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Purpose@#The development of optics-based wearables for bladder volume monitoring has emerged as a significant topic in recent years. Given the innovative nature of this technology, there is currently no bladder phantom available to effectively validate these devices against more established gold standards, such as ultrasound. In this study, we showcase and demonstrate the performance of our hybrid bladder phantom by using an optical device and making comparisons with ultrasound. @*Methods@#A series of validation tests, including phantom repeatability, ultrasound scanning, and an optical test, were performed. A near-infrared optical device was utilized to conduct diffuse optical spectroscopy (DOS). Machine learning models were employed to construct predictive models of volume using optical signals. @*Results@#The size and position of an embedded balloon, serving as an analog for the bladder, were shown to be consistent when infused with 100 mL to 350 mL of water during repeatability testing. For DOS data, we present 7 types of machine learningbased models based on different optical signals. The 2 best-performing models demonstrated an average absolute volume error ranging from 12.7 mL to 19.0 mL. @*Conclusions@#In this study, we introduced a hybrid bladder phantom designed for the validation of near-infrared spectroscopy-based bladder monitoring devices in comparison with ultrasound techniques. By offering a reproducible and robust validation tool, we aim to support the advancement of next-generation optical wearables for bladder volume monitoring.
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Purpose@#Current guidelines recommend clean intermittent catheterization (CIC) at regular time intervals for patients with spinal cord injuries; however, many patients experience difficulties. Performing time-based CIC outside the home is a significant burden for patients. In this study, we aimed to overcome the limitations of the current guidelines by developing a digital device to monitor bladder urine volume in real-time. @*Methods@#The optode sensor is a near-infrared spectroscopy (NIRS)-based wearable device intended to be attached to the skin of the lower abdomen where the bladder is located. The sensor’s primary function is to detect changes in urine volume within the bladder. An in vitro study was conducted using a bladder phantom that mimicked the optical properties of the lower abdomen. To validate the data in the human body at the proof-of-concept level, one volunteer attached the device to the lower abdomen to measure the light intensity between the first voiding and immediately before the second voiding. @*Results@#The degree of attenuation at the maximum test volume was equivalent across experiments, and the optode sensor with multiplex measurements demonstrated robust performance for patient diversity. Moreover, the symmetric feature of the matrix was deemed a potential parameter for identifying the accuracy of sensor localization in a deep-learning model. The validated feasibility of the sensor showed almost the same results as an ultrasound scanner, which is routinely used in the clinical field. @*Conclusions@#The optode sensor of the NIRS-based wearable device can measure the urine volume in the bladder in real-time.
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Background and Objectives@#MYC, also known as an oncogenic reprogramming factor, is a multifunctional transcription factor that maintains induced pluripotent stem cells (iPSCs). Although MYC is frequently upregulated in various cancers and is correlated with a poor prognosis, MYC is downregulated and correlated with a good prognosis in lung adenocarcinoma. MYC and two other MYC family genes, MYCN and MYCL, have similar structures and could contribute to tumorigenic conversion both in vitro and in vivo. @*Methods@#and Results: We systematically investigated whether MYC family genes act as prognostic factors in various human cancers. We first evaluated alterations in the expression of MYC family genes in various cancers using the Oncomine and The Cancer Genome Atlas (TCGA) database and their mutation and copy number alterations using the TCGA database with cBioPortal. Then, we investigated the association between the expression of MYC family genes and the prognosis of cancer patients using various prognosis databases. Multivariate analysis also confirmed that co-expression of MYC/MYCL/MYCN was significantly associated with the prognosis of lung, gastric, liver, and breast cancers. @*Conclusions@#Taken together, our results demonstrate that the MYC family can function not only as an oncogene but also as a tumor suppressor gene in various cancers, which could be used to develop a novel approach to cancer treatment.
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Thyroid hormones play an important physiological role in maintaining adult bone structure and strength. Consequently, thyroid dysfunction is related to skeletal outcomes. Overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, leading to osteoporosis and increased fracture risk. Hyperthyroidism induced by thyroid-stimulating hormone-suppressive therapy in patients with differentiated thyroid cancer is a cause of secondary osteoporosis. In contrast, there is a lack of evidence on the negative impact of hypothyroidism on bone health. Considering the clinical updates on the importance of bone health in thyroid dysfunction, the Task Force from the Clinical Practice Guidelines Development Committee of the Korean Thyroid Association recently developed a position statement on the evaluation and management of bone health of patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid-stimulating hormone-suppressive therapy-associated hyperthyroidism in patients with differentiated thyroid cancer. Herein, we review the Korean Thyroid Association’s position statement on the evaluation and management of bone health associated with thyroid diseases.
