Trends in Incidence and Drug Prescriptions for Croup in Children Under 5 Years of Age: A 2002-2019 Population-Based Study.

BACKGROUND: Tracking national croup trends can provide important insights for childhood health management. This study aimed to analyze the incidence and drug prescription trends in Korean children over a two-decade period. METHODS: This population-based study encompassed 479,783 children aged < 5 years from 2002-2019, utilizing the National Health Insurance Service-National Sample Cohort. We identified participants with a primary croup diagnosis who were admitted to or visited the emergency room. Age-specific and age-adjusted incidence rates/10,000 person-years were calculated. We assessed using orthogonal polynomial contrasts and stratified by various factors (sex, age, residential area, economic status, comorbidities, and healthcare facility types). We observed changes in the use of five medications: inhaled steroids, systemic steroids, inhaled epinephrine, antibiotics, and short-acting bronchodilators. Generalized binomial logistic regression was used to analyze factors influencing prescription strategies. RESULTS: In 2002, the croup-related visits were 16.1/10,000 person-years, increasing to 98.3 in 2019 (P for trend < 0.001). This trend persisted, regardless of age, sex, region, and economic status. Children with comorbid atopic dermatitis or asthma maintained consistent croup rates, while those without comorbidities increased. Treatment trends showed decreasing antibiotic (73-47%) and oxygen use (21.3-3.4%), with increasing nebulized epinephrine (9.3-41.5%) and multiple drug prescriptions (67.8-80.3%). Primary care centers exhibited a greater increase in prescription usage and hospitalization duration than did tertiary healthcare institutions. CONCLUSION: Over the past two decades, croup incidence has risen, accompanied by increased epinephrine use and decreased antibiotic prescriptions. Longer hospitalization and higher medication use were mainly observed in primary care facilities.

Analysis of genome variants in dwarf soybean lines obtained in F6 derived from cross of normal parents (cultivated and wild soybean).

Plant height is an important component of plant architecture and significantly affects crop breeding practices and yield. We studied DNA variations derived from F5 recombinant inbred lines (RILs) with 96.8% homozygous genotypes. Here, we report DNA variations between the normal and dwarf members of four lines harvested from a single seed parent in an F6 RIL population derived from a cross between Glycine max var. Peking and Glycine soja IT182936. Whole genome sequencing was carried out, and the DNA variations in the whole genome were compared between the normal and dwarf samples. We found a large number of DNA variations in both the dwarf and semi-dwarf lines, with one single nucleotide polymorphism (SNP) per at least 3.68 kb in the dwarf lines and 1 SNP per 11.13 kb of the whole genome. This value is 2.18 times higher than the expected DNA variation in the F6 population. A total of 186 SNPs and 241 SNPs were discovered in the coding regions of the dwarf lines 1282 and 1303, respectively, and we discovered 33 homogeneous nonsynonymous SNPs that occurred at the same loci in each set of dwarf and normal soybean. Of them, five SNPs were in the same positions between lines 1282 and 1303. Our results provide important information for improving our understanding of the genetics of soybean plant height and crop breeding. These polymorphisms could be useful genetic resources for plant breeders, geneticists, and biologists for future molecular biology and breeding projects.

Factors Associated with Lifestyle Habits and Mental Health Problems in Korean Adolescents: The Korea National Health and Nutrition Examination Survey 2017-2018.

