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Medical Applications of 3D Printing and Standardization Issues
Get PDFThe three-dimensional (3D) printing itself is not a novel technology, it is more than 30 years old. Stereolithographic
(SLA) technology has been used as the first and popular technology for medical application
of 3D printing. Since 1991 Radiology and Plastic Surgery have published articles about SLA for
rapid prototyping anatomical 3D models. Medical applications of 3D printing have been popularizing
and stabilizing so far. Implantable medical devices such as metal or absorbable implants, surgical
guide systems, prosthesis and orthosis, and 3D anatomical models for normal or diseased anatomy
have been developing and expanding its markets so far. There are many obstacles, such as insurance,
authorization as a medical device, and lack of standards technology for further expansion of medical
applications. Many technical specifications and guidelines for authorization as medical device have
been published by regulatory bodies from many countries. Even though international standards for 3D
printing have been developing more and more, there have been few standards for medical application
of 3D printing. In this harsh environment academia, company, research institute, regulatory bodies, and
government have been doing good job for the development of 3D printing industry.ope
Long-Term Clinical Outcomes of Patients with Chronic Obstructive Pulmonary Disease with Sarcopenia
Get PDFBackground and objective: Sarcopenia with muscle wasting and weakness is a common occurrence among patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the clinical outcomes of sarcopenia in patients with COPD. Methods: We reviewed the electronic medical records of 71 patients with COPD between 1 January 2012, and 31 December 2018. We longitudinally analyzed clinical outcomes in patients with COPD with and without sarcopenia. Results: Compared to the non-sarcopenia group COPD, the sarcopenia group showed a higher rate of acute exacerbation events of COPD (AE COPD, 84.6% vs. 31.0%, p = 0.001), all-cause mortality (30.8% vs. 5.2%, p = 0.022), and pneumonia occurrence per year (median [first quartile–third quartile]; 0.2 [0.0–1.6] vs. 0.0 [0.0–0.2], p = 0.025). Sarcopenia was an independent risk factor for AE COPD in Cox regression analysis (hazard ratio, 5.982; 95% confidence interval, 1.576–22.704). Hand grip strength was associated with the COPD Assessment Test (CAT) score and annual Charlson’s comorbidity index score change. Total skeletal muscle mass index (SMMI) was associated with the modified medical research council dyspnea scale score, CAT score, body mass index, airflow obstruction, dyspnea, and exercise (BODE) index, and alanine transaminase. Trunk SMMI was significantly associated with AE COPD, while appendicular SMMI was associated with BODE index and annual intensive care unit admissions for AE COPD. Conclusions: Sarcopenia is associated with clinical prognosis, pneumonia occurrence, and the acute exacerbation of COPD requiring intensive care in patients with COPD. Therefore, it is important to carefully monitor sarcopenia development as well as recommend appropriate exercise and nutritional supplementation in patients with COPD.ope
Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial
Get PDFBACKGROUND: To maintain adequate oxygenation is of utmost importance in intraoperative care. However, clinical evidence supporting specific oxygen levels in distinct surgical settings is lacking. This study aimed to compare the effects of 30% and 80% oxygen in off-pump coronary artery bypass grafting (OPCAB). METHODS: This multicenter trial was conducted in three tertiary hospitals from August 2019 to August 2021. Patients undergoing OPCAB were cluster-randomized to receive either 30% or 80% oxygen intraoperatively, based on the month when the surgery was performed. The primary endpoint was the length of hospital stay. Intraoperative hemodynamic data were also compared. RESULTS: A total of 414 patients were cluster-randomized. Length of hospital stay was not different in the 30% oxygen group compared to the 80% oxygen group (median, 7.0 days vs 7.0 days; the sub-distribution hazard ratio, 0.98; 95% confidence interval [CI] 0.83-1.16; P = 0.808). The incidence of postoperative acute kidney injury was significantly higher in the 30% oxygen group than in the 80% oxygen group (30.7% vs 19.4%; odds ratio, 1.94; 95% CI 1.18-3.17; P = 0.036). Intraoperative time-weighted average mixed venous oxygen saturation was significantly higher in the 80% oxygen group (74% vs 64%; P < 0.001). The 80% oxygen group also had a significantly greater intraoperative time-weighted average cerebral regional oxygen saturation than the 30% oxygen group (56% vs 52%; P = 0.002). CONCLUSIONS: In patients undergoing OPCAB, intraoperative administration of 80% oxygen did not decrease the length of hospital stay, compared to 30% oxygen, but may reduce postoperative acute kidney injury. Moreover, compared to 30% oxygen, intraoperative use of 80% oxygen improved oxygen delivery in patients undergoing OPCAB. Trial registration ClinicalTrials.gov (NCT03945565; April 8, 2019). © 2023. The Author(s).ope
Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study
Get PDFPurpose: The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR6m <60 mL/min/1.73 m2(eGFR6m <60) and identify the risk factors that can predict the occurrence of eGFR6m <60 in living kidney donors.
