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Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial

  • Gungorduk, Kemal;Asicioglu, Osman;Ozdemir, Isa Aykut
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.92.1-92.9
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    • 2018
  • Objective: To evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery. Methods: In total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position ($30^{\circ}$) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of $40cmH_2O$) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0-10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge. Results: Postoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group ($2.2{\pm}0.5$ and $2.0{\pm}0.4$) than in the control group ($4.0{\pm}0.5$ and $3.9{\pm}0.4$; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group ($3.1{\pm}0.4$ and $2.9{\pm}0.4$ vs. $2.9{\pm}0.5$ and $4.9{\pm}0.5$; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719). Conclusion: The PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.

Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

  • Suh, Woosuck;Kim, Bi Na;Kang, Hyun Mi;Yang, Eun Ae;Rhim, Jung-Woo;Lee, Kyung-Yil
    • Clinical and Experimental Pediatrics
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    • v.64 no.6
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    • pp.293-300
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    • 2021
  • Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). Conclusion: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.

Effectiveness and Technical Considerations of Solitaire Platinum 4×40 mm Stent Retriever in Mechanical Thrombectomy with Solumbra Technique

  • Yi, Ho Jun;Sung, Jae Hoon;Lee, Dong Hoon;Song, Seung Yoon
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.30-38
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    • 2021
  • Objective : The Solitaire Platinum 4×40 mm stent retriever contains radiopaque markers with a long length. We evaluated the effect of Solitaire Platinum 4×40 mm stent retriever in Solumbra technique thrombectomy, and compared it with shorter Solitaire stent retrievers. Methods : A total of 70 patients who underwent Solumbra technique thrombectomy with equal diameter (4 mm) and different length (40 vs. 20 mm) Solitaire stent retrievers were divided into two groups : the Solitaire Platinum 4×40 mm stent (4×40) group and the Solitaire FR 4×20 mm stent or Solitaire Platinum 4×20 mm stent (4×20) group. The clinical outcomes, Thrombolysis in Cerebral Infarction score, the first pass reperfusion status, and complications were evaluated and compared between the two groups. Multivariate analysis was performed to evaluate the predictive factors for reperfusion and complete reperfusion from the first pass. Results : Higher first-pass reperfusion and complete reperfusion were achieved in the 4×40 group (68.0% and 48.0%) than in the 4×20 group (46.7% and 33.3%; p=0.004 and 0.007, respectively). In multivariate analysis, radiopaque device and longer stent retriever were correlated with first-pass reperfusion (p=0.014 and 0.008, respectively) and first-pass complete reperfusion (p=0.022 and 0.012, respectively). Conclusion : Our study demonstrated the usefulness of the Solitaire Platinum 4×40 mm stent retriever, which led to higher first-pass reperfusion and complete reperfusion rates than the Solitaire FR 4×20 mm stent or the Solitaire Platinum 4×20 mm stent, especially in Solumbra technique thrombectomy.

Validity Study of the Systemic Exertion Intolerance Disease Questionnaire (SEID-Q27) for Chronic Fatigue Syndrome (CFS) Diagnosis (SEID(Systemic Exertion Intolerance Disease) 진단 기준을 바탕으로 한 만성 피로 증후군 진단 설문지(SEID-Q27) 타당도 연구)

  • Lim, Eun-jin;Son, Chang-gue;Jang, Eun-su
    • The Journal of Internal Korean Medicine
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    • v.41 no.6
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    • pp.1015-1029
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    • 2020
  • Purpose: This study assessed the validity of a questionnaire (SEID-Q27) for diagnosis of chronic fatigue syndrome (CFS), designed based on the systematic exertion intolerance disorder (SEID) criteria. Methods: Two groups of participants were recruited: 1. a non-CFS control group: adult university personnel with a Chalder fatigue scale (CFQ) score ≥15, and 2. a CFS patient group: patients from an online CFS community diagnosed with CFS (diagnostic code of G93.3) with the symptoms present. The survey ran from September to October, 2020. The validity of the questionnaire was investigated by factor analysis and receiver operator characteristic (ROC) analysis. Results: Among the 35 adults surveyed, 30 (86%) participants had CFQ scores ≥15 (15 males and 15 females) and 5 (14%) had a CFS diagnosis (2 males and 3 females). The total mean score was significantly different between the two groups (CFS: 6.8±2.2 vs. control: 4.4±2.4, p<0.05). The area under the curve (AUC) was 0.827. With a cut-off point 62, the sensitivity was 60%, specificity 97%, and the discriminant ability of the survey was 79%. Conclusions: The SEID -Q27 appears to be a useful instrument for the diagnosis of CFS using SEID criteria. However, further large-scale studies are needed with greater numbers of participants.

