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Comparison of L L Polyethylene Glycol Plus Ascorbic Acid and Oral Sodium Sulfate Tablets for Colonoscopy Bowel Preparation
No full textBackground and Aims: A low-volume (1 L) polyethylene glycol plus ascorbic acid (PEG-A) solution and an oral sodium sulfate tablet (OST) formulation are recently introduced agents for colonoscopy bowel preparation. This study investigated the efficacy, safety, and tolerability of 1 L PEG-A vs. OST. Methods: This single-center, prospective, randomized, endoscopist-blinded study randomly assigned patients into 2 groups: 1 L PEG-A (group A); and OST (group B). Efficacy of bowel preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Tolerability and safety were investigated with a standardized questionnaire. Results: A total of 174 patients were included in the final analysis (group A, n = 92; group B, n = 82). Successful bowel preparation was achieved in 91.3% and 95.1% of patients in groups A and B, respectively (p = 0.324). Overall mean satisfaction with bowel preparation was greater among those in group B vs. those in group A (8.2 ± 1.7 vs. 6.8 ± 2.0, respectively; p < 0.001). Although abdominal distension was less common in group A than group B (3/92 [3.3%] vs. 9/82 [11.0%], respectively; p = 0.045), overall adverse events developed similarly in both groups (27/92 [29.3%] vs. 21/82 [25.6%], p = 0.583). In subgroup analysis of older patients (≥65 years of age), efficacy, overall satisfaction, and safety profiles were not different between groups A and B. Conclusions: Both 1 L PEG-A and OST demonstrated efficacy, tolerability, and safety for colonoscopy bowel preparation. OST was slightly better tolerated, whereas 1 L PEG-A resulted in less abdominal distension. Both agents were effective and safe in older patients
Deep learning-based metastasis detection in patients with lung cancer to enhance reproducibility and reduce workload in brain metastasis screening with MRI: a multi-center study
No full textObjectives
To assess whether a deep learning-based system (DLS) with black-blood imaging for brain metastasis (BM) improves the diagnostic workflow in a multi-center setting.
Materials and methods
In this retrospective study, a DLS was developed in 101 patients and validated on 264 consecutive patients (with lung cancer) having newly developed BM from two tertiary university hospitals, which performed black-blood imaging between January 2020 and April 2021. Four neuroradiologists independently evaluated BM either with segmented masks and BM counts provided (with DLS) or not provided (without DLS) on a clinical trial imaging management system (CTIMS). To assess reading reproducibility, BM count agreement between the readers and the reference standard were calculated using limits of agreement (LoA). Readers’ workload was assessed with reading time, which was automatically measured on CTIMS, and were compared between with and without DLS using linear mixed models considering the imaging center.
Results
In the validation cohort, the detection sensitivity and positive predictive value of the DLS were 90.2% (95% confidence interval [CI]: 88.1-92.2) and 88.2% (95% CI: 85.7-90.4), respectively. The difference between the readers and the reference counts was larger without DLS (LoA: -0.281, 95% CI: -2.888, 2.325) than with DLS (LoA: -0.163, 95% CI: -2.692, 2.367). The reading time was reduced from mean 66.9 s (interquartile range: 43.2-90.6) to 57.3 s (interquartile range: 33.6-81.0) (P <.001) in the with DLS group, regardless of the imaging center.
