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1.
Artículo en Inglés | MEDLINE | ID: mdl-33802062

RESUMEN

Although exposure to asbestos via various routes has been acknowledged, comprehensive exposure and risk assessment methods have not been developed at the national level. We conducted a study to reconstruct comprehensive past asbestos exposure estimations and to suggest a method to calculate the Excess Lifetime Cancer Risk (ELCR) of Koreans. The past occupational exposure reconstruction was conducted by rebuilding the previous general population job-exposure matrix (JEM). The para-occupational and household exposure estimation was based on the pooled analysis of data from other countries as well as Korea. The neighborhood exposure from occupational sources by distance was estimated by the exponential decay model. As a result, 141 JEM exposure groups across four periods including ~79, the 80s, 90s, 2000s with a ratio of 2.0:1.0:0.5:0.05 were reconstructed. The para-occupational and household exposures were 11% and 1% of the JEM respectively. The environmental exposure source concentration from outside occupational exposure was 2.5% of the inside concentration. The ratio of the concentration of environmental exposure source (C0) to distance d (Cd) was exp-kd  with a decay constant k of 6.834. The mean concentrations (f/cc) were 2.28 × 10-3 for outdoor, 4.65 × 10-5 for indoor, 1.95 × 10-2 for transportation activity, 4.44 × 10-2 for agricultural activity, and 4.68 × 10-2 for daily life activity in naturally occurring asbestos areas. Indoor and outdoor asbestos concentrations from living in a slate roof house were 1.73 × 10-6 and 2.70 × 10-8, respectively. For improved generalizability, validity, and applicability of the proposed method, further studies on each route with real assessments and experiments are required.

2.
Viruses ; 13(3)2021 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-33673635

RESUMEN

Wild aquatic birds, a natural reservoir of avian influenza viruses (AIVs), transmit AIVs to poultry farms, causing huge economic losses. Therefore, the prevalence and genetic characteristics of AIVs isolated from wild birds in South Korea from October 2019 to March 2020 were investigated and analyzed. Fresh avian fecal samples (3256) were collected by active monitoring of 11 wild bird habitats. Twenty-eight AIVs were isolated. Seven HA and eight NA subtypes were identified. All AIV hosts were Anseriformes species. The HA cleavage site of 20 representative AIVs was encoded by non-multi-basic amino acid sequences. Phylogenetic analysis of the eight segment genes of the AIVs showed that most genes clustered within the Eurasian lineage. However, the HA gene of H10 viruses and NS gene of four viruses clustered within the American lineage, indicating intercontinental reassortment of AIVs. Representative viruses likely to infect mammals were selected and evaluated for pathogenicity in mice. JB21-58 (H5N3), JB42-93 (H9N2), and JB32-81 (H11N2) were isolated from the lungs, but JB31-69 (H11N9) was not isolated from the lungs until the end of the experiment at 14 dpi. None of infected mice showed clinical sign and histopathological change in the lung. In addition, viral antigens were not detected in lungs of all mice at 14 dpi. These data suggest that LPAIVs derived from wild birds are unlikely to be transmitted to mammals. However, because LPAIVs can reportedly infect mammals, including humans, continuous surveillance and monitoring of AIVs are necessary, despite their low pathogenicity.