To identify factors associated with Korean adolescents' lifestyle habits and mental health problems (stress perception, depressive mood, and suicidal thoughts), data from 842 adolescents' (13-18 years) responses to the Korea National Health and Nutrition Examination Survey (VII-2 and 3; 2017-2018) were analyzed. After controlling for sociodemographic and health status characteristics, results of multinomial logistic regression revealed drinking alcohol (stress perception: odds ratio (OR) = 1.61, 95% confidence interval (CI) = 1.19-2.19; depressive mood: OR = 2.59, 95% CI = 1.67-4.02; suicidal thoughts: OR = 2.28, 95% CI = 1.18-4.42), increased sedentary time (stress perception: OR = 1.88, 95% CI = 1.36-2.58), ≤6 h weekday sleep (stress perception: OR = 1.28, 95% CI = 1.00-1.66; suicidal thoughts: OR = 1.98, 95% CI = 1.05-3.75), and 8 h ≤ weekend sleep (stress perception: OR = 0.74, 95% CI = 0.56-0.98; depressive mood: OR = 0.63, 95% CI = 0.41-0.98; suicidal thoughts: OR = 0.41, 95% CI = 0.21-0.79) were significantly associated with mental health problems. Reducing Korean adolescents' mental health issues may require alcohol education, timed breaks/reduced sedentary time, and campaigns encouraging adequate sleep for teenagers.

Complement C3a, But Not C5a, Levels in Amniotic Fluid Are Associated with Intra-amniotic Infection and/or Inflammation and Preterm Delivery in Women with Cervical Insufficiency or an Asymptomatic Short Cervix (≤ 25 mm).

BACKGROUND: We aimed to estimate whether elevated levels of complement C3a and C5a in amniotic fluid (AF) are independently associated with increased risks of intra-amniotic infection and/or inflammation (IAI) and spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤ 25 mm). METHODS: We conducted a retrospective cohort study of 96 consecutive women with cervical insufficiency (n = 62) or a short cervix (n = 34) at 17 to 27 weeks, and who underwent an amniocentesis. AF was cultured and analyzed for C3a and C5a by enzyme-linked immunosorbent assay kits. The primary outcome measures were IAI (defined as a positive AF culture and/or an elevated AF interleukin-6 level [≥ 7.6 ng/mL]) and SPTD at < 32 weeks. RESULTS: In multivariable analysis, AF level of C3a was the only variable significantly associated with IAI, whereas C5a level in AF and serum C-reactive protein level were not associated with IAI. Using SPTD at < 32 weeks as the outcome variable in logistic regression, elevated AF levels of C3a were associated with increased risk of SPTD at < 32 weeks after adjusting for other baseline confounders, whereas elevated AF levels of C5a were not. CONCLUSION: In women with cervical insufficiency or a short cervix, elevated AF level of C3a, but not C5a, is independently associated with increased risks of IAI and SPTD at < 32 weeks. These findings suggest that subclinical IAI or SPTD in the context of cervical insufficiency is related to activation of complement system in AF.

Plasma inflammatory and immune proteins as predictors of intra-amniotic infection and spontaneous preterm delivery in women with preterm labor: a retrospective study.

BACKGROUND: We investigated whether various inflammatory and immune proteins in plasma predict intra-amniotic infection and imminent preterm delivery in women with preterm labor and compared their predictive ability with that of amniotic fluid (AF) interleukin (IL)-6 and serum C-reactive protein (CRP). METHODS: This retrospective cohort study included 173 consecutive women with preterm labor who underwent amniocentesis for diagnosis of infection and/or inflammation in the AF. The AF was cultured, and assayed for IL-6. CRP levels and cervical length by transvaginal ultrasound were measured at the time of amniocentesis. The stored maternal plasma was assayed for IL-6, matrix metalloproteinase (MMP)-9, and complements C3a and C5a using ELISA kits. The primary and secondary outcome criteria were positive AF cultures and spontaneous preterm delivery (SPTD) within 48 h, respectively. Univariate, multivariate, and receiver operating characteristic analysis were used for the statistical analysis. RESULTS: In bivariate analyses, elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery, whereas elevated plasma levels of MMP-9, C3a, and C5a were not associated with these two outcomes. On multivariate analyses, an elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery after adjusting for confounders, including high serum CRP levels and short cervical length. In predicting intra-amniotic infection, the area under the curve (AUC) was significantly lower for plasma IL-6 than for AF IL-6 but was similar to that for serum CRP. Differences in the AUCs between plasma IL-6, AF IL-6, and serum CRP were not statistically significant in predicting imminent preterm delivery. CONCLUSIONS: Maternal plasma IL-6 independently predicts intra-amniotic infection in women with preterm labor; however, it has worse diagnostic performance than that of AF IL-6 and similar performance to that of serum CRP. To predict imminent preterm delivery, plasma IL-6 had an overall diagnostic performance similar to that of AF IL-6 and serum CRP. Plasma MMP-9, C3a, and C5a levels could not predict intra-amniotic infection or imminent preterm delivery.