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The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. These guidelines provide the grade of recommendations, which includes both the strength of recommendations and the level of evidence. In the absence of sufficient evidence, recommendations are based on expert opinion. These guidelines have been revised and supplement the previous guidelines "Clinical Guidelines for Precocious Puberty 2011," and are drawn from a comprehensive review of the latest domestic and international research and the grade of recommendation appropriate to the domestic situation. This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty.
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@#Introduction: Lean sustainability has gained prominence in the health sector for operational and business advantages. However, understanding the link between lean and healthcare sustainability, especially in social and environmental aspects, remains limited. This study introduces a preliminary framework for measuring lean healthcare sustainability in hospitals. The framework aligns Critical Success Factors (CSFs) with sustainability objectives and business strategies to ensure successful and enduring lean deployment. Methods: The study was conducted among 52 Lean Agile Hospitals in Malaysia using a cross-sectional approach. The validated questionnaire was employed for data collection. A reliability test and Exploratory Factor Analysis (EFA) were also performed to assess and validate the framework using Statistical Package for Social Sciences (SPSS) version 27. Results: The content validation was 0.9, which indicates that the instrument is sufficient to measure the research objective. The data screening test was performed to eliminate problem observation. The overall reliability value was over 0.830 which depicts data consistency and stability. The Kaiser-Meyer-Olkin exceeded 0.6, Bartlett’s test was under 0.001 and factor loading was between 0.507 to 0.948, thus indicating a significant correlation matrix among at least some of the variables. Therefore, the latent factors were significant to specific items of the research. Conclusion: It is concluded that important CSF is aligned with the strategic level influence of lean deployment in healthcare, which has a specific impact on certain sustainability performance. Thus, this paper proposed a generic preliminary framework to measure lean healthcare sustainability.
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Background@#Ultrasound-guided first sacral transforaminal epidural steroid injection (S1 TFESI) is a useful and easily applicable alternative to fluoroscopy or computed tomography (CT) in lumbosacral radiculopathy. When a needle approach is used, poor visualization of the needle tip reduces the accuracy of the procedure, increasing its difficulty. This study aimed to improve ultrasound-guided S1 TFESI by evaluating radiological S1 posterior foramen data obtained using three-dimensional CT (3D-CT). @*Methods@#Axial 3D-CT images of the pelvis were retrospectively analyzed. The radiological measurements obtained from the images included 1st posterior sacral foramen depth (S1D, mm), 1st posterior sacral foramen width (S1W, mm), the angle of the 1st posterior sacral foramen (S1A, °), and 1st posterior sacral foramen distance (S1ds, mm). The relationship between the demographic factors and measured values were then analyzed. @*Results@#A total of 632 patients (287 male and 345 female) were examined. The mean S1D values for males and females were 11.9 ± 1.9 mm and 10.6 ± 1.8 mm, respectively (P < 0.001); the mean S1A 28.2 ± 4.8° and 30.1 ± 4.9°, respectively (P < 0.001); and the mean S1ds, 24.1 ± 2.9 mm and 22.9 ± 2.6 mm, respectively (P < 0.001); however, the mean S1W values were not significantly different. Height was the only significant predictor of S1D (β =0.318, P = 0.004). @*Conclusions@#Ultrasound-guided S1 TFESI performance and safety may be improved with adjustment of needle insertion depth congruent with the patient’s height.
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Objective@#A growing body of evidence reports on the effect of different types of childhood abuse on the structural and functional architecture of the brain. In the present study, we aimed to investigate the differences in cortical thickness according to specific types of childhood abuse between patients with major depressive disorder (MDD) and healthy controls (HCs). @*Methods@#A total of 61 patients with MDD and 98 HCs were included in this study. All participants underwent T1-weighted magnetic resonance imaging, and the occurrence of childhood abuse was assessed using the Childhood Trauma Questionnaire. We investigated the association between whole-brain cortical thickness and exposure to any type of childhood abuse and specific type of childhood abuse in the total sample using the FreeSurfer software. @*Results@#No significant difference was reported in the cortical thickness between the MDD and HC groups nor between the “any abuse” and “no abuse” groups. Compared to no exposure to childhood sexual abuse (CSA), exposure to CSA was significantly associated with cortical thinning in the left rostral middle frontal gyrus (p=0.00020), left (p=0.00240), right fusiform gyri (p=0.00599), and right supramarginal gyrus (p=0.00679). @*Conclusion@#Exposure to CSA may lead to cortical thinning of the dorsolateral prefrontal cortex, which is deeply involved in emotion regulation, to a greater extent than other types of childhood abuse.
