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1.
Death Stud ; : 1-11, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32048559

RESUMO

The current study aimed to develop and investigate the psychometric properties of the Meaning Making in Grief Scale based on contemporary approaches to bereavement adaptation as a meaning reconstruction process. The research entailed three steps: scale development, exploratory factor analysis, and confirmatory factor analysis. The current 21-item scale was composed of three subscales: Meaning of the Significant Other, Being Present, and Coping and Growth. Support was found for the reliability and validity of the scale, as reflected in the high levels of coherence of the subscales and their hypothesized correlation with established measures of meaning and grief symptomatology.

2.
J Mol Biol ; 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32035902

RESUMO

The class B G protein-coupled receptor (GPCR) calcitonin receptor (CTR) is a drug target for osteoporosis and diabetes. N-glycosylation of asparagine 130 in its extracellular domain (ECD) enhances calcitonin hormone affinity with the proximal GlcNAc residue mediating this effect through an unknown mechanism. Here, we present two crystal structures of salmon calcitonin-bound, GlcNAc-bearing CTR ECD at 1.78 and 2.85 Å resolutions and analyze the mechanism of the glycan effect. The N130 GlcNAc does not contact the hormone. Surprisingly, the structures are nearly identical to a structure of hormone-bound, N-glycan-free ECD, which suggested that the GlcNAc might affect CTR dynamics not observed in the static crystallographic snapshots. Hydrogen-deuterium exchange mass spectrometry and molecular dynamics simulations revealed that glycosylation stabilized a ß-sheet adjacent to the N130 GlcNAc and the N-terminal α-helix near the peptide-binding site, while increasing flexibility of the peptide-binding site turret loop. These changes due to N-glycosylation increased the ligand on-rate and decreased its off rate. The glycan effect extended to RAMP-CTR amylin receptor complexes and was also conserved in the related CGRP receptor. These results reveal that N-glycosylation can modulate GPCR function by altering receptor dynamics.

3.
Medicine (Baltimore) ; 99(1): e18617, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895818

RESUMO

Development of patient-specific CT imaging phantoms with randomly incorporated lesions of various shapes and sizes for calibrating image intensity and validating quantitative measurement software is very challenging. In this investigation, a physical phantom that accurately represents a patient's specific anatomy and the intensity of lung CT images at the voxel level will be fabricated using fused deposition modeling (FDM) 3D printing. Segmentation and modeling of a patient's CT data were performed by an expert and the results were confirmed by a thoracic radiologist with more than 20 years of experience. This facilitated the extraction of the details of the patient's anatomy; various kinds of nodules with different shapes and sizes were randomly added to the modeled lung for evaluating the size-accuracy of the quantification software. To achieve these Hounsfield Units (HU) ranges for the corresponding voxels in acquired CT scans, the infill ratios of FDM 3D printing were controlled. Based on CT scans of the 3D printed phantoms, the measured HU for normal pulmonary parenchyma, ground glass opacity (GGO), and solid nodules were determined to be within target HU ranges. The accuracy of the mean absolute difference and the mean relative difference of nodules were less than 0.55 ±â€Š0.30 mm and 3.72 ±â€Š1.64% (mean difference ±â€Š95 CI), respectively. Patient-specific CT imaging phantoms were designed and manufactured using an FDM printer, which could be applied for the precise calibration of CT intensity and the validation of image quantification software.


