Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index.

Background/Aims: Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. Methods: The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Results: Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (<0.9) and positive CAVI (≥9.0) were significantly higher in the high-risk adenoma group (22.0% and 55.9%) than in the no adenoma (12.3% and 39.6%) and the overall adenoma group (15.7% and 44.0%) (p=0.008 and p=0.006, respectively). Multivariate analysis revealed a positive CAVI and smoking status to be significantly associated with high-risk adenoma with an odds ratio of 1.595 (95% confidence interval 1.055-2.410, p=0.027) and 1.579 (1.072-2.324, p=0.021), respectively. Conclusions: In this study, a significant correlation between positive CAVI and high-risk adenomas was observed. Therefore, CAVI may be a significant predictor for high-risk colorectal adenoma.

Do age, gender, and subjective health-related factors influence health-related life satisfaction in people with disabilities who are physically active?: a secondary analysis.

PURPOSE: This study explored the factors influencing the health-related life satisfaction of people with disabilities who engaged in physical activity, by age and gender. METHODS: A secondary analysis was conducted of the 2020 Third Disability and Life Dynamics Panel (2021). The participants were 2,796 people who performed regular physical activity at least once a week. The variables selected were disability-related factors (degree of disability, multiple disabilities, and type of disability), sociodemographic factors (age, gender, living alone, and mean monthly family income), and health-related factors (amount of physical activity, self-esteem, depression, chronic disease, subjective health, and health-related life satisfaction). Descriptive statistics, the chi-square test, the t-test, two-way analysis of variance, and multiple regression analysis were conducted. RESULTS: In total, 58.0% of participants were male, and 42.0% were female. For age groups, 14.4% were children/adolescents (0-19 years), 42.6% were adults (20-59 years), and 43.0% were seniors (≥60 years). The mean score for health-related life satisfaction was 5.0±2.15 out of 10. Adults and seniors whose level of physical activity met or exceeded recommendations had higher subjective health. Moreover, men had better subjective health than women in seniors. Health-related life satisfaction was higher among those who had higher self-esteem, were not depressed, did not have chronic diseases, and had better subjective health. CONCLUSION: Gender significantly influenced health-related life satisfaction in children/ adolescents and seniors. Disability-related factors were significant in adults, and health-related factors were significant in all age groups. Therefore, these factors should be considered when designing interventions to promote subjective health and health-related life satisfaction of people with disabilities.

Theoretical and experimental study of waste-heat-recovery boiler with water injection.

The waste-heat-recovery boiler with water injection (HR-B/W) applies the heat exchange between the intake air and exhaust gas with the water injection into the intake air. Previous theoretical studies have discussed that the HR-B/W would increase the thermal efficiency of the boiler by the active heat exchange between the intake air and exhaust gas. It has also been discussed that the increased fraction of water vapor in the air would reduce the flame temperature which in turn decreases the NOx emission. However, the potential performance of the HR-B/W has not been validated through practical boiler tests by considering the evaporation characteristics of the injected water, which plays a critical role in the performance of the HR-B/W. In this study the effects of water injection into the intake air on the thermal efficiency and pollutant emissions of the waste-heat-recovery boiler are investigated using a commercial 24 kW condensing boiler in full load condition. Thermodynamic analysis is performed to evaluate the adequate amount of water injection and trace the physical properties in the boiler upon the water injection amount and evaporation characteristics. The boiler test results showed water injection can increase thermal efficiency to 4.4% point and reduce NOx and CO emissions by 69% and 33% respectively compared to those without water injection. These advantages can be further enhanced if the atomization and evaporation performance of injected water is improved.

Boosting oxygen evolution reaction activity with Mo incorporated NiFe-LDH electrocatalyst for efficient water electrolysis.

