: Statin therapy could be associated with reduced mortality in patients with cardioembolic stroke.

Leptomeningeal collaterals are associated with modifiable metabolic risk factors.

OBJECTIVE: We sought to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke. METHODS: Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery ± intracranial internal carotid artery occlusions on baseline computed tomographic angiography (CTA) from May 2004 to July 2009 were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using a previously validated regional leptomeningeal score (rLMC). RESULTS: Baseline characteristics (N = 206) were: mean age = 66.9 ± 11.6 years, median baseline National Institutes of Health Stroke Scale = 14 (interquartile range [IQR] = 11-20), and median time from stroke symptom onset to CTA = 166 minutes (IQR = 96-262). Poor collateral status at baseline (rLMC score = 0-10) was seen in 73 of 206 patients (35.4%). On univariate analyses, patients with poor collateral status at baseline were older; were hypertensive; had higher white blood cell count, blood glucose, D-dimer, and serum uric acid levels; and were more likely to have metabolic syndrome. Multivariate modeling identified metabolic syndrome (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.69-6.15, p < 0.001), hyperuricemia (per 1mg/dl serum uric acid; OR = 1.35, 95% CI = 1.12-1.62, p < 0.01), and older age (per 10 years; OR = 1.34, 95% CI = 1.02-1.77, p = 0.03) as independent predictors of poor leptomeningeal collateral status at baseline. INTERPRETATION: Metabolic syndrome, hyperuricemia, and age are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke.

Effective mechanical thrombectomy in a patient with hyperacute ischemic stroke associated with cardiac myxoma.

Ischemic stroke is the most common neurologic manifestation of cardiac myxoma. However, there has been no current guideline on the treatment of hyperacute ischemic stroke due to cardiac myxoma. We describe a patient with hyperacute stroke caused by cardiac myxoma who had a good outcome with rapid recanalization through mechanical thrombectomy. A 46-year-old man was admitted with acute symptoms of right side hemiplegia and global aphasia. Brain computed tomography (CT) angiography showed a T occlusion of the left internal carotid artery. Intravenous recombinant tissue plasminogen activator was administered. However, his clinical symptoms did not improve. Thus, we performed endovascular treatment and had a successful outcome. A pathologic examination of the retrieved clot revealed a tumor emboli from a cardiac myxoma. Transthoracic echocardiogram revealed a left atrial myxoma in which a large mass was attached to the posterior wall of the aorta. The patient's neurologic deficits recovered with the exception of left eye blindness. Reperfusion therapy with mechanical thrombectomy might be safe and effective for the rapid revascularization of large vessel occlusions in hyperacute ischemic stroke, from which the tumor thrombi can be retrieved.

Electrodeposition of polydopamine thin films for DNA patterning and microarrays.

The controlled electrodeposition of functional polydopamine (PDA) thin films from aqueous dopamine solutions is demonstrated with a combination of electrochemistry, atomic force microscopy (AFM), and surface plasmon resonance (SPR) measurements. PDA micropatterns are then fabricated by electrodeposition on micrometer length scale gold electrodes and used for attaching amino-modified single-stranded DNA (ssDNA). After hybridization with fluorescently labeled ssDNA, the fluorescence microscopy characterization reveals that: (i) PDA can be toposelectively deposited at the microscale and (ii) electrochemically deposited PDA can be functionalized with amino-terminated ssDNA using the same chemistry as that for spontaneously deposited PDA. Finally, the application of electrodeposited PDA thin films to fabricate ssDNA microarrays is reported using SPR imaging (SPRI) measurements for the detection of DNA and DNA-modified gold nanoparticles.

Fabrication of DNA microarrays on polydopamine-modified gold thin films for SPR imaging measurements.

Polydopamine (PDA) films were fabricated on thin film gold substrates in a single-step polymerization-deposition process from dopamine solutions and then employed in the construction of robust DNA microarrays for the ultrasensitive detection of biomolecules with nanoparticle-enhanced surface plasmon resonance (SPR) imaging. PDA multilayers with thicknesses varying from 1 to 5 nm were characterized with a combination of scanning angle SPR and AFM experiments, and 1.3 ± 0.2 nm PDA multilayers were chosen as an optimal thickness for the SPR imaging measurements. DNA microarrays were then fabricated by the reaction of amine-functionalized single-stranded DNA (ssDNA) oligonucleotides with PDA-modified gold thin film microarray elements, and were subsequently employed in SPR imaging measurements of DNA hybridization adsorption and protein-DNA binding. Concurrent control experiments with non-complementary ssDNA sequences demonstrated that the adhesive PDA multilayer was also able to provide good resistance to the nonspecific binding of biomolecules. Finally, a series of SPR imaging measurements of the hybridization adsorption of DNA-modified gold nanoparticles onto mixed sequence DNA microarrays were used to confirm that the use of PDA multilayer films is a simple, rapid, and versatile method for fabricating DNA microarrays for ultrasensitive nanoparticle-enhanced SPR imaging biosensing.

Effect of flip angle for optimization of image quality of gadoxetate disodium-enhanced biliary imaging at 1.5 T.

