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.

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.

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.

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 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.

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.).

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.

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.

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.

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.

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].

Association between Serum Folic Acid Levels and Asthma in the Korean Population: A Study Based on the 2016-2018 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Folic acid is involved in inflammatory reactions; however, the association between folic acid and allergic diseases, particularly asthma, remains unclear. Thus, this study aimed to evaluate the association between serum folic acid levels and asthma in Koreans. METHODS: This study analyzed the serum folic acid levels of 6,615 individuals included in the 2016-2018 Korea National Health and Nutrition Examination Survey. The prevalence of asthma was determined using a questionnaire that identified cases of physician-diagnosed asthma. The relationship between serum folic acid levels and asthma was analyzed using logistic regression analysis. RESULTS: Multiple logistic regression analysis showed that a 1 ng/mL increase in serum folic acid level significantly reduced the risk of asthma after adjusting for confounding factors including sex, age, household income, current smoking, current alcohol use, and body mass index (odds ratio [OR], 0.930; 95% confidence interval [CI], 0.876- 0.987; P=0.017). The relationship between the adjusted odds of asthma and serum folic acid levels were consistently inverse (OR, 2.266; 95% CI, 1.126-4.420; P for trend=0.038). CONCLUSION: Serum folic acid levels are inversely associated with physician-diagnosed asthma in the Korean population.

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.

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.

Association between Near Work Time and Depression among Workers in South Korea.

BACKGROUND: The aim of this study was to evaluate the association between near work time and depression. METHODS: Data of 1,551 workers aged 19-49 years from the sixth Korea National Health and Nutrition Examination Survey were examined. The Patient Health Questionaire-9 scores were used to screen for depression. Participants who scored a total of 10 or above, which is suggestive of the presence of depression, were classified as the depression group; the rest were classified as normal. The correlation between daily near work time and depression was analyzed using multivariate logistic analysis after adjusting for other sociodemographic and health behavior-related variables. RESULTS: Multivariate logistic analysis found that workers with 3 or more hours of near work were more likely to report depression compared to the reference group who had 2 or fewer hours per day of near work (adjusted odds ratio, 2.471; 95% confidence interval, 1.062-5.747). CONCLUSION: Longer near work time was associated with depression among South Korea's workers. Therefore, it is necessary to reduce near work time to prevent depression.

High Prevalence of Metabolic Syndrome in Middle-Aged Men Born in Spring.

Background: Metabolic syndrome (MetS) is a major cause of increased cardiovascular disease mortality in middle-aged men. Previous studies examined the birth season and health status such as obesity and cardiovascular mortality in adulthood. However, the relationship between birth season and MetS has not yet been studied. In this study, we examined the prevalence of MetS in middle-aged men according to birth season. Materials and Methods: In this cross-sectional study, the data were collected from 4575 middle-aged men 30-50 years of age, who underwent a comprehensive health checkup examination. The subjects were separated into four seasons according to birth month. Results: There were no statistically significant differences in age according to birth season. However, there was a significant difference in the prevalence of MetS according to birth season: it was highest in spring (25.9%) and lowest in autumn (21.7%, odds ratio [OR] 0.787, 95% confidence interval [CI] 0.646-0.960, P = 0.001). Middle-aged men born in the spring had the highest body mass index (BMI) and prevalence of high waist circumference (WC), high fasting plasma glucose (FPG), and high blood pressure (BP), while those born in autumn had the lowest BMI (η2 = 0.007, P = 0.001) and prevalence of high WC (OR = 0.664, 95% CI 0.558-0.790, P = 0001), high FPG (OR = 0.761, 95% CI 0.624-0.928, P = 0.03), and high BP (OR = 0.633, 95% CI 0.531-0.755, P = 0.001). The prevalence of MetS according to birth months was highest in March (26.8%) and lowest in July (18.6%, OR 0.629, 95% CI 0.444-0.980, P = 0.001). Conclusion: Middle-aged men born in the spring had a higher prevalence of MetS than those born in the fall.

Acute Myocarditis Following mRNA-1273 SARS-CoV-2 Vaccination.

Myocarditis has been described previously as a rare side effect of both influenza and smallpox vaccines. In this report, we present a case of acute perimyocarditis in a young, healthy man after vaccination with the mRNA-1273 severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2; Moderna) vaccine. He presented with chest pain and decompensated heart failure 3 days after administration of his second dose, and his symptoms resolved by 9 days post-inoculation. This case highlights a rare but potentially serious side effect of this mRNA vaccine that primary care physicians and cardiologists should be aware of in order to identify and appropriately manage these patients.

