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1.
Korean J Intern Med ; 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36517957

RESUMO

Background/Aims: There have been little research on the cancer risks of patients with Peutz-Jeghers syndrome (PJS) in Korea. We aimed to investigate the clinical features of PJS patients and their cancer incidence rate. Methods: Patients with PJS from nine medical centers were enrolled. In those patients diagnosed with cancer, data obtained included the date of cancer diagnosis, the tumor location, and the cancer stage. The cumulative risks of gastrointestinal cancers and extra-gastrointestinal cancers were calculated using the Kaplan-Meier method. Results: A total of 96 PJS patients were included. The median age at diagnosis of PJS was 23.4 years. Cancer developed in 21 of the 96 patients (21.9%). The age of PJS diagnosis was widely distributed (0.9 to 72.4 years). The most common cancers were gastrointestinal cancer (n = 12) followed by breast cancer (n = 6). The cumulative lifetime cancer risk was calculated to be 62.1% at age 60. The cumulative lifetime gastrointestinal cancer risk was 47.1% at age 70. The cumulative lifetime extra- gastrointestinal cancer risk was 40.3% at age 60. Conclusions: PJS onset may occur at any age and the risks of gastrointestinal and extra-gastrointestinal cancer are high. Thorough surveillance of PJS patients for malignancies is vital.

2.
Korean J Gastroenterol ; 80(6): 241-246, 2022 Dec 25.
Artigo em Coreano | MEDLINE | ID: mdl-36567436

RESUMO

As clinical practices change to involve patients more actively and patient feedback becomes integrated into ongoing measures of quality, patients themselves, along with their families and friends, could play a creative part in crafting solutions to improve patient's experience. We could convene focus groups of patients to help examine varied aspects of our practice, ranging from the flow through our offices to the way we communicate. They could work with us, helping us make choices and set priorities. Incorporating both patients' perceptions and suggestions for change can address clinically significant aspects of the patient experience, foster the involvement of patients in their care, and help assess and improve the quality of the care we deliver. The electronic medical record and secure patient portals increasingly provide a powerful opportunity to actively promote patient involvement. Improving of patient's experience can help doctors draw closer to their patients and restore and strengthen public trust. It can both improve the quality of our care and add to the joy of being a doctor. Our purpose is to improve patients' treatment results, and through this, to feel rewarding as a doctor as a professional and to continue working as a doctor. To this end, improving the doctor-patient relationship through improving patient experience can be a key factor.


Assuntos
Gastroenterologia , Médicos , Humanos , Relações Médico-Paciente , Trato Gastrointestinal
3.
Diagnostics (Basel) ; 12(11)2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36359583

RESUMO

This study reviews the recent progress of explainable artificial intelligence for the early diagnosis of gastrointestinal disease (GID). The source of data was eight original studies in PubMed. The search terms were "gastrointestinal" (title) together with "random forest" or "explainable artificial intelligence" (abstract). The eligibility criteria were the dependent variable of GID or a strongly associated disease, the intervention(s) of artificial intelligence, the outcome(s) of accuracy and/or the area under the receiver operating characteristic curve (AUC), the outcome(s) of variable importance and/or the Shapley additive explanations (SHAP), a publication year of 2020 or later, and the publication language of English. The ranges of performance measures were reported to be 0.70-0.98 for accuracy, 0.04-0.25 for sensitivity, and 0.54-0.94 for the AUC. The following factors were discovered to be top-10 predictors of gastrointestinal bleeding in the intensive care unit: mean arterial pressure (max), bicarbonate (min), creatinine (max), PMN, heart rate (mean), Glasgow Coma Scale, age, respiratory rate (mean), prothrombin time (max) and aminotransferase aspartate (max). In a similar vein, the following variables were found to be top-10 predictors for the intake of almond, avocado, broccoli, walnut, whole-grain barley, and/or whole-grain oat: Roseburia undefined, Lachnospira spp., Oscillibacter undefined, Subdoligranulum spp., Streptococcus salivarius subsp. thermophiles, Parabacteroides distasonis, Roseburia spp., Anaerostipes spp., Lachnospiraceae ND3007 group undefined, and Ruminiclostridium spp. Explainable artificial intelligence provides an effective, non-invasive decision support system for the early diagnosis of GID.

