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BackgroundLeft ventricular ejection fraction (LVEF) is a crucial prognostic indicator of acute myocardial infarction (AMI). However, there is a lack of studies on the clinical characteristics and prognosis of patients with mildly reduced ejection fraction (EF) after AMI.MethodsWe categorized 6,553 patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) between November 2011 and December 2015 into three groups based on their EF, as assessed by echocardiography during index hospitalization: reduced EF (LVEF ≤40%), mildly reduced EF (LVEF 41%–49%), and preserved EF (LVEF ≥50%). The primary outcome was all-cause death within 2 years. The secondary outcomes included myocardial infarction (MI), revascularization, and patient-oriented composite endpoint (POCE), which was defined as a composite of all-cause death, any MI, or revascularization.ResultsOf the total 6,553 patients, 884 (13.5%) were classified into the reduced EF group, 1,749 (26.7%) into the mildly reduced EF group, and 3,920 (59.8%) into the preserved EF group. Patients with mildly reduced EF exhibited intermediate mortality (reduced EF, 24.7%; mildly reduced EF, 8.3%; preserved EF, 4.6%; p

Abstract Ticagrelor-based dual antiplatelet therapy (DAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the influence of early ticagrelor dose reduction (120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients who received standard-dose ticagrelor-based DAPT (180 mg) after PCI for complex lesions. Major adverse cardiovascular event (MACE: a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization), bleeding, and net adverse clinical events (NACE: a composite of MACE and bleeding) were assessed. Among the 772 patients on standard-dose ticagrelor-based DAPT, 115 (14.8%) switched to low-dose ticagrelor-based DAPT (120 mg) within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariable Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding, and NACE were not different between the low-dose and standard-dose groups throughout the entire follow-up period and the period beyond 6 months post-PCI. Time-varying multivariable CPH models of the ticagrelor dose reduction yielded similar results. A reduction of the ticagrelor dose within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.

Background/Aims The Genoss DES™ is a novel, biodegradable, polymer-coated, sirolimus-eluting stent with a cobalt-chromium stent platform and thin strut. Although the safety and effectiveness of this stent have been previously investigated, real-world clinical outcomes data are lacking. Therefore, the aim of this prospective, multicenter trial was to evaluate the clinical safety and effectiveness of the Genoss DES™ in all-comer patients undergoing percutaneous coronary intervention. Methods The Genoss DES registry is a prospective, single-arm, observational trial for evaluation of clinical outcomes after Genoss DES™ implantation in all-comer patients undergoing percutaneous coronary intervention from 17 sites in South Korea. The primary endpoint was a device-oriented composite outcome of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization (TLR) at 12 months. Results A total of 1,999 patients (66.4 ± 11.1 years of age; 72.8% male) were analyzed. At baseline, 62.8% and 36.7% of patients had hypertension and diabetes, respectively. The implanted stent number, diameter, and length per patient were 1.5 ± 0.8, 3.1 ± 0.5 mm, and 37.0 ± 25.0 mm, respectively. The primary endpoint occurred in 1.8% patients, with a cardiac death rate of 1.1%, target vessel-related MI rate of 0.2%, and clinically driven TLR rate of 0.8%. Conclusions In this real-world registry, the Genoss DES™ demonstrated excellent safety and effectiveness at 12 months among all-comer patients undergoing percutaneous coronary intervention. These findings suggest that the Genoss DES™ may be a viable treatment option for patients with coronary artery disease.

