Yonsei University Hospital

Objective Mindfulness is a promising psychological resource that can alleviate dysfunctional fear responses and promote mental health. We investigated how mindfulness affects fear and depression in isolated patients with coronavirus disease 2019 (COVID-19), and whether it acts as a mediator. Methods We conducted an online survey of COVID-19 patients undergoing at-home treatment from February to April 2022. The survey included a questionnaire on fear of COVID-19 (measured by the Fear of COVID-19 Scale), mindfulness (measured by the Mindful Attention Awareness Scale), and depression (measured by the Patient Health Questionnaire). A total of 380 participants completed the questionnaire. We analyzed the correlation between each variable and performed a mediation analysis using hierarchical regression and bootstrapping to verify the statistical significance of the mediating effects. Results Each variable was significantly correlated. Hierarchical regression analysis showed that the association between the fear of COVID-19 and depression decreased from 0.377-0.255, suggesting that mindfulness partially mediates the relationship between fear of COVID-19 and depression. Bootstrapping analysis showed that the indirect effect of the mediating variable (mindfulness) is 0.121, which accounts for 32.3% of the total effect. Conclusions Interventions that promote mindfulness in patients with acute COVID-19 may be beneficial for their mental health.

Neural stem cells (NSCs) in the subventricular zone (SVZ) are identified as cells-of-origin harboring driver mutations in glioblastoma (GBM), which is the most devastating brain tumor with highly heterogeneous nature. However, the sequential transformation of a limited number of mutation-harboring NSCs into a distant tumor with high intratumoral heterogeneity remains poorly understood. In this study, we have identified transcriptionally distinct types of mutation-harboring precancerous cells in our spontaneous, somatic mouse model recapitulating human GBM evolution as well as in tumor-free SVZ tissues from patients. These precancerous cells emerge via oligodendrocyte lineage specification, exhibiting unique transcriptional programs involving dysregulated translations and extracellular matrix remodeling. Subsequently, they give rise to heterogeneous tumor cell populations by activating multiple programs crucial for gliomagenesis. Our findings highlight the pivotal role of precancerous cells in tumor evolution and intratumoral heterogeneity, suggesting their potential as a novel therapeutic target for GBM.

Bone wax, an essential material for bone hemostasis in orthopedic, thoracic, and neurological surgeries, is defined as a substance that physically controls bleeding caused by bone fractures. Absorbable bone-wax products such as poloxamer multiblock copolymers can be topically applied, form a physical barrier, are biocompatible, and can be absorbed by/excreted from the body. However, absorbable bone waxes continue to have limited physical properties, poor bone adhesion, and low hemostatic quality. When applied to the affected area, they quickly dissolve in blood and body fluids, preventing maintenance of the physical barrier over a certain period and thereby reducing the hemostatic effect. This study introduces a new type of absorbable bone wax (OSSTOP) constructed from 2 poloxamer multiblock copolymers with different molecular weight ranges. To determine whether OSSTOP overcomes the limitations of the existing products, the physicochemical properties and efficacy of OSSTOP were compared with those of 2 existing absorbable bone-wax products, OSTENE and NOVOSEAL. The adhesive strengths, yield loads, and solubilities of the products were evaluated and compared in vitro. Hemostasis at the bone-amputation site and absorption/degradation of the products were then evaluated through animal experiments in vivo. The biological safety (cytotoxicity) of the newly developed OSSTOP was also assessed. A histological analysis confirmed superior hemostasis at the bone-amputation site and a favorable biological response after treatment with OSSTOP. We expect that OSSTOP will improve the convenience, hemostatic performance, and biocompatibility of bleeding cessation at bone-amputation sites in the clinical environment.