3.
PLoS One ; 16(3): e0248020, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33651848

RESUMEN

Osteoporosis is the most common disease of the musculoskeletal system in old age. Therefore, research on osteoporosis risk factors is actively being conducted. However, whether socioeconomic inequality is associated with the prevalence and diagnosis experience of osteoporosis remains largely unexplored. This study aims to investigate whether socioeconomic inequality can be a risk factor for osteoporosis in postmenopausal women. Cross-sectional data of 1,477 postmenopausal women aged over 50 obtained from the Korea National Health and Nutrition Examination Survey V-2 were analyzed. Univariate analyses were performed to calculate the prevalence of osteoporosis and the rate of osteoporosis diagnosis experience according to the risk factor categories. Multivariate logistic regression analysis was performed to identify the independent variables' associations with osteoporosis prevalence and diagnosis experience. The prevalence of osteoporosis was 34.8%, while the diagnosis experience rate was 22.1%. The higher the age, the higher the probability of osteoporosis presence and diagnosis experience. The lowest household income level was associated with a 1.63 times higher risk of osteoporosis. On the contrary, this factor was not significant for diagnosis experience. These results were similar for the 50-59 and 60-69 age groups. Among postmenopausal women, those who are older and have low socioeconomic levels are at a high risk of developing osteoporosis. Moreover, the lower the socioeconomic level, the lower the awareness of osteoporosis. Therefore, there is a need to develop more proactive preventive measures in postmenopausal women with low socioeconomic levels.

4.
Angle Orthod ; 90(4): 556-563, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33378503

RESUMEN

OBJECTIVES: To investigate the associations between nasal airway volume and the presence and severity of obstructive sleep apnea (OSA) in adults. MATERIALS AND METHODS: The medical records of adult patients who visited the sleep clinic at University Hospital between June 2013 and April 2017 and underwent overnight polysomnography for the diagnosis of obstructive sleep apnea were reviewed retrospectively. Using computed tomography, the volumes of the nasal airways and maxillary sinuses were measured, and associations with the presence and severity of OSA were analyzed while controlling for the effects of possible confounders such as lateral cephalometric variables, maxillary widths, tongue/hyoid position, and soft palate dimensions. RESULTS: Comparison between normal subjects and patients with OSA revealed that the latter had decreased ratios of maxillary sinus volume to whole nasal airway volume (P = .029) than normal subjects. OSA severity was greater in those with inferior positions of the hyoid (P = .010), in older patients (P = .011), and in those with high body mass index (P = .001). The volume of the total nasal airway or maxillary sinuses were not associated with OSA severity. CONCLUSIONS: A decreased ratio of maxillary sinus volume to whole nasal airway volume is associated with adult OSA. However, OSA severity is not associated with either maxillary sinus volume or whole nasal airway volume.


Asunto(s)
Seno Maxilar , Apnea Obstructiva del Sueño , Adulto , Anciano , Cefalometría , Humanos , Seno Maxilar/diagnóstico por imagen , Polisomnografía , Estudios Retrospectivos , Apnea Obstructiva del Sueño/diagnóstico por imagen
5.
Angle Orthod ; 90(6): 890, 2020 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-33126258
6.
Endocrinol Metab (Seoul) ; 35(3): 628-635, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32981305

RESUMEN

BACKGROUND: Salivary cortisol is routinely used as a diagnostic test for Cushing syndrome. The diagnostic use of salivary cortisol for adrenal insufficiency (AI), however, is less established. We aimed to investigate the utility of morning basal and adrenocorticotropic hormone-stimulated salivary cortisol in diagnosing AI in Korean adults. METHODS: We prospectively included 120 subjects (female, n=70) from Seoul National University Hospital. AI was defined as a stimulated serum cortisol level of <496.8 nmol/L during the short Synacthen test (SST). Serum and saliva samples were drawn between 8:00 AM and 10:00 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. RESULTS: Thirty-four patients were diagnosed with AI according to the SST results. Age, sex, body mass index, serum albumin levels, and serum creatinine levels did not significantly differ between the normal and AI groups. Basal and stimulated salivary cortisol levels were positively correlated with basal (r=0.538) and stimulated serum cortisol levels (r=0.750), respectively (all P<0.001). Receiver operating characteristic curve analysis yielded a cutoff level of morning basal salivary cortisol of 3.2 nmol/L (sensitivity, 84.9%; specificity, 73.5%; area under the curve [AUC]=0.822). The optimal cutoff value of stimulated salivary cortisol was 13.2 nmol/L (sensitivity, 90.7%; specificity, 94.1%; AUC=0.959). Subjects with a stimulated salivary cortisol level above 13.2 nmol/L but a stimulated serum cortisol level below 496.8 nmol/L (n=2) had lower serum albumin levels than those showing a concordant response. CONCLUSION: The diagnostic performance of stimulated salivary cortisol measurements after the SST was comparable to serum cortisol measurements for diagnosing AI.

