Sacred Heart Hospital

Mild cognitive impairment (MCI) represents a high-risk stage for dementia, yet limited non-pharmacological interventions are accessible. Although nature-based interventions have potential cognitive benefits, empirical validation for MCI populations remains limited. This study aims to address this gap. Fifty older adults with MCI were recruited from a psychiatric outpatient clinic and local dementia centers. The intervention group included 25 participants who received a four-session nature-based intervention over 4 weeks, while controls, matched for age and sex, received no intervention. Pre- and post-tests assessed cognitive, emotional, physiological, and physical functions. Mini-Mental State Examination (MMSE) scores demonstrated a significant time×group interaction [F(1,45)=10.226, p=0.003]. The nature-based intervention group showed that MMSE scores increased significantly (t=-2.270, p=0.034). In contrast, the control group exhibited a significant decline (t=2.262, p=0.034). No significant time and group interactions were found for emotional, physiological, or physical outcomes. This short-term, nature-based intervention yielded cognitive benefits in older adults with MCI, which supported its feasibility as an accessible, non-pharmacological intervention. Further longitudinal randomized controlled trials should confirm sustained effects across multiple domains.

Early identification and appropriate management of dysphagia are critical for improving outcomes of acute ischemic stroke. To develop a simple and reliable scoring system to predict the severity of dysphagia in patients with acute ischemic stroke by integrating ultrasound (US) parameters with clinical variables. Prospective, cross-sectional observational study. Inpatient neurology department of a university-affiliated hospital. A total of 212 patients with acute ischemic stroke were prospectively enrolled in this study. The mild dysphagia group and severe dysphagia group comprised 146 patients and 66 patients, respectively. Group assignment was based on the need for dietary modifications confirmed via retrospective review of dietary status, videofluoroscopic swallowing study results, and the occurrence of aspiration pneumonia during hospitalization. Dynamic M-mode US of the suprahyoid muscle (SHM) was performed during swallowing. The following six SHM parameters were obtained: SHM thickness (baseline thickness of the SHM); SHM displacement (peak-to-peak amplitude of SHM movement); SHM difference (SHM displacement - SHM thickness); SHM ratio (SHM displacement/SHM thickness); peak-to-peak time; and total duration. The study population was randomly split into training (70%) and test (30%) sets. Least absolute shrinkage and selection operator and logistic regression analyses were performed to identify significant predictors of severe dysphagia. These predictors were used to develop and validate a simple scoring system. Brainstem lesion, bilateral lesion, National Institutes of Health Stroke Scale (NIHSS) score, SHM difference, and total duration were identified as key predictors of severe dysphagia. A simple scoring system based on these variables showed excellent discriminative performance. Areas under the receiver-operating characteristic curves (AUCs) of the training set and the test set were 0.963 and 0.935, respectively. A cutoff of ≥3 points yielded sensitivity of 97.9% and specificity of 86.4% for the training set as well as sensitivity of 78.9% and specificity of 95.3% for the test set. This simple scoring system combining US and clinical parameters enabled early identification of patients at increased risk for severe dysphagia. The dysphagia severity prediction score can facilitate timely management of patients with acute ischemic stroke, thus potentially reducing complications and enhancing dysphagia rehabilitation.

Persistent symptoms after SARS-CoV-2 infection (PASC, long COVID) remain a major public-health concern. We developed a data-driven definition and static and dynamic PASC scoring systems in a multicenter, prospective-retrospective observational cohort across 12 South Korean institutions. Adults enrolled December 2022-March 2025 were followed up to 24 months; 8761 were recruited (7208 infected; 1553 controls) and 4668 met analysis criteria (4388 infected; 280 controls). Using participant-reported symptoms, surveys, and laboratory data, we identified nine symptoms robustly associated with PASC, with anosmia/ageusia and fatigue most influential. A static score integrating indicators observed within 24 months yielded an optimal threshold of 13, classifying 19% of infected participants and 4% of controls as PASC positive. A dynamic score tracking six-month intervals showed symptom burdens peaking at 0-5 months post-infection and declining thereafter; at the same threshold, 33% of infected participants were classified as PASC positive, reflecting temporal fluctuation. These data establish a quantitative definition of PASC and introduce a dynamic scoring framework to identify and monitor PASC, supporting future clinical research and practice.

In the PROACTIVE-HF trial, remote heart failure (HF) management using comprehensive vital signs and seated mean pulmonary artery pressure (mPAP) was safe and resulted in a low reported rate of HF hospitalization (HFH) and all-cause mortality (HFH/D) through 12 months. In this report, we extend the results from the PROACTIVE-HF study through 2 years, stratified by ejection fraction (EF). PROACTIVE-HF was a prospective, multicenter, open-label, single-arm trial evaluating the safety and efficacy of patient management using the Cordella PA pressure sensor system in patients with New York Heart Association class III symptoms, regardless of EF. In the first 24 months, the incidence of HF events (HFE)/D was 0.89 (95% CI 0.81-0.99) events per patient, driven by HFH. Patients with HF with reduced EF had greater HFE/D rates than those with HF with preserved EF (1.0 vs 0.8 events per patient, P = .048). For patients with HF experiencing moderate-to-severe symptoms, management using the Cordella PA sensor system was associated with low event rates and improved health status at 2 years, regardless of EF. Comprehensive remote monitoring of vital signs, seated PAP, and patient-reported symptoms via a digital platform supports sustained benefit for high-risk patients with HF.

