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Background@#Many studies have shown that Hashimoto’s thyroiditis (HT) acts as a protective factor in differentiated thyroid cancer (DTC), but little is known about its effects on mortality. Therefore, this study was performed to reveal the prognosis of HT on mortality in patients with DTC. @*Methods@#This study included two types of research results: retrospective cohort study using the National Epidemiologic Survey of Thyroid cancer (NEST) in Korea and meta-analysis study with the NEST data and eight selected studies. @*Results@#Of the 4,398 patients with DTC in NEST, 341 patients (7.8%) died during the median follow-up period of 15 years (interquartile range, 12.3 to 15.6). Of these, 91 deaths (2.1%) were related to DTC. HT was associated with a smaller tumor size and less aggressive DTC. In Cox regression analysis after adjusting for age and sex, patients with HT showed a significantly lower risk of all-cause death (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96) and DTC-related death (HR, 0.33; 95% CI, 0.14 to 0.77). The analysis with inverse probability of treatment weight data adjusted for age, sex, and year of thyroid cancer registration showed similar association. The meta-analysis showed that patients with HT showed a lower risk of all-cause mortality (risk ratio [RR], 0.24; 95% CI, 0.13 to 0.47) and thyroid cancer-related mortality (RR, 0.23; 95% CI, 0.13 to 0.40) in comparison with patients without HT. @*Conclusion@#This study showed that DTC co-presenting with HT is associated with a low risk of advanced DTC and presents a low risk for all-cause and DTC-related death.
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Background/Aims@#Based on their anatomy, cholangiocarcinomas (CCAs) are classified into intrahepatic, hilar, and distal CCAs. Although the diagnosis and treatment of each type of CCA are thought to be different, real-world data studies on the current practice are limited. Therefore, this study was designed to capture the current practice of diagnosing and treating perihilar CCA in Korea. @*Methods@#We conducted a survey using an online platform. The questionnaire consisted of 18 questions designed to evaluate the current practice of diagnosing and treating perihilar CCA in Korea. The targets of this survey were biliary endoscopists who are members of the Korean Pancreatobiliary Association. @*Results@#In total, 119 biliary endoscopists completed the survey. Of the respondents, 89.9% thought that the use of the International Classification of Diseases, 11th Revision (ICD-11) system is necessary to classify CCA. Approximately half of the respondents would recommend surgery or chemotherapy until patients were 80 years of age. For the pathological diagnosis of CCA, endoscopic retrograde cholangiopancreatography with biopsy was the most preferred modality. Routine preoperative biliary drainage was performed by 44.5% of the respondents. For operable CCAs, 64.7% of the respondents preferred endoscopic biliary drainage using plastic stents. For palliative biliary drainage, 69.7% of the respondents used plastic stents. For palliative endoscopic biliary drainage using metal stents, 63% of the respondents preferred the stent-in-stent method. @*Conclusions@#A new coding system using the ICD-11 is needed for classifying CCAs. Guidelines for diagnosing and treating CCA based on the clinical situation in Korea are needed.
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Osteoarthritis (OA) involves cartilage degeneration, thereby causing inflammation and pain. Cardiovascular diseases, such as dyslipidemia, are risk factors for OA; however, the mechanism is unclear. We investigated the effect of dyslipidemia on the development of OA. Treatment of cartilage cells with low-density lipoprotein (LDL) enhanced abnormal autophagy but suppressed normal autophagy and reduced the activity of transcription factor EB (TFEB), which is important for the function of lysosomes. Treatment of LDL-exposed chondrocytes with rapamycin, which activates TFEB, restored normal autophagy. Also, LDL enhanced the inflammatory death of chondrocytes, an effect reversed by rapamycin. In an animal model of hyperlipidemia-associated OA, dyslipidemia accelerated the development of OA, an effect reversed by treatment with a statin, an anti-dyslipidemia drug, or rapamycin, which activates TFEB. Dyslipidemia reduced the autophagic flux and induced necroptosis in the cartilage tissue of patients with OA. The levels of triglycerides, LDL, and total cholesterol were increased in patients with OA compared to those without OA. The C-reactive protein level of patients with dyslipidemia was higher than that of those without dyslipidemia after total knee replacement arthroplasty. In conclusion, oxidized LDL, an important risk factor of dyslipidemia, inhibited the activity of TFEB and reduced the autophagic flux, thereby inducing necroptosis in chondrocytes.
