Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis.

BACKGROUND: Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. METHODS: We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. RESULTS: We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14-1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15-1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07-1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08-1.69, P=0.008). CONCLUSIONS: Blood transfusions were associated with decreased survival of patients with lung cancer.

Evaluation of Gastric Emptying Time of a Rice-Based Meal Using Serial Sonography.

The aim of this prospective study was to evaluate the gastric emptying time of a rice-based meal by serial ultrasonography of the stomach. After baseline ultrasonographic assessment of ten fasted healthy volunteers, volunteers ingested standardized 420 g, 536 kcal rice-based meal (bibimbap), and serial evaluations were performed every hour until the stomach became empty. At baseline, all the participants had an empty stomach. The average time of complete gastric emptying of the rice-based meal was 5.8 ± 0.8 h (95% confidence interval (CI), 5.0 h to 6.5 h). Since the first postintake cross-sectional area (CSA) measurement, a decrease was observed, and CSA was maintained until postprandial 3-4 h (P > 0.05). It declined rapidly 4 h after meal intake (P=0.031), reaching the nadir at approximately 6 h after meal intake. The gastric CSA and hunger score showed a positive correlation (correlation r = 0.616, P < 0). The rice-based meal is emptied after 5.8 ± 0.8 h on average in healthy volunteers. Based on our results, 6.5 h (upper limit of CI) of fasting after the ingestion of a rice-based meal would be a safe preoperative fasting time, and this is in accordance with the current guidelines for preoperative fasting.

A Novel Method of Locating Foramen Ovale for Percutaneous Approaches to the Trigeminal Ganglion.

BACKGROUND: For patients with trigeminal neuralgia who do not respond to medication and for whom surgical approaches are too risky, percutaneous procedures targeting the trigeminal ganglion are the current standard treatment. Percutaneous procedures are performed via the transoval approach under radiologic guidance. Identification of the foramen ovale (FO) under fluoroscopic guidance is an important part of determining the success or failure of the procedures. OBJECTIVES: Previous studies have described how to visualize the FO under fluoroscopic guidance, but those methods are limited by poor reproducibility. In this study, we have investigated how to visualize the FO clearly and easily under fluoroscopic guidance. STUDY DESIGN: Retrospective analysis. SETTING: University hospital in Korea. METHODS: Seventy-two 3-dimensional facial computed tomography scans without anatomic abnormalities of the skull base were analyzed for verifying the novel method. First, the mandibular angle and the occipital cortical line were overlapped and then turned by 15° oblique rotation using the software package. After these manipulations, the visualization of the FO was graded according to a 4-point scale (0: poor; 1: fair; 2: good; 3: excellent), and the inferior transfacial and oblique angles were measured. RESULTS: This enabled clear visualization of the FO. The mean visual grade of 54 right and 46 left FO (total 100) was 2.74 (0: poor; 1: fair; 2: good; 3: excellent). All recorded FOs had at least grade 2 visibility. LIMITATIONS: This study is lacking application in clinical practice and comparative data to the submental view. CONCLUSIONS: The mandible angle and the occipital cortex line are obvious anatomic landmarks and are visible even to nonexperienced practitioners. Therefore, our method using these anatomic landmarks can improve the reproducibility and accuracy of FO visualization. KEY WORDS: Trigeminal neuralgia, foramen ovale, trigeminal ganglion, 3-dimensional (3D) facial computed tomography (CT) scans.

The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study.

BACKGROUND: For prevention of ventilator-associated pneumonia (VAP), a bundle approach was applied to patients receiving mechanical ventilation in intensive care units. The incidence of VAP and the preventive efficacy of the VAP bundle were investigated. METHODS: A quasi-experimental study was conducted in adult intensive care units of 6 university hospitals with similar VAP rates. We implemented the VAP bundle between March 2011 and June 2011, then compared the rate of VAP after implementation of the VAP bundle with the rate in the previous 8 months. Our ventilator bundle included head of bed elevation, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, and oral decontamination with chlorhexidine 0.12%. Continuous aspiration of subglottic secretions was an option. RESULTS: Implementation of the VAP bundle reduced the VAP rate from a mean of 4.08 cases per 1,000 ventilator-days to 1.16 cases per 1,000 ventilator-days. The incidence density ratio (rate) was 0.28 (95% confidence interval, 0.275-0.292). CONCLUSIONS: Implementing the appropriate VAP bundle significantly decreased the incidence of VAP in patients with mechanical ventilation.

Development and validation of the digestive function assessment instrument for traditional korean medicine: sasang digestive function inventory.

Objective. This study was conducted for development and validation of the Sasang Digestive Function Inventory (SDFI) with type-specific digestive function-related symptoms for identification of Sasang type and pathological pattern. Methods and Materials. We selected questionnaire items for pathophysiological symptoms using internal consistency analysis and examined construct validity using 193 healthy participants. Test-retest reliability with a four-week interval as well as convergent validity was examined using the Nepean Dyspepsia Index-Korean (NDIK), Functional Dyspepsia-Related Quality of Life (FDQOL), Dutch Eating Behavior Questionnaire (DEBQ), and Body Mass Index (BMI). Results. The 21-item SDFI showed satisfactory internal consistency (Cronbach's alpha = 0.743) and test-retest reliability (r = 0.886, P < 0.001). Three extracted subscales, SDFI-Digestion, SDFI-Appetite, and SDFI-Eating pattern, explained 56.02% of the total variance. The SDFI showed significant (P < 0.001) correlation with total symptom score of NDIK, FDRQOL-Eating status, DEBQ-External Eating scale, and BMI. The SDFI score of the Tae-Eum (50.62 ± 8.05) type was significantly (P < 0.001) larger than that of the So-Eum (43.11 ± 11.26) type. Conclusion. Current results demonstrated the reliability and validity of the SDFI and its subscales, which can be utilized as an objective instrument for diagnosis of Sasang types and assessment of the type-specific digestive function.