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Background and Objectives@#The global coronavirus disease 2019 (COVID-19) pandemic has had a major impact on healthcare, especially in the area of critical care due to the longer period of mechanical ventilation. Ultrasound-guided percutaneous tracheostomy (US-PDT) is considered a safe alternative method.Materials and Method Patients with severe COVID-19 hospitalized in the intensive care unit (ICU) who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. The procedure was performed with personal protective equipment with powered air purifying respirator (PAPR) in the ICU isolated by negative pressure. Parameters such as mortality, incidence of infection to medical staff, major and minor complications were observed. @*Results@#The average time taken for US-PDT was 6.4 minutes. Five patients (27.8%) showed oxygen saturation of less than 90% due to apnea during tracheotomy, but there was no case of severe hypoxemia that required discontinuation or re-intubation. There was no COVID-19 infection of medical staff related to the procedure. A total of 9 patients (50%) died from COVID-19 pneumonia, and 1 patient (5.6%) was decannulated. There was no death due to US-PDT and no serious complications such as pneumothorax or accidental decannulation were observed. @*Conclusion@#As patients eligible for tracheostomy increased significantly due to the COVID-19 epidemic, US-PDT can be considered to be a useful technique for COVID-19 patients who require long-term mechanical ventilation. This technique can lower the risk of transmission to medical staffs who are at the forefront of being exposed to the risk of infection when an epidemic breaks out.
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Background@#Many studies have evaluated the prevalence of different reasons for retraction in samples of retraction notices. We aimed to perform a systematic review of such empirical studies of retraction causes. @*Methods@#The PubMed/MEDLINE database and the Embase database were searched in June 2023. Eligible studies were those containing sufficient data on the reasons for retraction across samples of examined retracted notices. @*Results@#A 11,181 potentially eligible items were identified, and 43 studies of retractions were included in this systematic review. Studies limited to retraction notices of a specific subspecialty or country, journal/publication type are emerging since 2015. We noticed that the reasons for retraction are becoming more specific and more diverse. In a meta-analysis of 17 studies focused on different subspecialties, misconduct was responsible for 60% (95% confidence interval [CI], 53–67%) of all retractions while error and publication issues contributed to 17% (95% CI, 12–22%) and 9% (95% CI, 6–13%), respectively. The end year of the retraction period in all included studies and the proportion of misconduct presented a weak positive association (coefficient = 1.3% per year, P = 0.002). @*Conclusion@#Misconduct seems to be the most frequently recorded reason for retraction across empirical analyses of retraction notices, but other reasons are not negligible. Greater specificity of causes and standardization is needed in retraction notices.
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Background/Aims@#Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019. @*Methods@#The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions. @*Results@#The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitison-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY. @*Conclusions@#Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.
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Objectives@#Tracheostomy is an important procedure for critically ill patients in the intensive care unit (ICU), and percutaneous dilatational tracheostomy (PDT) has gained popularity due to its safety and effectiveness. However, there are limited data comparing ultrasound-guided PDT (US-PDT) with surgical tracheostomy (ST). In our previous study, we reported that US-PDT had similar safety and effectiveness to ST, with a shorter procedure time. However, the study design was retrospective, and the sample size was small. Therefore, we conducted a randomized controlled trial to demonstrate the safety and efficacy of US-PDT compared to ST. @*Methods@#A total of 70 patients who underwent either US-PDT (n=35) or ST (n=35) were enrolled in the study between October 20, 2020, and July 26, 2022. The patients were randomly assigned to their respective procedures. The data collected included patient clinical characteristics, procedure time and details, complications, duration of ICU stay, time taken for weaning from mechanical ventilation, and hospital mortality. @*Results@#The procedure time of US-PDT was shorter than that of ST (4.0±2.2 minutes vs. 10.1±4.6 minutes). The incision length of US-PDT was also shorter than that of ST (1.5±0.5 cm vs. 1.8±0.4 cm). There were no statistically significant differences in demographics, procedure details, complications, length of ICU stay, ventilator weaning time, and hospital mortality. @*Conclusion@#US-PDT has a similar complication rate and shorter procedure time compared with ST. It can be safely and effectively performed in critically ill patients and can serve as a potential alternative to ST.