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Background/Aims@#We investigated the clinical practice patterns of post-polypectomy colonoscopic surveillance among Korean endoscopists. @*Methods@#In a web-based survey conducted between September and November 2021, participants were asked about their preferred surveillance intervals and the patient age at which surveillance was discontinued. Adherence to the recent guidelines of the U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) was also analyzed. @*Results@#In total, 196 endoscopists completed the survey. The most preferred first surveillance intervals were: a 5-year interval after the removal of 1–2 tubular adenomas 10 adenomas, 5–10 SSLs, and SSLs with dysplasia. In piecemeal resections of large polyps ( > 20 mm), surveillance colonoscopy was mostly preferred after 1 year for adenomas and 6 months for SSLs. The mean USMSTF guideline adherence rate was 30.7%. The largest proportion of respondents (40.8%–55.1%) discontinued the surveillance at the patient age of 80–84 years. @*Conclusions@#A significant discrepancy was observed between the preferred post-polypectomy surveillance intervals and recent international guidelines. Individualized measures are required to increase adherence to the guidelines.
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Endosalpingiosis is a benign, non-neoplastic disease in which glandular tissue lined with ciliated tubal epithelium is ectopically present outside the fallopian tubes. Endosalpingiosis is rarely observed in the pelvic organs and its occurrence in the urinary bladder is particularly uncommon. Herein, we present a case of endosalpingiosis in the urinary bladder of a 62-year-old woman, which mimicked a bladder neoplasm, along with the corresponding magnetic resonance imaging (MRI) findings. The mass was a subepithelial lesion in the posterior portion of the urinary bladder dome. The lesion exhibited multiple cystic components with T2 high-intensity foci and mild heterogeneous enhancement on T1-weighted images. If there is a non-epithelial mass in the urinary bladder, especially on the posterior wall or dome, and the lesion exhibits MRI findings as described above, it is important to consider differential diagnoses, such as a non-neoplastic disease like endosalpingiosis.
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Background@#Among the various pain-related diseases that can be encountered at the clinic, there is a neuropathic pain that is difficult to treat. Numerous methods have been proposed to treat neuropathic pain, such as taking medication, nerve block with lidocaine, or neurolysis with alcohol or phenol. Recently, a method of perineural injection using dextrose instead of lidocaine was proposed. This study was designed to compare the effects of perineural injection therapy (PIT) with buffered 5% dextrose or 0.5% lidocaine on neuropathic pain. @*Methods@#The data were collected from the database of pain clinic from August 1st, 2019 to December 31st, 2022 without any personal information. The inclusion criteria were patients diagnosed with postherpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), or peripheral neuropathy (PN), and patients who had undergone PIT with buffered 5% dextrose (Dextrose group) or 0.5% lidocaine (Lidocaine group) for pain control. The data of patients, namely sex, age, and pain score (numerical rating scale, NRS) were collected before PIT. The data of NRS, side effects, and satisfaction grade (excellent, good, fair, or poor) were collected one week after each of the four PIT, and two weeks after the last PIT. @*Results@#Overall, 112 subjects were enrolled. The Dextrose group included 89 and Lidocaine group included 23 patients. Because the number of patients in the Lidocaine group was too small to allow statistical analysis, the trend in Lidocaine group was just observed in each disease. There were no significant side effects except for a few bruise cases on the site of injection in all groups. The NRS in most Dextrose groups except CRPS were reduced significantly; however, the Lidocaine group showed a trend of pain reduction only in PHN. The Dextrose group except CRPS showed increased satisfaction two weeks after the final PIT. @*Conclusion@#From the results, it is suggested that PIT with buffered 5% dextrose may have a good effect for neuropathic pain without any side effect except for patients with CRPS. This may offer a window into a new tool that practitioners can employ in their quest to help patients with neuropathic pain.
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Purpose@#This study aimed to identify the relationship between nursing professionalism and nursing intention for patients with emerging infectious diseases of nursing students who had experienced coronavirus disease 2019 (COVID-19), with a focus on the mediating effect of e-Health literacy. @*Methods@#The study surveyed 177 nursing students who had experienced COVID-19. The data were collected using self-reported questionnaires. The collected data were analyzed using IBM SPSS statistics 25.0, and the mediating effect was analyzed through the SPSS Process macro model 4. @*Results@#Nursing professionalism (β=.26, p=.002) and e-Health literacy (β=.18, p=.021) were found to be significant predictors of nursing intention for patients with emerging infectious diseases. In addition, e-Health literacy partially mediated the relationship between nursing professionalism and nursing intention for patients with emerging infectious diseases. @*Conclusion@#e-Health literacy was a mediating factor in the relationship between the nursing professionalism and nursing intention of nursing students for patients with emerging infectious diseases. In order to improve nursing intention of nursing students for patients with emerging infectious diseases, it is important to develop an education program that can enhance their e-Health literacy as well as nursing professionalism.
