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OBJECTIVE: This study aims to assess the effectiveness of 5% dextrose (D5W) in comparison to corticosteroids for treating carpal tunnel syndrome (CTS). DATA SOURCES: A comprehensive systematic search was conducted across MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials on November 13, 2023. These were supplemented by manual searches using Google Scholar. STUDY SELECTION: Two independent authors reviewed the literature, resolving any discrepancies through detailed discussions and consultation with a third author. DATA EXTRACTION: Data on primary outcomes (pain assessment) and secondary outcomes (symptom severity and functional status using the Boston Carpal Tunnel Questionnaire, electrophysiologic measures, cross-sectional area, and adverse effects) were extracted independently by the two authors. DATA SYNTHESIS: The analysis included 4 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 212 patients (220 hands) with mild to moderate CTS. RESULTS: Within 3 months, the D5W injections showed a statistically significant improvement in functional status compared to the corticosteroids with a standard mean difference of -0.34 (95% confidence interval (CI), -0.62 to -0.05). D5W was associated with fewer adverse incidents than corticosteroids (risk ratio 0.13; 95% CI 0.03 to 0.51). No difference was observed between the two treatments in other areas. CONCLUSION: For patients with mild to moderate CTS, D5W injections were more effective than corticosteroid injections in improving functional status and demonstrated fewer adverse effects. D5W injections also paralleled corticosteroids in pain reduction, symptom severity, electrodiagnostic measures, and cross-sectional area of nerve, recommending D5W as a preferred treatment for mild to moderate CTS.
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OBJECTIVE: Area under the curve (AUC)-based vancomycin dose adjustment is recommended to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. AUC estimation methods include Bayesian software programs and simple analytical equations. This study compared the AUC obtained using the Bayesian approach with that obtained using an equation-based approach. MATERIALS AND METHODS: Patients receiving intravenous vancomycin for MRSA infection were included. Peak and trough levels were measured for each patient on days 3, 7, and 10 post vancomycin dosing (day 1). AUC was calculated using software based on the Bayesian method (MwPharm Online) and an equation-based calculator, Stanford Health Care (SHC) calculator. RESULTS: The AUC estimated using MwPharm Online was similar to that estimated using the SHC calculator. The geometric mean ratio (GMR) and their 90% confidence intervals (90% CI) were 1.08 (1.05 - 1.11), 1.03 (0.99 - 1.07), and 0.99 (0.94 - 1.05) at days 3, 7, and 10, respectively. Furthermore, according to the software used, there were no significant differences in the proportions of patients in the categories "within" and "below or above" the AUC target range. Additionally, trough levels predicted by both software programs were lower than the observed ones. Still, there was no significant difference between the predicted and observed peak levels for both software programs on day 10. CONCLUSION: AUC calculated using the Bayesian software allows for calculation with samples at a non-steady state, can integrate covariates, and is interconvertible with that estimated using an equation-based calculator, which is simpler and relies on fewer assumptions. Therefore, either method can be used, considering each method's strengths and limitations.
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Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Humanos , Vancomicina , Teorema de Bayes , Antibacterianos , Área Bajo la Curva , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Pruebas de Sensibilidad MicrobianaRESUMEN
OBJECTIVE: This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. METHODS: Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3 months (N = 153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. RESULTS: Meal intervention statistically significantly stabilized serum phosphorus level (ß = -0.81 mg/dL, 95% confidence interval = [-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio = 1.21, 95% confidence interval = [1.04, 1.40]). Meal group showed better nutritional status (MIS = 3.65) than the education group (MIS = 5.10) at week 8 (adjusted p < .05). No significant changes were observed in serum potassium level, depression, and self-efficacy. CONCLUSION: It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.
