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1.
BMC Pulm Med ; 22(1): 175, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501757

RESUMO

BACKGROUND: Although pulmonary rehabilitation is helpful for patients following lung cancer surgery, rehabilitation is not widely available, due in part to a lack of medical resources. Recent developments in digital health care have overcome the space limitations associated with in-person health care. This study will evaluate and compare the efficacy of three different smartphone healthcare systems in patients with lung cancer. METHODS: This single center randomized controlled study is designed to evaluate the efficacy of digital healthcare applications for lung cancer patients after thoracoscopic lung resection. A total of 320 patients will be enrolled and randomized 1:1:1:1 into four different groups, with one group each using the smartphone applications NOOM, Walkon, and Efilcare and the fourth being the control group without intervention. Questionnaires will be administered to patients at baseline and after 3, 6, and 12 months. The primary endpoint will be the score on the EuroQol five-dimension index. Secondary endpoints will include other questionnaires about quality of life and dyspnea. DISCUSSION: This prospective randomized controlled study may allow assessments and comparisons of the efficacy of various smartphone applications in patients who undergo lung cancer surgery. This process may enable the introduction of healthcare interventions that maintain quality of life in patients with lung cancer. Trial registration CRIS, KCT0005447. Registered 06 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/19346.


Assuntos
Neoplasias Pulmonares , Qualidade de Vida , Atenção à Saúde , Humanos , Neoplasias Pulmonares/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Smartphone
2.
J Infect Chemother ; 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35400550

RESUMO

BACKGROUND: We aimed to investigate treatment outcomes according to the presence or absence of cavitary lesions in patients with the interstitial lung disease (ILD) subtype of unclassifiable type Mycobacterium avium complex (MAC) pulmonary disease (PD). METHODS: Study subjects were enrolled at a tertiary referral center in South Korea from 2001 to 2020. Among patients with MAC-PD who had ILD as an underlying disease, 38 patients who were diagnosed with the ILD subtype of unclassifiable MAC-PD and who received treatment for ≥1 year were selected for this study. Treatment outcomes in terms of microbiological cure at 1 year were retrospectively analyzed for these patients. RESULTS: The mean age of the patients was 64.4 ± 12.9 years, and 63.2% were male. The presence of cavitary lesions was noted in 68.4% (26/38) patients. A usual interstitial pneumonia pattern was the predominant type of ILD, which was identified in 26 (68.4%) patients. The overall 1-year microbiological cure rate of the 38 patients was 65.8% (25/38). Of the 26 patients with cavitary lesions, microbiological cure at 1 year was achieved in 14 patients (53.8%), which is significantly lower than that in patients without cavitary lesions (91.7%, 11/12, p = 0.030). CONCLUSIONS: A clear difference in treatment outcomes was noted in the ILD subtype of MAC-PD according to the presence or absence of cavitary lesions.

3.
Sci Rep ; 12(1): 5532, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365722

RESUMO

Blood and fluid analysis is extensively used for classifying the etiology of pleural effusion. However, most studies focused on determining the presence of a disease. This study classified pleural effusion etiology employing deep learning models by applying contrastive-loss. Patients with pleural effusion who underwent thoracentesis between 2009 and 2019 at the Asan Medical Center were analyzed. Five different models for categorizing the etiology of pleural effusion were compared. The performance metrics were top-1 accuracy, top-2 accuracy, and micro-and weighted-AUROC. UMAP and t-SNE were used to visualize the contrastive-loss model's embedding space. Although the 5 models displayed similar performance in the validation set, the contrastive-loss model showed the highest accuracy in the extra-validation set. Additionally, the accuracy and micro-AUROC of the contrastive-loss model were 81.7% and 0.942 in the validation set, and 66.2% and 0.867 in the extra-validation set. Furthermore, the embedding space visualization in the contrastive-loss model exhibited typical and atypical effusion results by comparing the true and false positives of the rule-based criteria. Therefore, classifying the etiology of pleural effusion was achievable using the contrastive-loss model. Conclusively, visualization of the contrastive-loss model will provide clinicians with valuable insights for etiology diagnosis by differentiating between typical and atypical disease types.


