Myongji Hospital

Purpose: We developed evidence-based recommendations for selecting and initiating the enteral nutrition (EN) delivery route in adult and pediatric patients to improve safety and standardize practice in Korea.Methods: Key questions covered feeding tube selection, methods to verify tube placement, confirmation in pediatric patients, and timing of EN following percutaneous endoscopic gastrostomy (PEG). Recommendations were drafted and refined through multidisciplinary expert consensus under the Korean Society for Parenteral and Enteral Nutrition (KSPEN).Results: Feeding tube selection should be based on gastrointestinal anatomy, function, and expected EN duration. Short-term feeding is recommended with nasogastric or orogastric tubes, whereas long-term feeding should use percutaneous or surgical routes such as PEG. Tube position must always be verified before use, preferably with radiography or pH testing; auscultation alone is unreliable and should not be used. In pediatric patients, radiographic confirmation remains the gold standard, although pH testing and insertion-length assessment may be considered when imaging is not feasible. After PEG, EN can be initiated safely within 4 hours in both adults and children without increasing complications if trained staff monitor for leakage or infection.Conclusion: This guideline offers a structured framework for safe and timely EN tailored to patient characteristics. Early verification and multidisciplinary collaboration help reduce complication, improving outcomes of EN therapy.

BackgroundDespite guideline recommendations, evidence for the use of non–vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with atrial fibrillation after implantation of a drug-eluting stent remains limited.MethodsIn this multicenter, randomized, open-label, noninferiority trial in South Korea, we assigned patients with atrial fibrillation who had undergone the implantation of a drug-eluting stent at least 1 year earlier in a 1:1 ratio to receive NOAC monotherapy or combination therapy (NOAC plus clopidogrel). The primary end point was net adverse clinical events, a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, systemic embolism, or major bleeding or clinically relevant nonmajor bleeding at 12 months. The noninferiority margin was 3.0 percentage points.ResultsA total of 960 patients underwent randomization: 482 patients to receive monotherapy and 478 to receive combination therapy. The mean age of the patients was 71.1 years, and 21.4% were women. At 12 months, a primary end-point event had occurred in 46 patients (Kaplan–Meier estimate, 9.6%) in the monotherapy group and in 82 patients (Kaplan–Meier estimate, 17.2%) in the combination-therapy group, for an absolute difference of –7.6 percentage points (95.2% confidence interval [CI], −11.9 to −3.3; P<0.001 for noninferiority) and a hazard ratio of 0.54 (95.2% CI, 0.37 to 0.77; P<0.001 for superiority). Major bleeding or clinically relevant nonmajor bleeding occurred in 25 patients (5.2%) in the monotherapy group and in 63 patients (13.2%) in the combination-therapy group (hazard ratio, 0.38; 95% CI, 0.24 to 0.60).ConclusionsAmong patients with atrial fibrillation who had undergone implantation of a drug-eluting stent at least 1 year earlier, NOAC monotherapy was noninferior to combination therapy for net adverse clinical events. (Funded by Cardiovascular Research Center and Samjin Pharmaceutical; ADAPT AF-DES ClinicalTrials.gov number, NCT04250116.)

Background/AimsThe first metabolic dysfunction-associated steatotic liver disease (MASLD) drug was approved with an unsatisfactorily small effect size. This study aimed to determine key factors impacting the cost-effectiveness of a new hypothetical MASLD drug as well as its treatment efficacy.MethodsA Markov model reflecting the natural history of MASLD was developed, incorporating fibrosis progression, cardiovascular disease risk, and mortality. Treatment effect of drug X (with $20,000 of annual cost) was assumed to achieve a ≥1 stage fibrosis regression, with a 25% gap of effect size in regression rate over non-treatment in the first year. The incremental cost-effectiveness ratio (ICER) over a 20-year horizon was estimated. And sensitivity analyses were conducted to explore uncertainty and identify influential factors.ResultsIn the base case analysis, drug X provided an incremental gain of 1.32 quality-adjusted life years (QALYs) and 1.20 life years compared to the non-treatment, with an ICER of $68,010/QALY–below the $100,000/QALY willingness-to-pay threshold, indicating that drug X treatment is cost-effective. Two-way sensitivity analysis further highlighted that the drug should achieve at least a 15% initial regression gap and maintain a minimum 3% sustained durability gap to remain cost-effective. In addition baseline fibrosis stage distribution also acted as an influencing factor.ConclusionsLong-term sustained durability of the hypothetical drug, patient distribution based on baseline fibrosis stage, as well as initial treatment response rate are key factors that influence the cost-effectiveness of new MASLD drugs.

