Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis

Purpose@#Evidence on factors influencing the variations of music’s effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics. @*Methods@#We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate. @*Results@#Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = −1.48, 95% confidence interval: −1.97 to −0.98), pain (Hedges's g = −0.67, −1.11 to −0.23), systolic blood pressure (MD = −4.62, −7.38 to −1.86), and heart rate (MD = −3.37, −6.65 to −0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain. @*Conclusions@#Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Genetic Differences between Physical Injury Patients With and Without Post-traumatic Syndrome: Focus on Secondary Findings and Potential Variants Revealed by Whole Exome Sequencing

Objective@#Sudden traumatic physical injuries often cause psychological distress, which may be associated with chronic disability. Although considerable effort has been expended to identify genetic predictors of post-traumatic stress disorder (PTSD) after traumatic events, genetic predictors of psychological distress in response to severe physical injuries have been yet to be elucidated using whole exome sequencing (WES). Here, the genetic architecture of post-traumatic syndrome (PTS), which encompasses a broad range of psychiatric disorders after traumatic events including depression, anxiety disorder, acute stress disorder, and PTSD, was explored using WES in severely physically injured patients, focusing on secondary findings and potential PTS-related variants. @*Methods@#In total, 141 severely physically injured patients were consecutively recruited, and PTS was evaluated within 1 month of the injury. Secondary findings were analyzed according to PTS status. To identify PTS-related variants, genome-wide association analyses and the optimal sequencing kernel association test were performed. @*Results@#Of the 141 patients, 88 (62%) experienced PTS. There were 108 disease-causing variants in severely physically injured patients. As secondary findings, the stress- and inflammation-related signaling pathways were enriched in the PTS patients, while the glucose metabolism pathway was enriched in those without PTS. However, no significant PTS-related variants were identified. @*Conclusion@#Our findings suggest that genetic alterations in stress and inflammatory pathways might increase the likelihood of PTS immediately after severe physical injury. Future studies with larger samples and longitudinal designs are needed.

Bioinformatics services for analyzing massive genomic datasets

The explosive growth of next-generation sequencing data has resulted in ultra-large-scale datasets and ensuing computational problems. In Korea, the amount of genomic data has been increasing rapidly in the recent years. Leveraging these big data requires researchers to use large-scale computational resources and analysis pipelines. A promising solution for addressing this computational challenge is cloud computing, where CPUs, memory, storage, and programs are accessible in the form of virtual machines. Here, we present a cloud computing-based system, Bio-Express, that provides user-friendly, cost-effective analysis of massive genomic datasets. Bio-Express is loaded with predefined multi-omics data analysis pipelines, which are divided into genome, transcriptome, epigenome, and metagenome pipelines. Users can employ predefined pipelines or create a new pipeline for analyzing their own omics data. We also developed several web-based services for facilitating downstream analysis of genome data. Bio-Express web service is freely available at https://www.bioexpress.re.kr/.

Bioinformatics services for analyzing massive genomic datasets

The explosive growth of next-generation sequencing data has resulted in ultra-large-scale datasets and ensuing computational problems. In Korea, the amount of genomic data has been increasing rapidly in the recent years. Leveraging these big data requires researchers to use large-scale computational resources and analysis pipelines. A promising solution for addressing this computational challenge is cloud computing, where CPUs, memory, storage, and programs are accessible in the form of virtual machines. Here, we present a cloud computing-based system, Bio-Express, that provides user-friendly, cost-effective analysis of massive genomic datasets. Bio-Express is loaded with predefined multi-omics data analysis pipelines, which are divided into genome, transcriptome, epigenome, and metagenome pipelines. Users can employ predefined pipelines or create a new pipeline for analyzing their own omics data. We also developed several web-based services for facilitating downstream analysis of genome data. Bio-Express web service is freely available at https://www.bioexpress.re.kr/.

Health-related Quality of Life in Korean Patients with Rheumatoid Arthritis: Association with Pain, Disease Activity, Disability in Activities of Daily Living and Depression

PURPOSE: The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). METHODS: The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression. RESULTS: Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables. CONCLUSION: Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.

