Background The risk–benefit trade‐offs after lower‐extremity revascularization among older patients with chronic kidney disease remain unclear. We compared how surgical versus endovascular lower‐extremity revascularization associates with clinical outcomes that may be valued differently by patients. Methods We selected adults aged ≥66 years with chronic kidney disease who underwent lower‐extremity revascularization from January 1, 2008, to December 31, 2017, with ≥12 months Medicare Parts A and B before the procedure. The primary outcome was days at home at 30, 180, and 365 days after revascularization. The secondary outcome was major adverse limb events (ie, lower‐extremity revascularization or major amputation). We report outcomes as the difference in survived days at home and days lost due to major adverse limb events by restricted mean time lost. Results Among 87 446 patients, 15.3% underwent surgical and 84.7% underwent endovascular revascularization. Surgical revascularization was associated with fewer days at home at 30 days (difference, −8.4 [95% CI, −8.6 to −8.2]), 180 days (difference, −21.2 [95% CI, −22.1 to −20.4]) and 365 days (difference, −31.9 [95% CI, −33.5 to −30.6]) compared with endovascular. Surgical revascularization was associated with fewer days lost to major adverse limb events at 180 days (difference, −6.9 [95% CI, −7.6 to −5.8]) and at 365 days (difference, −17.3 [95% CI, −19.3 to −14.7]). Conclusions In this study of older patients with chronic kidney disease, surgical lower‐extremity revascularization was associated with fewer survived days at home, but also with fewer days lost to major adverse limb events compared with an endovascular approach. Considering different risk–benefit profiles when planning for lower‐extremity revascularization is essential to facilitate shared decision making.

BACKGROUND:The optimal revascularization strategy for patients with chronic limb-threatening ischemia (CLTI) with chronic kidney disease (CKD) remains unknown. We evaluated whether the efficacy and safety of surgical vs endovascular revascularization differ by kidney function. METHODS:In this post hoc secondary analysis of BEST-CLI trial (NCT02060630), 1,704 patients with CLTI were stratified by baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): non-CKD (eGFR ≥ 90), mild-moderate CKD (eGFR 45-89), advanced CKD (eGFR < 45 or dialysis). The primary outcome was a composite of major adverse limb events (MALE) or death. We estimated the difference in restricted mean time lost (RMTL, in days) adjusted for inverse probability treatment weights. RESULTS:Surgical revascularization was significantly associated with fewer days with MALE or death in non-CKD (RMTL difference: -127.8 days; 95% CI -176.1, -79.6) and mild-moderate CKD (-63.2 days; 95% CI -104.7, -21.8) but not in advanced CKD (-16.4 days; 95% CI -78.8, 46.0; P interaction = .02). This attenuation reflected a diminishing mortality benefit with more severe CKD (P interaction = .01), whereas the association with fewer days with MALE remained consistent across CKD strata (P interaction = .34). Major adverse cardiovascular events and serious adverse events were more common with more severe CKD but did not differ significantly by treatment. CONCLUSIONS:Surgical vs endovascular revascularization was consistently associated with fewer days with MALE across CKD strata. However, its association with mortality varied by kidney function, attenuating the overall benefit for the composite endpoint of MALE or death. These results support individualized revascularization strategies, but require prospective confirmation. TRIAL REGISTRATION:The BEST CLI trial is registered at ClinicalTrials.gov (NCT02060630).

Background: Supination-adduction (SAD) ankle fractures involve a vertical medial malleolar fracture and potential tibial plafond impaction, but pattern-specific evidence in older patients remains limited. We compared postoperative complications and clinical/radiographic outcomes between older and younger patients and explored complication-associated factors within the older group.Methods: We retrospectively reviewed 51 patients who underwent surgery for SAD-type ankle fractures (2010–2020): 30 younger (<65 years) and 21 older (≥65 years). The primary outcome was a composite of surgical site infection, loss of reduction, or delayed union. Functional recovery was assessed using Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores through 12 months. Union and posttraumatic osteoarthritis were assessed radiographically at ≥18 months. Preoperative dual- energy X-ray absorptiometry was performed in older patients for exploratory analyses.Results: Postoperative complications were higher in the older group (38.1% vs. 10.0%, P=0.035). In older patients, diabetes mellitus was associated with complications (odds ratio [OR], 9.17; 95% confidence interval [CI], 1.15–73.24; P=0.037); smoking was not (OR, 5.50; 95% CI, 0.71–42.60; P=0.103). At 12 months, OMAS and AOFAS scores did not differ significantly. One older patient developed nonunion, and posttraumatic osteoarthritis occurred in one patient per group. Lower T-scores (mean, −2.3±0.5) correlated with greater tibial plafond impaction depth (3.1±1.2 mm; ρ=−0.46, P=0.036) and showed a borderline significant correlation with articular step-off (2.0±0.8 mm; ρ=−0.43, P=0.052).Conclusions: Older patients had higher postoperative complication rates than younger patients, although 12-month functional and late radiographic outcomes were comparable. Diabetes was associated with complications, though the small sample warrants cautious interpretation. Findings support careful perioperative optimization and individualized fixation based on fracture morphology and bone quality in older patients, especially those with diabetes.Level of evidence: III.