Summary: Background: The impact of titrated versus fixed intensity statin therapy in patients with coronary artery disease (CAD) and diabetes mellitus (DM) remains to be elucidated. Methods: This was a pre-specified analysis of patients with and without DM from the LODESTAR trial. Patients with CAD were randomly assigned to receive either a treat-to-target strategy with a target LDL-C level of 50–70 mg/dL or a high-intensity statin treatment. Primary outcome was the 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. Secondary outcomes were safety endpoints. This trial is registered with ClinicalTrials.gov, NCT02579499. Findings: Between September 9, 2016 and November 27, 2019, 4400 patients with CAD were enrolled in the LODESTAR trial. The median age was 65 years (interquartile range, 59–73 years), 3172 (72%) were male, and 1468 (33%) had DM at baseline. There was no significant difference in the occurrence of the primary outcome between the treat-to-target group and high-intensity statin group among patients with DM (10.5% versus 11.1%, hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.69–1.29, p = 0.70) and those without DM (6.9% versus 7.5%, HR 0.93, 95% CI 0.71–1.21, p = 0.58). Among patients without DM, there was a trend towards a lower risk of new-onset DM in the treat-to-target group (8.4% versus 10.4% in the high-intensity statin group, HR 0.79, 95% CI 0.62–1.01; p = 0.06). Interpretation: In patients with CAD, a treat-to-target LDL-C strategy of 50–70 mg/dL as the goal was comparable to high-intensity statin therapy in terms of 3-year clinical efficacy and safety outcomes regardless of the presence of DM. Funding: Sam Jin Pharmaceutical, Seoul, Korea and Chong Kun Dang Pharmaceutical, Seoul, Korea.

This study analyzes the effects of innovation and innovation characteristics on the survival of Small and Medium-sized Enterprises (SMEs) in the service industry. After analyzing around 22,300 innovative SMEs in Korea's service industry using Kaplan-Meier analysis, it is confirmed that the better the overall technological prowess (T-grade), the longer the survival period until delinquency (overdue payments for more than three months) and default. The technological innovation characteristics that significantly affect the survival period are derived using a time-dependent Cox model. Owner capability, productization capability, and profit prospects are found to positively affect the survival period of excellent SMEs, while R&D capability, technology superiority, and market status are found to have a negative effect. From an optimization perspective, if R&D capability is above an appropriate level, it can hinder the survival period of SMEs. Thus, it is interpreted that the more positive the market status, the more negative the survival period, because it accelerates the inflow of new competitors. Considering that owner capability, productization capability, and profit prospects are appraisal items based on business feasibility along with the technological prowess of SMEs, it is concluded that technology with business feasibility has a significantly positive effect on the survival period of innovative SMEs in the service industry.

The first breeding of osprey (Pandion haliaetus) on Jeju Island, South Korea, were observed in 2015, and ospreys bred on three sites. We found a total of three nests and observed that A site nest bred on successfully from 2017 to 2020. The number of eggs per clutch ranged from two to four, with a mean ± SD of 3.16 ± 0.75. The nesting period varied from 71 days to 79 days, with an average duration of 76.2 ± 3.18 days. The incubation period ranged from 34 days to 38 days, averaging 35.8 ± 1.72 days. Fledging dates ranged from July 4th to 13th. The nest tree species was Pinus thunbergii, and the average tree height was 16.2 ± 3.12 m. On average, the nest height from the ground was 14.8 ± 2.57 m. The average diameter at breast height of the nesting trees was 36.1 ± 2.02 cm. Of the total 19 eggs produced, the hatching rate was 91.4% ± 10.2%, fledgling rate was 68.6% ± 26.9%, and breeding success was 65.6% ± 25.1%. Little ecological information is available on osprey living in South Korea; therefore, this study makes a meaningful contribution to provide baseline ecological data from South Korea for this species.

