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Comparative Analysis of Ultrasound and Surgical Findings in Anatomical Variations of de Quervain’s Disease
No full textBACKGROUND: This study compares ultrasound and surgical findings of anatomical variations in de Quervain's disease. METHODS: Seventy-four wrists from patients with unilateral de Quervain's disease were examined through ultrasonography and surgery. Presence of intracompartment septum, abductor pollicis longus (APL) slips, and selective stenosis were verified by both methods. Two orthopedic surgeons assessed ultrasound findings for intra- and interobserver reliability. RESULTS: Amongst 74 participants (43 women and 31 men), 60.8% had a complete septum, 31.1% had an incomplete septum, and 8.1% had no septum; 70.3% had multi-slip APL and 66.2% had extensor pollicis brevis stenosis. Surgical and ultrasonographic findings displayed a high level of sensitivity and specificity. Intraobserver reliability was high, and interobserver reliability was substantial. CONCLUSIONS: The study confirms ultrasonography's reliability in identifying anatomical variations in de Quervain's disease, with high sensitivity, specificity, and substantial intra- and interobserver reliability, emphasizing its usefulness in preoperative assessment and planning
The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04)
No full textBackground/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150-275) vs. 170 (105-265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons
Validity, reliability and responsiveness of digital visual analogue scales for chronic spontaneous urticaria monitoring: A CRUSE® mobile health study
No full textBACKGROUND: CRUSE(R) is an app that allows patients with chronic spontaneous urticaria (CSU) to monitor their daily disease activity through the use of visual analogue scales (VASs). We aimed to determine the concurrent validity, reliability, responsiveness and minimal important difference (MID) of CRUSE(R) VASs. METHODS: We evaluated the properties of three daily VASs: VAS for how much patients were affected by their CSU ('VAS urticaria'), VAS for the impact of urticaria on work/school productivity ('VAS productivity') and the VAS of EQ-5D. Concurrent validity was assessed by measuring the association between each VAS and the Urticaria Activity Score (UAS). Intra-rater reliability was determined based on the data of users providing multiple daily questionnaires within the same day. Test-retest reliability and responsiveness (ability to change), respectively, were tested in clinically stable and clinically unstable users. MIDs were determined using distribution-based methods. RESULTS: We included 5938 patients (67,380 days). Concurrent validity was high, with VAS urticaria being more strongly associated with the UAS score than the remaining VASs. Intra-rater reliability was also high, with intraclass correlation coefficients (ICC) being above 0.950 for all VASs. Moderate-high test-retest reliability and responsiveness were observed, with reliability ICC being highest for VAS EQ-5D and responsiveness being highest for VAS urticaria. The MID for VAS urticaria was 17 (out of 100) units, compared to 15 units for VAS productivity and 11 units for VAS EQ-5D. CONCLUSION: Daily VASs for CSU available in the CRUSE(R) app display high concurrent validity and intra-rater reliability and moderate-high test-retest reliability and responsiveness
Medication-Taking Trajectory and Its Correlates in Patients With Diabetes: Based on the Information–Motivation–Behavioral Skills Model
No full textPURPOSE: The purpose was to identify trajectories of medication taking among patients with diabetes and investigate correlates of these trajectories using the information-motivation-behavioral skills (IMB) model. METHODS: This study employed a descriptive correlational, longitudinal design using convenience sampling. The participants were 96 adults with diabetes from an outpatient diabetes clinic at a university-affiliated hospital. Medication taking was assessed at 3 time points: baseline, 6 months, and 12 months. At baseline, study variables based on the IMB model were measured: medication knowledge (information), motivational readiness and social support (motivation), and medication self-efficacy (behavioral skills). Group-based trajectory modeling was used to identify medication-taking trajectories, and multinomial logistic regression was used to assess factors associated with medication-taking trajectories. RESULTS: Three distinct medication-taking trajectory groups were identified: "high medication taking," "increasing medication taking," and "low medication taking." Higher medication knowledge was associated with the high and increasing medication-taking trajectory groups. Motivational readiness was associated with the high and increasing medication-taking groups. In contrast, higher medication self-efficacy was associated only with the high medication-taking group, not with the increasing and low medication-taking groups. CONCLUSIONS: The findings suggest that knowledge, motivational readiness, and self-efficacy are essential in IMB model-based intervention strategies across dynamic medication-taking patterns to enhance medication taking. Health care providers can help patients with diabetes improve medication taking by understanding their medication-taking trajectories and their correlates. Strategies that enhance medication self-efficacy are essential for patients in the increasing and low medication-taking groups
Impact of Regulatory Post-Market Safety Advisories on Prescribing Practices: An Interrupted Time Series Analysis
