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BACKGROUND: Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting. METHODS: The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg-1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume. RESULTS: Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4-0.7) mL.kg-1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities. CONCLUSION: Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.
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Extensive research has been conducted on the in vitro mass propagation of pear (Pyrus spp.) trees through vegetative propagation, demonstrating high efficiency in shoot multiplication across various pear species. However, the low in vitro rooting rates remain a significant barrier to the practical application and commercialization of mass propagation. This study aims to determine the favorable conditions for inducing root formation in the in vitro microshoots of Pyrus genotypes. The base of the microshoots was exposed to a high concentration (2 mg L-1) of auxins (a combination of IBA and NAA) for initial root induction at the moment when callus formation begins. The microshoots were then transferred to an R1 medium (1/2 MS with 30 g L-1 sucrose without PGRs) to promote root development. This method successfully induced rooting in three European pear varieties, one Asian pear variety, and a European-Asian hybrid, resulting in rooting rates of 66.7%, 87.2%, and 100% for the European pear (P. communis), 60% for the Asian pear (P. pyrifolia), and 83.3% for the hybrid pear (P. pyrifolia × P. communis) with an average of 25 days. In contrast, the control group (MS medium) exhibited rooting rates of 0-13.3% after 60 days of culture. These findings will enhance in vitro root induction for various pear varieties and support the mass propagation and acclimatization of pear. The in vitro root induction method developed in this study has the potential for global commercial application in pear cultivation.
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Cryopreservation is a promising method for the long-term preservation of plant germplasm, especially for vegetatively propagated species like freesias. In this study, we investigate streamlining the cryopreservation process for 'Sunny Gold' Freesia, starting from effective in vitro initiation and proliferation using various plant growth regulator combinations. We also assess the impact of subculture on regrowth rates after cryopreservation. The shoot tips were successfully initiated in vitro after sterilization. The shoots were multiplied an average of three times in media containing N6-benzyladenine and kinetin. The regrowth rates of non-cryopreserved shoot tips excised from different subculture cycles did not differ significantly, with rates of 44% observed for plants from more than five subcultures and 47% for those from three subcultures. However, only the shoot tips excised from cultures subjected to three subculture cycles were able to recover after cryopreservation, with a regrowth rate of 31%. Our findings lay the groundwork for the development of an efficient cryopreservation protocol for freesias in the future.
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Intraoperative lung-protective ventilation, including low tidal volume and positive end-expiratory pressure, reduces postoperative pulmonary complications. However, the effect and specific alveolar recruitment maneuver method are controversial. We investigated whether the intraoperative intermittent recruitment maneuver further reduced postoperative pulmonary complications while using a lung-protective ventilation strategy. Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to the recruitment or control groups. Intraoperative ventilation was adjusted to maintain a tidal volume of 6-8 mL kg-1 and positive end-expiratory pressure of 5 cmH2O in both groups. The alveolar recruitment maneuver was applied at three time points (at the start and end of the pneumoperitoneum, and immediately before extubation) by maintaining a continuous pressure of 30 cmH2O for 30 s in the recruitment group. Clinical and radiological evidence of postoperative pulmonary complications was investigated within 7 days postoperatively. A total of 125 patients were included in the analysis. The overall incidence of postoperative pulmonary complications was not significantly different between the recruitment and control groups (28.1% vs. 31.1%, P = 0.711), while the mean ±â standard deviation intraoperative peak inspiratory pressure was significantly lower in the recruitment group (10.7â ±â 3.2 vs. 13.5 ±â 3.0 cmH2O at the time of CO2 gas-out, Pâ <â 0.001; 9.8â ±â 2.3 vs. 12.5 ±â 3.0 cmH2O at the time of recovery, Pâ <â 0.001). The alveolar recruitment maneuver with a pressure of 30 cmH2O for 30 s did not further reduce postoperative pulmonary complications when a low tidal volume and 5 cmH2O positive end-expiratory pressure were applied to patients undergoing laparoscopic colorectal surgery and was not associated with any significant adverse events. However, the alveolar recruitment maneuver significantly reduced intraoperative peak inspiratory pressure. Further study is needed to validate the beneficial effect of the alveolar recruitment maneuver in patients at increased risk of postoperative pulmonary complications. Trial registration: Clinicaltrials.gov (NCT03681236).