Assuntos
Aprendizado Profundo , Derrame Pleural , Exsudatos e Transudatos , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Toracentese
4.
Environ Monit Assess ; 194(4): 268, 2022 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-35266055

RESUMO

The simultaneous determination of 8 polychlorinated biphenyls (PCBs), 23 organic chlorine pesticides (OCPs), and 35 polycyclic aromatic hydrocarbons (PAHs) in black-tailed gull eggs was described using ultrasound-assisted extraction and gas chromatography-tandem mass spectrometry (GC-MS/MS). The ranges of the lower limits of detection for PCBs, OCPs, and PAHs were 0.006-0.029, 0.01-0.10, and 0.01-0.20 µg kg-1, respectively. The intraday precision was in the range of 0.650-12.9% and the intraday accuracy was in the range of 86.6-113%. When the proposed method was used to analyze the target compounds in gull eggs collected from six sites in the Republic of Korea, the analytical results demonstrated concentration ranges of 113.32-394.07 µg kg-1 for total PCBs, 422.92-1082.09 µg kg-1 for total OCPs, and 134.50-231.27 µg kg-1 for total PAHs in the samples. The PCA results for PAHs and OCPs were well differentiated by sampling site, whereas those for PCBs differed little by sampling site. There were more pyrogenic PAHs in the West Sea and the South Sea with many industrial areas than in the East Sea with few industrial areas. Differences in the OCP patterns of samples from the West Sea close to China were considered to be related to the use of DDT in China until recently. PCBs were accumulated in the samples regardless of region, so there was no significant difference in the PCB patterns between the samples obtained from the three Seas.


Assuntos
Charadriiformes , Hidrocarbonetos Clorados , Praguicidas , Bifenilos Policlorados , Hidrocarbonetos Policíclicos Aromáticos , Animais , Cloro/análise , Monitoramento Ambiental , Cromatografia Gasosa-Espectrometria de Massas , Hidrocarbonetos Clorados/análise , Praguicidas/análise , Bifenilos Policlorados/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Espectrometria de Massas em Tandem
5.
Antimicrob Agents Chemother ; 66(2): e0152221, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-34930036

RESUMO

During the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD), ethambutol or rifampin is often discontinued because of adverse events. This study investigated the treatment outcomes when broader-spectrum fluoroquinolones replace ethambutol or rifampin in MAC-PD treatment based on the radiologic type. From 2006 to 2019, patients who initiated standard treatment and whose treatment duration was ≥1 year were retrospectively identified at a tertiary referral center in South Korea, including 178 patients with cavitary disease (fibrocavitary and cavitary nodular bronchiectatic types) and 256 patients with the noncavitary nodular bronchiectatic (NC-NB) type. We compared the microbiologic cure at 1 year between the patients who maintained the initial regimen and those who replaced ethambutol or rifampin with fluoroquinolones (moxifloxacin or levofloxacin). The overall microbiologic cure rate of the 178 patients with cavitary disease was 71.3%. Among these, the microbiologic cure rates of the 16 patients who substituted fluoroquinolones for ethambutol were lower than those of the 156 patients who maintained three-drug oral antibiotics with aminoglycoside (37.5% versus 74.4%, respectively; P = 0.007), which was statistically significant in multivariate analysis. The outcomes of the six patients receiving fluoroquinolones as an alternative to rifampin were similar to that of those continuing the initial regimen. The microbiologic cure rate of the patients with the NC-NB type receiving daily or intermittent oral three-drug therapy was similar regardless of maintaining the initial therapy or replacing ethambutol or rifampin with fluoroquinolones. In conclusion, in cavitary MAC-PD, replacing ethambutol with fluoroquinolones resulted in inferior patient outcomes.