Risk factors for failure in the newborn hearing screen test in very preterm twins.

BACKGROUND: We aimed to identify prenatal and postnatal risk factors associated with abnormal newborn hearing screen (NHS) results and subsequently confirmed sensorineural hearing loss (SNHL) in preterm twin neonates. METHODS: Electronic medical records of 159 twin neonates who were born alive after ≤32 weeks were retrospectively reviewed for hearing loss in both ears. Histopathologic examination of the placenta was performed and clinical data, including method of conception and factors specific to twins, were retrieved from a computerized perinatal database. The main outcome measure was failure to pass the NHS test. The generalized estimation equations model was used for twins. RESULTS: Thirty-two neonates (20.1%) had a "refer" result, and, on the confirmation test, permanent SNHL was identified in 4.4% (7/159) of all neonates. Neonates who had a "refer" result on the NHS test were more likely to be of lower birth weight, more likely to have been conceived with the use of in vitro fertilization (IVF), and more likely to have higher rates of intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia. However, monochorionic placentation, death of the co-twin, or being born first was not associated with a "refer" result on the NHS test. Multivariable logistic regression revealed that conception after IVF and the presence of IVH were the only variables to be statistically significantly associated with "refer" on the NHS test. No parameters studied were found to be significantly different between the SNHL and no SNHL groups, probably because of the relatively small number of cases of SNHL. CONCLUSION: In preterm twin newborns, IVF and the presence of IVH were independently associated with an increased risk of abnormal NHS results, whereas the factors specific to twins were not associated with abnormal NHS results.

Effects of augmented reality-based Otago exercise on balance, gait, and physical factors in elderly women to prevent falls: a randomized controlled trial.

[Purpose] To determine the effect of augmented reality (AR)-based otago exercise on muscle strength, balance, and physical factors in falls of elderly women. [Subjects and Methods] Thirty subjects were randomly assigned to AR group (AR, n=10), yoga group (yoga, n=10), and self-exercise group (self, n=10). For 12 weeks, these groups were given lessons related to AR-based otago exercise including strengthening, balance training, or yoga three times a week (60 minutes each time) and self-exercise using elastic band exercise program. [Results] Knee flexion and ankle dorsiflexion strength were significantly improved in all three groups (AR, yoga, and self-exercise groups). Regarding balance, eye open center of pressure-x (EO CoP-x) was significantly decreased in AR group and yoga group. However, eye close CoP-x, eye open standard deviation-x (EO SD-x), and eye open height of ellipse (EO HoE) were only significantly decreased in AR group. AR group also showed meaningfully improved results in morse fall scale. [Conclusion] Augmented reality-based otago exercise can improve muscle strength, balance, and physical factors in elderly women to prevent falls.

Asymmetry of eye color in the common cuckoo.

Bilateral symmetry is assumed to contribute to the evolution of eye color, with the left and right eye being the same color in most vertebrates; yet, few studies tested this assumption. Here, we compared the amount of iris flecking (black spots presented on the iris) between the left and right eye of 76 adult common cuckoos Cuculus canorus. We found considerable variation in the total amount of iris flecking among individuals, with variation being associated with body size and sex. We also found that the amount of iris flecking differed between the left and right eye and that this left-right asymmetry was not random, with the left eye almost always being darker than the right eye. Furthermore, this asymmetry was negatively associated with wing length; however, this effect was limited to individuals with dark eyes. Overall, the asymmetric, but non-random, distribution of iris flecking between the left and right eye may indicate that selection pressures driving asymmetry (such as visual lateralization) act on the development of iris colors, even though this effect might be limited, due to the role of bilateral symmetry.