Osteoporosis, a bone disease characterized by decreased bone mineral density (BMD) resulting in decreased mechanical strength and an increased fracture risk, remains poorly understood in children. Herein, we developed/validated a deep learning-based model to predict pediatric BMD using plain spine radiographs. Using a two-stage model, Yolov8 was applied for vertebral body detection to predict BMD values using a regression model based on ResNet-18, from which a low-BMD group was classified based on Z-scores of predicted BMD. Patients aged 10–20-years who underwent dual-energy X-ray absorptiometry and radiography within 6 months at our hospital were enrolled. Ultimately, 601 patients (mean age, 14 years 4 months [SD 2 years]; 276 males) were included. The model achieved robust performance in detecting vertebral bodies (average precision [AP] 50 = 0.97, AP [50:95] = 0.68) and predicting BMD, with significant correlation (r = 0.72), showing consistency across different vertebral segments and agreement (intraclass correlation coefficient: 0.64). Moreover, it successfully classified low-BMD groups (area under the receiver operating characteristic curve = 0.85) with high sensitivity (0.76) and specificity (0.87). This deep-learning approach shows promise for BMD prediction and classification, with potential to enhance early detection and streamline bone health management in high-risk pediatric populations.

Glycogen storage disease (GSD) is a group of rare inherited metabolic disorders characterized by abnormal glycogen storage and breakdown. These disorders are caused by mutations in G6PC1, which is essential for proper glucose storage and metabolism. With the advent of continuous glucose monitoring systems, development of algorithms to analyze and predict glucose levels has gained considerable attention, with the aim of preemptively managing fluctuations before they become problematic. However, there is a lack of research focusing specifically on patients with GSD. Therefore, this study aimed to forecast glucose levels in patients with GSD using state-of-the-art deep-learning (DL) algorithms. This retrospective study utilized blood glucose data from patients with GSD who were either hospitalized or managed at Yonsei University Wonju Severance Christian Hospital, Korea, between August 2020 and February 2024. In this study, three state-of-the-art DL models for time-series forecasting were employed: PatchTST, LTSF N-Linear, and TS Mixer. First, the models were used to predict the patients’ Glucose levels for the next hour. Second, a binary classification task was performed to assess whether hypoglycemia could be predicted alongside direct glucose levels. Consequently, this is the first study to demonstrate the capability of forecasting glucose levels in patients with GSD using continuous glucose-monitoring data and DL models. Our model provides patients with GSD with a more accessible tool for managing glucose levels. This study has a broader effect, potentially serving as a foundation for improving the care of patients with rare diseases using DL-based solutions.

Exposure to PM2.5 (particulate matter <2.5 μm) has been implicated in increasing the risk of endometriosis and worsening its symptoms. However, the molecular mechanisms and direct associations remain unclear. This study explored whether PM2.5 contributes to the onset or progression of endometriosis using in vitro and in vivo models. Endometrial (EM) cells from women without endometriosis were cultured to the second passages (P2) with or without exposure to PM2.5 at a concentration of 200 µg/mL (N = 5 for each group). Z-stack confocal imaging confirmed PM accumulation in the nucleus and cytoplasm of exposed EM cells. Initial PM exposure at the primary passage (P0) led to decreased proliferation, migration, anti-apoptosis, and oxidative stress, accompanied by downregulation of associated pathways. However, repeated PM exposure during subculturing to P2 led to increased proliferation, enhanced anti-apoptotic activity, and elevated oxidative stress. Given the similarity of these gene expression alterations to those observed in endometriosis, an endometriosis-induced mouse model was established to assess the potential of repeated PM exposure to exacerbate the condition in vivo. To investigate the in vivo effects, an endometriosis-induced mouse model was developed using female C57BL/6 mice exposed to low (10 mg/kg/day) or high (20 mg/kg/day) doses of PM2.5 for 4 weeks (n = 6 for each group). PM exposure significantly enlarged endometriotic lesions compared to controls (no PM exposure). Upregulated gene expression in endometriotic lesions included anti-apoptotic (Bcl2/Bax), proliferative (p-ERK), inflammatory (p-NF-κB, p-c-jun, IL-6, IL-1β), and migration (MMP-2, MMP-9) markers. PM exposure altered estrogen receptor (ER) expression, resulting in a decreased ERα/ERβ ratio in both dose groups. The control group exhibited a ratio of 1.03 ± 0.09, while the low-dose and high-dose mice had ratios of 0.57 ± 0.08 (p = 0.02) and 0.46 ± 0.26 (p = 0.03), respectively. In conclusion, PM2.5 exposure alters gene expression related to cell growth, survival, oxidative stress, and migration in EM cells and exacerbates endometriotic lesions in vivo, likely through ER modulation. These findings suggest PM2.5 may contribute to other estrogen-dependent conditions, such as leiomyoma or adenomyosis, by influencing ER pathways.