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Desnutrición , Estado Nutricional , Humanos , Inflamación/etiología , Desnutrición/prevención & control , Desnutrición/etiología , Fósforo , Diálisis Renal/efectos adversosRESUMEN
Background and Objectives: Spinal anesthesia is widely used in various types of surgery. However, several complications can occur afterward. This study aimed to identify differences in the incidence of anesthesia-related complications according to the approach methods (midline versus paramedian) for landmark-based spinal anesthesia. Materials and Methods: We searched electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, for eligible randomized controlled trials. The primary outcome was post-dural puncture headache (PDPH) incidence, and secondary outcomes were low back pain (LBP) incidence and success rate in the first trial of spinal anesthesia. We estimated the odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results: In total, 2280 patients from 13 randomized controlled trials were included in the final analysis. The incidence rates of PDPH were 5.9% and 10.4% in the paramedian and midline approach groups, respectively. The pooled effect size revealed that the incidence of PDPH (OR: 0.43, 95% CI [0.22-0.83]; p = 0.01; I2 = 53%) and LBP (OR: 0.27, 95% CI [0.16-0.44]; p < 0.001; I2 = 16%) decreased, and the success rate in the first attempt was higher (OR: 2.30, 95% CI [1.36-3.87]; p = 0.002; I2 = 35%) with the paramedian than with the midline approach. Conclusions: Paramedian spinal anesthesia reduced PDPH and LBP and increased the success rate of the first attempt.
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Anestesia Raquidea , Dolor de la Región Lumbar , Cefalea Pospunción de la Duramadre , Adulto , Humanos , Anestesia Raquidea/efectos adversos , Incidencia , Dolor de la Región Lumbar/etiología , Cefalea Pospunción de la Duramadre/epidemiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides noninferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery. METHODS: 100 patients were randomized undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared. RESULTS: Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a noninferiority margin of 1 (worst pain score: mean difference, 0.9; 95% CI, 0.1 to 1.7; resting pain score: mean difference, 0.5; 95% CI, 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group. CONCLUSIONS: Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.
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Bloqueo del Plexo Braquial , Hombro , Humanos , Hombro/cirugía , Hombro/diagnóstico por imagen , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/epidemiología , Analgésicos , Ultrasonografía Intervencional , Paresia , Artroscopía , Anestésicos LocalesRESUMEN
BACKGROUND: Although previous research has made substantial progress in developing high-performance artificial intelligence (AI)-based computer-aided diagnosis (AI-CAD) systems in various medical domains, little attention has been paid to developing and evaluating AI-CAD system in ophthalmology, particularly for diagnosing retinal diseases using optical coherence tomography (OCT) images. OBJECTIVE: This diagnostic study aimed to determine the usefulness of a proposed AI-CAD system in assisting ophthalmologists with the diagnosis of central serous chorioretinopathy (CSC), which is known to be difficult to diagnose, using OCT images. METHODS: For the training and evaluation of the proposed deep learning model, 1693 OCT images were collected and annotated. The data set included 929 and 764 cases of acute and chronic CSC, respectively. In total, 66 ophthalmologists (2 groups: 36 retina and 30 nonretina specialists) participated in the observer performance test. To evaluate the deep learning algorithm used in the proposed AI-CAD system, the training, validation, and test sets were split in an 8:1:1 ratio. Further, 100 randomly sampled OCT images from the test set were used for the observer performance test, and the participants were instructed to select a CSC subtype for each of these images. Each image was provided under different conditions: (1) without AI assistance, (2) with AI assistance with a probability score, and (3) with AI assistance with a probability score and visual evidence heatmap. The sensitivity, specificity, and area under the receiver operating characteristic curve were used to measure the diagnostic performance of the model and ophthalmologists. RESULTS: The proposed system achieved a high detection performance (99% of the area under the curve) for CSC, outperforming the 66 ophthalmologists who participated in the observer performance test. In both groups, ophthalmologists with the support of AI assistance with a probability score and visual evidence heatmap achieved the highest mean diagnostic performance compared with that of those subjected to other conditions (without AI assistance or with AI assistance with a probability score). Nonretina specialists achieved expert-level diagnostic performance with the support of the proposed AI-CAD system. CONCLUSIONS: Our proposed AI-CAD system improved the diagnosis of CSC by ophthalmologists, which may support decision-making regarding retinal disease detection and alleviate the workload of ophthalmologists.
