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Risk Factors for Long-Term Delayed Gastric Emptying and Its Impact on the Quality of Life After Laparoscopic Pylorus-Preserving Gastrectomy in Patients with Gastric Cancer: Secondary Analysis of the Prospective Multicenter Trial KLASS-04
No full textBackground/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as "nearly normal diet residue" at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014-0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients
Prospective Analysis of Asian Type 2 Integrated Lag Screws (Hip Fracture Nail) in Patients with Intertrochanteric Fractures
No full textBACKGROUND: The Hip Fracture Nail (HFN), developed by modifying the design and diameter of the INTERTAN nail, has been introduced to the market. The purpose of our study was to evaluate the clinical and radiological outcomes, as well as the perioperative complications, associated with the use of the HFN in Asian patients with intertrochanteric fractures. METHODS: Patients over the age of 60 years with intertrochanteric fractures were prospectively enrolled at 6 university hospitals in South Korea and underwent surgical treatment using the HFN between October 2018 and January 2022. Patients who died or were lost to follow-up within 1 year were excluded from the analysis. Intraoperative surgical records related to the HFN, along with postoperative clinical and radiological data, were prospectively collected. Intraoperative and postoperative complications were recorded during the 1-year follow-up after surgery. RESULTS: Of the 320 patients, 159 patients were followed up for at least 1 year. The mean follow-up period was 17 +/- 3 months. A total of 111 patients (70%) recovered their pre-fracture status. The mean time to bony union was 10.2 weeks. Reduction quality was acceptable or good in 99% of patients. Superior positioning of the lag screws in the femoral head occurred in only 2 cases. Difficulty in targeting the distal interlocking screw hole during the operation occurred in 4 cases (2.6%), with 2 of these patients developing periprosthetic fractures at distal interlocking screw holes. Postoperative complications requiring reoperation occurred in 5 patients (3.1%). Two cases of cut-out accompanied by nonunion underwent replacement arthroplasty (nonunion rate, 1.3%). Three cases of periprosthetic fractures at the distal static screw hole underwent refixation with a longer intramedullary nail. The remaining postoperative complications, including collapse at the fracture site in 5 cases (3.1%), the lateral wall fractures in 1 case (0.6%), and malunion in 1 case (0.6%), did not require surgical intervention. CONCLUSIONS: This study demonstrated that the HFN provided good clinical and radiological outcomes in Asian patients with intertrochanteric fractures. However, difficulty in targeting the distal interlocking screw hole may occur with low probability, requiring caution during surgery
mTORC2/Akt axis promotes proteotoxic stress and mitochondrial Ca2+ overload during celastrol-induced paraptosis
No full textCelastrol, a triterpenoid with anticancer potential, induces paraptosis in breast cancer cells-a non-apoptotic form of cell death characterized by vacuolization of the endoplasmic reticulum (ER) and mitochondria. Although celastrol shows therapeutic promise, the signaling mechanisms mediating this pathway remain poorly defined. Here, we report that celastrol transiently activates both mTORC1 and mTORC2; however, only the mTORC2/Akt axis is essential for executing paraptotic cell death. Genetic or pharmacological inhibition of mTORC2 or Akt attenuated celastrol-induced cell death, reduced proteotoxic stress-evident from diminished polyubiquitinated protein accumulation and CHOP expression-and suppressed mitochondrial Ca(2+) overload by downregulating the mitochondrial calcium uniporter (MCU) and MICU1. Knockdown of Raptor (mTORC1 component) did not affect these processes, indicating a specific role for mTORC2. These findings define mTORC2/Akt signaling as a pro-death regulator in paraptosis, highlighting its unexpected role in driving proteotoxic and mitochondrial stress
Comparison of Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or Angioembolization
No full textBackground: Preperitoneal pelvic packing (PPP) and angioembolization (AE) are current hemostatic techniques in patients with bleeding pelvic fracture. Concerns exist that PPP may delay definitive internal fixation of pelvic fractures. This study aimed to determine whether PPP results in delayed internal fixation compared with AE.
Study design: A retrospective cohort study was conducted using the TQIP database from 2017 to 2021. Adults with isolated pelvic fractures requiring transfusion within 24 hours were included. Patients underwent internal fixation and received either PPP (90) or AE only (253). Inverse probability of treatment weighting was used to adjust for confounding variables. The primary outcome was time from admission to internal fixation; secondary outcomes included in-hospital mortality and hospital resource use.
Results: Time to definitive fixation was not significantly different between groups (PPP median 51.4 hours vs AE median 37.5 hours; p = 0.071). In-hospital mortality was higher in the PPP group (4.4% vs 0.6%; p = 0.009). The PPP group had longer ICU and hospital stays, extended mechanical ventilation duration, and higher rates of acute kidney injury and severe sepsis. No significant difference in transfusion volume within 4 hours was observed between the groups.