Materials and Methods: Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR6m <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR6m <60 occurrence were determined using the Youden index.
Results: The eGFR6m <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m2), and degree of increase in creatinine levels on postoperative day 2 compared to those before sur gery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR6m <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR6m <60 than that with preoperative eGFR alone {area under the receiver operating charac teristic curve=0.886 [95% confidence interval (CI), 0.863–0.908] vs. 0.862 (95% CI, 0.838–0.887), p<0.001}.
Conclusion: The incidence of eGFR6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR6m <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR6m <60.ope
Comparison of spasmolytic regimen for prevention of radial artery spasm during the distal radial approach: A single-center, randomized study
Get PDFBackground: The distal radial approach (DRA) for coronary catheterization is increasingly being used worldwide yet the optimal medication regimen to prevent radial artery spasm (RAS), an important factor for the success of the procedure, remains unclear. The aim of this study is to examine the effectiveness of medication for preventing RAS via the DRA.
Methods: This was a prospective, comparative randomized study including 400 patients who underwent coronary catheterization via DRA in single center by three experienced DRA operators. Patients were randomized to either nitroglycerin (NTG) injection (N = 200) or NTG plus verapamil (N = 200) to compare the effectiveness and safety of these regimens.
Results: There were no differences between the groups in the changes in radial artery diameter at most spastic area (0.34 ± 0.20 in the NTG group, 0.35 ± 0.20 in the NTG plus verapamil group; P = 0.73). There was no difference between the groups in the ratio of patients without arm pain during the procedure (95.0% in the NTG group, 93.5% in the NTG plus verapamil group; P = 0.67). However, there was a greater reduction in diastolic blood pressure in the NTG plus verapamil group (-8.3 ± 7.9 mmHg) than in the NTG group (-6.6 ± 7.6 mmHg) (P = 0.03).
Conclusion: Intra-arterial injection of NTG as a single agent is effective and safe in the prevention of RAS during coronary catheterization via the DRA compared with a cocktail regimen of NTG plus verapamil.
cocktail regimen of NTG plus verapamil.ope
Sex differences in the anatomy of the anterior-superior acetabular rim in relation to pincer-type femoroacetabular impingement in Koreans: a three-dimensional quantitative analysis
Get PDFPURPOSE: The aim of this study was to compare the anatomical structures of the acetabular rim around the anterior inferior iliac spine (AIIS) ridge that indicate anterior focal coverage of acetabulum between the sexes using a three-dimensional (3D) model. METHODS: 3D models of 71 adults (38 men and 33 women) with normal hip joints were used. Based on the location of the inflection point (IP) of the acetabular rim around the AIIS ridge, the patients were classified into anterior and posterior types, and the ratios thereof for each sex were compared. Coordinates for the IP, the most anterior point (MAP), and the most lateral point (MLP) were obtained and compared between the sexes and between anterior and posterior types. RESULTS: Coordinates for IPs in men were located anterior and inferior to those in women. MAP coordinates for men were located inferior to those for women, and MLP coordinates for men were located lateral and inferior to those for women. Comparing AIIS ridge types, we noted that coordinates for IPs of the anterior type were located medial, anterior, and inferior to those of the posterior type. Meanwhile, MAP coordinates of the anterior type were located inferior to those of the posterior type, and MLP coordinates of the anterior type were located lateral and inferior to those of the posterior type. CONCLUSION: Anterior focal coverage of the acetabulum appears to differ between the sexes, and this difference may affect the development of pincer-type femoroacetabular impingement (FAI). Additionally, we found that anterior focal coverage differs according to anterior or posterior positioning of the bony prominence around the AIIS ridge, which may affect development of FAI. © 2023. The Author(s).ope
Validation of original, alternative, and updated alternative fistula risk scores after open and minimally invasive pancreatoduodenectomy in an Asian patient cohort
No full textBackground: This study aimed to validate and compare the performance of the original fistula risk scores (o-FRS), alternative (a-FRS), and updated alternative FRS (ua-FRS) after open pancreatoduodenectomy (OPD) and laparoscopic pancreatoduodenectomy (LPD) in an Asian patient cohort.
Methods: Data of 597 consecutive patients who underwent PD (305 OPD, 274 LPD) were collected from two tertiary centers. Model performance was assessed using the area under the receiver operating curve (AUC).