Assuntos
Pulmão/diagnóstico por imagem , Imagens de Fantasmas , Impressão Tridimensional , Tomografia Computadorizada por Raios X/instrumentação , Humanos
4.
Invest Radiol ; 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31917765

RESUMO

OBJECTIVES: The aim of this study was to investigate the clinical feasibility of the simultaneous reduction of radiation and contrast doses using spectral computed tomography (CT) in patients at high-risk for hepatocellular carcinoma. MATERIALS AND METHODS: Between May 2017 and March 2018, this prospective study recruited participants at risk of hepatocellular carcinoma with body mass indexes less than 30 and randomly assigned them to either the standard-dose group or the double low-dose group, which targeted 30% reductions in both radiation and contrast media (NCT03045445). Lesion conspicuity as a primary endpoint and lesion detection rates were then compared between hybrid iterative reconstruction (iDose) images of standard-dose group and low monoenergetic (50 keV) images of double low-dose group. Qualitative and quantitative image noise and contrast were also compared between the 2 groups. Participants and reviewers were blinded for scan protocols and reconstruction algorithms. Lesion conspicuity was analyzed using generalized estimating equation analysis. Lesion detection was evaluated using weighted jackknife alternative free-response receiver operating characteristic analysis. RESULTS: Sixty-seven participants (male-to-female ratio, 59:8; mean age, 64 ± 9 years) were analyzed. Compared with the standard-dose group (n = 32), significantly lower CTDIvol (8.8 ± 1.7 mGy vs 6.1 ± 0.6 mGy) and contrast media (116.9 ± 15.7 mL vs 83.1 ± 9.9 mL) were utilized in the double low-dose group (n = 35; P < 0.001). Comparative analysis demonstrated that lesion conspicuity was significantly higher on 50 keV images of double low-dose group than on iDose images of standard dose on both arterial (2.62 [95% confidence interval (CI), 2.31-2.93] vs 2.02 [95% CI, 1.73-2.30], respectively, P = 0.004) and portal venous phases (2.39 [95% CI, 2.11-2.67] vs 1.88 [95% CI, 1.67-2.10], respectively, P = 0.005). No differences in lesion detection capability were observed between the 2 groups (figure of merit: 0.63 in standard-dose group; 0.65, double low-dose group; P = 0.52). Fifty kiloelectronvolt images of double low-dose group showed better subjective image noise and contrast than iDose image of standard-dose group on arterial and portal venous phases (P < 0.001 for all). Contrast-to-noise ratio of the aorta and portal vein was also higher in double low-dose group than in standard-dose group (P < 0.001 for all), whereas there was no significant difference of quantitative image noise between the 2 groups on arterial and portal phases (P = 0.4~0.5). CONCLUSIONS: Low monoenergetic spectral CT images (50 keV) can provide better focal liver lesion conspicuity than hybrid iterative reconstruction image of standard-dose CT in nonobese patients while using lower radiation and contrast media doses.

5.
Arthroscopy ; 36(2): 524-532, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31901388

RESUMO

PURPOSE: To compare the serial changes in radiographic outcomes in terms of the mechanical axis (MA) angle and medial joint space width (JSW) between medial meniscus posterior root tear (MM PRT) and non-root tear (MM NRT) after arthroscopic partial meniscectomy (APM). METHODS: Patients who underwent APM for degenerative MM PRT or MM NRT from January 1999 to July 2012 were retrospectively reviewed. One hundred ten patients each in the MM PRT group and the MM NRT group, who were matched through propensity score matching (adjusting for confounding factors such as age, sex, body mass index, anatomic axis, cartilage state of the medial compartment, and follow-up period), were included in the study. The MA angle on weightbearing whole-leg radiographs and the medial JSW on weightbearing 45° flexion posteroanterior radiographs were measured to evaluate the radiographic outcomes. The serial changes were compared between radiographs taken before surgery, at postoperative 3 to 5 years, and at postoperative 5 years to the last follow-up. The linear mixed model was used to compare the changes in radiographic outcomes during the follow-up period between groups. RESULTS: The 2 groups were balanced with standardized mean differences of <0.2 after propensity score matching. Both the MM PRT and NRT groups showed increased varus alignment after surgery. However, there was no significant difference in the change in the MA angle during the follow-up period between groups (P = .182). The medial JSW also showed progression of joint space narrowing after surgery in both groups; however, there was no significant difference in the change in medial JSW during the follow-up period between groups (P = .270). CONCLUSION: The radiographic outcomes after partial meniscectomy in terms of the MA angle and medial JSW show comparable results between degenerative MM PRT and NRT after proper matching of confounding factors. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

6.
Hip Int ; : 1120700019896970, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31912760

RESUMO

BACKGROUND: Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture's polyethylene liner for >15 years in terms of survival and wear rate. METHODS: This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined. RESULTS: HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups. CONCLUSIONS: Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.

