Purpose: PTH (parathyroid hormone) level is a useful index for prediction of hypocalcemia after thyroidectomy. The fast results are required for an early diagnosis of hypocalcemia. In this study, we evaluated the PTH change according to incubation time, and investigated the usefulness of hypocalcemia diagnosis of PTH results in early incubation time. Materials and Methods: The subjects were 131 patients who had taken the PTH test from July to August in 2009. All experiments were used IRMA method. PTH value were evaluated with the correlation between precision (10 times repeat) and recovery rate and at 0.5, 3, 6 and $18{\pm}2$ (below overnight) hours following incubation time. Data analysis was investigated with relationship of the sensitivity, specificity, PPV (positive predictive value) and accuracy. Results: The correlation was time-dependent with levels reaching $R^2$=0.987 at 0.5 hours, $R^2$=0.993 at 3 hours and $R^2$=0.996 at 6 hours compare to overnight levels. The precision (%CV${\pm}$SD) were $15.92{\pm}15.54$ at 0.5 hours, $6.91{\pm}7.38$ at 3 hours, $4.30{\pm}4.69$ at 6 hours and $4.59{\pm}2.59$ at overnight. The recovery rate (%Mean${\pm}$SD) were $96.8{\pm}5.44$ at 0.5 hours, $102.6{\pm}4.35$ at 3 hours, $100.7{\pm}2.56$ at 6 hours and $102.2{\pm}5.98$ at overnight. When 15 pg/ml of overnight density was set up as criteria, we measured the sensitivity, specificity and PPV, accuracy at 0.5, 3, 6 hours. The sensitivity was shown to 97.5% at all times. The specificity was 96.0% at 0.5 hours, 100% at 3 hours and 92.3% at 6 hours for control, respectively. The PPV was 86.6% at 0.5 hours, 100% at 3 hours and 92.8% at 6 hours. The accuracy was shown to 84.7% at 0.5 hours, 97.5% at 3 hours and 90.6% at 6 hours. These data were accompanied by a corresponding PTH value of overnight incubation time, which significantly correlated with early time results. Conclusion: The values of PTH at 3 hours has favorable the rate of concordance of 94.1% and may be useful for prediction of hypocalcemia, and it responses to overnight incubation PTH values. Therefore, This method may be an attractive alternative to proper treatment to stop symptom revelation by giving a calcium agent to the patient.
Background and Objectives To assess the effectiveness of overnight orthokeratology (OK) in myopia using a new contact lens design over a one-month wearing period. Materials and Methods Participants were required to have myopia between -3.00 and -7.50D and astigmatism ≤ 2.00 D to participate in the study. The participants underwent OK with the White OK lens® (Interojo, Pyungtek, Korea), which has a 6-curve lens design. Participants were assessed at weeks 1, 2, and 4 using slit-lamp bio-microscopy, and tested for refraction, uncorrected distance visual acuity, and corneal topography. Success was defined as achieving a Logarithm of the Minimum Angle of Resolution (logMAR) ≤ 0.1. Results A total of 46 eligible subjects with a mean age of 23.11 ± 7.89 years were recruited. Baseline logMAR was 1.18 ± 0.30 and a consistent decrease in logMAR was observed from week 1 to week 4. The success rate was 95.35% at week 4. The mean sphere significantly decreased from a mean pre-fitting value of -4.58 ± 1.28 D to a mean value of -0.65 ± 0.69 D at week 4 (p < 0.0001). Statistically significant corneal flattening was detected during keratometry at week 4. Conclusion Overnight OK with the White OK lens is effective for the correction of moderate and high myopia with astigmatism over a one-month wearing period.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
/
v.46
no.2
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pp.125-132
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2020
Objectives: The requirement for overnight hospital stay should be considered preoperatively according to patient-related factors, type of surgery, and anesthetic management plan. In this study, we aimed to define the major factors that influence consideration of overnight hospital stay in patients undergoing oral and maxillofacial (OMF) surgery in an operating room (OR) of a dental hospital in an outpatient setting. Materials and Methods: The records of patients who underwent oral procedures under general anesthesia between 2014-2017 were reviewed. Results: A total of 821 patients underwent oral procedures under general anesthesia; 631 of them underwent OMF surgery in the OR of a dental hospital, and 174 of these patients were hospitalized for overnight stay. There was no significant difference in the number of patients with comorbidities between the outpatient and hospitalized patient groups (P=0.389). The duration of surgery was longer in the hospitalized patient group (105.25±57.48 vs 189.62±82.03 minutes; P<0.001). Double-jaw (n=15; 310.00±54.21 minutes) and iliac crest grafting surgeries (n=59; 211.86±61.02 minutes) had the longest durations. Patients who underwent iliac crest grafting had the highest rates of hospitalization (79%). The overall recovery period was longer in outpatients (119.40±41.60 vs 149.83±52.04; P<0.001). Conclusion: Duration of surgery was the main determinant in considering whether a patient required overnight hospital stay. However, patients with an American Society of Anesthesiology physical status score <3 may be scheduled for OMF surgery in the OR of a dental hospital in an outpatient setting regardless of duration of surgery if overnight hospital stay is planned or an extended recovery period is provided until patients meet the discharge criteria.
