Cardiovascular Comorbidity and its Impact on Patients with COVID-19 in a Tertiary Care Hospital, Bangladesh

Background: People with cardiovascular issues have been shown to be at an elevated risk of acquiring the 2019 new corona virus infection, according to studies (COVID-19). This study’s objective was to determine if cardiovascular disease has any effect on the severity of COVID-19.Material & Methods:Between January 2020 and December 2020, 210 comorbid patients aged over 40 years old diagnosed with COVID-19 admitted in BIRDEM hospital in Bangladesh were recruited purposively for a cross sectional study as per inclusion criteria. A baseline study was created for each patient based on their medical history, physical examination, biochemical tests, and the amount of care they needed (intensive care vs. ward-based care). SPSS 26 was used to analyze the data.Results:Among the 210 comorbid individuals, 74 had cardiovascular comorbidities and the remaining 136 had other comorbidities. Among the respondents, 48% were serious cases and required ICU support within 30 days. Cases with up to 2 comorbidities did not require ICU support. The severity of COVID-19 was predicted by factors such as age above 80 years (OR 35.5, 95 percent CIs 18.7,98.5), male gender (OR 3.14, CI 1.16, 3.50), and a high troponin level in the patient’s blood (OR 1.34, CI 0.84,3.54). It was shown that cardiovascular comorbidities (CI=1.8,3.0) were 2.9 times more likely to be linked to severity. The risk factors also included a history of diabetes, hypertension, and chronic obstructive pulmonary disease. Conclusions:Cardiovascular patients, who were previously grouped together as high risk due to the nature of their ailment, need more tailored counseling and treatment from public health authorities and clinicians.

DANTE prepulse SPACE MR sequence in quantitative evaluation of arachnoid granules / 中国医学影像技术

Objective To explore the value of delay alternating with nutation for tailored excitation (DANTE)- sampling perfection with application optimized contrast using different flip-angle evolution (SPACE) sequences in quantitative evaluation of arachnoid granules (AG). Methods Thirty patients with arachnoid granules confirmed by conventional imaging were enrolled. All patients underwent SPACE and DANTE-SPACE sequences scanning. Distribution characteristics of arachnoid particles in sinus cavities and cranial plate on SPACE and DANTE-SPACE sequence images were evaluated, and the measurements were performed and statistically analyzed, including maximum cross-sectional area, longest diameter, SNR and CNR. Results A total of 43 arachnoid particles were detected with SPACE sequence, 29 in the sinus cavities and 14 in the cranial plate, while 45 arachnoid particles were found with DANTE-SPACE, 31 in the sinus cavities and 14 in the cranial plate. SPACE and DANTE-SPACE sequences showed no statistically significant difference in distribution of arachnoid particles (χ2=0.155, P=0.997). In the sinus cavity, SPACE and DANTE-SPACE sequences showed significant differences of the maximum cross-sectional area ([32.55±17.08]mm2, [29.15±16.24]mm2), the longest diameter ([7.13±2.00]mm, [6.42±1.81]mm), SNR (88.82±29.57, 83.30±32.11) and CNR (45.99±28.57, 65.33±30.96) of arachnoid particles (all P0.05). Conclusion DANTE-SPACE can effectively inhibit slow blood flow artifacts in the sinus, and accurately display arachnoid particles.

