Yonsei Medical Journal最新文献

{"title":"Real-World Effectiveness of Omalizumab Treatment in Adult Asthma Patients.","authors":"Jae-Hyuk Jang, ChulHyoung Park, Chungsoo Kim, Youngsoo Lee, Eunyoung Lee, Rae Woong Park, Hae-Sim Park","doi":"10.3349/ymj.2024.0320","DOIUrl":"https://doi.org/10.3349/ymj.2024.0320","url":null,"abstract":"<p><strong>Purpose: </strong>Omalizumab improves clinical outcomes for patients with severe asthma (SA), but its long-term effectiveness and potential biomarkers for predicting patient response require further investigation. This study aimed to evaluate the real-world effectiveness of omalizumab in treating SA and to identify potential biomarkers for predicting a favorable treatment response.</p><p><strong>Materials and methods: </strong>Clinical outcomes were compared between asthma patients receiving omalizumab (omalizumab group) and those on inhaled corticosteroid with long-acting beta-agonist (ICS-LABA) alone (ICS-LABA group). Propensity score matching and Cox proportional hazards model were used to calculate hazard ratios (HRs). Study outcomes included severe asthma exacerbation (SAE), incompletely controlled asthma, intravenous (IV) corticosteroid use, and asthma-related hospitalization. Incompletely controlled asthma was defined by blood eosinophil counts ≥150 cells/µL, fractional exhaled nitric oxide (FeNO) ≥25 ppb, forced expiratory volume in one second (FEV1%) <80%, or SAE occurrence.</p><p><strong>Results: </strong>The omalizumab group had significantly lower risks of SAE (HR 0.17, <i>p</i>=0.03), incompletely controlled asthma (HR 0.56, <i>p</i>=0.04), IV corticosteroid treatment (HR 0.38, <i>p</i>=0.02), and asthma-related hospitalization (HR 0.27, <i>p</i>=0.05). Blood eosinophil count stayed lower in the omalizumab group. FEV1% was higher with the omalizumab group, while blood neutrophil count, FeNO, and serum total IgE showed no differences. Furthermore, subgroup analysis showed patients with treatment-favorable response (>50% reduction in systemic corticosteroid dose) exhibited decreased blood neutrophil counts but increased FEV1% and serum total IgE levels compared with the treatment-unfavorable group.</p><p><strong>Conclusion: </strong>Omalizumab treatment effectively reduces SAE and improves lung function and asthma control. Blood neutrophil counts and serum total IgE may be potential biomarkers for predicting favorable responses to omalizumab treatment.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"545-555"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Alzheimer's Disease Prevalence among National Health Insurance and Medical Aid Beneficiaries from 2010 to 2019.","authors":"Sanghyun Kim, Changsoo Kim, Yoon Jung Choi","doi":"10.3349/ymj.2024.0303","DOIUrl":"https://doi.org/10.3349/ymj.2024.0303","url":null,"abstract":"<p><strong>Purpose: </strong>Alzheimer's disease (AD) is the leading cause of dementia and is associated with various socioeconomic factors. This study aimed to ascertain the differences in AD prevalence based on healthcare coverage type as a proxy of socioeconomic status in South Korea.</p><p><strong>Materials and methods: </strong>We examined Health Insurance Review and Assessment Service claims from 2010-2019, identifying AD as the main disease. Crude prevalence rate and age- and sex-standardized prevalence were estimated from healthcare utilization data. Subgroup analysis by age, sex, comorbidities (hypertension, diabetes, and cardiovascular disease), and type of healthcare coverage [Medical Aid (MA) vs. National Health Insurance (NHI)] was performed to estimate the standardized prevalence rate ratio (PRR).</p><p><strong>Results: </strong>AD prevalence increased 3.9 times from 2010 (175688 cases) to 2019 (680800 cases). In the NHI group, the standardized prevalence increased 2.3-fold (624.4 in 2010 and 1433.2 in 2019), whereas the MA group saw a 2.7-fold increase (1251.0 in 2010 and 3391.9 in 2019). AD was significantly higher in the MA group from 2010 [PRR=2.00, 95% confidence interval (CI) 1.98-2.03] to 2019 (PRR=2.37, 95% CI 2.35-2.38) compared to the NHI group. From 2010 to 2019, a proportion of comorbidities increased in MA and NHI groups. Compared to the NHI group, the MA group showed significantly higher proportion of comorbidities.</p><p><strong>Conclusion: </strong>In this study, we identified significant differences in AD prevalence between NHI and MA recipients, with a notable increase in the MA group, especially among those under 60 years of age.