8-isoprostane (8-$isoPGF_{2{\alpha}}$) is a reliable marker and considered a gold standard for lipid peroxidation. There are very few reports of 8-isoprostane levels in cancer patients, and in patients undergoing chemotherapy. Oxidative stress is however expected and has been observed in patients with cancer. This study measured 8-isoprostane levels in urine by ELISA of 25 patients undergoing chemotherapy for advanced non-small cell lung cancer, at cycles 1, 2, and 3 of treatment. It considers the creatinine clearance of the patients, and correction of 8-isoprostane levels by creatinine clearance, and overnight urine volume methods. The average 8-isoprostane levels in urine increased more than 6 to 12 fold on chemotherapy treatment, from $532{\pm}587$ pg/mL at cycle $1,6181{\pm}4334$ at cycle 2, and $5511{\pm}2055$ at cycle 3. Similar results were obtained if 8-isoprostane levels were corrected for overnight urine volume, giving averages of $285{\pm}244{\mu}g$ at cycle $1,4122{\pm}3349$ at cycle 2, and $3266{\pm}1200$ at cycle 3. No significant difference was seen in average total overnight urine volume or number of urinations between chemotherapy cycles except for a large variation in urine volume between cycle 2 and 3. Creatinine levels were significantly different only between cycles 1 and 2 (p=0.016). In conclusion, cisplatin therapy has been shown to induce high levels of lipid peroxidation in lung cancer patients and can be assessed from the 8-isoprostane marker in overnight urine, with or without urine volume correction.
Purpose: Percutaneous liver biopsy (PLB), a diagnostic procedure to identify several hepatobiliary disorders, is considered safe with low incidence of associated complications. While postoperative monitoring guidelines are suggested for adults, selection of procedural recovery time for children remains at the discretion of individual operators. We aim to determine if differences exist in frequency of surgical complications, unplanned admissions, and healthcare cost for children undergoing outpatient PLB for cohorts with same-day vs. overnight observation. Methods: We performed a retrospective cohort study in children 1 month to 17 years of age undergoing ultrasound-guided PLB from January 2009 to August 2017 at a tertiary care, pediatric referral center. Cohorts were defined by postprocedural observation duration: same-day (${\leq}8$ hours) vs. overnight observation. Outcomes included surgical complications, medical interventions, unscheduled hospitalization within 7 days, and total encounter costs. Results: One hundred and twelve children met study criteria of which 18 (16.1%) were assigned to same-day observation. No differences were noted in demographics, anthropometrics, comorbidities, biopsy indications, or preoperative coagulation profiles. No major complications or acute hospitalizations after PLB were observed. Administration of analgesia and fluid boluses were isolated and given within 8 hours. Compared to overnight monitoring, same-day observation accrued less total costs (US $992 less per encounter). Conclusion: Same-day observation after PLB in children appears well-tolerated with only minor interventions and complications observed within 8 hours of procedure. We recommend a targeted risk assessment prior to selection of observation duration. Same-day observation appears an appropriate recovery strategy in otherwise low-risk children undergoing outpatient PLB.
