Sugammadex reduces postoperative complications. We sought to determine whether it could reduce the length of hospital stay, post-anesthetic recovery time, unplanned readmission, and charges for ...patients who underwent robot-assisted laparoscopic prostatectomy (RALP) when compared to neostigmine.
This was a retrospective observational study of patients who underwent RALP between July 2012 and July 2017, in whom rocuronium was used as a neuromuscular blocker. The primary outcome was the length of hospital stay after surgery in patients who underwent reversal with sugammadex when compared to those who underwent reversal with neostigmine. The secondary outcomes were post-anesthetic recovery time, hospital charges, and unplanned readmission within 30 days after RALP.
In total, 1430 patients were enrolled. Using a generalized linear model in a propensity score-matched cohort, sugammadex use was associated with a 6% decrease in the length of hospital stay (mean: sugammadex 7.7 days vs. neostigmine 8.2 days; odds ratio OR 0.94, 95% confidence interval CI 0.89, 0.98, P = 0.008) and an 8% decrease in post-anesthetic recovery time (mean: sugammadex 36.7 min vs. neostigmine 40.2 min; OR 0.92, 95% CI 0.90, 0.94, P < 0.001) as compared to neostigmine use; however, it did not reduce the 30-day unplanned readmission rate (P = 0.288). The anesthesia charges were higher in the sugammadex group than in the neostigmine group (P < 0.001); however, there were no significant differences between the groups in terms of postoperative net charges (P = 0.061) and total charges (P = 0.100).
Compared to the reversal of rocuronium effects with neostigmine, reversal with sugammadex after RALP was associated with a shorter hospital stay and post-anesthetic recovery time, and was not associated with 30-day unplanned readmission rates and net charges.
•Coenzyme Q10 inhibited cerulein-induced and PDL-induced acute pancreatitis.•Coenzyme Q10 inhibited the inflammatory cell infiltration during acute pancreatitis.•Coenzyme Q10 reduced the ERK and JNK ...activation.
Acute pancreatitis (AP) refers to inflammation in the pancreas, which may lead to death in severe cases. Coenzyme Q10 (Q10), generally known to generate energy, plays an important role as an anti-oxidant and anti-inflammatory effector. Here, we showed the effect of Q10 on inflammatory response in murine AP model. For this study, we induced AP by injection of cerulein intraperitoneally or pancreatic duct ligation (PDL) in mice. The level of cytokines and digestive enzymes were measured in pancreas, and blood. All pancreatic tissues were excised for investigation such as histological changes, infiltration of immune cells. Administration of Q10 attenuated the severity of AP and its associated pulmonary complication as shown by reduction of acinar cell death, parenchymal edema, inflammatory cell infiltration and alveolar thickening in both cerulein-induced AP and PDL-induced AP. Moreover, reduction of the cytokines such as interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α were observed in pancreas and pancreatic acinar cells by Q10. Furthermore, Q10 reduced the infiltration of immune cells such as monocytes and neutrophils and augmentation of chemokines such as CC chemokine-2 (CCL2) and C-X-C chemokine-2 (CXCL2) in pancreas of AP mice. In addition, Q10 deactivates the phosphorylation of extracellular signal-regulated kinase (ERK) and c-jun NH2-terminal kinase (JNK) in pancreas. In conclusion, these observations suggest that Q10 could attenuate the pancreatic damage and its associated pulmonary complications via inhibition of inflammatory cytokines and inflammatory cell infiltration and that the deactivation of ERK and JNK by Q10 might contribute to the attenuation of AP.
Background
Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over ...surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly.
Methods
Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (
n
= 46, ≥70 years of age) and the non-elderly groups (
n
= 130, <70 years of age).
Results
Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06 years,
p
< 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%,
p
= 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%,
p
= 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%,
p
= 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%,
p
= 0.299) and perforation (13.0 vs. 6.2%,
p
= 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (
p
= 0.307).
Conclusion
ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.