A New Tailored Sinc Pulse and Its Use for Multiband Pulse Design

PURPOSE: Among RF pulses, a sinc pulse is typically used for slice selection due to its frequency-selective feature. When a sinc pulse is implemented in practice, it needs to be apodized to avoid truncation artifacts at the expense of broadening the transition region of the excited-band profile. Here a sinc pulse tailored by a new apodization function is proposed that produces a sharper transition region with well suppression of truncation artifacts in comparison with conventional tailored sinc pulses. A multiband pulse designed using this newly apodized sinc pulse is also suggested inheriting the better performance of the newly apodized sinc pulse. MATERIALS AND METHODS: A new apodization function is introduced to taper a sinc pulse, playing a role to slightly shift the first zero-crossing of a tailored sinc pulse from the peak of the main lobe and thereby producing a narrower bandwidth as well as a sharper pass-band in the excitation profile. The newly apodized sinc pulse was also utilized to design a multiband pulse which inherits the performance of its constituent. Performances of the proposed sinc pulse and the multiband pulse generated with it were demonstrated by Bloch simulation and phantom imaging. RESULTS: In both simulations and experiments, the newly apodized sinc pulse yielded a narrower bandwidth and a sharper transition of the pass-band profile with a desirable degree of side-lobe suppression than the commonly used Hanning-windowed sinc pulse. The multiband pulse designed using the newly apodized sinc pulse also showed the better performance in multi-slice excitation than the one designed with the Hanning-windowed sinc pulse. CONCLUSION: The new tailored sinc pulse proposed here provides a better performance in slice (or slab) selection than conventional tailored sinc pulses. Thanks to the availability of analytical expression, it can also be utilized for multiband pulse design with great flexibility and readiness in implementation, transferring its better performance.

Minocycline quadruple versus tailored therapy in retreatment of Helicobacter pylori infection / 中华内科杂志

Objective To compare eradication rates,safety and compliance of minocycline quadruple and tailored therapies in patients retreated for Helicobacter pylori (H.pylori) infection.Methods Between January 2014 and June 2014,135 patients with dyspepsia (18-70 years) and H.pylori infection after at least one previous eradication treatment at a tertiary hospital were randomly assigned to a 10-day treatment with minocycline quadruple therapy versus tailored triple regimen of PPI,amoxicillin and a third antibiotic.In the group of tailored therapy,medications were adjusted based on clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype.Eradication status was assessed 4-12 weeks after treatment.Results Although H.pylori eradication rates were higher in the minocycline therapy group than that in the tailored therapy group in intention-to-treat [84.1％ (95％ CI 75.0％-93.2％) vs 75.8％ (95％ CI 65.1％-86.5％),P =0.245] and per-protocol [88.3％ (95％ CI 80.3％-96.3％) vs 79.7％ (95％CI 69.7％-89.7％),P =0.197] analyses,the differences between the two groups were not statistically significant.The incidence of adverse effects and compliance between the two groups were also comparable.Conclusions The tailored therapy in this study had a poor eradication efficacy in the retreated patients with H.pylori infection.Minocycline quadruple therapy achieved a relatively satisfactory eradication efficacy and may be an alternative choice for the retreatment of H.pylori infection.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-TRC-13003975.

Change in Musculoskeletal Pain in Patients With Work-Related Musculoskeletal Disorder After Tailored Rehabilitation Education: A One-Year Follow-Up Survey

OBJECTIVE: To apply tailored rehabilitation education to video display terminal (VDT) workers with musculoskeletal pain and to assess changes in musculoskeletal pain after rehabilitation education. METHODS: A total of 8,828 VDT workers were screened for musculoskeletal disorders using a self-report questionnaire. Six hundred twenty-six VDT workers selected based on their questionnaires were enrolled in musculoskeletal rehabilitation education, which consisted of education on VDT syndrome and confirmed diseases, exercise therapy including self-stretching and strengthening, and posture correction. One year later, a follow-up screening survey was performed on 316 VDT workers, and the results were compared with the previous data. RESULTS: Compared with the initial survey, pain intensity was significantly decreased in the neck area; pain duration and frequency were significantly decreased in the low back area; and pain duration, intensity, and frequency were significantly decreased in the shoulder and wrist after tailored rehabilitation education. In addition, pain duration, intensity, and frequency showed a greater significant decrease after tailored rehabilitation education in the mild pain group than in the severe pain group. CONCLUSIONS: This study found that work-related musculoskeletal pain was reduced after tailored rehabilitation education, especially in the shoulder, wrist, and low back.

