Eulji University

Evogliptin, a dipeptidyl peptidase-4 inhibitor with a glucose-dependent mechanism of action, is widely used as a monotherapy or in combination with other agents. However, observational studies in routine clinical settings remain limited. This study aimed to evaluate the effectiveness and safety of evogliptin in combination with other antidiabetic agents frequently used in clinical practice. This study was conducted in 51 hospitals in South Korea. We evaluated evogliptin in three groups: the evogliptin add-on, evogliptin-switching, and initial combination groups. The primary endpoint was the change in haemoglobin A1c (HbA1c) levels (%) from baseline to 12 weeks. The change in HbA1c (%) levels from baseline to 24 weeks was a secondary endpoint in the extended study. Proportions of patients achieving the HbA1c target, changes in fasting and postprandial glucose levels, and safety endpoints were also evaluated. Between-group comparisons were performed between the add-on and initial combination groups. In the 1596 patients of the effectiveness set, the mean changes in HbA1c levels at 12 weeks were -0.8% ± 1.2%, -0.3% ± 0.8% and -1.9% ± 1.4% for the evogliptin add-on, evogliptin-switching and initial combination groups, respectively. Among the 1920 patients in the safety set, 23 experienced adverse drug reactions, and there was no significant difference among the three groups. Evogliptin reduces blood glucose levels and is well-tolerated when used as an add-on, as a switch from other dipeptidyl peptidase 4 inhibitors, or as part of an initial combination therapy in patients with type 2 diabetes mellitus.

The relationship between body mass index (BMI) and cardiovascular outcomes in chronic kidney disease (CKD) remains controversial. While the obesity paradox has been observed in this population, the impact of longitudinal BMI patterns over time is not well established. In this study, we investigated the association between BMI trajectories and the risk of cardiovascular events (CVEs) using data from 1061 patients enrolled in the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). BMI was categorized as high (≥ 23 kg/m2) or low (< 23 kg/m2), and assessed at three time points over a 7-year period. We applied targeted maximum likelihood estimation (TMLE) and marginal structural models (MSMs) to adjust for time-varying covariates, including estimated glomerular filtration rate, blood pressure, hemoglobin, albumin, and C-reactive protein, as well as baseline demographic and clinical characteristics. Patients with persistently high BMI had a significantly reduced risk of CVEs (relative risk 0.279; 95% CI 0.143–0.546; P < 0.001) compared to those with consistently low BMI. Transient increases or decreases in BMI did not show the same benefit. Our findings suggest that sustained high BMI may be protective against cardiovascular events in patients with CKD, challenging current weight management recommendations and supporting individualized approaches based on long-term risk profiles.

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08-0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50-0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27-0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39-0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60-0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53-84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14-5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04-1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08-1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support.

This study aimed to evaluate the associations of baseline income, cumulative income exposure, and income volatility with the incidence of pancreatic and biliary tract cancers in a nationwide Korean cohort. We analyzed 3,361,091 adults aged 30-65 years who underwent the 2012 National Health Insurance Service (NHIS) health screening. Income level was derived from insurance premium data assessed over the five years preceding baseline (2008-2012) and categorized into baseline income quartiles, cumulative exposure to low or high income, and income volatility based on annual percentage changes. Incident pancreatic and biliary tract cancers were identified using diagnostic codes and the copayment reduction registry. Associations were evaluated using Cox proportional hazards models with adjustment for demographic, lifestyle, and clinical covariates, and cumulative incidence was compared using Kaplan-Meier curves. During a median follow-up of 9.6 years, 14,469 pancreatic cancers and 6,647 biliary tract cancers were newly diagnosed. Lower baseline income was associated with a higher risk of pancreatic and biliary tract cancers, whereas sustained high-income exposure was associated with reduced risk. Cumulative low-income exposure showed a positive linear trend with pancreatic cancer incidence. Income volatility was modestly associated with pancreatic cancer and was positively associated with biliary tract cancer in the fully adjusted model. These associations were generally consistent across subgroups, with a stronger inverse association between prolonged high-income exposure and pancreatic cancer among individuals without diabetes. Income level and income stability were significantly associated with the incidence of pancreatic and biliary tract cancers. Lower baseline income was associated with higher risk, whereas sustained high-income exposure was protective. Income volatility was associated with increased cancer risk, particularly for biliary tract cancer. These findings highlight the importance of incorporating income dynamics into cancer prevention strategies and addressing socioeconomic instability among vulnerable populations.