Background The epidural blood patch (EBP) is the treatment of choice for spontaneous intracranial hypotension (SIH). Studies have shown that targeted EBP is more effective than blind EBP. Additionally, a greater volume of injected blood during EBP has been associated with better therapeutic outcomes. However, symptoms such as back pain often prevent achieving the desired blood volume. This study aimed to analyse factors influencing the tolerable EBP volume, including structural, clinical, and psychological factors. Methods This retrospective study included patients diagnosed with SIH who underwent single-level EBP at a tertiary care centre from 2019 to 2024. Data collected encompassed target levels, cross-sectional area, types of EBP, demographics, imaging findings, maximum intensity of orthostatic headache, Headache Impact Test-6, psychological state (Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9), and somatic symptom burden (Widespread Pain Index and Symptom Severity Scale). A linear mixed model (LMM) was used to investigate factors influencing the total injected blood volume, accounting for repeated EBP procedures per patient. Sensitivity analysis was performed to assess model robustness. Results A total of 103 EBP procedures from 53 patients (62% female; mean age, 39.9 ± 11.1 years) were analysed. The results of the LMM revealed that lower spinal levels (beta = 0.306, P = 0.029) and male sex (beta = 4.347, P = 0.024) were significantly associated with higher tolerable EBP volumes. Psychological factors or somatic symptom burden did not have a significant impact on the injected blood volume. In the sensitivity analysis, the number of EBP procedures (beta = -0.804, P = 0.001) was also significantly associated with lower tolerable EBP volume. Conclusions Lower spinal levels and male sex were associated with higher tolerable EBP volumes in patients with SIH. The trade-off between spinal level and tolerable EBP volume should be considered when developing targeted blood patch strategies and evaluating their efficacy. Graphical Abstract

Both Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and sarcopenia are associated with numerous chronic diseases, and the link between the two broad-spectrum phenotypes has been extensively researched. We focused on the relationship between the hepatic steatosis index (HSI) and hand grip strength (HGS). The Korean National Health and Nutrition Examination Surveys (2014–2019) were utilized to identify the association between estimated MASLD (eMASLD) and muscle strength. HSI determined eMASLD status, and HGS evaluated muscle strength. The HSI demonstrated a positive correlation with HGS. The alanine transaminase (ALT)/aspartate aminotransferase (AST) ratio and diabetes among the five components of HSI exhibited significant relationships with HGS in men and women. The robust linearity between HSI and HGS was observed in multivariate models and stratified analyses, particularly in older non-diabetic men with a higher body mass index (BMI) and young women without diabetes. However, younger men and older women exhibited nonlinear associations influenced by the ALT/AST ratio, BMI, and diabetes. After adjusting HGS with BMI, a significant negative association between HSI and muscle strength was observed, particularly in women. The disruption in linearity was influenced by the ALT/AST ratio, particularly in men with diabetes. Our findings highlight the complex interplay between HSI and HGS. The relationship between the two broad-range phenotypes was observed, and liver profiles influenced the linearity.