4.
Toxicol Res ; 38(4): 479-486, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36277357

RESUMO

The pharmacological or toxicological activities of the degradation products of drug candidates have been unaddressed during the drug development process. Ischemic stroke accounts for 80% of all strokes and is responsible for considerable mortality and disability worldwide. Despite decades of research on neuroprotective agents, tissue plasminogen activators (t-PA), a thrombolytic agent, remains the only approved acute stroke pharmacological therapy. NXY-059, a free radical scavenger, exhibited striking neuroprotective properties in preclinical models and met all the criteria established by the Stroke Academic Industry Roundtable (STAIR) for a neuroprotective agent. In phase 3 clinical trials, NXY-059 exhibited significant neuroprotective effects in one trial (SAINT-I), but not in the second (SAINT-II). Some have hypothesized that N-t-butyl hydroxylamine (NtBHA), a breakdown product of NXY-059 was the actual neuroprotective agent in SAINT-I and that changes to the formulation of NXY-059 to prevent its breakdown to NtBHA in SAINT -II was the reason for the lack of efficacy. We evaluated the neuroprotective effect of NtBHA in N-methyl-D-aspartate (NMDA)-treated primary neurons and in rat focal cerebral ischemia. NtBHA significantly attenuated infarct volume in rat transient focal ischemia, and attenuated NMDA-induced cytotoxicity in primary cortical neurons. NtBHA also reduced free radical generation and exhibited mitochondrial protection.

5.
Medicine (Baltimore) ; 101(41): e30784, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36254074

RESUMO

Endoscopists frequently have difficulty approaching biliary lesions using biopsy forceps. The aim of this study was not only to describe an easy technique for biliary biopsy assisted by a looped guidewire but also to present preliminary results regarding its safety and feasibility. A preliminary proof-of-concept study was performed at a single tertiary medical center. Between August 2019 and January 2020, 13 patients with bile duct strictures underwent endoscopic retrograde cholangiopancreatography (ERCP) with a new loop guidewire-assisted forceps approach technique. The efficacy and safety were evaluated using the success rate as the primary outcome and diagnostic yield and complication rates as secondary outcomes. The tissue sampling success rate was 100% (13/13). All samples were acceptable for histopathological analysis. Eleven specimens were confirmed to be adenocarcinomas. After reexamination of the remaining 2 patients, all cases were eventually diagnosed as being malignant. The sensitivity of the single procedure was 84.6% (11/13). There were 2 patients with mild hyperamylasemia, but there were no severe complications with respect to safety. This new technique could enhance the success rate and diagnostic yield and reduce the risk of failure when using the biopsy forceps approach during ERCP.


Assuntos
Ductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Ductos Biliares/patologia , Biópsia/efeitos adversos , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos de Viabilidade , Humanos
6.
Sci Rep ; 12(1): 16702, 2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36202924

RESUMO

The clinical implication of using serum tumor markers in patients with interstitial lung disease (ILD) is inconclusive. In this retrospective study, we analyzed the data of 1176 subjects (294 with ILDs and 882 healthy controls). Eligible patients were who had at least one or more available tumor marker results [carbohydrate antigen (CA) 19-9, CA 125, and carcinoembryonic antigen (CEA)] with no evidence of malignancies or other benign diseases that could be related to the increasing concentration of the values. The healthy controls selected from a health screening program were also screened for the presence of active cancer, and matched at a ratio of 1:3 with age and sex. The proportion of patients with abnormal values in the ILD group (121, idiopathic pulmonary fibrosis (IPF); 173, non-IPF-ILDs) was higher than in the matched control group (CEA, 21.5% vs. 5.5%; CA 19-9, 27.9% vs. 4.0%; CA 125, 36.4% vs. 2.0%). In the multivariable analysis, higher CEA levels were associated with shorter survival after adjusting for age, sex, lung function, and ILD subtypes (hazard ratio: 2.323, 95% confidence interval: 1.271-4.248, P = 0.006). In subgroup analysis, CEA remained a prognostic factor in patients with non-IPF-ILDs, but not in those with IPF.