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"590-598"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Implication of LDL-C Variability and Its Association with Lipid-Lowering Strategies: Insights from the RACING and LODESTAR Trials.","authors":"Jaeoh Lee, Sripal Bangalore, Kyeong Ho Yun, Sang-Hyup Lee, Yong-Joon Lee, Seung-Jun Lee, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Bum-Kee Hong, Myeong-Ki Hong","doi":"10.3349/ymj.2024.0476","DOIUrl":"10.3349/ymj.2024.0476","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to compare the visit-to-visit variability in low-density lipoprotein cholesterol (LDL-C) according to different lipid-lowering strategies and evaluate its prognostic implications using data from previous trials.</p><p><strong>Materials and methods: </strong>We analyzed two randomized clinical trials: the RACING trial and the LODESTAR trial. LDL-C variability was evaluated using standard deviation (SD), coefficient of variation, and variation independent of mean. The primary endpoint was a composite of death, myocardial infarction, stroke, or coronary revascularization.</p><p><strong>Results: </strong>Among the 6800 patients included, when compared with patients randomized to high-intensity statins, LDL-C variability was similar in the group randomized to moderate-intensity statin plus ezetimibe combination, but it was higher in those randomized to treat-to-target strategy. The variability in LDL-C (by SD) was a predictor of primary endpoint even after adjustment for lipid-lowering strategy and mean LDL-C (hazard ratio 1.024; 95% confidence interval 1.014 to 1.035; <i>p</i><0.001). Every 1-SD increase in LDL-C variability (SD) was also independently associated with higher risk of myocardial infarction by 2.1%, stroke by 3.5%, and coronary revascularization by 2.7%.</p><p><strong>Conclusion: </strong>Compared to high-intensity statin therapy, LDL-C variability was not increased with the moderate-intensity statin plus ezetimibe combination therapy; however, it was increased in the treat-to-target strategy. Even among those treated with moderate- or high-intensity statins or statins with a target LDL-C levels of 50-70 mg/dL, increased LDL-C variability was associated with higher risk of adverse cardiovascular outcomes.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"537-544"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with the Utilization of Out-of-Region Medical Institutions for Brain Diseases.","authors":"Kyeong-O Go, Mi-Ji Kim, Kihwan Hwang, Seong-Hyo Seo, Joo Hyun Sung","doi":"10.3349/ymj.2024.0510","DOIUrl":"https://doi.org/10.3349/ymj.2024.0510","url":null,"abstract":"<p><strong>Purpose: </strong>In South Korea, medical institutions are distributed by region according to the population ratio. However, the utilization rate of out-of-region medical institutions is higher than that of local medical institutions, including among patients with brain diseases requiring surgical intervention. This study aimed to analyze the factors associated with the utilization of out-of-region medical institutions among patients with brain diseases requiring neurosurgical intervention.</p><p><strong>Materials and methods: </strong>We included data regarding patients with brain disease from the National Health Insurance Service of the Republic of Korea. We analyzed patient-, disease-, and institution-related factors related to the utilization rate of out-of-region medical institutions. Patient-related factors included sex, age, health insurance premiums, impairment status, and underlying disease, while disease- and institution-related factors included treatment method, disease classification, type of medical institution, and region. Statistical analysis was performed using logistic regression.</p><p><strong>Results: </strong>The utilization rate of out-of-region medical institutions was higher among females, individuals without impairment, individuals with underlying diseases, individuals with high economic status, young patients, and individuals living in non-capital areas. Regarding the disease type, the utilization rate was highest in trauma, followed by tumor, others (infectious, functional brain diseases, etc.), and cerebrovascular disease. For diseases other than cerebrovascular disease, patients requiring surgery had a higher utilization rate compared to those requiring procedures.</p><p><strong>Conclusion: </strong>These findings provide valuable insights into among-group differences in the utilization of medical institutions. Identifying factors that may influence regional concentration in these medical utilization behaviors can provide clues to identifying and improving problems in the allocation of medical resources.