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This paper presents a classification model for eye diseases utilizing attention mechanisms to learn features from fundus images and structures. The study focuses on diagnosing glaucoma by extracting retinal vessels and the optic disc from fundus images using a ResU-Net-based segmentation model and Hough Circle Transform, respectively. The extracted structures and preprocessed images were inputted into a CNN-based multi-input model for training. Comparative evaluations demonstrated that our model outperformed other research models in classifying glaucoma, even with a smaller dataset. Ablation studies confirmed that using attention mechanisms to learn fundus structures significantly enhanced performance. The study also highlighted the challenges in normal case classification due to potential feature degradation during structure extraction. Future research will focus on incorporating additional fundus structures such as the macula, refining extraction algorithms, and expanding the types of classified eye diseases.
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Algoritmos , Fondo de Ojo , Glaucoma , Humanos , Glaucoma/diagnóstico por imagen , Glaucoma/patología , Disco Óptico/diagnóstico por imagen , Disco Óptico/patología , Procesamiento de Imagen Asistido por Computador/métodos , Redes Neurales de la Computación , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Retina/diagnóstico por imagen , Retina/patologíaRESUMEN
The incidence of peripheral facial palsy is on the rise, with psychological issues influencing quality of life due to visible symptoms. Consequently, patient-reported outcome measures are critical in assessing the disease burden and the treatment efficacy of peripheral facial palsy from patients' perspective. This study examines factors influencing patients' global impression of change (PGIC) scores, a type of patient-reported outcome measure, in hospitalized patients with peripheral facial palsy. This retrospective study analyzed the electronic medical records of 200 patients with peripheral facial palsy who were admitted to the Korean Medicine Hospital, Kyung Hee University Medical Center from May 1, 2022 to April 30, 2023. Impact of demographic, electrophysiological, intervention, and clinical factors on PGIC scores were evaluated. Descriptive statistics showed that the length of hospitalization (Pâ =â .020), time from disease onset to hospitalization (Pâ =â .022), lacrimal disorders (Pâ =â .002), House-Brackmann (HB) grade evaluated at admission (Pâ =â .016) and at discharge (Pâ <â .001), improvement in HB-grade from admission to discharge (Pâ =â .002), and total facial disability index (FDI) score at discharge (Pâ <â .001) were significantly associated with PGIC scores. In multivariate logistic regression analysis, HB-grade at admission (OR: 13.89, 95% CI: 2.18-113.60), length of stay (OR: 0.27, 95% CI: 0.07-0.92), time from disease onset to hospitalization (OR: 5.55, 95% CI: 1.36-24. 77), tear-related symptoms (OR: 0.41, 95% CI: 0.17-0.96), total FDI score (OR: 0.45, 95% CI: 0.20-0.98), and greater improvement in HB-grade at discharge compared to admission (OR: 0.08, 95% CI: 0.02-0.31) were significantly associated with PGIC scores. Patients with milder initial disease severity, hospitalization period exceeding 7 days, shorter time from disease onset to hospitalization, improvement of lacrimal symptoms, total FDI score, and HB-grade between admission and discharge experienced more significant subjective improvement in peripheral facial palsy.
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Parálisis Facial , Humanos , Masculino , Femenino , Estudios Retrospectivos , Parálisis Facial/psicología , Parálisis Facial/terapia , Persona de Mediana Edad , República de Corea/epidemiología , Anciano , Adulto , Medición de Resultados Informados por el Paciente , Índice de Severidad de la Enfermedad , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Calidad de Vida , Pacientes Internos/estadística & datos numéricosRESUMEN
BACKGROUND: Pragmatic acupuncture trials (PATs) are a research tool for assessing the effectiveness of acupuncture treatments in a real-world setting. This study aimed to provide a comprehensive methodological analysis of PATs using the PRECIS-2(PRagmatic Explanatory Continuum Indicator Summary-2) tool to determine their pragmatism. METHODS: The MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials, CINAHL, Allied and Complementary Medicine Database, China National Knowledge Infrastructure, VIP, WANFANG, Taiwan Periodical Literature Database, KoreaMed, KMbase, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, CiNii and ClinicalTrials.gov were searched. The search included randomised controlled trials (RCTs) and protocols of RCTs that investigated all types of acupuncture and used self-declared pragmatic design. Two authors independently collected the basic information and characteristics of the studies and assessed their pragmatism using the nine PRECIS-2 domains and the additional domain of control. RESULTS: A total of 93 studies were included. The means of eligibility, recruitment, organisation, primary outcome, primary analysis, and control domains were statistically larger than three and were shown to be pragmatic. The means of setting, flexibility:delivery, and follow-up domains were not greater than three and were shown to be non-pragmatic. For flexibility:adherence domain was inappropriate for assessment owing to insufficient information in the studies. CONCLUSIONS: PATs were pragmatic in the domain of eligibility, recruitment, organisation, primary outcome, primary analysis, and control and were not pragmatic in the domain of setting, flexibility:delivery, and follow-up. Future PATs need to strengthen the pragmatism in the setting, flexibility:delivery, and follow-up domains and to describe the flexibility:adherence domain in more detail. TRIAL REGISTRATION: CRD42021236975.