Non-invasive prediction of preterm birth in women with cervical insufficiency or an asymptomatic short cervix (≤25 mm) by measurement of biomarkers in the cervicovaginal fluid.

OBJECTIVE: To determine whether various proteins in the cervicovaginal fluid (CVF) known to be involved in immune regulation, alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤25 mm). METHODS: This retrospective cohort study included 62 asymptomatic women with cervical insufficiency (n = 27) or an asymptomatic short cervix (n = 35) at 18-27 weeks. CVF swab samples were taken for assays of vitamin D binding protein (VDBP), interleukin (IL)-8, matrix metalloproteinases (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and Dickkopf-related protein 3 (DKK3) before cervical examination, and maternal blood was collected for the determination of the C-reactive protein (CRP) level. The primary outcome measurement was SPTD at <32 weeks of gestation. Logistic regression analysis and receiver operating characteristic curves were used for the statistical analyses. RESULTS: The rate of SPTD at <32 weeks was 40.3% (25/62). The CVF levels of VDBP, TIMP-1, and DKK3, but not IL-8 and MMP-9, were significantly higher in the women who had SPTD at <32 weeks than in those who did not deliver spontaneously at <32 weeks. The women who had SPTD at <32 weeks had a significantly more advanced cervical dilatation at presentation and a higher level of serum CRP. Using the stepwise regression analysis, a prediction model was developed by combining various proteins in the CVF and clinical factors, resulting in the inclusion of cervical dilatation, CVF VDBP, and use of corticosteroids (area under curve, 0.909). CONCLUSIONS: In women with cervical insufficiency or a short cervix, VDBP, TIMP-1, and DKK3 in the CVF may be useful as non-invasive predictors of SPTD at <32 weeks. A combination of these markers and clinical factors appears to improve the predictability of SPTD compared with the markers alone.

Short cervical lengths initially detected in mid-trimester and early in the third trimester in asymptomatic twin gestations: Association with histologic chorioamnionitis and preterm birth.

OBJECTIVE: To determine whether short cervical lengths (≤20 mm) that were initially detected in mid-trimester and early in the third trimester are independently associated with increased risks of subsequent histologic chorioamnionitis and spontaneous preterm birth (SPTB, defined as a delivery before 34 weeks) in asymptomatic women with twin pregnancies. MATERIAL AND METHODS: This is a prospective study including 292 consecutive asymptomatic women with twin gestations. Cervical length measurements were carried out at 20 to 24 weeks' gestation and at 28 to 32 weeks' gestation. Both placentas of each twin pair were examined histologically after delivery. The generalized estimation equations models and logistic regression analysis were used for statistical analyses. RESULTS: Multivariable generalized estimation equations analysis revealed that short cervical length at mid-trimester was independently associated with an increased risk for subsequent histologic chorioamnionitis, whereas short cervical length initially detected early in the third trimester was not. By using the likelihood of SPTB as an outcome variable, multivariable logistic regression analysis indicated that short mid-trimester cervical length and histologic chorioamnionitis were independently associated with a greater risk for SPTB. Similarly, based on the multivariable analysis, a short third trimester cervical length was independently and significantly associated with a greater risk for SPTB. CONCLUSIONS: In asymptomatic women with twin pregnancies, a short mid-trimester cervical length is independently associated with an increased risk of both subsequent histologic chorioamnionitis and SPTB, whereas a short cervical length initially detected early in the third trimester is independently associated with preterm delivery, but not subsequent histologic chorioamnionitis.

Frequency and clinical significance of short cervix in patients with preterm premature rupture of membranes.

