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68 (1.58-4.53), 31.02 (9.46-101.74), and 1.89 (1.12-3.17) in boys; and 6.50 (3.22-13.11), 20.09 (7.08-57.04), and 3.94 (1.98-7.77) in girls, respectively.

SHS exposure was significantly associated with elevated urine NNAL levels in Korean adolescents, particularly in female adolescents and in those with home exposure. These findings remind us of the need to protect adolescents from SHS.

SHS exposure was significantly associated with elevated urine NNAL levels in Korean adolescents, particularly in female adolescents and in those with home exposure. These findings remind us of the need to protect adolescents from SHS.

We reviewed the long-term outcomes after tetralogy of Fallot (TOF) repair with trans-annular incision; and evaluated the effectiveness of pulmonary valve replacement (PVR) on outcomes.

This was a retrospective review of clinical outcomes of 180 of 196 TOF patients who underwent total correction with trans-annular incision from 1991 to 1997 (PVR group 81; non-PVR group 99).

The median age of the patients was 14.0 months (interquartile range [IQR], 10.7-19.8 months) at TOF repair. Ten in-hospital deaths (5.1%) occurred. During the follow-up, 81 patients underwent PVR at the median age of 13.5 years (IQR, 11.2-17.1 years). The patients in PVR group showed better outcomes than non-PVR group in overall survival rate (100% in PVR vs. 88.7% in non-PVR, p=0.007), in all adverse events (arrhythmia, neurologic complications, 95.5% in PVR vs. learn more 74.6% in non-PVR, p=0.024) at 20 years. Age at TOF repair younger than 1 year (hazard ratio [HR], 2.265; p=0.01) and previous shunt history (HR, 2.195; p=0.008) were predictive for requiring PVR. During follow-up, 10 late deaths (5 sudden deaths) occurred in the non-PVR group, mainly due to ventricular arrhythmia and right ventricular failure; there was 1 late death (not a sudden death) in the PVR group.

Long-term survival after repair of TOF with trans-annular incision were acceptable. However, arrhythmias were frequently observed during 20 years of follow-up. The patient age <1 year at the time of TOF repair and shunt implantation prior to TOF repair were predictive factors for requiring PVR.

Long-term survival after repair of TOF with trans-annular incision were acceptable. However, arrhythmias were frequently observed during 20 years of follow-up. The patient age less then 1 year at the time of TOF repair and shunt implantation prior to TOF repair were predictive factors for requiring PVR.

A mobile application (app)-based electrocardiogram (ECG) consultation system (InterMD Co., Ltd., Seoul, Korea) using the collective intelligence (CI) and the availability of large-scale digitized ECG data would extend the utility of ECGs beyond their current limitations, while at the same time preserving interpretability that remains critical to medical decision-making.

We developed a new mobile app-based ECG consultation system by CI for general practitioners. We compared the responses of ECG reading between the mobile app-based CI system and the conventional system in a tertiary referring hospital.

We analyzed 376 consecutive ECGs between December 2017 and May 2019. Of these, 159 ECGs (42.3%) were interpreted by CI through the mobile app-based ECG consultation system and 217 ECGs (57.7%) were analyzed by cardiologists in the conventional systems based on electronic medical record data in a tertiary hospital. All ECG readings were confirmed by an electrophysiologist (EP). The time to an initial response by the CI system was faster than that of the conventional system (6.6 hours vs. 35.8 hours, p<0.0001). The number of responses of each ECG in CI system outnumbered those of the conventional system in the tertiary hospital (3.1 vs. 1.2, p<0.0001). The consensus of the ECG readings with EP was similar in both systems (98.6% vs. 100%, p=0.158).

The mobile app-based ECG consultation system by CI is as reliable method as the conventional referral system. It would expand the app of the 12-lead ECG with the collaboration of physicians in clinics and hospitals without time and space constraints.

The mobile app-based ECG consultation system by CI is as reliable method as the conventional referral system. It would expand the app of the 12-lead ECG with the collaboration of physicians in clinics and hospitals without time and space constraints.

Smoking is well-established as a risk factor for coronary artery disease. However, recent studies demonstrated favorable results, including reduced mortality, among smokers, which are referred to as the "smoker's paradox". This study examined the impact of smoking on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Patients with AMI undergoing PCI between 2004 and 2014 were enrolled and classified according to smoking status. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, stroke, and revascularization.

Among the 10,683 patients, 4,352 (40.7%) were current smokers. Smokers were 10.7 years younger and less likely to have comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, stroke, and prior PCI. Smokers had less MACE (hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.594-0.698; p<0.001) and cardiac death (HR, 0.494; 95% CI, 0.443-0.551; p<0.001) compared to nonsmokers during the 5 years in an unadjusted model. However, after propensity-score matching, smokers showed higher risk of MACE (HR, 1.125; 95% CI, 1.009-1.254; p=0.034) and cardiac death (HR, 1.190; 95% CI, 1.026-1.381; p=0.022). Smoking was a strong independent predictor of lung cancer (propensity-score matched HR, 2.749; 95% CI, 1.416-5.338; p=0.003).

In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.

In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.