7.
Artículo en Inglés | MEDLINE | ID: mdl-32973680

RESUMEN

Many patients with type 1 diabetes (T1D) do not achieve the glycemic target goal with insulin treatment. In this study, we aimed to evaluate the efficacy and safety of add-on to insulin therapy in patients with T1D. We conducted direct and indirect network meta-analyses using Bayesian models and ranked hypoglycemic agents via mixed treatment comparison, using data from the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases. Randomized controlled trials (RCTs) involving patients with T1D treated with insulin and add-on metformin or sodium-glucose cotransporter inhibitors or glucagon-like peptide-1 receptor agonists from January 1970 to September 2019 were included in this study. Twenty-three RCTs with 5,151 subjects were divided into the following groups: insulin alone, insulin+metformin, insulin+canagliflozin, insulin+dapagliflozin, insulin+empagliflozin, insulin+sotagliflozin, insulin+liraglutide, and insulin+exenatide. HbA1c level in the insulin+sotagliflozin group was significantly lower than that in the insulin alone group (mean difference: -0.43, 95% credible interval: -0.62 to -0.23). Total daily insulin dose in the insulin+sotagliflozin group was significantly lower than that in the insulin alone group. Compared with that in the insulin alone group, body weight in the groups treated with insulin+add-on canagliflozin, sotagliflozin, and exenatide was significantly decreased by 4.5, 2.8, and 5.1 kg, respectively. Hypoglycemic episodes did not differ among the groups. In patients with T1D, insulin+sotagliflozin decreased the HbA1c level, daily insulin dose, and body weight without hypoglycemia compared with insulin monotherapy. Insulin+canagliflozin or insulin+exenatide was effective in reducing body weight compared with insulin alone. In conclusion, sotagliflozin treatment decreased not only the HbA1c levels and insulin dose but also the body weight without causing hypoglycemia in patients with T1D. Treatment with canagliflozin and exenatide effectively reduced body weight in patients with T1D. However, ketoacidosis associated with the use of SGLT inhibitors should be considered in these patients. Thus, our results suggest that sotagliflozin has a high probability of being ranked first as an adjunctive therapy to insulin in patients with T1D.

8.
Acute Crit Care ; 35(3): 149-155, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32907308

RESUMEN

BACKGROUND: Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients. METHODS: We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis. RESULTS: Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors. CONCLUSIONS: Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

9.
Medicine (Baltimore) ; 99(22): e20061, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481375

RESUMEN

BACKGROUND: The rates of cardiovascular mortality and morbidity are increased in advanced chronic kidney disease (CKD). Mild to moderate CKD is associated with an increase in cardiovascular events. This study aims to investigate the effects of statins on patient mortality and cardiac events. STUDY APPRAISAL AND SYNTHESIS METHODS: Studies on statins (atorvastatin, rosuvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and simvastatin + ezetimibe) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2019 were analyzed. Inclusion criteria were randomized control trials and adult patients (>18 years old). Reviews, observational studies, and clinical trials that did not clearly define outcomes or that did not have thrombosis as an outcome were excluded. We performed direct and indirect network meta-analysis using Bayesian models and ranked different statins using generation mixed treatment comparison (GeMTC) and Stata version 13. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. The outcomes were cardiac events, cardiac mortality, and all-cause mortality. RESULTS: Nineteen studies (45,863 patients) were included. Compared with placebos, pravastatin 40 mg group showed a significantly lower patient mortality (odds ratio 0.66 [95% credible interval, 0.46-0.91]).Atorvastatin 80 mg, fluvastatin 40 mg, lovastatin 20 mg, pravastatin 40 mg, and simvastatin 40 mg showed significant results in reducing cardiac events.In rank probability, pravastatin showed the best effect at all-cause mortality rate. Lovastatin, fluvastatin, and pravastatin showed good effects in the 1st, 2nd, and 3rd ranks in cardiac events. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Pravastatin 40 mg demonstrated the best effect on all-cause mortality, and was observed to be effective with high ranking in cardiac events. We anticipate that the data of this study will assist physicians in making informed decisions when selecting statins, such as pravastatin, as a treatment option for CKD patients.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Insuficiencia Renal Crónica/complicaciones , Humanos , Metaanálisis en Red
10.
Comput Methods Programs Biomed ; 194: 105513, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32403052