The Role of Computed Tomography in the Presurgical Diagnosis of Foraminal Entrapment of Lumbosacral Junction

OBJECTIVE: On the basis of preoperative computed tomography (CT) scans, we studied the change of the size of anterior primary division (APD) of the L5 spinal root in the presence of foraminal/extraforaminal entrapment of the L5 spinal root. METHODS: Two independent radiologists retrospectively reviewed the preoperative CT scans of 27 patients treated surgically and compared the sizes of the APDs on bilateral L5 spinal roots. If one side APD size was larger than the other side APD size, it was described as left or right "dominancy" and regarded this as "consensus (C)" in case that there was a consensus between the larger APD and the location of sciatica, and regarded as "non-consensus (NC)" in case that there was not a consensus. Oswestry Disability Index (ODI) scores were used for preoperative and postoperative evaluation. RESULTS: On CT scans, twenty-one (77%) of 27 patients were the consensus group (APD swelling) and 6 (22%) were a non-consensus group (APD no swelling). In 9 patients with acute foraminal disc herniations, asymmetric enlargement of the APD on L5 spinal root was detected in all cases (100%) and detected in 11 (64%) of 17 patients with stenosis. Preoperative ODI score was 75-93 (mean 83) and postoperative ODI scores were improved to 13-36 (mean 21). The mean follow-up period was 6 months (range, 3-11 months). CONCLUSION: An asymmetric enlargement of the APD on L5 spinal root on CT scans is meaningfully associated with a foraminal or extraforaminal entrapment of the L5 spinal root on the lumbosacral junction.

Thoracic Intraspinal Synovial Cyst Causing Myelopathy: A Case Report

Intraspinal synovial cysts are commonly found in the lumbar spine and occur less commonly in the cervical spine. Occurrence of a cyst in the thoracic spine causing myelopathy is extremely rare. We report here the radiological findings of a case of a thoracic intraspinal synovial cyst that caused myelopathy at the T2-3 level with an accompanying review of the clinical literature.

Percutaneous Endoscopic Thoracic Discectomy: Posterolateral Transforaminal Approach

OBJECTIVE: Development of diagnostic tools has resulted in early detection of thoracic disc herniations(TDH) even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy(PETD) technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. METHODS: Eight consecutive patients (range, 31 to 75 years) with soft lateral or central TDH (from T2-3 to T11-12) underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and fluoroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index(ODI). RESULTS: The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. CONCLUSION: The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

Effect of PDN(R)(Prosthetic Disc Nucleus) on the Mobility and Height of the Intervertebral Disc: Preliminary Report

OBJECTIVE: The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. METHODS: Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. RESULTS: There were seven men and six women whose mean age was 37 years(range, 24-49 years). The mean follow-up period was nine months(range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4degrees(+/-2.3degrees) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. CONCLUSION: The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.

The Effect of Transglutaminase on the Recovery of Somatosensory Evoked Potentials in the Rat Model of Spinal Cord Injury

OBJECTIVE: The authors present an investigation of the effect of transglutaminase(TG) on the recovery of somatosensory evoked potentials in the rat model of spinal cord injury. METHODS: Female Sprague-Dawley rats(280-310g) were used for this study. Rats were divided into two groups: TG treated and control. The lesion was made by transecting the right dorsal column of the thoracic spinal cord without damage to the vasculature using specially devised micro-glass pipette after laminectomy. For TG treated group, normal saline with TG were injected into the lesion site using micro-pipette through the opening of the dura. Saltatory repetitive somatosensory evoked potentials(SSEPs) recording were carried out on post-injury 6th and 12th week. RESULTS: The amplitudes of N19 were 1.28+/-1.60 microV on 6th week, 3.45+/-3.63 microV on 12th week in control group(n=10) and 1.46+/-1.75 microV on 6th week and 5.01+/-2.65 microV on 12th week in TG-treated group(n=11). Statis-tically significant recovery of SSEPs were seen in TG-treated group(p=0.003, Wilcoxon Signed Ranks Test). In TG-treated group, vacuolated degeneration around the lesion site was rarely observed on histological evaluation. CONCLUSION: This study demonstrates the possibility of long-term survival and saltatory recording of SSEPs in small animals like rats, after selective spinal cord injury. In addition, this study shows that TG is a factor facilitating the recovery of injured axon of central nervous system.