Background:Local anesthesia–related pain is associated with injection speed. An electronic constant-speed injector was developed to deliver slow and steady injections, aiming to alleviate pain during dermatologic anesthesia. We aimed to validate the efficacy of an electronic constant-speed injector in reducing pain during local anesthetic infiltration by comparing it with the conventional manual injection method.Methods:Patients undergoing local anesthetic infiltration in an area greater than 5 cm2 during a scalp procedure were included. Each side of the surgical field was randomly assigned to receive a local injection using either a manual or electronic injector. Patients rated the pain of each injection using the numeric rating scale (NRS).Results:A total of 128 patients were enrolled, with a mean age of 45.96 ± 12.19 years. The procedures included scalp micropigmentation and hair transplantation, with most injections located on the frontal scalp. The manual injection had a mean NRS score of 4.30 ± 1.46, whereas the electronic injectors had a score of 2.63 ± 1.04. The mean difference in NRS scores between the 2 methods was 1.68 ± 1.00, indicating significantly lower pain scores with the electronic injector.Conclusions:The electronic constant-speed injector effectively reduced pain associated with local anesthetic infiltration compared with the manual injection method.

Purpose Metabolic syndrome (MetS) is increasingly prevalent among adolescents, and thyroid-stimulating hormone (TSH) levels influence metabolic health. This study investigates whether TSH levels are associated with MetS and its components in euthyroid adolescents.Methods We used data from the Korean National Health and Nutrition Examination Survey between 2013 and 2015. The study included 940 euthyroid adolescents aged 10–18 years, who were divided into 2 groups: high-normal TSH group (top 25% of euthyroid TSH levels) and nonhigh TSH group (remaining 75%). We analyzed the association between high-normal TSH levels and MetS and its components.Results TSH quartiles were related to MetS (P for trend=0.006). The prevalence of MetS was 3.5% in the high-normal TSH group and 1.9% in the nonhigh group (P=0.1929). Abdominal obesity was more prevalent in the high-normal TSH than in the nonhigh TSH group (16.2% vs. 9.6%, P=0.0153). Other MetS components were more prevalent in the high-normal TSH group, but the difference was not significant. High-normal TSH was significantly associated with abdominal obesity (adjusted odds ratio, 1.975; 95% confidence interval, 1.104–3.531, P=0.0218).Conclusions In euthyroid adolescents, a significant trend was observed between TSH quartile and MetS. Specifically, high-normal TSH levels showed a significant association with abdominal obesity, a key component of MetS.

A fixed-dose combination of rosuvastatin and amlodipine (Ros/Aml) offers a simplified approach to simultaneously address hypertension and dyslipidemia. While pivotal trials have demonstrated the efficacy and safety of this regimen, real-world evidence on its clinical outcomes related to major adverse cardiovascular and cerebrovascular events (MACCE) had been limited. This multicenter, prospective, non-interventional study was conducted across 39 sites in South Korea (2020-2024) to evaluate the 12-month effectiveness and safety of Ros/Aml in adults with coexisting hypertension and dyslipidemia. The primary endpoint was the incidence of MACCE. Secondary endpoints included changes in blood pressure, lipid profiles, and safety outcomes. A total of 5018 patients were enrolled, with 5009 (99.82%) included in the Safety and Efficacy Sets. The mean age was 66.80 years, and 60.39% were male. In the efficacy set, the 12-month MACCE incidence was 0.54% [95% CI: 0.36-0.78], with no significant differences among four dose groups. Ros/Aml significantly reduced systolic and diastolic blood pressure at 6 and 12 months (both P < 0.001), and LDL-C levels (P < 0.0001). Adverse drug reactions were reported in 3.11% of patients; with only 0.06% experiencing serious ADRs and no ADR-related deaths occurred, suggesting a tolerable safety profile. In this large real-world study, Ros/Aml demonstrated a favorable safety profile and was effective in reducing MACCE risk, blood pressure, and lipid levels over 12 months. These findings in patients with hypertension and dyslipidemia support its use as a viable strategy for integrated cardiovascular risk management in clinical practice.