7.
Diagn Interv Radiol ; 26(1): 45-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31904570

RESUMO

PURPOSE Most patients with intrahepatic cholangiocarcinoma (ICC) are not eligible for surgical resection due to advanced stage. We aimed to evaluate the feasibility, local tumor control, and long-term survival of intraoperative radiofrequency ablation (IORFA) with surgical resection to treat unresectable intrahepatic cholangiocarcinoma (ICC). METHODS From 2009 to 2016, 20 consecutive patients (12 primary ICC, 8 recurrent ICC) underwent curative IORFA with hepatic resection for surgically unresectable ICC. Patients were not qualified to undergo surgical resection due to multiple lesions causing postoperative hepatic insufficiency and undesirable tumor locations for surgical resection or percutaneous RFA. Of the 51 treated tumors (mean, 2.6±0.9 tumors/patient), 24 were treated by IORFA and 27 were surgically removed. The technical success and effectiveness, overall survival, progression-free survival (PFS), and complications were assessed retrospectively. The overall survival and PFS rates were estimated by the Kaplan-Meier method. RESULTS The technical success and effectiveness of IORFA were 100%. The overall survival rates at 6 months, 1, 3, and 5 years were 95%, 79%, 27%, and 14%, respectively. The median overall survival time was 22.0±3.45 months. The PFS rates at 6 months, 1, 3, and 5 years were 70%, 33%, 13%, and 13%, respectively. The median PFS was 9.0±1.68 months. The prognosis was significantly worse for patients with recurrent ICC than for patients with primary ICC. One patient (5%) had major complications due to IORFA such as liver abscess and biliary stricture. CONCLUSION IORFA with surgical resection can be a feasible option for ICC cases that are not amenable to treatment with surgical resection alone. This strategy provides acceptable local tumor control and overall survival.

8.
Biofabrication ; 12(2): 025003, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31783385

RESUMO

Recently, decellularized extracellular matrix-based bio-ink (dECM bio-ink) derived from animal organs is attracting attention because of its excellent biocompatibility. However, its poor 3D printability and weak mechanical properties remain a challenge. Here, we developed a new dECM bio-ink with enhanced 3D printability and mechanical properties. dECM micro-particles of about 13.4 µm in size were prepared by decellularizing a porcine liver followed by freeze-milling. The new bio-ink, named as dECM powder-based bio-ink (dECM pBio-ink), was prepared by loading the dECM micro-particles into a gelatin mixture. The usefulness of the dECM pBio-ink was evaluated by assessing its mechanical properties, printability, and cytocompatibility. The results showed that its mechanical properties and 3D printability were greatly improved. Its elastic modulus increased by up to 9.17 times that of the conventional dECM bio-ink. Micro-patterns with living cells were successfully achieved with 93% cell viability. Above all, the new bio-ink showed superior performance in stacking of layers for 3D printing, whereas the conventional bio-ink could not maintain its shape. Finally, we demonstrated that the dECM pBio-ink possessed comparable cytocompatibility with the conventional dECM bio-ink through in vitro tests with endothelial cells and primary mouse hepatocytes.

9.
Am J Sports Med ; 48(2): 326-333, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31825644

RESUMO

BACKGROUND: Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood. PURPOSE/HYPOTHESIS: We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and >8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score. RESULTS: A total of 27 lateral MATs were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at >8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at >8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively. CONCLUSION: During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.