Assuntos
Pneumopatias , Infecção por Mycobacterium avium-intracellulare , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Etambutol/uso terapêutico , Fluoroquinolonas/uso terapêutico , Humanos , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/microbiologia , Estudos Retrospectivos , Rifampina
6.
Neurol Sci ; 42(12): 5213-5218, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33825117

RESUMO

Pupil palsy has been a frequent finding in Miller Fisher syndrome (MFS), but its clinical characteristics have not been clearly defined. The basis for differential diagnosis with other diseases with pupil palsy has also remained vague. We report cases of four MFS patients with bilateral pupil palsy and specify pupil characteristics of light-near dissociation (LND), cholinergic super-sensitivity, vermiform movements, and prognosis. We conducted a literature review to compare with our cases and investigate common findings of pupil palsy in MFS patients. We suggest that the acute generalized pupil palsy without vermiform movements can serve as a key finding for the diagnosis of pupil palsy associated with MFS. However, the presence of LND and cholinergic super-sensitivity was not distinctive clinical findings in MFS patients who had pupil palsy and did not prove useful for differential diagnosis. The prognosis of pupil palsy in MFS patients was good in our 4 cases and the literature review.


Assuntos
Síndrome de Miller Fisher , Diagnóstico Diferencial , Humanos , Síndrome de Miller Fisher/complicações , Síndrome de Miller Fisher/diagnóstico , Paralisia , Prognóstico , Pupila
7.
Ann Palliat Med ; 10(2): 1431-1437, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33183040

RESUMO

BACKGROUND: Several radiologic imaging techniques have been used to predict the effects of treatment on lumbar facet joint (LFJ) pain. However, there are no reports on the use of contrast-enhanced magnetic resonance imaging (MRI) in the management of LFJ pain. In the current study, we aimed to evaluate the clinical ability of contrast-enhanced MRI to predict treatment outcomes for LFJ pain. METHODS: A total of 26 patients with LFJ pain were recruited and intraarticular (IA) corticosteroid injections were administered to each patient. We assessed the treatment outcomes using a numerical rating scale (NRS), and two radiologists independently investigated LFJ enhancement and osteoarthritis grading. No serious complications or adverse events were reported. RESULTS: IA corticosteroid injections were administered to 26 patients (12 women and 14 men; mean age: 65.19±11.05 years) with LFJ pain. Among the 26 patients, 16 patients were included in the facet joints with enhancement group, and the remaining 10 patients were included in the facet joints with non-enhancement group, based on contrast-enhanced MRI scans. In both the enhancement and non-enhancement groups, NRS scores significantly decreased at 1, 2, and 3 months after treatment (P<0.05). However, we saw no significant difference between the groups from pretreatment to three months after treatment (P>0.05). CONCLUSIONS: The routine use of contrast-enhanced MRI is not recommended in patients with LFJ pain.


Assuntos
Dor Lombar , Articulação Zigapofisária , Idoso , Feminino , Humanos , Injeções Intra-Articulares , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Articulação Zigapofisária/diagnóstico por imagem
8.
Int J Chron Obstruct Pulmon Dis ; 15: 2297-2305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061347

