Search

To examine the effectiveness of breastfeeding education and peer support groups organized by International Board Certified Lactation Consultants (IBCLCs) during the first week (T1) and the fifth to sixth week postpartum (T2), in terms of breastfeeding self-efficacy and exclusive breastfeeding rate.A quasi-experimental design.A maternity ward of a medical center in northern Taiwan.214 postpartum women.The control group (n = 122) received standard care, while the intervention group (n = 92) received standard care and attended a support group at T1 and T2.Outcome measures were assessed through self-administered questionnaires: Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and exclusive breastfeeding rate. Demographic and obstetric data were collected from participants and from their medical records. A general estimating equation, t-tests, and chi-square tests were adopted to examine hypotheses.Before examining the hypotheses, homogeneous tests confirmed the equality between the groups at T1. There were significant differences in breastfeeding self-efficacy (B = 0.21, p 0.01) between the two groups from T1 to T2. The breastfeeding self-efficacy of participants in the intervention group was significantly higher than those in the control group (t = 3.26, p = 0.01) at T2. The exclusive breastfeeding rate (61%) in the intervention group at T2 was significantly higher than the rate (39%) in the control group (chi-square=11.28, p = 0.001).Attending IBCLC-organized breastfeeding education and support groups during early postpartum hospitalization may increase mothers' breastfeeding self-efficacy and exclusive breastfeeding rate.

The World Health Organization (WHO) has declared COVID-19 a pandemic. We review and reduce the clinical literature on diagnosis of COVID-19 through symptoms that might be remotely detected as of early May 2020. Vital signs associated with respiratory distress and fever, coughing,and visible infections have been reported. Fever screening by temperature monitoring is currently popular. However, improved noncontact detection is sought. Vital signs including heart rate and respiratory rate are affected by the condition. Cough, fatigue, and visible infections are also reported as common symptoms. There are non-contact methods for measuring vital signs remotely that have been shown to have acceptable accuracy, reliability, and practicality in some settings. Each has its pros and cons and may perform well in some challenges but be inadequate in others. Our review shows that visible spectrum and thermal spectrum cameras offer the best options for truly noncontact sensing of those studied to date, thermal cameras due to their potential to measure all likely symptoms on a single camera, especially temperature, and video cameras due to their availability, cost, adaptability, and compatibility. Substantial supply chain disruptions during the pandemic and the widespread nature of the problem means that cost-effectiveness and availability are important considerations. Refereed/Peer-reviewed

Summary Background Seroma is a recognized complication encountered at the reconstructed breast and donor site after abdominal-based breast reconstruction. Seroma is caused by lymphatic channel disruption and the formation of a large space between the deep fascia during flap elevation. Surgical techniques to preserve the lymphatics and secure the closure of the donor site can reduce seroma formation. This study investigated the safety and effectiveness of the diuretic hydrochlorothiazide at reducing interstitial fluid accumulation and seroma formation during deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods Sixty patients with breast cancer who underwent skin- or nipple-sparing mastectomy and DIEP flap reconstruction were enrolled between August 2016 and June 2017. The patients were randomly assigned to receive either 25 mg per day of hydrochlorothiazide from the second to the twentieth day after surgery (treatment) or no diuretic (control). The clinicopathological characteristics, drainage time, and drainage volume were statistically compared between the two groups. Results The average total drainage volume at the donor site was 291 mL in the treatment group and 434 mL in the control group (p = 0.003). The differences in body mass index and flap weight between the two groups were not statistically significant (p = 0.879 and p = 0.963, respectively). No hypotension or electrolyte imbalance was noted during the follow-up. Conclusions Intake of 25 mg per day of hydrochlorothiazide tablets effectively reduced the total abdominal drainage volume and removal time of indwelling drains. However, the adverse effects should be further investigated in a large population and multiracial cohort before using hydrochlorothiazide for seroma prevention.