Protein-losing enteropathy (PLE) is a serious complication after the Fontan operation with limited treatment options. This phase 2, multi-center, open-label trial evaluated the efficacy and safety of Camostat Mesylate (CM), a serine protease inhibitor, as adjunctive therapy for PLE. Nineteen patients aged 4 years and older with PLE after the Fontan operation were enrolled. CM was administered for six months in addition to their individualized conventional treatments. Assessments were made at 1, 3, and 6 months of CM administration, and at one month after CM discontinuation. Outcomes evaluated were the changes in serum albumin level, stool alpha-1 antitrypsin, and clinical symptoms such as, diarrhea, edema, weight change, and ascites. Of the 19 patients enrolled, 4 voluntarily withdrew consent, and the data from the 15 patients who completed the study were analyzed. Their median age was 15.0 years (interquartile range, 12.0–21.5) and the median time between the Fontan surgery and PLE diagnosis was 2.4 years. Serum albumin levels increased from 2.2 to 2.5 g/dL (p = 0.183), while stool alpha-1 antitrypsin levels significantly decreased from 215.6 to 75.5 mg/dL (p = 0.016) over six months. Patients with baseline diarrhea showed notable improvements: serum albumin increased from 1.8 to 2.4 g/dL (p = 0.138) and stool alpha-1 antitrypsin decreased from 220.3 to 75.5 mg/dL (p = 0.075) over 6 months. No serious adverse events occurred. CM demonstrated significant reductions in gastrointestinal protein losses, particularly in patients with baseline diarrhea. Trial registration NCT05474664.

Purpose Anterior vertebral bone resorption, commonly observed in cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF), has not been extensively studied in the context of APCF. This study aims to investigate the phenomenon of anterior vertebral bone resorption following APCF, its potential causes, and its clinical significance. Methods A retrospective analysis was performed on 177 patients (857 vertebral segments) who underwent multilevel APCF between April 2014 and April 2022. Radiographs and CT scans were used to measure anterior-posterior vertebral body length (APL) and its ratio to the C2 vertebra (APLR) immediate-postoperatively and at 1-year follow-up. The bone resorption ratio (BRR) quantified changes in APLR. Correlations between lordosis and BRR were evaluated using Pearson’s correlation and linear regression. Intra- and inter-observer reliability were assessed using intraclass correlation coefficients (ICC). Results Bone resorption was significantly greater in well-fused AP group compared to pseudoarthrosis or posterior-only fused segments (mean BRR: 11.9%, 5.1%, -1.3%, respectively; P < 0.001). Greater postoperative lordosis correlated positively with higher BRR (R = 0.263, P < 0.001), while a reduction in lordosis correlated negatively with BRR (R=-0.285, P = 0.01). Intra- and inter-observer reliability were excellent, with ICC values ranging from 0.77 to 0.85. Conclusion Anterior vertebral bone resorption in APCF is a physiological phenomenon reflecting biomechanical adaptation according to Wolff’s law. It is more pronounced in well-fused segments with a greater degree of lordosis and may indicate successful fusion and good sagittal alignment restoration. Further research is needed to evaluate its long-term clinical implications.

Background Cryolipolysis is a nonsurgical adiposity reduction treatment that is increasing in popularity globally. The aim of this paper was to carry out a systematic review with meta-analysis on cryolipolysis and associated health outcomes, adverse events (AE) and patient satisfaction. Methods Major databases were searched from inception until April 4, 2024. Meta-analysis was performed using random-effect models to calculate the pooled effects size and 95% confidence interval (CI) of each finding. The systematic review protocol was registered on PROSPERO, CRD-42024548077. Results A total of 30 studies were included, including 3158 participants. The result of meta-analyses showed reduced body mass index (mean differences [MD] = −1.80, 95% confidence interval [CI] −2.98, −0.62, p = 0.0003), waist-to-hip ratio (MD = −0.09, 95% CI −0.16, −0.02, p = 0.001), mean abdominal circumference (cm) (MD = −3.56, 95% CI −4.98, −2.15, p = 0.000001), and mean suprailiac fat thickness (FT) (mm) (MD = −5.22, 95% CI −9.03, −1.42, p = 0.0007), 12 weeks after cryolipolysis as compared with baseline values. The satisfaction rate was 80.4% and the AE of cryolipolysis was 49.5% for numbness, 44.5% for erythema, 30.5% for edema, 28.8% for pain, 25.4% for sensitivity, 15.2% for tingling, and 2% for hyperpigmentation. Conclusion In the present study, it was found that cryolipolysis was associated with a reduction in the number of adiposity parameters at 3 months follow-up. A relatively high level of minor AEs was reported; however, patient satisfaction was high suggesting that the treatment is well tolerated.