10.
J Autism Dev Disord ; 50(1): 333-339, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630294

RESUMO

The prevalence of autism spectrum disorder (ASD) is increasing worldwide. We investigated the economic burden of ASD in South Korea using a nationally representative data source. The direct medical and non-medical costs, and indirect costs resulting from ASD were estimated. The total prevalence was 5.04 (per 100,000) in 2008, and 10.97 in 2015. The economic cost of ASD was estimated to be $2,700,596 in 2008 and $9,645,503 in 2015. Of the total economic cost in 2015, 72.3% was from direct costs and 27.7% from indirect costs, and 87.5% related to male patients and 12.5% to female patients. The results suggest that the increase in economic costs was greater than the increase in prevalence.

11.
Graefes Arch Clin Exp Ophthalmol ; 258(1): 201-207, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31713749

RESUMO

PURPOSE: We investigated the etiology of punctal stenosis based on the histopathological features of puncta and clinical correlations in punctal stenosis patients. METHODS: A retrospective review was conducted of 69 cases from 38 patients who were diagnosed with punctal stenosis. Slit-lamp examination, the lacrimal irrigation test, dacryocystography, and spectral domain-optical coherence tomography were performed for the evaluation of punctal occlusions. For treatment, punctoplasty using a punch biopsy with or without silicone tube insertion and histopathological examinations were performed. RESULTS: The pathological features of the punctal membranes were classified into two types of epithelia: squamous (95.7%, 66/69) and columnar (4.3%, 3/69). The squamous epithelial specimens were divided into three groups: fibrous tissue (66.8%, 48/69), goblet cells (21.8%, 48/69), and keratinization (4.3%, 3/69). Most of the subepithelial pathology was fibrosis (82.6%, 57/69), and inflammation was noted in 17.4% (12/69) of the patients. Subepithelial fibrosis was the most common pathological feature in patients exhibiting stenosis with a squamous epithelium, while inflammation was more strongly correlated with patients with a columnar epithelium. However, there was no correlation between the histopathological findings and treatment outcomes. CONCLUSION: Our histopathological findings suggest that primary fibrosis of the stenotic punctum was caused by intrinsic inflammation of the puncta rather than spreading from the conjunctiva or eyelid. Punctoplasty was effective in treating punctal stenosis, regardless of the epithelial type.

12.
Eur Radiol ; 30(2): 735-743, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31471750

RESUMO

OBJECTIVES: To determine whether sirolimus has beneficial effects on lymphangioleiomyomatosis (LAM) lung cysts in CT with long-term follow-up (FU) and to investigate whether CT is an appropriate imaging biomarker to monitor and evaluate LAM progression. METHODS: In this retrospective study, 73 female patients diagnosed with definite LAM between May 2001 and June 2018 were included. Among these, 39 (53.4%) were treated with sirolimus. Quantitative and qualitative CT scoring for lung cysts (CS) were performed and compared between time points (baseline vs. FU at starting sirolimus, baseline vs. last FU, and FU at starting sirolimus vs. last FU for patients treated with sirolimus; baseline vs. last FU for patients without sirolimus). The correlation between CS at each time point and pulmonary function tests (PFTs) at each time point in the patients treated with sirolimus was also investigated. The quantitative and qualitative analyses and PFT results were compared between time points. RESULTS: In both quantitative and qualitative analyses, CS significantly increased from baseline to FU after starting sirolimus, and from baseline to last FU (all p < 0.05), whereas there was no significant difference between scores at the start of sirolimus vs. last in the patients treated with sirolimus. After sirolimus treatment, diffusing capacity for carbon monoxide (DLCO) was significantly increased. There were significant correlations between CS at each time point and PFT (correlation coefficient [r], - 0.383-0.935; all p < 0.001). CONCLUSION: Patients with LAM benefited from sirolimus. CT could be a useful imaging biomarker for evaluating and monitoring lung cysts in LAM. KEY POINTS: • Qualitative analysis showed a total of 15.8% to 21.1% of patients had a reduced lung cyst volume after sirolimus treatment, and in quantitative analysis, there was no significant difference in lung cyst volume between CT at the start of sirolimus therapy and the last CT. • Pulmonary function was also improved or maintained after sirolimus treatment. • Chest CT could be a useful imaging biomarker for evaluating and monitoring lung cysts in patients with lymphangioleiomyomatosis.

