Knowledge on the impact of neoadjuvant and adjuvant treatments on post-surgery lymphedema (LE) in patients with breast cancer is limited due to methodological limitations and an insufficient sample ...size. We investigated the risk of LE in patients going through long-term anticancer treatment regimens using a national cohort from the Korean National Health Insurance Service database from 2011-2013. Incidence rate ratio, Kaplan-Meier analysis, and Cox proportional regression analysis were performed. A total of 39,791 patients were included. While minimal lymph node dissection (SLNB) reduced the risk of LE (hazard ratio HR 0.51) as expected, neoadjuvant chemotherapy (NAC) followed by SLNB did not reduce the risk. Adjusting for adjuvant chemotherapy (AC) as time-varying exposure decreased the risk of LE in the SLNB group (HR 0.51), but not the mortality risk (HR 0.861). A longer duration of NAC, especially taxane-based, combined with SLNB reversed the effect and increased risk of LE. The findings highlight the importance of not only early surveillance before and after surgery, but also long-term surveillance during adjuvant treatment by surgeons and oncologists in order to reduce the risk of LE.
This study sought to investigate the safety of percutaneous left atrial appendage (LAA) occlusion for stroke prevention in patients with nonvalvular atrial fibrillation who have LAA thrombus. From ...October 2010 to October 2016, LAA occlusions were performed in facilities within a Korean multicenter registry in patients without (n = 132) or with (n = 10) LAA thrombus (detected during preprocedural assessments). The incidences of periprocedural complications, including stroke, pericardial tamponade, major bleeding, and device embolization, were assessed and compared between the groups. The incidence of periprocedural complications was not significantly different between patients with and without LAA thrombus (0% vs 5% 6 of 132; p = 0.49). During the mean 23.2 ± 17.5-month follow-up duration, 7 major adverse cardiac events occurred (1 cardiovascular death, 6 ischemic strokes), but overall event rates were not significantly different between the groups (14% vs 9%; p = 0.47). In conclusion, percutaneous LAA occlusion in nonvalvular atrial fibrillation patients with LAA thrombus may be a safe and feasible alternative to anticoagulation in select patients at a high risk of bleeding or contraindication to anticoagulation, or in whom anticoagulation failed to prevent stroke.
Guest Editorial: Marine Robotics and Control Systems Yu, Son-Cheol; Pascoal, Antonio M.; Kim, Jinwhan
International journal of control, automation, and systems,
03/2020, Letnik:
18, Številka:
3
Journal Article
Odprti dostop
This special issue is devoted to the topic of marine robot’s control, intelligence, and perception. In terms of the mobility platform, a marine robot is challenging due to the restriction of sensing ...and moving environment, water surface, or underwater. In terms of marine vehicle control, there are many rooms to improve. This special issue deals with the control strategy of a surface vessel and an underwater vehicle. Surface and underwater perception is the key to automate the marine system. Optical vision is strictly limited in underwater and sonar data; few available sensing methods have poor S/N with low resolution. Electromagnetic or electric field-based sensing is very challenging. This special issue provides representative solutions for the sensing and perception in marine sensing. Localization and the multi-agent system are also important issues of marine robots. This issue deals with the precision ASV navigation method and optimal multi-ASV operation strategy. Seabed or underwater objects’ 3D mapping is also a critical application of marine robots. Notably, most papers of this special issue have sea-trial with actual marine robot/vehicle. These studies could provide solid lessons for the marine robot’s study. KCI Citation Count: 0
This retrospective study aimed to evaluate the correlation between ophthalmologic factors and proteinuria in patients with pre-eclampsia using swept-source optical coherence tomography (OCT) and OCT ...angiography. In total, 61 pregnant patients diagnosed with pre-eclampsia were recruited during their hospital stay. The authors investigated the relationship between urine protein-creatinine ratio (PCR) and chorioretinal measurements including choroidal thickness (CT), choroidal vascularity index (CVI), foveal avascular zone (FAZ), vascular density (VD), ganglion cell layer+ (GCL+) and GCL++. The associations between mean arterial pressure (MAP) and ophthalmologic factors were also evaluated. Central subfield CT of the right eye (p = 0.031) and paracentral CT of both eyes were related to higher PCR (≥1.35 mg/mg). A significant association with PCR after logarithm transformation was noted (r = 0.284, p = 0.026). Retinal measurements (FAZ, VD, GCL+ and GCL++) and CVI were not related with PCR. There was a positive association between MAP and PCR after logarithm transformation (r = 0.296, p = 0.021); however, chorioretinal factors were not related with MAP. In pregnant women with pre-eclampsia, CT using OCT is a novel factor that is correlated with PCR. Ocular structural alteration in patients with pre-eclampsia may be one of systemic vascular changes caused by pre-eclampsia rather than hypertension.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Study Design.
Retrospective, cross-sectional study.
Objectives.
The aim of this study was to analyze types and cost of care for scoliosis and present health care utilization by patients to provide ...data on the standard treatment and cost for scoliosis in South Korea.
Summary of Background Data.
Scoliosis is defined as an abnormally laterally curved spine with a Cobb angle of ≥10°.Data are lacking on which treatments are popular for general scoliosis and which service categories incur the most cost in South Korea.
Methods.
Data from the Health Insurance Review and Assessment Service-National Patient Sample were used. In total, 108,643 final cases and 32,362 patients in South Korea who received Western medicine care or Korean medicine care at least once with scoliosis
(ICD-10
code M41) as the principal diagnosis during January 2010 to December 2018 comprised the study sample. We analyzed health care utilization according to certain factors
(e.g.,
age, sex, payer type, type of visit, and medical institution), health care utilization by service category and service code, and medication prescriptions filled by private or hospital pharmacies.