Background Systemic ischemic-reperfusion injury following cardiac arrest results in multisystem organ failure, brain injury and death. The aim of this trial is to investigate whether the combined use of cortisol, ascorbic acid (vitamin C), and thiamine during the early post-resuscitation period reduces the neurologic injury among out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). Method This is a single-blind, multi-center, randomized, placebo-controlled trial to be conducted in nine tertiary university-affiliated hospitals in South Korea. A total of 160 OHCA survivors treated with TTM will be randomly assigned to the treatment or control groups (1:1 ratio). For the treatment group, patients will intravenously receive a combination dose of ascorbic acid (50 mg/kg, maximum single dose 3 g), thiamine (200 mg), and cortisol (100 mg) that will be mixed in three separate 50mL bags of 0.9% saline, respectively, every 12 hours for 3 days. For the placebo group, patients will receive three separate 50mL bags of 0.9% saline intravenously in the same manner. The primary outcome is the peak neuron-specific enolase level at 48–72 hours after the return of spontaneous circulation. Discussion The potential benefits of ascorbic acid, thiamine, and cortisol as neuroprotective agents have been reported in previous preclinical trials. This trial is the first clinical trial to assess the neuroprotective effectiveness of a combination of ascorbic acid, thiamine, and cortisol for OHCA survivors. Trial registration ClinicalTrials.gov NCT04921189

Background This study aimed to explore the effects of teriparatide (TPTD) on treatment duration, surgical procedures, and bone turnover markers in medication-related osteonecrosis of the jaw (MRONJ). Methods We analyzed 76 patients with MRONJ post-treatment and divided them into conservative/surgical and TPTD/non-TPTD groups. Key assessments included treatment duration, surgery count, and changes in bone markers (serum C-terminal telopeptide of type 1 collagen [CTX], osteocalcin [OC], procollagen type 1 N-terminal propeptide [P1NP], parathyroid hormone [PTH], 25-OH-vitamin D [25(OH)D], calcium, and inorganic phosphorus) measured at the initial and post-treatment stages. Results TPTD-treated surgical patients experienced shorter treatment periods and underwent fewer surgeries than did non-TPTD counterparts. Post-treatment, both groups showed significant increases in CTX, OC, and 25(OH)D levels. P1NP elevation was significant only in the non-TPTD group. Although the PTH levels decreased in both groups, the difference was not statistically significant. Calcium and phosphorus levels increased in both groups, but only calcium levels increased significantly in the TPTD group. Additionally, TPTD-treated patients showed significant improvements in T-scores, particularly in the lumbar spine and femur neck, compared to the non-TPTD group. Conclusions TPTD administration during MRONJ treatment potentially reduces the need for surgical intervention and accelerates recovery, significantly affecting bone metabolism. These findings highlight TPTD’s role in enhancing the efficacy of MRONJ treatment. TPTD could potentially offer the dual benefit of promoting bone healing and reducing the need for surgical intervention, thus improving overall outcomes for patients with MRONJ.

