Influence of MAFLD and NAFLD on arterial stiffness: A longitudinal cohort study.

BACKGROUND AND AIMS: This cohort study investigated associations of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with risk of increase in arterial stiffness (AS), measured as brachial-ankle pulse wave velocity (baPWV). METHODS AND RESULTS: Participants who had health examinations between 2006 and 2019 were analyzed for fatty liver and increased baPWV using liver ultrasonography and automatic volume plethysmography device. Participants were classified based on presence of MAFLD or NAFLD and further divided into subgroups: no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD. Subgroups were additionally stratified by sex. Cox proportional hazard model was utilized to analyze the risk of developing baPWV ≥1400 cm/s in participants without baseline elevation of the baPWV. The NAFLD and MAFLD groups exhibited higher risks of increased baPWV (NAFLD: adjusted hazard ratio (aHR), 1.35 [95% CI, 1.29-1.42]; MAFLD: aHR, 1.37 [95% CI, 1.31-1.43]) compared to group without the conditions. Incidence of NAFLD or MAFLD were higher in men than in women but aHR of developing the increase in AS was higher in women. In subgroup analysis, the MAFLD-only group presented the strongest associations with increase in AS (aHR, 1.53 [95% CI, 1.43-1.64]), with the trend more pronounced in women than in men (Women, aHR, 1.63 [95% CI, 1.08-2.46]; Men, aHR 1.45 [95% CI, 1.35-1.56]). CONCLUSIONS: Both NAFLD and MAFLD are significantly associated with elevated AS. These associations tended to be stronger in MAFLD than in NAFLD, in women than in men.

Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial.

BACKGROUND: We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). METHODS: A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months. RESULTS: During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts). CONCLUSIONS: Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.

Decomposing Magnetic Dark-Field Contrast in Spin Analyzed Talbot-Lau Interferometry: A Stern-Gerlach Experiment without Spatial Beam Splitting.

We have recently shown how a polarized beam in Talbot-Lau interferometric imaging can be used to analyze strong magnetic fields through the spin dependent differential phase effect at field gradients. While in that case an adiabatic spin coupling with the sample field is required, here we investigate a nonadiabatic coupling causing a spatial splitting of the neutron spin states with respect to the external magnetic field. This subsequently leads to no phase contrast signal but a loss of interferometer visibility referred to as dark-field contrast. We demonstrate how the implementation of spin analysis to the Talbot-Lau interferometer setup enables one to recover the differential phase induced to a single spin state. Thus, we show that the dark-field contrast is a measure of the quantum mechanical spin split analogous to the Stern-Gerlach experiment without, however, spatial beam separation. In addition, the spin analyzed dark-field contrast imaging introduced here bears the potential to probe polarization dependent small-angle scattering and thus magnetic microstructures.

Neutron grating interferometer with an analyzer grating based on a light blocker.

We study an analyzer grating based on a scintillation light blocker for a Talbot-Lau grating interferometer. This is an alternative way to analyze the Talbot self-image without the need for an often difficult to fabricate absorption grating for the incident radiation. The feasibility of this approach using a neutron beam has been evaluated and experiments have been conducted at the cold neutron imaging facility of the NIST center for Neutron Research. The neutron grating interferometer with the proposed analyzer grating successfully produced attenuation, differential phase, and dark-field contrast images. In addition, numerical simulations were performed to simulate the Talbot pattern and visibility using scintillation screens of different thicknesses and there is good agreement with the experimental measurements. The results show potential for reducing the difficulty of fabricating analyzer grating, and a possibility for the so-called shadow effect to be eliminated and large-area gratings to be produced, especially when applied to X-rays. We report the performance of the analyzer grating based on a light blocker and evaluate its feasibility for the grating interferometer.

Effects of poloxamer-based thermo-sensitive sol-gel agent on urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia: a multicentre, single-blinded, randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of poloxamer-based thermo-sensitive sol-gel instillation, after transurethral resection of the prostate (TURP), for preventing urethral stricture. PATIENTS AND METHODS: In all, 198 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: groups A and B. Patients in Group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation and patients in the Group B (98 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 (V1), 12 (V2), and 24 weeks (V3) after TURP. The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), and cystoscopy. RESULTS: Amongst the initial 198 participants, 80 patients in Group A and 83 in Group B completed the study. There were no significant differences in IPSS-QoL and OAB-q between the groups. However, Qmax was significantly different between groups A and B, at a mean (SD) of 18.92 (9.98) vs 15.58 (9.24) mL/s (P = 0.028) at 24 weeks after TURP. On cystoscopic examination, urethral stricture after TURP was found in two of the 80 patients in Group A and 10 of 83 in Group B (P = 0.023). CONCLUSIONS: Poloxamer-based thermo-sensitive sol-gel instillation after TURP lowered the incidence of urethral stricture.