Conclusions: PPP does not significantly delay definitive internal fixation. However, the implementation of PPP for patients with pelvic fractures may be associated with increased complications and hospital resource use compared with AE alone as a hemostatic measure
Safety and Effectiveness of Pravastatin in Korean Patients with Dyslipidemia Based on the Cardiovascular Risk Classification: Pooled Analysis of Four Observational Studies
No full textBACKGRUOUND: Despite their efficacy, statin-related adverse events (AEs) may interfere with statin treatment and contribute to negative outcomes in patients with cardiovascular diseases. In this study, we evaluated the safety and effectiveness of pravastatin in Korea. METHODS: Pooled data were collected from four multicenter prospective observational studies conducted in Korea between 2011 and 2020. Finally, 7,334 and 2,022 participants were included in the safety and effectiveness analyses, respectively. Overall safety, particularly muscle-related, incidence of new-onset diabetes mellitus (DM), changes in fasting plasma glucose and hemoglobin A1c level, achievement of target low-density lipoprotein cholesterol (LDL-C) level, and changes in LDL-C level were analyzed. RESULTS: At week 24, after 20 or 40 mg pravastatin treatment, safety results showed that AEs and adverse drug reactions (ADRs) were 8.7% and 1.3%, respectively, and that muscle-related AEs and ADRs were 0.5% and 0.3%, respectively, with no statistically significant difference in risk factors for statin-associated muscle symptoms. No patients developed DM during the study period. Additionally, at week 24, the achievement rates of target LDL-C levels were 87.9%, 78.4%, 57.8%, and 11.6% in low-, moderate-, high-, and very high-risk groups, respectively. CONCLUSION: This study found that 20 or 40 mg pravastatin had minimal side effects and was safe for use in real-world clinical settings in Korea. Specifically, these doses effectively achieved the target LDL-C levels in patients with dyslipidemia in low-, moderate-, and high-risk groups for atherosclerotic cardiovascular disease (ASCVD). These results demonstrate that pravastatin can be safely administered continuously to patients with low-, moderate-, and high-risk ASCVD in a real-world clinical setting
Relationship Between Musculoskeletal Disorders and Productivity Loss Among Hospital Nurses: An Analytical Cross-Sectional Study With Secondary Data Analysis
No full textAIM: To identify the prevalence of musculoskeletal disorders among hospital nurses and explore their effects on productivity loss. DESIGN: An analytical cross-sectional study with secondary data analysis was conducted. METHODS: Data were collected via an online survey of 607 registered nurses working in general and tertiary hospitals in South Korea. Multivariate logistic regression analysis was performed to examine the association between musculoskeletal disorders and four productivity loss indicators: absenteeism, presenteeism, perceived productivity loss, and work limitations. RESULTS: Musculoskeletal disorders were highly prevalent among hospital nurses, with 83.9% of participants reporting musculoskeletal disorder symptoms in the past week. Lower back complaints had the highest prevalence. Nurses with musculoskeletal disorders were 3.74 times more likely to experience presenteeism than those without musculoskeletal disorders. They were also 3.00 times more likely to report perceived productivity loss and 2.24 times more likely to experience work limitations. However, no significant relationship was observed between musculoskeletal disorders and absenteeism. CONCLUSION: Musculoskeletal disorders contribute to presenteeism, productivity loss, and work limitations among hospital nurses. Targeted interventions for preventing and managing musculoskeletal disorders are essential to mitigate productivity losses and improve nurses' health and job performance. Strategies such as ergonomic workplace modifications, early detection, and effective management of musculoskeletal disorders can help maintain nurses' productivity and well-being. CLINICAL RELEVANCE: Addressing musculoskeletal disorders is critical for enhancing nurse productivity and for ensuring the delivery of high-quality patient care. Healthcare organizations can safeguard nurses' health and patient outcomes by reducing presenteeism and work limitations
A plain language summary of the MIRACLE study: benralizumab in people in Asia with severe asthma
No full textWhat is this summary about?This summary describes the results of the Phase 3 MIRACLE study, originally published in the Respiratory Medicine journal. MIRACLE was the first clinical trial to evaluate the efficacy and safety of benralizumab injections in a large group of people from Asia with severe asthma.What were the main results of the MIRACLE study?People with severe asthma who took benralizumab had fewer asthma attacks (also called exacerbations). They also had better lung function, fewer asthma symptoms, better symptom control, and better health-related quality of life. The improvements in lung function and symptom control began as early as 4 weeks after the first benralizumab dose. A similar percentage of people in the benralizumab and placebo groups had adverse events.What do the results of MIRACLE mean?The MIRACLE results support the use of benralizumab as a treatment option for people in Asia with severe eosinophilic asthma. Benralizumab shows potential to improve asthma control and health-related quality of life in this population