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Coriorretinopatía Serosa Central , Diagnóstico por Computador , Humanos , Algoritmos , Inteligencia Artificial , Coriorretinopatía Serosa Central/diagnóstico por imagen , Computadores , Aprendizaje ProfundoRESUMEN
PURPOSE: Postoperative delirium (POD) occurs commonly in older adults, resulting in unfavorable outcomes. Several recent clinical studies have suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists can treat and prevent POD. In this retrospective study, the association between 5-HT3 receptor antagonists and POD was investigated in older adults who underwent hip fracture surgery. METHODS: The electronic medical records of older adults aged ≥ 65 years who underwent hip fracture surgery between January 2011 and June 2018 were reviewed retrospectively. Multivariable logistic regression analysis was used to investigate the association between 5-HT3 receptor antagonists and the occurrence of POD. In addition to the incidence of POD, anesthesia-, surgery-, and patient-related factors related to POD were evaluated. RESULTS: Of the 1025 patients included, 813 (79.3%) were administered 5-HT3 receptor antagonists intraoperatively; 471 (45.9%) were administered ramosetron, and 342 (33.4%) were administered palonosetron. POD was identified in 242 patients (23.6%). Ramosetron and palonosetron reduced the POD incidence by 53% (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.32â0.71; P < 0.001) and 41% (OR 0.59; 95% CI 0.39â0.89; P = 0.011), respectively. Additionally, age, American Society of Anesthesiologists physical status class 4, and male were confirmed as risk factors for POD. CONCLUSION: Intraoperative 5-HT3 receptor antagonists may be associated with a reduced risk of POD and can be considered one of the preventive strategies for POD in older adults undergoing hip fracture surgery.
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Delirio , Delirio del Despertar , Fracturas de Cadera , Humanos , Masculino , Anciano , Delirio del Despertar/complicaciones , Estudios Retrospectivos , Serotonina , Palonosetrón , Prevalencia , Delirio/epidemiología , Delirio/etiología , Delirio/prevención & control , Fracturas de Cadera/cirugía , Factores de Riesgo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: The incidence of early-onset diabetes is increasing among young adults. However, there are limited data on the characteristics and management of young Korean adults with diabetes. This study assessed the clinical and demographic characteristics, health behaviors, and mental health among young Korean adults with diabetes mellitus. METHODS: This cross-sectional study included young Korean adults with diabetes (n = 225) with an onset age of 20-39 years from four university hospitals. Demographic characteristics, management of diabetes, and mental health were assessed using a questionnaire survey. RESULTS: Type 2 diabetes was the most common type (73.3%), and 13.8% of participants were classified as other types or unknown. Approximately, 64.7% of participants had a strong family history of diabetes, and 76% had treatment within three months of diagnosis. Approximately, 11.1% of participants had diabetic complications; 39.1% of participants received insulin injections, including oral anti-diabetic medications. Additionally, 30.4% were smokers, and only 28% had active physical activity; 26.5% of participants had >3 hours of screen time. One third of participants never had breakfast, and 60.5% went out to eat at least three times a week. Half of the participants showed moderate to severe stress perception, and 21.4% of patients had moderate to severe levels of depression based on the Korean version of Beck Depression Inventory score. CONCLUSION: Early-onset diabetes was associated with a strong family history and early insulin treatment. Young adults with diabetes had poor health behaviors and frequent mental depression. These findings suggest the necessity of health policies for improving health behaviors and mental distress.