The management of gastrointestinal (GI) and cardiovascular (CV) complications in patients with ischemic heart disease (IHD) receiving long-term antiplatelet therapy remains a clinical challenge.Proton pump inhibitors (PPIs) have traditionally been the standard strategy to prevent upper GI complications in this high-risk population. 1 More recently, potassium-competitive acid blockers (P-CABs) have emerged as promising alternatives, offering rapid and potent acid suppression. 2Despite their growing use, real-world data directly comparing the clinical outcomes of P-CABs and PPIs-particularly in patients on antiplatelet therapy-have been limited.In this context, the recent study by Lee et al. 3 retrospectively evaluated the incidence of upper GI complications and CV events in 604 patients with IHD who received either tegoprazan or a PPI after percutaneous coronary intervention (PCI).The authors found no significant differences between the two treatment groups.Tegoprazan use was associated with a hazard ratio (HR) of 0.34 for GI complications compared with PPIs (95% confidence interval [CI], 0.04-2.97)and an HR of 0.57 for major adverse cardiovascular events (MACEs) (95% CI, 0.15-2.19),indicating no statistically significant differences.These findings reinforce the potential role of P-CABs as reliable agents for GI protection in patients exposed to antiplatelet therapy and contribute to ongoing efforts to address concerns about possible pharmacodynamic interactions-particularly those involving CYP450 pathways-between PPIs and clopidogrel. 2lthough the results are encouraging, they warrant cautious interpretation.The retrospective design introduces the possibility of unmeasured confounding, and the relatively small number of GI and CV events limits statistical power to detect treatment-related differences.Furthermore, long-term safety data for P-CABs remain insufficient; while shortterm studies demonstrate strong acid-suppressive effects, evidence regarding the safety of prolonged P-CAB use-especially in patients requiring lifelong antiplatelet therapy-remains limited.Despite these limitations, the study provides valuable exploratory evidence and establishes a foundation for future research.As P-CABs become increasingly integrated into clinical practice, rigorously designed prospective studies will be essential to establish their long-term safety, define optimal dosing strategies, and clarify their role in patients receiving complex antithrombotic regimens such as dual antiplatelet therapy.The present study offers meaningful early evidence supporting the comparable safety profiles of tegoprazan and PPIs after PCI and underscores

The present Reply addresses the commentary by Pagnoni et al. on our recent study exploring explainable artificial intelligence (AI) for mortality risk prediction in pulmonary arterial hypertension (PAH). We acknowledge the importance of several key issues raised by the authors, including endpoint selection, calibration, decision thresholds, and external validation, all of which are central to translating AI-based prognostic models into clinical practice. Our original endpoint, defined as death by the next follow-up visit, was driven by the structure of nationwide registry data and reflects real-world clinical workflows, although we recognize the advantages of predefined time horizons and time-to-event approaches for future analyses. We discuss the trade-off between sensitivity and precision, emphasizing our deliberate prioritization of minimizing false-negative classifications in high-risk patients, while acknowledging the need for structured clinical pathways to manage false-positive results. We further address calibration and threshold selection, underscoring the necessity of additional clinical studies to support intervention-oriented recommendations. The role of phenotypic determinants and modifiable risk factors in enhancing personalization is highlighted as a key direction for future model development. We reaffirm the value of SHAP-based explainability for improving model transparency, while recognizing the need for continued refinement and clinical validation. Finally, we emphasize the strengths and challenges inherent to registry-based analyses, the importance of external validation, and the need for methodologically sound comparisons with established risk calculators. Overall, this exchange underscores the critical role of interdisciplinary collaboration in advancing clinically actionable and interpretable AI solutions for PAH.

Guidelines recommend that the foundation four guideline-directed medical therapy (GDMT), which includes mineralocorticoid receptor antagonists (MRAs), should be initiated early in the treatment paradigm of heart failure due to mortality benefits and reduction in hospitalization for heart failure. However, the practical implementation of these guidelines in the real-world clinical scenario is lacking. Delay in initiating MRA is common, and patients often do not receive the optimum dose of MRA. The clinical considerations and guideline recommendations for early initiation and optimum dosing of MRA in HF can form the scientific basis for improving the correct usage of MRA in HF in real-world settings.