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Terapia por Acupuntura , Ensayos Clínicos Pragmáticos como Asunto , Humanos , Terapia por Acupuntura/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de InvestigaciónRESUMEN
With aging, men develop testosterone-deficiency syndrome (TDS). The development is closely associated with age-related mitochondrial dysfunction of Leydig cell and oxidative stress-induced reactive oxygen species (ROS). Testosterone-replacement therapy (TRT) is used to improve the symptoms of TDS. However, due to its various side effects, research on functional ingredients derived from natural products that do not have side effects is urgently needed. In this study, using the mitochondrial dysfunction TM3 (mouse Leydig) cells, in which testosterone biosynthesis is reduced by H2O2, we evaluated the effects of elderberry extract and monosaccharide-amino acid (fructose-leucine; FL) on mRNA and protein levels related to steroidogenesis-related enzymes steroidogenic acute regulatory protein (StAR), cytochrome P450 11A1(CYP11A1, cytochrome P450 17A1(CYP17A1), cytochrome P450 19A1(CYP19A1, aromatase), 3ß-hydroxysteroid dehydrogenase (3ß-HSD), and 17ß-hydroxysteroid dehydrogenase(17ß-HSD). We analyzed elderberry extract and extract-derived FL for changes in ROS scavenging activity and testosterone secretion. Elderberry extract and FL significantly reduced H2O2-induced intracellular ROS levels, improved testosterone secretion, and increased the mRNA and protein expression levels of steroidogenesis-related enzymes (StAR, 3b-HSD, 17b-HSD, CYP11A1, CYp17A1). However, the conversion of testosterone to estradiol was inhibited by elderberry extract and extract-derived FL, which reduced the mRNA and protein expression of CYP19A1. In conclusion, elderberry extract and FL are predicted to have value as novel functional ingredients that may contribute to the prevention of TDS by ameliorating reduced steroidogenesis.
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Peróxido de Hidrógeno , Células Intersticiales del Testículo , Extractos Vegetales , Testosterona , Animales , Células Intersticiales del Testículo/metabolismo , Células Intersticiales del Testículo/efectos de los fármacos , Ratones , Peróxido de Hidrógeno/metabolismo , Extractos Vegetales/farmacología , Extractos Vegetales/química , Masculino , Línea Celular , Aminoácidos/metabolismo , Monosacáridos , Sambucus/química , Especies Reactivas de Oxígeno/metabolismo , Estrés Oxidativo/efectos de los fármacos , Fosfoproteínas/metabolismo , Fosfoproteínas/genéticaRESUMEN
BACKGROUND: Women from Asian and western countries have vastly different ages of onset of breast cancer, with the disease tending to occur at an older age in the West. Through an investigation of the patterns of old-onset breast cancer (OBC) in Korean women, we aimed to identify the characteristics of Korean OBC and evaluate whether these patterns are changing in relation to increasing westernization. METHODS: This study retrospectively evaluated 102,379 patients who underwent surgical treatment of primary breast cancer between January 1, 2000 and December 31, 2013 in Korea. We used hospital -based breast cancer registry and analyzed data from these patients using multiple linear regression analysis to compare the characteristics and chronologically changing patterns between OBC (70 years of age or older) and non-OBC (40-69 years of age) patients in Korea. RESULTS: A total of 6% of the 102,379 patients had OBC. Overall, OBC had more favorable biological features, such as a higher incidence of luminal A subtype, than did non-OBC, except for a higher incidence rate of triple-negative breast cancer (TNBC). However, OBC also presented with a higher overall disease stage, including higher T and M stages. Although the incidence rates of both OBC and non-OBC have increased overtime, the relative proportion of OBC patients has slightly increased, whereas that of non-OBC has slightly decreased. The increase in the incidence of both OBC and non-OBC was primarily due to the luminal A subtype. CONCLUSIONS: Based on a hospital-based registry, overall, Korean OBC had favorable biological features but showed a higher rate of TNBC and advanced cancer stages. The incidence trend of breast cancer in Korea is slowly shifting toward an older age at onset, largely due to the luminal A subtype. Our results may provide novel insights into OBC in Asia, and aid in the development of optimal management of the disease in Asia. TRIAL REGISTRATION: Retrospectively registered.