RESUMEN

BACKGROUND AND OBJECTIVE: An accurate lateral cephalometric analysis is vital in orthodontic diagnosis. Identification of anatomic landmarks on lateral cephalograms is tedious, and errors may occur depending on the doctor's experience. Several attempts have been made to reduce this time-consuming process by automating the process through machine learning; however, they only dealt with a small amount of data from one institute. This study aims to develop a fully automated cephalometric analysis method using deep learning and a corresponding web-based application that can be used without high-specification hardware. METHODS: We built our own dataset comprising 2,075 lateral cephalograms and ground truth positions of 23 landmarks from two institutes and trained a two-stage automated algorithm with a stacked hourglass deep learning model specialized for detecting landmarks in images. Additionally, a web-based application with the proposed algorithm for fully automated cephalometric analysis was developed for better accessibility regardless of the user's computer hardware, which is essential for a deep learning-based method. RESULTS: The algorithm was evaluated with datasets from various devices and institutes, including a widely used open dataset and achieved 1.37 ± 1.79 mm of point-to-point errors with ground truth positions for 23 cephalometric landmarks. Based on the predicted positions, anatomical types of the subjects were automatically classified and compared with the ground truth, and the automated algorithm achieved a successful classification rate of 88.43%. CONCLUSIONS: We expect that this fully automated cephalometric analysis algorithm and the web-based application can be widely used in various medical environments to save time and effort for manual marking and diagnosis.

11.
Angle Orthod ; 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32091265

RESUMEN

OBJECTIVES: To investigate the associations between nasal airway volume and the presence and severity of obstructive sleep apnea (OSA) in adults. MATERIALS AND METHODS: The medical records of adult patients who visited the sleep clinic at University Hospital between June 2013 and April 2017 and underwent overnight polysomnography for the diagnosis of obstructive sleep apnea were reviewed retrospectively. Using computed tomography, the volumes of the nasal airways and maxillary sinuses were measured, and associations with the presence and severity of OSA were analyzed while controlling for the effects of possible confounders such as lateral cephalometric variables, maxillary widths, tongue/hyoid position, and soft palate dimensions. RESULTS: Comparison between normal subjects and patients with OSA revealed that the latter had decreased ratios of maxillary sinus volume to whole nasal airway volume (P = .029) than normal subjects. OSA severity was greater in those with inferior positions of the hyoid (P = .010), in older patients (P = .011), and in those with high body mass index (P = .001). The volume of the total nasal airway or maxillary sinuses were not associated with OSA severity. CONCLUSIONS: A decreased ratio of maxillary sinus volume to whole nasal airway volume is associated with adult OSA. However, OSA severity is not associated with either maxillary sinus volume or whole nasal airway volume.

