Yeouido St. Mary's Hospital

Introduction: Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain. Materials and Method: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias. Results: Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison. Conclusions: Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging.

BackgroundAlzheimer's disease (AD) is a neurodegenerative disorder characterized by cognitive deficits predominantly linked to hippocampal and cortical atrophy. Emerging evidence highlights the cerebellum's involvement in both cognitive and neuropsychiatric symptoms of AD, challenging its traditional characterization as resistant to AD pathology. This study investigates longitudinal cerebellar volume changes across the AD spectrum, from preclinical stages to dementia, and their associations with cognitive and neuropsychiatric symptoms.MethodsA total of 229 older adults from the Catholic Aging Brain Imaging Database (CABID) were classified into four groups: Normal Cognition (NC), Preclinical AD (PAD), Aβ‐positive Mild Cognitive Impairment (MCI), and AD Dementia (ADD). Over an average follow‐up of two years, participants underwent MRI, PET imaging, and clinical assessments. Regional cerebellar volumes were analyzed using SPM12 with the SUIT atlas, and statistical models assessed group differences and longitudinal changes.ResultsAt baseline, significant cerebellar volume reductions were identified in the ADD group, particularly in Crus I, Crus II, and the Vermis. Longitudinal analyses revealed progressive volume reductions in the PAD group, notably in the left Crus I and left VI, preceding significant cognitive decline. In contrast, no longitudinal changes were observed in the NC or MCI groups. Notably, cerebellar volume reductions in the PAD group correlated with episodic memory performance, while reductions in the ADD group were linked to neuropsychiatric symptoms, including psychosis, irritability, and euphoria. These findings underscore the cerebellum's involvement in AD pathology and its interconnected role with cortical regions in executive function and memory.ConclusionLongitudinal cerebellar volume changes offer critical insights into the trajectory of AD, suggesting that the cerebellum may serve as an early biomarker and potential therapeutic target in AD progression.

While multicomponent frailty interventions have demonstrated short-term effectiveness, evidence on long-term health and cost outcomes is limited. To evaluate the 66-month health and cost outcomes of a multicomponent frailty intervention for older adults in rural Korea. This economic evaluation used data from the Aging Study of Pyeongchang Rural Area-Intervention Study, a nonrandomized clinical trial conducted from August 2015 to January 2017. Individual-level data were linked to National Health Insurance Service claims data through December 2021, and analyses were performed from June 2024 to August 2025. Participants were socioeconomically vulnerable adults aged 65 years and older living alone or receiving medical aid in a rural Korean community. Volunteers were enrolled in the intervention, while those who declined enrollment served as controls. Propensity score matching was performed using frailty, functional status, demographics, comorbidities, depression, and prior health service use. A 24-week multicomponent program including structured exercise and nutrition, with depression management, deprescribing, and home hazard reduction provided by risk profile. Survival analyses assessed a composite of all-cause mortality or long-term care insurance eligibility over 66 months. Cost outcomes included cumulative health service-use costs and cost:benefit ratios, calculated as incremental costs relative to intervention costs. Among 383 eligible adults, 187 volunteered to participate and 196 individuals served as controls; NHIS linkage was successful for 181 (96.8%) and 192 (98.0%) participants, respectively. Among 119 matched pairs (238 [68.9%] aged ≥75 years; 177 [74.4%] female), participants had longer composite outcome-free survival at 66 months (mean difference, 6.53 [95% CI, 1.38-11.68] months). Health service-use costs were consistently lower in the participants group, mainly from reduced hospitalizations and long-term care use, with per-person savings of $7688 (95% CI, 1197-14 615) at 66 months, representing a cost:benefit ratio of 8.82. In this economic evaluation of a nonrandomized clinical trial, participants in a 24-week multicomponent intervention had longer survival free from death or long-term care eligibility and had lower health service-use costs over 66 months. These findings support consideration of broader implementation of community-based frailty interventions in older adults.

Background and aim Direct oral anticoagulants (DOACs) carry a risk of gastrointestinal bleeding (GIB). We aimed to develop and validate machine learning (ML) models to predict GIB in DOAC users and compare them with conventional risk scores. Methods We retrospectively analyzed 4,494 patients aged ≥18 years prescribed DOACs from December 2014 to October 2020. Patients were allocated to the training (n = 3,147), internal (n = 677), and external (n = 670) validation cohorts. Three ML algorithms, Gradient Boosting Machine (GBM), XGBoost, and Generalized Linear Model (GLM), predicted GIB at 12 and 24 months. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and specificity at 100% sensitivity, compared with the HAS-BLED, ATRIA, VTE-BLEED, and ORBIT scores. Results At 24 months, XGBoost achieved the AUCs in the training (0.862), internal validation (0.819), and external validation (0.905) sets. At 12 months, XGBoost performed with AUCs of 0.917, 0.839, and 0.948, respectively. XGBoost exceeded the conventional scores, although ORBIT was the best among the latter (AUC 0.780 at 24 months, 0.728 at 12 months). The ML models also achieved higher specificity at 100% sensitivity. At 12 months, XGBoost and GB model demonstrated 79.8% specificity at 100% sensitivity, whereas GLM showed 67.8%. The conventional models were lower, with an ORBIT of 39.8%. By 24 months, GLM and ORBIT specificities were 43.8% and 40.0%, respectively. Conclusions ML models, particularly XGBoost, outperformed traditional bleeding risk scores in predicting GIB in DOAC users. However, the performance of the ML models was unsatisfactory. Further research is warranted to achieve a better performance.

The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR). In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years. Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes. Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI. NCT03217877.

In phase 3 trials, tenofovir alafenamide (TAF) showed antiviral efficacy comparable to that of tenofovir disoproxil fumarate (TDF) for chronic hepatitis B (CHB), with an improved safety profile. This study aimed to compare the clinical efficacy of TAF and TDF in terms of the risk of hepatocellular carcinoma (HCC). We conducted a nationwide historical population cohort study on treatment-naïve adult patients with CHB receiving TAF (n = 29 309) or TDF (n = 58 046) as first-line therapy from 2017 to 2022 using data from the Korean National Health Insurance Service database. Cumulative HCC incidence and associated risk factors were estimated using competing risk factors. Propensity score (PS)-matched analysis was used to minimise the confounding effects. A total of 54 185 patients were included in the study, with 20 994 in the TAF group and 33 191 in the TDF group. The annual incidence of HCC was significantly lower in the TAF group (7.5/1000 patient-years [PYs]) than in the TDF group (10.3/1000 PYs; subdistribution hazard ratio [SHR], 0.74; p < 0.001). After PS matching, TAF continued to exhibit a protective effect against HCC (7.5/1000 PYs vs. 9.9/1000 PYs; p < 0.001). Multivariable analysis with Fine-Gray proportional subdistribution hazards model identified TAF as significantly associated with a reduced HCC incidence (SHR: 0.76; p < 0.001). Subgroup analysis confirmed the hepatoprotective effect of TAF against HCC even in patients with cirrhosis (SHR: 0.78; p = 0.003). This study showed that TAF had a hepatoprotective effect against HCC in patients with CHB, providing valuable guidance for clinicians in selecting the appropriate initial treatment for these patients.