RESUMO
Food insecurity is an indicator of well-being in the United States. A high proportion of recipients of charitable food assistance (CFA) are women and are often in charge of specific household managerial responsibilities (e.g., childcare, transportation). Consequently, they frequently face choices between paying for food and paying for other basic need(s). This study aims to examine which hunger-coping economic tradeoffs place females with at least one dependent child in the house and females without a dependent child in the house at risk for experiencing food insecurity. Data was collected at 10 Houston-area and 10-Atlanta-area food pantries in 2022 (N = 883). Using USDA cutoff criteria, households were considered food insecure based on ≥3 affirmative responses to the 18-item Food Security Scale Module. Hunger-coping economic tradeoff experiences were based on affirmative responses to whether anyone in the household ever had to choose between food and six basic needs (i.e. childcare, medicine/medical care, utilities, rent/mortgage, transportation, education). Covariate-adjusted logistic regression models were conducted to understand the relationship between six hunger-coping economic tradeoffs and food insecurity for the entire analytic sample and stratified by whether the female participant had a child in house. Standard errors in all regression models were corrected to account for multiple observations within a pantry. Adults, on average, were 55 years old (58% food insecure; 47% Hispanic; 42% black). Four hunger-coping economic tradeoffs were related to experiencing food insecurity. Economic tradeoffs between food and a) medicine/medical care and b) transportation elevated the likelihood of food insecurity, regardless of child status. Tradeoffs between food and childcare increased the risk for experiencing food insecurity among females with a dependent child. Deciding to pay between food and utilities was related to food insecurity experiences among females without a dependent child. Increases in Supplemental Nutrition Assistance Program (SNAP) benefits and eligibility along with programs to enhance resources related to medical care, transportation, childcare and utilities could help reduce food insecurity, especially among CFA recipients.
RESUMO
BACKGROUND: The role of the cervix in female sexual functioning is controversial. The loop electrosurgical excision procedure (LEEP) induces structural changes in the cervix. This study aimed to investigate whether LEEP affected sexual dysfunction in Korean women. METHODS: A prospective cohort study enrolled 61 sexually active women with abnormal Papanicolaou smear or cervical punch biopsy results and required LEEP. The patients were assessed before and six to twelve months after LEEP using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS). RESULTS: The prevalence of female sexual dysfunction according to FSFI scores before and after LEEP was 62.5% and 66.7%, respectively. LEEP-related changes in total FSFI and FSDS scores were not significant (P = 0.399 and P = 0.670, respectively). The frequency of sexual dysfunction in the desire, arousal, lubrication, orgasm, satisfaction, and pain subdomains of the FSFI was not significantly altered by LEEP (P > 0.05). The proportion of women experiencing sexual distress according to FSDS scores did not significantly increase after LEEP (P = 0.687). CONCLUSION: A large proportion of women with cervical dysplasia experience sexual dysfunction and distress both before and after LEEP. LEEP itself may be not associated with negative effects on female sexual function.
Assuntos
Eletrocirurgia , Disfunções Sexuais Fisiológicas , Feminino , Humanos , Povo Asiático , Eletrocirurgia/efeitos adversos , Eletrocirurgia/métodos , Estudos Prospectivos , República da Coreia , Disfunções Sexuais Fisiológicas/etiologia , Colo do Útero/cirurgiaRESUMO
The plasma membrane, which is a phosphoglyceride bilayer at the outer edge of the cell, plays diverse and important roles in biological systems. Visualization of the plasma membrane in live samples is important for various applications in biological functions. We developed an amphiphilic two-photon (TP) fluorescent probe (THQ-Mem) to selectively monitor the plasma membrane in live samples. This probe exhibited red emission (620-700 nm), large TP absorption cross sections (δmax > 790 GM), and high selectivity to the plasma membrane. In cultured cells and in vivo hepatic tissue imaging, THQ-Mem showed bright TP-excited fluorescence (TPEF) and remarkable selectivity for the plasma membrane. Furthermore, simultaneous in vivo imaging with THQ-Mem and a TP lipid droplet probe could serve as an efficient tool to monitor morphological and physiological changes in the plasma membrane and lipid droplets.