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Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/metabolismo , Conductas Relacionadas con la Salud , Salud Mental/estadística & datos numéricos , Calidad de Vida/psicología , Edad de Inicio , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/psicología , Hemoglobina Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Smartphones have become novel healthcare tools for patients with diabetes. However, it is uncertain whether the smartphone application support system helps in glycaemic control in patients with type 2 diabetes. AIMS: To evaluate the efficacy and plausibility of smartphone-based integrated online real-time diabetes care. METHODS: Forty patients with type 2 diabetes were randomly assigned to the smartphone-based care (SC) (n = 20) and conventional care (CC) (n = 20) groups for 12 weeks. The SC group was instructed to use smartphone application (Noom Coach) and a glucose meter, and was provided medical supervision based on blood glucose level and food intake information sent to the central database server. The efficacy was evaluated by glycated haemoglobin (A1C ≤ 6.5%). The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was collected at baseline and at week 12. RESULTS: Seventeen and 18 patients of the SC and CC groups completed the study respectively. In the SC group, more patients achieved target A1C compared with the CC group (47.1% vs 11.1%, P = 0.019). In both group, SDSCA scores excluding the exercise item showed overall improvement (general diet, 1.4 ± 2.0 â 2.6 ± 2.3 vs 0.4 ± 1.1 â 1.8 ± 2.2; specific diet, 4.2 ± 1.7 â 5.4 ± 1.2 vs 3.8 ± 1.6 â 5.1 ± 1.1; blood glucose test, 3.3 ± 2.8 â 4.9 ± 2.3 vs 1.0 ± 2.2 â 4.7 ± 2.3; foot care, 1.5 ± 1.6 â 3.6 ± 2.8 vs 1.4 ± 1.9 â 6.1 ± 1.4; all P < 0.05). There was no difference between both groups other than the aspect of foot care (P = 0.008). CONCLUSIONS: The smartphone-based integrated online real-time diabetes care system through glucose and diet data management showed clinical plausibility in glucose control in real clinical practice.
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Diabetes Mellitus Tipo 2 , Teléfono Inteligente , Glucemia , Diabetes Mellitus Tipo 2/terapia , Dieta , Glucosa , Humanos , Proyectos Piloto , Autocuidado , Resultado del TratamientoRESUMEN
BACKGROUNDS: Glomerular diseases, a set of debilitating and complex disease entities, are related to mortality and morbidity. To gain insight into pathophysiology and novel treatment targets of glomerular disease, various types of biospecimens linked to deep clinical phenotyping including clinical information, digital pathology, and well-defined outcomes are required. We provide the rationale and design of the KOrea Renal biobank NEtwoRk System TOward Next-generation analysis (KORNERSTONE). METHODS: The KORNERSTONE, which has been initiated by Korea Centres for Disease Control and Prevention, is designed as a multi-centre, prospective cohort study and biobank for glomerular diseases. Clinical data, questionnaires will be collected at the time of kidney biopsy and subsequently every 1 year after kidney biopsy. All of the clinical data will be extracted from the electrical health record and automatically uploaded to the web-based database. High-quality digital pathologies are obtained and connected in the database. Various types of biospecimens are collected at baseline and during follow-up: serum, urine, buffy coat, stool, glomerular complementary DNA (cDNA), tubulointerstitial cDNA. All data and biospecimens are processed and stored in a standardised manner. The primary outcomes are mortality and end-stage renal disease. The secondary outcomes will be deterioration renal function, remission of proteinuria, cardiovascular events and quality of life. DISCUSSION: Ethical approval has been obtained from the institutional review board of each participating centre and ethics oversight committee. The KORNERSTONE is designed to deliver pioneer insights into glomerular diseases. The study design allows comprehensive, integrated and high-quality data collection on baseline laboratory findings, clinical outcomes including administrative data and digital pathologic images. This may provide various biospecimens and information to many researchers, establish the rationale for future more individualised treatment strategies for glomerular diseases. TRIAL REGISTRATION: NCT03929887 .