13.
Eur J Radiol ; 123: 108787, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31877509

RESUMO

PURPOSE: To evaluate the clinical efficacy of transcatheter arterial embolization (TAE) for managing pancreatic adenocarcinoma-related gastrointestinal (GI) bleeding, and to determine the factors associated with clinical outcomes. METHOD: From 2001-2017, this retrospective study included 58 patients who underwent TAE for pancreatic adenocarcinoma-related GI bleeding. The technical and clinical success of TAE, clinical factors including patient characteristics and embolization details, complications, and the 30-day mortality were evaluated. Univariate analyses were performed to determine the factors related to the clinical outcomes. RESULTS: On angiography, bleeding foci were detected in 47 patients (81%), while the other 11 patients showed tumor staining. Technical success rate was 98%, and first session and overall clinical success rates were 79% and 88%, respectively. N-butyl cyanoacrylate (NBCA) was the most commonly used embolic agent (53%). Stent-related bleeding was shown in 22 patients with characteristic angiogram such as arterial cut-off (13/22) and arteriobiliary fistula (5/22), with comparable clinical success rate (82%). Bleeding from the superior mesenteric artery (n = 3) at the first session of angiography and complications (n = 2), such as ischemic hepatitis and small bowel infarction, were all associated with a 30-day mortality. The overall 30-day mortality rate was 22%. Univariate analysis showed that massive transfusion and TNM stage 4 were related to clinical failure (P = 0.035 and 0.038, respectively). CONCLUSIONS: TAE was effective and safe for pancreatic adenocarcinoma-related GI bleeding. Stent-related bleeding was not uncommon, and associated with vascular abnormality amenable to TAE. Massive transfusion and TNM stage 4 were related to clinical failure.

14.
Thyroid ; 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31880976

RESUMO

Background: Estimating the growth rate of lung metastases for the treatment of patients with metastases of differentiated thyroid carcinoma (DTC) is important. This study aimed to evaluate survival outcomes according to different criteria for estimating the growth rate of lung metastases. Methods: Patients with macronodular (≥1 cm) lung metastases of DTC who underwent total thyroidectomy and high-dose radioactive iodine therapy between 1995 and 2013 were enrolled. The time to progressive disease (PD) by the Response Evaluation Criteria in Solid Tumors (RECIST), average tumor volume doubling time of the two dominant target lung lesions (midDT), and thyroglobulin doubling time (TgDT) were measured in each patient, and their association with disease-specific survival (DSS) was evaluated. Results: Forty-four patients with target lung metastatic nodules with an initial maximal diameter of 1.3 cm (median) were followed-up for a median of 6.8 years after the diagnosis of lung metastases. Based on RECIST, 12 patients (27.3%) showed fast tumor progression, with time to PD <1 year. When assessed by midDT, nine patients (20.5%) had midDT ≤1 year, showing rapid tumor progression. Seven of 33 patients (21.2%) who were negative for thyroglobulin antibody had midDT <1 year. Growth rates assessed by all three criteria were significantly associated with DSS. However, midDT had the highest predictive value for DSS, with a proportion of variation explained of 33.6%. Five-year DSS was 29.6% in patients with midDT ≤1 year, 50.0% in patients with time to PD <1 year, and 42.9% in patients with TgDT <1 year. Conclusions: Among the different criteria for estimating the growth rate of metastases in patients with lung metastases of DTC, midDT was the most powerful for predicting DSS, in comparison with RECIST and TgDT. Performing at least three serial chest computed tomography scans during the first year from the diagnosis of lung metastases can facilitate early detection of patients with rapid tumor progression and provide objective guidance for initiation of systemic therapy.