Assuntos
Gotículas Lipídicas , Fótons , Corantes Fluorescentes , Membrana Celular , FluorescênciaRESUMO
BACKGROUND: This study aimed to investigate the effects of orthodontic treatment on cumulative out-of-pocket (OOP) expenditures for up to 8 years and the factors contributing to changes in individual OOP dental expenses. METHODS: The data of adults aged ≥19 years, 218 with experience of orthodontic treatment (OT group) and 654 without experience of orthodontic treatment (non-OT group) were extracted from the Korea Health Panel Survey between 2009 and 2017 using the propensity score matching method. The total personal OOP expenditure for dental care incurred after orthodontic treatment in the OT group and that incurred in the matched non-OT group were calculated. Since dependent variables, cumulative dental expenditures, were continuous with excess zeros, Tweedie compound Poisson linear models were used to explore the influence of orthodontic treatment experience and demographic and socioeconomic factors, including private insurance, on per capita OOP dental expenditures. RESULTS: The OT group had socioeconomic characteristics distinct from those of general dental patients. The Box-Cox transformed per capita OOP expenditures for dental care in the OT group were lower than those in the non-OT group (P < 0.05). When all covariates were held constant, the non-OT group spent 1.4-times more on OOP dental expenditures, but this was not statistically significant (P > 0.1). The data from those with higher incomes revealed the opposite trend (P < 0.05), while the other covariates were not statistically significant. CONCLUSIONS: Orthodontic treatment had no positive or negative effect on future oral care use. This finding is similar to the inconsistent results of previous clinical studies on oral health and orthodontic treatment.
Assuntos
Gastos em Saúde , Renda , Adulto , Humanos , Seguimentos , Fatores Socioeconômicos , Assistência OdontológicaRESUMO
Despite binge eating being important to public health, no recent reviews have been conducted to produce a comprehensive synthesis of current literature on the relationship between social media use and binge eating. The aims of this review were: (1) to standardize the measurement of social media use in recent research, (2) to identify eating types that include binge-eating concepts, and (3) to identify the relationships between social media use and binge eating. This is an integrative review of studies conducted from 2016 to 2021 on binge eating and social media use. Searches were conducted in PubMed, PsycInfo, and Web of Science; eight studies were included in this integrative review. Included studies found direct or indirect effects of social media use on binge eating. The more participants use social media, the more likely they are to have increased appetite or intention to eat, which can lead to binge eating. The recent binge-eating studies indicated a significant relationship between social media use and binge eating. Interventions for binge eating should be developed with an understanding of individuals' social media use.
Assuntos
Transtorno da Compulsão Alimentar , Bulimia , Mídias Sociais , Humanos , IntençãoRESUMO
BACKGROUND: The diagnostic accuracy of magnetic resonance imaging (MRI) is low for detecting a subscapularis tendon tear. PURPOSE: To identify MRI findings that may predict the presence of a clinically significant subscapularis tendon tear requiring surgical repair. MATERIAL AND METHODS: We reviewed shoulder MR images of patients who had undergone arthroscopic rotator cuff repair at our institution between June 2018 and May 2019. Patients were divided into two groups: the study group (n = 51), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI and intermediate or higher grade of the tendon tear proven on arthroscopy; and the control group (n = 18), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI but no tear or low-grade partial thickness tear of the tendon shown on arthroscopy. Preoperative MR images were retrospectively evaluated by two readers for the size of the subscapularis tendon tear, bone reactions at the lesser tuberosity, and long head of the biceps tendon (LHBT) pathology. RESULTS: The subscapularis tendon tear measured by reader 2 was larger in the study group than in the control group. The prevalence of a tear (P = 0.006 for reader 1; P = 0.011 for reader 2) and malposition (P < 0.001 for both readers) of the LHBT were significantly greater in the study group. CONCLUSION: A tear and malposition of the LHBT on MR images may predict the presence of a clinically significant subscapularis tendon tear.
