The purpose of this prospective study was to investigate whether office hysteroscopy (OH) can be used to assess the mechanisms of action of progestogen-only contraceptives (POCs), diagnose possible local causes of abnormal uterine bleeding (AUB), and support the treatment plan of symptomatic patients using POCs compared with those who do not use hormones. The study included 140 women who were divided into two groups. Group A consisted of 70 women who used POCs, whereas group B consisted of 70 women who did not use hormones. They were successively examined using transvaginal ultrasonography (TVS), OH, and endometrial sampling. The TVS results were consistent with those of OH and histopathology. The changes in endometrial thickness and vasculature, as well as fallopian tube (FT) functions, were significantly more pronounced in POC users than in non-POC users. There was a significant reduction in the peristalsis of the proximal part of the FT, as well as a reduction in the bubble flow test in group A compared with group B. In addition, the combination of peristalsis and the bubble flow test (Darwishscope test) was significantly lower in group A. It was concluded that using OH as a simple diagnostic tool in women with POCs would contribute to a better understanding of the mechanisms of endometrial and FT effects and explain some local endometrial causes of AUB. This ensures that the combination of TVS and OH would limit routine endometrial sampling in POCs users.

This study was conducted to determine whether level-1 emergency medical technicians (EMTs) can adequately recognize ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) and whether their ability to do so differs from that of emergency medicine physicians (EMP). From December 2022 to November 2023, patients aged 20 years or older visiting the ED with chief complaints suggesting acute coronary syndrome (ACS) were enrolled. As soon as the patient arrived at the ED, a level-1 EMT conducted a 12-lead electrocardiogram (ECG) to assess STEMI; an EMP subsequently assessed whether to activate the percutaneous coronary intervention team. Demographic characteristics, test results, and final diagnoses were collected from the medical records. Among the 723 patients with case report forms, 720 were included in the analysis. These were categorized as follows: 117 (16.3%) with STEMI, 159 (22.1%) with non-ST-segment elevation ACS, and 444 (61.7%) with other conditions. STEMI was correctly recognized in 100 patients (91.7%) by level-1 EMTs and in 104 patients (95.4%) by EMPs (kappa=0.646). EMTs with less than 1 year of ED work experience correctly recognized 60 out of 67 STEMI patients (89.6%), which was comparable with the EMPs who recognized 65 out of 67 STEMI patients (97.0%, kappa=0.614). EMTs with more than 1 year of ED work correctly recognized 40 out of 42 STEMI patients (95.2%), and therefore performed better than EMPs, who recognized 39 out of 42 STEMI patients (92.9%, kappa=0.727). The level-1 EMTs adequately recognized STEMI using a 12-lead ECG and were in substantial agreement with the evaluations of the EMPs.

Understanding the effectiveness of statin treatment is essential for developing tailored stroke prevention strategies. We aimed to evaluate the efficacy of statin treatment in preventing recurrent stroke among patients with various ischemic stroke subtypes. Using data from the Clinical Research Collaboration for Stroke-Korea-National Institute for Health (CRCS-K-NIH) registry, we included patients with acute ischemic stroke admitted between January 2011 and July 2020. To evaluate the differential effects of statin treatment based on the ischemic stroke subtype, we analyzed patients with large artery atherosclerosis (LAA), cardio-embolism (CE), and small vessel occlusion (SVO). The primary outcomes were recurrent ischemic stroke and recurrent stroke events. The hazard ratio for outcomes between statin users and nonusers was compared using a Cox proportional hazards model adjusted for covariates. A total of 46,630 patients who met the inclusion criteria were analyzed. Statins were prescribed to 92%, 93%, and 78% of patients with LAA, SVO, and CE subtypes, respectively. The hazards of recurrent ischemic stroke and recurrent stroke in statin users were reduced to 0.79 (95% confidence interval [CI], 0.63-0.99) and 0.77 (95% CI, 0.62-0.95) in the LAA subtype and 0.63 (95% CI, 0.52-0.76) and 0.63 (95% CI, 0.53-0.75) in CE subtype compared to nonusers. However, the hazards of these outcomes did not significantly decrease in the SVO subtype. The effectiveness of statin treatment in reducing the risk of recurrent stroke in patients with LAA and CE subtypes has been suggested. Nonetheless, no significant effect was observed in the SVO subtype, suggesting a differential effect of statins on different stroke subtypes.

Massive gastric mucosal ruptures during upper gastrointestinal endoscopy in patients with esophageal hiatal hernias are rare. However, tearing of the gastric mucosa alone, without tearing of the gastroesophageal junction, is even rarer. This study reports a case of a large mucosal rupture that occurred on the posterior wall of the upper body of the stomach during upper gastrointestinal endoscopy in an 83-year-old woman with an esophageal hiatal hernia while sedated. The patient was treated with endoclips for the rupture.