The Efficacy of Anterior Lumbar Interbody Fusion in Degenerative Disc Disease and Degenerative Spondylolisthesis: Comparative Review of 44 Single-Level Cases

OBJECTIVE: The authors conduct a retrospective study to evaluate the efficacy of anterior lumbar interbody fusion(ALIF) in treating degenerative disc disease(DDD) and degenerative spondylolisthesis(DS). METHODS: During 1998, eighty-six patients underwent mini-retroperitoneal ALIF with Brantigan carbon cages. Among them, 19 patients were lost during the follow-up period and 23 patients underwent multilevel fusion procedures. The authors evaluated 44 single-level cases(31 with DDD; 13 with DS) with Macnab's criteria for clinical outcomes and the Criteria of Brantigan and Steffee for fusion results. The extent of slippage of patient with DS was not greater than grade 1. The mean follow-up period was 24 months. RESULTS: The overall fusion rate was 88.6%(94% in DDD; 77% in DS). Based on the Macnab's criteria, excellent or good results were achieved in 38 of 44 patients(86.3%). Overall clinical outcome was significantly associated with preoperative diagnosis(p=0.03), radiologically demonstrated fusion(p=0.001), and subsidence of cages(p=0.03). In DDD sub-group, two cases of fusion failure and four of subsidence of cages belonged to excellent or good results. But, in DS sub-group, fusion failure or subsidence rate were significantly high and all three cases with poor result belonged to this sub-group. One of them underwent posterior operation. CONCLUSION: ALIF is considered as a good surgical method for a patient with discogenic back pain caused by degenerative disc disease. But in degenerative spondylolisthesis, considering the comparatively poor clinical and radiological result, it seems that ALIF alone does not provide sufficient strength to overcome the instability. Despite the advantage of minimal invasiveness, more careful application of ALIF is needed in the of degenerative spondylolisthesis.

Clinical Application of Image Guided Surgery: Zeiss SMN System

No abstract available.

Transthoracic-Extrapleural Approach for Microsurgical Thoracic Discectomy with Video Assistance: Technical Report of Three Cases

No abstract available.

Thoracoscopic Discectomy of the Herniated Thoracic Discs

No abstract available.

Laparoscopic Interbody Fusion in Degenerative Disc Disease of the Lumbosacral Spine

OBJECTIVE: The surgical treatment of symptomatic degenerative disc disease remains one of the most controversial topics among spine surgeons. Recently, advances in many endoscopic surgical techniques have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The purpose of this study is to evaluate the efficacy of laparoscopic anterior lumbosacral interbody fusion in our patients with symptomatic degenerative disc disease. PATIENTS AND METHODS: We performed laparoscopic anterior interbody fusion for degenerative disc disease at L5-S1 in 26 patients who were unresponsive to conservative treatments for 1 year, from Oct. 1996 to Dec. 1997. This technique consists of a four-puncture laparoscopic approach with a 10mm trocar at the umbilicus for laparoscope, two 5mm trocars at left and right flanks for dissection, and a 15mm trocar at suprapubic area for working port. We performed complete discectomy and stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Laparoscopic fusion at L5-S1 was successful in 22 of 26 patients and the remaining four patients were successfully converted to minilaparotomy. The operation time averaged 150 minutes, hospitalization 4.1 days and average blood loss was 90cc. The mean follow-up period was 16.8 months. Radiographic fusion was achieved in 23 of 26 patients(88.5%) and clinical results showed excellent in 11/26, good in 11/26, fair in 3/26, poor in 1/26 according to Macnab's criteria. There were four complications; retroplacement of cages(1), transient dry ejaculation (1), transient urinary bladder dysfunction(1) and malposition of cages(1). CONCLUSION: Laparoscopic fusion at L5-S1 in degenerative disc disease seems to be safe, with satisfactory clinical results. Main advantage are early recovery and short hospitalization time compared with conventional technique.

Intracranial Hypoglossal Neurinoma: A Case Report

Hypoglossal neurinoma is vary rare cranial base neoplasm. With the recent advances in the neuroimaging and surgical technique, radical surgical resection is amenable. A case of hypoglossal neurinoma which is located ventral to the medulla is reported. The patient was presented with right hypoglossal nerve palsy, glossal hemiatrophy, and decreased gag reflex on the right side. Magnetic resonance imaging(MRI) revealed an ovoid mass ventral to the medulla with enlarged hypoglossal canal. Because of the ventral location of the mass, far lateral transcondylar approach was selected to minimize the postoperative morbidity. Radical total resection was achieved. This report describes that far lateral transcondylar approach is better than conventional suboccipital approach in regards to satisfactory exposure of the hypoglossal canal and prevention of excessive retraction of the neuraxis.