Spatio-temporal patterns of the minimum rest time for outdoor workers exposed to summer heat stress in South Korea.

In this study, the spatio-temporal characteristics of the minimum rest time for the safety of South Korean outdoor workers during hot summer months (June to August) are examined based on the hourly wet-bulb globe temperature (WBGT) across 27 weather stations in South Korea. The WBGT thresholds in the work-rest recommendation of the Korea Occupational Safety and Health Agency (KOSHA 2017) for the quantification of the minimum rest time are evaluated through a comparison of the given thresholds with the occurrences of occupational heat-related illness patients due to outdoor work during hot summer months in South Korea. The long-term (2009-2018) average of the hourly WBGT values during summer months shows that outdoor workers with a moderate workload are exposed to heat stress during approximately 30% of the entire daytime working hours (06:00-18:00). According to the WBGT thresholds modified from the KOSHA (2017) guidelines, the daily minimum rest time for a moderate workload noticeably increases up to 18% (11 min/h) in mid-summer (late July and early August). During mid-summer, the minimum rest time for a continuous moderate outdoor workload even increases up to 31% (18 min/h) between 12:00 and 13:00 and is regionally higher in the southwestern than in the southeastern regions of the Korean Peninsula. These results suggest that in summertime high-heat environments, a mandatory rest time must be provided according to appropriate heat management programs for the safety of workers.

Multilevel States of Nano-Electromechanical Switch for a PUF-Based Security Device.

A nano-electromechanical (NEM) switch using multilevel states based on the high security physical unclonable function (PUF) is proposed and experimentally demonstrated. Using the asymmetric random stiction of a silicon nanowire (SiNW), the conventional binary state is simply expanded to a quaternary-state encryption key without increasing chip area. The multiple states are determined by the asymmetrically bent direction and stiction of the SiNW. The experimental results show that the fabricated NEM-PUF with multistates retains unique, random, and robust characteristics, while the key capacity is doubled, even with the same array size footprint.

Effect of highly concentrated hyaluronic acid/chondroitin sulphate instillation on ureteric stent-induced discomfort after ureteroscopic lithotripsy: a multicentre randomised controlled pilot study.

OBJECTIVE: To investigate the effectiveness and safety of instilling highly concentrated hyaluronic acid (HA)/chondroitin sulphate (CS) on ureteric stent-related pain, urinary symptoms, and quality of life (QoL) of patients who underwent ureteroscopic lithotripsy for ureteric stones followed by ureteric stent placement. PATIENTS AND METHODS: Eligible patients were randomly allocated to receive intravesical instillation with HA/CS or normal saline just after ureteric stent placement. Just before stent removal on postoperative day 7, the patients completed the Ureteric Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS) QoL question, and a pain visual analogue scale (VAS). RESULTS: In total, 92 patients (46 each in the treatment and control arms) completed the study. The groups did not differ in terms of age or stent indwelling time. Compared with the control group, the treatment group had significantly lower USSQ urinary symptom domain scores (24.6 vs 32.5; P < 0.001), better IPSS QoL scores (3.5 vs 4.4, P = 0.018), and lower VAS pain scores (2.0 vs 3.2; P < 0.001). They also had lower total body pain subscores (16.7 vs 22.0; P = 0.01) and lower additional pain subscores due to urinary tract infections (2.1 vs. 3.2; P = 0.01) in the USSQ. CONCLUSIONS: Highly concentrated HA/CS effectively improved urinary symptoms and pain, and reduced the need for additional medication or procedures after ureteric stent placement.

Quality of randomized controlled trials published in the International Urogynecology Journal 2007-2016.