This work demonstrates a simple and scalable methodology for the binder-free direct growth of Mo-doped NiFe-layered double hydroxides on a nickel substrate via an electrodeposition route at room temperature. A three-dimensional (3D) nanosheet array morphology of the electrocatalyst provides immense electrochemical surface area as well as abundant catalytically active sites. Mo incorporation in the NiFe-LDH plays a crucial role in regulating the catalytic activity of oxygen evolution reaction (OER). The prepared electrocatalyst exhibited low overpotential (i.e., 230 mV) at 30 mA cm-2 for OER in an alkaline electrolyte (i.e., 1 M KOH). Furthermore, the optimized Mo-doped NiFe-LDH electrode was used as an anode in a laboratory-scale in situ single cell test system for alkaline water electrolysis at 80 °C with a continuous flow of 30 wt% KOH, and it shows the efficient electrochemical performance with a lower cell voltage of 1.80 V at a current density of 400 mA cm-2. In addition, an admirable long-term cell durability is also demonstrated by the cell for 24 h. This work encourages new designs and further development of electrode material for alkaline water electrolysis on a commercial scale.

Thin Film Composite Membranes as a New Category of Alkaline Water Electrolysis Membranes.

Alkaline water electrolysis (AWE) is considered a promising technology for green hydrogen (H2 ) production. Conventional diaphragm-type porous membranes have a high risk of explosion owing to their high gas crossover, while nonporous anion exchange membranes lack mechanical and thermochemical stability, limiting their practical application. Herein, a thin film composite (TFC) membrane is proposed as a new category of AWE membranes. The TFC membrane consists of an ultrathin quaternary ammonium (QA) selective layer formed via Menshutkin reaction-based interfacial polymerization on a porous polyethylene (PE) support. The dense, alkaline-stable, and highly anion-conductive QA layer prevents gas crossover while promoting anion transport. The PE support reinforces the mechanical and thermochemical properties, while its highly porous and thin structure reduces mass transport resistance across the TFC membrane. Consequently, the TFC membrane exhibits unprecedentedly high AWE performance (1.16 A cm-2 at 1.8 V) using nonprecious group metal electrodes with a potassium hydroxide (25 wt%) aqueous solution at 80 °C, significantly outperforming commercial and other lab-made AWE membranes. Moreover, the TFC membrane demonstrates remarkably low gas crossover, long-term stability, and stack cell operability, thereby ensuring its commercial viability for green H2 production. This strategy provides an advanced material platform for energy and environmental applications.

Epidemiologic and Clinical Features of Campylobacter Enteritis Before and During COVID-19 in Korea.

BACKGROUND: With the increase in meals at home due to coronavirus disease 2019 (COVID-19), the pattern and incidence of enteritis seemed to change. Some types of enteritis, such as Campylobacter enteritis, appear to have increased. Our study aimed to evaluate the change in the trend of enteritis, especially Campylobacter enteritis, before COVID-19 (2016-2019) and at the present time during COVID-19 in South Korea. METHODS: We analyzed data from the Health Insurance Review and Assessment Service. From 2016 to 2020, the International Classification of Diseases codes related to enteritis were examined to distinguish bacterial and viral enteritis and the trends of each were analyzed. The aspects of enteritis, before and after the COVID-19 outbreak, were compared. RESULTS: Both bacterial and viral enteritis declined in all age groups from 2016 to 2020 (P < 0.001). In 2020, the reduction rate of viral enteritis was higher than that of bacterial enteritis. However, unlike other causes of enteritis, even after COVID-19, Campylobacter enteritis increased in all age groups. An increase of Campylobacter enteritis in 2020 was particularly noticeable in children and adolescents. The prevalence of viral and bacterial enteritis was higher in urban areas than in rural areas (P < 0.001). Campylobacter enteritis was more common in the rural areas (P < 0.001). CONCLUSION: Although the prevalence of bacterial and viral enteritis have decreased in COVID-19, Campylobacter enteritis has increased in all age groups and in rural areas compared to urban areas. Recognizing that the trend of Campylobacter enteritis before and during COVID-19 is helpful for future public health measures and interventions.

Colossal Dielectric Perovskites of Calcium Copper Titanate (CaCu3 Ti4 O12 ) with Low-Iridium Dopants Enables Ultrahigh Mass Activity for the Acidic Oxygen Evolution Reaction.