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Purpose@#This study aimed to examine the mediating effect of learning immersion in clinical simulations on the relationship between nursing student learning motivation and achievement in clinical simulation. @*Methods@#This study was conducted using a cross-sectional survey with 184 nursing students from two universities who participated in clinical simulation between September and December 2022. The participants completed a self-administered questionnaire, and the collected data were analyzed using independent an independent t-test, Mann–Whitney U-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple regression analysis to identify the mediating effects of learning immersion on the relationship between nursing student learning motivation and achievement. @*Results@#Among the subvariables of nursing student learning motivation, task value and self-efficacy for learning and performance had a significant effect on learning immersion (respectively, β=.36, p=.001; β =.31, p<.001) and learning achievement (respectively, β=.48, p<.001; β=.38, p<.001). With the input of learning motivation variables, the direct effect of learning immersion on learning achievement was significant (β=.20, p=.003), and the effects of learning motivation and task value and self-efficacy on learning achievement was reduced after controlling for learning immersion, which is a mediating variable (respectively, β=.41, p<.001; β=.32, p<.001). The bootstrapping test to confirm the mediating effect of learning immersion was also significant (task value 95% confidence interval [95% CI], 0.02~0.20; self-efficacy 95% CI, 0.01~0.12). @*Conclusion@#The results of this study suggest that simulation educators should consider learners’ motivation and immersion when organizing and operating clinical simulations.
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Purpose@#This study aimed to develop a counseling program called Motivational Interviewing-Cognitive Behavioral Therapy Integrated Counseling Program (MICBT-CP) and evaluate its effectiveness in post-case management of individuals who have attempted suicide. @*Methods@#Twenty-eight participants with a history of suicide attempts and high scores on Beck’s Scale for Suicidal Ideation were divided into three groups: an experimental group (EG), control group 1 (CG1), and control group 2 (CG2). Each group received different interventions: MICBT-CP for the EG, cognitive-behavioral treatment-based case management (CBT-CM) for CG1, and general case management (GCM) for CG2. Measurements of suicidal ideation, depression, hopelessness, problem-solving competence, life motivation, and perceived motivation were taken at baseline (T1), 6 weeks (T2), and 18 weeks (T3). @*Results@#Significant improvements in life motivation, perceived motivation, and problem-solving competence were observed in the EG compared to CG1 and CG2. Moreover, the EG showed significant reductions in suicidal ideation, hopelessness, and depression. The treatment of CG2 with GCM did not yield significant results, indicating the limitations of current GCM in post-suicide attempt case management. @*Conclusion@#The study emphasizes the need for effective programs such as MICBT-CP and improved practitioner skills in post-suicide case management.
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Background@#Coronavirus disease 2019 (COVID-19) vaccination is effective in preventing the disease transmission and progression. However, the relatively mild disease course of the omicron variant and the decrease in antibodies over time after vaccination raise questions about the effectiveness of vaccination, especially in young people. We compared the prevalence of pneumonia and chest X-ray severity score according to vaccination status among patients < 50 years old with COVID-19. @*Methods@#From January 17 to March 17, 2022, 579 patients with COVID-19, who were < 50 years old and had a known vaccination history in our institution, were all included in this study. All patients underwent initial chest radiography, and follow-up chest radiographs were obtained every two days until discharge. Pneumonia was scored from the radiographs using the Brixia scoring system. The scores of the six lung zones were added for a total score ranging from 0 to 18. Patients were divided into four groups according to 10-year age intervals. Differences between groups were analyzed using the χ2 or Fisher’s exact tests for categorical variables and the Kruskal–Wallis test or analysis of variance for continuous variables. @*Results@#Among patients aged 12–19 years, the prevalence of pneumonia did not differ depending on vaccination status (non-vaccinated vs. vaccinated, 1/47 [2.1%] vs. 1/18 [5.6%]; P = 0.577).Among patients in their 20s, the prevalence of pneumonia was significantly higher among nonvaccinated patients than among vaccinated patients (8/28, 28.6% vs. 7/138, 5.1%, P < 0.001), similar to patients in their 40s (32/52 [61.5%] vs. 18/138 [13.0%]; P < 0.001). The chest X-ray severity score was also significantly higher in non-vaccinated patients than that in vaccinated patients in their 20s to their 40s (P < 0.001), but not among patients aged 12–19 years (P = 0.678). @*Conclusion@#In patients aged 20–49 years, vaccinated patients had a significantly lower prevalence of pneumonia and chest X-ray severity score than non-vaccinated patients.