La myocardite a auparavant été considérée comme un effet secondaire rare des vaccins antigrippaux et antivarioliques. Dans ce rapport, nous présentons le cas d'un homme, jeune et en bonne santé, atteint d'une périmyocardite aiguë après avoir reçu le vaccin à ARNm-1273 contre le coronavirus du syndrome respiratoire aigu sévère 2 (SARS-CoV-2, de l'anglais severe acute respiratory syndrome coronavirus-2; Moderna). Il a éprouvé une douleur thoracique et présenté une décompensation cardiaque 3 jours après l'administration de la seconde dose. Les symptômes se sont résorbés 9 jours après l'inoculation. Ce cas illustre un effet secondaire rare, mais potentiellement sérieux, de ce vaccin à ARNm, que les médecins de premier recours et les cardiologues doivent connaître pour être en mesure de détecter et prendre en charge adéquatement ces patients.

The Relationship of Sitting Time and Physical Activity on the Quality of Life in Elderly People.

Few studies have shown the combined impact of sitting time and physical activity on quality of life in older people. This cross-sectional study, using data from the 2016-2018 Korean National Health and Nutrition Examination Survey, examines the association between sitting time and physical activity and health-related quality of life (HRQoL) in Korean adults aged ≥ 65 years. HRQoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). We divided subjects into groups based on sitting time and physical activity and analyzed the combined association of sitting time and physical activity with HRQoL. The association between longer sitting time (≥8 h) and HRQoL was analyzed using multiple logistic regression. In total, 4276 participants were included. Prolonged sitting time was associated with all of the EQ-5D dimensions: mobility (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.22-1.68), self-care (OR: 1.65 [95% CI 1.25-2.17]), usual activities (OR: 2.07 [95% CI 1.69-2.52]), pain/discomfort (OR: 1.57 [95% CI 1.34-1.84]), and anxiety/depression (OR: 1.49 [95% CI 1.17-1.91]). The prolonged sitting time/inactive group had higher ORs for all the EQ-5D dimensions than the low sitting time/active group. Prolonged sitting time was associated with low HRQoL in elderly Korean adults; physical activity could weaken the negative influence of prolonged sitting time on HRQoL.

Association Between Weekend Catch-Up Sleep and Metabolic Syndrome with Sleep Restriction in Korean Adults: A Cross-Sectional Study Using KNHANES.

BACKGROUND: Many researchers have identified that adequate sleep duration is linked to the quality of life and metabolic diseases. Nowadays, it is hard to take enough sleep, so weekend catch-up sleep (CUS) may be an alternative option in modern society. To our knowledge, no previous studies reported the association between weekend CUS and metabolic syndrome, especially in the Korean population. OBJECTIVE: We investigated the association between weekend CUS and the prevalence of metabolic syndrome in Korean adults (≥20 years old) with less than 6 hours of average weekday sleep. PATIENTS AND METHODS: A total of 1,453 individuals were selected from the Korean National Health and Nutrition Examination Survey. Weekend CUS was divided into four categories: ≤0 hour, 0-1 hour, 1-2 hours, and ≥2 hours. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate and multivariate logistic regression analyses. RESULTS: Participants with weekend CUS ≥1 hour had decreased risk of metabolic syndrome in univariate analysis (CUS 1-2 hours: OR: 0.413, 95% CI: 0.301-0.568; CUS ≥2 hours: OR: 0.382, 95% CI 0.296-0.493). Weekend CUS 1-2 hours reduced the risk of metabolic syndrome in multivariate logistic regression analysis (OR: 0.552, 95% CI: 0.369-0.823). Based on the age group analysis, weekend CUS ≥1 hour reduced the metabolic syndrome among those aged 20-39 and 40-65 (20-39: CUS 1-2 hours OR: 0.248, 95% CI: 0.078-0.783, CUS ≥2 hours OR: 0.374, 95% CI: 0.141-0.991; 40-65: CUS 1-2 hours OR: 0.507, 95% CI 0.309-0.832 CUS ≥2 hours OR: 0.638, 95% CI: 0.415-0.981). CONCLUSION: Weekend CUS was associated with a low risk of metabolic syndrome among Korean adults with sleep restriction.