Assuntos
Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Biomarcadores Tumorais , Antígeno Ca-125 , Antígeno CA-19-9 , Carboidratos , Antígeno Carcinoembrionário , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Estudos Retrospectivos
7.
Artigo em Inglês | MEDLINE | ID: mdl-36141991

RESUMO

This study designed to evaluate the short- and long-term outcomes of outborn and inborn preterm infants enhancing the regional perinatal system in South Korea. It is a prospective cohort study of the Korean neonatal network database for infants born at <29 weeks of gestation between 2013 and 2015. Of 2995 eligible infants, 312 were outborn, and 976 completed the assessment of long-term outcome at 18-24 months of corrected age. The mean gestational age was significantly younger in outborn infants than in inborn infants (p = 0.004). The mean Apgar score at 5 min was higher in inborn infants (p = 0.046). More inborn preterm infants died before discharge (p < 0.001); however, most of the other short-term outcomes occurred significantly more often in outborn infants than in inborn infants. The outborn infants had higher odds of neurodevelopmental impairment (adjusted odds ratio (aOR) 2.412, 95% confidence interval (CI) 1.585-3.670), cerebral palsy (aOR 4.460, 95% CI 2.249-8.845) and developmental impairment (aOR 2.238, 95% CI 1.469-3.408). In preterm infants, the location of birth may be a key factor influencing short- and long-term outcomes. Thus, to provide adequate care and efficiently allocate medical resources to high-risk preterm infants, nationwide regional perinatal systems need to be improved and standardized.


Assuntos
Mortalidade Infantil , Recém-Nascido Prematuro , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Gravidez , Estudos Prospectivos
8.
Artigo em Inglês | MEDLINE | ID: mdl-36113016

RESUMO

ABSTRACT: BACKGROUNDPolyethylene glycol with ascorbic acid (PEG/Asc) is a well-established bowel preparation solution with guaranteed effectiveness and safety. A new low-volume agent, 1 L-PEG/Asc, has recently been released. This study aimed to compare the bowel cleansing efficacy and safety of 1 L-PEG/Asc and 2 L-PEG/Asc administered to adult outpatients in a split-dose manner.METHODSOutpatients undergoing colonoscopy enrolled in a single-blind, single-center, non-inferiority study conducted between July and October 2021 were randomized in a 1:1 manner to 1 L-PEG/Asc or 2 L-PEG/Asc groups. Bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS) and the Harefield Cleansing Scale (HCS) in intention-to-treat (ITT) and per-protocol populations.RESULTSTwo hundred and forty subjects were randomized and allocated, with 120 patients in the 1 L and 2 L-PEG/Asc groups, respectively. Non-inferiority was demonstrated for overall successful bowel cleansing (BBPS: 92.5% vs. 90.8%; 95% confidence interval [CI], -0.054-0.087) and the high-quality cleansing rate of the right-sided colon (BBPS=3, 40.0% vs. 35.8%; 95% CI, -0.082-0.165; HCS ≥3, 50.0% vs. 43.3%; 95% CI, -0.060-0.194) in the ITT population. The overall incidence of adverse events was similar in both groups ([82/120] 68.3% vs. [72/120] 60.0%; p=0.178). The tolerability, acceptability, and compliance rates of both regimens were similar, with no significant differences.CONCLUSIONSCompared to 2 L-PEG/Asc, 1 L-PEG/Asc achieved successful overall bowel cleansing efficacy with high-quality cleansing in the proximal colon and proved its non-inferiority. Therefore, 1 L-PEG/Asc is an acceptable alternative bowel-cleansing solution.