OBJECTIVE: Cervical length measurement has been uggested as a useful tool for predicting intra-amniotic infection/inflammation in preterm labor, but little information is available in the setting of preterm premature rupture of membranes (pPROM). We aimed to determine whether a short cervical length is independently associated with an increased risk of intra-amniotic infection or inflammation and impending preterm delivery in women with pPROM. METHODS: This was a retrospective cohort study involving 171 consecutive singleton pregnant women with pPROM (21+0-33+6 weeks' gestation), who underwent amniocentesis. Amniotic fluid (AF) was cultured, and assayed for interleukin (IL)-6 and IL-8. Cervical length was measured at the time of amniocentesis by transvaginal ultrasonography with an aseptic technique. Short cervical length was defined as a cervical length of ≤15 mm. Intra-amniotic infection was defined as a positive AF culture for microorganisms and intra-amniotic inflammation was defined as elevated AF concentrations of IL-6 or IL-8 (IL-6 ≥1.5 ng/mL and/or IL-8 ≥1.3 ng/mL). RESULTS: Fifty (29.2%) women had a sonographic cervical length of ≤15mm. On univariate analysis, short cervical length was associated with an increased risk for intra-amniotic infection and/or inflammation; no other parameters studied showed a significant association. Multivariable analyses indicated that short cervical length was significantly associated with a higher risk of impending preterm delivery (within 2 days of measurement, within 7 days of measurement, and before 34 weeks), and remained significant after adjustment for potential confounders. CONCLUSION: In women with pPROM, short cervical length is associated with an increased risk for intra-amniotic infection/inflammation and associated with impending preterm delivery, independent of the presence of intra-amniotic infection/inflammation.

Effect of Coffee Added to a Polyethylene glycol plus Ascorbic acid Solution for Bowel Preparation prior to Colonoscopy.

BACKGROUND AND AIMS: Conventional bowel cleansers for colonoscopy have an unpleasant taste and a large volume of solution must be ingested. Coffee increases bowel motility and has an intense flavor. The addition of coffee to a polyethylene glycol+ascorbic acid solution reduces the volume of the solution to be consumed without reducing efficacy, improves the taste of the solution and enhances patient comfort. METHODS: Outpatients with clinical indication or people who wanted screening for cancer were considered eligible. Control group (PEGAS group) consumed a 1-L solution of polyethylene glycol+ascorbic acid twice. Study group (COF group) consumed 750 mL of coffee+polyethylene glycol+ascorbic acid twice. Bowel cleansing was rated using the Aronchick, Ottawa scale, polyp detection rate and colonoscopic insertion time. Tolerability, acceptability, preference, and adverse events were investigated by questionnaires. RESULTS: The COF group had non-inferiority in efficacy (non-inferiority margin, -15%; lower limit of 95% confidence interval for difference between success rates, -4.7% and -8.4% from both scales, respectively). Polyp detection rates were 0.48 and 0.60, respectively (P=0.067). Colonoscopic insertion times were 323.6+/-166.8 s and 330.7+/-243.6 s, respectively (P=0.831). Significant improvement was observed with respect to ease of drinking (P=0.012), taste (P=0.026) and preference (P=0.046) in the COF group. Adverse events occurred in 52.4% and 60.4% in the two groups, respectively (P = 0.251). CONCLUSION: The addition of coffee to polyethylene glycol+ascorbic acid solution reduces the required volume for bowel preparation without reduced efficacy and enhances patient comfort in coffee-drinkers.

Efficacy and safety of a 24-day regimen of drospirenone-containing combined oral contraceptive in Korean women.

This study assesses the efficacy and safety of a 24-day regimen of drospirenone-containing combined oral contraceptive, and demonstrates that it is an effective and safe option for contraception, releasing symptom of premenstrual dysphoric disorder and acne in Korean women.

Is laparoendoscopic single-site surgery (LESS) retroperitoneal hysterectomy feasible?: Surgical outcomes of the initial 27 cases.