Conclusion
Deep learning-based BM detection and counting with black-blood imaging improved reproducibility and reduced reading time, on multi-center validation
Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease
No full textBackground: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men
Effect of Teamwork, Communication Skill, and Organizational Silence on Surgical Competency of Operating Room Nurses
No full text최신 수술 기술과 장비의 발전으로 수술실 간호사들의 역할이 확장되고 있으며, 이로 인해 전문화된 역할이 강조되고 있다. 수술실 간호사는 다양한 수술 종류에 따른 의료진의 요구사항, 수술 기구와 장비, 그리고 진료재료에 대한 지식과 기술을 습득해야 하고, 수술 과정에서 수술간호를 수행하며 의료진과 효과적으로 협력해야 하므로 환자안전을 위해 팀워크와 효과적인 의사소통능력이 필요하다. 그러나 조직의 업무개선과 관련하여 의도적으로 자신의 생각이나 의견을 표현하지 않는 조직침묵은 조직내 의사소통과 혁신, 변화를 저해하고, 간호사의 긍정적인 직무태도를 약화시킨다. 따라서 본 연구는 수술실 간호사를 대상으로 팀워크, 의사소통능력, 조직침묵 및 수술업무역량을 파악하고, 수술업무역량에 미치는 영향을 검증하기 위해 시도된 서술적 조사연구이다. 본 연구의 자료수집은 연구윤리위원회의 승인을 받은 후 2023년 8월 18일부터 9월 4일까지 1개의 상급종합병원과 5개의 종합병원에서 수술실에 근무하는 수술실 간호사 총 164명을 대상으로 자기 보고식 설문지를 이용하여 실시되었다. 설문지는 대상자의 일반적 특성, 팀워크, 의사소통능력, 조직침묵, 수술업무역량에 관한 도구로 구성되었다. 수집된 자료는 IBM SPSS statistics 29.0 프로그램을 이용하여 연구목적에 따라 독립표본 t검정, 일원배치 분산분석, 피어슨 상관 분석, 다중 회귀 분석으로 분석하였으며, 연구 결과는 다음과 같다. 첫째, 대상자의 팀워크는 5점 만점에 3.82±0.55점이었으며 의사소통능력은 205점 만점에 151.66±13.50점이었다. 조직침묵과 수술업무역량은 각각 5점 만점에 3.19±0.64점과 3.66±0.55점으로 나타났다. 둘째, 일반적 특성에 따른 수술업무역량은 연령(F=5.87, p=.003), 결혼상태(t=- 2.78, p=.006), 근무경력(F=-3.91, p<.001), 근무형태(F=-2.39, p=.018), 직급(F=5.17, p=.002), 월수입(F=-3.02, p=.003), 교육경험(t=4.37, p<.001), 병상수(F=6.10, p=.003)에서 유의한 차이가 나타났다. 셋째, 수술실 간호사의 팀워크, 의사소통능력, 조직침묵 및 수술업무역량 간 관계에서 수술업무역량은 팀워크(r=.37, p<.001), 의사소통능력(r=.49, p<.001)과 유의한 양의 관계, 조직침묵(r=-.45, p<.001)과는 유의한 음의 상관관계를 나타냈다. 넷째, 다중회귀분석 결과, 프리셉터 교육경험이 있는 경우(β=.25, p<.001) 수술업무역량이 유의하게 높았으며, 의사소통능력(β=.46, p<.001)이 높을수록, 수술업무역량은 높아짐을 알 수 있었다. 본 연구를 통하여 수술실 간호사의 프리셉터 교육경험과 의사소통능력이 수술실 간호사의 수술업무역량에 영향력 있는 변수임을 확인할 수 있었다. 이에 수술실 간호사의 수술업무역량을 높이기 위한 방안으로 수술실 간호사의 의사소통능력을 개발하고, 관련 교육을 모색하여 이를 수술실 간호사에게 적용시킬 필요가 있다. 주요어: 수술, 수술실, 수술실 간호사, 팀워크, 의사소통능력, 수술간호, 조직침묵, 수술업무역량, 역량Maste
Seismic Behavior Characteristics of Spherical Storage Tanks Supported by Inelastic Members and Performance-Based Seismic Design Based on Reliability
No full text비선형지지구조 저장탱크의 지진거동 특성과 신뢰도 기반 성능기반 내진설계 울산대학교 대학원 건설환경공학과 장 정 민 산업시설은 국가의 경제에 상당한 기여를 하는 중요한 시설일뿐만 아니라 피해 시 화재 및 폭발, 유해물질의 누출로 인한 토양, 수질 및 대기 오염 등 상당한 2차 피해도 유발된다. 석유화학 플랜트에는 여러 기계설비 및 구조물이 서로 연계되어 운전성을 확보한다. 따라서 이들 시설물 중 하나라도 지진 시 파괴가 발생하면 운 전성을 확보할 수 없으며, 이는 직간접적으로 국가 경제에 큰 영향을 미친다. 현행 내진설계는 붕괴방지를 목표로 하고 운전성 확보에 미흡하므로 성능기반 내 진설계가 필요하다. 따라서 같은 공정에 속한 시설물은 설계지진에 대해 운전성이 확보 되도록 내진성능을 확보하여야 하며, 시설물의 지진거동에 따라 다른 손상수 준(내진성능수준)을 부여하는 것이 바람직하다. 성능기반 설계는 현행의 사양기반 설계와 대비되는 설계개념이다. 사양기반 설계는 규정된 설계법 이외의 다른 설계 법을 허용하지 않는 데 반해 성능기반 설계는 요구되는 성능을 만족한다는 것이 검 증된다면 어떠한 설계법도 허용한다. 이 연구에서는 비선형지지구조를 갖는 구형 저장탱크의 비선형 동적해석을 통해 지진거동 특성을 분석하였다. 비선형 해석기법은 해석적 검증방법 시 적용 가능하 고, 분석된 지진거동 특성은 성능기반설계의 대안적 설계방법의 기초자료로 활용된 다. 구형(볼) 저장탱크는 여러 개의 기둥과 브레이스로 지지되어 브레이스와 기둥의 좌굴 및 항복 등으로 지진 시 복잡한 비선형거동을 보인다. 이 연구에서는 비선형 거동 특성을 통계적으로 분석하고 이에 기반하여 성능기반 내진설계의 새로운 방법 을 제시하였다.Maste