The relationship between reproductive breast risk factors and breast cancer survival in patients with different breast cancer subtypes is not well known.We examined a large-sized, retrospective study of 23,882 subjects from the Korean Breast Cancer Registry. The breast cancer subtype was determined by immunohistochemical staining for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). Information regarding reproductive factors, including breastfeeding, age at first birth (AFB), and parity, was gathered. Multivariate Cox regression analysis was used to estimate the association among breast cancer subtypes, such as luminal A, luminal B, Her-2/neu overexpressing, and triple negative breast cancer (TNBC), and breast cancer survival as dependent variables and adjusting for age and stage.High parity (≥ 5) increased the recurrence risk of luminal A and B breast cancer (hazard ratio [HR], 1.95; 95% confidence interval [CI], 0.96-3.97; P = .0055 and HR, 1.12; 95% CI, 0.42-3.02, respectively; P = .0073) in breast cancer-specific survival (BCSS), but 1 to 3 child births decreased the recurrence risk of luminal A breast cancer (HR, 0.56; 95% CI, 0.34-0.91; P = .0055) and luminal B breast cancer (HR, 0.32; 95% CI, 0.17-0.61; P = .0073) in BCSS. Early AFB (20 years) increased the recurrence risk of luminal A breast cancers (HR, 1.61; 95% CI, 0.62-4.26; P = .039) in BCSS and of TNBC (HR, 1.31; 95% CI, 0.78-2.21; P = .0006) in overall survival. Her-2/neu overexpressing breast cancer had no correlation with parity and AFB in breast cancer survival.High parity (≥ 5) and early AFB (20 years) were correlated with worse clinical outcomes in patients with luminal breast cancer, but not with other subtyped breast cancers.

Background/aims This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC). Methods We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010. Results Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0±29.2 months (mean±SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047). Conclusions BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.

Although everolimus, a mammalian target of rapamycin inhibitor, has been used as a potent immunosuppressive agent in organ transplantation, data regarding its adverse effect profile compared with that of sirolimus in clinical circumstances are limited. A 50-year-old man who underwent simultaneous liver and kidney transplantation 14 months previously was admitted with large pleural effusion, pericardial effusion, and ascites. Laboratory findings and cultures for possible infectious causes were all negative. Pericardial window surgery with drainage of the pericardial fluid was performed on day 3. Pleural and pericardial biopsy revealed non-specific inflammation without evidence of malignant cells. Everolimus was discontinued and replaced by mycophenolate mofetil on day 4. Significant clinical improvement was observed after discontinuation of everolimus, and follow-up echocardiography and chest radiography showed no recurrence of the pericardial or pleural effusion after discharge.

Objective To determine whether endothelial nitric oxide synthase (eNOS) polymorphisms confer susceptibility to Behcet’s disease (BD). Methods A meta-analysis was conducted on the associations between the G894T and 4b/a polymorphisms of eNOS and BD using: (i) the allele contrast, (ii) the recessive model, (iii) the dominant model and (iv) the additive model. Results A total of eight studies, which included 841 cases and 866 controls, were included in the meta-analysis. Meta-analysis of the G894T polymorphism revealed no association with BD in all study subjects or in Turkish and Asian populations. However, one Tunisian study of the T allele showed a significant association with BD (OR = 0.707, 95% CI = 0.510–0.980, P = 0.038), but the OR of the T allele among Tunisians was lower, whereas it was higher in Europeans (OR = 2.129, 95% CI = 1.407–3.220, P = 0.0003). Meta-analysis showed no association between BD and the 4b/a polymorphism in all study subjects. Stratification by ethnicity indicated no significant association between the a allele of the 4b/a polymorphism and BD in Turkish and Asian populations. Conclusions This meta-analysis shows that the eNOS G894T and the 4b/a polymorphisms are not associated with BD in the Turkish and Asian populations. These data suggest that the G894T and the 4b/a polymorphisms may not confer susceptibility to BD in the Turkish and Asian populations.