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Neoplasias de la Mama , Neoplasias de la Mama Triple Negativas , Humanos , Femenino , Anciano , Adulto , Persona de Mediana Edad , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Neoplasias de la Mama Triple Negativas/epidemiología , Estudios Retrospectivos , Mama , Sistema de Registros , HospitalesRESUMEN
Most previous studies have been focused on isoflavone profile with biological activities from soybean seed and its related products. However, in the present study, eighty-three flavonoid derivatives (55 flavonols, 9 flavones and 19 isoflavones) were comprehensively identified and quantified from young leaves of 21 core-collected soybean cultivars based on ultra-performance liquid chromatography-diode array detector with quadrupole time of flight/mass spectrometry (UPLC-DAD-QToF/MS). Among total flavonoids from soybean leaves (SLs), the abundant flavonols (83.6%) were primarily composed of di- and tri- glycosides combined to the aglycones (K, kaempferol; Q, quercetin; I, isorhamnetin). Particularly, K-rich SLs (yellow coated seed), Nongrim 51 (breeding line) and YJ208-1 (landrace) contained mainly kaempferol 3-O-(2â³-O-glucosyl-6â³-O-rhamnosyl)galactoside and 3-O-(2â³,6â³-di-O-rhamnosyl)galactoside, and were expected to be superior cultivars by their higher flavonoids. Besides, the new tri-I-glycosides (soyanins I-V) were presented as predominant components in Junyeorikong (landrace, black). Thus, this study suggest that the SLs can be considered as valuable edible resources due to their rich flavonoids. Also, these detailed profiles will support breeding of superior varieties with excellent biological activities as well as relationship with seed anthocyanins production, and contribute to perform metabolomics approach to investigate the changes of SLs flavonols during the leaf growth and fermentation in further research.
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Fabaceae , Isoflavonas , Antocianinas/química , Cromatografía Líquida de Alta Presión , Flavonoides/química , Flavonoles/química , Galactósidos , Glicósidos/química , Isoflavonas/análisis , Quempferoles , Espectrometría de Masas , Fitomejoramiento , Hojas de la Planta/química , Glycine maxRESUMEN
INTRODUCTION: Peripheral facial palsy (PFP) results in weakness or paralysis of the affected side of the face. In Korea, there is a high demand for Korean medicine treatment for PFP. The clinical practice guidelines (CPGs) of Korean medicine for facial palsy were developed; however, there remains insufficient evidence to support the effectiveness and safety of Korean medicine treatment. Thus, this study aimed to evaluate the effectiveness and safety of Korean medicine treatment based on the CPGs in patients with acute PFP. METHODS: This is a multicenter, prospective, observational study. The participants will be recruited from one Korean medicine hospital and eight Korean medicine clinics. The participants will receive Korean medicine treatments based on the CPGs, fill in survey questionnaires, and undergo electrophysiologic testing. The changes in House-Brackmann (H-B) grade, movement of the lip and eye, symptoms related to or accompanied by facial palsy, Facial Disability Index, EuroQol 5-dimension 5-level (EQ-5D-5L), and EuroQol Visual Analogue Scale (EQ-VAS), and the results of electromyography (EMG), electroneurography (ENoG), and Blink Reflex test will be analyzed. For the safety analysis, adverse events will be recorded, and for the feasibility analysis, the results of the Was It Worth It questionnaire will be assessed. CONCLUSION: We expect to draw real-world clinical data on the effectiveness and safety of Korean medicine treatment based on the CPGs in patients with acute PFP from this study. It would be the basis for complementing and improving the CPGs and provide the basis of clinical and policy decision-making. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of Kyung Hee University Korean Medicine Hospital (2021-06-005-001), and registered with the Korean Clinical Trial Registry (CRIS), Republic of Korea (KCT0006562).