INTRODUCTION AND HYPOTHESIS: Randomized controlled trials (RCTs) provide the best quality clinical evidence. The aim of this study was to assess the quality of RCTs published by the International Urogynecology Journal (IUJ) in 2007-2016. METHODS: RCTs in original articles were extracted from PubMed and IUJ homepage. Change in RCT quality over time was assessed with Jadad and van Tulder scales and Cochrane Collaboration's risk of bias tool (CCRBT). Jadad scores of 3-5 or van Tulder scores of >5 indicated high-quality RCTs. The effect on RCT quality of including funding source and institutional review board (IRB) approval statements and describing the intervention was assessed. In addition, changes in RCT topics over time were assessed. RESULTS: Annual RCT frequencies did not change significantly (6.7-15.7%): 36.1% and 25.7% described blinding and allocation concealment, respectively. Both tended to increase between 2013 and 2016, particularly 2013 and 2014. Funding statement inclusion (39.1% overall) and intervention description (78.2% overall) tended to increase steadily. IRB statement inclusion (60.4% overall) increased significantly (p < 0.01). Jadad scores and van Tulder rose significantly until 2014 (p < 0.01). Frequencies of high-quality RCTs tended to rise. CCRBT indicated that RCTs with a low risk of bias tended to increase until 2014. However, from 2015, Jadad scores, van Tulder, and CCRBT the low risk tended to decreased. RCTs with funding and IRB approval statements had higher Jadad and van Tulder scores than unfunded RCTs (p < 0.01 and p < 0.01, respectively). Intervention description did not associate with better quality. CONCLUSIONS: RCT quality improved over time, but a dip in quality was observed in 2015-2016 because of decreased blinding and allocation concealment.

The application rate for urology specialty compared with other specialties from 2007 to 2014 in Korea: is it influenced by social interest manifested by internet trends?

BACKGROUND: Reduced clinical exposure to urology at the undergraduate or internship level is the main explanation for the marked decrease in applicants to urology residencies. This manuscript was to access the application rate for urology specialty compared with that of other specialties and to investigate the relationship between the decreasing trend in urology applications and social interest using internet trend tests. METHODS: We reviewed data collected by the Korean Hospital Association from 2007 to 2014. We assessed internet trends using Naver Trend for domestic social interest and Google Trends for international social interest (2007 to 2014). Trend tests and Spearman correlations were used for statistical analyses. RESULTS: Among the all specialties, the application rates to obstetrics and gynecology, emergency medicine, and occupational medicine are significantly increasing (p = 0.015, 0.012, and 0.048, respectively). Application to other specialties is mostly decreasing. The decreasing trend is highest for urology (beta = - 12.21 and p < 0.001). The application rate and domestic social interest revealed by Naver trends were significantly correlated (r = 0.786 and p = 0.021). No correlation was found between Naver trends and Google trends (r = - 0.19 and p = 0.651). CONCLUSIONS: The rate of application to urology specialty is decreasing the fastest, and this trend is related to domestic social interest. An attempt should be made to increase the number of urologic applicants.

Effects of climate change-related heat stress on labor productivity in South Korea.

This study assessed the potential impact of heat stress on labor productivity in South Korea; as such, stress is expected to increase due to climate change. To quantify the future loss of labor productivity, we used the relationship between the wet-bulb globe temperature and work-rest cycles with representative concentration pathways (RCPs) 4.5 and 8.5 as the climate change scenarios. If only climate factors are considered, then future labor productivity is expected to decline in most regions from the middle of the twenty-first century onwards (2041-2070). From the late twenty-first century onwards, the productivity of heavy outdoor work could decline by 26.1% from current levels under the RCP 8.5 climate scenario. Further analysis showed that regional differences in labor characteristics and the working population had noteworthy impacts on future labor productivity losses. The heat stress caused by climate change thus has a potentially substantial negative impact on outdoor labor productivity in South Korea.

Engineering the Charge Transport of Ag Nanocrystals for Highly Accurate, Wearable Temperature Sensors through All-Solution Processes.

All-nanocrystal (NC)-based and all-solution-processed wearable resistance temperature detectors (RTDs) are introduced. The charge transport mechanisms of Ag NC thin films are engineered through various ligand treatments to design high performance RTDs. Highly conductive Ag NC thin films exhibiting metallic transport behavior with high positive temperature coefficients of resistance (TCRs) are achieved through tetrabutylammonium bromide treatment. Ag NC thin films showing hopping transport with high negative TCRs are created through organic ligand treatment. All-solution-based, one-step photolithography techniques that integrate two distinct opposite-sign TCR Ag NC thin films into an ultrathin single device are developed to decouple the mechanical effects such as human motion. The unconventional materials design and strategy enables highly accurate, sensitive, wearable and motion-free RTDs, demonstrated by experiments on moving or curved objects such as human skin, and simulation results based on charge transport analysis. This strategy provides a low cost and simple method to design wearable multifunctional sensors with high sensitivity which could be utilized in various fields such as biointegrated sensors or electronic skin.