9.
Endocrinol Metab (Seoul) ; 37(3): 444-454, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35654578

RESUMO

BACKGRUOUND: No consensus exists regarding the early use of subcutaneous (SC) basal insulin facilitating the transition from continuous intravenous insulin infusion (CIII) to multiple SC insulin injections in patients with severe hyperglycemia other than diabetic ketoacidosis. This study evaluated the effect of early co-administration of SC basal insulin with CIII on glucose control in patients with severe hyperglycemia. METHODS: Patients who received CIII for the management of severe hyperglycemia were divided into two groups: the early basal insulin group (n=86) if they received the first SC basal insulin 0.25 U/kg body weight within 24 hours of CIII initiation and ≥4 hours before discontinuation, and the delayed basal insulin group (n=79) if they were not classified as the early basal insulin group. Rebound hyperglycemia was defined as blood glucose level of >250 mg/dL in 24 hours following CIII discontinuation. Propensity score matching (PSM) methods were additionally employed for adjusting the confounding factors (n=108). RESULTS: The rebound hyperglycemia incidence was significantly lower in the early basal insulin group than in the delayed basal insulin group (54.7% vs. 86.1%), despite using PSM methods (51.9%, 85.2%). The length of hospital stay was shorter in the early basal insulin group than in the delayed basal insulin group (8.5 days vs. 9.6 days, P=0.027). The hypoglycemia incidence did not differ between the groups. CONCLUSION: Early co-administration of basal insulin with CIII prevents rebound hyperglycemia and shorten hospital stay without increasing the hypoglycemic events in patients with severe hyperglycemia.


Assuntos
Cetoacidose Diabética , Hiperglicemia , Hipoglicemia , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/complicações , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemiantes , Insulina/uso terapêutico
10.
Ann Palliat Med ; 11(7): 2319-2326, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35695054

RESUMO

BACKGROUND: Hospitalists are becoming increasingly involved in end-of-life (EOL) care decision making. They participate in the completion of physician orders for life-sustaining treatment (POLST) for patients who have not yet decided whether to proceed with life-sustaining treatment (LST) at the EOL. However, hospitalists are not physicians who have continuously treated patients in outpatient settings; hence, the continuity of care may be poor. We aimed to analyze the effect of outpatient physician involvement on the POLST completed by hospitalists. METHODS: A retrospective cohort study was conducted in patients aged 18 years or older treated by hospitalists who completed POLST at Seoul National University Bundang Hospital from February 2018 to March 2020. The clinical and sociodemographic data were obtained through a medical chart review, and the differences in the characteristics of POLST were analyzed depending on the status of outpatient physician involvement. RESULTS: A total of 3,533 POLST forms were written, of which 175 (5.22%) were completed by the hospitalists. The proportion of POLSTs completed by hospitalists gradually increased from 2.53% in 2018 to 4.58% in 2019 and 15.9% in 2020. A total of 144 (82.3%) patients had malignancies, while 31 (17.7%) patients had non-cancer illnesses. In 47.4% of the patients, outpatient physicians were involved in completing physician's orders for LST. When the outpatient physicians were involved, more patients signed the POLST form themselves (P=0.02) and chose comfort measures only when asked to determine their preferred LST type (P=0.00). CONCLUSIONS: The completion of POLST by hospitalists is gradually increasing. LST was reduced when the outpatient physicians participated in the completion of POLST. Using measures to increase the involvement of outpatient providers in goal care discussions, the quality and goal concordance of EOL care can be improved.


Assuntos
Planejamento Antecipado de Cuidados , Médicos Hospitalares , Assistência Terminal , Diretivas Antecipadas , Estudos Transversais , Humanos , Pacientes Ambulatoriais , Ordens quanto à Conduta (Ética Médica) , Estudos Retrospectivos
11.
Talanta ; 244: 123408, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35364336