RESUMO

Purpose: Pulmonary rehabilitation (PR) is a well-established treatment for chronic obstructive pulmonary disease (COPD). The standard protocol for PR requires frequent hospital visits, which can be difficult for patients. We performed this study to assess whether unsupervised home-based PR (HBPR) is effective for patients with COPD. Patients and Methods: After assessing the outcome data, including the results of a COPD assessment test (CAT); the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; a spirometry; the modified Medical Research Council (mMRC) dyspnea scale; and the 6-min walking test (6MWT), specialists imparted 1-hour education to patients regarding unsupervised HBPR at the baseline visit. This included methods for breathing, inhaler use, stretching, and exercise. On reviewing diaries after 8 weeks from the first visit, patients who exercised at least thrice per week were classified as the compliant group and the others were categorized as the noncompliant group. Changes in the outcomes were compared between the compliant and noncompliant groups. Results: A total of 41 patients were enrolled in this study; for 8 weeks of unsupervised HBPR, there were significant improvements in CAT scores (-4.62±4.61 vs 2.40±6.73; P=0.002), BODE index (-1.00±1.06 vs -0.20±0.56; P=0.01), and forced expiratory volume in 1 s (0.05±0.19 vs -0.09±0.16; P=0.02) among patients in the compliant group, compared with the noncompliant group. Moreover, their CAT (16.46±7.80 vs 11.85±7.23; P=0.03) and mMRC scores (2.54±0.76 vs 1.81±0.63; P=0.001) improved significantly after 8 weeks, compared with those at baseline. On the other hand, patients in the noncompliant group showed no significant improvement in any of the outcomes. Conclusion: In this study, compliant patients with unsupervised HBPR achieved favorable outcomes in 8 weeks. Thus, we recommend unsupervised HBPR for patients with COPD, even when regular hospital visits for PR are not possible. Trial Registration: NCT03754881.


Assuntos
Tolerância ao Exercício , Doença Pulmonar Obstrutiva Crônica , Idoso , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/reabilitação
9.
Eur Geriatr Med ; 11(1): 139-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32297230

RESUMO

PURPOSE: To investigate characteristics of dysphagia in the oldest-old population and the effect of aging on swallowing physiology. METHODS: 418 (364 men, 54 women) patients who underwent videofluoroscopic swallow study (VFSS) for dysphagia were included. The patients were divided into an older group, group I (60-79 years old, n = 275) and the oldest-old group, group II (80-96 years old, n = 143). Sex, cognition, duration of symptoms, BMI (body mass index), frailty index derived from comprehensive geriatric assessment (FI-CGA), penetration aspiration scale (PAS), and videofluoroscopic dysphagia scale (VDS) scores and the etiologies of dysphagia were compared between the groups. The correlation analysis of BMI and FI-CGA with dysphagia severity and age was performed. RESULTS: The proportion of males, K-MMSE scores, the duration of symptoms, BMI scores and FI-CGA were significantly greater in group I than II. The PAS and VDS scores were significantly higher in group II than I. The proportion of CNS disorders was significantly higher in group I than in group II. The proportion of poor general medical condition was significantly higher in group II than in group I. A negative correlation between BMI and dysphagia severity and a positive correlation between FI-CGA and dysphagia severity were observed. CONCLUSION: Dysphagia tends to be more severe in the oldest-old, and can be caused by health conditions unrelated to swallowing. Malnutrition and frailty correlated positively with dysphagia severity, irrespective of age.


Assuntos
Transtornos de Deglutição , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cinerradiografia , Deglutição , Transtornos de Deglutição/epidemiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino
10.
Korean J Intern Med ; 35(5): 1145-1153, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32066222

RESUMO

BACKGROUND/AIMS: Although re-evaluation of radiographic follow-up after 2 to 3 months of therapy is recommended for patients administered anti-tuberculosis medication owing to suspected pulmonary tuberculosis, reported findings are limited. Therefore, this study aimed to investigate changes in 1- and 2-month chest X-ray (CXR) findings after the treatment initiation and compared them according to the final diagnosis of tuberculosis or non-tuberculosis. METHODS: Patients who started anti-tuberculosis medication for suspected pulmonary tuberculosis were selected at a tertiary referral hospital in South Korea between January 2012 and December 2015. Changes in the 1- and 2-month CXR findings were classified as improved, unchanged, and aggravated. RESULTS: Among the 120 patients enrolled in the 1-month CXR group, 76 (63.3%) had the final diagnosis of tuberculosis. Comparison between the 1-month CXR changes and diagnosis showed that the final diagnosis was tuberculosis in 81.8% (45/55), 50.0% (26/52), and 38.5% (5/13) of patients whose 1-month CXR was improved, unchanged, and aggravated, respectively. In the 2-month CXR group, 167 patients were enrolled, and 139 (83.2%) of them were diagnosed with tuberculosis. Tuberculosis was the final diagnosis in 92.6% (100/108), 70.0% (35/50), and 44.4% (4/9) patients with improved, unchanged, and aggravated 2-month CXR findings, respectively. In patients with the final diagnosis of non-tuberculosis, nontuberculous mycobacteria and malignancy were the most common causes of improved and aggravated 1- and 2-month CXR findings, respectively. CONCLUSION: Two-month CXR findings were of limited value for deciding on whether to continue anti-tuberculosis treatment. One-month CXR findings could help determine the need for further work-up.