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The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey’s syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.
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BACKGROUND@#Hospitalized patients recovering from coronavirus disease 2019 (COVID-19) may experience disability and suffer from significant physical and mental impairment requiring physical rehabilitation following their discharge. However, to date, no attempt has been made to collate and synthesize literature in this area.@*OBJECTIVE@#This systematic review examines the outcomes of different physical rehabilitation interventions tested in COVID-19 patients who were discharged from hospital.@*SEARCH STRATEGY@#A systematic search of MEDLINE/PubMed, CINAHL, Scopus and medRxiv was conducted to identify articles published up to March 2022.@*INCLUSION CRITERIA@#This systematic review included studies of outpatient rehabilitation programs for people recovering from COVID-19 who received physical activity, exercise, or breathing training to enhance or restore functional capacity, pulmonary function, quality of life, and mental health or function.@*DATA EXTRACTION AND ANALYSIS@#Selection of included articles, data extraction, and methodological quality assessments were conducted by two review authors respectively, and consensus was reached through discussion and consultation with a third reviewer. Finally, we review the outcomes of studies based on four categories including: (1) functional capacity, (2) pulmonary function, (3) quality of life, and (4) mental health status.@*RESULTS@#A total of 7534 titles and abstracts were screened; 10 cohort studies, 4 randomized controlled trials and 13 other prospective studies involving 1583 patients were included in our review. Early physical rehabilitation interventions applied in COVID-19 patients who were discharged from the hospital improved multiple parameters related to functional capacity, pulmonary function, quality of life and mental health status.@*CONCLUSION@#Physical rehabilitation interventions may be safe, feasible and effective in COVID-19 patients discharged from the hospital, and can improve a variety of clinically relevant outcomes. Further studies are warranted to determine the underlying mechanisms. Please cite this article as: Rahmati M, Molanouri Shamsi M, Woo W, Koyanagi A, Won Lee SW, Keon Yon DK, Shin JI, Smith L. Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review. J Integr Med. 2022; 21(2): 149-158.
Subject(s)
Humans , Patient Discharge , Quality of Life , COVID-19 , Prospective Studies , Hospitals , Randomized Controlled Trials as TopicABSTRACT
Background@#There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children. @*Methods@#This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months.Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date. @*Results@#The median age at the index date was 3.8 (95% confidence interval [CI], 1.7–5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5–17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30–1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ. @*Conclusion@#Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.
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Background and Objectives@#Spermatogonial stem cells (SSCs) are the most primitive cells in spermatogenesis and are the only adult stem cells capable of passing on the genome of a given species to the next generation. SSCs are the only adult stem cells known to exhibit high Oct4 expression and can be induced to self-reprogram into pluripotent cells depending on culture conditions. Epigenetic modulation is well known to be involved in the induction of pluripotency of somatic cells. However, epigenetic modulation in self-reprogramming of SSCs into pluripotent cells has not been studied. @*Methods@#and Results: In this study, we examined the involvement of epigenetic modulation by assessing whether selfreprogramming of SSCs is enhanced by treatment with epigenetic modulators. We found that second-generation selective class I HDAC inhibitors increased SSC reprogramming efficiency, whereas non-selective HDAC inhibitors had no effect. @*Conclusions@#We showed that pluripotent stem cells derived from adult SSCs by treatment with small molecules with epigenetic modulator functions exhibit pluripotency in vitro and in vivo. Our results suggest that the mechanism of SSC reprogramming by epigenetic modulator can be used for important applications in epigenetic reprogramming research.
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Background and Objectives@#Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI).Materials and Method We prospectively evaluated the efficacy of Mucomyst® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst® for 4 and 8 weeks. @*Results@#The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis. @*Conclusion@#Inhaled Mucomyst® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst® treatment as a standard treatment for globus.