OBJECTIVES: The aim of the present study was to determine the feasibility of retroperitoneal hysterectomy by laparoendoscopic single-site surgery (LESS) and to suggest technical tips. MATERIALS AND METHODS: This study is a prospective single-center study. One surgeon trained in minimally invasive surgery performed LESS retroperitoneal hysterectomy on 27 consecutive patients with symptomatic uterine myomas or adenomyosis between September 2012 and February 2013. LESS retroperitoneal hysterectomy requires an additional eight steps including development of the retroperitoneal space, dissection of the ureter, and ligation of the uterine artery where it originates from the internal iliac artery. RESULTS: LESS retroperitoneal hysterectomies were successfully performed in 23 (85.2%) patients. Of the four failed cases, three failed to develop the retroperitoneal space because of laterally located large myomas. Another patient with severe pelvic adhesion was converted to multiport laparoscopic vaginal hysterectomy. Total operative and bilateral uterine ligation time by the retroperitoneal approach was 84 (67.0-95.6) minutes and 16 (12-22) minutes, respectively. The median estimated blood loss was 150 (100-350) mL. One patient required postoperative transfusion. No other operative complications including ureteric injury were observed during the hospital stay or the 3-month follow-up period after discharge. CONCLUSION: LESS retroperitoneal hysterectomy is feasible and can be a good option.

[Development and evaluation of the Empowering A Self-Efficacy (EASE) program for children with epilepsy].

PURPOSE: The purpose of this study was to verify effects of the Empowering A Self-Efficacy (EASE) program on self-efficacy, self-management, and child attitude toward illness in children with epilepsy. METHODS: This was a quasi-experimental study with a non-equivalent control group pre-post test design. Participants were 10 to 15 year old children with epilepsy (11 in the experimental group and 10 in the control group) who were registered at one hospital in S city. The experimental group received the EASE program for 3 weeks. In the first week, a group meeting lasting 570 minutes was conducted on a single day. Over the next two weeks, telephone counselling was conducted twice a week. Data were analyzed using SPSS 18.0. RESULTS: There was a significant difference of pre-post evaluation of the epilepsy self-management scores in the experimental group. However, differences between the experimental group and the control group for seizure self-efficacy and child attitude toward illness were not significant. CONCLUSION: This is the first study in Korea to develop and evaluate an intervention program for children with epilepsy. Further studies are needed to confirm the effects of the EASE program.

Transenteral bowel preparation for colonoscopy is more comfortable than the traditional method with no inferiority in efficacy.

BACKGROUND: Transenteral (TE) administration of a bowel cleanser prior to colonoscopy avoids the discomfort associated with drinking a large volume of unpalatable cleanser. AIM: To explore patient comfort, preference for future colonoscopy, the efficacy and adverse events associated with TE bowel preparation. METHODS: Bowel preparation is traditionally practised using polyethylene glycol (PEG) + ascorbic acid (ASC), which was the treatment used in the control group (peroral group; PO group). In the study group (TE group), PEG + ASC were administered directly to the third portion of the duodenum through a scope immediately after completing upper gastrointestinal endoscopy. RESULTS: A higher proportion of subjects in the TE group graded their degree of comfort as very or rather comfortable (28.4 % in the PO group, 65.1 % in the TE group; p = 0.000) and had greater preference for future colonoscopy (69.6 % in the PO group, 82.5 % in the TE group; p = 0.030), compared with the PO group. The TE group had non-inferiority in efficacy compared with the PO group (non-inferiority margin -15 %; lower limit of 95 % confidence interval for difference between success rates -6.4 %, when using the Aronchick Scale, and -7.1 % when using the Ottawa Scale). Nausea or vomiting were more prevalent during preparation in the PO group (46.1 vs. 17.5 %; p = 0.000), and dizziness was more common in the TE group (0 vs. 12.6 %; p = 0.000). CONCLUSIONS: TE preparation was found to be more comfortable than the traditional peroral method and not inferior in efficacy. The adverse events rate was acceptable.

Comparison of changes in etiologic microorganisms causing early-onset neonatal sepsis between preterm labor and preterm premature rupture of membranes.