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Parálisis de Bell , Parálisis Facial , Parálisis de Bell/terapia , Parálisis Facial/tratamiento farmacológico , Humanos , Estudios Multicéntricos como Asunto , Estudios Observacionales como Asunto , Dimensión del Dolor , Estudios Prospectivos , República de CoreaRESUMEN
In this study, thirty-eight isoflavone derivatives were comprehensively identified and quantified from the raw, steamed and fermented seeds of four selected soybean cultivars based on UPLC-DAD-QToF/MS results with reference to the previously reported LC-MS library and flavonoid database, and summarized by acylated group including glucosides (Glu), malonyl-glucosides (Mal-Glu), acetyl-glucosides (Ac-Glu), succinyl-glucosides (Suc-Glu) and phosphorylated conjugates (Phos) in addition to aglycones. Among them, Suc-Glu and Phos derivatives were newly generated due to fermentation by B. subtilis AFY-2 (cheonggukjang). In particular, Phos were characterized for the first time in fermented soy products using Bacillus species. From a proposed roadmap on isoflavone-based biotransformation, predominant Mal-Glu (77.5-84.2%, raw) decreased rapidly by decarboxylation and deesterification into Ac-Glu and Glu (3.5-8.1% and 50.0-72.2%) during steaming, respectively. As fermentation continued, the increased Glu were mainly succinylated and phosphorylated as well as gradually hydrolyzed into their corresponding aglycones. Thus, Suc-Glu and Phos (17.3-22.4% and 1.5-5.4%, 36 h) determined depending on cultivar type and incubation time, and can be considered as important biomarkers generated during cheonggukjang fermentation. Additionally, the changes of isoflavone profile can be used as a fundamental report in applied microbial science as well as bioavailability research from fermented soy foods.
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Isoflavonas , Fermentación , Glucósidos/metabolismo , Isoflavonas/metabolismo , Semillas/metabolismo , Glycine max/metabolismoRESUMEN
INTRODUCTION: The pragmatic design has received much attention in the field of acupuncture clinical trials because of insufficient information about the specific effects of acupuncture. However, pragmatism in pragmatic acupuncture trials has not been comprehensively investigated. The PRECIS-2 tool was developed and has been gradually used to design pragmatic trials; therefore, we will apply the PRECIS-2 tool to investigate the pragmatism of pragmatic acupuncture trials in this study. METHODS AND ANALYSIS: In this systematic review, self-declared 'pragmatic' randomised clinical trials (RCTs) or protocols of self-declared 'pragmatic' RCTs investigating acupuncture will be searched and included to be reviewed. MEDLINE, EMBASE, the Cochrane Central Register for Controlled Trials, CINAHL, Allied and Complementary Medicine Database (AMED), China National Knowledge Infrastructure, VIP, WANFANG, Taiwan Periodical Literature Database, KoreaMed, KMbase, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, CiNii and ClinicalTrials.gov for registered trials will be electronically searched from inception to March 2022. Protocols of published RCTs or secondary analysis of RCTs will be excluded. Additionally, no language restriction will be applied. Two authors will independently extract descriptive information and assess the pragmatism of pragmatic acupuncture trials using nine domains of the PRECIS-2 tool and one additional domain-control. Descriptive statistics will be reported for each domain and the overall score, and a one-sample t-test will be used to statistically analyse whether the score is greater than 3 (equally pragmatic and explanatory). The wheel diagrams of the nine domains of the PRECIS-2 tool will be used to demonstrate the pragmatism of the included studies. ETHICS AND DISSEMINATION: Ethical approval is not warranted as this study will obtain data from previously reported articles. The results will be disseminated through peer-reviewed journals and conferences. PROSPERO REGISTRATION NUMBER: CRD42021236975.