Gregor Kemper, Friedrich Mehrhoff / 中国康复理论与实践

Treating physicians and hospitals are hard-pressed to ensure a seamless rehabilitation process during day-to-day treatment, in which the appropriate service is always provided at the optimal moment by the best qualified service provider. Consistent efforts to meet the reintegration objective require the social security carrier to implement active action plans via a professional case management. It is widely accepted thatPrevention is better than cure, leading to the principle ofprevention before rehabilitation and rehabilitation before compen-sation. However, prevention also plays an integral part of professional rehabilitation management. Prevention by early intervention aims to prevent people with disabilities from entering a downward social spiral until the bottom of which they become dependent on their family or social security. Even though time matters, tailored measures are key to preventive rehabilitation, too. Accordingly, case managers need to en-sure that the insured's individual work situation is taken into account from the very beginning of the rehabilitation process in order to facili-tate the goal of return to work. Preventive rehabilitation can only succeed if the experts' work is accepted and supported by the insured indi-vidual right from the start of the rehabilitation process. This is a key element of the individual's motivation in the process of medical and oc-cupational rehabilitation. Rehabilitation management must take particular account of individual needs and early involvement (participation). Of at least the same importance is the reintegration of people with disabilities. A major requirement of a professional rehabilitation manage-ment for disabled people is the qualification of the experts running it. Therefore the International Disability Management Standards Council (IDMSC) has developed internationally acknowledged training modules and a certification processes reflecting the combined highest stan-dards on disability management around the world. Professionals trained on twenty five specific training modules that, in addition, have passed an exam are certified as CDMP, Certified Disability Management Professionals.

Changing concepts of cancer stem cells and their application into targeted therapy for cancer

Cancer stem cells (CSCs) are characterized by self-proliferation, an ability for symmetric/asymmetric division and an ability to propagate cancer in vivo. Contrary to our expectation, CSCs show a quiescent nature, the morphology of small resting cells, resistance to multiple drugs/radiation, and side-population phenotypes distinct from major cancer cells. Research has been focused on overcoming drug resistance, discovery of biomarkers for CSCs, and tailored treatment targeting CSCs. Recently changing concepts of CSCs reflect the genetic heterogeneity, hierarchy of cancer tissue, and evolving dynamic mutations within one tumor. First, multiple CSC clones with different mutations including initiating driver mutations can coexist within one tumor. Second, CSCs stand at the top of the tumor hierarchy during therapy or disease progression, and the proportions of these clones are changing dynamically, depending on the cancer progression. Third, tailored treatments should be not fixed, according to the initial situation at diagnosis, but appropriate treatment should be attempted in accordance with the dynamic properties of CSCs at each stage of cancer.

Individualized Surgery for Gastric Cancer / 대한소화기학회지

Recently, tailored and multidisciplinary treatment of gastric cancer was emerging in the field of clinical oncology. Gastric cancer is the most frequently diagnosed cancer in Korea. Surgery is the only possible curative procedure, and extensive gastrectomy and D2 lymph node dissection has been accepted as standard treatment in all gastric cancer patients until recently. In early gastric cancer, many researchers established the indications of limited surgery including endoscopic mucosal resection based on various well-collected retrospective data. Limited surgery and minimally invasive surgery contribute to quality of life in gastric cancer patients. In advanced gastric cancer, eastern surgeons believe that D2 lymph node dissection is standard treatment if done by credential surgeons in specialized centers despite of different opinion of western surgeon. In addition, adjuvant chemotherapy after good local control by D2 dissection has gained survival benefit rather than D2 dissection alone in randomized trials. In conclusion, present confronted issue is to establish tailored treatments of individualized patients through extent of disease in gastric cancer patients.

Effects of Workplace Nutrition Education Program Tailored for the Individual Chronic Disease Risks

The incidence of chronic disease is continuously increasing in Korea. Especially, office workers have higher risk of chronic disease because of their dietary habit and lifestyle. The study aimed to investigate the effect of tailored nutrition counseling on improving chronic disease risk factors. Ninety-nine male workers (age 46.9 +/- 7.0 yrs) volunteered for 12 weeks of nutrition program containing dietary intake and physical activity adjustment. Five individualized programs were performed with the main theme of weight loss (WL, n = 16), blood pressure lowering (BL, n = 34), normalizing blood glucose (GL, n = 21), lipid lowering (LL, n = 13) and reducing MS risk factors (ML, n = 15). Anthropometric data, blood-pressure, self-reported questionnaire, blood profiles were measured before and after 12weeks of nutrition education. The education program included 5 times of 1:1 interview. Compared to 0 week, anthropometric data (weight, BMI, fat, visceral fat, waist, SBP, DBP) were significantly decreased after 12 weeks (p < 0.001). Fasting blood glucose and total cholesterol were decreased (p < 0.05). The primary outcomes with individually tailored programs showed to be more effective than one general nutrition program.