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Bancos de Muestras Biológicas , Bases de Datos Factuales , Glomerulonefritis/patología , Fallo Renal Crónico/patología , Riñón/patología , Glomerulonefritis/genética , Glomerulonefritis/metabolismo , Glomerulonefritis/terapia , Humanos , Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/terapia , Evaluación del Resultado de la Atención al Paciente , Terapia de Reemplazo Renal , República de CoreaRESUMEN
Background: Although arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD), the association between vascular access types and quality of life is not well-known. We investigated the relationships between HD vascular access types and all-cause mortality, health-related quality of life (HRQOL) and the degree of depression in a large prospective cohort.Methods: A total of 1461 patients who newly initiated HD were included. The initial vascular access types were classified into AVF, arteriovenous graft (AVG), and central venous catheter (CVC). The primary outcomes were all-cause mortality and HRQOL and depression. The secondary outcome was all-cause hospitalization. Kidney Disease Quality of Life Short Form 36 (KDQOL-36) and Beck's depression inventory (BDI) scores were measured to assess HRQOL and depression.Results: Among 1461 patients, we identified 314 patients who started HD via AVF, 76 via AVG, and 1071 via CVC. In the survival analysis, patients with AVF showed significantly better survival compared with patients with other accesses (p < .001). The AVF and AVG group had higher KDQOL-36 score and lower BDI score than CVC group at 3 months and 12 months after the initiation of HD. The frequency of hospitalization was higher in patients with AVG compared to those with AVF (AVF 0.7 vs. AVG 1.1 times per year) (p = .024).Conclusions: The patients with AVF had better survival rate and low hospitalization rate, and the patients with AVF or AVG showed both higher HRQOL and lower depression scores than those with CVC.
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Derivación Arteriovenosa Quirúrgica/efectos adversos , Depresión/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica/instrumentación , Derivación Arteriovenosa Quirúrgica/psicología , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Depresión/etiología , Depresión/psicología , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/psicología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Calidad de Vida , Diálisis Renal/instrumentación , Diálisis Renal/métodos , República de Corea/epidemiología , Factores de Riesgo , Autoinforme/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Grado de Desobstrucción VascularRESUMEN
Tumor-induced lymphangiogenesis, a major conduit for cancer cell dissemination from the primary tumor site to lymph nodes and beyond, eventually leads to metastasis in cancer patients. Given the recent evidence revealing that the suppression of ELK3 inhibits the metastasis of triple-negative breast cancer cells, we aimed to study the underlying mechanism of impaired metastasis in ELK3-suppressed MDA-MB-231 cells (ELK3 KD) with regard to lymphangiogenesis. We found that the secretome of ELK3 KD cells inhibited tube formation, whereas it promoted the migration and invasion of lymphatic endothelial cells (LECs) in vitro. In vivo analysis revealed that peritumoral lymphatic vessels were not developed around the xenografted tumors of ELK3 KD. We further revealed that the suppression of NF-κB signaling in ELK3 KD was the primary cause of the reduced VEGFC expression. Taken together, we suggest that ELK3 is an upstream regulator of the NF-κB signaling pathway, the inhibition of which leads to the suppression of peritumoral lymphatic vessel development, possibly due to a low VEGFC expression.
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Linfangiogénesis , FN-kappa B/metabolismo , Proteínas Proto-Oncogénicas/metabolismo , Factores de Transcripción/metabolismo , Neoplasias de la Mama Triple Negativas/metabolismo , Neoplasias de la Mama Triple Negativas/patología , Factor C de Crecimiento Endotelial Vascular/metabolismo , Animales , Línea Celular Tumoral , Regulación Neoplásica de la Expresión Génica , Humanos , Metástasis Linfática , Ratones , Proteínas Proto-Oncogénicas c-etsRESUMEN
Background: Recent reports have suggested the possible benefit of beginning hemodialysis (HD) at a rate less frequent than three times weekly and incrementally increasing the dialysis dose. However, the data regarding the benefits and safety of incremental HD are insufficient. Methods: We analyzed 927 patients with newly initiated HD from the Clinical Research Center for End-Stage Renal Disease cohort from 2008 to 2014. The patients were classified into a thrice-weekly initiation group or an incremental initiation group (one to two sessions per week) according to the frequency of HD per week at baseline. We compared health-related quality of life (HRQOL), daily urine volume at 12 months and all-cause mortality between the groups. We matched the thrice-weekly and incremental groups at a 1:2 ratio using propensity score matching. Results: A total of 312 patients (207 in the thrice-weekly group and 105 in the incremental group) were selected. All-cause mortality was comparable between the two groups before and after propensity score matching. The HRQOL tended to be better in the incremental group for the majority of domains of the Kidney Disease Quality of Life Short Form and Beck's Depression Inventory; however, only the symptoms and problems domain was significantly better in the incremental group at 3 months after HD. At 12 months after HD, there were no differences between the groups. The daily urine volume at 12 months after HD was similar between the two groups. Conclusions: Incremental HD initiation showed comparable results to thrice-weekly initiation for HRQOL, residual renal function and all-cause mortality. Incremental HD may be considered an additional option for HD initiation in selected patients.
