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1.
J Clin Neurosci ; 87: 1-7, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33863515

RESUMO

PURPOSE: Whether M1 occlusions proximal (pM1) and distal (dM1) to the lenticulostriate perforators result in different clinical outcomes after mechanical thrombectomy (MT) is unknown. We retrospectively compared the clinical outcomes and baseline characteristics of patients with these two types of occlusions. METHODS: From March 2010 to May 2019, we performed MT for 141 M1 occlusions, including pM1 occlusions (n = 58) and dM1 occlusions (n = 83). RESULTS: Good clinical outcomes (modified Rankin Scale score 0 to 2) were achieved in 28 out of 58 (48.3%) patients with pM1 occlusions and 46 out of 83 (55.4%) patients with dM1 occlusions without significance (p = 0.493). Cardioembolic occlusions represented 19 out of 58 (32.6%) pM1 occlusions and 53 out of 83 (63.9%) dM1 occlusions, and atherosclerotic occlusions represented 37 out of 58 (63.8%) pM1 occlusions and 27 out of 83 (32.5%) dM1 occlusions, with significance (p = 0.001). Rescue treatments, such as balloon angioplasty or stenting, were needed more for pM1 occlusions than dM1 occlusions (21 out of 58 (36.2%) vs. 8 out of 83 (9.8%), p < 0.001). The multivariable logistic regression analysis demonstrated that the need for rescue treatment was associated with pM1 occlusions (adjusted odds ratio; 3.804, 95% confidence interval; 1.306-11.082, p = 0.014). CONCLUSIONS: In our series, pM1 and dM1 occlusions did not significantly differ in good clinical outcomes. Our study also showed that pM1 occlusions were more strongly associated with atherosclerotic occlusions, while dM1 occlusions were more strongly associated with cardioembolic occlusions, and rescue treatments were needed more often for pM1 occlusions than dM1 occlusions.

2.
Resuscitation ; 163: 78-85, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33895236

RESUMO

BACKGROUND: The recently developed deep learning (DL)-based early warning score (DEWS) has shown potential in predicting deteriorating patients. We aimed to validate DEWS in multiple centres and compare the prediction, alarming and timeliness performance with the modified early warning score (MEWS) to identify patients at risk for in-hospital cardiac arrest (IHCA). METHOD/RESEARCH DESIGN: This retrospective cohort study included adult patients admitted to the general wards of five hospitals during a 12-month period. The occurrence of IHCA within 24 h of vital sign observation was the outcome of interest. We assessed the discrimination using the area under the receiver operating characteristic curve (AUROC). RESULTS: The study population consists of 173,368 patients (224 IHCAs). The predictive performance of DEWS was superior to that of MEWS in both the internal (AUROC: 0.860 vs. 0.754, respectively) and external (AUROC: 0.905 vs. 0.785, respectively) validation cohorts. At the same specificity, DEWS had a higher sensitivity than MEWS, and at the same sensitivity, DEWS reduced the mean alarm count by nearly half of MEWS. Additionally, DEWS was able to predict more IHCA patients in the 24-0.5 h before the outcome, and DEWS was reasonably calibrated. CONCLUSION: Our study showed that DEWS was superior to MEWS in three key aspects (IHCA predictive, alarming, and timeliness performance). This study demonstrates the potential of DEWS as an effective, efficient screening tool in rapid response systems (RRSs) to identify high-risk patients.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33647891