Assuntos
Imageamento por Ressonância Magnética , Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia , Ruptura/cirurgia , Tendões/diagnóstico por imagemRESUMO
Although hepatitis C virus (HCV) genotype 3 infection is thought to be an important risk factor for hepatocellular carcinoma (HCC), current evidence is limited because only a few Western studies have evaluated the occurrence of HCC in patients with HCV genotype 3 infection. We evaluated the impact of genotype 3 and non-3 on HCC incidence and on disease progression in chronic HCV patients; this is the first study reporting such findings in an Asian population. We performed a retrospective cohort study using the data of 1448 consecutive chronic HCV patients evaluated at three centres in Korea between January 2005 and December 2016. Of these, 604, 675 and 169 had genotype 1, genotype 2 and genotype 3 HCV infections, respectively. Over a mean follow-up period of 53.2 months, 75 and 143 patients of all the patients developed HCC and experienced disease progression, respectively. The incidences of HCC were 1.10, 0.92 and 2.50 per 100 person-years, and those of disease progression were 1.95, 1.62 and 6.72 per 100 person-years for HCV genotypes 1, 2 and 3, respectively. In multivariate Cox regression analysis, genotype 3 was associated with an increased risk of HCC (hazard ratio [HR] = 4.26, 95% confidence interval [CI] = 2.02-8.97) and an increased risk of disease progression (HR = 4.88, 95%; CI = 2.94-8.08). Our study proposes that HCV genotype 3 is an independent risk factor for HCC and disease progression in chronic HCV patients.
Assuntos
Carcinoma Hepatocelular/virologia , Hepacivirus/genética , Hepatite C Crônica/virologia , Neoplasias Hepáticas/virologia , Adulto , Idoso , Carcinoma Hepatocelular/epidemiologia , Progressão da Doença , Feminino , Genótipo , Hepatite C Crônica/epidemiologia , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Approximately 20% to 25% of patients with colorectal cancer (CRC) have distant organ metastasis at the time of initial diagnosis. The primary tumor location has been suggested as a prognostic factor for patients with metastatic CRC. In recent years, the distinction between right colon cancer (RCC) and left colon cancer (LCC) has been brought into focus due to their different outcomes, prognoses, and clinical responses to chemotherapy. In this article we aimed to review the underlying differences between metastatic RCC and LCC in terms of epidemiology, clinical features, and oncologic outcomes. The outcomes of patients with left-sided tumors were better than those of patients with right-sided tumors in terms of overall survival (OS) and objective response rate (ORR) after treatment with chemotherapy + panitumumab in the PRIME and 20050181 trials. The outcomes of patients with LCC were better than those of patients with RCC in terms of OS, progression-free survival (PFS) and ORR after treatment with FOLFIRI + cetuximab in the CRYSTAL and CALGB 80405 trials. In the FIRE-3 trial, the OS and PFS, but not the ORR, of patients with LCC were superior to those of patients with RCC. LCC and RCC exhibit distinctive clinical features and epidemiology. However, we must further investigate the impact of these distinctive features and how they influence the differential oncologic outcomes.
Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Adenocarcinoma/tratamento farmacológico , Neoplasias do Colo/tratamento farmacológico , Humanos , Prognóstico , Taxa de SobrevidaRESUMO
PURPOSE: We hypothesized that CIH may affect the upper airway immune system and aimed to verify whether CIH can induce airway inflammation in a murine obstructive sleep apnea (OSA) model. METHODS: C57BL6 male mice were exposed to intermittent hypoxia (CIH group; 5 ~ 21% FiO2, 120 sec cycles, 12 h/d, n = 6) or room air (Sham group, n = 6) for up to 4 weeks in identical chambers. Nasal and lung tissues and lavage fluid were collected and analyzed by multiplex assay. Lung lavage fluid was also utilized for FACS analysis to determine eosinophil count. RESULTS: We determined the protein level of 24 different cytokines, chemokines, and inflammatory mediators. Among various cytokines, levels of IL-1α, IL-1ß, IL-4, IL-6, and IL-13 were significantly elevated in nose or lung tissue from the CIH group. In addition, MCP-1 and periostin were elevated in nose and lung tissue and lavage fluid from the CIH group. CONCLUSIONS: CIH for 4 weeks altered the levels of inflammatory mediators in both the nose and lungs of mouse model. We suggest that the airway immune system may be deteriorated by CIH and allergic inflammation in the upper or lower airway could be worsened by sleep apnea.