Assuntos
Radiografia Torácica , Tuberculose Pulmonar , Humanos , Radiografia , República da Coreia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Raios X
11.
J Gynecol Oncol ; 31(1): e10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789000

RESUMO

OBJECTIVES: Two randomized, controlled studies comparing outcomes in patients treated with direct oral anticoagulants or low-molecular weight heparin for cancer-associated venous thromboembolism (VTE) have previously been performed. However, gynecologic cancers accounted for approximately 10% of the study populations. We compared the outcomes of patients with primary gynecological cancers who were treated for cancer-associated VTE with either rivaroxaban or dalteparin. METHODS: The 162 eligible patients with gynecologic cancers who were treated with either dalteparin (n=60) or rivaroxaban (n=102) were reviewed. The primary outcome was a composite event, which included recurrence or clinically relevant bleeding events during the therapeutic period. Secondary outcomes were recurrence, clinically relevant bleeding events, and mortality. RESULTS: During the therapeutic period, there were no significant differences between the groups in the proportion of composite events, recurrence, or clinically relevant bleeding. Multivariate analysis using the Cox proportional hazards model also showed no significant difference in the number of composite events and clinically relevant bleeding between the groups. In the rivaroxaban group, 44.0% of patients experienced gastrointestinal bleeding and 24.0% experienced urinary tract bleeding. In the dalteparin group, bleeding was most common in the urinary tract (44.4%) and at the injection site (22.2%). CONCLUSION: In this study, although there were no significant differences in effectiveness or safety between the rivaroxaban and dalteparin groups, rivaroxaban use was associated with a higher rate of clinically relevant bleeding than dalteparin. Therefore, caution should be taken when prescribing rivaroxaban for gynecologic cancer-associated VTE and bleeding events should be carefully monitored.


Assuntos
Dalteparina/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Rivaroxabana/efeitos adversos , Tromboembolia Venosa/tratamento farmacológico , Idoso , Dalteparina/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Feminino , Neoplasias dos Genitais Femininos/complicações , Hemorragia/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia , Rivaroxabana/administração & dosagem , Tromboembolia Venosa/etiologia
12.
IEEE Trans Cybern ; 50(7): 3056-3067, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31295139

RESUMO

The main concern of this paper is to design the efficient sampled-data controller scheme that resolves the stabilization issue of a surface-mounted permanent magnet synchronous generator (PMSG)-based wind energy conversion system (WECS). Distinct to the existing controller schemes on WECS, the present scheme contains both continuous (plant) and discrete (control) type of signals which outperforms the traditional scheme with continuous or discrete signals. Besides that the fundamental analysis of the closed-loop system under the designed controllers explore the dynamical characteristics of the considered PMSG-based WECS. The stability and stabilization of the proposed closed-loop system have guaranteed through the Lyapunov stability theory and solvable linear matrix inequalities (LMIs). In detail, first, the nonlinear PMSG model has equivalently expressed into linear submodels via the Takagi-Sugeno (T-S) fuzzy approach based on suitable membership rules. Second, the sufficient conditions have been derived as LMIs that ensure the stability and stabilization of the formulated T-S fuzzy PMSG-based WECS. Finally, the effectiveness of the designed controller as well as the consistency of sufficient conditions has demonstrated through numerical evaluations of the closed-loop system.