RESUMO

A15 Nb3Si is, until now, the only "high" temperature superconductor produced at high pressure (~110 GPa) that has been successfully brought back to room pressure conditions in a metastable condition. Based on the current great interest in trying to create metastable-at-room-pressure high temperature superconductors produced at high pressure, we have restudied explosively compressed A15 Nb3Si and its production from tetragonal Nb3Si. First, diamond anvil cell pressure measurements up to 88 GPa were performed on explosively compressed A15 Nb3Si material to trace Tc as a function of pressure. Tc is suppressed to ~ 5.2 K at 88 GPa. Then, using these Tc (P) data for A15 Nb3Si, pressures up to 92 GPa were applied at room temperature (which increased to 120 GPa at 5 K) on tetragonal Nb3Si. Measurements of the resistivity gave no indication of any A15 structure production, i. e. no indications of the superconductivity characteristic of A15 Nb3Si. This is in contrast to the explosive compression (up to P~110 GPa) of tetragonal Nb3Si, which produced 50-70 % A15 material, Tc = 18 K at ambient pressure, in a 1981 Los Alamos National Laboratory experiment. This implies that the accompanying high temperature (1000 oC) caused by explosive compression is necessary to successfully drive the reaction kinetics of the tetragonal -> A15 Nb3Si structural transformation. Our theoretical calculations show that A15 Nb3Si has an enthalpy vs the tetragonal structure that is 70 meV/atom smaller at 100 GPa, while at ambient pressure the tetragonal phase enthalpy is lower than that of the A15 phase by 90 meV/atom. The fact that "annealing" the A15 explosively compressed material at room temperature for 39 years has no effect shows that slow kinetics can stabilize high pressure metastable phases at ambient conditions over long times even for large driving forces of 90 meV/atom.

4.
Ther Adv Respir Dis ; 15: 1753466621992735, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33764224

RESUMO

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) feeding provides enteral nutrition to patients with neurological dysphagia. However, the conditions in which PEG should be applied to prevent pneumonia remain unclear. We aimed to evaluate the effect of PEG for patients with neurological dysphagia in preventing pneumonia. METHODS: We undertook a retrospective data review of 232 patients with neurological dysphagia who had undergone PEG from January 2008 to December 2018 at Inha University Hospital, in Incheon, Korea. We excluded patients who had not been followed up 6 months pre- and post-PEG feeding. In total, our study comprised 42 patients. We compared pneumonia episodes and incidence pre- and post-PEG. RESULTS: During the median post-PEG follow-up period, the 6-month pneumonia incidence among patients who had undergone PEG had decreased [median 0.3 (interquartile range (IQR) 0.0-0.7) versus 0.1 (IQR 0.1-0.3) episodes, p = 0.04]. In a multiple mixed model, PEG did not decrease the incidence of pneumonia (p = 0.76). However, the association between PEG and the incidence of pneumonia differed significantly depending on the presence or absence of recurrent pneumonia (p < 0.001). CONCLUSIONS: PEG could effectively reduce the incidence of pneumonia in patients with neurogenic dysphagia, especially in those who had experienced recurrent pneumonia.The reviews of this paper are available via the supplemental material section.

5.
Polymers (Basel) ; 13(4)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33672256

RESUMO

In this study, a superabsorbent polymer (SAP) comprising poly (IA-co-cellulose-co-VSA-co-AA; ICVA) core-SAP (CSAP) was synthesized through radical polymerization using itaconic acid (IA), acrylic acid (AA), cellulose, and vinyl sulfonic acid (VSA) as monomers. The absorption performances and relative biodegradability of various compositions prepared by adjusting the amounts of cellulose and VSA with constant IA and AA content were compared. Increasing the cellulose content in CSAP contributed to improved biodegradation of the surface-crosslinked SAP (SSAP) and gel strength, although the free absorbency (FA) and centrifuge retention capacity (CRC) decreased. Increasing the VSA content resulted in strong anionicity, which enables the absorption of large amounts of water. Surface-crosslinking technology was applied to the CSAP synthesized with the optimal composition ratio to increase its absorption performance and gel strength. Improved performance of the synthesized SSAP (a CRC of 30.4 g/g, absorbency under load (AUL) of 23.3 g/g, and permeability of 55 s) was achieved by selecting the optimal surface-crosslinking treatment time and the amount of distilled water in the surface-crosslinking solution: as the latter was increased in the surface-crosslinking solution, the AUL and permeability of the SSAP were improved, and its biodegradability was found to be 54% compared to the 100% biodegradable cellulose hydrogel in the control group.