15.
Sci Rep ; 9(1): 18738, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822774

RESUMO

To investigate the reproducibility of computer-aided detection (CAD) for detection of pulmonary nodules and masses for consecutive chest radiographies (CXRs) of the same patient within a short-term period. A total of 944 CXRs (Chest PA) with nodules and masses, recorded between January 2010 and November 2016 at the Asan Medical Center, were obtained. In all, 1092 regions of interest for the nodules and mass were delineated using an in-house software. All CXRs were randomly split into 6:2:2 sets for training, development, and validation. Furthermore, paired follow-up CXRs (n = 121) acquired within one week in the validation set, in which expert thoracic radiologists confirmed no changes, were used to evaluate the reproducibility of CAD by two radiologists (R1 and R2). The reproducibility comparison of four different convolutional neural net algorithms and two chest radiologists (with 13- and 14-years' experience) was conducted. Model performances were evaluated by figure-of-merit (FOM) analysis of the jackknife free-response receiver operating curve and reproducibility rates were evaluated in terms of percent positive agreement (PPA) and Chamberlain's percent positive agreement (CPPA). Reproducibility analysis of the four CADs and R1 and R2 showed variations in the PPA and CPPA. Model performance of YOLO (You Only Look Once) v2 based eDenseYOLO showed a higher FOM (0.89; 0.85-0.93) than RetinaNet (0.89; 0.85-0.93) and atrous spatial pyramid pooling U-Net (0.85; 0.80-0.89). eDenseYOLO showed higher PPAs (97.87%) and CPPAs (95.80%) than Mask R-CNN, RetinaNet, ASSP U-Net, R1, and R2 (PPA: 96.52%, 94.23%, 95.04%, 96.55%, and 94.98%; CPPA: 93.18%, 89.09%, 90.57%, 93.33%, and 90.43%). There were moderate variations in the reproducibility of CAD with different algorithms, which likely indicates that measurement of reproducibility is necessary for evaluating CAD performance in actual clinical environments.

16.
Sleep Breath ; 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792907

RESUMO

PURPOSE: To evaluate the association of sleep duration with health-related quality of life (HRQOL) and examine the influence of age, sex, and common comorbidities on this association. METHODS: Using appropriate survey design, we analyzed 50,181 adults who participated in the 2007-2015 Korea National Health and Nutrition Examination Survey. Participants were categorized into five groups according to self-reported sleep duration ≤ 5 (short sleeper), 6, 7, 8, and ≥ 9 h (long sleeper). HRQOL was measured with the European Quality of Life-5 Dimensions (EQ-5D) index and visual analogue scale (VAS). RESULTS: In multiple linear regression, short sleep duration was associated with lower EQ-5D index (ß = - 0.024; 95% confidence interval [CI], - 0.027 to - 0.021) and lower EQ-VAS (ß = - 3.0; 95% CI, - 3.7 to - 2.3), and long sleep duration was associated with lower EQ-5D index (ß = - 0.016; 95% CI, - 0.021 to - 0.011) and lower EQ-VAS (ß = - 2.2; 95% CI, - 3.1 to - 1.3) compared with 7-h sleepers. Old-age (≥ 65 years old) short and long sleepers had significantly lower EQ-5D index than those of < 65 years old. When separated according to sex, men with long sleep and women with short sleep showed the lowest EQ-5D index. Short and long sleepers with hypertension, diabetes, hypercholesterolemia, cardiovascular disease, or depression showed significantly lower EQ-5D index than those without comorbidities. CONCLUSIONS: Extreme sleep duration was associated with poor HRQOL. Short and long sleepers with old age and comorbidities had significantly lower HRQOL than those without such conditions.