Assuntos
Quimiocinas/metabolismo , Citocinas/metabolismo , Hipóxia/metabolismo , Animais , Interleucina-13/metabolismo , Interleucina-1alfa/metabolismo , Interleucina-1beta/metabolismo , Interleucina-4/metabolismo , Interleucina-6/metabolismo , Pulmão/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Boca/metabolismoRESUMO
PURPOSE: To compare R0 resection rates and short-term and oncologic outcomes between laparoscopy and open surgery for T4 colon cancer. METHODS: Patients with non-metastatic T4 colon cancer (n = 117) underwent treatment either through laparoscopy (n = 51) or open surgery (n = 66). Conversion to open surgery occurred in seven cases (13.7%). RESULTS: History of abdominal surgery (2.0 vs. 12.1%) and emergency operation (2.1 vs. 24.2%) were less frequent in the laparoscopy group. Conversion to open surgery occurred in seven cases (13.7%). Resection of adjacent organs was less frequently performed in the laparoscopy group (27.5 vs. 53.0%, p = .005). The mean operative time (189 vs. 210 min) and rate of 30-day postoperative complications (12 vs. 24%) were similar between the two groups. Shorter time to soft diet (7 vs. 9 days, p = .018) and hospital stay (14 vs. 18 days, p = .044) were observed in the laparoscopy group. T4b tumor was also less frequent in the laparoscopy group (3.9 vs. 18.2%, p = .018), while R0 resection rates were similar between the laparoscopy (96.1%) and open surgery group (95.5%). The mean number of lymph nodes was 22 in the laparoscopy group and 27 in the open surgery group (p = .021). No differences in 3-year overall survival rate (82.5 vs. 75.7%), recurrence-free survival rate (61.9 vs. 63.5%), and local recurrence-free survival rate (89.8 vs. 88.5%) were observed between the groups. Operation time, blood loss, 30-day complication rate, time to diet, duration of hospital stay, R0 resection rate, 3-year overall and local recurrence-free survival rates showed no difference between the converted and open surgery groups. CONCLUSIONS: Our results indicate that laparoscopy is a surgically safe and oncologically acceptable approach and thus could be considered for well-selected patients with T4 colon cancer in order to allow faster short-term recovery.
Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia , Idoso , Estudos de Coortes , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Masculino , Duração da Cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: In experimental models, bone marrow-derived mesenchymal stem cells (BM-MSCs) have the capacity to differentiate into hepatocytes and exhibit antifibrotic effects. However, there have been no studies in humans with alcoholic cirrhosis. AIM: The aim of this study was to elucidate the antifibrotic effect of BM-MSCs in patients with alcoholic cirrhosis, as a phase II clinical trial. METHODS: Twelve patients (11 males, 1 female) with baseline biopsy-proven alcoholic cirrhosis who had been alcohol free for at least 6 months were enrolled. BM-MSCs were isolated from each patient's BM and amplified for 1 month, and 5 × 10(7) cells were then injected twice, at weeks 4 and 8, through the hepatic artery. One patient was withdrawn because of ingestion of alcohol. Finally, 11 patients completed the follow-up biopsy and laboratory tests at 12 weeks after the second injection. The primary outcome was improvement in the patients' histological features. RESULTS: According to the Laennec fibrosis system, histological improvement was observed in 6 of 11 patients (54.5%). The Child-Pugh score improved in ten patients (90.9%) and the levels of transforming growth factor-ß1, type 1 collagen and α-smooth muscle actin significantly decreased (as assessed by real-time reverse transcriptase polymerase chain reaction) after BM-MSCs therapy (P < 0.05). No significant complications or side effects were observed during this study. CONCLUSIONS: Bone marrow-derived mesenchymal stem cells therapy in alcoholic cirrhosis induces a histological and quantitative improvement of hepatic fibrosis.