Designing Metallic and Insulating Nanocrystal Heterostructures to Fabricate Highly Sensitive and Solution Processed Strain Gauges for Wearable Sensors.

All-solution processed, high-performance wearable strain sensors are demonstrated using heterostructure nanocrystal (NC) solids. By incorporating insulating artificial atoms of CdSe quantum dot NCs into metallic artificial atoms of Au NC thin film matrix, metal-insulator heterostructures are designed. This hybrid structure results in a shift close to the percolation threshold, modifying the charge transport mechanism and enhancing sensitivity in accordance with the site percolation theory. The number of electrical pathways is also manipulated by creating nanocracks to further increase its sensitivity, inspired from the bond percolation theory. The combination of the two strategies achieves gauge factor up to 5045, the highest sensitivity recorded among NC-based strain gauges. These strain sensors show high reliability, durability, frequency stability, and negligible hysteresis. The fundamental charge transport behavior of these NC solids is investigated and the combined site and bond percolation theory is developed to illuminate the origin of their enhanced sensitivity. Finally, all NC-based and solution-processed strain gauge sensor arrays are fabricated, which effectively measure the motion of each finger joint, the pulse of heart rate, and the movement of vocal cords of human. This work provides a pathway for designing low-cost and high-performance electronic skin or wearable devices.

Efficacy and Safety of a Fixed-Dose Combination Therapy of Tamsulosin and Tadalafil for Patients With Lower Urinary Tract Symptoms and Erectile Dysfunction: Results of a Randomized, Double-Blinded, Active-Controlled Trial.

BACKGROUND: Phosphodiesterase type 5 inhibitors and α-adrenergic blocking agents (α-blockers) are widely used for the treatment of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). AIMS: To assess the efficacy and safety of fixed-dose combinations (FDCs) of tamsulosin and tadalafil compared with tadalafil monotherapy in patients with comorbid BPH-associated LUTS and ED. METHODS: A randomized, double-blinded, active-controlled trial was conducted of 510 men with BPH-associated LUTS and ED. Patients were treated with FDCs of tamsulosin 0.4 mg plus tadalafil 5 mg (FDC 0.4/5 mg), tamsulosin 0.2 mg plus tadalafil 5 mg (FDC 0.2/5 mg), or tadalafil 5 mg for a 12-week treatment period. For a subsequent 12-week extension period, the patients were administered FDC 0.4/5 mg. OUTCOMES: The primary outcomes were changes from baseline in total International Prostate Symptom Score (IPSS) and International Index of Erectile Function erectile function domain (IIEF-EF) score at week 12 to prove superiority and non-inferiority of FDCs compared with tadalafil 5 mg. The safety assessments were adverse reactions, laboratory test results, and vital signs at week 24. RESULTS: The mean changes in total IPSS and IIEF-EF scores were -9.46 and 9.17 for FDC 0.4/5 mg and -8.14 and 9.49 for tadalafil 5 mg, respectively, which indicated superiority in LUTS improvement (P = .0320) and non-inferiority in ED treatment with FDC 0.4/5 mg compared with tadalafil 5 mg. However, the results from FDC 0.2/5 mg failed to demonstrate superiority in LUTS improvement. No clinically significant adverse events regarding the investigational products were observed during the 24-week period. CLINICAL IMPLICATIONS: The FDC 0.4/5 mg is the first combined formulation of an α-blocker and a phosphodiesterase type 5 inhibitor that offers benefits in patient compliance and as add-on therapy in patients with comorbid BPH-associated LUTS and ED. STRENGTHS AND LIMITATIONS: The study clearly demonstrated the advantage of FDC 0.4/5 mg. The main advantage of FDC 0.4/5 mg was the enhanced efficacy on BPH-associated LUTS comorbidity with ED, the lower incidence of side effects, and the simplification and convenience of therapy, which led to better overall patient compliance. However, the lack of a tamsulosin monotherapy control group was a limitation of this study. CONCLUSION: The FDC 0.4/5 mg therapy was safe, well tolerated, and efficacious, indicating that combination therapy could provide clinical benefits for patients with BPH-associated LUTS complaints and ameliorate the comorbidity of ED. Kim SW, Park NC, Lee SW, et al. Efficacy and Safety of a Fixed-Dose Combination Therapy of Tamsulosin and Tadalafil for Patients With Lower Urinary Tract Symptoms and Erectile Dysfunction: Results of a Randomized, Double-Blinded, Active-Controlled Trial. J Sex Med 2017;14:1018-1027.