Subject(s)
Laparoscopy , Positive-Pressure Respiration , Postoperative Complications , Humans , Male , Female , Laparoscopy/methods , Laparoscopy/adverse effects , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Middle Aged , Aged , Positive-Pressure Respiration/methods , Tidal Volume , Lung Diseases/prevention & control , Lung Diseases/etiology , Pulmonary Alveoli , Colorectal Surgery/adverse effects , Colorectal Surgery/methodsABSTRACT
BACKGROUND: Chronic inflammation, which becomes more prevalent during aging, contributes to sarcopenia by reducing muscle mass and strength. PURPOSE: Wheat seedlings extract (WSE) is known for its various physiological activities, including anti-inflammation and antioxidant effects. However, its efficacy against sarcopenia is not well documented. STUDY DESIGN: 8-week-old and 50-week-old C57BL/6 J mice were used as young control (YC group) and aged controls (AC group), respectively. Then, aged mice were randomly divided into 5 groups (WSE100mg/kg, WSE200mg/kg, WSE400mg/kg, and schizandrin as a positive control) and fed each experimental diet for 10 weeks. METHOD: We investigated the effects of WSE on muscle quality and protein homeostasis pathways based on improvements in mitochondrial function and chronic inflammation. We then used TNFα-treated C2C12 to investigate the effects of isoorientin (ISO) and isoschaftoside (ISS), the active substances of WSE, on the myogenic pathway. RESULTS: We administered WSE to aging mice and observed an increase in muscle mass, thickness, protein content, and strength in mice treated with WSE at a dose of 200 mg/kg or 400 mg/kg. Furthermore, the administration of WSE led to a reduction in inflammatory factors (TNFα, IL-1, and IL-6) and an increase in mitochondrial biogenesis (p-AMPK/SIRT3/PGC1α) in muscle. This effect was also observed in TNFα-induced muscle atrophy in C2C12 cells, and we additionally identified the upregulation of myogenic regulatory factors, including Myf5, Myf6, MyoD, and myogenin, by WSE, ISO, and ISS. CONCLUSION: These findings suggest that WSE could function as a dietary anti-inflammatory factor and mitochondrial activator, potentially exerting modulatory effects on the metabolism and mechanical properties of skeletal muscles in the aging population. Furthermore, Our results demonstrate the potential value of ISO and ISS as functional food ingredients for preventing muscle atrophy.
Subject(s)
Anti-Inflammatory Agents , Mice, Inbred C57BL , Organelle Biogenesis , Plant Extracts , Sarcopenia , Seedlings , Triticum , Animals , Sarcopenia/drug therapy , Plant Extracts/pharmacology , Anti-Inflammatory Agents/pharmacology , Male , Triticum/chemistry , Muscle, Skeletal/drug effects , Muscle, Skeletal/metabolism , Aging/drug effects , Mice , Protein Biosynthesis/drug effects , Proteolysis/drug effects , Tumor Necrosis Factor-alpha/metabolism , Mitochondria/drug effects , Mitochondria/metabolism , Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha/metabolism , Lignans/pharmacologyABSTRACT
Biofouling is inevitable in the membrane process, particularly in membrane bioreactors (MBR) combined with activated sludge processes. Regulating microbial signaling systems with diffusible signal factors such as cis-2-Decenoic acid (CDA) can control biofilm formation without microbial death or growth inhibition. This study assessed the effectiveness of CDA in controlling biofouling in membrane bioreactors (MBRs), essential for wastewater treatment. By modulating microbial signaling, CDA mitigated biofilm formation without hindering microbial growth. Analysis using Confocal Laser Scanning Microscopy (CLSM) revealed structural alterations in the biofilm, reducing biomass and thickness upon CDA application. Moreover, examination of extracellular polymeric substances (EPS) highlighted a decrease in total EPS, particularly effective polysaccharides. In addition, the possibility of shifting from high molecular weight EPS to low molecular weight EPS was revealed through the change in dispersion activity. The 56% extension of MBR operational lifespan resulting from the reduction in EPS is anticipated to offer potential cost savings and improved performance. Despite these results, further investigation is crucial to validate any potential environmental risks associated with CDA and to comprehend its long-term effects at various conditions.