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Terapia por Acupuntura , Medicina Tradicional de Asia Oriental , Terapia por Acupuntura/métodos , China , Humanos , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , TaiwánRESUMEN
BACKGROUND: As postoperative pain after laparoscopic cholecystectomy may delay recovery and discharge, a multimodal and pre-emptive analgesic approach is necessary. This study demonstrated that a multimodal analgesic bundle improves postoperative recovery, using the Quality of Recovery-40K (QoR-40K) questionnaire during the first 24 h after laparoscopic cholecystectomy. METHODS: In this prospective non-randomized study with two parallel groups, 80 patients undergoing laparoscopic cholecystectomy were allocated into either the multimodal analgesia group or the conventional analgesia group. The multimodal analgesia group received a pre-emptive analgesic bundle (preoperative intravenous administration of paracetamol, ketorolac, and dexamethasone, and a posterior approach to the transversus abdominis plane block), while the conventional analgesia group did not. The primary outcome was the QoR-40K score during the first 24 h after surgery. Secondary outcomes were the peak visual analog scale pain score at rest and the incidence rates of rescue analgesic use and nausea/vomiting during the first 24 h after surgery. RESULTS: The QoR-40K score was higher in the multimodal analgesia group than in the conventional analgesia group (196 [190-199] vs. 182 [172-187], p < 0.001). The peak visual analog scale pain score was significantly lower in the multimodal analgesia group than in the conventional analgesia group. Multimodal analgesia also reduced the incidence rates of rescue analgesic use and postoperative nausea/vomiting (22.5% [95% CI, 9.6-35.4%] vs. 55.0% [39.6-70.4%], p = 0.003), compared to conventional analgesia. CONCLUSIONS: Multimodal analgesia significantly improves the quality of early postoperative recovery after laparoscopic cholecystectomy, as shown by the QoR-40K score.
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Colecistectomía Laparoscópica , Músculos Abdominales , Analgésicos/uso terapéutico , Analgésicos Opioides , Método Doble Ciego , Humanos , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Estudios ProspectivosRESUMEN
BACKGROUND: Robot-assisted laparoscopic prostatectomy (RALP) is a favored surgical approach for treating prostate cancer. However, RALP does not decrease postoperative pain significantly despite its minimal invasiveness. The pain associated with robot-assisted surgery is most severe during the immediate postoperative period. We aimed to demonstrate that preoperative rectus sheath block (RSB) can reduce acute pain after RALP. METHODS: A prospective non-randomized study with two parallel groups was performed from June 2020 to August 2020. A total of 100 patients undergoing RALP were divided into two groups: the RSB group (n = 50) and the non-RSB group (n = 50). Ultrasound-guided RSB was performed preoperatively only in the RSB group. The primary outcome of the study was the visual analog scale (VAS) pain score during coughing (VAS-C) 1 h after surgery. In addition, the VAS pain score at rest (VAS-R) and the VAS-C were assessed up to 24 h after surgery. The doses of postoperative opioids consumed were also recorded. RESULTS: The RSB group had a significantly lower VAS-C 1 h after RALP (58 [47-73] vs. 74 [63-83] mm, p = 0.001). In addition, the RSB group had significantly lower VAS-R and VAS-C scores, and postoperative opioid requirement, up to 6 h after surgery compared to the non-RSB group. Moreover, the VAS-R was significantly lower in the RSB group than in the non-RSB group 24 h after surgery. CONCLUSION: Preoperative RSB significantly improved analgesia during the early period after RALP. The long-term analgesic efficacy of RSB needs further study.