Recent advance in tailored treatment of gastric cancer / 대한내과학회지

Even the overall incidence is decreasing and the proportion of early gastric cancer is increasing from the national mass screening program, still gastric cancer is the major issue in Korea. Multimodality approach and the development of novel therapeutic agents enabled us to improve the survival rate of gastric cancer. However, the proper treatment strategy for the subgroups of patients is necessary, which is now categorized based on the clinicopathologic parameters. We need more in-depth information regarding the molecular biology of gastric cancer, and the development of novel targeted biological agents and the biomarkers for the future. Currently, the recent chemotherapeutic agents showed the improved response in advanced gastric cancer. Hence, the basic concept of adjuvant chemotherapy, palliative chemotherapy, neoadjuvant treatment with or without incorporation of radiotherapy become settle down with more evidences from several phase III trials. Especially, after understanding the difference between Asia and Western countries including biology, ethnic difference, operation technology, and the treatment approaches, the qualified, well-designed multinational clinical trials are on-going. Based on the current results, here, I describe the current status of gastric cancer treatment strategy.

Stage Related Cognitive Rehabilitation for Alzheimer's Disease

Because no effective curative approaches are available, cognitive rehabilitation in the field of Alzheimer's disease (AD) are needed. In the types of cognitive rehabilitation, there are behavior-oriented approaches, emotion-oriented approaches, cognition-oriented approaches and stimulation-oriented approaches. The decline of cognitive and adaptive capacities associated with the progression of AD necessitates that different Cognitive rehabilitation programs are provided at different stage. In initial stages of AD, cognitionoriented approaches has centered on the enhancement of memory and speed of processing, with the goal of maximizing current function and reducing the risk of cognitive decline, while in more severe stages interventions such as stimulation-oriented approaches and Behavior-oriented approaches are used. Cognitive rehabilitation is always individually tailored, involving working on personal goals, often using external cognitive aids and with some use of learning strategies. A cognitive rehabilitation based on awareness of stages of AD provides the possibility of tailored treatments for many different patients.

Implication of aspirin resistance: Simple laboratory finding or important clinical criteria? / 대한내과학회지

Aspirin resistance defined by light transmittance aggregometry (LTA) or urinary 11-dehydro-thromboxane B2 has been associated with an increased risk of adverse clinical events. However, aspirin resistance based on the point-of-care VerifyNow-Aspirin assay (aspirin reaction unit > or = 550) shows poor sensitivity compared with LTA. In aspirin-treated patients, activation by cyclooxygenase- independent pathways may be associated with residual platelet reactivity, which may cause adverse clinical outcomes in some portion. A large-scale, prospective study using several platelet function assays should be performed to establish the long-term clinical significance of antiplatelet resistance in Korean patients treated with coronary stenting. Accordingly, we can apply tailored antiplatelet therapy in resistant patients.

A Tailored Approach for Recurrent Groin Hernias

PURPOSE: Recurrent groin hernias are a significant problem with high recurrence rates. There is a great deal of controversy regarding their management. This study examined the outcome of patients who had undergone a repair of recurrent groin hernias. METHODS: This study examined retrospectively the medical records of all patients who underwent repairs of recurrent groin hernias (a total 239 cases) between January 1998 and December 2006. The repair was tailored to the previous operation and the patients' medical condition. The types of previous operations, present operation, complications and re-recurrence rate were analyzed. RESULTS: Of the 2,542 groin hernias operated on, 239 cases (9.4%) were treated for recurrent groin hernias. The types of previous surgery were conventional open tissue repair in 199 cases (83.3%), Lichtenstein repair in 28 cases (11.7%), open mesh repair (PHS, Perfix plug) in 6 cases (2.5%) and laparoscopic repair in 6 cases (2.5%). The recurrent groin hernias were repaired using a laparoscopic method in 123 cases (51.4%), open mesh repair in 92 cases (38.4%), Lichtenstein repair in 18 cases (7.5%) and a conventional open tissue repair in 6 cases (2.5%). Postoperative complications occurred in 40 cases (16.7%), which included 10 seromas, 4 wound infections, 3 hematomas, 2 wound swellings, 8 scrotal swelling, 5 dysurias, 2 chronic neuralgias. There were 6 cases of re-recurrence in the 239 cases of recurrent groin hernias (2.5%). CONCLUSION: A tailored approach based on the previous repair and the medical condition of the patients with recurrent groin hernias is associated with a decrease in the incidence of major postoperative complications and a low recurrence rate (2.5%).