BACKGROUND AND HYPOTHESIS:Proton pump inhibitors (PPIs) are widely used for acid suppression but have been associated with kidney injury. Potassium-competitive acid blockers (P-CABs) such as tegoprazan provide rapid, reversible inhibition of gastric H⁺/K⁺-ATPase, yet their renal safety remains unclear. We compared the risk of incident chronic kidney disease (CKD) between tegoprazan and PPIs in a nationwide population-based cohort. METHODS:Using the Korean Health Insurance Review and Assessment database, we identified adults without prior kidney disease who initiated tegoprazan or a PPI during 2020-2021. After 1:3 propensity score matching, we compared the risk of incident CKD using Cox proportional hazards models. Sensitivity and subgroup analyses examined robustness and effect modification by age, sex, and comorbidities. RESULTS:Among 901,606 new users (43,864 tegoprazan; 857,742 PPIs), PPI use was associated with a higher CKD incidence (6.16 vs 4.63 per 1,000 person-years). In the matched cohort, PPI initiation was associated with a higher risk of CKD than tegoprazan initiation (hazard ratio 1.22; 95% CI 1.09-1.37; P < 0.01). Findings were consistent across subgroups and sensitivity analyses, including the unmatched cohort (HR 1.34; 95% CI 1.20-1.48; P < 0.01). CONCLUSION:In this large real-world analysis, PPI initiation was associated with a higher rate of newly coded CKD than tegoprazan initiation. These findings provide comparative kidney safety data and suggest that risk of kidney injury may be one consideration, alongside efficacy and cost, when prolonged acid suppression is required.

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation.

Background Dipeptidyl peptidase-4 inhibitors (DPP-4i) are antidiabetic drugs known for their minimal side effects and limited drug interaction witih immunosuppressants, making them suitable for patients with diabetes and kidney transplant recipients. However, there is limited real-world information regarding the use of DPP-4 inhibitors in patients with post transplant diabetes mellitus (PTDM). Method We performed a retrospective observational cohort study of 13,828 kidney transplant recipients form Janary 1, 2002, through December 21, 2018, using the Korean National Health Information Database. We extracted PTDM patients, and divided the patients into 2 groups baased on whether they received DPP4-inhibitor which needs dose adjustement (group A) or not (Group B) according to estimaged glomerular filtration rate. Results Out of 3154 patients who developed PTDM after transplantation, 738 patients prescribed DPP-4 inhibitors. Among these, 490 patients prescribed Group B DPP-4 inhibitors and 238 patients prescribed Group A DPP-4 inhibitors. Multivariate-adjusted Cox regression analysis showed that compared Group B, Group A DPP-4 inhibitors was associated with higher incidence rate of genital tract infection (hazard ratio (HR) 1.87, 95% Confidence Interval (CI) 1.18-2.99), and emergency department visit (HR 3.12, 95% CI 1.89-5.16). However, there was no significantly difference in death (any cause), admission, graft failure, infection, or hypoglycemia between the 2 groups. Conclusions In patients with PTDM, some kinds of DPP-4 inhibitors, which need dose adjustment according to renal function, were associated with an increased rate of emergency department visit and genital tract infection.

Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 levels at discharge on early post-transplant outcomes in a large Korean cohort. Materials and Methods: This retrospective analysis included 5293 KT recipients from the Korean Organ Transplant Registry (KOTRY) who received a kidney transplant between 2014 and 2019. Recipients were categorized into three groups based on C0 levels at discharge: <5.9 ng/mL, 5.9-9.5 ng/mL, and >9.5 ng/mL. Clinical outcomes, including serum creatinine (sCr), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization, were analyzed using the Kruskal-Wallis test and chi-squared test. Results: The BPAR rates were 22.5%, 20.9%, and 21.5% for the low, middle, and high C0 groups, respectively (p = 0.221). However, the incidence of infections requiring hospitalization was significantly higher in the high C0 group (28.1%) compared to the middle (23.9%) and low (21.7%) groups at 1-year follow-up (p < 0.001). In high-risk recipients, lower C0 levels correlated with increased BPAR rates (33.9% vs. 29.1% and 26.4%, p = 0.030). Higher intrapatient variability (IPV) between discharge and 6 months was linked to higher infection risk in all recipients and increased BPAR and infection risk in high-risk patients. Conclusions: Optimal C0 levels at discharge are essential to balance rejection and infection risks in KT. Lower C0 levels and higher IPV increase the risk of adverse outcomes, especially in high-risk sensitized recipients, underscoring the need for careful monitoring and personalized management.

OBJECTIVES:Pruritus in hemodialysis patients (HDP) is one of the serious complications associated with the quality of life and psychiatric disorder of patients. The narrowband ultraviolet B phototherapy (NB-UVB) treatment showed a statistically significant reduction of itching when performed more than 4 times compared to conservative treatment for itching, and the difference was confirmed to increase with repetition. We aim to compare newly developed Nalfuranfine HCL, kappa-opioid receptor agonist, with NB-UVB in HDP. METHODS:Twenty HDP were enrolled from Wonju severance Christian hospital. Visual analog scale (VAS) score, Shiratori score, skin inflammatory cytokine levels, and blood calcium/phosphate/vitamin D levels were measured before four weeks of treatment, during four weeks of treatment, and after four weeks of treatment. RESULTS:VAS and Shiratori score was reduced in both nalfurafine and NB-UVB treatment groups significantly. After four weeks of treatment, the NB-UVB treatment group maintained a low Shiratori score, however, the Shiratori score increased in nalfurafine treatment group. Calcium phosphate product concentration was increased in the UVB treatment group and decreased in the nalfurafine treatment group. Vitamin D level was increased only in the UVB treatment group. Skin inflammatory cytokines levels showed a decreasing trend in both groups but not statistically significant. There were no side effects in both treatment groups. CONCLUSIONS:Nalfurafine could be an alternative treatment option compared with NB-UVB as an oral medication in pruritis in hemodialysis patients, especially those with hyperphosphatemia.

Background: Bone mineral density (BMD) is well-documented in relation to fractures of the spine, hip, distal radius, and proximal humerus; however, its correlations with other fracture types are less established. This study aimed to analyze BMD and associated risk factors in older adults (≥65 years of age) with osteoporotic ankle fractures. These fractures involve low-energy trauma, resulting from falls from a standing height or lower, and occur from impacts which typically do not cause fractures in individuals with normal bone. Methods: This retrospective study analyzed data from 1,411 patients diagnosed with ankle fractures admitted to Chosun University Hospital between February 2012 and April 2023. After applying inclusion criteria (age ≥65 years; low energy ankle fracture) and exclusion criteria (high energy trauma, open/multiple fractures, missing dual X-ray absorptiometry [DXA]), 73 of 1,411 patients were analyzed. Lumbar spine, femoral neck, and total hip T scores were obtained with a Horizon Wi DXA scanner, and associations with age, sex, mechanism of injury, comorbidities, smoking status, alcohol consumption, body mass index (BMI), and history of fractures were tested by ANOVA with Scheffe post hoc and Fisher exact tests.Results: Lower BMD correlated significantly with older age, female sex, and lower BMI (P<0.05) in older adults with ankle fractures. No significant associations were observed for comorbidities (diabetes, hypertension, dementia), smoking, alcohol consumption, injury mechanism, or prior fractures.Conclusion: These results indicate that older age, female, and lower BMI are linked to reduced BMD in ankle fracture patients over 65 years of age. Focused osteoporosis screening and management may therefore be most beneficial for older, low BMI women presenting with ankle fractures.Level of evidence: IV.