To assess the long-term effectiveness, safety, and economic viability of recently approved Alzheimer's disease (AD) therapies, as well as to evaluate the real-world application of novel diagnostics among AD patients with diverse comorbidities, comprehensive real-world data (RWD) analysis is essential. The Korean JOint RegistrY for ALZheimer's Treatment and Diagnostics (JOY-ALZ) endeavors to create a registry of RWD derived from clinical practice on new diagnostic methods and therapeutic agents for AD introduced in Korea since 2021. Participants must fulfill all the following: 1) be at least 19 years old; 2) be actively receiving, scheduled to initiate, or undergoing evaluation for any AD disease-modifying treatment; 3) have completed amyloid positron emission tomography or cerebrospinal fluid AD immunoassay (a positive result is not essential for participation); 4) have a clinical classification of cognitively unimpaired, mild cognitive impairment, or probable AD dementia. Data generated during routine care is segmented into a minimum dataset, extended dataset, and research-only dataset requiring extra consent. Assessments encompass clinical, cognitive, functional, neurobehavioral, neuroimaging, and biomarker evaluations, in addition to systematic monitoring of new AD treatments and their safety. Data are collected and monitored at baseline, at semiannual intervals during the initial 2 years, and then annually up to 2034. To date, 46 medical centers will participate in JOY-ALZ. JOY-ALZ is expected to promote understanding of the long-term clinical outcomes, safety, and cost-effectiveness of recently introduced diagnostics and treatments for AD, thereby supporting the progress of precision medicine in AD care and diagnosis. ClinicalTrials.gov Identifier: NCT06889818.

This article provides perspectives on the use of Cerebrolysin as an adjunct treatment to reperfusion therapy in acute ischemic stroke (AIS). In the evolving landscape of AIS reperfusion therapy, we hypothesize that adjunctive cerebroprotective therapy, such as Cerebrolysin, is likely to further improve patient outcomes. Beyond its established neurorecovery benefits, recent data indicate that Cerebrolysin also offers protection to the neurovascular unit and the blood-brain barrier. This paper introduces the CErebrolysin in RECanalization And Perfusion (CERECAP) program, a collaborative initiative of independent academic investigations exploring the favorable trends of Cerebrolysin in reperfusion. The CERECAP program has generated compelling data demonstrating Cerebrolysin's alignment with current AIS reperfusion therapy concepts, particularly its role in early intervention targeting multiple pathways. We review these studies and discuss the critical need to clearly define the patient population that benefit most from adjunctive Cerebrolysin therapy in AIS.

The role of IV thrombolysis before endovascular thrombectomy (bridging thrombectomy, BT) in posterior circulation large-vessel occlusion stroke remains uncertain. This study evaluated the effectiveness and safety of BT compared with direct thrombectomy (DT) using data from 2 nationwide registries and an updated meta-analysis. Patients from collaborative registries in Taiwan and South Korea who underwent thrombectomy for vertebral, basilar, and posterior cerebral artery occlusions were included. This observational study included hospital-based registry data with standardized collection of treatments and outcomes. Propensity score matching was applied to adjust for baseline differences between BT and DT groups. Outcomes included 90-day modified Rankin Scale (mRS) score, mortality, successful reperfusion, and symptomatic intracranial hemorrhage (sICH). We also performed a systematic review and meta-analysis of observational studies comparing BT vs DT in posterior circulation large-vessel occlusion stroke. Among the combined 9,942 patients, 873 (median age 71, 32% female) who underwent thrombectomy for posterior circulation stroke were analyzed. Of them, 281 received BT and 592 received DT. BT was associated with a lower 90-day mRS score (median 3 vs 4; adjusted odds ratio [OR] 1.44 per 1-point improvement, 95% CI 1.09-1.91) and lower mortality (17.4% vs 26.9%; adjusted OR 0.51, 95% CI 0.33-0.81). The proportions of successful reperfusion (79.3% vs 81.1%) and sICH (2.5% vs 2.9%) were comparable. In propensity score-matched cohorts (n = 205 each), BT remained associated with better functional outcomes (OR 1.44, 95% CI 1.00-2.07) and reduced mortality (matched OR 0.45, 95% CI 0.26-0.78). The meta-analysis, which included 39 studies and 7,288 patients, confirmed that BT was associated with higher odds of achieving 90-day mRS score 0-2 (OR 1.57, 95% CI 1.28-1.94), 90-day mRS score 0-3 (OR 1.33, 95% CI 1.05-1.68), and lower mortality (OR 0.77, 95% CI 0.61-0.97), without an increased risk of sICH (OR 1.01, 95% CI 0.71-1.44). BT was associated with better 90-day functional outcomes and lower mortality, without increasing hemorrhagic risk in posterior circulation large-vessel occlusion stroke. These findings support the use of BT in eligible patients, pending further validation from randomized trials. This study provides Class III evidence that in patients with posterior circulation stroke undergoing thrombectomy, previous IV thrombolysis is associated with better 90-day functional outcomes and lower mortality without increasing hemorrhagic risk.