6.
Nucl Med Commun ; 42(5): 553-565, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625179

RESUMO

OBJECTIVES: This study sought to provide data supporting the expanded clinical use of respiratory gating by assessing the diagnostic accuracy of breathing motion correction using amplitude-based respiratory gating. METHODS: A respiratory movement tracking device was attached to a PET-computed tomography scanner, and images were obtained in respiratory gating mode using a motion phantom that was capable of sensing vertical motion. Specifically, after setting amplitude changes and intervals according to the movement cycle using a total of nine combinations of three waveforms and three amplitude ranges, respiratory motion-corrected images were reconstructed using the filtered back projection method. After defining areas of interest in the acquired images in the same image planes, statistical analyses were performed to compare differences in standardized uptake value (SUV), lesion volume, full width at half maximum (FWHM), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). RESULTS: SUVmax increased by 89.9%, and lesion volume decreased by 27.9%. Full width at half maximum decreased by 53.9%, signal-to-noise ratio increased by 11% and contrast-to-noise ratio increased by 16.3%. Optimal results were obtained when using a rest waveform and 35% duty cycle, in which the change in amplitude in the respiratory phase signal was low, and a constant level of long breaths was maintained. CONCLUSIONS: These results demonstrate that respiratory-gated PET-CT imaging can be used to accurately correct for SUV changes and image distortion caused by respiratory motion, thereby providing excellent imaging information and quality.

7.
Respir Res ; 22(1): 60, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602228

RESUMO

BACKGROUND: Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes. METHODS: Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS < 5 days) and late deterioration (LOS ≥ 5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors. RESULTS: Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44-1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45-1.91). CONCLUSIONS: Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

8.
J Korean Med Sci ; 36(2): e7, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33429471

RESUMO

BACKGROUND: A rapid response system (RRS) contributes to the safety of hospitalized patients. Clinical deterioration may occur in the general ward (GW) or in non-GW locations such as radiology or dialysis units. However, there are few studies regarding RRS activation in non-GW locations. This study aimed to compare the clinical characteristics and outcomes of patients with RRS activation in non-GW locations and in the GW. METHODS: From January 2016 to December 2017, all patients requiring RRS activation in nine South Korean hospitals were retrospectively enrolled and classified according to RRS activation location: GW vs non-GW RRS activations. RESULTS: In total, 12,793 patients were enrolled; 222 (1.7%) were non-GW RRS activations. There were more instances of shock (11.6% vs. 18.5%) and cardiac arrest (2.7% vs. 22.5%) in non-GW RRS activation patients. These patients also had a lower oxygen saturation (92.6% ± 8.6% vs. 88.7% ± 14.3%, P < 0.001) and a higher National Early Warning Score 2 (7.5 ± 3.4 vs. 8.9 ± 3.8, P < 0.001) than GW RRS activation patients. Although non-GW RRS activation patients received more intubation (odds ratio [OR], 3.135; P < 0.001), advanced cardiovascular life support (OR, 3.912; P < 0.001), and intensive care unit transfer (OR, 2.502; P < 0.001), their hospital mortality (hazard ratio, 0.630; P = 0.013) was lower than GW RRS activation patients upon multivariate analysis. CONCLUSION: Considering that there were more critically ill but recoverable cases in non-GW locations, active RRS involvement should be required in such locations.