Background: Ankle fractures are common in older adults; however, their relationship with osteoporotic fractures remains unclear. This study aimed to evaluate potential risk factors for ankle fractures in older adults by analyzing individual clinical components of the Fracture Risk Assessment (FRAX) tool and comorbidities. Methods: We conducted a retrospective case-control study including 84 patients aged ≥65 years with ankle fractures and 150 controls who underwent bone mineral density (BMD) testing without prior ankle fractures. The variables analyzed included age, sex, body mass index, smoking, alcohol consumption, prior fracture history, and comorbidities such as hypertension, diabetes mellitus, and dementia. BMD was measured at the spine, total hip, and femoral neck. Results: Univariate analysis showed that alcohol consumption, diabetes mellitus, and total hip T-score categories were significantly associated with ankle fractures. In binary logistic regression, alcohol consumption remained significantly associated with higher ankle fracture risk (odds ratio [OR], 5.302; 95% confidence interval [CI], 1.778–15.811; P=0.003), and both osteopenia and osteoporosis at the total hip were also associated with increased risk (OR, 3.260, P=0.049; OR, 3.561, P=0.031, respectively). Diabetes mellitus did not reach statistical significance in the adjusted model (P=0.074). Model fit was adequate (Hosmer-Lemeshow P=0.377), and post hoc power analysis confirmed sufficient sample size. Conclusions: These findings suggest that lower total hip BMD and alcohol-related factors may be associated with ankle fracture risk in older adults. The FRAX score itself was not calculated; instead, this study focused on analyzing selected clinical components. Limitations include the retrospective design, lack of fall and medication data, and cross-sectional BMD assessment.Level of evidence: III.

OBJECTIVES:To investigate the effect of hypertension (HTN) and antihypertensive medications on the incidence of cardiovascular disease in healthy young adults (approximately 20 to 45 years). PATIENTS AND METHODS:In total, 4,590,597 young Korean adults without comorbidities who underwent regular health examinations were included in this study. They were stratified into 4 groups according to their blood pressure (BP) (optimal BP, normal BP, high normal BP, and HTN). The primary outcome was a composite of the incidence of myocardial infarction and ischemic and hemorrhagic stroke, obtained by tracking the medical use data of the first-ever International Classification of Diseases, Tenth Revision codes. Subgroup analysis was conducted by categorizing the HTN group into 2 subgroups according to the prescription ratios of the antihypertensive drugs during the follow-up period. RESULTS:The average age was 33.8 years, and the median follow-up duration was 15.9 years. Hypertension elevated the incidence risk of major cardiovascular disease by 2.16 times compared with that of the optimal BP group. Dyslipidemia and HTN were the most dominant risk factors for myocardial infarction and stroke, respectively. In the subgroup analysis, antihypertensive medications decreased the incidence of cardiovascular disease by 70% in all diseases. CONCLUSION:Cardiovascular risk factors, including HTN, contribute to major cardiovascular disease incidence in young adults. Antihypertensive medications decreased the major cardiovascular disease incidence estimates.

RATIONALE:The prevalence of kidney failure in people aged 65 years and above is gradually increasing. However, there is insufficient evidence to determine which treatment is better for people with kidney failure, conservative kidney management (CKM) or dialysis. OBJECTIVES:We aimed to assess the effects of CKM and dialysis in older people with kidney failure. SEARCH METHODS:We searched the Cochrane Kidney and Transplant Register of Studies, MEDLINE, Embase, the WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and regional databases (LILACS, KoreaMed, CADTH), as well as grey literature repositories up to 22 September 2025. ELIGIBILITY CRITERIA:Randomised and non-randomised studies evaluated CKM compared to dialysis in people aged 65 years and above with kidney failure. OUTCOMES:The critical outcomes included death (any cause), cardiovascular death, cardiovascular events, and health-related quality of life (HRQoL). The important outcomes included overall adverse events, hospitalisation, malnutrition, sarcopenia, and residual kidney function. RISK OF BIAS:Two authors independently performed the risk of bias analysis. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I) tool to assess the risk of bias in the included studies. SYNTHESIS METHODS:Treatment estimates were summarised using random effects pair-wise meta-analysis and expressed as a relative risk (RR), mean difference (MD), or standard mean difference (SMD) with a corresponding 95% confidence interval (CI). Evidence certainty was assessed using GRADE. INCLUDED STUDIES:We included 24 non-randomised studies that involved 26,127 people with kidney failure. These studies compared CKM to dialysis. SYNTHESIS OF RESULTS:Compared to dialysis, CKM had uncertain effects on death (any cause) (23 studies, 24,628 participants: 813 per 1000 with CKM versus 630 per 1000 with dialysis) (RR 1.28, 95% CI 1.17 to 1.41; I² = 89%; very low-certainty evidence) and cardiovascular death (3 studies, 262 participants: 114 per 1000 with CKM versus 66 per 1000 with dialysis) (RR 1.72, 95% CI 0.68 to 4.34; I² = 0%; very low-certainty evidence). For HRQoL, the Physical Component Summary (PCS) score (2 studies, 186 participants) was on average about 1.46 points lower with CKM compared with dialysis (MD -1.46, 95% CI -12.08 to 9.16; I² = 77%; very low-certainty evidence). The Mental Component Summary (MCS) score (2 studies, 186 participants) was about 2.5 points lower with CKM (MD -2.50, 95% CI -7.82 to 2.82; I² = 19%; very low-certainty evidence). We found no randomised controlled trials. The certainty of evidence from non-randomised studies was very low due to a high risk of bias, because of significant imbalances in prognostic factors that could not be fully addressed. None of the included studies reported cardiovascular events, malnutrition, sarcopenia, residual kidney function, or adverse events. AUTHORS' CONCLUSIONS:CKM had uncertain effects on death (any cause), cardiovascular death, hospitalisation, and HRQoL compared to dialysis. FUNDING:Supported by the National Evidence‑based Healthcare Collaborating Agency (NA21‑001). REGISTRATION:Protocol available via https://doi.org/10.1002/14651858.CD015151.