RESUMO

In this study, we developed organelle-specific blue-emitting two-photon (TP) probes for Ca2+ (BCa-1, BCa-2mito, and BCa-3mem), with absorption maxima (λmax) at 350-358 nm, emission maxima (λfl) at 464-466 nm, and TP action cross-section (Φδmax) values of 55-70 × 10-50 cm4s/photon, in the presence of excess Ca2+ at 750 nm. Moreover, the probes had dissociation constants of 0.18, 2.7, and 100 µM, respectively, which are appropriate values for sensing Ca2+ in the cytoplasm, mitochondria, and plasma membrane, respectively. The measurements were conducted using a calcium calibration buffer (10 mM 3-[N-morpholino]propanesulfonic acid and 100 mM KCl) at pH 7.2. The TP microscopy results revealed that the probes could facilitate the real-time detection of Ca2+ in the cytoplasm, mitochondria, and plasma membranes of live cells and tissues. Additionally, we developed a green-emitting TP probe for H+ (FHEt-1lyso) with λmax = 359 nm, λfl = 571 nm, and Φδmax = 70 × 10-50 cm4s/photon at pH 4.3 in a universal buffer (0.1 M citric acid, 0.1 M KH2PO4, 0.1 M Na2B4O7, 0.1 M tris[hydroxymethyl]aminomethane, and 0.1 M KCl); this probe could detect H+ in the lysosomes. Using BCa-1 and FHEt-1lyso, it was possible to simultaneously monitor the changes in cytosolic Ca2+ and lysosomal H+ concentrations in live cells and tissues using dual-color TP microscopy in real time. When used with TP probes emitting wavelengths of green light or longer, these blue-emitting Ca2+ probes can be used to investigate the physiological role of Ca2+ in cellular organelles as well as the crosstalk between Ca2+ and other metal ions in specific organelles.


Assuntos
Cálcio , Prótons , Cálcio/metabolismo , Corantes Fluorescentes , Íons , Lisossomos/metabolismo , Fótons
12.
J Clin Gastroenterol ; 2022 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-35470308

RESUMO

BACKGROUND: We aimed to compare trough infliximab levels and the development of antidrug antibody (ADA) for 1 year between Crohn's disease (CD) and ulcerative colitis (UC) patients who were biologic-naive, and to evaluate their impact on clinical outcomes. METHODS: This was a prospective, multicenter, observational study. Biologic-naive patients with moderate to severe CD or UC who started CT-P13, an infliximab biosimilar, therapy were enrolled. Trough drug and ADA levels were measured periodically for 1 year after CT-P13 initiation. RESULTS: A total of 267 patients who received CT-P13 treatment were included (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%,P<0.001) at week 54 were significantly higher in CD than in UC. The median trough drug level (µg/mL) was significantly higher in CD than in UC up to week 14 (week 2, 18.7 vs. 14.7,P<0.001; week 6, 12.5 vs. 8.6,P<0.001; week 14, 3.4 vs. 2.5,P=0.001). The median ADA level (AU/mL) was significantly lower in CD than in UC at week 2 (6.3 vs. 6.5,P=0.046), week 30 (7.9 vs. 11.8,P=0.007), and week 54 (9.3 vs. 12.3,P=0.032). Development of ADA at week 2 [adjusted odds ratio (aOR)=0.15,P=0.026], initial C-reactive protein level (aOR=0.87,P=0.032), and CD over UC (aOR=1.92,P<0.001) were independent predictors of clinical remission at week 54. CONCLUSION: Infliximab shows more favorable pharmacokinetics, including high drug trough and low ADA levels, in CD than in UC, which might result in better clinical outcomes for 1-year infliximab treatment in CD patients.