9.
J Clin Neurosci ; 82(Pt A): 128-133, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317720

RESUMO

PURPOSE: To reduce procedural thromboembolisms, tailored antiplatelet drug preparation has been used according to antiplatelet resistance for endovascular coiling of unruptured aneurysms. We compared an aspirin plus clopidogrel group with a ticagrelor group using diffusion-weighted imaging (DWI) after stent-assisted coiling for unruptured aneurysms. METHODS: From October 2018 to April 2019, 72 patients with 78 aneurysms underwent stent-assisted coiling, with aspirin plus clopidogrel (n = 20 patients with 22 aneurysms) or ticagrelor (n = 52 patients with 56 aneurysms) as an antiplatelet preparation, and were enrolled in our study. All patients were evaluated using DWI 2 h after coiling to detect procedural thromboembolisms. RESULTS: Postprocedure infarction was observed on DWI in 37 procedures (47.4%), and symptomatic infarction occurred in 1 procedure (1.28%). Postprocedure infarction was significantly lower in the aspirin plus clopidogrel than in ticagrelor group (27.3% vs. 55.4%, p = 0.043). Postprocedure infarction was associated with aneurysm type (sidewall aneurysm (30.8%) vs. aneurysm with incorporated branches (64.1%), p = 0.006) and guiding catheter type (single (23.8%) vs. double (56.1%), p = 0.020). Multivariable logistic regression analysis demonstrated that postprocedure infarction was related to aneurysm type (adjusted odds ratio (OR); 3.317, confidence interval (CI); 1.223-8.991, p = 0.018), guiding catheter type (adjusted OR; 2.783, CI; 0.828-9.353, p = 0.098), and antiplatelet medication (adjusted OR; 1.295, CI; 0.969-1.730, p = 0.080). CONCLUSIONS: Postprocedure infarction was observed on DWI after stent-assisted coiling for unruptured aneurysms more frequently in the ticagrelor group than in the aspirin plus clopidogrel group. However, our study suggests that postprocedure infarction is more associated with aneurysm type than antiplatelet medication.


Assuntos
Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Tromboembolia/tratamento farmacológico , Ticagrelor/uso terapêutico , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Stents
10.
J Environ Manage ; : 111546, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33187782

RESUMO

Determining appropriate road drainage grate installation intervals requires an equation for estimating the flow intercepted by each grate inlet and its interception efficiency. In this study, 720 experiments were performed using a hydraulic model to estimate the flow intercepted by a grate inlet on a road. The flow calculation considered the number of lanes (2-4), longitudinal slope of the road (2-10%), transverse slope of the gutter (2-10%), and design capacity (up to 30 years of rainfall). The experimental results revealed that the flow intercepted by a grate inlet increased with increasing transverse slope of the gutter or the inlet length, thereby increasing its interception efficiency. Intercepted flow estimation equation was derived by regression analysis, and the derived equation was found to be more accurate than an existing empirical equation. The derived equation can thus be used to determine the installation of drainage grate inlets more effectively.

11.
Acute Crit Care ; 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33161687

RESUMO

Background: The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs. Methods: Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included. Results: A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups. Conclusion: In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

12.
ACS Omega ; 5(45): 29577-29584, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33225189

RESUMO

This study details the preparation and application of supramolecular host-guest inclusion complexes entrapping biomineralized microspheres for long-term storage and their pH-responsive behavior. The microspheres were assembled using a CaCO3 synthesis process coupled with cyclodextrin-tetrahydrocurcumin (CD-THC) inclusion complexes, forming fine-textured and mechanically stable hybrid materials. The products were successfully characterized using field-emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDS), Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), and particle size analysis (PSA). Various parameters such as the Brunauer-Emmett-Teller (BET) surface area, single point total pore volume, and pore size via adsorption/desorption analysis were also determined. The obtained THC-entrapped hybrid microspheres contained as high as 20 wt % THC loading and were very stable, preserving 90% of the initial concentration over four weeks of storage at different temperatures, largely limiting THC leaching and indicating high stability in a physiological environment. In addition, the pH-responsive release of THC from the hybrid microspheres was observed, showing potential use for application to weakly acidic skin surfaces. To our knowledge, this is the first demonstration of antiaging cosmetic formulation technology using biomineralization based on the co-synthesis of CaCO3 and CD-THC complexes.

13.
Medicina (Kaunas) ; 56(11)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33137936

RESUMO

Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH2O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH2O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury.