Background Korean infants born at 32–35 weeks gestational age (wGA) receive palivizumab prophylaxis to prevent respiratory syncytial virus hospitalization (RSVH) if they are born during the RSV season and have a sibling. The aim of this study was to evaluate the impact of using the International Risk Scoring Tool (IRST) to target prophylaxis in Korea. Methods The IRST includes 3 risk factors: birth 3 months before to 2 months after the RSV season starts; smokers in the household and/or smoking while pregnant; and, siblings/daycare. First, the accuracy of the Korean guidelines to predict RSVH was compared to that of the IRST using a historic dataset of 13,475 infants born 32–35 wGA. Second, a published cost‐utility model was adapted using Korean‐specific parameters for costs (2022) and resource use to assess the cost‐effectiveness of palivizumab versus no prophylaxis guided either by the Korean guidelines or the IRST. Results Using the Korean guidelines identified 26.9% of RSVHs, with an area under the receiver operating characteristic curve of 0.512. The corresponding results for infants assessed at moderate‐ to high‐risk by the IRST were 85.1% and 0.773, respectively. The incremental cost per quality‐adjusted life year (QALY) for prophylaxis versus no prophylaxis was ₩29,674,102 (USD22,977) using the Korean guidelines, with a 67.0% probability for cost‐effectiveness against a willingness‐to‐pay threshold of ₩41,655,203 (USD32,255). For the IRST, it was ₩26,265,142 (USD20,338)/QALY and 70.8% probability. Conclusions Adoption of the IRST in Korea would provide greater protection of the most vulnerable infants born 32–35 wGA against RSVH whilst improving cost‐effectiveness.

Aims Cardiac magnetic resonance (CMR) imaging for tissue characterization offers valuable insights for risk stratification among patients with cardiomyopathy. This study aimed to assess the prognostic value of CMR-based tissue characterization in predicting response to cardiac resynchronization therapy (CRT) in patients with non-ischaemic cardiomyopathy (NICM). Methods and results Retrospective analysis was performed on CMR data from NICM patients before CRT implantation. Various CMR parameters, including the late gadolinium enhancement (LGE), native T1, T2, and extracellular volume (ECV), were analysed. Among the 101 patients (mean age: 66 years, male: 52.5%), 72 (71.3%) were CRT responders. The CRT responders had lower LGE burden (13.1 vs. 35.3%, P < 0.001), native T1 (1334.5 vs. 1371.6 ms, P = 0.012), T2 (42.2 vs. 45.7 ms, P < 0.001), and ECV (30.8 vs. 36.8%, P < 0.001) compared with CRT non-responders. After adjusting for other risk factors, LGE burden ≤ 20% [odds ratio (OR): 22.61, 95% confidence interval (CI): 4.73–176.68, P < 0.001], ECV ≤ 34% (OR: 15.93, 95% CI: 3.01–115.13, P = 0.002), and T2 ≤ 45 ms (OR: 8.10, 95% CI: 1.82–43.75, P = 0.008) were identified as predictors of good CRT response and favourable clinical outcomes (log-rank P < 0.001). Conclusion Cardiac magnetic resonance-based tissue parameters effectively predict CRT response and clinical outcomes in patients with NICM, independently of conventional predictors.

Background/Aims Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C virus (HCV) infection. The long-term hepatic and extrahepatic outcomes of DAAs in chronic hepatitis C (CHC) patients receiving curative antivirals are elusive. Methods CHC patients were retrieved from two phase III sofosbuvir-based clinical trials conducted from 2013–2014. Patients who achieved a sustained virological response have been followed prospectively for 5 years since 2016. A propensity score-matched interferon-based historical control with a 1:3 ratio was used for comparison. Quality of life (QoL) was measured by the SF-36, liver fibrosis was measured by electrography, and fibrosis-related markers were followed annually in the prospective cohort. Results A total of 160 DAA- and 480 interferon-treated patients were enrolled. Twenty-eight patients developed hepatocellular carcinoma (HCC) over a follow-up period of 4424 person-years (annual incidence: 0.6%). The incidence of HCC did not differ significantly between the DAA cohort and interferon-treated patients (P = 0.07). Cox regression analysis revealed that FIB-4 was the only factor independently associated with HCC development (hazard ratio [HR]: 95% confidence interval [CI] 3.59/1.68–7.66, P = 0.001). The incidence of newly developed cardio-cerebrovascular disease was 13.8 per 1000 person-years and 0.9 per 1000 person-years in interferon-treated patients and the DAA cohort, respectively (P < 0.001). Interferon-based patients had a significantly greater incidence of cardio-cerebrovascular disease (HR/CI 3.39/1.28–8.96, P = 0.014). There was a substantial decrease in liver stiffness (Ptrend = 0.08) and M2BPGi (Ptrend = 0.05) and a significant reduction in LOXL2 (Ptrend = 0.02) over 5 years. A significant decrease in QoL was observed in role limitations due to physical health and emotional problems, whereas the other parameters were maintained consistently throughout the 5 years of follow-up. Conclusions HCV eradication by DAAs improved liver- and non-liver-related outcomes, constantly promoted liver fibrosis regression, and maintained quality of life after HCV cure. Clinical Trial Number NCT03042520.