Subject(s)
Biofilms , Biofouling , Bioreactors , Fatty Acids, Monounsaturated , Membranes, Artificial , Wastewater , Biofouling/prevention & control , Biofilms/drug effects , Wastewater/chemistry , Waste Disposal, Fluid/methods , Extracellular Polymeric Substance Matrix , Sewage/chemistryABSTRACT
BACKGROUND: Deep neuromuscular blockade (NMB) has benefits in various surgical procedures, however, precise quantitative neuromuscular monitoring is crucial for its proper maintenance and recovery. Neuromuscular blocking agent dosage relies on actual body weight (ABW), but this varies among individuals. Therefore, this study hypothesizes that there is a correlation between the rocuronium requirement for deep NMB and muscle mass ratio measured by bioelectric impedance analysis. METHODS: Ninety adult female patients undergoing laparoscopic operation were enrolled in this study. Muscle and fat masses were assessed using a body composition analyser. Deep NMB, defined as a post-tetanic count of 1-2, was maintained through the continuous infusion of rocuronium. The primary outcome involves determining the correlation between the rocuronium dose required for deep NMB and the muscle mass ratio. Conversely, secondary outcomes included assessing the relationship between the rocuronium dose for deep NMB and fat mass ratio, and ABW. Additionally, we investigated their relationship with rocuronium onset time and profound blockade duration. RESULTS: No relationship was observed between the muscle mass ratio and rocuronium dose required for maintaining deep NMB (r = 0.059 [95% CI = 0.153-0.267], p = 0.586). Fat mass ratio and ABW showed no correlation with the rocuronium dose, whereas rocuronium onset time was positively correlated with muscle mass ratio (r = 0.327) and negatively correlated with fat mass ratio (r = -0.302), respectively. Profound blockade duration showed no correlation with any of the assessed variables. CONCLUSIONS: No correlation was detected between muscle mass ratio and the rocuronium dose required to achieve deep NMB.
Subject(s)
Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents , Rocuronium , Humans , Rocuronium/administration & dosage , Female , Neuromuscular Blockade/methods , Prospective Studies , Neuromuscular Nondepolarizing Agents/administration & dosage , Adult , Middle Aged , Muscle, Skeletal/drug effects , Electric Impedance , Dose-Response Relationship, Drug , Body Composition/drug effects , Laparoscopy/methods , Body Weight , Neuromuscular Monitoring/methodsABSTRACT
BACKGROUND: Colonic diverticulitis (CD), typically seen in the elderly of Western countries, is increasingly prevalent worldwide, yet data on CD in children and adolescents are scarce. This study explores the characteristics of CD in this younger demographic. METHODS: In a multicenter, retrospective review, 104 patients under 20 years diagnosed with CD at four Korean tertiary hospitals from June 2003 to December 2020 were analyzed. Abdominal CT scans were used for diagnosis, with the modified Hinchey classification assessing the severity of CD. RESULTS: CD was found in the cecum or ascending colon in 103 (99%) of cases. The mean patient age was 17.24⯱â¯2.4 years, with males constituting 59.6% of cases. Solitary lesions were noted in 93 (89.4%) of patients. Severity was classified as modified Hinchey stage 0 in 58.7%, stage Ia in 29.8%, and stage Ib in 11.5%, with no cases of stage II or higher. Misdiagnosis as acute appendicitis occurred in six instances. IV antibiotics were administered to 68.3%, and oral antibiotics were sufficient for 24%. Surgical treatment was necessary for two patients. A 7.8% recurrence rate was noted among first-time CD patients, yet all cases were amenable to conservative management. CONCLUSION: While uncommon, CD in children and adolescents is a growing concern, with most cases presenting as solitary lesions in the cecum or ascending colon. The severity is typically less than that in adults, and conservative treatment is generally effective. These findings underscore the need for specific management guidelines for pediatric CD, advocating for non-surgical initial approaches.