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Bloqueo Nervioso , Robótica , Analgésicos Opioides/uso terapéutico , Humanos , Masculino , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Prostatectomía , Recto del Abdomen , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: Recently, automated detection has been a new approach to address the risks posed by prescribing errors. This study focused on prescription errors and utilized real medical data to supplement the Drug Utilization Review (DUR)-based rules, the current prescription error detection method. We developed a new hybrid method through artificial intelligence for prescription error prediction by utilizing actual detection accuracy improvement to reduce 'warning fatigue' for doctors and improve medical care quality. OBJECT: This study was conducted in the Department of Pediatrics, targeting children sensitive to drugs to develop a prescription error detection system. Based on the DUR prescription history, 15,281 patient-level observations of children from Konyang University Hospital (KYUH)'s common data model (CDM) and DUR were collected and analyzed retrospectively. METHOD: Among the CDM data, inspection information was interlocked with DUR and reflected as standard information for model development; this included outpatient prescriptions from January 1 to December 31, 2018. Through consultation with pediatric clinicians, rule definitions and model development were conducted for 35 drugs, with 137,802 normal and 1609 prescription errors. RESULTS: We developed a novel hybrid method of error detection in the form of an advanced rule-based deep neural network (ARDNN), which showed the expected performance (precision: 72.86, recall: 81.01, F1 score: 76.72) and reduced alarm pop-up alert fatigue to below 10%. We also created an ARDNN-based comprehensive dashboard that allows doctors to monitor prescription errors with alarm pop-ups when prescribing medications. CONCLUSION: These results can advance the existing rule-based model by developing a prescription error detection model using deep learning. This method can improve overall medical efficiency and service quality by reducing doctors' fatigue.
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Aprendizaje Profundo , Inteligencia Artificial , Niño , Prescripciones de Medicamentos , Humanos , Errores de Medicación/prevención & control , Estudios RetrospectivosRESUMEN
While Human Papillomavirus (HPV) is a prominent cause of cervical cancer and mortality among underserved women, HPV vaccine completion rates remain stagnant (54%) among US adolescents. Our objective is to identify how adolescents' mothers' engagement with anti-vaccine versus pro-vaccine social media content is associated with their children's HPV vaccination rates via increased vaccine hesitancy. We employ the notion of loss aversion escalated in an emotion-laden circumstance in consumer behavior literature given that HPV vaccination decisions directly affect children's well-being. Based on this escalated loss aversion tendency for an emotion-laden decision, we explain why anti-vaccine content disproportionately increases mothers' overarching vaccine hesitancy, while pro-vaccine content does not decrease vaccine hesitancy. We conducted a population-based survey among 426 mothers of US adolescents aged 13-18. Our sample closely mimics the socioeconomic and demographic factors of the population group of mothers of adolescents in the US census. Our results show that anti-vaccine social media posts are associated with increases in mothers' overarching vaccine hesitancy and with decreases in their children's HPV vaccination rates, while pro-vaccine content has no significant association with either.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Medios de Comunicación Sociales , Adolescente , Niño , Emociones , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Infecciones por Papillomavirus/prevención & control , Aceptación de la Atención de Salud , VacunaciónRESUMEN
OBJECTIVE: In 2017, the International Standard for Reporting Items for practice Guideline in HealThcare (RIGHT) published reporting guidelines to enhance transparency and clarity in the process of developing clinical practice guidelines (CPGs). Given the original tool was developed in 2017 and demanded in developing and reporting high quality of acupuncture CPGs, an extension with a focus on a specific reporting checklist was warranted. STUDY DESIGN AND SETTING: The study was designed based on the methodology recommended by the Enhancing the Quality and Transparency Of Health Research (EQUATOR) Network with modification accordingly. A reporting checklist and its elaboration and explanations for users were developed. RESULTS: A checklist of seven sections (Basic information, Background, Evidence, Recommendations, Funding, Declaration and management of interest, Other information), twenty-three first level items and forty-three second level items was developed. We clarified the rationales of the items and provided explanations and examples of each item for additional guidance. CONCLUSION: The RIGHT for Acupuncture checklist identifies a set of items to be reported when reviewing clinical practice guidelines on acupuncture. This extension can be expected to improve the reporting quality of CPGs on acupuncture.