Assuntos
Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea/métodos , Glucocorticoides/uso terapêutico , Pneumonia Viral/terapia , Respiração Artificial/métodos , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Feminino , Humanos , Imunização Passiva , Masculino , Pessoa de Meia-Idade , Pandemias
14.
Int J Mol Sci ; 21(21)2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33113984

RESUMO

Arylacetonitrilase from Alcaligenes faecalis ATCC8750 (NitAF) hydrolyzes various arylacetonitriles to the corresponding carboxylic acids. A systematic strategy of amino acid residue screening through sequence alignment, followed by homology modeling and biochemical confirmation was employed to elucidate the determinant of NitAF catalytic efficiency. Substituting Phe-140 in NitAF (wild-type) to Trp did not change the catalytic efficiency toward phenylacetonitrile, an arylacetonitrile. The mutants with nonpolar aliphatic amino acids (Ala, Gly, Leu, or Val) at location 140 had lower activity, and those with charged amino acids (Asp, Glu, or Arg) exhibited nearly no activity for phenylacetonitrile. Molecular modeling showed that the hydrophobic benzene ring at position 140 supports a mechanism in which the thiol group of Cys-163 carries out a nucleophilic attack on a cyanocarbon of the substrate. Characterization of the role of the Phe-140 residue demonstrated the molecular determinant for the efficient formation of arylcarboxylic acids.

15.
Respir Med Case Rep ; 30: 101086, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32489848

RESUMO

Ground glass opacities, consolidation, and pleural effusions are observed in herpes simplex virus (HSV) pneumonia. Neither necrosis nor cavitation has been reported in areas of parenchymal disease. We describe a case of HSV pneumonia with unusual multiple cavitary and necrotic changes in an immunocompetent person. To our knowledge, this is the first reported case of HSV pneumonia with multiple cavitary and necrotic changes in areas of consolidation and nodules.

16.
World J Clin Cases ; 8(10): 1939-1943, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32518784

RESUMO

BACKGROUND: Noninvasive ventilation (NIV) reduces intubation rates, mortalities, and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Helmet-based NIV is better tolerated than oronasal mask-based ventilation, and thus, allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks. CASE SUMMARY: A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough, sputum, and dyspnea of several days' duration. For 10 mo, he had been on oxygen at home by day and had used an oronasal mask-based NIV at night. At intensive care unit admission, he breathed using respiratory accessory muscles. Hypercapnia and signs of infection were detected, and infiltration was observed in the right lower lung field by chest radiography. Thus, we diagnosed AECOPD by community-acquired pneumonia. After admission, respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary. However, the patient refused this option, and thus, we selected helmet-based NIV as a salvage treatment. After 3 d of helmet-based NIV, his consciousness level and hypercapnia recovered to his pre-hospitalization level. CONCLUSION: Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.

17.
Am J Hosp Palliat Care ; 37(11): 943-949, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32452209

RESUMO

PURPOSE: An important role of the rapid response system (RRS) is to provide opportunities for end-of-life care (EOLC) decisions to be appropriately operationalized. We investigated whether EOLC decisions were made after the RRS-recommended EOLC decision to the primary physician. MATERIALS AND METHODS: We studied whether patients made EOLC decisions consistent with the rapid response team's (RRT) recommendations, between January 1, 2017, and February 28, 2019. The primary outcome was the EOLC decision after the RRT's recommendation to the primary physician. The secondary outcome was the mechanism of EOLC decision-making: through institutional do-not-resuscitate forms or the Korean legal forms of Life-Sustaining Treatment Plan (LSTP). RESULTS: Korean LSTPs were used in 26 of the 58 patients who selected EOLC, from among the 75 patients for whom the RRS made an EOLC recommendation. Approximately 7.2% of EOLC decisions for inpatients were related to the RRT's interventions in EOLC decisions. Patients who made EOLC decisions did not receive cardiopulmonary resuscitation, mechanical ventilation, or dialysis. CONCLUSION: The timely intervention of the RRS in EOLC facilitates an objective assessment of the patient's medical conditions, the limitation of treatments that may be minimally beneficial to the patient, and the choice of a higher quality of care. The EOLC decision using the legal process defined in the relevant Korean Act has advantages, wherein patients can clarify their preference, the family can prioritize the patient's preference for EOLC decisions, and physicians can make transparent EOLC decisions based on medical evidence and informed patient consent.