Understanding the ultra-fast dynamics of ferroelectric materials is essential for advancing the development of next-generation high speed electronic and photonic devices. Here, the ultrafast piezoelectric response of cobalt-substituted BiFeO3 (BiFe1-xCoxO3) with x = 0.15, consisting of morphotropic phase boundary of monoclinic M-C and M-A -type phases is investigated. The real-time piezoelectric response in (001)-oriented BiFe0.85Co0.15O3 (BFCO) epitaxial thin film was monitored using the time-resolved X-ray microdiffraction technique under an applied electric field with pulse widths 70 ns and 100 ns. The BFCO thin film yielded a high piezoelectric strain of approximately 0.53 % along [001] direction, with a giant c/a ratio (similar to 1.26) at an electric field of 1.3 MV/cm and a pulse width of 100 ns, with a piezoelectric coefficient (d(33)) of 40 pm/V. This finding is an important step towards the development of a high performance lead-free piezoelectric material for ultrafast operations in advanced technological applications.

Background:Historically, human leukocyte antigen (HLA) matching has been a cornerstone of kidney transplantation (KT), with favorable outcomes. However, the survival benefit of KT with zero HLA mismatches appears to have decreased with the accumulation of transplantation experience and advancements in immunosuppressive therapies. Methods:This was a prospective observational cohort study based on data from the Korean Organ Transplantation Registry, including patients who underwent deceased donor KT from May 2014 to December 2022. A total of 3,350 KT patients were propensity score-matched at a 1:1 ratio and compared according to zero HLA mismatching (zero group) vs. non-zero HLA mismatching (non-zero group). Results:After matching, 276 patients in the zero group were compared to 276 patients in the non-zero group. Over a follow-up period of 38.4 ± 28.8 months, the use of immunosuppressants was similar between the two groups. Multivariable-adjusted hazard ratios of non-zero group vs. zero group were 1.63 (95% confidence interval [CI], 0.72-3.69; p = 0.24) for death censored graft failure, 1.62 (95% CI, 0.96-2.76; p = 0.07) for biopsy-proven rejection, 2.09 (95% CI, 0.87-5.00; p = 0.10) for death, 1.38 (95% CI, 1.02-1.86; p = 0.03) for posttransplant infection and 4.48 (95% CI, 1.52-13.25; p = 0.001) for antibody mediated rejection. Conclusion:This study suggests that rigid adherence to HLA matching may be less critical than previously thought, particularly due to advancements in immunosuppressive therapies.