Background Thiazolidinediones are oral antidiabetic agents known for their wide‐ranging pleiotropic effects, potentially offering cardiovascular protection. Using a nationwide health claims database in Korea, we evaluated whether thiazolidinedione treatment was associated with long‐term cardiovascular prognosis after carotid revascularization. Methods and Results This retrospective cohort study included patients with type 2 diabetes who underwent carotid endarterectomy or stent insertion in Korea between 2009 and 2020. The use of medications, including thiazolidinediones, was determined from prescription records, identifying exposure to medications within 30 days following carotid revascularization. The primary outcome was the composite occurrence of stroke, myocardial infarction, and all‐cause death following carotid revascularization. A multivariate Cox regression analysis was conducted to assess the primary outcomes. The cohort included 14 220 patients with type 2 diabetes who underwent carotid revascularization (2669 via carotid endarterectomy and 11 551 via carotid stent insertion). Among them, 1034 patients received thiazolidinedione treatment. Over a mean follow‐up period of 4.13±3.14 years, 4087 patients experienced a primary outcome. Thiazolidinedione treatment was significantly associated with a reduced risk of primary outcomes (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71–0.93]; P =0.002). The protective effect of thiazolidinediones was supported in a propensity score–matched analysis comparing thiazolidinedione users with nonusers (HR, 0.81 [95% CI, 0.68–0.95]; P =0.013). Conclusions Thiazolidinedione treatment following carotid revascularization was associated with favorable cardiovascular outcomes in patients with type 2 diabetes. Further research is needed to explore the cardioprotective roles of thiazolidinediones in this high‐risk group.

Background We investigated the sex‐specific variations in distal radial access (DRA)–associated outcomes, as well as the factors influencing these outcomes, by utilizing a comprehensive real‐world registry. Methods In this post‐hoc analysis of the KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial, we selected 4608 patients who underwent successful coronary procedures, including percutaneous coronary intervention or coronary angiography, via DRA. Primary end points were overall DRA site outcomes including bleeding, radial artery occlusion, tenderness, hand edema, numbness, perforation, and dissection. We performed both propensity score matching and multivariable logistic regression to evaluate sex‐specific differences in DRA‐associated outcomes. Moreover, a multivariable analysis using logistic regression was also performed to evaluate the independent associated factors of DRA site outcomes. Results The mean age was 66.5±11.8 years, and 67.8% (3125 men and 1483 women) were male among 4608 enrolled patients. The incidence of overall DRA site outcomes was significantly higher in women than in men (7.5% versus 4.1%, P <0.001). However, there was no major bleeding in both groups. In the multivariable analysis, female sex was a significant risk factor of overall DRA site outcomes, along with body mass index, chronic kidney disease, percutaneous coronary intervention procedure, use of potent P2Y 12 inhibitor, and unfractionated heparin dose. Conclusions This subgroup analysis of the KODRA trial by sex showed that overall DRA site outcomes following coronary procedures via DRA were more common in women than in men. However, no major bleeding was observed in either men or women. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04080700.