Optimal Modified Extended Antibiotic Prophylaxis for Prostate Biopsy: The Addition of Two Intravenous Doses of Amikacin to Ciprofloxacin

  • Yu, Seong Hyeon;Jung, Seung Il;Kim, Myung Soo;Chung, Ho Seok;Kwon, Dong Deuk
    • Urogenital Tract Infection
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    • v.13 no.3
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    • pp.72-78
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    • 2018
  • Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB). Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1 g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1 g, IV) before one hour TRUSPB and again on the day after TRUSPB. Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2. Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

Nutritional condition in the dry period is related to the incidence of postpartum subclinical endometritis in dairy cattle

  • Taniguchi, Asako;Nishikawa, Tatsuya;Morita, Yasuhiro
    • Animal Bioscience
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    • v.34 no.4
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    • pp.539-545
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    • 2021
  • Objective: Endometritis is a major disease, that causes infertility in cattle, and is usually categorized as clinical or subclinical endometritis (SCE). The nutritional condition during the dry period is important for recovery after the last stage of the lactation period, and for postpartum production and reproduction. This study aimed to clarify the relationship between nutritional and metabolic characteristics in the dry period, and the risk of postpartum SCE. Methods: Multiparous Holstein dairy cows (n = 25, raised in a tied stall) were used. Endometrial cytological analysis was performed around 30 days post-partum, with 5% to 14% polymorphonuclear (PMN) as a cut-off point to define SCE. Serum levels of glucose, non-esterified fatty acids, β-hydroxybutyric acid (BHBA), blood urea nitrogen, total cholesterol, aspartate aminotransferase, γ-glutamyl transpeptidase, calcium, phosphorus, and magnesium were measured in the cows at the dry period to evaluate energy status, protein metabolism, and mineral metabolism. Results: The incidence of SCE in the cows was 60.0% (n = 15/25) and the mean PMN% in postpartum cows diagnosed as SCE was 8.05%±2.6%. Overall, 17 and 8 samples were collected from the cows in the far-off and close-up periods, respectively. The serum concentration of BHBA in the far-off period and serum glucose concentration in the closeup period were correlated with postpartum PMN% (r = 0.62, p<0.01; r = -0.74, p<0.05, respectively). Serum levels of calcium and magnesium in the dry period were associated with the incidence of postpartum SCE (healthy vs SCE cows, p<0.05). Conclusion: Blood levels of glucose, BHBA, calcium, and magnesium in dry periods could be useful parameters for predicting the risk of postpartum SCE. The present study also suggests that management in the close-up period is essential for promoting recovery from calving fatigue.

The estimation of cholesterol intake in elderly: reliability and validity of short, Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ)

  • Nindya, Triska Susila;Mahmudiono, Trias;Rachmah, Qonita
    • Journal of Nutrition and Health
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    • v.54 no.1
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    • pp.95-103
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    • 2021
  • Purpose: High intake of cholesterol leads to cardiovascular disruption. Estimating the actual intake of cholesterol can be beneficial for nutrition intervention. This research aimed to develop Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) to estimate cholesterol intake and analyze its reliability and validity. Methods: SQ-FFQ was developed by sorting high cholesterol food items in Indonesian food database and food items' availability. A total of 30 older adults were randomly chosen from Public Health Center in Jagir District, Surabaya, Indonesia to test its validity. Reliability test was done by measuring the same developed SQ-FFQ in one-month period, while validity test was done by comparing SQ-FFQ results with 6-days food record. Statistical analysis used for reliability test was paired t-test, the Intra-class Correlation Coefficient (ICC), and Cronbach's α to measure the internal consistency. Meanwhile, validity of developed SQ-FFQ was analyzed using paired t-test and Bland-Altman. Results: Reliability of 2 administered SQ-FFQs showed a good agreement based on paired t-test analysis (p = 0.200), ICC (0.609), and Cronbach's α (0.757). Strong agreement was found in most of food items, but agreements for egg yolk and fried duck were poor. Significant difference was found between those food items (p = 0.001 vs. p < 0.001, respectively) with mean difference were -25.3 mg and 46.2 mg. Validity of developed SQ-FFQ2 compared to 6-days food diary records also found a strong agreement based on paired t-test and the Bland-Altman analysis. Conclusion: This baseline research provides a reasonably valid and repeatable measure of cholesterol intake estimation that can be widely used in nutrition and public health study, especially in Indonesia. No study has been conducted in Indonesia on the development of tools to estimate the cholesterol intake.