BackgroundOpen reduction and internal fixation of a displaced unstable fracture of the lateral condyle of the humerus in a child usually produces a good result. Only a few reports have focused on ...closed reduction and internal fixation of these fractures. We prospectively studied closed reduction and internal fixation to determine its usefulness as the initial treatment for displaced unstable fractures of the lateral condyle of the humerus.MethodsWe classified lateral condylar humeral fractures into five groups according to the degree of displacement and the fracture pattern as determined on four radiographic views and created an algorithm for the treatment of these fractures on the basis of this classification system. We prospectively treated sixty-three unstable fractures (in forty-two boys and twenty-one girls) and assessed the quality of closed reduction.ResultsThirteen of seventeen stage-3 fractures were reduced to ≤1 mm of residual displacement. Thirty of forty stage-4 fractures and three of six stage-5 fractures were reduced to ≤2 mm of displacement. In ten of forty stage-4 fractures and three of six stage-5 fractures, closed reduction to within 2 mm failed and open reduction and internal fixation was performed. There were no major complications such as osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest.ConclusionsClosed reduction and internal fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in many children. If fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
Introduction
It is likely that posterior-wall involvement in association with two-column fractures plays a pivotal role in outcomes because of the potential for hip instability if it is not ...anatomically reduced and fixed. Uncertainty remains about how this fracture is best treated, especially regarding how posterior-wall involvement may affect functional results.
Materials and methods
To better understand the role that posterior-wall involvement may play in determining functional results, we compared data for outcomes for patients with posterior-wall involvement and for those without in a consecutive series of two-column fractures. Between 2000 and 2013, 42 patients who underwent surgical treatment for two-column acetabular fractures were evaluated after a minimum follow-up period of 1 year. Data were prospectively collected and retrospectively evaluated. Of the 42 patients, 25 had only a two-column fracture (group 1) and 17 had a two-column fracture with posterior-wall involvement (group 2).
Results
There were no differences between groups in terms of reduction accuracy, radiographic results, clinical results, or complication rates. All hips in patients with internal fixation for the associated posterior-wall fracture had anatomical reduction. At the latest follow-up evaluation, three patients from group 1 (without posterior-wall involvement) and three patients from group 2 (with posterior-wall involvement) had undergone total hip arthroplasty.
Conclusion
These results suggest that a posterior-wall fracture in a two-column fracture does not compromise functional outcomes when the treatment algorithm discussed here is followed.
•Presently, we determined the pathogenicity and transmissibility of the three different clades H5 viruses in mandarin ducks to compare the potential of wild bird infection.•None of mandarin ducks ...with H5N8 and H5N1 viruses caused severe clinical signs and mortality and the gross lesions were only observed in a few tissues of mandarin ducks; viral replication and shedding were greater in H5N8-infected ducks than in H5N1-infected ducks.
A highly pathogenic avian influenza (HPAI) H5N8 virus was first detected in poultry and wild birds in South Korea in January 2014. Here, we determined the pathogenicity and transmissibility of three different clades of H5 viruses in mandarin ducks to examine the potential for wild bird infection. H5N8 (clade 2.3.4.4) replicated more efficiently in the upper and lower respiratory tract of mandarin ducks than two previously identified H5N1 virus clades (clades 2.2 and 2.3.2.1). However, none of the mandarin ducks infected with H5N8 and H5N1 viruses showed severe clinical signs or mortality, and gross lesions were only observed in a few tissues. Viral replication and shedding were greater in H5N8-infected ducks than in H5N1-infected ducks. Recovery of all viruses from control duck in contact with infected ducks indicated that the highly pathogenic H5 viruses spread horizontally through contact. Taken together, these results suggest that H5N8 viruses spread efficiently in mandarin ducks. Further studies of pathogenicity in wild birds are required to examine possible long-distance dissemination via migration routes.
Background/Aims
There have been few population-based studies on the prevalences of gastroesophageal reflux disease (GERD) and dyspepsia using Rome III criteria in Asian countries.
Methods
A ...population-based, cross-sectional study was conducted by telephone interviews of 5,000 Koreans between the ages of 20–69 years. Gastrointestinal symptoms were assessed by a translated Korean version of Rome III criteria. Uninvestigated dyspepsia (UID) was defined by symptom criteria of Rome III. GERD was defined by troublesome heartburn and/or acid regurgitation occurring at least once a week. The EQ5D assessment tool was used for the evaluation of quality of life.