Assuntos
Cirrose Hepática Alcoólica/cirurgia , Fígado/patologia , Transplante de Células-Tronco Mesenquimais , Actinas/genética , Actinas/metabolismo , Adulto , Biópsia , Células Cultivadas , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Injeções Intra-Arteriais , Fígado/metabolismo , Cirrose Hepática Alcoólica/metabolismo , Cirrose Hepática Alcoólica/patologia , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , RNA Mensageiro/metabolismo , República da Coreia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo , Fator de Crescimento Transformador beta1/genética , Fator de Crescimento Transformador beta1/metabolismo , Transplante Autólogo , Resultado do TratamentoRESUMO
Methimazole (MMI)-induced acute pancreatitis is very rare but severe adverse reaction. A 51-yr-old male developed a high fever, chills, and abdominal pain, two weeks after commencement on MMI for the treatment of Graves' disease. There was no evidence of agranulocytosis, and fever subsided soon after stopping MMI treatment. However, 5 hr after taking an additional dose of MMI, abdominal pain and fever developed again. His symptoms, biochemical, and imaging studies were compatible with acute pancreatitis. After withdrawal of MMI, he showed clinical improvement. This is the first case of MMI-induced acute pancreatitis in Korea. Clinicians should be aware of the rare but possible MMI-induced pancreatitis in patients complaining of fever and abdominal pain.
Assuntos
Dor Abdominal/induzido quimicamente , Febre de Causa Desconhecida/induzido quimicamente , Doença de Graves/tratamento farmacológico , Metimazol/efeitos adversos , Metimazol/uso terapêutico , Pancreatite/induzido quimicamente , Dor Abdominal/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Febre de Causa Desconhecida/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Resultado do TratamentoRESUMO
Dementia is one of the leading causes of death worldwide. In this study, we analyzed the association of periodontal treatment with the risk of death in patients with dementia. The analyzed data were obtained by linking the National Health Insurance Corporation claims data between 2002 and 2018 to the Statistics Korea death registry. In total, 1,131,406 patients with dementia aged ≥ 65 years had undergone dental treatment during the study period. Time-dependent Cox proportional hazards model was performed. The mortality rate was approximately 10% among the patients with dementia. The 17-years cumulative survival rates for patients who received periodontal treatment and their untreated counterparts were 83.5% and 71.5%, respectively. The crude hazard ratio of the periodontal group was approximately twice as high as that of the non-periodontal group (1.99; P < 0.001). Furthermore, in the regression model that was adjusted for socio-demographic variables and systematic chronic diseases, the risk of death in the non-periodontal group was approximately 1.83 times higher than that of the periodontal group (P < 0.00). These findings suggest that preventive periodontal treatment may decrease mortality risk in older people with dementia.
Assuntos
Demência , Doenças Periodontais , Humanos , Idoso , Estudos Retrospectivos , Assistência Odontológica , Programas Nacionais de Saúde , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Doenças Periodontais/terapiaRESUMO
OBJECTIVE: We investigated the effect of our quality control (QC) program on the management strategy, completeness of the surgery, and clinical outcomes in advanced ovarian cancer. METHODS: A retrospective review of medical records from January 2005 to December 2019 identified 129 patients with advanced ovarian cancer. Cases were categorized into group 1 (2005-2013) and group 2 (2014-2019) before and after implementation of the QC program. Comparisons included clinicopathological variables, operative details, recurrence and survival outcomes. RESULTS: In Group 2 (n=44), after QC program implementation, primary debulking surgery (PDS) decreased (87.1% vs. 63.6%) and interval debulking surgery (IDS) increased (12.9% vs. 36.4%), indicating a shift in surgical strategy. Optimal resection rates improved significantly for PDS in group 2 (50.0% to 75.0%, p=0.007) and remained high for IDS in both groups (81.8% vs. 81.3%, p>0.999). Post-QC, advanced debulking procedures and co-operation with other departments increased in the IDS (p<0.05). Intra/post-operative complication rates were statistically comparable (p>0.05), whereas postoperative hospital stay was significantly shorter in group 2 (17 days vs. 22 days, p=0.001). Median recurrence-free survival increased after QC, although not statistically significant (19.18 months vs. 25.38 months, p=0.855). CONCLUSION: With QC program, treatment strategies and clinical outcomes were significantly improved in advanced ovarian cancer. Systematic QC monitoring program should be considered as routine surveillance for better surgical outcomes.
