Machine learning for prediction of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a still highly relevant problem and is known to be a distressing side effect in patients. The aim of this study was to develop a machine learning model to predict PONV up to 24 h with fentanyl-based intravenous patient-controlled analgesia (IV-PCA). METHODS: From July 2019 and July 2020, data from 2,149 patients who received fentanyl-based IV-PCA for analgesia after non-cardiac surgery under general anesthesia were applied to develop predictive models. The rates of PONV at 1 day after surgery were measured according to patient characteristics as well as anesthetic, surgical, or PCA-related factors. All statistical analyses and computations were performed using the R software. RESULTS: A total of 2,149 patients were enrolled in this study, 337 of whom (15.7%) experienced PONV. After applying the machine-learning algorithm and Apfel model to the test dataset to predict PONV, we found that the area under the receiver operating characteristic curve using logistic regression was 0.576 (95% confidence interval [CI], 0.520-0.633), k-nearest neighbor was 0.597 (95% CI, 0.537-0.656), decision tree was 0.561 (95% CI, 0.498-0.625), random forest was 0.610 (95% CI, 0.552-0.668), gradient boosting machine was 0.580 (95% CI, 0.520-0.639), support vector machine was 0.649 (95% CI, 0.592-0.707), artificial neural network was 0.686 (95% CI, 0.630-0.742), and Apfel model was 0.643 (95% CI, 0.596-0.690). CONCLUSIONS: We developed and validated machine learning models for predicting PONV in the first 24 h. The machine learning model showed better performance than the Apfel model in predicting PONV.

Evaluation of the relationship between non-caries cervical lesions and the tooth and periodontal tissue: An ex-vivo study using micro-computed tomography.

The purpose of this study was to analyze the relationship between the height and depth of buccal non-carious cervical lesions (NCCLs) and the relationship between the size of buccal NCCLs and clinical crown-root ratio of both buccal and lingual (palatal) sides using micro-computed tomography (micro-CT) images of the teeth and periodontal tissues from the cadavers. The micro-CT images of 56 teeth and their supporting tissues were obtained from 17 cadavers. From these images, the height and depth of NCCLs and the length of the buccal and lingual (palatal) clinical crowns were measured, and the conventional/modified clinical crown-root ratios were calculated. The height and depth ratio of NCCLs were analyzed statistically with the conventional/modified crown-root ratios by Pearson's correlation and multiple regression. According to the Pearson's correlation, the height and depth of buccal NCCLs were positively correlated with the modified buccal clinical crown-root ratio (p < 0.001 and p = 0.013, respectively). The regression model composed of variables of crown-root ratios explained the height of buccal NCCLs, and the prominent factor of the model was the modified buccal clinical crown-root ratio (p < 0.001). Moreover, the depth of buccal NCCLs was also explained by the regression model, and its prominent factor was the proportion of modified buccal and lingual (palatal) clinical crowns (p = 0.004). The buccal NCCLs were related to the crown-root ratios; particularly, the level of buccal gingival margin could be associated with the formation of buccal NCCLs.

Comparison of impacts of intraperitoneal saline instillation with and without pulmonary recruitment maneuver on post-laparoscopic shoulder pain prevention: a randomized controlled trial.

BACKGROUND: Intraperitoneal isotonic saline instillation (SI) and pulmonary recruitment maneuver (RM) were indicated to alleviate post-laparoscopic shoulder pain (PLSP) effectively. The aim of this study was to compare the effects of the single strategy using SI alone and the combined strategy using SI and RM on PLSP reduction. METHODS: Subjects undergoing elective gynecologic laparoscopy were randomly allocated to a control group (no intervention, n = 48) and two intervention groups (single strategy of SI alone, n = 48; combined strategy of SI and RM, n = 48). In the control group, carbon dioxide was removed only via passive evacuation through the port sites at the completion of the laparoscopic procedure. In the saline instillation group, 20-mL/kg of body weight SI was performed. In the combined strategy group, RM using five pulmonary inflations was performed, in addition to SI. The PLSP scores, which were the primary outcome, were recorded using a visual analog scale postoperatively. RESULTS: The PLSP scores 24 and 48 h after surgery were significantly lower in the two intervention groups than in the control group (P = 0.014 and P = 0.001, respectively), while no significant differences were observed between the two intervention groups. CONCLUSIONS: The single strategy using SI alone is as effective as the combined strategy of SI and RM for removing residual carbon dioxide and consequently preventing PLSP. Therefore, considering the potential risks of pulmonary or hemodynamic complications associated with RM, the single strategy using SI alone might be a better choice than the combined strategy.

Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy.

Background: Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method: The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results: Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions: PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.