13.
Artigo em Inglês | MEDLINE | ID: mdl-35270746

RESUMO

This study employs machine learning and population data for testing the associations of preterm birth with inflammatory bowel disease (IBD), salivary gland disease, socioeconomic status and medication history, including proton pump inhibitors. The source of population-based retrospective cohort data was the Korea National Health Insurance Service claims data for all women aged 25-40 years and who experience their first childbirths as singleton pregnancy during 2015 to 2017 (402,092 women). These participants were divided into the Ulcerative Colitis (UC) Group (1782 women), the Crohn Group (1954 women) and the Non-IBD Group (398,219 women). For each group, the dependent variable was preterm birth during 2015-2017, and 51 independent variables were included. Random forest variable importance was employed for investigating the main factors of preterm birth and testing its associations with salivary gland disease, socioeconomic status and medication history for each group. The proportion of preterm birth was higher for the UC Group and the Non-IBD Group than for the Crohn Group: 7.86%, 7.17% vs. 6.76%. Based on random forest variable importance, salivary gland disease was a top 10 determinant for the prediction of preterm birth for the UC Group, but this was not the case for the Crohn Group or the Non-IBD Group. The top 5 variables of preterm birth for the UC Group during 2015-2017 were socioeconomic status (8.58), age (8.00), proton pump inhibitors (2.35), progesterone (2.13) and salivary gland disease in 2014 (1.72). In conclusion, preterm birth has strong associations with ulcerative colitis, salivary gland disease, socioeconomic status and medication history including proton pump inhibitors.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Nascimento Prematuro , Doenças das Glândulas Salivares , Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças Inflamatórias Intestinais/epidemiologia , Aprendizado de Máquina , Programas Nacionais de Saúde , Gravidez , Nascimento Prematuro/epidemiologia , Inibidores da Bomba de Prótons , Estudos Retrospectivos , Doenças das Glândulas Salivares/complicações
14.
Biomater Sci ; 10(8): 2076-2087, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35315847

RESUMO

Despite the rise in the global burden of inflammatory bowel disease, there is a lack of safe and effective therapies that can meet the needs of clinical patients. In this study, we investigated the beneficial effects of bovine milk, especially colostrum-derived exosomes (Col-exo) in a murine model of ulcerative colitis induced by dextran sodium sulfate (DSS). Col-exo activated the proliferation of colonic epithelial cells and macrophages, and created an environment to relieve inflammation by effectively removing reactive oxygen species and regulating the expression of immune cytokines. Besides, Col-exo could pass through the gastrointestinal tract intact and efficiently deliver bioactive cargoes to the stomach, small intestine, and colon. Our results showed that oral gavage of Col-exo can alleviate colitis symptoms including weight loss, gastrointestinal bleeding, and chronic diarrhea by modulating intestinal inflammatory immune responses. Overall, bovine colostrum-derived exosomes with excellent structural and functional stability may offer great potential as natural therapeutics for the recovery of colitis.


Assuntos
Colite , Exossomos , Animais , Colite/induzido quimicamente , Colite/prevenção & controle , Colostro/metabolismo , Citocinas/metabolismo , Sulfato de Dextrana , Modelos Animais de Doenças , Exossomos/metabolismo , Feminino , Humanos , Inflamação/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Estresse Oxidativo , Gravidez
15.
Turk J Pediatr ; 64(1): 160-165, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35286045

RESUMO

BACKGROUND: Aplasia cutis congenita (ACC) is a rare congenital localized skin defect that is mostly diagnosed in the newborn or infant period. ACC type 5 often involves the trunk or extremities accompanied by fetus papyraceous (FP) or placental infarcts. The etiology and pathogenesis of this rare type of ACC are not well known. In this case, we report an ACC type 5 with a definite etiology. CASE: We report a preterm infant with ACC type 5, with diffuse bilateral leg lesions found at birth. He was the first baby of dichorionic twin after reduction from a dichorionic triplet pregnancy conceived through in vitro fertilization. A fetus papyraceous was found in juxtaposition with the affected baby`s placenta. After 37 days of hospitalization, his leg lesions were successfully epithelized with supportive care. He is regularly visiting the Dermatology clinic for scar care and shows normal development without motor limitation. CONCLUSIONS: Herein, we present a preterm infant with ACC type 5 and the placental pathology with fetus papyraceous of the artificially reduced monochorionic co-twin of the affected infant. We suggest a precautious decision in multifetal pregnancy reduction (MFPR) in dichorionic triplets, presenting ACC type 5 as an adverse outcome of MFPR.