Subject(s)
Anti-Bacterial Agents , Diverticulitis, Colonic , Severity of Illness Index , Humans , Adolescent , Male , Female , Diverticulitis, Colonic/diagnosis , Diverticulitis, Colonic/therapy , Diverticulitis, Colonic/diagnostic imaging , Retrospective Studies , Child , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/administration & dosage , Tomography, X-Ray Computed , Recurrence , Young Adult , Conservative Treatment , Republic of Korea/epidemiology , Diagnostic Errors , Appendicitis/diagnosis , Appendicitis/surgery , Appendicitis/diagnostic imagingABSTRACT
OBJECTIVE: To compare the effects of volatile anesthetics and propofol on neurocognitive function after cardiac surgery. DESIGN: A systematic review and meta-analysis of randomized controlled trials. SETTING: A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science databases was conducted. PARTICIPANTS: A total of 10 randomized controlled trials comparing volatile anesthetics and propofol in cardiac surgery were included in the study. INTERVENTIONS: The standardized mean difference and risk ratio were calculated to estimate pooled effect sizes. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the postoperative neurocognitive function score, and the secondary outcome was the incidence of delirium after cardiac surgery. The analysis did not show significant differences in postoperative neurocognitive function scores (standardized mean difference -0.06, 95% CI -0.81-0.69; p = 0.879). The incidences of delirium (risk ratio 1.10, 95% CI 0.81-1.50) between the volatile anesthetics and propofol groups were not significant (p = 0.533). CONCLUSIONS: Unlike noncardiac surgery, there are no differences between volatile anesthetics and propofol regarding postoperative neurocognitive dysfunction after cardiac surgery.
Subject(s)
Anesthetics, Inhalation , Cardiac Surgical Procedures , Delirium , Propofol , Humans , Propofol/adverse effects , Anesthetics, Intravenous/adverse effects , Anesthetics, Inhalation/adverse effects , Cardiac Surgical Procedures/adverse effects , Cognition , Delirium/chemically induced , Delirium/diagnosis , Delirium/epidemiology , Randomized Controlled Trials as TopicABSTRACT
In recent years, there has been a shift towards a greater demand for more nutritious and healthier foods, emphasizing the role of diets in human well-being. Edible Alliums, including common onions, garlic, chives and green onions, are staples in diverse cuisines worldwide and are valued specifically for their culinary versatility, distinct flavors and nutritional and medicinal properties. Green onions are widely cultivated and traded as a spicy vegetable. The mild, onion-like flavor makes the crop a pleasant addition to various dishes, serving as a staple ingredient in many world cuisines, particularly in Eastern Asian countries such as China, Japan and the Republic of Korea. The green pseudostems, leaves and non-developed bulbs of green onions are utilized in salads, stir-fries, garnishes and a myriad of culinary preparations. Additionally, green onions have a rich historical background in traditional medicine and diets, capturing the attention of chefs and the general public. The status of the crop as an important food, its culinary diversity and its nutraceutical and therapeutic value make it a subject of great interest in research. Therefore, the present review has examined the distribution, culinary, nutritional and therapeutic significance of green onions, highlighting the health benefits derived from the consumption of diets with this aromatic vegetable crop as a constituent.
