Bibliometric analysis of research articles on post-herpetic neuralgia published from 1991 to 2020.

Post-herpetic neuralgia (PHN) is one of the most painful diseases, which has made it a major concern for pain physicians. We aimed to quantitatively analyze the research outputs of studies on PHN published over the past 30 years using bibliometric analysis. We also aimed to analyze the research outputs of studies on interventional treatments for PHN and evaluate the academic achievements of Korean pain physicians. Bibliometric analysis was performed by searching the Web of Science database for PHN-related articles published between 1991 and 2020. Publication number, year, source, country, institution, and citation-related information were retrieved from the database. We also quantitatively analyzed publications related to interventional treatments for PHN. A total of 3285 publications were extracted from the database; 101 (3.1%) of the articles were published by South Korean authors, making South Korea the 11th in the order of countries that published the most articles. There were 185 articles on the effects of interventional treatments for PHN. South Korean authors published 30 (16.2%) articles out of these, making South Korea the 3rd in the order of countries that published the most articles on the effects of interventional treatment for PHN. Our results showed an increasing trend in the number of PHN-related publications and the academic achievements of Korean pain physicians in this field over the past 3 decades. However, the proportion of studies on interventional treatments is relatively small. Korean pain physicians need to establish academic evidence on interventional treatment to expand their role in this field and improve the outcomes of PHN patients.

Ultrasound-assisted spinal anesthesia: A randomized comparison between midline and paramedian approaches.

STUDY OBJECTIVE: Neuraxial ultrasonography can improve the technical performance of spinal anesthesia. However, there are no data regarding the optimal approach for ultrasound-assisted spinal anesthesia. This study aimed to compare the midline and paramedian approaches for ultrasound-assisted spinal anesthesia in adult orthopedic patients. DESIGN: A single-center, prospective, randomized controlled trial. SETTING: Operating room. PATIENTS: One hundred and twelve patients undergoing orthopedic surgery were included. INTERVENTIONS: Patients were randomized to undergo either the midline or paramedian approach for preprocedural ultrasound-assisted spinal anesthesia. MEASUREMENTS: The primary outcome was the number of needle passes required for successful dural puncture. Secondary outcomes were the number of needle insertions, first pass/attempt success rate, procedural time, and the incidence of periprocedural complications. MAIN RESULTS: The median number of needle passes was significantly lower in the paramedian group (1 [IQR, 1-2]) than in the midline group (3 [2-6]; P < 0.001). The paramedian approach showed higher first pass/attempt success rates compared with the midline group (58.9% vs. 21.4%; 91.1% vs. 53.6%; both, P < 0.001). Total procedure times were significantly shorter in the paramedian group than in the midline group (113 [72.5-146.5] vs. 196 [138-298.5] seconds; P < 0.001). The quality of sonographic images was graded as good in 94.6% of paramedian sagittal oblique views and 54.5% of transverse median views. No significant intergroup differences were found in the incidence of periprocedural complications. CONCLUSIONS: Compared with the midline approach, the ultrasound-assisted paramedian approach showed improved efficacy in terms of the number of needle manipulations, first pass success rates, and procedural time. These results suggest that the paramedian approach may be more efficient for preprocedural ultrasound-assisted spinal anesthesia. TRIAL REGISTRATION NUMBER: NCT03491943.

Performance of the ACEF and ACEF II risk scores in predicting mortality after off-pump coronary artery bypass grafting.

STUDY OBJECTIVE: The age, creatinine, and ejection fraction (ACEF) I and II scores are known to predict operative mortality after cardiac surgery. However, data from few cases of off-pump coronary artery bypass grafting (OPCAB) were considered during the development of these scores. This study aimed to validate and update the ACEF I and II scores for the prediction of in-hospital mortality after OPCAB. DESIGN: Single-center retrospective observational study. SETTING: Tertiary university hospital. PATIENTS: All adult patients (≥18 years) who underwent isolated OPCAB between 2011 and 2020 were included in our analysis. MEASUREMENTS: Predicted in-hospital mortality after OPCAB was calculated using ACEF and ACEF II scores. Performance of ACEF I and II scores in predicting in-hospital mortality after OPCAB was evaluated using receiver operating characteristics curves and calibration plots. Scores were recalibrated and modified using the closed testing procedure and multivariable fractional polynomial analysis. MAIN RESULTS: In total, 1450 patients were analyzed. The ACEF I and II scores discriminated in-hospital mortality with the c-statistics of 0.86 and 0.83, respectively. The calibration plots revealed that both scores overestimated the risk of in-hospital mortality. The ACEF I score was recalibrated by re-estimating only the model intercept. The ACEF II score was modified by substituting hematocrit with left main coronary artery disease. The c-statistic of the updated ACEF II score increased to 0.86. Both the updated ACEF I and II scores were well-calibrated. CONCLUSIONS: The ACEF I and II scores discriminated in-hospital mortality after OPCAB with excellent accuracy, although calibration properties were suboptimal. The updated scores showed even better discrimination and calibration. Thus, the ACEF I and ACEF II scores can be relatively straightforward and useful tools for prognostication of patients undergoing OPCAB.

Cephalocaudal tumor diameter is a predictor of diabetes insipidus after endoscopic transsphenoidal surgery for non-functioning pituitary adenoma.

PURPOSE: Diabetes insipidus (DI) develops commonly after endoscopic transsphenoidal surgery (ETS). We retrospectively investigated the incidence, onset, duration and predictors of DI after ETS in patients with non-functioning pituitary adenoma (NFPA). METHODS: A total of 168 patients who underwent ETS to remove NFPAs were included. Various perioperative data on demographics, comorbidities, previous treatments, perioperative hormone deficiencies, tumor characteristics, surgery, anesthesia, intraoperative fluid balance, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed. Patients were diagnosed with DI and treated with desmopressin when they showed urine output > 5 mL/kg/hr with a serum sodium concentration > 145 mmol/L or an increase ≥ 3 mmol/L in serum sodium concentration between two consecutive tests after surgery. DI was considered permanent when desmopressin was prescribed for > 6 months after surgery. RESULTS: Seventy-seven (45.8%) patients experienced postoperative DI and 10 (6.0%) patients suffered from permanent DI. The median onset of DI and the median duration of transient DI were postoperative day 1 and 5 days, respectively. In multivariable logistic regression analysis, cephalocaudal tumor diameter (odds ratio [95% confidence interval] 2.59 [1.05-6.36], P = 0.038) was related to postoperative DI. In receiver operating characteristic analysis, its area under the curve was 0.68 (95% confidence interval 0.59-0.76, P < 0.001). Its optimal cutoff value that maximized the sum of sensitivity and specificity for postoperative DI was 2.7 cm. CONCLUSIONS: Postoperative DI was observed in 45.8% of patients undergoing ETS to remove NFPAs. A large cephalocaudal tumor diameter was predictive of postoperative DI in such patients.

Safety and efficacy of immune checkpoint inhibitors for end-stage renal disease patients undergoing dialysis: a retrospective case series and literature review.

Despite the lack of safety and efficacy data regarding immune checkpoint inhibitors (ICIs) for renal dysfunction, they have been approved to treat even in the patients with end-stage renal disease (ESRD). We report our experience with ICI administration to three ESRD patients undergoing hemodialysis. One of the patients had a partial response for several months; however, the other patients had a stable disease while undergoing dialysis. The toxicity was tolerable; however, one patient developed grade 2 pneumonitis. A literature review of other rarely reported cases of hemodialysis revealed that 10 out of 13 patients had a partial response or complete response; in addition, grade 3 or grade 4 immune-related adverse events occurred in 3 patients. ESRD combined with dialysis may not be a contraindication for the use of ICIs. ICIs can be beneficial to ESRD patients undergoing dialysis. However, caution is needed regarding immune-related adverse events. Further prospective studies involving pharmacokinetic analyses are necessary to obtain reliable safety and efficacy data.