Purpose. This study introduces an Adaptive Optimization-based Multi-Material Decomposition with Total Nuclear Variation (AO-MMD-TNV) for dual-energy CT (DECT), designed to achieve accurate and noise-robust material fraction estimation.Methods. Three experimental datasets-a digital phantom, a tissue characterization phantom, and a human-shaped phantom-were used to evaluate the proposed method. The algorithm combines a robust Huber data term, iteratively reweighted L1 sparsity, and Total Nuclear Variation (TNV) regularization under simplex constraints. Adaptive weighting was applied to balance physical fidelity, sparsity, and boundary coherence. The performance was quantitatively compared with a conventional triplet-based MMD approach using metrics of volume fraction accuracy (VFA) and standard deviation (STD).Results. The AO-MMD-TNV achieved 100% VFA for all five materials in the digital phantom, with complete noise suppression (STD = 0). In the tissue characterization phantom, the method demonstrated improved VFA in most ROIs, though minor accuracy reductions were observed for breast and solid water (ROIs 3 and 4) due to their similar attenuation to background. In the human-shaped phantom, the AO-MMD-TNV maintained stable performance across six organ-related ROIs, outperforming MMD in quantitative consistency and noise robustness.Conclusions. The proposed AO-MMD-TNV framework effectively enhances quantitative reliability, reduces noise and crosstalk, and preserves anatomical boundaries. While further optimization is needed for low-contrast materials, AO-MMD-TNV demonstrates strong potential for precise, physically consistent DECT-based material quantification and clinical application.

Introduction: Despite previous studies suggesting an association between venous outflow (VO) and clinical outcomes, the relationship between VO status and comprehensive efficacy and safety outcomes after endovascular thrombectomy (EVT), including the influence of systolic blood pressure variability (BPV), remains unclear. Patients and Methods: We performed a secondary analysis of the OPTIMAL-BP trial. Patients were categorized into unfavorable VO (cortical vein opacification score (CVOS) &lt;3) or favorable VO (CVOS ≥3). Efficacy outcomes included modified Rankin Scale (mRS) scores of 0–2 and 0–3 at three months, excellent NIHSS recovery, and final infarction volume (FIV). Safety outcomes consisted of any intracerebral hemorrhage (ICH), symptomatic ICH, any parenchymal hemorrhage (PH), PH type 2, and subarachnoid hemorrhage (SAH). BPV parameters, including time rate (TR), standard deviation, coefficient of variation, and variation independent of mean, were calculated within the first 24 hours after randomization. Results: Among 226 patients, unfavorable VO significantly correlated with lower odds of achieving mRS 0–2 (adjusted odds ratio [aOR], 0.44 [95% CI, 0.22–0.87]), mRS 0–3 (aOR, 0.39 [0.20–0.73]), excellent NIHSS recovery (aOR, 0.40 [0.15–0.95]), and increased FIV (adjusted coefficient, 37.18 [14.81–59.55]). It was also associated with increased odds of any ICH (aOR, 2.28 [1.20–4.39]), symptomatic ICH (aOR, 9.82 [3.12–39.40]), any PH (aOR, 6.08 [2.76–14.07]), PH type 2 (aOR, 174.59 [14.41–7276.24]), and SAH (aOR, 2.44 [1.13–5.29]). Only increased systolic BPV TR correlated significantly with poorer efficacy outcomes in unfavorable VO group. Sensitivity analyses using a Bayesian approach yielded results consistent with the primary analysis Conclusion: Unfavorable VO was associated with poorer clinical and safety outcomes after successful recanalization following EVT and increased post-EVT BPV further worsened clinical outcomes only in unfavorable group. These finding suggest that BPV modulation may improve prognosis in stroke patients with unfavorable VO.

Sex disparities in stroke outcomes are well-recognized, but it remains unclear whether these disparities vary across stroke subtypes and how they relate to differences in acute care delivery. The aim of the study was to examine sex differences in long-term mortality, functional outcomes, and acute stroke management across stroke subtypes using a nationwide population-based cohort. This retrospective cohort study analyzed linked clinical audit and claims data from 58,429 patients with acute stroke admitted to 269 hospitals in South Korea between 2018 and 2021. Clinical data were derived from the national Acute Stroke Quality Assessment Program and linked to claims. The primary outcome was all-cause mortality. The secondary outcome was poor functional outcome at discharge. Multivariable Cox and logistic regression models were used to assess associations between sex and outcomes, stratified by stroke subtype and adjusted for age, stroke severity, and comorbidities. Differences in acute stroke care were also analyzed. Of 58,429 patients (mean [SD] age, 68.6 [13.8] years; 43.9% female), 76.1% had ischemic stroke (IS), 15.7% intracerebral hemorrhage (ICH), and 8.2% subarachnoid hemorrhage (SAH). Females were older than males across all subtypes and had different comorbidity profiles. After adjustment, females had significantly lower mortality in all subtypes (adjusted hazard ratios [95% CI]: IS, 0.77 [0.74-0.80]; ICH, 0.60 [0.56-0.64]; SAH, 0.60 [0.54-0.67]; all P < 0.001). Functional outcomes varied: females had worse outcomes in IS, better in ICH, and no difference in SAH. Males were more likely to receive reperfusion and surgical therapies; females were more likely to receive rehabilitation services. These care differences did not fully explain the observed disparities in outcomes. In this national cohort, sex disparities in stroke outcomes differed by subtype. Despite lower adjusted mortality in females, functional outcomes were not uniformly better. These findings underscore the importance of adopting sex- and subtype-specific approaches to stroke care, secondary prevention, and rehabilitation.