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Magnesium enhances the effects of neuromuscular blocking agents. However, there is a paucity of evidence demonstrating possible effects of magnesium on neostigmine-induced recovery from neuromuscular blockade with rocuronium. This study compared the profiles of recovery from neuromuscular blockade between groups treated with magnesium (Group M) and placebo controls (Group C). Sixty-four patients were randomly allocated to Group M or Group C. Patients in Group M received a loading dose of 50 mg/kg magnesium and continuous infusion of 15 mg/kg/hr. Patients in Group C received a comparable amount of saline. Rocuronium at 0.6 mg/kg was used for tracheal intubation and 0.1 mg/kg of rocuronium was additionally administered to maintain train-of-four (TOF) status of 2-3 during surgery. At the end of surgery, neostigmine (50 µg/kg) plus glycopyrrolate (10 µg/kg) were administered, and the recovery time for TOF ratios of 0.7, 0.8, and 0.9 was measured. The primary outcome was the time from neostigmine administration to recovery with a TOF ratio of 0.9. In addition, rocuronium onset time (time from administration of rocuronium to 95% suppression of the first TOF twitch response), additional requirements for rocuronium and spontaneous recovery period (the time from administration of rocuronium to reappearance of the first TOF twitch response) were also measured. Neostigmine-induced recovery time was comparable between Group M and Group C (10.6 ± 4.3 vs. 9.1 ± 5.0 min, respectively, p = 0.22). The rocuronium onset time was shorter in Group M, and the spontaneous recovery period was longer in Group M. The amount of additional rocuronium administered was 27% lower in Group M, but this difference was not significant. Magnesium was not shown to prolong neostigmine-induced recovery time from neuromuscular blockade with rocuronium, however, it enhanced the clinical effects of rocuronium.
Subject(s)
Anesthetics , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents , Humans , Rocuronium , Neostigmine/pharmacology , Neostigmine/therapeutic use , Neuromuscular Blockade/adverse effects , Magnesium Sulfate/pharmacology , Magnesium Sulfate/therapeutic use , Neuromuscular Nondepolarizing Agents/pharmacology , Magnesium , Androstanols/pharmacologyABSTRACT
Onion (Allium cepa L.) is an economically important vegetable crop worldwide. However, various fungal diseases, including Fusarium basal rot (FBR), neck rot, and white rot, reduce onion production or bulb storage life. FBR caused by Fusarium species is among the most destructive onion diseases. In this study, we identified Fusarium species associated with FBR in Jeolla and Gyeongsang Provinces in South Korea and evaluated fungicides against the pathogens. Our morphological and molecular analyses showed that FBR in onions is associated with Fusarium commune, Fusarium oxysporum, and Fusarium proliferatum. We selected seven fungicides (fludioxonil, hexaconazole, mandestrobin, penthiopyrad, prochloraz-manganese, pydiflumetofen, and tebuconazole) and evaluated their inhibitory effects on mycelial growth of the pathogens at three different concentrations (0.01, 0.1, and 1 mg/mL). We found that prochloraz-manganese was highly effective, inhibiting 100% of the mycelial growth of the pathogens at all concentrations, followed by tebuconazole. Fludioxonil showed < 50% inhibition at 1 mg/mL for the tested isolates.
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BACKGROUND: Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings. AIM: The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings. DESIGN: Scoping review. DATA SOURCES: Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias. RESULTS: Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool. CONCLUSIONS: While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes. PROTOCOL REGISTRATION: Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU).