OBJECTIVE: To investigate changes in the etiologic microorganisms causing early-onset neonatal sepsis (EONS) in preterm labor (PTL) or preterm premature rupture of membranes (pPROM) cases over the past 16 years and to analyze the associated factors. METHODS: We included consecutive singleton pregnancies delivered before 34 weeks due to PTL or pPROM. The etiologic microorganisms causing EONS in PTL and pPROM cases were compared between period 1 (1996-2004) and period 2 (2005-2012). RESULTS: There was no difference in the incidence of Gram-positive bacteria causing EONS between period 1 and 2, either in PTL (2.0% versus 2.1%, p = 1.0) or in pPROM (1.5% versus 1.6%, p = 1.0). However, the incidence of EONS caused by Gram-negative bacteria was significantly increased in pPROM (0.6% versus 2.7%, p = 0.040) during period 2, compared to period 1; but not in PTL (0.3% versus 1.2%, p = 0.211). Multivariable analysis revealed that a prolonged ROM-to-delivery interval (>7 d) was significantly associated with EONS caused by Gram-negative bacteria in pPROM (odds ratio: 6.6, 95% confidence interval: 1.4-31.8, p = 0.018). CONCLUSIONS: The etiologic microorganisms causing EONS have changed over the past 16 years in pPROM cases but not in PTL cases.

Robotic single-port hysterectomy, adnexectomy, and lymphadenectomy in endometrial cancer.

STUDY OBJECTIVE: To report the feasibility of performing robotic single-port surgery including pelvic lymphadenectomy in endometrial cancer. DESIGN: Canadian Task Force III. PATIENT: A 49-year-old, multiparous patient diagnosed with well-differentiated Fédération Internationale de Gynécologie et d'Obstétrique stage I endometrioid adenocarcinoma. SETTING: The patient underwent robotic single-port peritoneal washing, total hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2.5-cm umbilical incision. We used a 5-lumen port for single-site instruments, a 3-dimensional high-definition 8.5-mm endoscope, a 5-mm accessory port, and insufflation channel. Monopolar cautery and a bipolar Maryland dissector were used for lymphadenectomy. Vaginal cuff closure was performed using a needle driver and Maryland dissector with V-lock suture. Near the end of the surgery, the 5-mm assistant port was changed with a 10-mm-sized port. Then, a dissected lymph node in an endobag and a needle used in vaginal cuff closure were removed through the 10-mm port. INTERVENTIONS: Total hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy were performed using robotic single-site platform. MEASUREMENTS AND MAIN RESULTS: The total operative time was 206 minutes. The total vaginal cuff closure time was 22 minutes, and lymphadenectomy took 48 minutes. The estimated blood loss was 100 mL; no intraoperative and postoperative complications occurred. The total number of excised lymph nodes was 11. CONCLUSION: Robotic single-port pelvic lymphadenectomy is feasible. Further studies should be performed to assess the benefits of this procedure.

Couple communication, emotional and sexual intimacy, and relationship satisfaction.

Emotional and sexual aspects of intimacy in romantic relationships are important correlates of couples' relationship satisfaction. However, few studies have examined the effect of emotional and sexual aspects of intimacy on relationship satisfaction within the context of the interpersonal relationship processes. In addition, the association between emotional and sexual aspects of intimacy remains unclear. With a sample of 335 married couples from the Flourishing Families Project, the authors examined the associations between couple communication, emotional intimacy, sexual satisfaction, and relationship satisfaction, using the couple as the unit of analysis. The results of path analysis suggested that sexual satisfaction significantly predicted emotional intimacy for husbands and wives, while emotional intimacy did not appear to have a significant influence on sexual satisfaction. Further, mediation associations were suggested within as well as between spouses. Within spouses (for each spouse), emotional intimacy and sexual satisfaction mediated the association between spouses' appraisal of their partners' communication and their own relationship satisfaction. Gender differences were revealed in terms of how a spouse's perception of sexual satisfaction is associated with his or her partner's relationship satisfaction. In this study, although wives' relationship satisfaction was not associated with their husbands' sexual satisfaction, husbands tended to report high levels of relationship satisfaction when their wives reported greater sexual satisfaction. Findings suggest that both components of intimacy--emotional and sexual--should be comprehensively addressed in research and clinical work with couples.

The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women.

[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.