To compare the diagnostic performance of sagittal multiplanar reconstruction (MPR) images and axial images for the detection of a nasal bone fracture.This prospective study included 533 consecutive patients who underwent three-dimensional images with 64-section multidetector-row CT for the evaluation of a facial bone fracture between June 2007 and May 2008 (366 males; 167 females; mean age +/- standard deviation 31.1+/-21.2 years; age range 1-92 years). Two observers independently scored the possibility of a nasal bone fracture on axial and sagittal images. Receiver operating characteristic (ROC) curve analysis was performed.The Az values of the sagittal images were higher than those of the axial images for both observers (p=0.002 and 0.010, respectively) with higher accuracy (p0.001 and 0.016, respectively). The sensitivities of sagittal images were superior to those of axial images, especially for type 1simple nasal bone fractures with no or minimal displacement (observer 1, 98.6 versus 72.8%; observer 2, 84.9 versus 71%).Sagittal MPR facial bone CT images provided superior diagnostic performance, and their addition to axial images is useful for the evaluation of nasal bone fractures.

We report the first case of subcutaneous hyalohyphomycosis caused by the genus Cephalotheca, which has not been reported to cause human infection. A 67-year-old immunocompetent farmer presented with a 10-year history of verrucous erythematous plaques on the right foot dorsum, great toe, heel and sole. Histopathology of the lesions revealed chronic granulomatous inflammation with numerous nonpigmented fungal spores in the dermis. Cultures of biopsy specimens on Sabouraud's dextrose agar for 2 weeks developed into yellowish brown, velvety colonies that subsequently turned black after 8 weeks because of the production of black cleistothecia indicating the teleomorph. On the basis of mycological features, scanning electron microscopic morphology and molecular analysis data, a new species of Cephalotheca was identified and designated Cephalotheca foveolata. Because there was no response to the antifungal agents administered, the patient was successfully treated by surgical excision with skin graft.

Background The transplantation of isolated islets is believed to be an attractive approach for cure of diabetes mellitus. Heat-shock protein (HSP70), which plays a vital role in cellular protection, has been detected in various tissues subjected to stress. Glutamine (GLN) is an important cellular fuel and an essential precursor for the antioxidant glutathione (GSH). It is believed to enhance cellular survival against a variety of stressful stimuli through HSP70. Thus, we performed this study to examine the hypothesis that preoperative GLN administration induces HSP70 and GSH expression before islet transplantation attenuating ischemic damage to rat islets. Methods Adult male Sprague-Dawley (SD) rats were randomly divided into two groups according to the administration of GLN after islet isolation. Group A served as the controls, receiving no GLN. Group B islet cells were cultured with L-GLN (10 mmol/L) supplementation for 24 hours. The GSH levels were measured in islet cells. Both HSP70 and proteins related to apoptosis were analyzed in islet cells by Western blots. Isolated rat islets were cultured with interleukin (IL)-1β. Nitrite production was measured using the Griess reagent. Results The GSH levels were significantly elevated in the glutamine-treated group. HSP70 expression in islets treated with GLN was markedly stronger compared with the control group. The basal Bcl-2 expression was markedly increased by GLN treatment. The GLN-treated group showed attenuated IL-1β–induced injury in association with NO production. Conclusion These results suggested that preoperative GLN administration induced HSP70 and GSH expressions before islet transplantation, thus attenuating IL-1β–induced injury in association with NO production and apoptosis, which might be potential tool to mitigate the ischemic damage to islet cells and the early inflammation at the site of implantation through a self-protective mechanism.