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Background@#The urinary levels of volatile organic compound (VOC) metabolites provide individual exposure levels compared to data obtained by measuring these compounds in ambient air. We aimed to investigate the association between personal urinary concentrations of VOC metabolites and symptoms of atopic dermatitis in schoolchildren. @*Methods@#Nine urinary VOC metabolites were analyzed from urine samples of 149 children. Diagnosis of atopic dermatitis was determined using standardized questionnaires. Pediatricians visited the schools and rated the severity of symptoms using the SCORing Atopic Dermatitis (SCORAD) in all children. @*Results@#Forty-five children (30.2%) had atopic dermatitis based on the International Study of Asthma and Allergies in Childhood (ISAAC) results and 35 children (23.8%) had symptoms of atopic dermatitis with positive SCORAD index values (defined as SCORAD ≥ 5). Children with benzylmercapturic acid detected in personal urines were associated with presence of atopic dermatitis and positive SCORAD index values. Children in the highest quartile of mandelic acid concentration were associated with presence of atopic dermatitis and positive SCORAD results. @*Conclusion@#Personal exposure to VOCs, as indicated by urinary levels of VOC metabolites, was associated with presence of atopic dermatitis and the SCORAD index value.
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The purpose of this study was to compare physical and biodegradable properties of 3D printed resorbable membranes that are used for guided tissue regenerations in periodontal tissues. Three types of 3D printed membranes (two types of non β-TCP and one type of β-TCP) were considered. The form and element compositions of 3D printed membranes were analyzed by field-emission scanning electron microscopy (FE-SEM) with energy-dispersive X-ray spectroscopy (EDS). Porosity and pore size were measured using Micro-CT. Also, tensile strength, biodegradability tests were performed. Statistical analyses were carried in tensile strength and cell viability test (p<0.05). The result of SEM images with EDS analyses showed linear layers of lattice structure with presence of C and O in all groups. There was a slight difference in Ca and P among some groups. Tensile strength was significantly different among all groups (p<0.05), and biodegradability showed that the group containing β-TCP resulted in the fastest degradation rate. Therefore, the results of this study concluded that the 3D printed resorbable membrane has variable physical and biodegradable properties for clinical use, where such information would be useful to be considered for the future development of related products and clinical application of the products.
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Background and Objectives@#To evaluate the cost-effectiveness of routine hypertension (HTN) screening as a part of the national health-screening program. @*Methods@#Two aspects of cost-effectiveness were examined using the national general healthscreening program. First, the cost of case-finding was computed for 5-year interval age groups. Second, the cost per quality adjusted life years (QALYs) gained were estimated for 12 different scenarios varying examination starting age, pattern and interval compared with no screening. @*Results@#The cost of finding one new HTN case was low as 26,284 Korean won (KRW) (approximately [approx.] United States Dollar 21) for 70–79 years old to as high as 70,552 KRW for 40–44 years old. Compared with no screening, the costs per QALYs of the following screening strategies were below the incremental cost-effectiveness ratio threshold (approx.KRW 30.5 million): first screening examination with the second confirmatory examination in adults aged ≥40 years every 3 years (KRW 10.2 million), every 2 years (KRW 13.2 million), or annually (KRW 19.9 million). One-way sensitivity analyses suggest that the results were mostly influenced by the sensitivity of the first screening examination, followed by the examination rate of the second confirmatory examination. @*Conclusions@#HTN screening as a part of routine national health screening program was cost-effective for adults aged 40 years or older. The most cost-effective HTN screening strategy was the first screening examination with the second confirmatory examination in aged 40 years or older every 3 years.
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Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO2 laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.
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Background@#There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. @*Methods@#Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. @*Results@#Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities,including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. @*Conclusion@#These QIs can be used to assess and improve the quality of health care for patients with RA.