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Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Diálisis Renal/mortalidad , Diálisis Renal/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Prospectivos , Calidad de Vida , República de Corea , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Quality of life is increasingly viewed as an important health outcome. However, the association of chronic kidney disease (CKD) and its severity with health-related quality of life is uncertain. STUDY DESIGN: Nationwide population-based cross-sectional study. SETTING & PARTICIPANTS: 46,676 adults participating in the Korea National Health and Nutrition Examination Survey (KNHANES) 2005 to 2013. PREDICTOR: CKD ascertained as dipstick-positive proteinuria or estimated glomerular filtration rate (eGFR)<60mL/min/1.73m(2). 5 eGFR categories of CKD were compared: ≥90 (with proteinuria), 60 to 89 (with proteinuria), 45 to 59, 30 to 44, and <30mL/min/1.73m(2). OUTCOMES: The EQ-5D index for health status (range, 0 [death] to 1 [optimal health]). RESULTS: The total crude CKD prevalence estimate for adults 20 years or older in Korea was 5.5%. After adjustments for age, sex, risk factors, and comorbid conditions, the EQ-5D index was lower in those with versus without CKD, with mean differences of -0.004 (95% CI, -0.015 to 0.007), -0.016 (95% CI, -0.032 to -0.000), -0.020 (95% CI, -0.029 to -0.011), -0.052 (95% CI, -0.072 to -0.032), and -0.067 (95% CI, -0.101 to -0.032), respectively, for CKD eGFR categories of ≥90, 60 to 89, 45 to 59, 30 to 44, and <30mL/min/1.73m(2). In the subgroup of older (≥60 years) individuals, the adjusted mean difference in the EQ-5D index was lower in the CKD eGFR category of 60 to 89mL/min/1.73m(2), but not in the eGFR category of 45 to 59mL/min/1.73m(2), compared to non-CKD. LIMITATIONS: The survey was conducted on noninstitutionalized civilians, and the chronicity of kidney disease was not verified. Caution is required if our results are applied to special settings and specific populations. CONCLUSIONS: There was a graded but complex association between CKD and poor health-related quality of life in this large community-based population.
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Calidad de Vida , Insuficiencia Renal Crónica , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Insuficiencia Renal Crónica/diagnóstico , República de CoreaRESUMEN
Chronic kidney disease is a leading public health problem related to poor quality of life and premature death. As a resource for evidence-informed health policy-making, we evaluated the prevalence of chronic kidney disease using the data of non-institutionalized adults aged ≥ 20 years (n = 15,319) from the Korean National Health and Nutrition Examination Survey in 2011-2013. Chronic kidney disease was defined as a urine albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) using the Chronic Kidney Disease-Epidemiology Collaboration equation. The total prevalence estimate of chronic kidney disease for adults aged ≥ 20 years in Korea was 8.2%. By disease stage, the prevalence of chronic kidney disease was as follows: stage 1, 3.0%; stage 2, 2.7%; stage 3a, 1.9%; stage 3b, 0.4%; and stages 4-5, 0.2%. When grouped into three risk categories according to the 2012 Kidney Disease: Improving Global Outcomes guidelines, the proportions for the moderately increased risk, high risk, and very high risk categories were 6.5%, 1.2%, and 0.5%, respectively. Factors including older age, diabetes, hypertension, cardiovascular disease, body mass indexes of ≥ 25 kg/m(2) and < 18.5 kg/m(2), and rural residential area were independently associated with chronic kidney disease. Based on this comprehensive analysis, evidence-based screening strategies for chronic kidney disease in the Korean population should be developed to optimize prevention and early intervention of chronic kidney disease and its associated risk factors.