13.
Curr Med Chem ; 27(6): 955-982, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30381067

RESUMO

BACKGROUND: Neuroinflammation plays a critical role in the development and progression of various neurological disorders. Therefore, various studies have focused on the development of neuroinflammation inhibitors as potential therapeutic tools. Recently, the involvement of autophagy in the regulation of neuroinflammation has drawn substantial scientific interest, and a growing number of studies support the role of impaired autophagy in the pathogenesis of common neurodegenerative disorders. OBJECTIVE: The purpose of this article is to review recent research on the role of autophagy in controlling neuroinflammation. We focus on studies employing both mammalian cells and animal models to evaluate the ability of different autophagic modulators to regulate neuroinflammation. METHODS: We have mostly reviewed recent studies reporting anti-neuroinflammatory properties of autophagy. We also briefly discussed a few studies showing that autophagy modulators activate neuroinflammation in certain conditions. RESULTS: Recent studies report neuroprotective as well as anti-neuroinflammatory effects of autophagic modulators. We discuss the possible underlying mechanisms of action of these drugs and their potential limitations as therapeutic agents against neurological disorders. CONCLUSION: Autophagy activators are promising compounds for the treatment of neurological disorders involving neuroinflammation.


Assuntos
Autofagia , Animais , Progressão da Doença , Inflamação , Doenças Neurodegenerativas , Neuroproteção
14.
Korean J Intern Med ; 35(2): 392-399, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-29768912

RESUMO

BACKGROUND/AIMS: To evaluate the association between the urinary sodium concentration and iodine status in different age groups in Korea. METHODS: This nationwide, population-based, cross-sectional study used data from the Korean National Health and Nutrition Examination Survey (VI 2-3, 2014 to 2015). We included 3,645 subjects aged 10 to 75 years with normal kidney function and without a history of thyroid disease. Adequate iodine intake was defined as a urinary iodine/creatinine (I/Cr) ratio of 85 to 220 µg/g. The urinary sodium/ creatinine (Na/Cr) ratios were classified as low (< 47 mmol/g), intermediate (47 to 114 mmol/g), or high (> 114 mmol/g). RESULTS: The median urinary iodine concentration (UIC) was 292 µg/L (interquartile range [IQR], 157 to 672), and the median urinary I/Cr ratio was 195 µg/g (IQR, 104 to 478). Iodine deficiency (< 100 µg/L) and iodine excess (> 300 µg/L) were observed in 11.3% and 49.0% of subjects, respectively. The UIC was significantly associated with the urinary sodium concentration, and the urinary I/Cr ratio was significantly correlated with the urinary Na/Cr ratio (both p < 0.001). The distributions of UIC, urinary I/Cr ratio, and Na/Cr ratio varied among age groups. Low urinary I/Cr and Na/Cr ratios were most common in young adults (age, 19 to 29 years), while high urinary I/Cr and Na/Cr ratios were most common in elderly people (age, 60 to 75 years). CONCLUSION: Iodine intake was significantly associated with sodium intake in the Korean population. Our study suggested that an adequately low salt intake might be helpful for preventing iodine excess in Korea.


Assuntos
Iodo , Adulto , Idoso , Estudos Transversais , Humanos , Iodo/análise , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , República da Coreia/epidemiologia , Sódio , Adulto Jovem
15.
Clin Endosc ; 52(4): 377-381, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31370380

RESUMO

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.