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BACKGROUND/AIM: Cancer-associated fibroblasts (CAFs) play an immunosuppressive role in the tumor microenvironment (TME) of human cancers; however, their characteristics and role in hepatocellular carcinoma (HCC) remain to be elucidated. METHODS: Nine tumor and surrounding liver tissue samples from patients with HCC who underwent surgery were used to isolate patient-derived CAFs. Cell morphology was observed using an optical microscope after culture, and cell phenotypes were evaluated using flow cytometry and immunoblotting. Cytokines secreted by CAFs into culture medium were quantified using a multiplex cytokine assay. RESULTS: CAFs were abundant in the TME of HCC and were adjacent to immune cells. After culture, the CAFs and non-tumor fibroblasts exhibited spindle shapes. We observed a robust expression of alpha-smooth muscle actin and fibroblast activation protein in CAFs, whereas alpha-fetoprotein, epithelial cell adhesion molecule, platelet/endothelial cell adhesion molecule-1, and E-cadherin were not expressed in CAFs. Furthermore, CAFs showed high secretion of various cytokines, namely C-X-C motif chemokine ligand 12, interleukin (IL)-6, IL-8, and C-C motif chemokine ligand 2. CONCLUSIONS: CAFs are abundant in the TME of HCC and play a crucial role in tumor progression. These fibroblasts secrete cytokines that promote tumor growth and metastasis.
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There is a paucity of clinical data about whether sugammadex forms precipitates with other medications. This laboratory experimental study was performed to determine the drugs that produce precipitates with sugammadex. Samples of 1 ml of sugammadex were prepared in transparent cylinders, to which 1 ml of test drugs (rocuronium, neostigmine, glycopyrrolate, atropine, nitroglycerin, dobutamine, dopamine, epinephrine, vasopressin, norepinephrine, phenylephrine, ephedrine, esmolol, nicardipine, and labetalol) was added. The precipitation reaction was observed visually and via light microscope. The pH of each drugs before and after mixing with sugammadex was measured. White crystals were formed when sugammadex was mixed with nicardipine or labetalol. Sugammadex formed precipitate when mixed with nicardipine or labetalol. Sufficient fluid flushing is required between injections of each drug to prevent these reactions.
Subject(s)
Labetalol , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents , Sugammadex , Nicardipine , Labetalol/therapeutic use , ResearchABSTRACT
Purpose: Appendectomy is one of the most common surgeries in children. Although various radiological examinations are performed, they do not always reveal a definitive diagnosis of appendicitis. This study aimed to investigate the clinical course of equivocal appendicitis, identify the factors associated with appendectomy, and suggest appropriate management for these patients. Methods: Patients younger than 19 years who visited Seoul National University Bundang Hospital with a differential diagnosis of appendicitis from January 2013 to December 2017 were included. All participants conducted 'appendiceal CT' with a scoring scale of 1-5. The higher the score, the higher the likelihood of a radiologic diagnosis of appendicitis. We defined the appendicitis CT score of 2-4 as equivocal appendicitis (n = 143). Medical records were reviewed retrospectively for demographics, further examination as abdominal ultrasonography, and appendectomy status (yes or no). The mean follow-up period was 15.6 ± 71 days. Results: Equivocal appendicitis accounted for 16.7%. Additional ultrasonography test was performed in 24.5% (35 of 143). In total, 34 patients (23.8%) underwent appendectomy. Among the patients with appendiceal CT scores 2, 3, and 4, 4.9%, 50.0%, and 87.5% underwent appendectomy, respectively. Higher WBC count, higher appendicitis CT score, and readmission were significantly associated with appendectomy in patients with equivocal appendicitis. Conclusion: Higher appendicitis CT score and WBC level were positively associated with appendectomy. Careful observation can be a treatment option in appendicitis CT score 2 or 3 groups. Appendectomy is the first-line treatment for patients with appendicitis score 4. Additional ultrasonography test is advisable to determine treatment modality for equivocal appendicitis.