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Encuestas Nutricionales , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Albuminuria/complicaciones , Creatina/orina , Femenino , Tasa de Filtración Glomerular , Humanos , Riñón/fisiología , Masculino , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal Crónica/patología , República de Corea/epidemiología , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
We report a simple detection of protein kinase activity using Zn(II)-mediated fluorescent resonance energy transfer (FRET) between quantum dots (QDs) and dye-tethered peptides. With neither complex chemical ligands nor surface modification of QDs, Zn(II) was the only metal ion that enabled the phosphorylated peptides to be strongly attached on the carboxyl groups of the QD surface via metal coordination, thus leading to a significant FRET efficiency. As a result, protein kinase activity in intermixed solution was efficiently detected by QD-FRET via Zn(II) coordination, especially when the peptide substrate was combined with affinity-based purification. We also found that mono- and di-phosphorylation in the peptide substrate could be discriminated by the Zn(II)-mediated QD-FRET. Our approach is expected to find applications for studying physiological function and signal transduction with respect to protein kinase activity.
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Técnicas Biosensibles/métodos , Transferencia Resonante de Energía de Fluorescencia/métodos , Nanopartículas/química , Proteínas Quinasas/metabolismo , Puntos Cuánticos/química , Zinc/química , Adenosina Trifosfato/farmacología , Pruebas de Enzimas , Magnesio/farmacología , Péptidos/metabolismo , Fosforilación/efectos de los fármacos , Especificidad por Sustrato/efectos de los fármacos , Factores de TiempoRESUMEN
Photoporation techniques based on plasmonic nanoparticles such as gold nanoparticles have been extensively studied for the intracellular delivery of substances via cell membrane disruption. However, the clinical application of AuNP is challenging due to its absorption in the 500 nm region of the light spectrum. To overcome this challenge, upconversion nanoparticles were employed to stimulate AuNP at NIR wavelengths. posAuNP@UCNPs nanocomposites were produced by coating 30 nm UCNPs on 80 nm AuNPs using DOPA-PEI, which were then irradiated with 980 nm NIR light to facilitate their intracellular delivery. TEM and DLS confirmed that posAuNP and UCNP combine to form nanocomposites. Additionally, multiphysics simulation was used to analyze the distribution of the posAuNP electric field based on morphological differences that change as the UCNP ratio increases. Next, effective LED irradiation conditions were established by applying upconverting-photon quenching-mediated perforation influx to C28/I2 cells as suspensions or spheroids. posAuNP@UCNP nanocomposites were confirmed to be effective for the delivery of baricitinib as a treatment for osteoarthritis in a three-dimensional osteoarthritis model. Finally, chondrocyte differentiation was induced through intracellular delivery of baricitinib using posAuNP@UCNPs. The findings suggest that posAuNP@UCNPs have great potential as a tool for non-invasive drug delivery via UCPPin.
RESUMEN
In this study, the effect of atmospheric hydrogen plasma treatment on the in-plane conductivity of solution-processed zinc oxide (ZnO) in various environments is reported. The hydrogen-plasma-treated and untreated ZnO films exhibited ohmic behavior with room-temperature in-plane conductivity in a vacuum. When the untreated ZnO film was exposed to a dry oxygen environment, the conductivity rapidly decreased, and an oscillating current was observed. In certain cases, the thin film reversibly 'switched' between the high- and low-conductivity states. In contrast, the conductivity of the hydrogen-plasma-treated ZnO film remained nearly constant under different ambient conditions. We infer that hydrogen acts as a shallow donor, increasing the carrier concentration and generating oxygen vacancies by eliminating the surface contamination layer. Hence, atmospheric hydrogen plasma treatment could play a crucial role in stabilizing the conductivity of ZnO films.