Oxygen evolution reaction (OER) under acidic conditions becomes of significant importance for the practical use of a proton exchange membrane (PEM) water electrolyzer. In particular, maximizing the mass activity of iridium (Ir) is one of the maiden issues. Herein, the authors discover that the Ir-doped calcium copper titanate (CaCu3Ti4O12, CCTO) perovskite exhibits ultrahigh mass activity up to 1000 A gIr -1 for the acidic OER, which is 66 times higher than that of the benchmark catalyst, IrO2 . By substituting Ti with Ir in CCTO, metal-oxygen (M-O) covalency can be significantly increased leading to the reduced energy barrier for charge transfer. Further, highly polarizable CCTO perovskite referred to as "colossal dielectric", possesses low defect formation energy for oxygen vacancy inducing a high number of oxygen vacancies in Ir-doped CCTO (Ir-CCTO). Electron transfer occurs from the oxygen vacancies and Ti to the substituted Ir consequentially resulting in the electron-rich Ir and -deficient Ti sites. Thus, favorable adsorptions of oxygen intermediates can take place at Ti sites while the Ir ensures efficient charge supplies during OER, taking a top position of the volcano plot. Simultaneously, the introduced Ir dopants form nanoclusters at the surface of Ir-CCTO, which can boost catalytic activity for the acidic OER.

Effect of intraoperative blood transfusion on inflammatory response in parturients with placenta previa undergoing cesarean section: A prospective observational study.

Background: The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red cell distribution width (RDW) have been reported as useful biomarkers for evaluating inflammation and a predictor of surgical prognosis. Although there have been recent reports that transfusion may affect inflammatory responses, studies on the post-transfusion inflammatory response in parturients are rare. Therefore, this study aimed to observe changes in inflammatory response after transfusion during cesarean section (C-sec) through NLR, PLR, and RDW. Methods: Parturients aged 20-50 years who underwent C-sec under general anesthesia due to placenta previa totalis from March 4, 2021, to June 10, 2021 were participated in this prospective observational study. We compared postoperative NLR, PLR, and RDW between the transfusion and non-transfusion groups. Results: A total of 53 parturients were included in this study, of which 31 parturients received intraoperative transfusions during C-sec. There were no significant difference in preoperative NLR (3.6 vs. 3.4, p = 0.780), PLR (132.8 vs. 111.3, p = 0.108), and RDW (14.2 vs. 13.6, p = 0.062) between the two groups. However, postoperative NLR was significantly higher in the transfusion group than in the non-transfusion group (12.2 vs. 6.8, p < 0.001). Postoperative RDW was significantly higher in the transfusion group than in the non-transfusion group (14.6 vs. 13.9, p = 0.002) whereas postoperative PLR was not significantly different between the two groups (108.0 vs. 117.4, p = 0.885). Conclusions: Postoperative NLR and RDW, the inflammatory biomarkers, were significantly higher in the transfused C-sec parturients. These results suggest a significant association between postoperative inflammatory response and transfusion in obstetric practice.

Cathodic Protection System against a Reverse-Current after Shut-Down in Zero-Gap Alkaline Water Electrolysis.

Growing the hydrogen economy requires improving the stability, efficiency, and economic value of water-splitting technology, which uses an intermittent power supply from renewable energy sources. Alkaline water electrolysis systems face a daunting challenge in terms of stabilizing hydrogen production under the condition of transient start-up/shut-down operation. Herein, we present a simple but effective solution for the electrode degradation problem induced by the reverse-current under transient power condition based on a fundamental understanding of the degradation mechanism of nickel (Ni). It was clearly demonstrated that the Ni cathode was irreversibly oxidized to either the ß-Ni(OH)2 or NiO phases by the reverse-current flow after shut-down, resulting in severe electrode degradation. It was also determined that the potential of the Ni electrode should be maintained below 0.6 VRHE under the transient condition to keep a reversible nickel phase and an activity for the hydrogen evolution reaction. We suggest a cathodic protection approach in which the potential of the Ni electrode is maintained below 0.6 VRHE by the dissolution of a sacrificial metal to satisfy the above requirement; irreversible oxidization of the cathode is prevented by connecting a sacrificial anode to the Ni cathode. In the accelerated durability test under a simulated reverse-current condition, lead was found to be the most promising candidate for the sacrificial metal, as it is cost effective and demonstrates chemical stability in the alkaline media. A newly defined metric, a reverse-current stability factor, highlights that our system for protecting the cathode against the reverse-current is an efficient strategy for stable and cost effective alkaline hydrogen production.