Tailored selective termination in second trimester in twin pregnancy / 대한산부인과학회지

OBJECTIVE: Recently, selective termination is employed in multifetal pregnancies, in the presence of an abnormal fetus, or in the complication of twin pregnancies. The purpose of this study is to evaluate effectiveness, safety of the tailored selective termination in multifetal pregnancies. METHODS: This study was retrospective and involved six cases. Indication of termination were 3 cases of structural anomalies (anencephaly, encephalocele, body stalk anomaly), 1 case of chromosomal anomaly (21 trisomy) and 2 cases of monochorionic twin complications (acardiac twin, twin to twin transfusion syndrome). RESULTS: We used KCL injection in 4 cases, they were all confirmed dichorionic twin, and in 2 cases of monochorionic twin, we used alcohol ablation of intra-abdominal umbilical artery in 1 case, and radiofrequency ablation of the cord in 1 case. CONCLUSION: All procedures were successful, and all normal infants were delivered in 3rd trimester. Tailored selective termination in 2nd trimester is effective and safe in abnormal multifetal pregnancies.

The Present and Future of Surgery

Surgery is a field of the medical science that aims to treat disease with the best possible medical skill. Until recently, surgeons have had a fixed idea that an adequate big incision is needed to perform a satisfactory operation and to get a good result. As we say in Korea, "Great surgeon, big incision was the traditional rule when training a surgeon. However, we are now at turning point and transition period for the surgical Department of medical science. Almost every day we are experiencing the change that the surgeon can perform a minimally invasive procedure for people with disease, and the present high technical procedures are less invasive have less complications, superior cosmetic results and faster recovery. This is partially because the consumers, i.e., the patients, demand this more advanced medical service and so surgeons, are, making strenuous efforts to achieve a more humanistic medical approach to treatment. Of course, minimally invasive surgery has some limitations and pitfalls for its technical and, economical, aspects. We cannot oppose to this general trend in spite of possible obstacles. We can anticipate rather major changes in surgery, such as "individualized minimally invasive surgery" or "tailored surgery". So, we should prepare ourselves with study and education to receive this new paradigm.

Effectiveness of Tailored Health Promotion Program for Reducing Cardiovascular Risk Factors in Subway Workers / 대한산업의학회지

OBJECTIVES: This study explores the effects of a tailored health promotion program, in order to reduce cardiovascular risk, in areas which include hypertension, dyslipidemia, abnormal blood glucose and body mass index. METHODS: In this paper, health risk appraisal relating to lifestyle was surveyed and physical fitness, blood pressure and blood lipid profile and glucose were checked. Then, a 12 week tailored health promotion program with 40 subway workers of Seoul was conducted. The Tailored health promotion program included a smoking cessation program, drinking restriction, diet, exercise prescription and a stress management program. RESULTS: The number of subjects engaging in regular exercise increased from 42.5% to 100%, and the number of smokers reduced from 72.5% to 60%, and 12.5% of contemplate stage was shift to action stage. The mean level of drinking per day, significantly decreased from 34.9 g to 24.2. The body mass index, systolic blood pressure, total cholesterol, triglyceride, and Fasting blood glucose significantly decreased after the intervention program. In addition the tailored health promotion program resulted in a significant reduction in two factors for the cardiovascular high risk group, hypertension above 140 mmHg in systolic blood pressure and dyslipidemia above 200 mg/dl in triglyceride. CONCLUSION: In this paper, it is demonstrated that the tailored health promotion program,, including the smoking cessation program, drinking restriction, diet, exercise prescription and stress management program, resulted in effective reduction in cardiovascular risk factor. Therefore associated workplace tailored health promotion programs relating to specific individual risk factor, should be developed and implemented.