12.
Angle Orthod ; 90(2): 181-186, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31769700

RESUMEN

OBJECTIVES: To investigate factors associated with spontaneous mesialization of impacted third molars after second molar protraction to close the space caused by a missing mandibular first molar (L-6) or retained deciduous mandibular second molars with a missing succedaneous premolar (L-E). MATERIALS AND METHODS: Panoramic radiographs of patients treated with mandibular second molar protraction to close the space due to missing L-6 or L-E (14 males, 36 females, mean age = 18.6 ± 4.4 years) were analyzed before treatment (T1) and after second molar protraction (T2). Factors associated with the amount of third molar mesialization were investigated using regression analyses. RESULTS: Mandibular second molars were protracted by 5.1 ± 2.1 mm and 5.8 ± 2.7 mm, measured at the crown and root furcation, respectively. After second molar protraction, third molars showed spontaneous mesialization by 4.3 ± 1.6 mm and 3.8 ± 2.6 mm, measured at the crown and root furcation, respectively. Nolla's stage of the third molar at T1 (B = 0.20, P = .026) and second molar protraction time (B = 0.04, P = .042) were significantly associated with the amount of third molar mesialization. CONCLUSIONS: Greater third molar mesialization was observed when Nolla's stage of the third molar was higher before treatment and when the second molar protraction time was longer.


Asunto(s)
Mandíbula , Tercer Molar , Diente Impactado , Adolescente , Adulto , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Diente Molar , Tercer Molar/diagnóstico por imagen , Radiografía Panorámica , Adulto Joven
13.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31690939

RESUMEN

CONTEXT: The long-term association between multiple cytokines and progression to diabetes is still uncertain. OBJECTIVE: To identify which cytokines could predict progression to prediabetes and type 2 diabetes over 10 years. METHODS: The study included 912 participants aged 40 to 69 years at baseline from the Ansung cohort, part of the Korea Genome Epidemiology Study. At baseline, a 75-g oral glucose tolerance test and 8 cytokines were measured: plasminogen activator inhibitor 1 (PAI-1), resistin, interleukin 6, leptin, monocyte chemoattractant protein 1, tumor necrosis factor alpha, retinol binding protein 4 (RBP4), and adiponectin. People with normal glucose tolerance (NGT, n = 241) and prediabetes (n = 330) were followed-up biennially for 10 years. Multinomial logistic regression analysis was used to evaluate the predictability of cytokines on the new-onset prediabetes and type 2 diabetes. RESULTS: At 10 years, 38 (15.8%) and 82 (34.0%) of those with NGT had converted to prediabetes and type 2 diabetes, respectively. Of those with prediabetes, 228 (69.1%) had converted to type 2 diabetes. In people with NGT or prediabetes at baseline, the highest tertile of RBP4 was associated with a 5.48-fold and 2.43-fold higher risk of progression to type 2 diabetes, respectively. The odds for converting from NGT to prediabetes in the highest tertile of PAI-1 and the lowest tertile of adiponectin were 3.23 and 3.37, respectively. In people with prediabetes at baseline, those in the highest tertile of resistin were 2.94 time more likely to develop type 2 diabetes (all P < 0.05). CONCLUSIONS: In this 10-year prospective study, NGT with higher serum RBP4 and PAI-1, and with lower adiponectin were associated with new-onset prediabetes and type 2 diabetes.


Asunto(s)
Citocinas/sangre , Diabetes Mellitus Tipo 2/epidemiología , Estado Prediabético/sangre , Adulto , Anciano , Diabetes Mellitus Tipo 2/sangre , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , República de Corea/epidemiología
14.
J Med Syst ; 44(1): 18, 2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31823091

RESUMEN

This study investigates the feasibility of estimation of blood pressure (BP) using a single earlobe photoplethysmography (Ear PPG) during cardiopulmonary resuscitation (CPR). We have designed a system that carries out Ear PPG for estimation of BP. In particular, the BP signals are estimated according to a long short-term memory (LSTM) model using an Ear PPG. To investigate the proposed method, two statistical analyses were conducted for comparison between BP measured by the micromanometer-based gold standard method (BPMEAS) and the Ear PPG-based proposed method (BPEST) for swine cardiac model. First, Pearson's correlation analysis showed high positive correlations (r = 0.92, p < 0.01) between BPMEAS and BPEST. Second, the paired-samples t-test on the BP parameters (systolic and diastolic blood pressure) of the two methods indicated no significant differences (p > 0.05). Therefore, the proposed method has the potential for estimation of BP for CPR biofeedback based on LSTM using a single Ear PPG.