Association of red cell distribution width/albumin ratio with intraoperative blood transfusion in cervical cancer patients.

BACKGROUND: Although minimally invasive surgical techniques have reduced intraoperative bleeding, the risk of transfusion exists. However, few studies have evaluated risk factors for transfusion in radical hysterectomy. We aimed to evaluate the association between preoperative red cell distribution width/albumin ratio (RDW/albumin) and transfusion in cervical cancer patients. METHODS: We analyzed 907 patients who underwent radical hysterectomy between June 2006 and February 2015. Logistic regression and Cox regression analyses were performed to determine the risk factors for transfusion and mortality at 5-year and overall. Net reclassification improvement (NRI) and integrated identification improvement (IDI) analyses were performed to verify the improvement of the intraoperative transfusion model upon the addition of RDW/albumin. RESULTS: RDW/albumin was an independent risk factor for transfusion (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.02-1.77, p = 0.035). Additionally, body mass index, operation time, laparoscopic surgery, total fluids, and synthetic colloid were risk factors for transfusion. RDW/albumin was an independent risk factor for 5-year mortality (hazard ratio [HR]: 1.51, 95% CI: 1.07-2.14, p = 0.020), and overall mortality (HR: 1.48, 95% CI: 1.06-2.07, p = 0.021). NRI and IDI analyses showed the discriminatory power of RDW/albumin for transfusion (p<0.001 and p = 0.046, respectively). CONCLUSIONS: RDW/albumin might be a significant factor in transfusion and mortality in cervical cancer patients.

Effect of solution pH, precursor ratio, agitation and temperature on Ni-Mo and Ni-Mo-O electrodeposits from ammonium citrate baths.

The induced co-electrodeposition of Ni and Mo is a complex process, where metallic Ni-Mo alloys and Ni-Mo-O composites can originate from the complete and partial reduction of Mo respectively. By adjusting electrolyte compositions and electrodeposition parameters, various metallic, metal/oxide composite, and oxide thin films of Ni-Mo and Ni-Mo-O were electrodeposited from ammonium citrate baths. Ni-ammonia complexes, which play a critical role in promoting the deposition of metallic Ni-Mo alloys, were enhanced at alkaline pH (i.e., 8-10) and lower temperature (i.e., 25-45°C). Moreover, the electrochemical reduction of Ni is under mass transfer limitation, so the deposited Mo content decreased with increasing agitation. On the other hand, higher Mo content can be achieved by relatively higher citrate concentration and larger Mo-to-Ni precursor molar ratio. However, a critical molar ratio of metal precursor resulted in transition from alloy to composite due to Ni inducing the reduction of Mo.

Effects of NH4 +/citrate complexing agent ratio on Ni-Mo and Ni-Mo-O electrodeposits from ammonium citrate baths.

To understand the effect of complexing agents (i.e., ammonium and citrate) in nickel-molybdenum electrodeposition, calculation of the concentration of various Ni and Mo species as a function of pH and initial concentration of metal ions and complexing agents was performed. In addition, linear sweep voltammetry and Hull cell experiments were systematically investigated to understand the effect of current density and ammonium-to-citrate ratio to film compositions, morphology, and crystallinity. The results indicated that Ni(NH3)3 2+ played a critical role in induced co-deposition mechanism of Ni-Mo alloys, which involved the reduced Ni and absorbed H atoms. Microstructure analysis of deposits indicated that the transition from smooth laminarly grown amorphous Ni-Mo-O composites to columnar and nanocrystalline metallic Ni-Mo alloys with a globular structure as the ammonium-to-citrate molar ratio increases. The highest Mo content of alloys was as high as 19 at%, and up to 70 at% O was present in the composites.