Pamrevlumab for Idiopathic Pulmonary Fibrosis: The ZEPHYRUS-1 Randomized Clinical Trial
No full textImportance: Current treatments for idiopathic pulmonary fibrosis slow the rate of lung function decline, but may be associated with adverse events that affect medication adherence. In phase 2 trials, pamrevlumab (a fully human monoclonal antibody that binds to and inhibits connective tissue growth factor activity) attenuated the progression of idiopathic pulmonary fibrosis without substantial adverse events.
Objective: To assess the efficacy and safety of pamrevlumab for patients with idiopathic pulmonary fibrosis.
Design, setting, and participants: Phase 3 randomized clinical trial including 356 patients aged 40 to 85 years with idiopathic pulmonary fibrosis who were not receiving antifibrotic treatment with nintedanib or pirfenidone at enrollment. Patients were recruited from 117 sites in 9 countries between July 18, 2019, and July 29, 2022; the last follow-up encounter occurred on August 28, 2023.
Interventions: Pamrevlumab (30 mg/kg administered intravenously every 3 weeks; n = 181) or placebo (n = 175) for 48 weeks.
Main outcomes and measures: The primary outcome was absolute change in forced vital capacity (FVC) from baseline to week 48. There were 5 secondary outcomes (including time to disease progression, which was defined as a decline of ≥10% in predicted FVC or death). The exploratory outcomes included patient-reported symptoms. Adverse events were reported.
Results: Among 356 patients (mean age, 70.5 years; 258 [72.5%] were men; 221 [62.1%] were White), 277 (77.8%) completed the trial. There was no significant between-group difference for absolute change in FVC from baseline to week 48 (least-squares mean, -260 mL [95% CI, -350 to -170 mL] in the pamrevlumab group vs -330 mL [95% CI, -430 to -230 mL] in the placebo group; mean between-group difference, 70 mL [95% CI, -60 to 190 mL], P = .29). There were no significant between-group differences in any of the secondary outcomes or in the patient-reported outcomes. In the pamrevlumab group, there were 160 patients (88.4%) with treatment-related adverse events and 51 patients (28.2%) with serious adverse events vs 151 (86.3%) and 60 (34.3%), respectively, in the placebo group. During the study, 23 patients died in each group (12.7% in the pamrevlumab group vs 13.1% in the placebo group).