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Objective@#This study enrolls diverse hospitals and analyzes the differences in meal provision and nutrition management services for patients with dysphagia. @*Methods@#A nationwide survey was conducted by mail and mobile for 850 medical institutions, and data were collected from 217 hospitals. We analyzed the status of the dysphagia diet and nutrition management by considering the type of hospital. @*Results@#Among the hospitals surveyed, 167 (77%) provided texture-modified diets for dysphagia patients. The status of providing dysphagia diets and nutrition management for dysphagia differed depending on the institution. In particular, nutrition services for dysphagia patients in long-term care hospitals were poor. Difficulties in providing a dysphagia diet included the complexity of the cooking process, difficulty maintaining constant viscosity, difficulty in hygiene management, and low meal bills. Using commercial thickeners in cooking accounted for 72.5%, and only 41.9% of hospitals provided a commercial thickener with meals. Compared to the regular diet, the additional food cost to provide a single dysphagia diet meal was estimated to be 500-1,000 won. Based on a 5-point scale, we determined that the average scores for the importance and performance of nutrition management in patients with dysphagia were 4.29 and 3.19 points, respectively. Regardless of the type of hospital, performances of all the steps in the nutrition care process were significantly lower than their importance. @*Conclusion@#Several difficulties are encountered in meal provision and nutrition management for patients with dysphagia, including the burden of expenses and human resources. Thus, the medical fees for a dysphagia diet need to be reasonably increased. Moreover, national health insurance should additionally cover nutrition education for dysphagia patients.
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Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.
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Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.
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Background@#There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB. @*Methods@#Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers. @*Results@#Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate. @*Conclusion@#FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients’ medical condition when deciding to perform FNABs would be advisable to lower potential complications.
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ABSTRACT Introduction: This study evaluated myocardial protection and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia compared with histidine-tryptophan-ketoglutarate (HTK) solution in valvular surgery. Methods: From January 2017 to May 2018, 71 adult patients who underwent valvular surgery with del Nido cardioplegia (n=37) or HTK cardioplegia (n=34) were retrospectively analyzed. Results: Patients' characteristics were comparable between groups. Postoperative peak troponin T levels were similar. The del Nido group had a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (13.51 vs. 55.88%; P<0.001), lower total volume of cardioplegia administered (1,000 [1,000, 1,250] vs. 1,800 [1,500, 2,000] mL; P<0.001), shorter hospital stay (6 [5, 8] vs. 7 [6, 10] days; P=0.03), and less postoperative red cell transfusion (34.29 vs. 61.11%; P=0.024). There is no difference in aortic cross-clamping time, postoperative change in left ventricular ejection fraction, intensive care unit stay, duration of inotropic support, new onset of atrial fibrillation, in-hospital mortality, complications, and three-year overall survival rate. Conclusion: Lactated Ringer's-based del Nido cardioplegia can be safely used for valvular surgery with acceptable clinical outcomes compared to HTK cardioplegia.
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El uso de fuentes de información es importante en la formación del estudiante de medicina; sin embargo, en Latinoamérica se ha reportado una disminución en su empleo y se han identificado problemas en su conocimiento. El objetivo del estudio consistió en determinar los factores asociados al uso de las fuentes de información en estudiantes de Medicina de una universidad de Tacna, Perú. Se realizó un estudio observacional, analítico y transversal en estudiantes de una universidad privada, mediante un muestreo aleatorio estratificado. Se utilizó un instrumento autoaplicado de forma virtual, que indagó en las características socioeducativas, la frecuencia de uso/capacitación de las fuentes de información y las características de la investigación científica. El resultado del estudio indicó un mayor uso de las fuentes de información, asociado con las variables independientes, mediante los modelos de regresión múltiple. De 274 estudiantes, el 32,1 % utilizó frecuentemente las fuentes de información. Las de mayor uso fueron: Google Académico (36,5 %) y SciELO (25,2 %); en contraste, la mayoría de los estudiantes desconocen las fuentes: HINARI (56,2 %) y EMBASE (55,5 %). Desempeñarse en un año académico superior y tener más percepción de las habilidades en la búsqueda de información científica, constituyen los factores asociados a un mayor uso de las fuentes de información.