16.
Respiration ; 98(3): 203-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096241

RESUMO

BACKGROUND: Standard therapy for cancer-associated venous thromboembolism (VTE) is low-molecular-weight heparin. The use of direct oral anticoagulants for cancer-associated VTE has increased; however, their efficacy and safety in lung cancer patients remain unclear. OBJECTIVES: We examined the efficacy and safety of rivaroxaban compared with dalteparin for cancer-associated VTE in patients with primary lung cancer. METHODS: A single-center retrospective study of 204 patients with primary lung cancer who were prescribed rivaroxaban (n = 131) or dalteparin (n = 73) for VTE was performed. The primary endpoint was a composite event including recurrence and major or clinically relevant nonmajor bleeding. Secondary endpoints included the incidence of recurrence, major and clinically relevant nonmajor bleeding, all-cause mortality, and bleeding or pulmonary embolism-related mortality. RESULTS: The composite event occurred in 38 (29.0) and 12 (16.4%) patients in the rivaroxaban and dalteparin (p = 0.045) groups, respectively. The multivariate Cox proportional hazards model for age, Eastern Cooperative Oncology Group performance score, and bleeding risk factors revealed the rivaroxaban group showed a 1.176-fold composite event risk without statistical significance (0.595-2.324, p = 0.641). There was no statistically significant intergroup difference for the incidence of VTE recurrence (5.3% in the rivaroxaban group versus 2.7% in the dalteparin group, p = 0.495) and major or clinically relevant nonmajor bleeding (23.7% in the rivaroxaban group versus 13.7% in the dalteparin group, p = 0.089). There was no significant difference in the all-cause mortality rate (hazard ratio 0.864, 95% CI 0.624-1.196, p = 0.337). CONCLUSIONS: There was no difference in the safety and efficacy profile of rivaroxaban compared with dalteparin. Therefore, rivaroxaban may be a valuable treatment option for lung cancer-associated VTE.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/complicações , Dalteparina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Neoplasias Pulmonares/complicações , Embolia Pulmonar/tratamento farmacológico , Rivaroxabana/uso terapêutico , Trombose Venosa/tratamento farmacológico , Idoso , Anticoagulantes/uso terapêutico , Carcinoma de Células Grandes/complicações , Causas de Morte , Duração da Terapia , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia/induzido quimicamente , Humanos , Hemorragias Intracranianas/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Mortalidade , Modelos de Riscos Proporcionais , Embolia Pulmonar/complicações , Recidiva , Doenças Respiratórias , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/complicações , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/complicações
17.
J Korean Med Sci ; 34(21): e160, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31144482

RESUMO

BACKGROUND: Low-molecular-weight heparin (LMWH) is the standard treatment for venous thromboembolism (VTE) in patients with active cancer. However, use of factor Xa inhibitors, such as rivaroxaban, is increasing on the basis of limited clinical evidence. The present single-center study compared the incidence of bleeding and other treatment outcomes in gastrointestinal and pancreatobiliary cancer (GI tract cancer) patients administered rivaroxaban or LMWH for the treatment of VTE. METHODS: Retrospective data from 281 GI tract cancer patients who were treated for VTE with rivaroxaban (n = 78) or LMWH (n = 203) between 1 January 2012 and 31 December 2016, were analyzed. Primary end-point was the incidence of major and clinically relevant bleeding. Secondary outcomes included the incidence of recurrent VTE and mortality. RESULTS: Clinically relevant bleeding occurred in 19 patients (24.4%) in the rivaroxaban group and 31 (15.3%) in the LMWH group (P = 0.074). No inter-group difference was observed for rate of VTE recurrence (3.8% with rivaroxaban vs. 3.9% with LMWH; P > 0.999) or incidence of major bleeding (5.1% with rivaroxaban vs. 8.9% with LMWH; P = 0.296). Multivariate Cox proportional hazards analysis for age, cancer type, metastasis, history of chemotherapy or recent surgery, and Eastern Cooperative Oncology Group performance status revealed a 1.904-fold higher risk of bleeding with rivaroxaban than LMWH (1.031-3.516; P = 0.040). No significant inter-group difference was found in terms of hazard ratio for all-cause mortality. CONCLUSION: Compared to LMWH, rivaroxaban was associated with a higher incidence of clinically relevant bleeding in GI tract cancer patients presenting with VTE.