The Effect of Labetalol on the Hemodynamic Response to Endotracheal Intubation / 대한마취과학회지

Transient increases in blood pressure and heart rate following laryngoscopy and endotra- cheal intubation are common. These stress responses are greatly exaggerated in patients with hypertension and cardiovascular diseases and can lead to cardiac arrhythmia, pulmo- nary edema, and cerebral hemorrhsge. Many approaches have been tried to attenuate these potentially adverse circulatory responses but none has been satisfactory. This study was made to evaluate the hemodynamic responses to tracheal intubation using combined alpha-and beta-adrenoreceptor blocking agent, labetalol. We intravenously administered labetalol or placebo prior to laryngoscopy and tracheal intubation in adult patients with ASA class 1, or 2. Sixty patients were randomly assigned to one of three treatment groups. Group 1 patients (control group,n=20) received normal saline 3ml, Group 2 patients (n=20) received labetalol 0.3mg/kg, and Group 3 patients (n= 20) received labetalol 0.6mg/kg intravenously. These drugs were injected 3 minutes before induction with thiopental sodium (5mg/kg). Succinylcholine chloride 1.0mg/kg i.v. was used to facilitate endotracheal intubation. After the completion of intubation, nitrous oxide/oxygen with enflurane or isoflurane was administered. The blood pressure and heart rate were measured upon arrival in the operating room (baseline), immediately before intubation, immediately after intubation, 1 minutes after intubation and at 2, 3, 5, 7, 10 minutes after intubation. There were no significant differences in preinduction values of blood pressure and heart rate. A significant reduction in heart rate was observed in the group 3, group 2 in that order compared with the group 1. Similarly, systolic, diastolic and mean arterial pressure de- creased in labetalol groups, but was not significantly different in all groups. None of the patients experienced any untoward side effects, such as hypotension, aignificant bradycardia, bronchospasm or electrocardiographic ehanges. In conclusion, in patients with no history of hypertension or significant cardiac disease, labetalol 0.3 or 0.6mg/kg i.v. is better suited to blunting tachycardia than to blunting hypertension to laryngoscopy and intubation.

Changes in End Tidal CO2 before and After Release of Tourniquet / 대한마취과학회지

In 24 healthy adult patients having orthopedic surgical procedures requiring the use of a tourniquet under general anesthesia with controlled mechanieal ventilation, we have deter- mined ehanges in end tidal CO2(PetCO2) and arterial blood gas values before and after release of tourniquet. After deflation of tourniguet, PETCO and PaCO2 increased significantly with the maximal elevation occuring within two minutes. The pH level decreased significantly and maximally within three minutes. There was statistically significant linear correlation between PCO and PaCO2 Sugesting prediction of the PaCO2, level by monitoring the PetCO2 level. On these findings, hyperventilation may be indicated to facilitate the return of PaCO2 and pH to baseline just before and for several minutes after tourniquet release, especially in patients with increased intracranial pressure. In conclusion, we recommend noninvasive monitoring of the PetCO2 level instead of invasive measure-ment of the PaCO2 level.

Tratment of Pathological Fractures in Metastatic Bone Tumors / 대한정형외과학회잡지

Better palliative management of patients with disseminated cancer has prolonged their lives but has raised the incidence of pathologic fractures in their variable lives. The essence of treatment is to prolong life, maintain comfort, and stabilize the patient with metastatic disease. The treatment of pathologic fractures with internal fixation has long been accepted by orthopedic surgeons and the benefits afforded to the patient are well known, so adequate fixation is essential. A combination of methylmethacrylate and internal fixation devices can greatly enhance the stability of fixation, because diseased bone is a poor base on which to insert an internal fixation device. The authors have treated 19 cases of the pathologic fracture of spine, humerus and femur by use of bone cement with and without internal fixation devices. The results are as follwed. 1. All cases utilized methylmethacrylate and there was no complication in methylmethacrylate in itself. 2. All cases had received various type of ancillary treatment: radiation in 9 cases, chemotherapy in 4 cases and in 8 cases, conservative pain control. 3. In spinal pathologic fracture with paraplegia or neurologic deficiency, the patients could walk with walker at an average of two weeks after operation. 4. Among the 19 cases, the pain was relieved markedly and ambulation was possible easily and early after operation in 16 cases. 5. Among the 19 cases, two survived less than 2 months, 7 surrived from 2 month to 3 month, five survived from 3 months to 6 months, four survived from 6 months to a year and one survived more than a year.

Sacrococcygeal Chordoma / 대한정형외과학회잡지

Sacrococcygeal chordoma is a rare malignant tumor which is believed to take its origin from remnants of the fetal notochord, and presents in the sacral hollow or occasionally posteriorly. The growth is leisurely and it is invasive rather than metastatic. In treatment, there is evidence that early diagnosis of sacrococcygeal chordoma followed by radical resection c palliative radiotherapy does provide the opportunity for cure. We have experienced two cases of sacrococcygeal chordoma, which were treated with one case of a complete surgical resection and the other case of only biopsy.