Asunto(s)
Inteligencia Artificial , Determinación de la Presión Sanguínea/métodos , Reanimación Cardiopulmonar , Fotopletismografía/instrumentación , Biorretroalimentación Psicológica , Estudios de Factibilidad , Humanos
15.
Pilot Feasibility Stud ; 5: 123, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31720002

RESUMEN

Background: Recruitment of a diverse participant pool to cancer clinical trials is an essential component of clinical research as it improves the generalizability of findings. Investigating and piloting novel recruitment strategies that take advantage of ubiquitous digital technologies has become an important component of facilitating broad recruitment and addressing inequities in clinical trial participation. Equitable and inclusive recruitment improves generalizability of clinical trial outcomes, benefiting patients, clinicians, and the research community. The increasing prevalence of online connectivity in the USA and use of the Internet as a resource for medical information provides an opportunity for digital recruitment strategies in cancer clinical trials. This study aims to measure the acceptability, preliminary estimates of efficacy, and feasibility of the Trial Library intervention, an Internet-based cancer clinical trial matching tool. This study will also examine the extent to which the Trial Library website, designed to address the linguistic and literacy needs of broader patient populations, influences patient-initiated conversations with physicians about clinical trial participation. Methods: This is a study protocol for a non-randomized, single-arm pilot study. This is a mixed methods study design that utilizes the statistical analysis of quantitative survey data and the qualitative analysis of interview data to assess the participant experience with the Trial Library intervention. This study will examine (1) acceptability as a measure of participant satisfaction with this intervention, (2) preliminary measure of efficacy as a measure of proportion of participants with documented clinical trial discussion in the electronic medical record, and (3) feasibility of the intervention as a measure of duration of clinical visit. Discussion: The principles that informed the design of the Trial Library intervention aim to be generalizable to clinical trials across many disease contexts. From the ground up, this intervention is built to be inclusive of the linguistic, literacy, and technological needs of underrepresented patient populations. This study will collect essential preliminary data prior to a multi-site randomized clinical trial of the Trial Library intervention. Trial registration: This study has received institutional approval from the Committee of Human Subjects Research at the University of California, San Francisco.

16.
Am J Orthod Dentofacial Orthop ; 156(2): 178-185, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375227

RESUMEN

INTRODUCTION: This study aimed to identify significant factors affecting the spontaneous angular changes of impacted mandibular third molars as a result of second molar protraction. Temporary skeletal anchorage devices in the missing mandibular first molar (ML-6) or missing deciduous mandibular second molar (ML-E) with missing succedaneous premolar spaces provided traction. METHODS: Forty-one mandibular third molars of 34 patients (10 male and 24 female; mean age 18.3 ± 3.7 years) that erupted after second molar protraction were included in this study. They were classified into upright (U) and tilted (T) groups. Linear and angular measurements were performed at the time of treatment initiation (T1) and of ML-6 or ML-E space closure (T2). Regression analyses were used to identify significant factors related to third molar uprighting. RESULTS: Nolla stage (odds ratio [OR] 4.1), sex (OR 0.003 for male), third molar angulation at T1 (OR 1.1), missing tooth space (OR 0.006), rate of third molar eruption (OR 23.3), and rate of second molar protraction (OR 0.2) significantly affected third molar uprighting. Age, third molar angulation at T1, rate of third molar eruption, and rate of second molar protraction were significant factors for predicting third molar angulation at T2. CONCLUSIONS: Available space for third molar eruption before and after second molar protraction is not associated with uprighting of erupting third molars. Older patients whose third molars are in greater Nolla stage, are in a more upright position at T1, and have a greater eruption rate have a greater chance for third molar uprighting. Alternatively, an increase in second molar protraction rate results in mesial tipping of the third molars.