Results
The prevalences of UID, postprandial distress syndrome (PDS), and epigastric pain syndrome (EPS) were 7.7, 5.6, and 4.2 %, respectively. Overlap between PDS and EPS was found in 27.1 % (104/384) of subjects with UID. There were no significant differences in demographic variables between patients with PDS and EPS. The prevalence of GERD was 7.1 %. Overlap between GERD and UID was found in 50.0 % of GERD patients. The EQ5D index of patients without either UID or GERD was 0.92 ± 0.07, and those of patients with only UID, with only GERD, and with both UID and GERD were 0.88 ± 0.09, 0.88 ± 0.11, and 0.84 ± 0.15, respectively.
Conclusions
GERD and UID based on Rome III criteria were prevalent and significantly affected the quality of life in Korea. In Korean patients with UID, there was considerable overlap and there were no significant differences in demographic variables between PDS and EPS.
Esophagogastric junction outflow obstruction (EGJOO) is a diagnostically heterogeneous group with variable clinical relevance. We studied whether evaluation of bolus transit by multichannel ...intraluminal impedance (MII) is useful for discriminating clinically relevant EGJOO.
A total 169 patients diagnosed as having EGJOO between June 2011 and February 2018 were analyzed. All the patients received a combined MII and high-resolution manometry (CMII-HRM). MII was reported as having abnormal liquid bolus transit (LBT) if ＜ 80% of swallows had complete bolus transit. EGJOO was defined as a median integrated relaxation pressure of ＞ 20 mmHg and when the criteria for achalasia were not met. Patients who progress to achalasia, show significant passage disturbance, or require pneumatic dilatation were defined as having a clinically relevant EGJOO.
Among the patients with EGJOO (n = 169), the clinically relevant group (n = 10) is more likely to have dysphagia (100% vs 25.2%,
＜ 0.001), compartmentalized pressurization (CP; 90.0% vs 22.0%,
＜ 0.001), and abnormal LBT (100% vs 66.7%,
= 0.032) compared to the non-relevant group (n = 159). The combination of dysphagia, CP, and abnormal LBT showed the best predictive power for clinically relevant EGJOO (sensitivity 90%, specificity 92.5%, positive predictive value 42.9%, negative predictive value 99.3%, positive likelihood ratio 11.9, and negative likelihood ratio 0.1). When CMII-HRM was used, an additional 8.3% of clinically relevant EGJOO cases were identified as compared with HRM alone.
Clinically relevant EGJOO can be predicted using CMII-HRM.
BACKGROUND:Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF ...and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients. We investigated the prevalence of aBMD discordance and the characteristics of patients with AFF.
METHODS:Medical records for 63 consecutive patients treated for AFF were retrospectively evaluated, and 48 patients, all female, were eligible for the study. The average age at the time of fracture was 73.0 years, the average duration of bisphosphonate use was 68.5 months, and the average presumed age at bisphosphonate initiation was 67.2 years. We evaluated the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual as well as demographic differences between the discordance and concordance groups. We also compared the prevalence of discordance in patients with AFF with that in 114 female patients with intertrochanteric femoral fracture (ITFF).
RESULTS:T-score concordance, minor discordance, and major discordance were seen in 14 (29%), 32 (67%), and 2 (4%) of the patients with AFF, respectively. The prevalence of discordance was significantly higher in those with AFF (71%) than in those with ITFF (23%) (p < 0.001). The average age at bisphosphonate initiation in the AFF group was lower in the discordance group (65.7 years) than in the concordance group (70.7 years) (p = 0.04).
CONCLUSIONS:The prevalence of T-score discordance between the hip and lumbar spine was relatively high in patients with AFF, and the presumed age at the initiation of bisphosphonate therapy was younger in patients with discordant T-scores in this study.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Polydimethylsiloxane (PDMS) is widely used in the fabrication of fluidic chips. Recently, a direct mechanical micromilling process using cryogenic cooling was considered to cut PDMS in order to ...reduce development time and prototyping costs. In this paper, the characteristics of cryogenic machining of PDMS were experimentally studied. The machined surface was analyzed with a variety of machining parameters, such as spindle speed and feed per tooth, and their effects on cutting temperature were examined. To improve geometric accuracy, a tool path compensation method that takes into account the shrinkage of PDMS at cryogenic temperatures was developed. Based on the preliminary results, the fabrication of a PDMS fluidic chip demonstrated that fluidic flow can be controlled by differences in the flow friction.
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