The use of information sources is important in the training of the medical student; however, in Latin America a decrease in its use has been reported and problems have been identified in its knowledge. The objective of the study was to determine the factors associated with the use of information sources in medical students at a university in Tacna, Peru. An observational, analytical and cross-sectional study was carried out in students of a private university, using a stratified random sampling. A virtual self-applied instrument was used, which inquired into the socio-educational characteristics, the frequency of use/training of the information sources and the characteristics of scientific research. The result of the study indicated greater use of information sources, associated with the independent variables, through multiple regression models. Out of 274 students, 32.1% frequently used information sources. The most used were: Google Scholar (36.5%) and SciELO (25.2%); in contrast, most students are unaware of the sources: HINARI (56.2%) and EMBASE (55.5%). In conclusion, performing in a higher academic year and having more perception of the skills in the search for scientific information are the factors associated with greater use of information sources.
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Objective@#: Craniopharyngiomas (CPs) are associated with hypothalamic damage that causes hypothalamic obesity, however, the mechanisms underlying CP-related postoperative weight gain remain debatable. This study aimed to elucidate whether the major determinant of postoperative weight gain in patients with CP is hypothalamic injury or steroid replacement therapy. @*Methods@#: We included 48 adult patients with CP (age ≥18 years) who underwent transsphenoidal surgery between 2010 and 2018 in a single tertiary center, and whose body weight was measured pre- and postoperatively (<120 days after the surgery). We recruited 144 age- and body mass index-matched patients with non-functioning pituitary adenoma (NFPA) as controls. @*Results@#: Patients with CP experienced greater postoperative weight gain than patients with NFPA (3.0±5.1 vs. 0.1±3.6 kg, p<0.001). The prevalence of postoperative steroid use was significantly higher in patients with CP than in those with NFPA (89.6% vs. 34.0%, p<0.001). Steroid replacement therapy and CP were associated with postoperative weight gain after adjusting for covariates in overall patients (p=0.032 and 0.007, respectively). In subgroup analysis with postoperative steroid users, weight gain was significantly greater in patients with CP (n=43, 0.96±0.25 kg/month) than in patients with NFPA (n=49, 0.26±0.23 kg/month) even after adjusting for the daily steroid dose (p=0.048). @*Conclusion@#: Patients with CP experience greater postoperative weight gain than those with NFPA. Hypothalamic damage itself as well as steroid replacement may contribute to the postoperative weight gain in patients with CP.
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Purpose@#This study was conducted to estimate the influence of knowledge of coronary artery disease (CAD) and self-efficacy on health behavior Compliance among patients with CAD. @*Methods@#Data were collected from August 11, 2020 to April 28, 2021. In total, 159 patients with CAD participated in this study. Data were analyzed using the independent t-test, analysis of variance, Pearson correlation analysis, and multiple regression analysis. @*Results@#Health behavior compliance was correlated with knowledge of CAD (r=.33, p<.001) and self-efficacy (r=.71, p<.001), Multiple regression analysis found self-efficacy (β=.67, p<.001) and knowledge of coronary artery disease (β=.16, p=.004), to be statistically significant influ encing factors, and the explanatory power of the model was approximately 52% (F=30.39, p<.001). @*Conclusion@#Interventions to enhance self-efficacy and education programs to improve disease-related knowledge are essential for patients with CAD to improve their self-care health behaviors compliance.
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Thyroid hormones have an important physiological role in maintaining adult bone structure and strength. Therefore, thyroid dysfunction is inevitably associated with various degrees of skeletal consequences. Endogenous overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, resulting in osteoporosis and an increased risk of fractures. Hyperthyroidism induced by thyroid stimulating hormone suppression therapy in patients with differentiated thyroid cancer also has emerged as a contributing factor to osteoporosis and fragility fractures. While, there is lack of evidence that hypothyroidism negatively affects bone health. Although there is growing clinical evidence of the importance of bone health in hyperthyroidism, clinical guidelines on how to evaluate and manage bone health in these diseases have not yet been published worldwide. The Task Force from the Korean Thyroid Association Committee of Clinical Practice Guideline has developed this position statement for the evaluation and management of bone health in patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid stimulating hormone suppression therapyassociated hyperthyroidism in patients with differentiated thyroid cancer.