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This retrospective cohort study aimed to compare coronavirus disease 2019 (COVID-19)-related clinical outcomes between patients with and without gout. Electronic health recordbased data from two centers (Seoul National University Hospital [SNUH] and Boramae Medical Center [BMC]), from January 2021 to April 2022, were mapped to a common data model. Patients with and without gout were matched using a large-scale propensityscore algorithm based on population-level estimation methods. At the SNUH, the risk for COVID-19 diagnosis was not significantly different between patients with and without gout (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.59–1.84). Within 30 days after COVID-19 diagnosis, no significant difference was observed in terms of hospitalization (HR, 0.57; 95% CI, 0.03–3.90), severe outcomes (HR, 2.90; 95% CI, 0.54–13.71), or mortality (HR, 1.35; 95% CI, 0.06–16.24). Similar results were obtained from the BMC database, suggesting that gout does not increase the risk for COVID-19 diagnosis or severe outcomes.
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Background@#Global Lung Function Initiative (GLI)-2012 reference equation is currently suggested for interpretation of spirometry results and a new local reference equation has been developed in South Korea. However, lung function profiles according to the different reference equations and their clinical relevance have not been identified in chronic obstructive pulmonary disease (COPD) patients. @*Methods@#Our cross-sectional study evaluated Choi’s, Korean National Health and National Examination Survey (KNHANES)-VI, and GLI-2012 reference equations. We estimated the percentages of predictive forced expiratory volume in one second (FEV 1) and airflow limitation severity according to reference equations and analyzed their associations with patient reported outcomes (PROs): COPD assessment test (CAT) score, St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) score, and six minute walk distance (6MWD). @*Results@#In the eligible 2,180 COPD patients, lower predicted values of FEV 1 and forced vital capacity (FVC) were found in GLI-2012 compared to Choi's and KNHANES-VI equations.GLI-2012 equation resulted in a lower proportion of patients being classified as FEV 1 < 80% or FVC < 80% compared to the other equations. However, the Z-scores of FEV 1 and FVC were similar between the KNHANES-VI and GLI-2012 equations. Three reference equations exhibited significant associations between FEV 1 (%) and patient-reported outcomes (CAT score, SGRQ-C score, and 6MWD). @*Conclusion@#GLI-2012 reference equation may not accurately reflect FEV 1 (%) in the Korean population, but the Z-score using GLI-2012 equation can be a viable option for assessing FEV 1 and airflow limitation in COPD patients. Similar to the other two equations, the GLI-2012 equation demonstrated significant associations with PROs.
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Background@#Multiple myeloma (MM) patients are at risk of skeletal-related events (SREs) like spinal cord compression, pathologic fractures, bone surgery, and radiation to bone. Realworld data regarding SREs in MM are limited. @*Methods@#We conducted a large, retrospective, nationwide cohort study using the Korean Health Insurance Review and Assessment Service (HIRA) database from 2007 to 2018. @*Results@#Over a 12-year study period, we identified 6,717 patients who developed symptomatic MM. After a median follow-up of 35.1 months (interquartile range [IQR], 20.8–58.2 months), 43.6% of these patients experienced SREs, and 39.6% had four or more SREs. One in five patients (20.0%) experienced pathologic fractures within the first year of follow-up. The median time to first SRE was 9.6 months (IQR, 1.2–25.8 months), with 3.0 months in the group with prior SREs and 19.8 months in the group without prior SREs.During follow-up, 78.5% of patients received bisphosphonates. Multiple logistic regression analysis revealed several factors associated with an increased risk of SREs, including being female (odds ratio [OR], 1.44), aged 50 or older (OR, 1.87), having cerebrovascular disease (OR, 1.34), undergoing first-line chemotherapy regimens not containing bortezomib or lenalidomide (OR, 1.49), and being in the group with prior SREs and bisphosphonate use (OR, 5.63), compared to the group without prior SREs and without bisphosphonate use. @*Conclusion@#This population-based study is the first to report the incidence and risk factors of SREs in Korean MM patients, which can be used to assess their bone health.