Asunto(s)
Maloclusión/prevención & control , Maloclusión/fisiopatología , Mandíbula/fisiopatología , Tercer Molar/fisiopatología , Diente Impactado/fisiopatología , Adolescente , Adulto , Puntos Anatómicos de Referencia , Diente Premolar , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Diente Molar/anatomía & histología , Diente Molar/diagnóstico por imagen , Diente Molar/fisiopatología , Tercer Molar/anatomía & histología , Tercer Molar/diagnóstico por imagen , Aparatos Ortodóncicos , Cierre del Espacio Ortodóncico , Ortodoncia Correctiva , Erupción Dental , Diente Primario , Diente Impactado/complicaciones , Diente Impactado/diagnóstico por imagen , Adulto Joven
17.
Transplant Proc ; 51(8): 2710-2713, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31447193

RESUMEN

BACKGROUND: Hyperlipidemia and cardiovascular disease are risk factors for long-term renal transplant dysfunction. However, no meta-analyses of randomized controlled trials have investigated the effects of statin treatment on graft function in renal transplant recipients. The aim of the present study was to evaluate the effects of statin use on renal transplant patients using a meta-analysis approach. METHODS: We conducted a systematic review and meta-analysis using random effects modeling. We searched the following databases for all studies published through to June 15, 2018: Cochrane Central Register, OVID MEDLINE, Embase, and PubMed. We reviewed all relevant reviews, registered trials, and relevant conference proceedings to compare clinical outcomes and survival between fluvastatin recipients and controls. RESULTS: Five trials with a total of 3725 patients were included. Glomerular filtration rates, graft loss, tacrolimus level, antibody-mediated rejection, T cell-mediated rejection, proteinuria, fungal infection (candida), and patient survival rates did not differ between the fluvastatin and control groups. However, major adverse cardiovascular events were 1.547 times more common in the control group than in the fluvastatin group (P = .001). CONCLUSIONS: Fluvastatin use was associated with a reduction in major adverse cardiac events among kidney transplant patients.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Fluvastatina/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Trasplante de Riñón , Rechazo de Injerto/epidemiología , Humanos , Trasplante de Riñón/mortalidad
18.
Transplant Proc ; 51(8): 2606-2610, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31439331

RESUMEN

BACKGROUND: Antithymocyte globulin (ATG) is an induction therapy in kidney transplantation, but our knowledge about the relation between outcomes and ATG regimens is limited. We compared ATG effectiveness in kidney transplantation according to dosage and administration schedule. METHODS: Reports from 1970 until May 2018 in CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded were searched. We performed direct and indirect network meta-analysis using Bayesian models and generated rankings for ATG dosage and injection number variations by generation mixed treatment comparison.We compared ATG dose and schedule in kidney transplantation in relation to all-cause death, graft failure, antibody-mediated rejection, T-cell mediated rejection, biopsy-proven acute rejection, and bacterial and viral infection. RESULTS: Ten studies (N = 1065) were analyzed by forming 6 groups: ATG alternate doses, 9 mg/kg, 6 mg/kg, and 4.5 mg/kg; single dose, 6 mg/kg, and 4.5 mg/kg; and control. Compared to placebo, ATG regimen variations were not associated with significant differences in survival, viral infection, renal function, or graft survival. ATG regimens 9 and 4.5 mg alternate dosing tended to reduce biopsy-proven acute rejection but without statistical significance. According to the highest rank probability, the 9 mg alternate dosing group had the highest tendency for cytomegalovirus and bacterial infections but without statistical significance. CONCLUSIONS: The rejection frequency tended to be lower for the 9 and 4.5 mg alternate dosing groups. Infections occurred at a higher rate in the 9 mg alternate dosing group, but the differences in the risk of infection among the groups with different ATG regimens were not statistically significant.