Conclusions and relevance: Among patients with idiopathic pulmonary fibrosis treated with pamrevlumab or placebo, there was no statistically significant between-group difference for the primary outcome of absolute change in FVC from baseline to week 48
Trastuzumab deruxtecan versus trastuzumab emtansine in Asian patients with HER2-positive metastatic breast cancer
No full textThe global phase 3 DESTINY-Breast03 study (ClinicalTrials.gov; NCT03529110) showed statistically significant and clinically meaningful improvements in progression-free survival (PFS) and overall survival (OS) with trastuzumab deruxtecan (T-DXd) over trastuzumab emtansine (T-DM1) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) previously treated with trastuzumab and a taxane. Here, we report a subgroup analysis of Asian patients enrolled in DESTINY-Breast03. In total, 309 patients (149 in the T-DXd arm and 160 in the T-DM1 arm) from Asian countries and regions were randomized. At data cutoff (July 25, 2022), the median duration of follow-up in the Asian subpopulation was 29.0 months with T-DXd and 26.0 months with T-DM1. The PFS (determined by blinded independent central review) hazard ratio was 0.30 (95% confidence interval 0.22-0.41) favoring T-DXd over T-DM1 (median PFS 25.1 vs. 5.4 months). Median OS was not reached in the T-DXd arm and was 37.7 months in the T-DM1 arm. The median treatment duration was 15.4 months with T-DXd and 5.5 months with T-DM1. The incidence of grade ≥3 drug-related treatment-emergent adverse events was similar between both treatment arms (49.0% vs. 46.5%) and was consistent with the overall DESTINY-Breast03 population. Adjudicated drug-related interstitial lung disease or pneumonitis occurred in 12.9% of patients treated with T-DXd and 2.5% treated with T-DM1, with a higher incidence in Japanese patients; none of these were grade ≥4 events. These efficacy and safety data reinforce the favorable benefit-risk profile of T-DXd in HER2-positive mBC, including in the Asian subgroup
Impact of preoperative nonselective beta-blocker use on acute kidney injury after living donor liver transplantation: Propensity score analysis
No full textIntroduction and Objectives
Acute kidney injury (AKI) is prevalent and has deleterious effects on postoperative outcomes following liver transplantation (LT). The impact of nonselective beta-blockers (NSBBs) in patients with liver cirrhosis remains controversial. This study investigated the association between preoperative NSBB use and AKI after living donor LT (LDLT).
Patients and Methods
We evaluated 2,972 adult LDLT recipients between January 2012 and July 2022. The patients were divided into two groups based on the preoperative NSBB use. Propensity score matched (PSM) and inverse probability of treatment weighting (IPTW) analyses were performed to evaluate the association between preoperative NSBB use and postoperative AKI. Multiple logistic regression analyses were also used to identify the risk factors for AKI.
Results
The overall incidence of AKI was 1,721 (57.9%) cases. The NSBB group showed a higher incidence of AKI than the non-NSBB group (62.4% vs. 56.7%; P = 0.011). After PSM and IPTW analyses, no significant difference in the incidence of AKI was found between the two groups (Odds ratio, OR 1.13, 95% confidence interval, CI 0.93-1.37, P = 0.230, PSM analysis; OR 1.20, 95% CI 0.99-1.44, P = 0.059, IPTW analysis). In addition, preoperative NSBB use was not associated with AKI after multivariate logistic regression analysis (OR 1.16, 95% CI 0.96-1.40, P = 0.118).
Conclusions
Preoperative NSBB use was not associated with AKI after LDLT. Further studies are needed to validate our results
Recommendations for evaluating photoplethysmography-based algorithms for blood pressure assessment
No full textPhotoplethysmography (PPG) is a non-invasive optical technique that measures changes in blood volume in the microvascular tissue bed of the body. While it shows potential as a clinical tool for blood pressure (BP) assessment and hypertension management, several sources of error can affect its performance. One such source is the PPG-based algorithm, which can lead to measurement bias and inaccuracy. Here, we review seven widely used measures to assess PPG-based algorithm performance and recommend implementing standardized error evaluation steps in their development. This standardization can reduce bias and improve the reliability and accuracy of PPG-based BP estimation, leading to better health outcomes for patients managing hypertension
Ultrathin Holey Pt-M Alloy Nanosheets via Sequential Kinetic-Thermodynamic Metal Reduction Control
No full textUltrathin two-dimensional (2D) metal nanosheets have attracted significant attention in the field of electrocatalysis. Herein, we present a rational synthetic approach mediated by sequential kinetic-thermodynamic metal reduction control for holey ultrathin Pt3M alloy nanosheets (Pt3M HU-NSs, where M = Ni, Co, Cu, Ir, Pd, Ru, Rh, Fe, or Mn) with a thickness of approximately 3 nm and abundant edge sites. The unique sequential kinetic-thermodynamic metal reduction control provides fine-tuning over the anisotropic 2D growth of Pt-based alloy nanostructures by restraining the three-dimensional growth of metals and stabilizing low-coordinated edge sites. The Pt3Ni HU-NSs display significantly enhanced oxygen reduction reaction activity and stability compared to other Pt3M HU-NSs, pure Pt HU-NSs, and state-of-the-art Pt/C catalysts, attributed to their distinctive morphology and composition. We believe that this synthesis strategy provides insights into the development of ultrathin 2D metal alloy structures with abundant edge sites that can be deployed to create advanced electrocatalysts