OBJECTIVE: The purpose of this study was to perform a qualitative and quantitative comparison of image quality of gadoxetate disodium-enhanced imaging of the biliary system acquired using different flip angles (FAs). MATERIALS AND METHODS: Thirty-two patients (21 men and 11 women; mean [± SD] age, 51 ± 16 years) who underwent gadoxetate disodium-enhanced 1.5-T MRI were included. A 3D fat-suppressed T1-weighted gradient-echo sequence was acquired during the hepatobiliary phase using FAs of 12°, 25°, and 40°. One radiologist, who was blinded to FA, measured signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the biliary tree. Two other blinded radiologists assessed subjective biliary duct clarity, overall image quality, background signal suppression, and ghosting artifact from the biliary tree using a scale of 1 to 4. RESULTS: SNRs and CNRs of the common bile duct were significantly higher for FAs of 25° (227.5 ± 113.2 and 191.0 ± 102.2, respectively) and 40° (239.6 ± 118.7 and 201.7 ± 107.7, respectively) than for 12° (168.9 ± 73.9 and 126.7 ± 59.7, respectively; all p < 0.001). There were no significant differences in SNR or CNR between FAs of 25° and 40° (p ≥ 0.360). Clarity of first-, second-, and third-order intrahepatic ducts, background signal suppression, and overall image quality were significantly higher for both readers for FAs of 25° and 40° than for 12° (all p ≤ 0.031). None of these comparisons was significantly different for either reader between FAs 25° and 40° (all p ≥ 0.091), aside from improved depiction of third-order ducts at 40° for one reader (p = 0.030). Biliary ghosting artifact was significantly worse at 40° than at 12° for both readers (p ≤ 0.016). CONCLUSION: The use of an FA larger than the clinical standard of approximately 12° has the potential to improve the image quality of gadoxetate disodium-enhanced biliary imaging.

Effects of Customized Digital Health Care Service on Metabolic Syndrome Status and Lifestyle Using a Health Care App: Clinical Trial.

BACKGROUND: Untact cultures have rapidly spread around the world as a result of the prolongation of the COVID-19 pandemic, leading to various types of research and technological developments in the fields of medicine and health care, where digital health care refers to health care services provided in a digital environment. Previous studies relating to digital health care demonstrated its effectiveness in managing chronic diseases such as hypertension and diabetes. While many studies have applied digital health care to various diseases, daily health care is needed for healthy individuals before they are diagnosed with a disease. Accordingly, research on individuals who have not been diagnosed with a disease is also necessary. OBJECTIVE: This study aimed to identify the effects of using a customized digital health care service (CDHCS) on risk factors for metabolic syndrome (MS) and lifestyle improvement. METHODS: The population consisted of 63 adults who underwent a health checkup at the National Health Insurance Service Ilsan (NHIS) Hospital in 2020. Measured variables include basic clinical indicators, MS-related variables, and lifestyle variables. All items were measured at NHIS Ilsan Hospital before the use of the CDHCS and 3 months thereafter. The CDHCS used in this study is a mobile app that analyzes the health condition of the user by identifying their risk factors and provides appropriate health care content. For comparison between before and after CDHCS use (pre-post comparison), paired t test was used for continuous variables, and a chi-square test was used for nominal variables. RESULTS: The study population included 30 (47.6%) male and 33 (52.4%) female participants, and the mean age was 47.61 (SD 13.93) years. The changes in clinical indicators before and after intervention results showed a decrease in weight, waist circumference, triglyceride, and high-density lipoprotein cholesterol and increases in systolic blood pressure and diastolic blood pressure. The distribution of the risk group increased from 32 (50.8%) to 34 (54%) and that of the MS group decreased from 18 (28.6%) to 16 (25.4%). The mean metabolic syndrome age-chronological age before the CDHCS was 2.20 years, which decreased to 1.72 years after CDHCS, showing a decrease of 0.48 years in the mean metabolic syndrome age-chronological age after the intervention. While all lifestyle variables, except alcohol consumption, showed a tendency toward improvement, the differences were not statistically significant. CONCLUSIONS: Although there was no statistical significance in the variables under study, this pilot study will provide a foundation for more accurate verification of CDHCS in future research.

10-year follow-up study on medical expenses and medical care use according to biological age: National Health Insurance Service Health Screening Cohort (NHIS-HealS 2002~2019).

OBJECTIVES: The world is witnessing a sharp increase in its elderly population, accelerated by longer life expectancy and lower birth rates, which in turn imposes enormous medical burden on society. Although numerous studies have predicted medical expenses based on region, gender, and chronological age (CA), any attempt has rarely been made to utilize biological age (BA)-an indicator of health and aging-to ascertain and predict factors related to medical expenses and medical care use. Thus, this study employs BA to predict factors that affect medical expenses and medical care use. MATERIALS AND METHODS: Referring to the health screening cohort database of the National Health Insurance Service (NHIS), this study targeted 276,723 adults who underwent health check-ups in 2009-2010 and kept track of the data on their medical expenses and medical care use up to 2019. The average follow-up period is 9.12 years. Twelve clinical indicators were used to measure BA, while the total annual medical expenses, total annual number of outpatient days, total annual number of days in hospital, and average annual increases in medical expenses were used as the variables for medical expenses and medical care use. For statistical analysis, this study employed Pearson correlation analysis and multiple regression analysis. RESULTS: Regression analysis of the differences between corrected biological age (cBA) and CA exhibited statistically significant increases (p<0.05) in all the variables of the total annual medical expenses, total annual number of outpatient days, total annual number of days in hospital, and average annual increases in medical expenses. CONCLUSIONS: This study quantified decreases in the variables for medical expenses and medical care use based on improved BA, thereby motivating people to become more health-conscious. In particular, this study is significant in that it is the first of its kind to predict medical expenses and medical care use through BA.