Results.
Patients aged 24 years or younger most frequently utilized health care services, with more female (64.84%) than male patients (35.16%). Most patients received only Western medicine care (92.18%), whereas 6.56% only received Korean medicine care. Most cases (99.37%) corresponded to outpatient. Regarding service category, treatment and surgery, examination, special equipment and radiologic diagnosis accounted for a substantial percentage. Regarding service code, cost of examination, imaging, and physiotherapy comprised a high percentage of Western medicine, whereas cost of examination, acupuncture, and cupping therapy accounted for a high percentage of Korean medicine. The most commonly prescribed medications for scoliosis in pharmacies were anti-inflammatory analgesics (nonsteroidal anti-inflammatory drugs), antacids, and skeletal muscle relaxers.
Conclusion.
The findings can be used as foundational data for experts such as health care policymakers, clinicians, and researchers.
Level of Evidence:
4
This study aimed to analyze current trends in healthcare utilization and medication usage in patients with insomnia. We reviewed the National Patient Sample data from the Health Insurance Review and ...Assessment Service to determine healthcare utilization in patients diagnosed with insomnia (International Classification of Diseases-10 codes G470, F510) between January 2010 and December 2016. There were 87,470 patients enrolled in this study who utilized healthcare services at least once during the 7-year period. Healthcare utilization trends, Korean and Western medicine (KM and WM, respectively) therapies utilized, comorbidities, and socioeconomic data were analyzed. The number of patients seeking WM or KM care for insomnia increased annually. Adults aged ≥45 years accounted for 73% of the cohort, and there were more female than male patients. KM treatment including acupuncture was the most common in KM (65.29%), while examination was the most common WM treatments (49.31%). In pharmacological therapy, sedatives and hypnotics were the most common (41.08%), followed by antianxiety (19.50%), digestive system and metabolism-related drugs (7.77%). The most common comorbidities were mental health disorders (50.56%) in WM but musculoskeletal disorders in KM (35.67%). Code G470 was used more frequently than code F510, and the difference was more evident in KM than in WM. The findings will provide valuable information for both clinicians and researchers.
Background Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. ...Methods We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance HLC group vs. low lactate clearance LLC group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval CI 0.985-0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC greater than or equai to 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42-0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate less than or equai to 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate less than or equai to 5 mmol/L = 0.660, p = 0.011). Conclusions Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC greater than or equai to 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016--retrospectively and prospectively registered, Keywords: Cardiogenic shock, Lactate clearance, Prognosis
This study was performed to investigate the efficacy of the treat-and-extend regimen using aflibercept for treating diabetic macular oedema (DME). This prospective, multicentre, interventional, ...single-arm, 104-week clinical trial included 48 patients with DME visual impairment. The patients' eyes received five consecutive intravitreal injections (2 mg aflibercept) every four weeks with two-week adjustments based on central subfield macular thickness (CSMT) changes. Injections were deferred when CSMT was stable. The number of injections, best-corrected visual acuity (BCVA), CSMT, and diabetic retinopathy severity scale scores were analysed. Compared to baseline, BCVA improved by + 9.1 letters at 52 weeks and was maintained with + 9.4-letter gain at 104 weeks (P < 0.001). Between baseline and 104 weeks, CSMT decreased from 489 to 298 μm (P < 0.001) and eyes with vision ≥ 20/40 increased from 17.4 to 43.5% (P = 0.007). The mean number of injections decreased from 8.5 in year one to 3.9 in year two. The injection interval was extended to ≥ 12 weeks in 56.5% of patients. The treat-and-extend regimen of aflibercept in DME showed 2-year efficacy comparable to that of fixed dosing regimens. The flexible dosing of this regimen reduced the number of injections in year two while maintaining efficacy.
This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions.
SB occlusion is a serious complication that ...occurs during percutaneous coronary intervention (PCI) for bifurcation lesions.
Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3.
SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio OR: 2.34; 95% confidence interval CI: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02).
Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..
We report new organic nonlinear optical salt crystals comprising bis(head-to-tail) complementary cation-anion assembly that results in extremely efficient THz wave generation. In the new salt ...crystals, each of the ends of the molecular anion, 4-(trifluoromethyl)benzenesulfonate, possesses bis(hydrogen-bond acceptors), while each of the ends of the nonlinear optical molecular cationic chromophore, 2-(4-(4-(hydroxymethyl)piperidin-1-yl)styryl)-3-methylbenzothiazol-3-ium, possesses bis(hydrogen-bond donors). The resulting assembly fulfills the requirements for efficient broadband THz wave generation, namely, perfectly parallel alignment of the nonlinear optical cationic chromophores for maximizing the optical nonlinearity as well as strong interionic binding interactions for reducing self-absorption of the generated THz waves. The new benzothiazolium crystals provide extremely high optical-to-THz conversion efficiency with a broad THz spectral bandwidth of 8 THz, where the peak-to-peak THz electric field amplitude is 36 times higher than that of the benchmark inorganic 1.0 mm-thick ZnTe crystal when pumped at 1300 nm and also notably higher than those of benchmark organic analogous crystals.
New ionic organic crystals with bis(head-to-tail) complementary cation-anion assembly result in extremely efficient THz wave generation due to strong interionic binding interactions and parallel alignment of nonlinear optical cationic chromophores.
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