Background:Despite the high suicide rates among patients with end-stage kidney disease (ESKD), there is no suicide prediction model specifically designed for this vulnerable population. Herein, we aimed to develop and validate a novel suicide risk score for ESKD patients. Methods:We analyzed data from the National Health Insurance Service (NHIS) of South Korea, including 251 819 patients aged above 18 years diagnosed with ESKD between 2007 and 2022 in South Korea. The mean follow-up duration was 6.6 years. The cohort was randomly divided into derivation (70%) and validation (30%) sets. Using multivariate Cox proportional hazard regression, key variables were incorporated to develop the suicide risk score, which was converted into a 48-point scoring system, which is composed of easily identifiable clinical parameters. Results:Among 176 273 patients in the derivation cohort, 1126 (0.64%) patients committed suicide. The suicide risk score demonstrated moderate discrimination in both the derivation (C-statistic, 0.694) and validation (C-statistic, 0.709) cohorts, with good calibration. In the validation cohort, patients scoring below 16, 17-32 and 33-48 had predicted 10-year suicide risk of 0.2%, 1.2% and 7.7%, respectively, while the observed 10-year risk were 0.3%, 0.8% and 3.9%. These findings highlight the model's ability to effectively stratify risk using routinely available clinical data. Conclusions:The suicide risk score is a significant advancement in suicide risk prediction for ESKD patients. It is based on simple, routinely collected clinical indicators and provides an actionable tool for risk stratification and early intervention in daily practice.

Background: Posterior malleolar fractures frequently accompany rotational ankle fractures. However, the morphological relationship between lateral and posterior malleolar fractures in supination-external rotation (SER) ankle fractures remains unclear. This study aimed to classify lateral malleolar fracture patterns in SER type 3 and 4 ankle fractures and investigated their associations with posterior malleolar fracture morphology.Methods: We retrospectively reviewed 132 patients with SER type 3 or 4 ankle fractures and concurrent posterior malleolar fractures between January 2016 and December 2021. Lateral malleolar fractures were categorized as fibular fractures extending <4.5 cm proximal to the ankle joint (102 ankles) or fibular fractures extending ≥4.5 cm proximal to the ankle joint (30 ankles) based on posterior cortex height measured using three-dimensional computed tomography (3D-CT). Posterior malleolar fracture morphology was assessed using the Haraguchi and Bartonicek classifications. Quantitative parameters—including fracture height, angle, and articular involvement—were analyzed using 3D-CT imaging.Results: Fibular fractures extending ≥4.5 cm proximal to the ankle joint were associated with a significantly higher frequency of Haraguchi type II and Bartonicek types 3 and 4 posterior malleolar fractures. This group also exhibited greater articular involvement (19.2% vs. 12.0%) and posterior cortical height (55.4 mm vs. 24.8 mm) compared to the <4.5 cm group (all P<0.001).Conclusions: In SER type 3 and 4 ankle fractures, a fibular fracture extending ≥4.5 cm proximal to the ankle joint may be associated with posterior malleolar fractures exhibiting greater articular involvement and medial extension. Preoperative evaluation of the lateral malleolar fracture pattern may provide useful insights into posterior malleolar morphology and assist in surgical planning. However, these findings should be interpreted with caution due to inherent study limitations.Level of evidence: IV

Background: The pathophysiological mechanism of cardiovascular disease in patients with chronic kidney disease (CKD) is complicated. Mediation analysis is an important statistical tool for gaining insight into the complex mechanisms of exposure -outcome effects. We investigated the potential mediating role of the left ventricular mass index (LVMI) on the association between fluid balance (overhydration/extracellular water, OH/ECW) and left ventricular diastolic function (E/e" ratio) in patients with CKD not yet on dialysis. Methods: Bioimpedance spectroscopy, echocardiography, and laboratory evaluations were performed on 425 consecutive patients on the same day. The patients were classified into two groups according to the estimated glomerular filtration rate corresponding to CKD stages 3 and 5. Mediation analysis was performed using the PROCESS macro and bootstrapping methods. Results: OH/ECW and LVMI were positively correlated with the E/e" ratio in both the CKD stages 3 and five groups. In CKD stage 5, there was a statistically significant association between OH/ECW and LVMI, whereas no correlation was observed in CKD stage 3. In the mediation analysis, LVMI positively mediated the relationship between OH/ECW and E/e" ratio when controlling for confounders in patients with CKD stage 5 (B = 2.602; Boot 95% confidence interval, 1.313-4.076). Conclusion: In our analysis, the indirect effect of mediators was significant in patients with advanced CKD. Therefore, our study suggests that further research on several other risk factors may be needed to determine the underlying mechanisms of association between the associated factors in all CKD stages.

[This corrects the article DOI: 10.1021/acsomega.9b04199.].