RESUMEN
Vancomycin, a first-line drug for treating methicillin-resistant Staphylococcus aureus infections, is associated with acute kidney injury (AKI). This study involved an evaluation of biomarkers for AKI detection and their comparison with traditional serum creatinine (SCr). We prospectively enrolled patients scheduled to receive intravenous vancomycin for methicillin-resistant S aureus infection. Blood samples for pharmacokinetic assessment and SCr and cystatin C (CysC) measurements were collected at baseline and on days 3, 7, and 10 from the initiation of vancomycin administration (day 1). Urinary biomarkers, including kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin, and clusterin, were collected from days 1 to 7 and adjusted for urinary creatinine levels. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Of the 42 patients, 6 experienced vancomycin-induced AKI. On day 7, the change from baseline eGFR using CysC (ΔeGFRCysC) showed a stronger correlation with vancomycin area under the curve (râ =â -0.634, Pâ <â .001) than that using SCr (ΔeGFRSCr; râ =â -0.437, Pâ =â .020). ΔeGFRSCr showed no significant correlation with vancomycin pharmacokinetic in patients with body mass indexâ ≥23. The median (interquartile range) level of KIM-1 (µg/mg) was significantly higher in the AKI group (0.006 [0.005-0.008]) than in the non-AKI group (0.004 [0.001-0.005]) (Pâ =â .039, Mann-Whitney U test), with area under the receiver operating characteristic curve (95% confidence interval) of 0.788 (0.587-0.990). Serum CysC, particularly in overweight individuals or those with obesity, along with urinary KIM-1 are important predictors of vancomycin-induced AKI. These results may aid in selecting better biomarkers than traditional SCr for detecting vancomycin-induced AKI.
Asunto(s)
Lesión Renal Aguda , Antibacterianos , Biomarcadores , Creatinina , Cistatina C , Receptor Celular 1 del Virus de la Hepatitis A , Vancomicina , Humanos , Vancomicina/efectos adversos , Vancomicina/farmacocinética , Vancomicina/administración & dosificación , Vancomicina/sangre , Biomarcadores/orina , Biomarcadores/sangre , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/orina , Lesión Renal Aguda/sangre , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Antibacterianos/efectos adversos , Antibacterianos/farmacocinética , Antibacterianos/administración & dosificación , Anciano , Receptor Celular 1 del Virus de la Hepatitis A/análisis , Cistatina C/sangre , Cistatina C/orina , Creatinina/sangre , Creatinina/orina , Tasa de Filtración Glomerular , Lipocalina 2/orina , Lipocalina 2/sangre , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus Resistente a Meticilina , Clusterina/orina , Clusterina/sangreRESUMEN
BACKGROUND: Patients with hip fracture often experience severe pain, particularly during movement or slight positional change, prior to the occurrence of surgery. It is essential to explore the appropriate analgesic methods before surgery in patients with hip fracture, especially those capable of alleviating dynamic pain. Pericapsular nerve group (PENG) block was introduced as a useful technique for hip analgesia. In this study, we aimed to compare the reduction in dynamic pain between the PENG block and supra-inguinal fascia iliaca compartment block (SIFICB). METHODS: This prospective trial included 80 hip fracture patients aged ≥19 years, with an American Society of Anesthesiologists Physical Status of 1-4 and a baseline dynamic pain score ≥4 on the numerical rating scale. The patients were randomly allocated into the PENG block (n=40) and SIFICB group (n=40). For the PENG block and SIFICB, 20 mL and 30 mL of 0.3% ropivacaine was used, respectively. The primary outcome was reduction in dynamic pain scores at 30 min following the peripheral nerve block. Dynamic pain score was evaluated when the leg was passively raised. RESULTS: A total of 79 patients were included in the final analysis, and the reductions in pain score during hip flexion were 3.1±2.4 and 2.9±2.5 in the PENG block and SIFICB groups, respectively, which was statistically insignificant (p=0.75). Moreover, no significant differences were observed in any of the outcomes. CONCLUSIONS: PENG block and SIFICB could effectively provide analgesia for dynamic pain in patients with hip fractures, with no significant difference between the two groups. TRIAL REGISTRATION NUMBER: NCT04677348.