Background/Aims While distal radial artery (DRA) access is increasingly being used for diagnostic coronary angiography, limited information is available regarding DRA size. We aimed to determine the DRA reference diameters of Korean patients and identify the predictors of DRA diameter < 2.3 mm. Methods The outer bilateral DRA diameters were assessed using a linear ultrasound probe in 1,162 consecutive patients who underwent transthoracic echocardiography. The DRA diameter was measured by the perpendicular angle in the dorsum of the hand, and the average values were compared by sex. DRA diameter < 2.3 mm was defined as unsuitable for routine diagnostic coronary angiography using a 5 Fr introducer sheath. Results The mean DRA diameters were 2.31 ± 0.43 mm (right) and 2.35 ± 0.45 mm (left). The DRA was smaller in women than men (right: 2.15 ± 0.38 mm vs. 2.43 ± 0.44 mm, p < 0.001; left: 2.18 ± 0.39 mm vs. 2.47 ± 0.45 mm, p < 0.001). The DRA diameter was approximately 20% smaller than the radial artery diameter. A total of 630 (54.2%) and 574 (49.4%) patients had DRA diameter < 2.3 mm in the right and left hands, respectively. Female sex, low body mass index (BMI), and low body surface area (BSA) were significant predictors of DRA diameter < 2.3 mm. Conclusions We provided reference DRA diameters for Korean patients. Approximately 50% of the studied patients had DRA diameter < 2.3 mm. Female sex, low BMI, and low BSA remained significant predictors of DRA diameter < 2.3 mm.

A triply periodic minimal surface (TPMS) is a functional cellular structure that is designed by defining the signed distance field (SDF) for periodically repeated unit cells. This study proposes a novel design methodology to functionally grade the morphology of a TPMS channel for enhancement of the fluid flow performance. Mathematical filtering was performed to change the SDF distribution through various combinations of multiple sigmoid functions, thus locally changing the TPMS geometry. The proposed local filtering was then implemented in the design of a TPMS flow channel to reduce the flow resistance in the inlet and outlet regions. Pressure drop tests were conducted using additively manufactured TPMS channels, and the results showed that the pressure drop decreased by 20% for the filtered design with a volume change of only 2.6%. Numerical simulations were performed to analyze the cause of reduced flow resistance in the locally filtered regions, and the results were verified through flow visualization experiments. Considering that a TPMS structure has a complex geometry and thus its manual modification is very difficult, the proposed filtering method offers an efficient approach for functionally changing the morphology of the TPMS structure.

Background/Aims Recently, distal radial approach (DRA), called as snuffbox approach, has gained the interest of interventional cardiologists, but there is a lack of data about the feasibility of DRA as an alternative route for primary percutaneous coronary intervention (PCI). Methods A total of 138 patients presenting with ST-elevation myocardial infarction (STEMI) in whom primary PCI via the DRA was attempted at three hospitals from October 2017 to September 2019 were analyzed. Results The success rate of snuffbox puncture in the setting of STEMI was 92.8% (128/138). Successful primary PCI via the DRA was achieved in all 128 patients. The snuffbox puncture time, defined as the time interval from local anesthesia induction to successful sheath cannulation, was 2.7 ± 1.6 minutes, and snuffbox puncture was performed within 5 minutes in 95.3% of patients. Moreover, the percentage of the puncture time in the door-to-balloon time was 3.3%. The left DRA was selected in 103 patients (80.5%), and primary PCI via the DRA was performed using a 6-Fr guiding catheter in 125 patients (97.7%). There was no major bleeding; however, there were four cases (3.1%) of access-site complications, including three cases of local hematoma (≤ 5 cm diameter) and one case of local numbness, which improved 3 months later. Conclusions In the setting of STEMI, the DRA could be a feasible alternative access route for primary PCI.

Non-native species threaten native ecosystems and species, particularly on islands where rates of endemism and vulnerability to threats are high. Understanding species invasion will aid in providing insights into ecological and evolutionary processes. To identify the non-native sika deer (Cervus nippon) population in Jeju, South Korea, and their phylogenetic affinities, we collected tissue samples from roadkill and the World Natural Heritage Headquarters in Jeju. Mitochondrial DNA cytochrome B (CytB) gene sequences were analyzed to determine two distinct CytB haplotypes. Phylogenetic analysis using maximum likelihood tree revealed two haplotypes of CytB clustered into two different groups representing two subspecies: C. n. yakushimae, native to Japan, and C. n. taiouanus, native to Taiwan. The tentative divergence time between the two subspecies was estimated at 1.81 million years. Our study confirmed that the two subspecies of sika deer are sympatric in the natural ecosystem of Jeju Island. This study provides valuable information to help government and conservation agencies understand alien species and determine control policies for conserving native biodiversity in South Korea.