Application of tailored radiofrequency (TRF) in T2-FLAIR MR imaging / 医疗卫生装备

Objective To investigate the influence of TRF on high-intensity cerebrospinal fluid artifacts in T2-FLAIR MR imaging.Methods In a GE Signa Twinspeed 1.5T system,50 cases were examined with T2-FLAIR sequences including 2 different optional imaging parameters according to the augmentation of TRF.Results TRF pulses significantly improved image quality(P

Tailored Pharmacotherapy of Psychotropic Drugs / 대한정신약물학회지

The pharmacotherapeutic responses such as clinical efficacy and adverse events exhibit wide variabilities in individuals and even in different races and populations. The human genetic diversity has been known as the one of the main factors in the variations of drug responses expressed in the area of pharmacokinetics and pharmacodynamics. Polygenetic implications have been suggested in the pathophysiology of psychiatric disorders. The risks in psychiatric disorders could be explored by combining the polymorphisms of multiple candidate genes. This suggests that drug therapy should be tailored to the genetic make-up of the individual. The emerging field of pharmacogenomics could be a landmark for the development of more effective clinical efficacy and less adverse events by individually tailored drugs.

Anterior Temporal Lobectomy with Tailored Hippocampectomy: Review of 100 Cases with Intractable Temporal Lobe Epilepsy

In terms of seizure control for the patients with medically intractable temporal lobe epilepsy(TLE), extensive medial resection, especially of the hippocampus, has been advocated in anterior temporal lobectomy. The relationship between the outcome of anterior temporal lobectomy for epilepsy and the size of the hippocampectomy tailored to intraoperative electrocorticographic findings was evaluated in 100 patients, with at least 12 months of follow-up. In 28 patients with small hippocampal resection(

A Morphological Study of Synaptic Reorganization in Mossy Fibers of the Dentate Gyrus according to Hippocampal Sclerosis in Temporal Lobe Epilepsy: A Comparison of Intraoperative ECoG Findings for Tailored Resection

This study was carried out to identify synaptic reorganization by mossy fibers of epileptic dentate gyrus by Timm sulphide silver histochemistry and to investigate degree of synaptic reorganization according to both hippocampal sclerosis and epileptiform discharge in human temporal lobe epilepsy(TLE). The control group was composed of two hippocampal tissues obtained from autopsied brain without neurological abnormalities. TLE group was composed of thirteen hippocampal tissues obtained from surgically resected temporal lobe. Among thirteen hippocampal tissues, five specimens were obtained both of two areas of each hippocampus with or without prominent epileptiform discharges on electrocorticogram(ECoG) for tailored hippocampal resection. Hippocampal cell density was quantitatively analyzed in TLE group and compared with that of control group. A portion of hippocampal tissue was observed under light microscopic and transmission electron microscopes after development with Danscher method. The results were as follows : Hippocampal cell loss was noted in all TLE group. Hippocampal cell loss greater than 30% of control values was found in 12 cases and average hippocampal cell loss was 70%(range 39-88%). The remaining 1 case had 13% hippocampal cell loss. The supragranular Timm granules were noted in inner molecular layer of dentate gyrus and tended to significantly increase in proportion as severity of hippocampal sclerosis. Average of hippocampal cell loss in two areas of five hippocampal tissues with or without prominent epileptiform discharge on ECoG was 73.6%(range 53-90%) and 66.4%(range 50-86%), which showed statistically significant (p<0.05) difference between these two areas and the supragranular Timm granules also tended to increase in the hippocampal tissue with epileptiform discharge. On transmission electron microscope, there showed distinct supragranular Timm granules correspond to mossy fiber synaptic terminals. The results of this study demonstrated that mossy fiber synaptic reorganization seems to play a major role in pathogenesis of human TLE and the development of mossy fiber synaptic reorganization is closely related to severity of hippocampal sclerosis. The result also support the rationale for tailoring the extent of hippocampal resection by intraoperative acute recording(ECoG) according to individual pathophysiology.