Assuntos
Displasia Ectodérmica , Gravidez de Trigêmeos , Displasia Ectodérmica/diagnóstico , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Placenta/patologia , Gravidez , Redução de Gravidez Multifetal/efeitos adversos
16.
Asian Pac J Cancer Prev ; 23(2): 485-494, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35225460

RESUMO

OBJECTIVE: Gastrointestinal (GI) cancer patients often experience severe malnutrition during cancer therapies due to gastrointestinal dysfunctions including poor digestion and absorption as well as tumor-associated anorexia. In this study, we performed a randomized clinical trial to determine the efficacy of oral nutrition supplement (ONS) enriched with omega-3 fatty acids on nutritional status, quality of life (QOL), and pro-inflammatory indices. METHODS: Patients diagnosed with GI cancers were recruited and screened for eligibility. A total of 58 patients were randomly allocated to either the control group (n=27) or the experimental group (n=31). The intervention group received 200 ml ONS twice a day while the control group received routine care. Anthropometrics, Patient-Generated Subjective Global Assessment (PG-SGA) score, QOL score and nutrient intake data were collected at baseline, week 4 and week 8. Blood was drawn for biochemical assessments. Nine patients from each group dropped out of the study Forty patients (18 control patients and 22 intervention patients) completed the study. RESULTS: This study showed that ONS intervention improved PG-SGA scores in the intervention group (p<0.01). Scores of physical functioning score and role functioning were declined only in the control group and the difference between week 8 and baseline for role functioning was significant (p<0.001). Fatigue score was steadily decreased in the experiment group, and the differences between week 8 and baseline was significant between two groups (p<0.02). However, no statistically significant improvement in biochemical markers of nutritional status and pro-inflammatory cytokine concentrations were found. These results suggests that ONS intervention for 8 weeks improves PG-SGA scores and QOL scores in patients undergoing cancer therapy.


Assuntos
Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Neoplasias Gastrointestinais/terapia , Desnutrição/prevenção & controle , Estado Nutricional , Idoso , Fadiga/etiologia , Fadiga/prevenção & controle , Feminino , Estado Funcional , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Avaliação Nutricional , Qualidade de Vida , Resultado do Tratamento
17.
Diagnostics (Basel) ; 12(2)2022 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-35204379

RESUMO

Confocal microscopy image analysis is a useful method for neoplasm diagnosis. Many ambiguous cases are difficult to distinguish with the naked eye, thus leading to high inter-observer variability and significant time investments for learning this method. We aimed to develop a deep learning-based neoplasm classification model that classifies confocal microscopy images of 10× magnified colon tissues into three classes: neoplasm, inflammation, and normal tissue. ResNet50 with data augmentation and transfer learning approaches was used to efficiently train the model with limited training data. A class activation map was generated by using global average pooling to confirm which areas had a major effect on the classification. The proposed method achieved an accuracy of 81%, which was 14.05% more accurate than three machine learning-based methods and 22.6% better than the predictions made by four endoscopists. ResNet50 with data augmentation and transfer learning can be utilized to effectively identify neoplasm, inflammation, and normal tissue in confocal microscopy images. The proposed method outperformed three machine learning-based methods and identified the area that had a major influence on the results. Inter-observer variability and the time required for learning can be reduced if the proposed model is used with confocal microscopy image analysis for diagnosis.

18.
Kidney Res Clin Pract ; 41(3): 310-321, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34974654

RESUMO

BACKGROUND: Although bicarbonate has traditionally been used to treat patients with rhabdomyolysis at high risk of acute kidney injury (AKI), it is unclear whether this is beneficial. This study compared bicarbonate therapy to non-bicarbonate therapy for the prevention of AKI and mortality in rhabdomyolysis patients. METHODS: In a propensity score-matched cohort study, patients with a creatine kinase (CK) level of >1,000 U/L during hospitalization were divided into bicarbonate and non-bicarbonate groups. Patients were subgrouped based on low-volume (<3 mL/kg/hr) or high-volume (≥3 mL/kg/hr) fluid resuscitation in the first 72 hours. Logistic regression analyses were used to identify the impacts of bicarbonate use and fluid resuscitation on AKI risk and need for dialysis. The Kaplan-Meier method was used to estimate survival. Volume overload and electrolyte imbalances were assessed. RESULTS: Among 4,077 patients, we assembled a cohort of 887 pairs of patients treated with and without bicarbonate. Bicarbonate group had a higher incidence of AKI, higher rate of dialysis dependency, higher 30-day mortality, and longer hospital stay than the non-bicarbonate group. Further, patients who received high-volume fluid therapy had worse renal outcomes and a higher mortality than those who received low-volume fluids regardless of bicarbonate use. Bicarbonate use, volume overload, and AKI were associated with higher mortality. Volume overload was significantly higher in the bicarbonate group than in the non-bicarbonate group. CONCLUSION: Bicarbonate or high-volume fluid therapy for patients with rhabdomyolysis did not reduce AKI or improve mortality compared to non-bicarbonate or low-volume fluid therapy. Limited use of bicarbonate and adjustment of fluid volume may improve the short- and long-term outcomes of patients with rhabdomyolysis.