High Dose Intramuscular Vitamin D3 Supplementation Impacts the Gut Microbiota of Patients With Clostridioides Difficile Infection.

Background and Aim: Current therapeutic strategies for Clostridioides difficile infections (CDI), including oral vancomycin, metronidazole and fecal microbial transplantation, have limited efficacy and treatment failure may occur in as many as one- third of cases. Recent studies have reported that lower concentrations of 25-hydroxyvitamin D are associated with CDI severity and recurrence. However, there have been no studies on microbiota composition after the administration of vitamin D in patients with CDI. Therefore, our study aimed to compare the microbiota composition between the two groups, including eight CDI-positive patients with vitamin D supplementation and ten CDI-positive patients without vitamin D supplementation by using 16S rRNA microbial profiling. Methods: Twenty subjects were enrolled in this prospective randomized controlled study. One subject dropped out due to lack of contact with the guardian after discharge and one subject dropped out due to withdrawal of consent. Thus, 18 patients with CDI and vitamin D insufficiency (vitamin D level < 17 ng/mL) were divided into two groups: CDI with vitamin D supplementation (n = 8) and CDI without vitamin D supplementation (control: n = 10). Subjects with vitamin D insufficiency were randomized to receive 200,000 IU intramuscular cholecalciferol whereas patients in the control group received only oral vancomycin. Stool samples were obtained twice before vancomycin was administered and eight weeks after treatment; the V3-V4 16S rRNA metagenomic sequencing was performed using EzBioCloud. Results: The alpha diversity of the gut microbiota in the recovery state was significantly higher than that in the CDI state. Analysis of bacterial relative abundance showed significantly lower Proteobacteria and higher Lachnospiraceae, Ruminococcaceae, Akkermansiaceae, and Bifidobacteriaceae in the recovery state. When comparing the control and vitamin D treatment groups after eight weeks, increase in alpha diversity and, abundance of Lachnospiraceae, and Ruminococcaceae exhibited the same trend in both groups. A significant increase in Bifidobacteriaceae and Christensenellaceae was observed in the vitamin D group; Proteobacteria abundance was significantly lower in the vitamin D treatment group after eight weeks than that in the control group. Conclusion: Our study confirmed that the increase in the abundance of beneficial bacteria such as Bifidobacteriaceae, and Christensenellaceae were prominently evident during recovery after administration of a high dose of cholecalciferol. These findings indicate that vitamin D administration may be useful in patients with CDI, and further studies with larger sample sizes are required.

The Structural Effect of Electrode Mesh on Hydrogen Evolution Reaction Performance for Alkaline Water Electrolysis.

Alkaline water electrolysis (AWE) is a mature water electrolysis technology that can produce green hydrogen most economically. This is mainly attributed to the use of Ni-based materials that are easy to process and inexpensive. The nickel-based meshes with various structures such as woven mesh and expanded mesh are widely used as electrode in the AWE due to its common availability and easy fabrication. However, the morphological effect of meshes on hydrogen evolution reaction (HER) performance has not been studied. Here a new parameter to determine the structural effect of mesh on HER performance was first proposed. The key factors of the parameter were found to be the strand width, pore width and the strand surface area. The woven mesh with the ratio of pore width to strand width that converges to 1 showed the lowest the overpotential. The expanded mesh with the higher the structural surface area exhibited the lowest the overpotential. This study will help to choose an optimal structure for the mesh with the HER electrode.

A Feasibility Study of Photovoltaic-Electrolysis-PEM Hybrid System Integrated Into the Electric Grid System Over the Korean Peninsula.