Aim: Met receptor tyrosine kinase abundance correlates with poor prognosis in many tumors including urothelial carcinoma; Met can promote tumor growth, angiogenesis and metastasis. Cabozantinib is an oral kinase inhibitor primarily targeting Met and VEGFR2. Tumor Met content and mutation status were assessed in bladder cancer pts receiving cabozantinib in a phase II clinical trial. Methods: Formalin-fixed paraffin-embedded (FFPE) primary and metastatic tumor samples were collected at baseline from consenting pts. Met content was assessed by immunohistochemistry (IHC) using the SP44 monoclonal antibody (Ventana Medical Systems). Met IHC scores were defined as: 3+ (strong staining for tumor cells); 2+ (moderate staining); 1+ (weak intensity); or 0 (no staining). Cases were reviewed by 2 pathologists. IHC score of 0-1+ was negative and 2-3+ was positive for Met content. Mutation detection was performed on 20ng of FFPE tissue DNA using Ampliseq (Life Technologies), which covers 2800 COSMIC hotspot mutations in 50 cancer genes. Results: 43 specimens from 30 cabozantinib treated pts (27 urothelial carcinoma, 1 small cell, 1 squamous cell carcinoma, 1 sarcomatoid of the bladder or upper tract) were analyzed. IHC scores were 0 (4/43, 9%); 1 (17/43, 40%); 2 (14/43, 33%); 3 (8/43, 18%). 12 pts had at least 2 different tissue samples from primary vs. metastatic site or different metastatic sites. 2/12 matched pt specimens had the same IHC score, and 7/12 (58%) were positive for MET (IHC score of 2-3+).8 pts with 12 specimens were responders (3 partial responses, 2 bone responses, 3 stable disease >8 mos.), and 16 pts with 23 specimens progressed at first restaging (non-responders). Met staining was positive (IHC score 2-3+) in 9/12, 75% of responders vs. 8/23, 35% of non-responders. The most common mutations found were EGFR 6%; FGFR3 13%; KRAS 13%; HRAS 13%, PIK3CA 25%; RB1 6% and TP53 56%. MET mutations were not found. Conclusions: Met expression was higher in bladder cancer pts that responded to cabozantinib treatment vs. pts that did not respond. IHC scores differed in specimens from different organ sites within the same pt. The frequency of mutations found is consistent with reports from The Cancer Genome Atlas. Disclosure: All authors have declared no conflicts of interest.

Background and Aims: Intestinal bacterial overgrowth (IBO) and bacterial translocation (BT) induce a marked proinflammatory activity in cirrhotic patients. The aim was to determine the correlation of serum lipopolysaccharide-binding protein (LBP) with severity of cirrhosis, presence of IBO, bacterial DNA in ascitic fluid (AF) and value of LBP in prediction of mortality. Methods: 42 cirrhotic patients were included in the prospective study. IBO was determined by hydrogen breath test (GASTROLYZER, Bedfont, UK). Bacterial DNA in AF were measured using polymerase chain reaction. LBP was measured by immunometric assay (ELISA Human LBP, Netherlands). The survival rate was evaluated during next forty-eight weeks. Statistical analyses were performed using SPSS 13.0. Results: LBP level increased with severity of cirrhosis according to Child–Pugh (p =0.001), it was higher in ascitic patients than in patients without ascites (p < 0.001). Patients with IBO showed greater (p = 0.001) LBP concentration than patients without IBO (15.74±12.56 versus 4.21±2.59mg/mL). Mean serum LBP level was higher in patients with BT (30.13±10.16mg/mL) in comparison with patients without BT (13.56±9.30mg/mL) (p = 0.005). Positive correlation was found between heart rate and LBP level and negative correlation between blood pressure and LBP level (p < 0.001). Using Cox-regression analysis LBP was found to be one of the risk factors of increased mortality during 48 weeks follow-up (p =0.009). Conclusions: Serum LBP elevation shows a significant correlation with severity of cirrhosis, ascites, presence of IBO and hemodynamic disorders. High LBP level is a reliable marker of BT and independent predictor of increased long-term mortality in cirrhotic patients.

Corrigendum to: The diagnostic value of the sagittal multiplanar reconstruction CT images for nasal bone fractures [65(4): 308e314] B.H. Kim , H.S. Seo *, A.-Y. Kim , Y.S. Lee , Y.H. Lee , S.-I. Suh , D.H. Lee d Department of Radiology, Korea University Ansan Hospital, 516 Gojan1-dong, Danwon-gu, Ansan-si, Gyunggi-do, 425e707, Republic of Korea Department of Radiology, Dongguk University International Hospital, Gyunggi-do, Republic of Korea Department of Diagnostic Radiology, Korea University Guro Hospital, Seoul, Republic of Korea Department of Radiology, Seoul Medical Center, Seoul, Republic of Korea