19.
Arch Gynecol Obstet ; 305(5): 1369-1376, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35038042

RESUMO

PURPOSE: To use machine learning and population data for testing the associations of preterm birth with socioeconomic status, gastroesophageal reflux disease (GERD) and medication history including proton pump inhibitors, sleeping pills and antidepressants. METHODS: Population-based retrospective cohort data came from Korea National Health Insurance Service claims data for all women who aged 25-40 years and gave births for the first time as singleton pregnancy during 2015-2017 (405,586 women). The dependent variable was preterm birth during 2015-2017 and 65 independent variables were included (demographic/socioeconomic determinants, disease information, medication history, obstetric information). Random forest variable importance (outcome measure) was used for identifying major determinants of preterm birth and testing its associations with socioeconomic status, GERD and medication history including proton pump inhibitors, sleeping pills and antidepressants. RESULTS: Based on random forest variable importance, major determinants of preterm birth during 2015-2017 were socioeconomic status (645.34), age (556.86), proton pump inhibitors (107.61), GERD for the years 2014, 2012 and 2013 (106.78, 105.87 and 104.96), sleeping pills (97.23), GERD for the years 2010, 2011 and 2009 (95.56, 94.84 and 93.81), and antidepressants (90.13). CONCLUSION: Preterm birth has strong associations with low socioeconomic status, GERD and medication history such as proton pump inhibitors, sleeping pills and antidepressants. For preventing preterm birth, appropriate medication would be needed alongside preventive measures for GERD and the promotion of socioeconomic status for pregnant women.


Assuntos
Refluxo Gastroesofágico , Nascimento Prematuro , Medicamentos Indutores do Sono , Antidepressivos/uso terapêutico , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Recém-Nascido , Aprendizado de Máquina , Masculino , Programas Nacionais de Saúde , Gravidez , Nascimento Prematuro/epidemiologia , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos
20.
Surg Endosc ; 36(6): 4392-4400, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35075522

RESUMO

BACKGROUND: The placement of a self-expanding metal stent in patients with obstructive colon cancer is used as a bridge to surgery. However, due to a lack of consensus and insufficient data, the long-term oncologic outcomes after colonic SEMS placement remain unclear. We assessed the long-term oncologic outcomes and adverse effects of colonic stenting for malignant colonic obstruction. METHODS: We included 198 patients admitted to Korea University Anam Hospital between 2006 and 2014 for obstructive colon cancer, of whom 98 underwent SEMS placement as a bridge to surgery and 100 underwent direct surgery without stenting. The clinicopathologic characteristics, overall survival, and disease-free survival were compared. RESULTS: There were no significant differences in long-term oncologic outcomes between the two groups. The median follow-up durations were 61.55 and 58.64 months in the SEMS and DS groups, respectively. There were also no significant differences in the 5-year OS (77.4% vs. 74.2%, p = 0.691) and 5-year DFS (61.7% vs. 71.0%, p = 0.194) rates between the groups. However, the DS group had significantly more early postoperative complications (p = 0.002). CONCLUSIONS: Colonic SEMS deployment as a bridge to surgery did not negatively affect long-term oncologic outcomes when compared with DS. In addition, colonic stenting decreased early postoperative complications and reduced the time for patients to return to normal daily activities.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Obstrução Intestinal , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
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