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To investigate usefulness of 3D printing for preoperative evaluations, student and resident education, and communication with parents or guardians of patients with pediatric retroperitoneal tumors. Ten patients planning retroperitoneal tumor resection between March and November 2019 were included. Preoperative computed tomography (CT) images were used for 3D reconstruction and printing. Surveyed items were understanding of preoperative lesions with 3 different modules (CT, 3D reconstruction, and 3D printing) by students, residents, and specialists; satisfaction of specialists; and comprehension by guardians after preoperative explanations with each module. The median age at operation was 4.2 years (range, 1.8-18.1), and 8 patients were diagnosed with neuroblastoma. The 3D printing was the most understandable module for all groups (for students, residents, and specialists, P = 0.002, 0.027, 0.013, respectively). No significant intraoperative adverse events or immediate postoperative complications occurred. All specialists stated that 3D printing enhanced their understanding of cases. Guardians answered that 3D printing were the easiest to comprehend among the 3 modules (P = 0.007). Use of 3D printing in treatment of pediatric patients with retroperitoneal tumors was useful for preoperative planning, education, and parental explaining with obtaining informed consents.
Subject(s)
Retroperitoneal Neoplasms , Humans , Child , Infant , Child, Preschool , Adolescent , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/surgery , Printing, Three-Dimensional , Tomography, X-Ray Computed , Educational Status , Informed ConsentABSTRACT
Background: The present study aimed to investigate the incidence of preoperative ionized hypomagnesemia and compare with that of total hypomagnesemia. Methods: This prospective observational study included 536 patients aged >20 years who were scheduled for elective surgery. Total and ionized magnesium levels were evaluated before and after the surgery. Based on these levels, patients were classified into the following groups: ionized hypo- (<0.42 mmol/L), normo- (0.42-0.59 mmol/L) and hypermagnesemia (>0.59 mmol/L), as well as total hypo- (<1.9 mg/dL[0.78 mmol/L]), normo- (1.9-2.7 mg/dL[0.78-1.11 mmol/L]) and hypermagnesemia (>2.7 mg/dL [1.11 mmol/L]). The primary objective was to establish the incidence of preoperative ionized hypomagnesemia. Results: There was a marked difference between the incidence of preoperative ionized and total hypomagnesemia (28% vs. 19%; p<0.001). The postoperative values of ionized magnesium, ionized calcium, and albumin were significantly lower than the respective preoperative values (p<0.001 for all three variables). Conclusion: The incidence of hypomagnesemia, determined by ionized magnesium concentration, was higher than that determined by total magnesium concentration.
Subject(s)
Magnesium Deficiency , Magnesium , Adult , Albumins , Calcium , Humans , Incidence , Magnesium Deficiency/epidemiologyABSTRACT
Background: The virtual reality (VR) experience of an operation room (OR) prior to anesthesia and surgery has been known to reduce the anxiety and distress of pediatric patients. However, the proper timing needed for this is unknown. This randomized clinical study aimed to evaluate the proper timing of a VR tour of an OR (a few days before vs. immediately before anesthesia) to reduce the anxiety in a pediatric patient undergoing elective surgery. Methods: The children from the ages of 4-10 years old were randomly divided into three groups. The control group received standard verbal information about the process of anesthesia and surgery 10 min before anesthesia. The VR A group experienced a VR tour at the outpatient clinic a few days before anesthesia, whereas the VR B group experienced the tour 10 min before anesthesia at the reception area of the OR. The 4-min VR video used in this study showed the experience of Pororo, an animation character, entering the OR and undergoing anesthesia. We evaluated the anxiety of children using the modified Yale preoperative anxiety scale (m-YPAS), the anxiety of caregivers using Beck anxiety inventory (BAI), and caregivers' satisfaction. Results: The m-YPAS of the VR B group was significantly lower than that of the control and VR A groups (p = 0.001), whereas there was no statistically significant difference in BAI (p = 0.605) among the 3 groups. The score of caregivers' satisfaction with the overall process of anesthesia and surgery was higher in VR A group than in the control and VR B groups (p = 0.054). Conclusion: The VR experience of an OR immediately before anesthesia was more effective than standard verbal information or a VR tour at the outpatient clinic a few days before anesthesia in reducing the anxiety and distress of children prior to surgery. Clinical trial registration: [https://cris.nih.go.kr/cris/search/detailSearch.do/20773], identifier [KCT0006845].