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Background@#Pulmonary nocardiosis is a rare opportunistic infection with occasional systemic dissemination. This study aimed to investigate the computed tomography (CT) findings and prognosis of pulmonary nocardiosis associated with dissemination. @*Methods@#We conducted a retrospective analysis of patients diagnosed with pulmonary nocardiosis between March 2001 and September 2023. We reviewed the chest CT findings and categorized them based on the dominant CT findings as consolidation, nodules and/ or masses, consolidation with multiple nodules, and nodular bronchiectasis. We compared chest CT findings between localized and disseminated pulmonary nocardiosis and identified significant prognostic factors associated with 12-month mortality using multivariate Cox regression analysis. @*Results@#Pulmonary nocardiosis was diagnosed in 75 patients, of whom 14 (18.7%) had dissemination, including involvement of the brain in 9 (64.3%) cases, soft tissue in 3 (21.4%) cases and positive blood cultures in 3 (21.4%) cases. Disseminated pulmonary nocardiosis showed a higher frequency of cavitation (64.3% vs. 32.8%, P = 0.029) and pleural effusion (64.3% vs. 29.5%, P = 0.014) compared to localized infection. The 12-month mortality rate was 25.3%. The presence of dissemination was not a significant prognostic factor (hazard ratio [HR], 0.80; confidence interval [CI], 0.23–2.75; P = 0.724). Malignancy (HR, 9.73; CI, 2.32–40.72; P = 0.002), use of steroid medication (HR, 3.72; CI, 1.33–10.38; P = 0.012), and a CT pattern of consolidation with multiple nodules (HR, 4.99; CI, 1.41–17.70; P = 0.013) were associated with higher mortality rates. @*Conclusion@#Pulmonary nocardiosis with dissemination showed more frequent cavitation and pleural effusion compared to cases without dissemination, but dissemination alone did not affect the mortality rate of pulmonary nocardiosis.
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Objective@#The Scales for Outcomes in Parkinson’s Disease–Cognition (SCOPA-Cog) was developed to assess cognition in patients with Parkinson’s disease (PD). In this study, we aimed to evaluate the validity and reliability of the Korean version of the SCOPACog (K-SCOPA-Cog). @*Methods@#We enrolled 129 PD patients with movement disorders from 31 clinics in South Korea. The original version of the SCOPA-Cog was translated into Korean using the translation-retranslation method. The test–retest method with an intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient were used to assess reliability. Spearman’s rank correlation analysis with the Montreal Cognitive Assessment-Korean version (MOCA-K) and the Korean Mini-Mental State Examination (K-MMSE) were used to assess concurrent validity. @*Results@#The Cronbach’s alpha coefficient was 0.797, and the ICC was 0.887. Spearman’s rank correlation analysis revealed a significant correlation with the K-MMSE and MOCA-K scores (r = 0.546 and r = 0.683, respectively). @*Conclusion@#Our results demonstrate that the K-SCOPA-Cog has good reliability and validity.
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Purpose@#Mitochondria play a crucial role in preserving skeletal muscle mass, and damage to mitochondria leads to muscle mass loss. This study investigated the effects of oxypeucedanin hydrate, a furanocoumarin isolated from Angelica dahurica radix, on myogenesis and mitochondrial function in vitro and in zebrafish models. @*Methods@#C2C12 myotubes cultured in media containing 0.1, 1, 10, or 100 ng/mL oxypeucedanin hydrate were immunostained with myosin heavy chain (MHC), and then multinucleated MHC-positive cells were counted. The expressions of markers related to muscle differentiation, muscle protein degradation, and mitochondrial function were determined by quantitative reverse transcription polymerase chain reaction. To investigate the effects of oxypeucedanin hydrate on mitochondrial dysfunction, Tg(Xla.Eef1a1:mito-EGFP) zebrafish embryos were treated with 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) with or without oxypeucedanin hydrate and analyzed for mito-EGFP intensity and mitochondrial length. @*Results@#Oxypeucedanin hydrate significantly increased MHC-positive multinucleated myotubes (≥ 3 nuclei) and increased the expression of the myogenic marker myosin heavy chain 4. However, it decreased the expressions of muscle-specific RING finger protein 1 and muscle atrophy f-box (markers of muscle protein degradation). Furthermore, oxypeucedanin hydrate enhanced the expressions of markers of mitochondrial biogenesis (peroxisome proliferator-activated receptor-gamma coactivator 1 alpha, transcription factor a mitochondrial, succinate dehydrogenase complex flavoprotein subunit A, and cytochrome c oxidase subunit 1) and mitochondrial fusion (optic atrophy 1). However, it reduced the expression of dynamin-related protein 1 (a mitochondrial fission regulator). Consistently, oxypeucedanin hydrate reduced FOLFIRI-induced mitochondrial dysfunction in the skeletal muscles of zebrafish embryos. @*Conclusion@#The study indicates that oxypeucedanin hydrate promotes myogenesis by improving mitochondrial function, and thus, suggests oxypeucedanin hydrate has potential use as a nutritional supplement that improves muscle mass and function.