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"599-608"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Transplant Surgeon-Innovated Ex Vivo Machine Perfusion: Validation in a Porcine Donation after Circulatory Death-Simulated Liver Transplant Model.","authors":"Mun Chae Choi, Yuri Cho, Yu Seol Lee, Sat Byol Lee, Ji Yun Bang, Eun-Ki Min, Deok-Gie Kim, Jae Geun Lee, Myoung Soo Kim, Soo Han Bae, Dong Jin Joo","doi":"10.3349/ymj.2024.0397","DOIUrl":"https://doi.org/10.3349/ymj.2024.0397","url":null,"abstract":"<p><strong>Purpose: </strong>Ex vivo machine perfusion (EVMP) is increasingly recognized as a promising technique for enhancing the preservation and viability of donor organs, particularly in donation after circulatory death (DCD) liver transplantation (LT). This study validates a transplant surgeon-innovated EVMP protocol by assessing its efficacy in preserving liver function and reducing ischemia-reperfusion injury (IRI) in a porcine DCD-simulated liver transplant (DCD sLT) model.</p><p><strong>Materials and methods: </strong>Twenty Yorkshire pigs were used to compare static cold storage (SCS) and EVMP. In Model 1, the SCS group (n=5) underwent 5 hours of cold storage, while the EVMP group (n=9) had 1 hour of cold storage followed by 4 hours of EVMP. In Model 2, the SCS group (n=3) underwent 6 hours of cold storage, while the EVMP group (n=3) had 2 hours of cold storage followed by 4 hours of EVMP. Hemodynamic stability during perfusion, laboratory findings, and apoptosis (via TUNEL assay) after reperfusion were evaluated.</p><p><strong>Results: </strong>The EVMP system was successfully used all 12 cases without technical complications. Hemodynamic parameters remained stable throughout perfusion. In Model 2, alanine aminotransferase levels were significantly lower in the EVMP group compared to the SCS group (e.g., 134.3±27.0 U/L vs. 48.0±6.2 U/L, <i>p</i>=0.006 at 3 hours post-reperfusion). TUNEL staining revealed significantly reduced hepatic apoptosis in the EVMP group compared to the SCS group at 2 and 3 hours post-reperfusion in both models.</p><p><strong>Conclusion: </strong>This study successfully demonstrated the stability of the transplant surgeon-innovated normothermic EVMP protocol, validating its efficacy in improving organ preservation and reducing IRI in a porcine DCD sLT model.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"574-581"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Child Abuse Cases Referred to a Hospital-Based Child Protection Teams in Korea and the Role of Psychiatric Intervention.","authors":"Tae Sun Han, Yeon Sik Bang, Dong Ho Song, Junghan Lee, Keun-Ah Cheon","doi":"10.3349/ymj.2024.0270","DOIUrl":"https://doi.org/10.3349/ymj.2024.0270","url":null,"abstract":"<p><strong>Purpose: </strong>Child protection teams (CPTs) have been implemented in hospital settings to effectively intervene in cases of child abuse. We investigated the changes in child abuse reporting rates and examined whether there was an increase in follow-up psychiatric outpatient visits. Furthermore, we aimed to identify the characteristics of children referred to CPTs and the factors that significantly influenced psychiatric outpatient visits.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed cases of patients under 18 years old who were referred to the CPT from 2014 to 2021. We examined the demographic and clinical characteristics of the abused children, reporting rates, and linkage to psychiatric outpatient visits.</p><p><strong>Results: </strong>This study included 108 child abuse cases. The average age was 7.3 years, with the highest incidence among adolescents (40.7%) and infants & toddlers (39.8%). Physical abuse was the most common abuse type (75.9%). In the infant & toddler group, the injuries resulting from abuse were more severe compared to other groups. There was a significant increase in both the number of child abuse interventions and reports to the National Child Protection Agency (<i>p</i><0.01). However, psychiatric outpatient visits did not increase proportionally. Psychiatric intervention within the CPT was a significant predictor of subsequent psychiatric outpatient visits (odds ratio=17.985, <i>p</i>=0.006).</p><p><strong>Conclusion: </strong>CPTs have enhanced the reporting and management of child abuse cases in Korean hospitals. Psychiatric intervention within CPT plays a crucial role for subsequent psychiatric outpatient visits. Since the infant and toddler group is more vulnerable to severe injuries, psychiatric intervention within the CPT should be conducted for all age groups.