Pulmonary Fibrosis in Critically Ill Patients With COVID-19: A Multi-Center Retrospective Cohort Study in Korea
No full textBACKGROUND: Pulmonary fibrosis can persist long after recovery from coronavirus disease 2019 (COVID-19) infection, thereby reducing quality of life and lung function. We aimed to evaluate the frequency and risk factors for pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation (MV), a high-risk group for developing pulmonary fibrosis. METHODS: Clinical data and chest computed tomography (CT) scans of patients with severe COVID-19 pneumonia requiring MV were retrospectively collected from nine hospitals in South Korea. Fibrotic-like changes on chest CT were visually assessed. RESULTS: We included 125 patients with a mean age of 68.5 years, 60.8% men and 7.2% having underlying lung disease. Based on follow-up chest CT (the median interval, 38.0 days; interquartile range, 24.0-68.0 days), 94 (75.2%) patients exhibited fibrotic-like changes, with traction bronchiectasis and/or bronchiolectasis being the most common change (60.8%). Among all patients, 17.6% died during hospitalization and 71.2% experienced complications, including intubation-related airway injury (12.8%), ventilator-associated pneumonia (44.8%), lung injury (11.2%), and hemodynamic disturbance (33.4%). In-hospital mortality (16.1% vs. 18.1%) and complications (67.7% vs. 72.3%) were similar between patients with and without fibrotic-like changes. In multivariable logistic regression analysis, a higher daily steroid dose (odds ratio, 0.961; 95% confidence interval, 0.849-0.993; P = 0.018) was associated with a reduced risk of pulmonary fibrosis, along with a higher heart rate on intensive care unit admission. CONCLUSION: Our study demonstrated that in patients with severe COVID-19 pneumonia requiring MV, chest CT revealed fibrotic-like changes in approximately three-quarters of patients. In addition, our results suggest that higher daily doses of steroids may be associated with a reduced risk of pulmonary fibrosis. Further research is needed to determine the appropriate steroid dose that may reduce the progression of pulmonary fibrosis and improve clinical outcomes. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0006312
Anti-VEGF neutralizing antibody delays osteomucosal healing by reducing collagen formation in mice
No full textMedication-related osteonecrosis of the jaw (MRONJ) is a detrimental side effect in patients undergoing treatment with antiresorptive agents. The anti-angiogenic agent, bevacizumab (anti-VEGF antibody (Ab)), has also been reported to be associated with MRONJ. However, the role of anti-VEGF Ab in MRONJ development, especially under conditions of pre-existing inflammation, remains elusive. This study examined anti-VEGF Ab effects on bone necrosis and osteomucosal healing, with or without pre-inflammation. Forty mice received biweekly i.p. injections of anti-VEGF Ab (10 mg/kg) or saline (Veh). For the tooth extraction (TE) model (n = 10), maxillary first molars were extracted. For the ligature-induced periodontitis and tooth extraction (LIP-TE) model (n = 10), maxillary second molars were ligated with 5-0 silk for 8 weeks before extraction. Mice were euthanized after 3 weeks of post-extraction healing. In both TE and LIP-TE models, anti-VEGF Ab-treated mice showed delayed osteomucosal healing with diminished bone formation, lower CD31 and collagen III expression, and increased osteoclast numbers than Veh-treated mice. There was no significant difference in necrotic bone areas. IL-23- or IL-17-producing cell numbers remained unchanged in both Veh- and anti-VEGF Ab-treated mice. Anti-VEGF Ab delayed osteomucosal healing by reducing collagen production in the presence or absence of pre-inflammatory conditions, without causing bone necrosis. Our data suggest anti-VEGF Ab delays osteomucosal wound healing but does not cause bone necrosis alone
재발성 양성 유두부 종양의 추적 관찰 및 치료
No full textThe widespread use of screening endoscopy has increased the detection rate of ampullary neoplasms. Most of these lesions are adenomas or carcinomas. The recurrence rates after an endoscopic papillectomy have been reported to range from 5% to 40%, even in cases with pathologically confirmed complete resection. An endoscopic mucosal resection (EMR) is commonly performed for residual or recurrent lesions, and endoscopic ablation therapies, such as argon plasma coagulation, may be used either as an alternative to or in conjunction with EMR. Recently, radiofrequency ablation (RFA) has garnered attention as a potential alternative to surgical treatment for intraductal residual or recurrent ampullary neoplasms after an endoscopic papillectomy, showing a 75.7% clinical success rate. In cases of recurrence after initial RFA, additional RFA has enabled oncologic control in nearly all patients without the need for surgery. Nevertheless, further prospective studies and accumulation of evidence are necessary to establish the efficacy and safety of RFA in this setting