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Purpose@#This study examined the impact of adolescents’ dietary behavior on their quality of life using the nutrition quotient for adolescents (NQ-A) for some high school students in Seoul. @*Methods@#The subjects were 176 high school students living in Seoul. The NQ-A was used to assess the dietary quality, and the quality of life was assessed by categorizing it into life satisfaction, environment, health, participation and safety, leisure activities, and emotional factors using survey questions validated through previous studies. @*Results@#The NQ score of the survey subjects was 49.30 points. Based on the NQ scores, 7.4%, 46.6%, and 46.0% of participants were categorized as the ‘high’, ‘medium’, and ‘low’ groups, respectively. The total NQ score and balance, diversity, and practice factor scores were positively correlated with life satisfaction, environment, health, participation and safety, and leisure activities among the quality of life subscales. Regression analysis showed that the total NQ score was positively associated with life satisfaction, health, leisure activities, and emotions; the moderation factor was negatively associated with life satisfaction and health. The balance factor was positively associated with the environmental factor. The practice factor was positively associated with health, leisure activities, and emotions, and the environment factor was negatively associated with emotions. @*Conclusion@#These results show that adolescents’ quality of life is closely related to their diet, so it is necessary to maintain a balanced and varied food intake and desirable eating behaviors to improve adolescents’ quality of life. Furthermore, adolescents’ quality of life is influenced by other factors. Therefore, further research is needed to assess the quality of life, including dietary factors, as well as physical, emotional, psychological, and social development.
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The majority of neurocritically ill patients have disorders of consciousness. Both level and content of consciousness should be assessed repeatedly throughout the course of patient care. In this review, we describe the definition and diagnostic criteria for disorders of consciousness, and the neurological examination and standardized neurobehavioral assessment tools as methods of assessing consciousness. Next, we will discuss neurophysiological and neuroimaging tests as tools for assessing consciousness: automated quantitative pupillometry, electroencephalogram, evoked potentials, brain imaging, functional near-infrared spectroscopy, and biomarkers. We discuss the clinical utility of each assessment tool and the importance of a multimodal approach in the diagnosis, treatment, and prognostication of disorders of consciousness.
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Background@#Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control. @*Methods@#This prospective, randomized, triple-blind trial was conducted in patients aged 11–20 undergoing PSF. Participants were randomized into three groups: the preemptive group (received IV acetaminophen 15 mg/kg after anesthetic induction/before surgical incision), the preventive group (received IV acetaminophen 15 mg/kg at the end of surgery/before skin closure), and the placebo group. The primary outcome was cumulative opioid consumption during the first 24 h postoperatively. @*Results@#Among the 99 enrolled patients, the mean ± standard deviation (SD) amount of opioid consumption during the postoperative 24 h was 60.66 ± 23.84, 52.23 ± 22.43, and 66.70 ± 23.01 mg in the preemptive, preventive, and placebo groups, respectively (overall P = 0.043). A post hoc analysis revealed that the preventive group had significantly lower opioid consumption than the placebo group (P = 0.013). However, no significant differences between the groups were observed for the secondary outcomes. @*Conclusions@#The preventive administration of scheduled IV acetaminophen reduces cumulative opioid consumption without increasing the incidence of drug-induced adverse events in pediatric and adolescent patients undergoing PSF.
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Evaluating the performance of a binary diagnostic test, including artificial intelligence classification algorithms, involves measuring sensitivity, specificity, positive predictive value, and negative predictive value. Particularly when comparing the performance of two diagnostic tests applied on the same set of patients, these metrics are crucial for identifying the more accurate test. However, comparing predictive values presents statistical challenges because their denominators depend on the test outcomes, unlike the comparison of sensitivities and specificities. This paper reviews existing methods for comparing predictive values and proposes using the permutation test. The permutation test is an intuitive, non-parametric method suitable for datasets with small sample sizes. We demonstrate each method using a dataset from MRI and combined modality of mammography and ultrasound in diagnosing breast cancer.