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Terapia por Acupuntura/normas , Protocolos Clínicos/normas , Medicina Tradicional China/normas , Guías de Práctica Clínica como Asunto , HumanosRESUMEN
BACKGROUND: Although many reports have shown that enhanced recovery after surgery (ERAS) programs improve the perioperative outcomes of patients undergoing colorectal surgery, the prevalence of early acute kidney injury (AKI) after surgery in such patients requires attention. Protective roles of the female sex in terms of chronic kidney disease and progression of ischemic renal injury have been described in many studies. We thus explored whether a sex difference was evident in terms of postoperative AKI in a colorectal ERAS setting. METHODS: From January 2017 to August 2019, 453 patients underwent laparoscopic colorectal cancer resection in an enhanced recovery program. Of these, 217 female patients were propensity score (PS)-matched with 236 male patients. Then, 215 patients of either sex were compared in terms of postoperative renal function and complications. RESULTS: Among the PS-matched patients, the incidence of AKI was significantly higher in male than female patients (24.2% vs. 9.8%, P < 0.001). Male patients also exhibited a greater reduction in the postoperative estimated glomerular filtration rate, compared with female patients. The male sex was associated with an approximately threefold increase in the risk of AKI. The rate of surgical complications was significantly higher in male than female patients. CONCLUSIONS: Caution must be taken to prevent postoperative AKI in patients (particularly males) participating in colorectal ERAS programs. The mechanism underlying the sex difference remains unclear. Additional studies are required to determine whether male patients require perioperative management that differs from that of females, to prevent postoperative AKI.
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Lesión Renal Aguda , Cirugía Colorrectal , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/prevención & control , Cirugía Colorrectal/efectos adversos , Femenino , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Puntaje de Propensión , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The present study was performed to investigate the analgesic efficacy of intrathecal morphine and bupivacaine (ITMB) in terms of treating early postoperative pain in adult patients who underwent robotic-assisted laparoscopic prostatectomy (RALP). METHODS: Fifty patients were prospectively enrolled and randomly classified into the non-ITMB (n = 25) and ITMB (n = 25) groups. The ITMB therapeutic regimen consisted of 0.2 mg morphine and 7.5 mg bupivacaine (total 1.7 mL). All patients were routinely administered the intravenous patient-controlled analgesia and appropriately treated with rescue intravenous (IV) opioid drugs, based on the discretion of the attending physicians who were blinded to the group assignments. Cumulative IV opioid consumption and the numeric rating scale (NRS) score were assessed at 1, 6, and 24 h postoperatively, and opioid-related complications were measured during the day after surgery. RESULTS: Demographic findings were comparable between patients who did and did not receive ITMB. The intraoperative dose of remifentanil was lower in the ITMB group than in the non-ITMB group. Pain scores (i.e., NRS) at rest and during coughing as well as cumulative IV opioid consumption were significantly lower in patients who received ITMB than in those who did not in the post-anesthesia care unit (PACU; i.e., at 1 h after surgery) and the ward (i.e., at 6 and 24 h after surgery). ITMB was significantly associated with postoperative NRS scores of ≤ 3 at rest and during coughing in the PACU (i.e., at 1 h after surgery) before and after adjusting for cumulative IV opioid consumption. In the ward (i.e., at 6 and 24 h after surgery), ITMB was associated with postoperative NRS scores of ≤ 3 at rest and during coughing before adjusting for cumulative IV opioid consumption but not after. No significant differences in complications were observed, such as post-dural puncture headache, respiratory depression, nausea, vomiting, pruritus, or neurologic sequelae, during or after surgery. CONCLUSION: A single spinal injection of morphine and bupivacaine provided proper early postoperative analgesia and decreased additional requirements for IV opioids in patients who underwent RALP. TRIAL REGISTRATION: Clinical Research Information Service, Republic of Korea; approval number: KCT0004350 on October 17, 2019. https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15637.
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Analgesia , Analgésicos Opioides/administración & dosificación , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Laparoscopía , Morfina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Procedimientos Quirúrgicos Robotizados , Anciano , Humanos , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego , Factores de Tiempo , Resultado del TratamientoRESUMEN
Our objective was to investigate whether inflammatory microenvironment induced by Trichomonas vaginalis infection can stimulate proliferation of prostate cancer (PCa) cells in vitro and in vivo mouse experiments. The production of CXCL1 and CCL2 increased when cells of the mouse PCa cells (TRAMP-C2 cell line) were infected with live T. vaginalis. T. vaginalis-conditioned medium (TCM) prepared from co-culture of PCa cells and T. vaginalis increased PCa cells migration, proliferation and invasion. The cytokine receptors (CXCR2, CCR2, gp130) were expressed higher on the PCa cells treated with TCM. Pretreatment of PCa cells with antibodies to these cytokine receptors significantly reduced the proliferation, mobility and invasiveness of PCa cells, indicating that TCM has its effect through cytokine-cytokine receptor signaling. In C57BL/6 mice, the prostates injected with T. vaginalis mixed PCa cells were larger than those injected with PCa cells alone after 4 weeks. Expression of epithelial-mesenchymal transition markers and cyclin D1 in the prostate tissue injected with T. vaginalis mixed PCa cells increased than those of PCa cells alone. Collectively, it was suggested that inflammatory reactions by T. vaginalis-stimulated PCa cells increase the proliferation and invasion of PCa cells through cytokine-cytokine receptor signaling pathways.