RESUMO
The measurement of the hepatic venous pressure gradient (HVPG) for the estimation of portal hypertension (PH) in cirrhosis has some limitations, including its invasiveness. Hepatic vein arrival time (HVAT), as assessed by microbubble contrast-enhanced ultrasonography (CEUS), is negatively correlated with the histological grade of liver fibrosis because of the associated hemodynamic abnormalities. Anatomical and pathophysiological changes in liver microcirculation are the initial events leading to PH. However, the direct relationship between HVAT and PH has not been evaluated. The present study measured both HVPG and HVAT in 71 consecutive patients with compensated cirrhosis and analyzed the relationship between the two parameters (i.e., the derivation set). Results were validated in 35 compensated patients with cirrhosis at another medical center (i.e., the validation set). The derivation set had HVPG and HVAT values of 11.4 ± 5.0 mmHg (mean ± standard deviation; range, 2-23) and 14.1 ± 3.4 seconds (range, 8.4-24.2), respectively; there was a statistically significant negative correlation between HVPG and HVAT (r(2) = 0.545; P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.973 for clinically significant PH (CSPH; HVPG, ≥ 10 mmHg), and the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios for CSPH for an HVAT cut-off value of 14 seconds were 92.7%, 86.7%, 90.5%, 89.7%, 6.95, and 0.08, respectively. In addition, a shorter HVAT was associated with worse Child-Pugh score (P < 0.001) and esophageal varices (P = 0.018). In the validation set, there was also a significant negative correlation between HVAT and HVPG (r(2) = 0.538; P < 0.001), and AUROC = 0.953 for CSPH. HVAT was significantly correlated with PH. These results indicate that measuring HVAT is useful for the noninvasive prediction of CSPH in patients with compensated cirrhosis.
Assuntos
Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/fisiopatologia , Hipertensão Portal/fisiopatologia , Cirrose Hepática/fisiopatologia , Fluxo Sanguíneo Regional , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Masculino , Microbolhas , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Ultrassonografia/métodosRESUMO
BACKGROUND: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated. OBJECTIVE: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD. DESIGN: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis. SETTING: A single, tertiary-care referral center. PATIENTS: A total of 182 patients. INTERVENTION: Gastric ESD and SLE. MAIN OUTCOME MEASUREMENTS: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis. RESULTS: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P = .66). There were no risk factors related to bleeding after ESD. LIMITATIONS: Single-center analysis. CONCLUSION: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. ( CLINICAL TRIAL REGISTRATION NUMBER: KCT0000146.).
Assuntos
Adenocarcinoma/cirurgia , Mucosa Gástrica/cirurgia , Gastroscopia/métodos , Hemorragia Pós-Operatória/diagnóstico , Cirurgia de Second-Look/métodos , Neoplasias Gástricas/cirurgia , Idoso , Dissecação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/prevenção & controle , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
BACKGROUND: Although endoscopic submucosal dissection (ESD)-induced ulcers heal faster and recur less often than non-iatrogenic gastric ulcers, the optimal dosage and duration of proton pump inhibitor treatment for ESD-induced ulcers remain unclear. AIMS: To evaluate the efficacy of half-dose rabeprazole on endoscopic submucosal dissection-induced ulcer compared with standard dose rabeprazole. METHODS: The study was a prospective randomized controlled double-blind trial at a single tertiary hospital. A total of 80 patients who underwent ESD for gastric neoplasia were enrolled. Of these patients, 10 were not followed to completion. Final analysis included the remaining 70 patients. Rabeprazole 20 or 10 mg, depending on randomization, was given orally for 4 weeks after ESD. RESULTS: Of the 70 patients, 45 (64 %) were men, and the median age was 65.2 ± 9.7 years. The mean ESD-induced ulcer area was 673 mm(2). No significant differences in ulcer area reduction ratio (p = 0.49) or ulcer-related symptoms (p = 0.91) were observed between the two groups at 4 weeks after ESD. CONCLUSION: For ESD-induced ulcers, treatment with 10 mg of rabeprazole daily produces a similar outcome as 20 mg of rabeprazole with regard to healing efficacy and symptom resolution.
Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/administração & dosagem , Gastroscopia/efeitos adversos , Inibidores da Bomba de Prótons/administração & dosagem , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/etiologia , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Rabeprazol , Estômago/patologia , Úlcera Gástrica/patologiaRESUMO
BACKGROUND AND AIM: The clinical impact and complications of hepatogenous diabetes (HD) on cirrhosis have not been elucidated. This study aimed to evaluate the relationship of HD with portal hypertension (PHT) and variceal hemorrhage and to assess the prevalence of HD. METHODS: From July 2007 to December 2009, 75-g oral glucose tolerance test and insulin resistance (IR) were evaluated for 195 consecutive cirrhotic liver patients (M:F = 164:1, 53.0 ± 10.2 years) who had no history of diabetes mellitus. IR was calculated using the homeostasis model of assessment-insulin resistance (HOMA-IR) formula. Endoscopy for varices, hepatic venous pressure gradient (HVPG), and serologic tests were also conducted. RESULTS: HD was observed in 55.4 % (108/194) of the patients. Among them, 62.0 % required OGTT for diagnosis because they did not show an abnormal fasting plasma glucose level. The presence of HD showed a significant correlation with high Child-Pugh's score, variceal hemorrhage, and HVPG (p = 0.004, 0.002, and 0.019, respectively). In multivariate analysis, Child-Pugh's score (OR 1.43, 95 % CI 1.005-2.038) and HVPG (OR 1.15, 95 % CI 1.003-2.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6 months) exhibited significantly higher glucose levels at 120 min in OGTT compared to patients without hemorrhages (p = 0.042). However, there was no difference in fasting glucose levels. The 120-min glucose level and HOMA-IR score were significantly and linearly correlated with HVPG (r (2) = 0.189, p < 0.001 and r (2) = 0.033, p = 0.011, respectively). CONCLUSION: HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significant relationship with variceal hemorrhage.
Assuntos
Diabetes Mellitus/etiologia , Varizes Esofágicas e Gástricas/patologia , Hemorragia Gastrointestinal/patologia , Cirrose Hepática/complicações , Pressão na Veia Porta , Adulto , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/complicações , Intolerância à Glucose , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
In this study, carbon black nanoparticles were synthesized by Liquid Phase Plasma (LPP) technique; plasma generated in the organic solvent of benzene at 4.9 kV with the pulse frequency of 15 kHz and width of 5 micros transformed the carbon atoms in the solvent into carbon blacks by oxidation and reduction reactions. Graphite phase was found to be introduced into the carbon blacks without any additional processes due to the characteristics of LPP process, resulting in a higher G/D ratio of 0.92, compared to 0.83 of commercial Ketjen carbon blacks. For the performance improvement, heat treatment was employed and its parameters such as temperature and duration time were optimized in relation to the crystallinity and specific surface area of the carbon blacks. Carbon blacks heat treated at 450 degrees C in the air for 20 min were measured to have the discharge capacity of 1750 mAh/g and irreversible charging and discharging capacity ratio of 52.6%.
Assuntos
Cristalização/métodos , Nanopartículas/química , Nanopartículas/ultraestrutura , Gases em Plasma/química , Fuligem/síntese química , Substâncias Macromoleculares/química , Teste de Materiais , Conformação Molecular , Tamanho da Partícula , Transição de Fase , Soluções , Propriedades de SuperfícieRESUMO
BACKGROUND: Successful cecal intubation (SCI) is not only a quality indicator but also an important marker in a colonoscopy trainee's progress. We conducted this study to determine factors predicting SCI in colonoscopy trainees, and to compare these factors before and after trainees achieve technical competence. METHODS: Design of this study was a cross-sectional studies of two time series design for one year at a single center. From March 2011 to February 2012, a total 2,050 subjects who underwent colonoscopy by four first-year gastrointestinal fellows were enrolled at Christian hospital, Wonju, Republic of Korea. Four gastrointestinal fellows have filled out the colonoscopic documentation. Main outcome measurement was predictive factors affecting cecal intubation failure and learning curves. RESULTS: Colonoscopy was successfully completed to the cecum in 1,720 patients (83.9%). Success rates gradually increased as trainees performed more colonoscopies: the rate of SCI was 62% in the first 50 cases, and grew to 93% by the 250th case. Logistic regression analysis of factors affecting cecal intubation failure showed that female gender, low BMI (BMI < 18.5 kg/m²), poor bowel preparation, and past history of stomach surgery were more often associated with cecal intubation failure, particularly before the trainees achieved technical competence. CONCLUSION: Several patient characteristics were identified that may predict difficulty of cecal intubation in colonoscopy trainees. Particularly, low BMI, inadequate bowel cleansing, and previous stomach operation were predictors of cecal intubation failure before the trainees have reached technical competency. The results could be informative so that trainees enhance the success rate regarding better colonoscopy training programs.