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"556-563"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Vancomycin Area under the Concentration-Time Curve Targets in Enterococcal Bacteremia: Balancing Efficacy and Nephrotoxicity.","authors":"Young Rong Kim, Ha-Jin Chun, Jung Yeon Heo, Hakjun Hyun, Young Hwa Choi, Eun Jin Kim","doi":"10.3349/ymj.2024.0513","DOIUrl":"https://doi.org/10.3349/ymj.2024.0513","url":null,"abstract":"<p><strong>Purpose: </strong>Vancomycin is critical in treating enterococcal bacteremia; however, its optimal pharmacokinetic (PK)/pharmacodynamics (PD) targets remain unclear. This study evaluates the association between vancomycin PK/PD parameters and clinical outcomes in patients with enterococcal bacteremia.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 70 patients with enterococcal bacteremia treated with vancomycin at a university-affiliated teaching hospital. The primary and secondary outcomes were unfavorable clinical outcome (30-day mortality or persistent bacteremia) and nephrotoxicity, respectively. Vancomycin area under the concentration-time curve (AUC)/minimal inhibitory concentration (MIC) was calculated using Bayesian methods. Receiver operating curve (ROC) analysis determined AUC/MIC thresholds for predicting unfavorable clinical outcomes and nephrotoxicity. Logistic regression analysis identified risk factors for clinical outcomes.</p><p><strong>Results: </strong>Unfavorable outcome occurred in 21 patients (30.0%), and 10 (14.3%) experienced nephrotoxicity. The ROC-derived AUC₂₄/MIC cutoff for unfavorable outcome and nephrotoxicity were AUC₂₄/MIC ≥466.0 [AUC=0.740; 95% confidence interval (CI), 0.618-0.862] and ≥643.2 (AUC=0.963; 95% CI, 0.922-1.000), respectively. Clinical success was achieved in 44.9% (22/49) of patients with an AUC₂₄/MIC <400, whereas 47.6% (10/21) experienced unfavorable outcome despite having an AUC₂₄/MIC of 400-600. Nephrotoxicity [adjusted odds ratio (aOR)=15.05; 95% CI, 2.15-105.14; <i>p</i>=0.006] and Charlson Comorbidity Index (CCI) (aOR=1.57; 95% CI, 1.18-2.08; <i>p</i>=0.002) were independent risk factors for unfavorable outcome. High AUC₂₄/MIC and CCI were associated with nephrotoxicity (aOR=1.03; 95% CI, 1.01-1.04; <i>p</i>=0.005, and aOR=1.83; 95% CI, 1.01-3.35; <i>p</i>=0.045).</p><p><strong>Conclusion: </strong>Nephrotoxicity and multiple comorbidities were stronger risk factors for unfavorable outcomes than vancomycin AUC/MIC. These findings highlight the need for individualized strategies to optimize efficacy while minimizing toxicity. Further large-scale studies are warranted to refine the optimal AUC/MIC threshold.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"609-617"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Benzodiazepine and Dementia Risk in Treating Depression after Breast Cancer Diagnosis: A Nationwide Population-Based Cohort Study.","authors":"Taehwan Kim, Hye Sun Lee, Soyoung Jeon, Dooreh Kim, Eunjoo Kim, Woo-Chan Park, Chang Ik Yoon, Jooyoung Oh","doi":"10.3349/ymj.2024.0262","DOIUrl":"https://doi.org/10.3349/ymj.2024.0262","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the risk of developing dementia in breast cancer patients diagnosed with depression within 2 years of their cancer diagnosis, comparing those taking antidepressants alone versus those taking both antidepressants and benzodiazepines.</p><p><strong>Materials and methods: </strong>Utilizing data from the Korean National Health Insurance claims database collected over 14 years, we included a cohort of 197917 breast cancer patients. Among them, 19170 were diagnosed with depression within 2 years of their cancer diagnosis. After matching for comorbidities and age, we included 1376 patients in each group for 1:1 matching, and 1326 patients taking only antidepressants and 5304 patients taking both antidepressants and benzodiazepines for 1:4 matching.</p><p><strong>Results: </strong>In the initial 1:1 matched analysis, no significant difference in dementia incidence was observed between the group taking only antidepressants and the group taking both antidepressants and benzodiazepines. However, further detailed analysis revealed that patients taking higher doses or using benzodiazepines for longer durations had an increased risk of dementia. In the 1:4 matched analysis, the group taking both medications exhibited a significantly higher incidence of dementia compared to those taking only antidepressants (hazard ratio, 1.807; 95% confidence interval, 1.263-2.583; <i>p</i>=0.0012).</p><p><strong>Conclusion: </strong>This study underscores the importance of cautious benzodiazepine use in breast cancer patients diagnosed with depression, given its potential to significantly increase dementia risk.