No full textLess frequent adverse drug reactions are usually discovered after a drug's release to the market, making effective and timely communication of regulatory post-market advisories essential for preventing emerging adverse effects. Time series analysis is a key study design for assessing the impact of post-market safety advisories. However, most previous studies have focused on narrow evaluations, limiting systematic assessment of how different safety advisories affect prescribing practices. This study aimed to investigate changes in prescribing practices following regulatory post-market safety advisories in Korea. Interrupted time series analyses were conducted using nationwide claims data from 2018 to 2021 and hospital datasets covering the period from 2 years before and 3 years after post-market safety advisories. We categorized the selected drugs into two groups: safety warning through letters and real-time safety alarms (contraindications or requiring attention). Twelve post-market safety advisories were analyzed, including four safety warnings and eight safety alarms, which showed an overall relative reduction (safety warning: relative change [95% confidence interval]: -8.06% [-10.23% to -5.84%], safety alarm on contraindication: -92.65% [-95.65% to -87.59%], and safety alarm on requiring attention: -8.04% [-9.98% to -6.05%]). All types of regulatory interventions reduced the prescribing of targeted drugs; however, the magnitude of these effects differed substantially depending on the type of intervention. By identifying and comparing the influence of regulatory post-market safety advisories, we can enhance these measures to better protect patient health. Continuous monitoring and systematic assessment of safety-related regulatory advisories, with ensured reproducibility, are warranted to optimize effectiveness and ensure safe medication practices
Optimal Timing of Vaccination: A Narrative Review of Integrating Strategies for COVID-19, Influenza, and Respiratory Syncytial Virus
No full textLower respiratory tract infections caused by SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) cause a significant disease burden globally, despite the availability of effective vaccines. Certain populations, such as older adults (>/= 60 years) and individuals of all ages with particular comorbidities, are at increased risk for severe outcomes, including hospitalization and death. National administration schedules for available vaccines against respiratory viruses are not unified, and not all current guidelines are clear and directive, concerning the optimal timing of vaccination. Herein, we formulate an evidence-based position regarding the optimal timing of COVID-19, influenza, and RSV vaccination for older adults and individuals with chronic comorbidities, based on a synthesis of the literature and current guidelines. Vaccination impact and timing were found to be influenced by vaccinee risk factors, including age and comorbidities, and waning vaccine effectiveness and seasonal pathogen burden. Because COVID-19, influenza, and RSV display unique seasonal patterns within and between regions, local epidemiological surveillance of each virus is crucial for determining optimal vaccination timing and guidelines. To maximize the benefits of these respiratory virus vaccines, the timing of peak vaccine effectiveness and period of greatest risk for severe outcomes should be aligned. Thus, COVID-19, influenza, and other recommended vaccines given ahead of the start of the respiratory virus season (or other regionally appropriate time) and co-administered at a single, routine visit represent the optimal approach to protecting at-risk populations. More data will be required to establish the clinical benefit of additional RSV vaccine doses and whether these may be integrated within a seasonal schedule. Coordinated policy decisions that align with strain selection for new and annually reformulated vaccines would enable the timely raising of public health awareness, ultimately leading to enhanced vaccine uptake. Implementation strategies will require engagement of healthcare providers and strong, evidence-based public health recommendations for integrated vaccine schedules
Risk of new-onset polymyalgia rheumatica following COVID-19 vaccination in South Korea: a self-controlled case-series study
No full textBACKGROUND: While several studies have reported some cases of polymyalgia rheumatica (PMR) following COVID-19 vaccination, studies using large databases are lacking. OBJECTIVES: To investigate the risk of PMR after COVID-19 vaccination using self-controlled case series (SCCS) analysis METHODS: We used the National Health Insurance Database, linked with the COVID-19 registry between February 2021 and August 2023, to identify adults aged 50 years or older who received at least one dose of COVID-19 vaccine and subsequently diagnosed with PMR within the observation period, defined as 240 days after the first dose of vaccine. The risk window was defined as 28 days after each dose of COVID-19 vaccination, and the control window encompassed the remainder of the observation period. Incidence rate ratios (IRRs) were estimated using conditional Poisson regression with 95% CIs, stratified by dose and vaccine type. RESULTS: Among 44 818 078 COVID-19 vaccine recipients, 376 patients were diagnosed with PMR. The analysis indicated that COVID-19 vaccination was not associated with an increased risk of PMR (IRR, 0.74; 95% CI 0.59 to 0.94). Rather, the risk of PMR was slightly reduced after the first dose (0.52; 0.34 to 0.79), with no significant association with other doses of COVID-19 vaccine (0.83; 0.59 to 1.16 for second dose, 0.77, 0.48 to 1.25 for third dose). CONCLUSION: In this nationwide SCCS, there was no association with the increased risk of PMR following COVID-19 vaccination. While these findings support the safety of COVID-19 vaccines, interpretation of the decreased risk of PMR should be cautious