18.
Medicine (Baltimore) ; 99(18): e19793, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358351

RESUMO

RATIONALE: Many previous studies have investigated the necessity of routine histopathological analysis of tonsillectomy specimen, and most recent studies have suggested that such an analysis is not justified in asymptomatic patients or those with no risk factors for malignancy. PATIENT CONCERNS: A 59-year-old man diagnosed with obstructive sleep apnea underwent surgery, including tonsillectomy; a tonsil specimen was sent to the department of pathology. DIAGNOSIS: Although the patient did not exhibit any tonsil-related signs or symptoms, nor did the appearance of the tonsil appear to be pathological, the right tonsil specimen was diagnosed with squamous cell carcinoma, with detection of human papilloma virus 16. INTERVENTIONS: Chemotherapy and radiotherapy were used to treat the tonsil cancer. OUTCOMES: No recurrence was observed during the 4-year follow-up. LESSONS: In the future, it may be necessary to reinvestigate the necessity of routine histopathological analysis of tonsillectomy specimens in asymptomatic patients, considering the drastically increased rate of detection of human papilloma virus-related oropharyngeal squamous cell carcinomas in these patients.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Primárias Desconhecidas/diagnóstico , Apneia Obstrutiva do Sono/cirurgia , Neoplasias Tonsilares/diagnóstico , Tonsilectomia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade
19.
Pain Med ; 21(10): 2288-2297, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32443142

RESUMO

OBJECTIVE: To compare the nonadaptive manual system with the position-adaptive system in subjects with permanent spinal cord stimulator (SCS) implantation over a two-year follow-up period. DESIGN: Retrospective study. SETTING: Tertiary university-based national hospital. SUBJECTS: Patients who underwent permanent SCS implantation procedures. METHODS: Patients were divided into an adaptive group and a nonadaptive group according to the type of implanted SCS device. The primary outcome was the change (%) in pain intensity from baseline between the adaptive and nonadaptive groups at 24 months after SCS implantation. The secondary outcomes were comparisons of detailed clinical variables such as the scores of patient pain and satisfaction during the two-year follow-up after SCS therapy. Further, the number of subjects with SCS removal or revision within two years after SCS implantation was investigated. RESULTS: Of 187 patients with permanent SCS implantation, 85 in the nonadaptive group and 64 in the position-adaptive group were finally analyzed. The reduction in pain intensity at 24 months was higher in the adaptive group (-38.6%) than in the nonadaptive group (-30.8%, P = 0.05). Similarly, patient satisfaction with the SCS treatment at 24 months was superior in the adaptive group than in the nonadaptive group (85.7% vs 67.5% were satisfied in each group, respectively, P = 0.024). During the two years, 5.3% of patients (N = 10) underwent SCS removal and 7.0% (N = 13) underwent revision procedures. CONCLUSIONS: There was a trend of a sustained reduction in pain intensity as well as improvement in patient satisfaction at two-year follow-up in the position-adaptive system, suggesting long-term benefit over the nonadaptive manual system during SCS treatment.

20.
J Int Med Res ; 48(5): 300060520926005, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32466703

RESUMO

Pulmonary cement embolism (PCE) is one of several complications of percutaneous vertebroplasty and kyphoplasty. Generally, PCE can be easily diagnosed based on typical chest radiograph findings such as single or multiple radiographically dense opacities with a tubular or branch shape in the lung field along with a recent history of percutaneous vertebroplasty or kyphoplasty. These findings can be alarming and may be encountered on routine chest radiographs, even in asymptomatic patients. One study showed that PCEs that were not visualized on chest radiograph were also not shown on chest computed tomography. However, we encountered a patient with dyspnea who had normal chest radiograph findings but was diagnosed with PCE through only the bone window setting on chest computed tomography. The present case will be beneficial to all physicians examining older patients with dyspnea.

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