Assuntos
Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Neoplasias Pancreáticas/patologia , Rivaroxabana/uso terapêutico , Neoplasias Gástricas/patologia , Tromboembolia Venosa/tratamento farmacológico , Anticoagulantes/efeitos adversos , Sistema Biliar/patologia , Inibidores do Fator Xa/efeitos adversos , Feminino , Trato Gastrointestinal/patologia , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Tromboembolia Venosa/complicações
18.
Neuroreport ; 30(7): 526-531, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932970

RESUMO

The aim of this study was to identify differences in structural and functional brain connectivity between poststroke mild and severe motor impairment. Twenty-four chronic stroke patients who underwent resting-state functional MRI and diffusion tensor image were retrospectively included. All patients were classified into two groups (mild motor impairment: 11 patients and severe motor impairment: 13 patients) according to their Fugl-Meyer motor assessment score. Tract-based spatial statistics and group independent component analyses were applied to investigate between-group differences in structural and functional connectivity, respectively. The fractional anisotropy values of motor-related brain regions in the affected hemisphere were significantly higher in mild motor impairment than in severe motor impairment (corrected P<0.05). The internetwork functional connectivity between (i) the supplementary motor area and primary motor cortex in the affected hemisphere, (ii) the supplementary motor area and dorsolateral prefrontal cortex in the unaffected hemisphere, and (iii) the ischemic lesion and primary motor cortex in the unaffected hemisphere was significantly higher in mild motor impairment than in severe motor impairment (PFWE<0.05). Better motor recovery after stroke could be facilitated by means of treatments aimed at enhancing structural and functional connectivity among motor-related brain regions such as noninvasive brain stimulation and neurodevelopmental therapy.


Assuntos
Encéfalo/fisiopatologia , Vias Neurais/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Doença Crônica , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Vias Neurais/patologia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/patologia
20.
J Food Sci ; 83(12): 2923-2932, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30506688

RESUMO

In food ink systems in which the particles are dispersed in a hydrocolloid matrix, the source of the particles and the particle content are the main factors affecting the printability and rheological properties of the system. In this study, different contents (10% and 30% w/w) of vegetable (broccoli, spinach, or carrot) powders were added to hydrocolloid matrices with different hydration properties, and their influence on the printability and rheological properties was investigated. At low powder contents (10%), slight differences in the printability and rheological values were observed between the different vegetable sources in all hydrocolloids. When the powder content was increased to 30%, the hydrocolloid with the lowest water hydration capacity, hydroxypropyl methylcellulose, showed the greatest differences in rheology and printability when different vegetable sources were used. Xanthan gum, with its higher water hydration capacity, inhibited the swelling of the particles, thus minimizing the increase in the rheological values at high volume fractions of powder and reducing the differences in printability between different vegetable sources. Confocal laser scanning microscopy analysis of the vegetable inks showed that xanthan gum inhibited swelling of the particles regardless of the vegetable powder source. The mixtures using xanthan gum could be smoothly extruded from the nozzle due to their low extruded hardness (2.96 ± 0.23 to 3.46 ± 0.16 kg), and the resulting objects showed high resolution without collapse over time. PRACTICAL APPLICATION: The powder-based texturization technology introduced in this study provides a standardized method of preparing food ink that can be universally applied to all food materials that can be powdered. In addition, the present invention can be applied to a 3D printing technique in which a powder and a hydrocolloid matrix are independently stored and mixed immediately before printing. This technique can minimize the inherent rheological differences between formulations with different food sources and compositions.


Assuntos
Coloides/química , Tinta , Impressão Tridimensional , Reologia , Verduras/química , Brassica/química , Daucus carota/química , Manipulação de Alimentos , Microscopia Confocal , Polissacarídeos Bacterianos/química , Pós , Spinacia oleracea/química
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