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"564-573"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Appendage Characteristics Assessed with Cardiac Computed Tomography in Patients with Atrial Fibrillation and Severe Mitral Valve Disease.","authors":"Hee Jeong Lee, Jiwon Seo, Kyu Kim, Seo-Yeon Gwak, Iksung Cho, Young Joo Suh, Seung-Hyun Lee, Sak Lee, Geu-Ru Hong, Jong-Won Ha, Young Jin Kim, Chi Young Shim","doi":"10.3349/ymj.2024.0455","DOIUrl":"https://doi.org/10.3349/ymj.2024.0455","url":null,"abstract":"<p><strong>Purpose: </strong>The morphological and functional characteristics and clinical significance of the left atrial appendage (LAA) are well established in patients with non-valvular atrial fibrillation (AF). However, data on the LAA characteristics in patients with mitral valve (MV) disease are limited. This study aimed to identify the LAA characteristics in AF patients with severe MV disease.</p><p><strong>Materials and methods: </strong>A total of 506 AF patients who underwent cardiac computed tomography (CT) as preoperative evaluations for MV surgery were retrospectively analyzed. The prevalences of different LAA morphologies (cactus, cauliflower, windsock, chicken wing), LAA ostium diameter, LAA volume, and LAA flow stasis or thrombus were assessed. The LAA variables were compared according to the predominant MV dysfunction.</p><p><strong>Results: </strong>The most common LAA morphology was cactus (n=211, 41.7%), followed by cauliflower (n=143, 28.3%), windsock (n=90, 17.8%), and chicken wing (n=60, 11.9%). The average LAA ostium maximal diameter and LAA volume were 35.3±8.0 mm and 22.1±15.1 mL, respectively. LAA stasis was found in 215 patients (42.5%) and LAA thrombus in 93 patients (18.4%). Patients with mitral stenosis predominance showed significantly smaller LAA volume compared to those with mitral regurgitation predominance (17.8±11.7 mL vs. 26.9±16.8 mL, <i>p</i><0.001). However, LAA flow stasis [190 (71.7%) vs. 25 (10.4%), <i>p</i><0.001] and thrombus [89 (33.6%) vs. 4 (1.7%), <i>p</i><0.001] were remarkably prevalent in these patients.</p><p><strong>Conclusion: </strong>Due to advanced LAA remodeling in AF patients with severe MV disease, the morphologic distribution of LAA types differs from that established in patients without MV disease.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"529-536"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Heterotopic Ossification in Traumatic Brain Injury: An Analysis of the Korean National Health Insurance Service Data.","authors":"Seo Yeon Yoon, Hyunsun Lim, Jun Min Cha, Sang Chul Lee, Jang Woo Lee","doi":"10.3349/ymj.2024.0399","DOIUrl":"https://doi.org/10.3349/ymj.2024.0399","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the risk factors for heterotopic ossification (HO) in patients with traumatic brain injury (TBI).</p><p><strong>Materials and methods: </strong>This was a retrospective study using the Korean National Health Insurance Service (KNHIS) database and included as many relevant factors as possible. Data were collected from the KNHIS cohort, a nationwide cohort covering the entire Korean population. Patients diagnosed with TBI from 2004 to 2018 were included. TBI was defined as individuals who 1) had been hospitalized, 2) were diagnosed with TBI under ICD-10 code S06, and 3) underwent brain imaging within 1 week before or after diagnosis. Among 637315 adult patients, 1909 (0.30%) developed HO. This study aimed to clarify the relationship between HO and various factors, including demographic and medical history, medication history, complications, and accompanying injuries in TBI patients.</p><p><strong>Results: </strong>Among TBI patients, HO was more common in female and peaked in patients in their 50s, with a lower incidence in their 70s. Preobesity and obesity were significant risk factors, while smokers had a reduced risk. HO was more common in patients with rheumatic diseases and medical comorbidities, and those who had undergone tracheostomies. The use of antiseptics was associated with an increased risk, whereas anticonvulsants, antithrombotics, steroids, and non-steroidal anti-inflammatory drugs were associated with lower risks. HO was more common in registered patients with disability due to brain lesion.</p><p><strong>Conclusion: </strong>In conclusion, middle-age range, female sex, obesity, comorbidities, injury severity, systemic inflammation, and bony metabolism-affecting medications appear to increase the risk of HO in patients with TBI.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 9","pages":"582-589"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}