Asunto(s)
Neoplasias de la Próstata , Tricomoniasis , Trichomonas vaginalis , Animales , Proliferación Celular , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Microambiente TumoralRESUMEN
BACKGROUND: This study investigated the optimal timing of analgesic transversus abdominis plane (TAP) block in the operating room for better recovery quality using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire in patients who had undergone open inguinal herniorrhaphy. METHODS: This single-centre, prospective randomised controlled study included adult male patients who had an ASA physical status of I-II. A total of 80 patients were analysed. The patients were randomly assigned and classified into pre-incisional TAP (pre-TAP) block (n = 40) and post-incisional TAP (post-TAP) block (n = 40) groups. The quality of postoperative functional recovery and complications were compared between the two groups during 24 h postoperatively. RESULTS: Preoperative findings of the two groups were comparable. The global QoR-40K score was higher in the pre-TAP group than in the post-TAP group. Among sub-dimensions, scores of physical comfort and pain were higher in the pre-TAP group than in the post-TAP group. In the post-anaesthesia care unit, the pre-TAP group showed lower pain scores than the post-TAP block group. There was no severe pain in the pre-TAP group, but two patients (5.0%) in the post-TAP block group suffered severe pain. The pre-TAP group required lower doses of IV rescue opioid in the PACU than the post-TAP group. All patients were discharged from hospital on postoperative day 1 without surgical complications. CONCLUSIONS: The timing of analgesic TAP block may be of clinical importance to prevent postoperative pain and to improve the quality of early patient recovery following open inguinal herniorrhaphy.
Asunto(s)
Músculos Abdominales/inervación , Analgesia/métodos , Hernia Inguinal/cirugía , Herniorrafia/métodos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Recuperación de la Función , Ultrasonografía Intervencional/métodos , Anciano , Hernia Inguinal/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
OBJECTIVES: We compared early recovery outcomes between living kidney donors who received total intravenous (IV) propofol versus inhalational desflurane during hand-assisted laparoscopic nephrectomy. DESIGN: A single-centre, prospective randomised controlled trial. SETTING: University hospital. PARTICIPANTS: Study participants were enrolled between October 2019 and February 2020. A total of 80 living donors were randomly assigned to an intravenous propofol group (n=40) or a desflurane group (n=40). INTERVENTION: Propofol group received intravenous propofol and desflurane group received desflurane, as a maintenance anaesthetic. PRIMARY AND SECONDARY OUTCOME MEASURES: The quality of postoperative functional recovery was primarily assessed using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire on postoperative day 1. Secondarily, ambulation, pain score, rescue analgesics, complications and total hospital stay were assessed postoperatively. RESULTS: Our study population included 35 males and 45 females. The mean age was 46±13 years. The global QoR-40K score (161 (154-173) vs 152 (136-161) points, respectively, p=0.001) and all five subdimension scores (physical comfort, 49 (45-53) vs 45 (42-48) points, respectively, p=0.003; emotional state, 39 (37-41) vs 37 (33-41) points, respectively, p=0.005; psychological support, 30 (26-34) vs 28 (26-32) points, respectively, p=0.04; physical independence, 16 (11-18) vs 12 (8-14) points, respectively, p=0.004; and pain, 31 (28-33) vs 29 (25-31) points, respectively, p=0.021) were significantly higher in the intravenous propofol group than the desflurane group. The early ambulation success rate and numbers of early and total steps were higher, but the incidence of nausea/vomiting was lower, in the intravenous propofol group than the desflurane group. The total hospital stay after surgery was shorter in the intravenous propofol group than the desflurane group. CONCLUSIONS: Intravenous propofol may enhance the quality of postoperative recovery in comparison to desflurane in living kidney donors. TRIAL REGISTRATION NUMBER: KCT0004365.