Objectives: The Obstructive sleep apnea syndrome is characterized by snoring, observed apnea during sleep and excessive daytime sleepiness. The overnight polysomnographic recording is used to investigate patients with possible obstructive sleep apnea syndrome. But the overnight polysomnographic recording is time consuming, expensive, and labor-intensive. Recently in diagnosis of obstructive sleep apnea syndrome, several simple screening tests have been suggested. Methods: This study was performed to assess the probability of application of clinical features and the degree of oxygen desaturation as a screening test for the obstructive sleep apnea syndrome. The sensitivity and specificity of the self-report of clinical features including snoring, observed apnea during sleep, excessive daytime sleepiness and insomnia were tested. And the degree of oxygen desaturation measured by oximetry in 42 subjects were compared with the overnight polysomnographic recording results. Results: In the prediction of apnea index more than 5, the sensitivity of observed apnea during sleep, snoring, excessive daytime sleepiness and insomnia were 96.8%, 93.5%, 38.7%, 25.8% and the specificity of those clinical features were 182%, 36.4%, 100%, 72.7%, respectively. In the prediction of apnea index more than 5, the sensitivity and specificity of the combination of more than three self-report clinical features were 54.8% and 90.9%. The degree of oxygen de saturation and maximal apnea duration in the group of apnea index more than 5 were significantly different from those in the group of apnea index below 5(P<0.001). And the apnea index was significantly correlated with the degree of oxygen desaturation and maximal apnea duration(P<0.001). Conclusion: These results suggest that application of clinical features alone as a screening test for the obstructive sleep apnea syndrome is inadequate because of it's high rate of false positive and false negative results. The degree of oxygen desaturation measured by oximetry is possibly applicable to screening test and follow up evaluation of treatment efficacy for the obstructive sleep apnea syndrome.
Purpose: The purpose of this study was to examine the corneal topographical changes associated with the wearing of everted silicone hydrogel soft lenses. Methods: The shape and fluorescein pattern of everted silicone hydrogel lenses were investigated. The subject wore the silicone hydrogel everted lenses overnight for 8 hours. Objective refractive error and corneal shape were evaluated at baseline, 1, 2, 3, 5, and 7 days after lens wearing and 1,2,3, and 4 days after discontinuation of lens wear. Results: The Fluorescein pattern of everted silicone hydrogel lenses was similar to the reverse geometry lenses with pressure profile. Objective refractive error(sphere power) and corneal refractive power were decreased and corneal shape had changed during the everted silicone hydrogel lenses wear and recovered during the 4 days of discontinuation. Subject experienced no discomfort associated with the everted silicone hydrogel lenses. Conclusions: It appears that everted silicone hydrogel lenses are capable of inducing significant changes in corneal topography, with overnight wear. Further study must be done to help understand these changes to develop a predictable and effective way of using soft contact lenses for corneal reshaping.
Shivanand Bomman;Sofya Malashanka;Adil Ghafoor;David J. Sanders;Shayan Irani;Richard A. Kozarek;Andrew Ross;Michal Hubka;Rajesh Krishnamoorthi
Clinical Endoscopy
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v.55
no.5
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pp.630-636
/
2022
Background/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution's programmatic allocation of resources during the safe implementation of TIF as a new procedure. Methods: A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition. Results: Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine esophagogram. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02). Conclusions: A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.
Approximately 1% to 3% of all children have obstructive sleep apnea syndrome (OSAS). OSAS in children can lead to a variety of symptoms and sequalae; impairment of development and quality of life, behavioral and personality disturbance, learning problem, cor pulmonale and hypertension. Diagnosis and treatment of OASA for children are different from those for adults in many respects. Adenotonsillar hypertrophy is major cause of childhood OSAS. Overnight polysomnography in a sleep laboratory is the gold standard for diagnosing childhood OSAS. However, because full polysomnography in children may be difficult to obtain, expensive, and inconvenient, other methods to diagnose OSAS have been investigated. Adenotonsillectomy is the most common surgical treatment of childhood OSAS. But if residual symptoms remained after adenotonsillectomy, it should be considered to additional treatment such as weight control, sleep positional change, and continuous positive airway pressure (CPAP).
Since its development in the early 70s, actigraphy has been widely used in sleep research and clinical sleep medicine as an assessment tool of sleep and sleep-wake cycles. The validation and reliability of actigraphic measures have been reasonably examined in healthy normal individuals with good sleep patterns. Recent literature suggests that the use of actigraphy could be further extended to monitor insomnia and circadian sleep-wake disturbances, and detect sleep changes associated with drug treatments and non-pharmacologic interventions, although it is generally recommended to use complementary assessments such as sleep diaries and overnight polysomnography when possible. The development of actigraphy includes its improved hardware sensors for better detection of movements and advanced algorithms to score sleep and wake epochs. In this paper, we briefly review the quantitative analysis methods of actigraphy and its potential applications in sleep research.
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