17.
Psychiatry Investig ; 16(12): 911-918, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801315

RESUMO

OBJECTIVE: This study aimed to examine the differences in personality, defense style, and coping styles among patients with depression according to age groups. METHODS: A total of 211 participants ranging from 19 to 81 years old were recruited for the study. To assess participants' five dimensions of personality, the Neuroticism-Extraversion-Openness Personality Inventory-Revised (NEO-PI-R) was administered. In addition, the Korean-Defense Style Questionnaire and the Korean version of the coping checklist were administered to examine the defense and coping style. RESULTS: In the analysis of NEO-PI-R, the mean value of Agreeableness, Conscientiousness, and Neuroticism showed significant differences between the young adult age group (20-34 years) and the late middle age group (50-64 years) (p<0.05). The young age group used more immature defense styles and made less use of problem-focused coping strategy than the old age patients (65 years and older) (p<0.05). CONCLUSION: In the young age group associations with lower Agreeableness and Conscientiousness, as well as higher Neuroticism than the late middle age group were observed. Moreover, the young age group had a higher usage of immature defense style, and restricted use of problem-focused coping style than other age groups.

18.
Acute Crit Care ; 34(4): 246-254, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31795622

RESUMO

BACKGROUND: To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards. METHODS: This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups. RESULTS: There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024). CONCLUSIONS: Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

19.
Respir Res ; 20(1): 271, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796019

RESUMO

BACKGROUND: All-cause mortality risk and causes of death in bronchiectasis patients have not been fully investigated. The aim of this study was to compare the mortality risk and causes of death between individuals with bronchiectasis and those without bronchiectasis. METHODS: Patients with or without bronchiectasis determined based on chest computed tomography (CT) at one centre between 2005 and 2016 were enrolled. Among the patients without bronchiectasis, a control group was selected after applying additional exclusion criteria. We compared the mortality risk and causes of death between the bronchiectasis and control groups without lung disease. Subgroup analyses were also performed according to identification of Pseudomonas or non-tuberculous mycobacteria, airflow limitation, and smoking status. RESULTS: Of the total 217,702 patients who underwent chest CT, 18,134 bronchiectasis patients and 90,313 non-bronchiectasis patients were included. The all-cause mortality rate in the bronchiectasis group was 1608.8 per 100,000 person-years (95% confidence interval (CI), 1531.5-1690.0), which was higher than that in the control group (133.5 per 100,000 person-years; 95% CI, 124.1-143.8; P < 0.001). The bronchiectasis group had higher all-cause (adjusted hazard ratio (aHR), 1.26; 95% CI, 1.09-1.47), respiratory (aHR, 3.49; 95% CI, 2.21-5.51), and lung cancer-related (aHR, 3.48; 95% CI, 2.33-5.22) mortality risks than the control group. In subgroup analysis, patients with airflow limitation and ever smokers showed higher all-cause mortality risk among bronchiectasis patients. Therefore, we observed significant interrelation between bronchiectasis and smoking, concerning the risks of all-cause mortality (P for multiplicative interaction, 0.030, RERI, 0.432; 95% CI, 0.097-0.769) and lung cancer-related mortality (RERI, 8.68; 95% CI, 1.631-15.736). CONCLUSION: Individuals with bronchiectasis had a higher risk of all-cause, respiratory, and lung cancer-related mortality compared to control group. The risk of all-cause mortality was more prominent in those with airflow limitation and in ever smokers.

20.
Artigo em Inglês | MEDLINE | ID: mdl-31781797

RESUMO

PURPOSE: This study aimed at determining whether overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint. METHODS: Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% overcorrection of WBL ratio (overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of overcorrection. RESULTS: The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively (P < 0.001). The average MPTA changed from 85.1 ± 1.7° preoperatively to 93.6 ± 2.6° postoperatively, resulting in an average tibia correction angle of 8.6 ± 3.1°. The average estimated correction from soft tissue factors was 5.8 ± 7.4% of the WBL ratio. Soft tissue correction of the WBL ratio > 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° (P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° (P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for overcorrection from soft tissue factors (P = 0.006; odds ratio, 30.2). CONCLUSIONS: The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle. LEVEL OF EVIDENCE: III.

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