Effects of anaemia development during pregnancy on maternal psychological health
No full textBACKGROUND: Anaemia during pregnancy is associated with maternal depressive symptoms during pregnancy and the postpartum period. However, the effect of anaemia development during pregnancy on maternal psychological health in non-anaemic women remains unclear. OBJECTIVE: To investigate the effect of anaemia development during pregnancy on maternal psychological health during pregnancy and the postpartum period. METHODS: This study includes a secondary analysis of data collected prospectively from the Korean Pregnancy Outcome Study. Depression and anxiety were evaluated in each trimester and 4-6 weeks postpartum. The Hospital Anxiety and Depression Scale was used for anxiety and the Edinburgh Postnatal Depression Scale for depression. FINDINGS: Among 3310 women with normal haemoglobin concentrations in the first trimester, 270 (8.1%) developed anaemia in the third trimester. Depression during the first trimester and anxiety during the second trimester were significantly more frequent among patients who later developed anaemia in the third trimester than among those who did not. Even after adjusting for confounding factors, anaemia development during pregnancy was significantly associated with increased risks of depression during the first trimester (aOR, 1.45; 95% CI, 1.07 to 1.96; p=0.017) and anxiety during the second trimester (aOR, 1.57; 95% CI, 1.04 to 2.38; p=0.033), respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS: Among women who were non-anaemic in the first trimester and developed anaemia by the third trimester, higher risks of maternal depression and anxiety were observed during the first and second trimester, respectively. It suggests that a decrease in haemoglobin concentrations during pregnancy negatively impacts on maternal psychological health
Intra-parotid lymph node metastasis in primary parotid gland cancer: a narrative review of its significance, anatomic distribution, and therapeutic implications
No full textBACKGROUND AND OBJECTIVE: Intra-parotid lymph node metastasis (LNM) has been proven to be an independent predictor of worse prognosis in patients with primary parotid gland cancer (PGC) as well as cervical LNM. However, the anatomic information or distribution of intra-parotid LNM within the parotid glands and its clinical significance remain largely unexplored. In this narrative review summarizing the relevant literature, we sought to answer the sub-site distribution of intra-parotid LNM in PGC, and suggest therapeutic implications. METHODS: A comprehensive review of the literature was conducted by searching the PubMed and Web of Science databases. Manuscripts offering objective data on the incidence, subsite distribution, and prognostic significances of intra-parotid LNM were selected for inclusion in this review. KEY CONTENT AND FINDINGS: Overall, the rate of intra-parotid LNM appears to be greater than 40% in high-grade PGC but not in low-grade PGC. As for the lymph node (LN) distribution in the normal parotid gland, the majority (>80%) of LNs in the parotid glands are located in the superficial lobe, while the deep lobe contains just one LN on average. The European Salivary Gland Society (ESGS) classification system of the parotid gland sub-site is straightforward and can be applied to confirm intra-parotid LNM. Taking into consideration the intra-parotid LNM location, most intra-parotid LNMs from PGC are observed in the superficial parotid LNs, while metastasis to the deep parotid LNs seems to compose less than 10% of cases. CONCLUSIONS: The rate of intra-parotid LNM in the parotid deep lobe is not high enough to justify total parotidectomy in all PGC cases. In some PGC cases, a more selective approach preserving a portion of the deep parotid gland with a low risk of intra-parotid LNM might be an alternative to total parotidectomy
Immunomodulation Effects of Porcine Cartilage Acellularized Matrix (pCAM) for Osteoarthritis Treatment
No full textBACKGROUND: Pain reduction, immunomodulation, and cartilage repair are key therapeutic goals in osteoarthritis (OA) treatment. In this study, we evaluated the therapeutic effects of porcine cartilage acellularized matrix (pCAM) derived from naive tissue and compared it with the synthetic material polynucleotides (PN) for OA treatment. METHODS: pCAM was produced from porcine cartilage through physicochemical processing. LC-MS protein profiling identified the key proteins. In vitro experiments involved treating human synovial cell with pCAM and PN to assess cell viability and reductions in pro-inflammatory cytokines (IL-1beta and IL-6). In vivo studies utilized a rat DMM-induced OA model. Pain was evaluated in weight-bearing tests, and inflammation reduction was confirmed using specific macrophage markers of CD68, CD86, and CD163 in immunohistochemical staining of synovial tissue. Cartilage regeneration was evaluated by histopathological analyses. RESULTS: The major protein components of pCAM include factors integral to cartilage and ECM integrity. They also contain proteins that help reduce inflammation. In vitro studies revealed a decrease in pro-inflammatory cytokines and survival of synovial cells were observed. In vivo treatment with pCAM resulted in a reduction of pain and inflammation, while promoting cartilage regeneration, thereby accelerating the healing process in OA. CONCLUSION: Our findings suggest that pCAM may contribute to the treatment of OA by alleviating synovial inflammation and supporting cartilage regeneration, thereby addressing both the inflammatory and degenerative aspects of the disease