Asunto(s)
Suero Antilinfocítico/uso terapéutico , Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Metaanálisis en Red , Adulto , Femenino , Rechazo de Injerto/mortalidad , Supervivencia de Injerto/efectos de los fármacos , Humanos , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad
19.
Comput Methods Programs Biomed ; 180: 105001, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31421606

RESUMEN

BACKGROUND AND OBJECTIVE: This study demonstrates deep learning approaches with an aim to find the optimal method to automatically detect sleep apnea (SA) events from an electrocardiogram (ECG) signal. METHODS: Six deep learning approaches were designed and implemented for automatic detection of SA events including deep neural network (DNN), one-dimensional (1D) convolutional neural networks (CNN), two-dimensional (2D) CNN, recurrent neural networks (RNN), long short-term memory, and gated-recurrent unit (GRU). Designed deep learning models were analyzed and compared in the performances. The ECG signal was pre-processed, normalized, and segmented into 10 s intervals. Subsequently, the signal was converted into a 2D form for analysis in the 2D CNN model. A dataset collected from 86 patients with SA was used. The training set comprised data from 69 of the patients, while the test set contained data from the remaining 17 patients. RESULTS: The accuracy of the best-performing model was 99.0%, and the 1D CNN and GRU models had 99.0% recall rates. CONCLUSIONS: The designed deep learning approaches performed better than those developed and tested in previous studies in terms of detecting SA events, and they could distinguish between apnea and hypopnea events using an ECG signal. The deep learning approaches such as 1D CNN and GRU can be helpful tools to automatically detect SA in sleep apnea screening and related studies.


Asunto(s)
Aprendizaje Profundo , Electrocardiografía , Síndromes de la Apnea del Sueño/diagnóstico , Automatización , Bases de Datos Factuales , Humanos
20.
Transplant Proc ; 51(8): 2689-2692, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31351773

RESUMEN

INTRODUCTION: Valganciclovir (VGCV) prophylaxis of 900 mg twice daily for 6 months is recommended to prevent cytomegalovirus (CMV) infection, which is a major cause of decreased graft and patient survival in kidney transplant recipients. However, recent studies have shown the efficacy of 900 mg once daily for 3 to 6 months. Maintaining VGCV compliance is difficult because of high drug costs and side effects, such as thrombocytopenia and leukopenia. Therefore, we studied the efficacy of ultra-low dose, short-duration VGCV (450 mg every other day for 3 months) in preventing CMV infection in ABO-incompatible (ABOiKT) and deceased donor kidney transplant (DDKT) recipients. METHODS: We retrospectively reviewed the medical records of all kidney transplant patients > 18 years old treated at Bong Seng Memorial Hospital from June 2009 to July 2016 who received ultra-low-dose VGCV prophylaxis (450 mg every other day for 3 months). The review included 74 CMV seropositive donor/seropositive recipient (D+/R+) ABOiKT and 78 CMV D+/R+DDKT recipients. The primary outcome was occurrence of CMV infection. Secondary outcomes were graft and patient survival and hematologic side effects. RESULTS: Mean prophylaxis and follow-up were 3 and 98 months, respectively. CMV disease occurrence was significantly higher in DDKT than in ABOiKT (12 cases, 8.1%, vs 1 case, .7%, P < .01). There were no significant differences in patient survival rate, graft survival rate, or hematologic side effects between the groups. CONCLUSION: Ultra-low-dose VGCV prophylaxis to prevent CMV infection is effective in ABOiKT, but other treatment protocols are needed for DDKT patients.


Asunto(s)
Antivirales/administración & dosificación , Infecciones por Citomegalovirus/prevención & control , Trasplante de Riñón , Valganciclovir/administración & dosificación , Adolescente , Adulto , Quimioprevención/métodos , Femenino , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
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