Abstract Background B-type natriuretic peptide (BNP) has prognostic significance in heart failure (HF), and reductions in BNP may predict clinical improvement. However, there are limited data regarding the prognostic value of BNP during short-term follow-up. The aim of this study was to evaluate the relationship between short-term follow-up BNP and mortality after discharge in patients with HF. Methods We analyzed 427 patients hospitalized with HF from the Wonju Severance Christian Hospital Heart Failure Registry from April 2011 to December 2013, with a planned follow-up period through February 2016. Of the 427 patients, 240 (mean age, 75 years; 102 males, 42.5%) had BNP measured on admission and within the short-term follow-up period (3 months). We compared all-cause mortality during the clinical follow-up period (median length of follow-up, 709.5 days) according to the median value of BNP on admission (as a baseline value) and over a short-term follow-up period after discharge. Results Median BNP at admission was 816.5 pg/ml, and median follow-up BNP was 369.7 pg/ml. Multivariate analysis revealed a positive association between risk of death and high BNP. High BNP during follow-up was significantly associated with a greater risk of all-cause mortality compared to low BNP (P

In order to understand the feeding ecology and dietary differences of roe deer (Capreolus pygargus tianschanicus) in different seasons and altitudes, this study was carried out at three altitudinal sites (Songdang 250–270 m above sea level (ASL), Aradong 330–370 m ASL, Mt. Hallasan 1100 m ASL) on Jeju Island, South Korea. Altogether, 205 plants taxa of six categories of foods (forbs-climbers, graminoids, trees, shrubs, conifers, and ferns) were identified using morphological and molecular analyses. The highest number of dietary plants was found in summer (93 taxa) and at Aradong (124 taxa) and lowest at Songdang (71 taxa) and in winter (51 taxa). Food categories were significantly different among the seasons (F = 15.646, p

BackgroundIn clinical practice, a risk prediction model is an effective solitary program to predict prognosis in particular patient groups. B-type natriuretic peptide (BNP)and N-terminal pro-b-type natriuretic peptide (NT-proBNP) are widely recognized outcome-predicting factors for patients with heart failure (HF).This study derived external validation of a risk score to predict 1-year mortality after discharge in hospitalized patients with HF using the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)program data. We also assessed the effect of adding BNP or NT-proBNP to this risk score model in a Korean HF registry population.Method and resultsWe included 5625 patients from the Korean acute heart failure registry (KorAHF) and excluded those who died in hospital. The MAGGIC constructed a risk score to predict mortality in patients with HF by using 13 routinely available patient characteristics (age, gender, diabetes, chronic obstructive pulmonary disorder (COPD), HF diagnosed within the last 18 months, current smoker, NYHA class, use of beta blocker, ACEI or ARB, body mass index, systolic blood pressure, creatinine, and EF). We added BNP or NT-proBNP, which are the most important biomarkers, to the MAGGIC risk scoring system in patients with HF. The outcome measure was 1-year mortality. In multivariable analysis, BNP or NT-proBNP independently predicted death. The risk score was significantly varied between alive and dead groups (30.61 ± 6.32 vs. 24.80 ± 6.81, p < 0.001). After the conjoint use of BNP or NT-proBNP and MAGGIC risk score in patients with HF, a significant difference in risk score was noted (31.23 ± 6.46 vs. 25.25 ± 6.96, p < 0.001).The discrimination abilities of the risk score model with and without biomarker showed minimal improvement (C index of 0.734 for MAGGIC risk score and 0.736 for MAGGIC risk score plus BNP or NT-proBNP, p = 0.0502) and the calibration was found good. However, we achieved a significant improvement in net reclassification and integrated discrimination for mortality (NRI of 33.4%,p < 0.0001 and IDI of 0.002, p < 0.0001).ConclusionIn the KorAHF, the MAGGIC project HF risk score performed well in a large nationwide contemporary external validation cohort. Furthermore, the addition of BNP or NT-proBNPto the MAGGIC risk score was beneficial in predicting more death in hospitalized patients with HF.