Diagnostic and Therapeutic Laparoscopy for Abdominal Trauma: A Single Surgeon's Experience at a Level I Trauma Center

  • Jo, Hancheol;Kim, Dong Hun
    • Journal of Trauma and Injury
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    • v.34 no.4
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    • pp.248-256
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    • 2021
  • Purpose: Laparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon's experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients. Methods: In total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages. Results: The mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups. Conclusions: Laparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.

The Benefit of Supplemental Cough Suppression Therapy for Chronic Refractory Cough (만성 난치성 기침에 대한 기침 억제 요법의 효과)

  • Yoo, Yong Jun;Park, Hye Jin;Han, Myung Woul;Kim, Ji Won
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.33 no.1
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    • pp.26-30
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    • 2022
  • Background and Objectives Cough suppression therapy (CST) is a physiotherapy that can be used for patients with chronic refractory cough (CRC). We aimed to investigate the efficacy of CST for CRC. Materials and Method A prospective randomized controlled trial was conducted in 27 patients with CRC. Participants were randomized to receive either standard mucolytic medications for CRC combined with supplemental CST (CST group) or standard medications alone (control group). CST consists of laryngeal hygiene management, humidification, cough suppression technique, breathing method, and counseling. We assessed the symptoms change at baseline and week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included the degree of cough Visual Analog Scale (VAS) score (0 to 100 scale). Results From 2019 to 2021, 14 CST group patients and 13 control group patients were included. The improvement was significantly greater in the CST group than in the control group for cough VAS score (36.67 to 13.33 vs. 74.29 to 16.43, p<0.001). Patients in the CST group had a significant improvement in total (70.14 to 107.71, p=0.005), physical (31.42 to 43.86, p=0.015), psychological (23.57 to 40.14, p=0.003), and social (15.14 to 23.71, p=0.005) LCQ scores. However, there was not a significant pre- to post-treatment LCQ score improvement in control group. Conclusion CST might be an effective supplemental intervention for CRC.

A Comparison Between the Korean Digits-in-Noise Test and the Korean Speech Perception-in-Noise Test in Normal-Hearing and Hearing-Impaired Listeners

  • Kim, Subin;You, Sungwha;Sohn, Myoung Eun;Han, Woojae;Seo, Jae-Hyun;Oh, Yonghee
    • Journal of Audiology & Otology
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    • v.25 no.4
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    • pp.171-177
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    • 2021
  • Background and Objectives: The purpose of the present study was to validate the performance and diagnostic efficacy of the Korean digits-in-noise (K-DIN) test in comparison to the Korean speech perception-in-noise (K-SPIN) test, which is the representative speech-in-noise test in clinical practice. Subjects and Methods: Twenty-seven subjects (15 normal-hearing and 12 hearing-impaired listeners) participated. The recorded Korean 0-9 digits were used to form quasirandom digit triplets; 50 target digit triplets were presented at the most comfortable level of each subject while presenting speech-shaped background noise at various levels of signal-to-noise ratios (-12.5, -10, -5, or +5 dB). Subjects were then instructed to listen to both target and noise masker unilaterally and bilaterally through a headphone. K-SPIN test was also conducted using the same procedure as the K-DIN. After calculating their percent correct responses, K-DIN and K-SPIN results were compared using a Pearson-correlation test. Results: Results showed a statistically significant correlation between K-DIN and K-SPIN in all hearing conditions (left: r=0.814, p<0.001; right: r=0.788, p<0.001; bilateral: r=0.727, p<0.001). Moreover, the K-DIN test achieved better testing efficacy, shorter average listening time (5 min vs. 30 min), and easier performance of task according to participants' qualitative reports than the K-SPIN test. Conclusions: In this study, the Korean version of digit triplet test was validated in both normal-hearing and hearing-impaired listeners. The findings suggest that the K-DIN test can be used as a simple and time-efficient hearing-in-noise test in audiology clinics in Korea.