Reporting of randomized controlled trials in andrology journals: a quality assessment.

INTRODUCTION: Quality assessment of randomized controlled trials (RCTs) is important to prevent the adoption of findings of low-quality trials into clinical practice. AIM: The aim of this study was to analyze the quality of studies reporting RCTs in andrology journals (The Journal of Sexual Medicine [JSM], the Asian Journal of Andrology [AJA], the Journal of Andrology [JOA], the International Journal of Andrology [IJA]). METHODS: A quality assessment was conducted on all studies identified as RCTs published in andrology journals (JSM, AJA, JOA, IJA) until 2011. The review period was divided into three terms: early, mid, and late each journal. MAIN OUTCOME MEASURES: The Jadad scale, van Tulder scale, and the Cochrane Collaboration Risk of Bias Tool (CCRBT) were employed. The RCTs were also categorized by country of origin, the inclusion of institutional review board (IRB) approval, funding, and blindness. RESULTS: There were1,954 original articles published in the JSM, 893 articles in the AJA, 2,527 articles in the JOA, and 2,086 articles in the IJA for the review period. There were 172 studies reporting on RCTs in the JSM, 33 RCTs in the AJA, 63 RCTs in the JOA, and 29 RCTs in the IJA. No significant increase in Jadad or van Tulder scale scores were found over time, nor were there any significant changes in the number of high-quality articles as assessed by CCRBT. However, significant differences in quality analysis were found according to blinding, funding, and IRB approval. CONCLUSION: The number of original articles and RCTs in andrology increased over time. However, the ratio of RCTs to original articles as well as RCT quality was statistically insignificant. It would be required for the researchers to focus efforts in performing high-quality studies to ensure appropriate randomization, reviews by IRB, financial support, and inclusion of allocation concealment during study performance.

Randomized controlled trials in the journal of sexual medicine: a quality assessment and relevant clinical impact.

INTRODUCTION: Quality assessment of randomized clinical trials (RCTs) is important to prevent the adoption of findings of low-quality trials into clinical practice. AIM: The aim if this study was to analyze the quality of studies reporting RCTs in the Journal of Sexual Medicine (JSM) and to find relevant clinical impact. METHODS: A quality assessment was conducted in all studies identified as RCTs published in the JSM from 2004 to 2012. The review period was divided into three periods: early (2004-2006), mid (2007-2009), and late (2010-2012). MAIN OUTCOME MEASURES: The Jadad scale, van Tulder scale, and the Cochrane Collaboration Risk of Bias Tool (CCRBT) quality scoring instruments were used. The RCTs were also categorized by country of origin, topic, the inclusion of institutional review board (IRB) approval, funding, citation rate, and impact factor. RESULTS: A total of 2,418 original articles were published in the JSM during the review period, and 188 were reports of RCTs. There were 39 (14.89%), 70 (7.77%), and 76 (6.29%) RCTs published during the early, mid, and late terms, respectively (P < 0.001). No significant increases in Jadad or van Tulder scale scores were found over time nor were there any significant changes in the number of low-risk articles as assessed by the CCRBT. However, significant differences in quality analysis were found in funding and IRB approval. Citation rates and impact factor were not correlated with RCT quality using any of the tools. CONCLUSIONS: The number of original articles and RCTs published in the JSM increased over time. However, the ratio of RCTs to original articles did not increase significantly. Adequate randomization and blinding methods, IRB review, and financial support are required for the conduct of high-quality RCTs.

Large-scale solvothermal synthesis of fluorescent carbon nanoparticles.

The large-scale production of high-quality carbon nanomaterials is highly desirable for a variety of applications. We demonstrate a novel synthetic route to the production of fluorescent carbon nanoparticles (CNPs) in large quantities via a single-step reaction. The simple heating of a mixture of benzaldehyde, ethanol and graphite oxide (GO) with residual sulfuric acid in an autoclave produced 7 g of CNPs with a quantum yield of 20%. The CNPs can be dispersed in various organic solvents; hence, they are easily incorporated into polymer composites in forms such as nanofibers and thin films. Additionally, we observed that the GO present during the CNP synthesis was reduced. The reduced GO (RGO) was sufficiently conductive (σ ≈ 282 S m(-1)) such that it could be used as an electrode material in a supercapacitor; in addition, it can provide excellent capacitive behavior and high-rate capability. This work will contribute greatly to the development of efficient synthetic routes to diverse carbon nanomaterials, including CNPs and RGO, that are suitable for a wide range of applications.