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Lenvatinib prolongs the survival of patients with advanced thyroid cancer. At initiation of lenvatinib therapy, advanced thyroid cancer patients frequently have lung metastasis and are vulnerable to pulmonary complications due to concealed lung damage caused by previous therapies including radioactive iodine (RAI) therapy. Among 24 patients treated with lenvatinib, pulmonary events were observed in three patients with lung metastasis, including one with interstitial lung disease (ILD) and two with pneumothorax. One patient who was previously treated with 750 mCi RAI developed uncontrolled ILD after lenvatinib therapy and died of respiratory failure. Two pneumothorax cases had previous cavitation of metastatic lung nodules. Pneumothorax resolved spontaneously in both patients. Pulmonary events in patients with lung metastases treated with lenvatinib are uncommon and manageable in most cases, but may be fatal if detection and management are delayed. Special attention should be given to patients with lung metastasis treated with high cumulative dose of RAI therapy or cavitary changes that develop after lenvatinib therapy.
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Trait impulsivity is a known risk factor for suicidality, and the prefrontal cortex plays a key role in impulsivity and its regulation. However, the relationship between trait impulsivity, neural basis, and suicidality has been inconsistent. Therefore, this study aimed to explore the relationship between impulsivity and its structural correlates (prefrontal gray matter volume), suicidal ideation, and actual suicide attempts. A total of 87 individuals with major depressive disorder participated in study, and the gray matter volume of the prefrontal regions was extracted from T1 images based on region of interest masks. The variables for the mediation models were selected based on correlation analysis and tested for their ability to predict suicide attempts, with impulsivity and suicidal ideation as the mediation variables and gray matter volume as the independent variable. A significant correlation was observed between suicidal ideation and the left dorsolateral prefrontal cortex and right dorsomedial prefrontal cortex. The dual-mediation model revealed a significant indirect relationship between gray matter volume in both regions and suicide attempts mediated by motor impulsivity and suicidal ideation. The counterintuitive positive relationship between gray matter volume and suicidality was also discussed.
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El desarrollo del cáncer se determina por la capacidad proliferativa de las células tumorales y por presentar facultades invasoras y de metastatizar a tejidos distantes. La compleja relación de la patología con el sistema inmunitario facilita la evolución de la enfermedad, por lo que mediante esta bidireccionalidad, la célula cancerígena tiene la capacidad de escapar de la regulación del huésped, evadiendo la respuesta inmune antitumoral, mediante mecanismos intrínsecos y extrínsecos. El objetivo de este manuscrito es describir a cabalidad y de una forma actualizada dichos mecanismos, con la finalidad de generar un impacto tangible y mayor conocimiento en la comunidad médico-científica sobre la génesis de posibles nuevos diagnósticos y tratamientos específicos que busquen disminuir las estadísticas de tan letal enfermedad. Para la realización de este trabajo, se hizo uso de las plataformas y bases de datos de PubMed, Google Académico, Scielo y Elsevier, durante un período de dos meses, así como de libros especializados en inmunología e inmunopatología, y artículos publicados en los últimos cinco años. Esta revisión narrativa permite incentivar la investigación de rutas de comunicación intercelulares que puedan cumplir en un futuro, quizás no muy lejano, con este propósito
Cancer's development is determined by the proliferative capacity of tumor cells and by presenting invasive abilities and to metastasize to distant tissues. The complex relationship of this pathology with the immune system facilitates its natural evolution; thus, this bidirectionality allows cancer cells to escape from the host's regulation, evading antitumoral immune responses, through intrinsic and extrinsic mechanisms. The aim of this manuscript is to describe exhaustively, and in the most updated way possible, said mechanisms, with the objective of generating a tangible impact and more awareness the medical-scientific community, regarding the genesis of possible new and more specific diagnostic and treatment options that diminish this lethal disease's statistics. The information used to write this article was obtained from medical digital archives, including PubMed, Google Scholar, Scielo, and Elsevier, as well as specialized books in immunology and immunopathology, and articles published in the last five years. This narrative review encourages the investigation of intercellular communication routes that may be fulfilled, in the non-too distant future, for this purpose