Background: Carotid intima-media thickness (CIMT) is a surrogate marker of cardiovascular disease (CVD). CIMT values ≥75th percentile of normal subjects are considered high and indicative of increased CVD risk. It is a rare data about normal CIMT values in Asian subjects without conventional CVD risk factors, coronary artery disease and cerebrovascular disease. So, we evaluate the normal CIMT values in a community cohort and the relationship between CVD risk factors and CIMT. Methods: We measured CIMT with B-mode ultrasound (Vivid 7, GE Healthcare) in 1,759 subjects aged 40–70 years from ARIRANG study. The normal healthy subject was defined as 1)whom without history of cerebrovascular disease, coronary artery disease, congestive heart failure, dyslipidemia and diabetes mellitus, 2) who was not smoking, 3) whose body mass index

Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

Ramsar wetlands are known for their high ecological and economic value; however, in some cases, the indigenous species community is rapidly changing owing to the presence of invasive alien plants (IAPs). To address this issue, we conducted a plant survey of five Ramsar wetland sites on Jeju Island from August 2021 to August 2022 and constructed a list of IAP species. A total of 24 IAP plant species belonging to 13 families were identified. Species of the Asteraceae and Poaceae families, which have high seed production, high adaptability to damaged ecosystems, and a wide range of organisms, from annuals to perennials, were found to be abundant. The distribution of IAP species was consistent with the pattern expected during the early stages of IAP invasion in Korea. Additionally, a positive correlation was observed between the distance from residential areas and the number of IAP species. Wetlands not visited by people were found to be relatively intact, while those frequented by tourists and visitors were susceptible to IAPs. These results suggest that the introduction of IAP species into the Jeju Ramsar wetlands may have been the result of anthropogenic activities, such as tourism. Our study demonstrated that the introduction of IAPs into the Jeju Ramsar wetlands is in its early stages and is mainly attributable to human activity. Therefore, it is necessary to identify the invasion pathways, develop strategies to control or reduce invasion, and control the geographic expansion of these species. Our study highlights the threat of alien species to Jeju Ramsar wetlands, providing the basis for a strategy to protect these wetlands from the threat of invasive species. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the habitat and breeding status of the Pleske's 22 Grasshopper Warbler Helopsaltes pleskei inhabiting unmanned coastal islets (Cheongdo, Jikgudo and Heukgeomdo) on the Jeju Chuja Marine Provincial Park in South Korea. A total of 13 nesting sites were observed between April 2019 and April 2021. On Cheongdo Islet, nests were located as follows: four in C. japonica, one in P. thunbergii, and one in Eurya emarginata. On Jikgudo Islet, four nests were distributed with two in C. japonica, one in P. thunbergii, and one in E. macrophylla. Meanwhile, on Heukgeomdo islet, three nests were located, all in C. japonica. During the study period, 36 individuals were observed: 14 in Cheongdo, 10 in Jikgudo and 12 in the Heukgeomdo Islets. Most nesting sites were located in the bushy areas of the inner islets. Thus, birds tended to select nesting locations in response to predation and microclimates to increase reproductive rates and maximize offspring survival. This study highlights the importance of unmanned islands (islets) and the presence of bushy shrubs as important nesting and hiding sites for the ecologically vulnerable Pleske's Grasshopper Warbler. [ABSTRACT FROM AUTHOR]