Assessing the quality of randomized controlled trials published in neurourology and urodynamics from 1993 to 2012.

AIMS: To assess the quality of randomized controlled trials (RCTs) published in Neurourology and Urodynamics (NAU) by using three types of analytical tools. METHODS: MEDLINE was used to extract RCTs from original articles published in the NAU from 1993 to 2012. The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed. To analyze the quality of the RCTs, the time period was divided into four sections and three tools were applied (e.g., the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool [CCRBT]). RESULTS: Among the 1,957 original articles, 93 (4.75%) were RCTs. The ratio between the number of NAU and RCTs over time increased. The Jadad score for years 1993-1997 was 3.25 ± 1.71, 1998-2002 was 2.10 ± 0.74, 2003-2007 was 2.09 ± 1.12, and 2008-2012 was 2.80 ± 1.09 (P = 0.014). The van Tulder scales were 6.25 ± 3.10, 4.40 ± 1.65, 4.97 ± 1.99, and 5.93 ± 1.98, respectively (P = 0.055). The CCRBT identified a low risk of bias in 1 (25%), 0 (0%), 1 (2.86%), and 5 (11.36%) articles, respectively. Trials with allocation concealment, Institutional review board (IRB) approval, and blinded studies had significantly higher quality than others. CONCLUSIONS: The quantitative increase of RCT presented in NAU over time was observed but there was no definite qualitative improvement. Effort is required to improve the quality of RCTs published in NAU from the design step.

Analysis of randomized controlled trials in Rheumatology International from 1981 to 2012: methodological assessment.

The aim of the study is to assess the methodological quality of randomized controlled trials (RCTs) published in Rheumatology International (RI) by using three types of analytical tools. MEDLINE was used to extract RCTs from original articles published in the RI from 1981 (vol. 1) to 2012 (vol. 32). The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed. To analyze the methodological quality of the RCTs, the time period was divided into several sections and three tools were applied (e.g., the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool). The number of RCTs published gradually increased with time significantly (p < 0.001). The differences in RCT quality scores by each method in the publication years evaluated were not statistically significant, but RCTs that included descriptions of allocation concealment methods had received institutional review board (IRB) approval, and that conducted in the multicenter had significantly higher-quality scores than other studies. In conclusion, although the number of RCTs published in RI since its publishing in 1981 has increased with time, but no qualitative improvement of RCT was observed over time. It is necessary to improve the reporting of concealment of allocation, generation of randomization sequences, design of blinded studies, and obtaining IRB approval, all of which are criteria of high-quality RCTs.

Cardiorespiratory Dynamics During Prone Positioning for Severe Ards: A Retrospective Cohort Study.

Objectives: To elucidate the changes in cardiorespiratory dynamics during neuromuscular blockade and prone positioning and determine the associations between changes in cardiorespiratory dynamics following prone positioning and mortality. Design: Single center retrospective cohort study of patients admitted to the medical ICU between June 1, 2020 and September 1, 2022 who received prone positioning while mechanically ventilated. Results: Our final cohort consisted of 136 patients. Prone position was associated with an improvement in A-a gradient of 113 mmHg (95% CrI 78 - 149) between the pre-proning values and 10 hours post proning. Norepinephrine dose did not significantly change before and after prone positioning (Estimated difference: 0.04 mcg/min 95% CrI -1.00 - 1.07). For the outcome of 7-d mortality, there was a high probability that the baseline factors of increasing age, male sex, and higher baseline A-a gradient were associated with increased risk of death. Increased total vasopressor requirement and increased in PCO2 were associated with worse prognosis while a decrease in instantaneous heart rate and a decrease in heart rate variability were associated with improved prognosis. Conclusion: The immediate changes in prone positioning primarily impact respiratory physiology, with limited influence on circulatory parameters. Predictors of short-term mortality after prone positioning include both respiratory and cardiovascular parameters suggesting that extrapulmonary effects, such as improvement in right ventricular heart function, might also contribute to the benefit of prone positioning.