Hyaluronic acid (HA) filler is the most commonly used filler for soft tissue augmentation. There are numerous commercially available HA fillers in the cosmetic market, and there are guidelines for each filler as determined by the manufacturing company. The successful use of injectable fillers requires an understanding of each option available so that the most appropriate form of hyaluronic acid may be selected for patients. The purpose of this study was to determine whether newly developed HA fillers are appropriate for forehead augmentation considering their rheological properties and the anatomical site of injection. The rheological properties of new HA fillers were assessed e.t.p.q. S100, S300, S500 (Zetema®). Comparing the rheological properties, the authors chose e.t.p.q. S300® for forehead augmentation. The filler was injected into the foreheads of 40 consecutive patients for esthetic purposes. e.t.p.q. S300® was determined to be an appropriate filler for the forehead. The injection procedure employed was considered to be easy and safe when applied to the preperiosteal layer using a cannula. None of the patients had complications such as vascular compromise, infections, granulomas, or migration. Understanding the physical properties of new fillers is necessary. As the preperiosteal layer of the forehead is an appropriate layer for the filler injection, physicians should consider injecting fillers with enough strength to withstand the shearing forces.

Background: To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM).Methods: This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3–5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis.Results: Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%,p < 0.001) and 6-month outcomes (89.2% vs. 73.0%,p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c > 6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c > 6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26–15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41–12.40, p < 0.001).Conclusions: This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.

Background: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. Methods: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. Results: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80–122) vs. 81 (70–88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632–13.490, p = 0.004). Conclusions: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.

Spectrin breakdown products 145 kDa (SBDP145) and neurofilament heavy chain (Nf-H) have been identified as potential biomarkers of neuronal injury. However, their ability to predict hypoxic-ischemic brain injury following cardiac arrest in humans is not well understood. This study aimed to investigate whether SBDP145 and Nf-H could be used as biomarkers to predict neurological outcomes after cardiac arrest. This prospective study was conducted at two academic hospitals and included adults who survived after cardiac arrest. Blood samples were collected at 0, 24, and 48 h after the return of spontaneous circulation, and biomarker analyses were performed to measure SBDP145 and Nf-H. Poor neurological outcome was defined as a modified Rankin Score of 4–6, and diagnostic performance was determined by receiver-operating characteristics analysis. A total of 56 patients were included in this study. There were no significant differences in levels of SBDP145 or Nf-H between the poor and good outcome groups at any time point. Areas under the receiver-operating characteristics curve of SBDP145 and Nf-H were small, ranging from 0.51 to 0.7. At 0, 24, and 48 h, SBDP145 showed very low sensitivity (18.61 %, 13.89 %, and 13.79 %, respectively) and accuracy (33.93 %, 36.74 %, and 39.02 %, respectively) at a cut-off value for 100 % specificity. Nf-H also showed very low sensitivity (9.30 %, 16.67 %, and 0 %, respectively) and accuracy (29.09 %, 36.74 %, and 30.95 %, respectively). SBDP145 and Nf-H were found to be poor predictors of poor neurological outcomes six months after cardiac arrest.

Background/Objectives: Some patients with severe hypoxic–ischemic brain injury after out-of-hospital cardiac arrest (OHCA) progress toward brain death, a trajectory not adequately captured by the conventional classification of favorable versus unfavorable neurological outcomes. We developed and internally evaluated a multimodal model combining quantitative brain computed tomography (CT), serum neuron-specific enolase (NSE) at 48 h, and clinical variables to predict operationally defined progression toward brain death (PTBD). Methods: This multicenter retrospective secondary analysis used prospectively collected data from the Korean Hypothermia Network registry. Adult comatose OHCA survivors treated with targeted temperature management between October 2015 and December 2020 were included. Multivariable logistic regression models were developed in the total cohort and in patients with poor neurological outcomes. Model performance was assessed using discrimination, calibration, the Brier score, and bootstrap internal validation. Results: Of 468 patients assessed, 376 were included; their mean age was 58.7 years, and 269 (71.5%) were male. Seventy-four patients (19.7%) met the operational definition of PTBD. In the total cohort, younger age, non-shockable rhythm, low gray-to-white matter ratio (GWR ≤ 1.19), and higher NSE at 48 h were independently associated with PTBD. Among 288 patients with poor neurological outcomes, younger age, low GWR, and higher NSE at 48 h remained independent predictors. The total-cohort model had an AUC of 0.895 and an optimism-corrected AUC of 0.890. Its AUC was higher than that of NSE at 48 h (p < 0.001) but not significantly different from that of GWR alone (p = 0.054). In the poor-outcome subgroup, the model had an AUC of 0.864 and an optimism-corrected AUC of 0.858 and significantly outperformed both GWR (p = 0.012) and NSE at 48 h (p < 0.001). Conclusions: PTBD represents a clinically distinguishable trajectory among patients with poor neurological outcomes after OHCA. A multimodal model using information available within 48 h demonstrated good internally validated performance and may support early risk stratification before definitive neuroprognostication. External validation is required before clinical implementation.