Results: The overall AUC values of o-FRS, a-FRS, and ua-FRS were 0.67, 0.69, and 0.68, respectively, which were lower than those of the Western validation. Three FRS systems had similar AUC values in the overall and OPD groups, whereas ua-FRS had a higher AUC than o-FRS in the LPD group. The accuracy of ua-FRS (47.2%) was higher than that of o-FRS (39.0%) and a-FRS (19.5%) overall, but low specificity and low positive predictive value were observed regardless of the operative type across the three FRS systems. In the multivariate analysis, pathology, estimated blood loss, and body mass index were not independent risk factors for CR-POPF in the OPD and LPD groups.
Conclusions: Current FRS systems have some limitations, including a relatively lower performance in an Asian cohort, low positive predictive values, and inclusion of insignificant risk factors.restrictio
Risk Assessment of Periodontitis according to Metabolic Score for Insulin Resistance in Korean Population: Korea National Health and Nutrition Examination Survey VI (2013–2015)
Get PDFBackground: Studies have reported an association between periodontitis, a chronic inflammatory disease of the periodontal tissues, and insulin resistance. The Metabolic Score for Insulin Resistance (METS-IR) index was recently developed to assess insulin resistance. This study aimed to investigate the association between periodontitis and insulin resistance according to the METS-IR index.
Methods: A total of 10,807 participants from the 6th National Health and Nutrition Examination Survey (2013–2015) were included in this study. We defined periodontitis as the community periodontal index score of 3 or higher in at least one site. Multiple logistic regression analyses were conducted to calculate odds ratios (OR) and 95% confidence intervals (CI) for periodontitis according to METS-IR index quartiles.
Results: Compared to the lowest quartile (Q1), the OR (95% CI) for periodontitis were 1.61 (1.37–1.90) in the second quartile (Q2), 2.37 (2.03–2.77) in the third quartile (Q3), and 2.89 (2.45–3.41) in the highest quartile (Q4) of the unadjusted model. After the adjustment for confounders, compared to Q1, the OR (95% CI) for periodontitis was 1.15 (0.93–1.42) in Q2, 1.30 (1.04–1.62) in Q3, and 1.39 (1.09–1.77) in Q4.
Conclusion: Our study found that METS-IR index had a significant positive association with the prevalence of periodontitis.ope
Alternative splicing in shaping the molecular landscape of the cochlea
Get PDFThe cochlea is a complex organ comprising diverse cell types with highly specialized morphology and function. Until now, the molecular underpinnings of its specializations have mostly been studied from a transcriptional perspective, but accumulating evidence points to post-transcriptional regulation as a major source of molecular diversity. Alternative splicing is one of the most prevalent and well-characterized post-transcriptional regulatory mechanisms. Many molecules important for hearing, such as cadherin 23 or harmonin, undergo alternative splicing to produce functionally distinct isoforms. Some isoforms are expressed specifically in the cochlea, while some show differential expression across the various cochlear cell types and anatomical regions. Clinical phenotypes that arise from mutations affecting specific splice variants testify to the functional relevance of these isoforms. All these clues point to an essential role for alternative splicing in shaping the unique molecular landscape of the cochlea. Although the regulatory mechanisms controlling alternative splicing in the cochlea are poorly characterized, there are animal models with defective splicing regulators that demonstrate the importance of RNA-binding proteins in maintaining cochlear function and cell survival. Recent technological breakthroughs offer exciting prospects for overcoming some of the long-standing hurdles that have complicated the analysis of alternative splicing in the cochlea. Efforts toward this end will help clarify how the remarkable diversity of the cochlear transcriptome is both established and maintained.ope
Age at onset of alcohol consumption and its association with alcohol misuse in adulthood
Get PDFObjective: This study aimed to explore the association between early age onset of
alcohol consumption and alcohol misuse in adulthood.
Methods: The study sample consisted of 16 829 individuals' (8349 males, 8435 females)
survey responses obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 through 2019. Alcohol dependence was measured using the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption), and the ages at which alcohol consumption began were grouped into four categories: under 16, 16 to 18, 19 to 23, and over 24. Multiple logistic regression was used to examine the association between current alcohol misuse and age at onset of alcohol consumption.
Results: Compared to individuals who started drinking alcohol after the age of 24, those
who began drinking alcohol before the age of 16 were more likely to score 8 or more on
AUDIT-C questions (under 16: males, odds ratio [OR] 2.50, confidence interval [CI] 1.97–
3.17; females, OR: 1.66, CI: 1.18–2.33). Similar to the main analysis, the earlier the onset
of alcohol assumption starts, the more likely one is to develop alcohol misuse in adult?hood according to subgroup analysis stratified by independent variables in both gender.
Conclusion: The lower the age at the onset of alcohol consumption, the higher the
likelihood of alcohol misuse in adulthood. While both males and females showed the
same trend in response to the AUDIT-C questions, males tended to have a stronger
association between early onset alcohol consumption and alcohol misuseope