A photovoltaic-electrolysis-PEM hybrid model was developed for a feasibility study, and simulations of several scenarios in Korea were performed. The solar irradiance was derived from the University of Arizona solar irradiance based on satellite-Korea Institute of Energy Research model which provides the satellite imagery over the Korean peninsula every 15 min. In Korea, the annual average solar irradiance is 1,310 kWh m-2 with a maximum of 1,440 kWh m-2 in 2017. Electricity load and solar irradiance information were used to test the performance model of the photovoltaic-electrolysis-PEM hybrid system for baseload and several peak load shave runs. When the baseload was set at 4200 MW, the total capacity of the Photovoltaic plants was 58.5 GWp. In contrast, the hybrid system reduced the peak load more efficiently during daytime. In particular, the capacity factor of the Proton Exchange Membrane system increased in winter because the solar irradiance is relatively weak in that season. These results provide useful insights for the development of control logic models for the PV-electrolysis-PEM system in micro-grid setups.

Effects of Perioperative Inflammatory Response in Cervical Cancer: Laparoscopic versus Open Surgery.

There are few studies between postoperative neutrophil to lymphocyte ratio (NLR) and survival in cervical cancer. We compared postoperative changes in NLR according to surgical methods and analyzed the effect of these changes on 5-year mortality of cervical cancer patients. A total of 929 patients were assigned to either the laparoscopic radical hysterectomy (LRH) (n = 721) or open radical hysterectomy (ORH) (n = 208) group. Propensity score matching analysis compared the postoperative NLR changes between the two groups, and multivariate logistic regression analysis evaluated the association between NLR changes and 5-year mortality. Surgical outcomes between the two groups were also compared. In the LRH group, NLR changes at postoperative day (POD) 0 and POD 1 were significantly lower than in the ORH group after matching (NLR change at POD 0, 10.4 vs. 14.3, p < 0.001; NLR change at POD 1, 3.5 vs. 5.4, p < 0.001). In multivariate logistic regression analysis, postoperative NLR change was not associated with 5-year mortality (2nd quartile: OR 1.55, 95% CI 0.56-4.29, p = 0.401; 3rd quartile: OR 0.90, 95% CI 0.29-2.82, p = 0.869; 4th quartile: OR 1.40, 95% CI 0.48-3.61, p = 0.598), whereas preoperative NLR was associated with 5-year mortality (OR 1.23, 95% CI 1.06-1.43, p = 0.005). After matching, there were no significant differences in surgical outcomes between the two groups. There were significantly fewer postoperative changes of NLR in the LRH group. However, the extent of these NLR changes was not associated with 5-year mortality. By contrast, preoperative NLR was associated with 5-year mortality.

The Association between Herpes Zoster and Increased Cancer Risk: A Nationwide Population-Based Matched Control Study.

BACKGROUND: Herpes zoster (HZ) is strongly associated with decreased immune function, a factor of cancer development. Previous studies suggested inconsistent results regarding the association between HZ and increased cancer risk. We aimed to analyze the association between HZ and specific cancer risk. METHODS: Of 134,454 patients diagnosed with HZ between 2002 and 2015, 81,993 HZ patients were matched 1:1 with non-HZ individuals by age, sex, and Charlson comorbidity index. Both groups were examined at 1, 3, and 5 years for cancer diagnosis. A Cox proportional hazard regression model was used to estimate cancer risk in both groups. The postherpetic neuralgia (PHN) and non-HZ groups were compared for specific cancer risk. RESULTS: The HZ group showed a slightly decreased overall cancer risk compared with the non-HZ group (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.90-0.97, p = 0.002). The HRs for specific cancer risk were 0.41 (95% CI, 0.33-0.50, p < 0.001); 0.86 (95% CI, 0.81-0.91, p < 0.001); 0.87 (95% CI, 0.78-0.97, p = 0.014); 0.80 (95% CI 0.73-0.87, p < 0.001); 1.20 (95% CI, 1.07-1.34, p = 0.001); and 1.66 (95% CI, 1.35-2.03, p < 0.001) for cancers of the lips, mouth, and pharynx; digestive system; respiratory system; unknown secondary and unspecified sites; thyroid and endocrine glands; and lymphoid and hematopoietic systems, respectively. The HZ with PHN group showed higher HR for specific cancer risk, such as lymphoid and hematopoietic systems (95% CI, 1.27-2.39, p < 0.001). CONCLUSION: HZ was associated with increased or decreased incidence of specific cancers. PHN further increased the risk of developing certain cancers in HZ patients.