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The purpose of this study was to compare physical and biodegradable properties of 3D printed resorbable membranes that are used for guided tissue regenerations in periodontal tissues. Three types of 3D printed membranes (two types of non β-TCP and one type of β-TCP) were considered. The form and element compositions of 3D printed membranes were analyzed by field-emission scanning electron microscopy (FE-SEM) with energy-dispersive X-ray spectroscopy (EDS). Porosity and pore size were measured using Micro-CT. Also, tensile strength, biodegradability tests were performed. Statistical analyses were carried in tensile strength and cell viability test (p<0.05). The result of SEM images with EDS analyses showed linear layers of lattice structure with presence of C and O in all groups. There was a slight difference in Ca and P among some groups. Tensile strength was significantly different among all groups (p<0.05), and biodegradability showed that the group containing β-TCP resulted in the fastest degradation rate. Therefore, the results of this study concluded that the 3D printed resorbable membrane has variable physical and biodegradable properties for clinical use, where such information would be useful to be considered for the future development of related products and clinical application of the products.
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Background and Objectives@#To evaluate the cost-effectiveness of routine hypertension (HTN) screening as a part of the national health-screening program. @*Methods@#Two aspects of cost-effectiveness were examined using the national general healthscreening program. First, the cost of case-finding was computed for 5-year interval age groups. Second, the cost per quality adjusted life years (QALYs) gained were estimated for 12 different scenarios varying examination starting age, pattern and interval compared with no screening. @*Results@#The cost of finding one new HTN case was low as 26,284 Korean won (KRW) (approximately [approx.] United States Dollar 21) for 70–79 years old to as high as 70,552 KRW for 40–44 years old. Compared with no screening, the costs per QALYs of the following screening strategies were below the incremental cost-effectiveness ratio threshold (approx.KRW 30.5 million): first screening examination with the second confirmatory examination in adults aged ≥40 years every 3 years (KRW 10.2 million), every 2 years (KRW 13.2 million), or annually (KRW 19.9 million). One-way sensitivity analyses suggest that the results were mostly influenced by the sensitivity of the first screening examination, followed by the examination rate of the second confirmatory examination. @*Conclusions@#HTN screening as a part of routine national health screening program was cost-effective for adults aged 40 years or older. The most cost-effective HTN screening strategy was the first screening examination with the second confirmatory examination in aged 40 years or older every 3 years.
ABSTRACT
Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO2 laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.
ABSTRACT
Background@#There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. @*Methods@#Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. @*Results@#Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities,including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. @*Conclusion@#These QIs can be used to assess and improve the quality of health care for patients with RA.
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Background and Objectives@#Neck stab wounds should be managed properly as they can result in life-threatening complications and death. However, guns are prohibited in South Korea and many previous studies conducted in other countries are thus inapplicable. Also, most of the existing case reports deal mostly with profound neck injury and might lead to misunderstanding regarding the severity of injuries when considering neck stab wounds. This study analyzed the clinical characteristics of neck stab wounds according to the cause of trauma.Subjects and Method A total of 89 patients with neck stab wounds who visited the emergency room between January 2005 and June 2017 were enrolled. Medical records and radiological findings were reviewed retrospectively. The patients were divided into two groups according to the cause of trauma (suicide attempt or assault by another person). A comparative analysis of the two groups was conducted. @*Results@#The patients consisted of 41 cases of (46.1%) attempted suicides and 26 cases of (29.2%) psychiatric disorders. Of these, more than half had superficial wounds above the platysma, and multiple anatomical lacerations were found in 40 cases (45%). Psychiatric diagnoses were identified only in the attempted-suicide group (p<0.001), and injuries to the posterior neck triangle were observed only in the assault-by-another-person group (p=0.029). There were 11 cases (12.4%) of profound injury, but there was no significant difference between the two groups. One patient with injury by another person died due to the cutting of the common carotid artery. @*Conclusion@#Superficial injuries were more common while profound injuries were relatively uncommon in this study. However, physicians should pay attention to proper evaluation and management comprehensively in cases of neck stab wounds.
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Second primary malignancy (SPM) is a well-known cause of death in head and neck cancers. Recently, with reports of many incidences of human papilloma virus (HPV) associated SPM, the disease has been widely investigated. We report a HPV-positive tracheal cancer in a 49-yearold male who had been diagnosed with HPV-positive squamous cell carcinoma of the right tonsil within intervals of two years. In this case, the metachronous tracheal cancer lesion as well as the primary tonsillar cancer showed the same subtype HPV-16.