Importance of Preoperative Screening Strategies for Coronavirus Disease 2019 in Patients Undergoing Cesarean Sections: A Retrospective, Large Single-Center, Observational Cohort Study.

During the coronavirus disease 2019 (COVID-19) pandemic, many guidelines have recommended postponing non-emergency operations. However, cesarean sections cannot be indefinitely delayed. Our institution has established a COVID-19 screening strategy for patients undergoing cesarean section. We evaluated the usefulness of this screening strategy. Parturients undergoing cesarean section at our center during the first peak of the COVID-19 outbreak were retrospectively analyzed. Each parturient underwent a questionnaire survey evaluating epidemiological correlation and symptoms at admission. Reverse transcriptase-polymerase chain reaction (RT-PCR) testing and/or chest radiography were performed. In total, 296 parturients underwent cesarean section. All elective and 37 emergency cesarean sections were performed in general operating rooms because they were considered to have a low risk of COVID-19 infection through the screening process. However, 42 emergency cases were performed in negative-pressure operating rooms with full personal protective equipment (PPE) because the RT-PCR results could not be confirmed in a timely manner. None of them were positive for RT-PCR, and there were no cases of nosocomial infection. A comprehensive preoperative screening strategy, including symptomatic and epidemiological correlation, PCR, and/or imaging test, should be performed in patients undergoing cesarian section. Further, cesarean sections in parturients with unconfirmed COVID-19 status should be performed in a negative-pressure operating room with appropriate PPE.

Comparative Effectiveness of Parasagittal Interlaminar and Transforaminal Cervical Epidural Steroid Injection in Patients with Cervical Radicular Pain: A Randomized Clinical Trial.

BACKGROUND: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy. OBJECTIVES: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain. STUDY DESIGN: A prospective randomized assessor-blind study. SETTING: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. METHODS: This prospective randomized, assessor-blind trial included 80 patients with cervical radicular pain. We randomly assigned patients to the TF or parasagittal IL approach for cervical ESI. The effectiveness of the 2 groups was compared based on pain intensity using the Numeric Rating Scale (NRS-11) at 1 and 3 months. The Neck Disability Index (NDI), Medication Quantification Scale (MQS), and responders at 1 and 3 months between the 2 groups were compared. RESULTS: The pain intensity of both groups significantly reduced after 1 and 3 months after each procedure (P < 0.001). Two-way repeated measures of analysis of variance showed no significant interaction between group and time for cervical radicular pain (P = 0.266), although NRS-11 pain score was lower in the TF group than the parasagittal IL group after 1 month (P = 0.010). NDI, MQS, and successful responders were not different between the 2 groups at 1 and 3 months after the procedure. We observed 7 cases (18.4%) of vascular visualization in the TF group, although no serious complications were found in either group. LIMITATIONS: This study had no placebo control group and limited follow-up time. CONCLUSIONS: Parasagittal IL ESI may be recommended over the TF ESI in reducing cervical radicular pain, considering both clinical effectiveness and safety.

Management of massive hemorrhage in pregnant women with placenta previa.

Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation. This condition can lead to serious obstetric complications, including maternal mortality and morbidity. The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking. The prevalence of previa parturients has increased due to the rising rates of cesarean section and advanced maternal age. For these reasons, we need to identify the risk factors for previa and identify adequate management strategies to respond to blood loss during surgery. This review evaluated the diagnosis of placenta previa and placenta accreta and assessed the risk factors for previa-associated bleeding prior to cesarean section. We then presented intraoperative anesthetic management and other interventions to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion.