Search

The aim of this study was to identify an appropriate scoring system for predicting postoperative urinary retention (POUR) after gynaecological laparoscopic surgery for benign disease. We analysed 99 patients who underwent gynaecological laparoscopic surgery for benign disease. All patients were asked to complete self-administered questionnaires, including the International Prostate Symptom Score (IPSS), voiding visual analogue scale (VAS), and Brief Pain Inventory-Korean version. Of the 99 patients, 27 (27.3%) experienced urinary retention at least once, while 72 (72.7%) did not. The preoperative and postoperative IPSS scores were not associated with the development of POUR. However, the voiding VAS score was significantly lower in patients that developed POUR (

The effect of hormone replacement therapy (HRT) on the malignant transformation of postmenopausal endometriosis remains unclear. This study aimed to investigate the impact of HRT on ovarian cancer occurrence in postmenopausal women with de novo endometriosis or a history of endometriosis. A total of 10,304 women that received HRT (the HRT group) and 10,304 that did not (the control group) were selected by 1:1 matching those that met the study criteria. Incidences of ovarian cancer (0.3% in the HRT group and 0.5% in the control group) and cumulative incidence rates of ovarian cancer were similar in the two groups. The overall mean duration of HRT was 1.4 ± 2.2 years, but the duration of HRT in women with ovarian cancer was 2.2 ± 2.9 years. After adjusting for co-variables, receipt of HRT, duration of HRT, combined use of estrogen and progesterone, and tibolone were not found to be risk factors for ovarian cancer. However, the use of estrogen alone was found to be a significant risk factor for ovarian cancer (HR 2.898; 95% CI 1.251–6.715; p = 0.013). With the exception of HRT using estrogen alone, HRT did not increase the risk of ovarian cancer in postmenopausal women with a history of endometriosis or de novo endometriosis.

ObjectiveThis study aimed to assess whether continuous anesthetic wound infusion (CAWI) increases postoperative activity in patients who undergo midline laparotomy for gynecological diseases.MethodsThis was an unplanned secondary analysis of a randomized controlled trial examining the effect of an activity tracker with feedback on postoperative activity in patients who underwent midline laparotomy for gynecological diseases (NCT02025387). Of the 53 patients included in the trial (12 patients used CAWI and 41 patients did not), 11 patients with CAWI (case group) and 11 without CAWI (control group) were selected by matching the duration of surgery. We compared the postoperative activity and other endpoints between the case and control groups.ResultsThe case and control groups had similar baseline and surgical characteristics. The recovery rate on postoperative day 4 (step counts at day 4/ daily step counts at preoperative baseline) of the case group was numerically higher, but not significantly different from that of the control group (58% vs. 44%; p=0.450). Least, average and present pain on postoperative day 2 were lower in the case group than in the control group. Pain on postoperative day 5, fatigue, gas out, soft blend diet initiation, ileus, and length of hospital stay were similar between the case and control groups.ConclusionsIn this exploratory analysis, CAWI was not associated with increased postoperative activity in patients who underwent midline laparotomy for gynecological diseases.

Background Surgery related to the meniscus can be divided into three categories: meniscectomy, meniscal repair and meniscus allograft transplantation (MAT). Meniscus injury is closely related to osteoarthritis, and the patient's age affects the choice of surgical method. As Korean society is rapidly changing into an aging society, the trend of meniscus treatment is expected to change according to the change in age structure. Methods This study analyzed longitudinal trends in meniscus surgery (e.g., meniscectomy, meniscal repair, and MAT) in Korea from 2010 to 2020 according to age distribution, hospital size, and region. Data were collected from the Korean Statistical Information Service and the Korean Health Insurance Review and Assessment Service. Results During the 2010–2020 study period, the rate of MAT per 1,000,000 people increased from 7.206 to 10.303 (time trend = 1.05; 95% confidence interval [CI]: 1.01–1.10, p = 0.025). The rate of meniscus repair per 1,000,000 people increased from 179.251 to 331.031 (time trend = 1.054; 95% CI: 1.04–1.07; P

We compared the effects of pressure-controlled volume-guaranteed ventilation (PCV) and volume-controlled ventilation (VCV) on respiratory mechanics and mechanical power (MP) in elderly patients undergoing laparoscopy. Fifty patients aged 65–80 years scheduled for laparoscopic cholecystectomy were randomly assigned to either the VCV group (n = 25) or the PCV group (n = 25). The ventilator had the same settings in both modes. The change in MP over time was insignificant between the groups (p = 0.911). MP significantly increased during pneumoperitoneum in both groups compared with anesthesia induction (IND). The increase in MP from IND to 30 min after pneumoperitoneum (PP30) was not different between the VCV and PCV groups. The change in driving pressure (DP) over time were significantly different between the groups during surgery, and the increase in DP from IND to PP30 was significantly higher in the VCV group than in the PCV group (both p = 0.001). Changes in MP during PCV and VCV were similar in elderly patients, and MP increased significantly during pneumoperitoneum in both groups. However, MP did not reach clinical significance (≥12 J/min). In contrast, the PCV group had a significantly lower increase in DP after pneumoperitoneum than the VCV group.

Background: This study aimed to evaluate whether a low- or high-pressure alveolar recruitment maneuver (ARM) might reduce postoperative pain and improve the quality of recovery after laparoscopic bariatric surgery. Methods: 90 patients with a body mass index > 30 kg/m2 scheduled for laparoscopic sleeve gastrectomy were randomly assigned to control (n = 30), low ARM (n = 30), or high ARM groups (n = 30). For the low and high ARM groups, ARM was repeated five times to hold the peak airway pressure at 30 cmH2O and 60 cmH2O for 5 s, respectively, before removal of the trocar. Conventional methods to reduce post-laparoscopic pain, such as intraperitoneal saline irrigation, hemovac drainage, and gentle abdominal compression were performed in all patients, regardless of the assigned group. Results: Shoulder and surgical site pain scores 24 h postoperatively and rescue meperidine requirement were similar between the groups (p = 0.141, 0.101, and 0.82, respectively). The quality of recovery 40 (QoR40) score 24 h postoperatively was similar between the groups (p = 0.755). Postoperative pulmonary complications were similar between the groups (p = 0.124). Conclusion: Application of a low- or high-pressure ARM in addition to conventional methods to remove remnant peritoneal CO2 gas did not reduce postoperative shoulder or surgical site pain or improve the quality of recovery after laparoscopic sleeve gastrectomy.

Summary Background This study aimed to compare the quality of life (QOL), psychosocial status, sexual function, and menopausal symptoms between the risk-reducing salpingo-oophorectomy (RRSO) and non-RRSO groups comprising BRCA mutation carriers and to evaluate the effect of timing of RRSO on those aspects. Methods This cross-sectional study recruited BRCA mutation carriers aged ≥35 years between September 2015 and September 2016. Demographic data of carriers were collected. Outcomes were measured using the questionnaires addressing QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms. Results Of 52 participants, 30 (57.7%) underwent RRSO, whereas 22 (42.3%) did not. In the RRSO group, 16 (53.3%) and 14 (46.7%) women underwent RRSO before and after menopause, respectively. The mean age in the RRSO group was higher than that in the non-RRSO group (49.8 vs. 42.1 years, respectively, p = 0.002). The scores for QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms were similar between both groups. In the multivariate analysis, RRSO uptake was associated with worse physical QOL (coefficient, −5.350; 95% confidence interval, −10.593 to −0.108). With respect to the timing of RRSO, only the mental QOL was significantly lower in the postmenopausal RRSO group than in the premenopausal RRSO group (39.2 vs. 43.7, respectively, p = 0.043). Conclusion We could not find any difference in mental QOL, psychosocial status, sexual function, and menopausal symptoms between the RRSO and non-RRSO groups. RRSO uptake only affected worse physical QOL. These results will help physicians counsel BRCA mutation carriers about the effect of RRSO on QOL.

Highlights • Gastrointestinal symptoms including diarrhea and constipation are common in patients with gynecologic cancer receiving pelvic chemoradiotherapy. • There was an increase of serum IL-6 levels in patients with ≥grade 2 diarrhea during pelvic chemoradiotherapy. • Serum IL-1β and TNFα levels did not change during pelvic chemoradiotherapy. • Radiotherapy-related and clinical factors affect the development of chemoradiotherapy-induced diarrhea., Purpose We investigated whether serum cytokines including Interleukin (IL)-1β, IL-6 and tumor necrosis factor alpha (TNFα) are increased during pelvic chemoradiotherapy (CRT) in patients with gynecologic malignancies, and sought to identify prognostic factors for the development of diarrhea during pelvic CRT. Materials and methods Patients with cervical or endometrial cancer receiving postoperative pelvic CRT were eligible for this prospective study. Patients were evaluated weekly during CRT for symptoms, including diarrhea and constipation. Serum cytokine levels were measured using immunoassays 1 week before CRT, and at week 3 and 5–6 during CRT. Radiotherapy-related parameters such as mean dose, minimum dose, and maximum dose to the small bowel were also analyzed. Multivariate logistic regression analysis was used to assess factors associated with development of enteritis symptoms. Results Twenty-six patients were enrolled, all of whom were eligible for symptom and dosimetric parameter evaluation; 24 were eligible for cytokine level measurement. Cytokine levels did not differ between patients with and without diarrhea before CRT. IL-6 levels increased during CRT, and were significantly higher in patients with diarrhea ≥grade 2 than in those with grade 0–1 at week 5–6 (6.771 ± 2.657 pg/mL vs. 3.396 ± 0.499 pg/mL, p = 0.046). Serum IL-1β and TNFα levels did not change during CRT. Diarrhea before CRT and the maximum dose to the small bowel were independent prognostic factors for CRT-induced diarrhea in the multivariate analysis. Conclusions There was an increase of serum IL-6 levels in patients with ≥grade 2 diarrhea during pelvic CRT. Serum IL-1β and TNFα levels did not change during CRT. Radiotherapy-related and clinical factors affect the development of diarrhea during pelvic CRT.

Aim To evaluate the effects of the combination of calcitriol and chemotherapy and to identify the molecular mechanisms underlying the effect of calcitriol on ovarian cancer cells. Materials and methods SKOV-3 cells were treated with calcitriol and cisplatin, and their effects alone and in combination in a dose-dependent manner were compared. Cell viability, cell proliferation, and apoptosis were assessed using the following assays: PrestoBlue, intracellular adenosine triphosphate, caspase-3/7 activity, annexin V, and immunoblotting, respectively. Results Calcitriol alone caused dose-dependent inhibition of cell survival and proliferation, and induced apoptotic cell death of SKOV-3 cells. We confirmed that the expression of vitamin D receptor was increased in a dose-dependent manner by calcitriol. Combination treatment using calcitriol at a physiological concentration of 10-100 nM plus cisplatin significantly suppressed cell survival and induced apoptosis. Furthermore, when calcitriol was administered alone, the activity of vascular endothelial growth factor decreased in a dose-dependent manner, and when combined with cisplatin, activity was more suppressed. Conclusion In SKOV-3 ovarian cancer cells, calcitriol plus cisplatin exerted greater antiproliferative, apoptotic, and anti-angiogenic effects than cisplatin alone. Adding calcitriol to platinum-based chemotherapy might be beneficial to patients with ovarian cancer.

No study has evaluated the effect of therapeutic granulocyte colony-stimulating factor (G-CSF) in preventing recurrence of febrile neutropenia (FN) and survival outcomes in gynecologic cancer patients. Objective of this study is to optimize and to identify the use of G-CSF and identify the critical factors for preventing the recurrence of FN in women undergoing chemotherapy for the treatment of gynecologic cancer. The medical records of consecutive patients who underwent chemotherapy for the treatment of gynecologic cancer and experienced FN at least once were retrospectively reviewed. Clinico-laboratory variables were compared between those with and without recurrence of FN to identify risk factors for the recurrence and the most optimal usage of G-CSF that can prevent FN. Student t test, χ2 test, and multivariate Cox regression analysis were used. A total of 157 patients who met the inclusion criteria were included. Of 157, 49 (31.2%) experienced recurrence of FN. Age ≥55 years (P = .043), previous lines of chemotherapy ≤1 (P = .002), thrombocytopenia (P = .025), total dose (P = .003), and maximum daily dose (P = .009) of G-CSF were significantly associated with recurrence of FN. Multiple regression analysis showed that age ≥55 years (HR, 2.42; 95% CI, 1.14-5.14; P = .022), previous chemotherapy ≤1 (HR, 4.01; 95% CI, 1.40-11.55; P = .010), and maximum daily dose of G-CSF ≤600 μg (HR, 5.18; 95% CI, 1.12-24.02; P = .036) were independent risk factors for recurrent FN. Multivariate Cox regression analysis showed that a maximum daily dose of G-CSF ≤600 μg was the only independent risk factor for short recurrence-free survival of FN (HR, 4.75; 95% CI, 1.15-19.56; P = .031). Dose-dense administration of G-CSF600 μg/day could prevent recurrence of FN in women who undergo chemotherapy for the treatment of gynecologic cancer and FN. Old age and FN at early lines of chemotherapy seem to be associated with FN recurrence.

Objective: To investigate the clinical features that affect the number of pelvic lymph nodes (PLNs) harvested and the prognostic significance of total number of PLNs removed in patients with cervical cancer stage IB1 to IIA2. Methods: Data from patients with cervical cancer stage IB1 to IIA2 who underwent hysterectomy with PLN dissection without receiving preoperative therapy, between June 2004 and July 2015, were reviewed retrospectively. Clinico-pathologic factors, such as age and BMI were collected and presence of PLN metastasis on imaging studies prior to surgery was reviewed. The number of PLN harvested and the presence of metastasis in the harvested PLNs was also evaluated. Logistic regression analysis was performed to assess which factors affect the number of harvested PLN. Disease free survival (DFS) for all patients according to the number of PLN harvested was analysed. Results: A total of 210 patients were included in the statistical analysis. Mean age, height and weight of the patients were 47 (25-81), 157.3 cm (± 6.68), and 57.6 kg (± 8.17), respectively. The mean number of PLN harvested were 23.1 (±11.7) and metastatic PLN was observed in 42 (20.0%) patients. Clinically, greater height and larger weight of the patient and preoperative positive PET finding was significantly associated with the higher number of PNL harvested, while positive MRI finding showed borderline significance. As pathologic factor, not the depth of invasion nor lymphovascular invasion, but larger size of the tumor was associated with the higher number of PLN harvested. Higher number of PLNs harvested was also associated with higher number of metastatic PLN and postoperative CCRT, but not with DFS. The patients height and tumor size were independent factors affecting the number of PLNs harvested in multivariate logistic regression analysis. Conclusion: These results suggested that overweight of the patient and preoperative imaging study may affect the number of PLNs harvested during the surgery but not the prognosis.

Purpose This study aimed to evaluate the risk of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Papanicolau (Pap) tests.Materials and Methods The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30-79 between 2007-2012. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1), two (N2), and three consecutive normal Pap tests (N3). Women who did not receive a Pap test during the study period were assigned in the N0 group.Results The 1-year cumulative incidence rates of cervical cancer were 58.9, 24.6, 20.3, and 14.2 per 105 in the N0, N1, N2, and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR], 0.825; 95% confidence interval [CI], 0.716 to 0.951) in the N2 group and 42% (RR, 0.578; 95% CI, 0.480 to 0.695) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not higher than that of the N1 group (79.6% vs. 81.3%, p=0.706).Conclusion As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests are not associated with improving survival outcomes in women shortly diagnosed with cervical cancer after the last normal Pap test.

The aim of the study were to identify the risk factors for recurrent vaginal intraepithelial neoplasia (VaIN)1+ and to evaluate the efficacy of laser vaporization in patients who underwent hysterectomy for the treatment of cervical intraepithelial neoplasia (CIN).Medical records of 374 women who underwent hysterectomy for the treatment of CIN were retrospectively reviewed. Recurrence was defined as VaIN1+ diagnosis by colposcopy-directed biopsy.Among 374 patients, 36 (9.6%) had VaIN1+ during a median follow-up of 32 (0-193) months: 13 (3.5%) had VaIN1, 6 (1.6%) VaIN2, 15 (4.0%) VaIN3, and 2 (0.5%) invasive cancer. Multivariate analysis showed that age of greater than 50 years was the only independent risk factor for VaIN1+ recurrence (odds ratio, 3.359; 95% CI, 1.60-7.07; p = .001). Among the 34 patients with VaIN, 21 (61.8%) were treated with laser vaporization and 11 (32.3%) were observed without treatment. Time to second recurrence was longer in the VaIN treated by laser vaporization group than that in the observation group (mean time to subsequent recurrence, 128.7 [95% CI, 101.4-156.0] vs. 41.8 [15.7-67.9] months; p = .003). Moreover, laser vaporization (hazard ratio, 0.125; 95% CI, 0.03-0.59; p = .009) was the only independent good prognostic factor for the second VaIN1+ recurrence.Patients older than 50 years who underwent hysterectomy for the treatment of CIN might be highly at risk of VaIN1+. Laser vaporization is the only independent prognostic factor that might prevent the second VaIN1+ recurrence.

Radiofrequency thermal (RFT) therapy is commonly performed to treat vaginal laxity (VL), but the optimal technique of RFT therapy is unclear. We aimed to evaluate the efficacy and safety of RFT therapy performed twice on the whole vaginal wall in women with VL.This was a single-arm, open-label clinical trial conducted in a tertiary hospital in the Republic of Korea from July 2018 to January 2019. Non-pregnant, adult women with VL, defined as a score ≤3 on a vaginal laxity questionnaire (VLQ), were recruited. RFT therapy consisted of 2 office procedures performed 3 weeks apart. Starting from the upper vaginal wall at the 12 o'clock position, the whole vaginal wall was slowly rubbed with a heated vaginal probe for 20 minutes. After the 2Thirty subjects were enrolled, but 28 were evaluated for efficacy measurements. RFT therapy improved the VLQ score (means at baseline, 4 weeks, and 12 weeks were 2.5, 4.9, and 4.8, respectively; p0.0001), FSFI score (means at baseline, 4 weeks, and 12 weeks were 21.9, 27.0, and 27.2, respectively; p0.0001), and FSDS score (means at baseline, 4 weeks, and 12 weeks were 33.8, 21.1, and 18.6, respectively; p0.0001); however, vaginal pressure did not increase. The effect of RFT therapy peaked at the 4-week follow-up and plateaued at week 12. No TEAE was observed, except transient grade 1 vaginal pain.RFT therapy performed twice on the whole vaginal wall showed promising efficacy and safety profiles and has merit for further investigation.

ObjectivePatients who undergo radical hysterectomy may require postoperative adjuvant radiotherapy, and all efforts should be made to reduce dual therapy in such patients. The aim of this study was to determine the optimal upper limit of tumor size in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2 cervical cancer who undergo radical hysterectomy.MethodsWe retrospectively reviewed the records of 114 patients with FIGO 2018 stage IB2 cervical cancer who underwent primary surgery either with (n=55) or without (n=59) adjuvant radiotherapy from June 2004 to December 2018. The inclusion criteria were as follows: women diagnosed with stage IB2 cervical cancer; primary radical surgery with pelvic lymph node dissection with or without para-aortic lymph node dissection; and patients treated with or without postoperative adjuvant radiation therapy, concurrent chemoradiation therapy, or chemotherapy. A receiver operating characteristic (ROC) curve analysis was used to determine the optimal tumor size cut-off value. The optimal tumor size cut-off value was determined by the maximum sum of sensitivity and specificity.ResultsThere were 55 and 59 patients treated with or without adjuvant therapy, respectively, after radical hysterectomy. Age, histologic type, and pelvic and para-aortic lymph node sampling/dissection status were similar between each group. The number of patients with a tumor size ConclusionsA cervical tumor larger than 2.7 cm before radical surgery in stage IB2 may predispose to potential complications from combining radical hysterectomy and concurrent chemoradiation,. We consider that concurrent chemoradiation therapy is a more appropriate choice for tumor size over 2.7 cm per the revised FIGO 2018 criteria for stage IB2 cervical cancer.

Purpose To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. Methods International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A meta-analysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. Results Five RCTs and six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. Conclusions This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. Results of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

The need to perform genetic sequencing to diagnose the polymerase epsilon exonuclease (Ninety-one samples (15Body mass index (BMI) and tumor grade were significantly associated with theBMI and expression of cyclin B1, caspase 8, and XBP1 are candidate markers distinguishing the

The purpose of this study was to identify the role of HOXB9 and associated molecular mechanism in acquiring chemoresistance to ovarian cancer cells. After establishing HOXB9-overexpressing cells (HOXB9-OE/SKOV3), cisplatin resistance-induced cells (Cis-R/SKOV3), and an ovarian cancer xenograft mouse model, the effects of HOXB9 were evaluated in vitro and in vivo. Expression levels of ERCC-1, MRP-2, XIAP, and Bax/Bcl-2 were assessed as putative mechanisms mediating chemoresistance. Cisplatin-induced apoptosis was significantly decreased in HOXB9-OE/SKOV3 compared to SKOV3. Cisplatin treatment of SKOV3 strongly induced ERCC-1, MRP-2, and XIAP, and apoptosis was strongly induced through the inhibition of Bcl-2 and activation of Bax. ERCC-1, MRP-2, XIAP, and Bcl-2 were also strongly induced in HOXB9 OE/SKOV3. In contrast to SKOV3, cisplatin treatment alone of HOXB9 OE/SKOV3 did not affect the expression of Bcl-2 and Bax, and consequently, there was no increase in apoptosis. HOXB9 knockdown suppressed the expression of ERCC-1 and XIAP, but did not affect MRP-2 and Bcl-2/Bax expression in HOXB9 OE/SKOV3 and Cis-R/SKOV3, and caused a small increase in apoptosis. Treatment of SKOV3 with both cisplatin and siRNA_HOXB9 led to complete suppression of ERCC-1, MRP-2, and XIAP, and significantly increased apoptosis through inhibition of Bcl-2 expression and activation of Bax. The results observed in Cis-R/SKOV3 were similar to that in HOXB9 OE/SKOV3. Our data suggest that HOXB9 overexpression may cause chemoresistance in ovarian cancer cells by differential induction of ERCC-1, MRP-2, and XIAP depending on the strength of HOXB9 expression through inhibition of the mitochondrial pathway of apoptosis, including Bax/Bcl-2.

The combination of supported metal nanoparticles and functional host oxides catalyze many major industrial reactions. However, uniform dispersion and ideal chemical configuration of such nanoparticles, which determines the catalytic activity, are often difficult to achieve. In this study, a unique combination is proposed of heterogeneous doping and ex-solution for the fabrication of Pt-Ni alloy nanoparticles on CeO

Background: Chronic exposure to glucocorticoids is associated with resistance to nondepolarising neuromuscular blocking agents. Therefore, we hypothesised that sugammadex-induced recovery in subjects with chronic exposure to dexamethasone was faster than that in subjects without dexamethasone exposure. Objective: To evaluate the recovery profile of rocuronium-induced neuromuscular blockade after sugammadex administration in rats. Design: An in vivo study on rats.Setting: Asan Institute for Life Sciences, Asan Medical Center, Korea, from April 2017 to October 2017.Animals: Thirty-six male Sprague-Dawley rats.Intervention: Sprague–Dawley rats were allocated to three groups (dexamethasone group, control group, and pair-fed group) for the in vivo study. Dexamethasone group received daily intraperitoneal injections of dexamethasone 500 μg kg-1 or 0.9% saline for 15 days. On the sixteenth day, 3.5 mg kg-1 of rocuronium was administered to achieve complete neuromuscular blockade. Main outcome measures: The recovery time to a train-of-four ratio Results: There were no significant differences in the recovery time to train-of-four ratio to 0.9 among the groups (P = 0.531). The time to second twitch of train-of-four recovery that indicated the duration of rocuronium-induced neuromuscular blockade was significantly shorter in Group D than in Groups C and P (P = 0.001). Conclusion: As previously reported, resistance to rocuronium was observed in rats with chronic exposure to dexamethasone. However, the neuromuscular recovery time after sugammadex administration was not significantly different between groups.

Introduction and hypothesis Overactive bladder (OAB) is a common condition that remains challenging to treat. We hypothesized that skin-adhesive low-level light therapy (LLLT) would be an effective treatment for OAB caused by bladder muscle contraction. Accordingly, we aimed to evaluate the efficacy and safety of an LLLT device for the treatment of OAB. Methods This prospective, randomized, double-blind, placebo-controlled, multicenter trial included patients with a clinical diagnosis of OAB who were treated at either of two university hospitals. Patients were instructed to apply an LLLT device (Color DNA-WSF) or a sham device at home three times daily for 12 weeks. The primary outcome was the change in the mean daily number of urge urinary incontinence (UUI) episodes between baseline and 12 weeks. The secondary outcomes were the mean changes in incontinence, voiding, and nocturia episodes from baseline and the likelihood of achieving a > 50% reduction in UUI and incontinence episodes after 12 weeks. All patients completed the Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), and Impact Urinary Incontinence-7 (IIQ-7) questionnaires. Safety parameters included treatment-emergent adverse events. Results Compared with those in the sham group, the numbers of UUI and urinary incontinence episodes in the LLLT group were significantly decreased at week 12 (UUI, (-1.0 ± 1.7 vs. -0.4 ± 2.5, P = 0.003; urinary incontinence, -1.1 ± 1.9 vs. -0.5 ± 2.9, P=0.002). Furthermore, the OABSS, UDI-6, and IIQ-7 scores at week 12 tended to be better in the LLLT group than in the sham group. The incidence of device-related treatment-emergent adverse events was similar between groups. Conclusions LLLT may be clinically useful and safe for the treatment of OAB.

Background The purpose of this study was to analyze the treatment efficacy and safety of stereotactic ablative body radiotherapy (SABR) boost for cervical cancer patients not amenable to brachytherapy. Methods A retrospective review of the medical records from single institution of 25 eligible patients was performed. The patients underwent pelvic radiotherapy (RT) in 25 or 28 fractions with a median dose of 45 Gy (range 44–50.4 Gy). SABR boost was delivered after pelvic RT, with a median dose of 25 Gy (range 20–33 Gy), and a median fraction number of 5 (range 4–6). 21 patients with a follow-up period of more than one year were included in the toxicity analysis, and hematuria and hematochezia that occurred later than 3 months after the RT were graded. Results The median follow-up period after radiotherapy was 2.85 years (range 0.33–6.60). The 3-year local control, locoregional control, disease-free survival, and overall survival rates were 80.9%, 75.8%, 40.9%, and 77.1%, respectively. 5 patients experienced grade 3 toxicity (3 genitourinary, 3 gastrointestinal), and no grade 4–5 toxicity was reported. Univariate analysis showed that cumulative D2cc in equivalent dose in 2 Gy fractions (EQD2) of rectum was marginally predictive for any grade of hematochezia (P = 0.051). Cumulative D2cc EQD2 of bladder was not predictive for hematuria. In the receiver operating characteristic (ROC) curve analysis, the optimal threshold of cumulative rectal D2cc EQD2 was 81.2 Gy for any grade of hematochezia. Conclusion SABR boost for cervical cancer was effective and tolerable. Although it cannot substitute brachytherapy, it can be a treatment option when brachytherapy is not possible.

Sevoflurane affects on the A1 receptor in the central nervous system and potentiates the action of neuromuscular blocking agents. In the present study, we investigated whether sevoflurane (SEVO) has the ability to potentiate the neuromuscular blocking effect of rocuronium and if the specific antagonist of adenosine receptor (SLV320) can reverse this effect. In this study, phrenic nerve–hemidiaphragm tissue specimens were obtained from 40 Sprague–Dawley (SD) rats. The specimens were immersed in an organ bath filled with Krebs buffer and stimulated by a train‐of‐four (TOF) pattern using indirect supramaximal stimulation at 20 s intervals. The specimens were randomly allocated to control, 2‐chloroadenosine (CADO), SEVO, or SLV320 + SEVO groups. In the CADO and SLV320 + SEVO groups, CADO and SLV320 were added to the organ bath from the start to a concentration of 10 μM and 10 nM, respectively. We then proceeded with rocuronium‐induced blockade of >95% depression of the first twitch tension of TOF (T1) and TOF ratio (TOFR). In the SEVO and SLV320 + SEVO groups, SEVO was added to the Krebs buffer solution to concentration of 400–500 μM for 10 min. Sugammadex‐induced T1 and TOFR recovery was monitored for 30 min until >95% of T1 and >0.9 of TOFR were confirmed, and the recovery pattern was compared by plotting these data. T1 recovery in the SEVO and CADO groups was significantly delayed compared with the control and SLV320 + SEVO groups (p, Effects of sevoflurane and adenosine receptor antagonist on the sugammadex‐induced recovery from rocuronium‐induced neuromuscular blockade in rodent phrenic nerve‐hemidiaphragm tissue specimens.

Simple Summary An increased risk of relapse and death from minimally invasive radical hysterectomy has been reported in some patients with early cervical cancer. Thus, the development of an intuitive and precise decision-aid tool, which estimates recurrence and mortality rates by surgical approach, is necessary. To develop models predicting survival outcomes according to the surgical approach, we collected clinicopathologic and survival data of patients with 2009 FIGO stage IB cervical cancer who underwent a radical hysterectomy. Using only variables that could be obtained preoperatively, we developed various models predicting the probability of 5-year progression-free survival and overall survival. Among them, hybrid ensemble models, combined with logistic regression and multiple machine learning models, achieved the best predictive performance. The developed models are expected to help physicians’ and patients’ decision making related to the surgical approach for primary radical hysterectomy. Abstract We purposed to develop machine learning models predicting survival outcomes according to the surgical approach for radical hysterectomy (RH) in early cervical cancer. In total, 1056 patients with 2009 FIGO stage IB cervical cancer who underwent primary type C RH by either open or laparoscopic surgery were included in this multicenter retrospective study. The whole dataset consisting of patients’ clinicopathologic data was split into training and test sets with a 4:1 ratio. Using the training set, we developed models predicting the probability of 5-year progression-free survival (PFS) and overall survival (OS) with tenfold cross validation. The developed models were validated in the test set. In terms of predictive performance, we measured the area under the receiver operating characteristic curve (AUC) values. The logistic regression models comprised of preoperative variables yielded AUCs of 0.679 and 0.715 for predicting 5-year PFS and OS rates, respectively. Combining both logistic regression and multiple machine learning models, we constructed hybrid ensemble models, and these models showed much improved predictive performance, with 0.741 and 0.759 AUCs for predicting 5-year PFS and OS rates, respectively. We successfully developed models predicting disease recurrence and mortality after primary RH in patients with early cervical cancer. As the predicted value is calculated based on the preoperative factors, such as the surgical approach, these ensemble models would be useful for making decisions when choosing between open or laparoscopic RH.

We evaluated droplet digital polymerase chain reaction (ddPCR) method for detectingWe reviewed 240 EC specimens from our hospital database. A ddPCR assay was used to identifyThe ddPCR assay identifiedHotspot

We aimed to identify the predictive risk factors for carboplatin-related hypersensitive reactions (HRs) and investigate their impact on survival outcomes in patients with epithelial ovarian cancer (EOC).This retrospective study included 222 patients with EOC who received carboplatin infusion between July 2016 and November 2019. We compared the clinicopathologic characteristics and survival outcomes between carboplatin-related hypersensitivity and non-hypersensitivity groups. Hypersensitivity data were classified using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, categorizing grades from 1 to 5 as mild/moderate/severe/life-threatening/death. Multiple logistic regression analysis was used to analyze risk factors of HRs. The Cox proportional hazard regression model was used to determine the factors of being significantly associated with overall survival.Of the 222 patients, eight exhibited HRs (incidence rate, 3.6%). All HRs were of grade 3 or 4 (life-threatening). In all cases, a desensitization protocol was followed. Advanced stage (III or IV) (P = 0.022), previous history of carboplatin use (P 0.001), and recurrent ovarian cancer (P = 0.001) were significantly associated with HR to carboplatin. Multivariate logistic analysis showed that a previous history of carboplatin was the only independent risk factor for carboplatin-related hypersensitivity (OR, 20.19; 95% CI 1.22 - 3034.10; P = 0.034). However, HR to carboplatin did not influence the overall survival (P = 0.526).In EOC patients, prior use of carboplatin was an independent risk factor for carboplatin-related HRs; HRs to carboplatin did not influence the overall survival. Clinicians should not underestimate the possibility risk of carboplatin HSRs when re-administrating carboplatin in EOC patients.

Background Neuromuscular blocking agents (NMBAs) and neuromuscular monitoring in anesthetic management are integral for endotracheal intubation, better visualization of the surgical field, and prevention of residual neuromuscular blockade and pulmonary complications. Sugammadex is a drug that reduces risk of residual neuromuscular blockade, with more rapid recovery compared to anticholinesterase. The purpose of this study was to investigate current usage status of NMBAs and antagonist with neuromuscular monitoring, among anesthesiologists in Korea. Methods Anesthesiologists working in Korea were invited to participate in an online survey via email January 2-February 28, 2018. The questionnaire consisted of 45 items, including preferred NMBAs, antagonists, neuromuscular monitoring, and complications related to the use sugammadex. A total of 174 responses were analyzed. Results Rocuronium was a commonly used NMBA for endotracheal intubation (98%) of hospitals, and maintenance of anesthesia (83.3%) in of hospitals. Sugammadex, pyridostigmine, and neostigmine were used in 89.1%, 87.9%, and 45.4% of hospitals. Neuromuscular monitoring was employed in 79.3% of hospitals; however only 39.7% of hospitals used neuromuscular monitoring before antagonist administration. Usual dosage range of sugammadex was 2.1-4 mg/kg in 35.1% of hospitals, within 2 mg/kg in 34.5% of hospitals, and 1 vial regardless of body weight in 22.4% of hospitals. Sugammadexrelated complications were encountered by 14.9% of respondents. Conclusions This survey indicates several minor problems associated with the use of antagonists and neuromuscular monitoring. However, most anesthesiologists appear to have appropriate information regarding the usage of NMBAs and sugammadex.

Nuclear power generates a large portion of the energy used today and plays an important role in energy development. To ensure safe nuclear power generation, it is essential to conduct an accurate analysis of reactor structural integrity. Accordingly, in this study, a methodology for obtaining accurate structural responses to the combined seismic and reactor coolant loads existing prior to the shutdown of a nuclear reactor is proposed. By applying the proposed analysis method to the reactor vessel internals, it is possible to derive the seismic responses considering the influence of the hydraulic loads present during operation for the first time. The validity of the proposed methodology is confirmed in this research by using the finite element method to conduct seismic and hydraulic load analyses of the advanced APR1400 1400 MWe power reactor, one of the commercial reactors. The structural responses to the combined applied loads are obtained using displacement-based and stress-based superposition methods. The safety of the subject nuclear reactor is then confirmed by analyzing the design margin according to the American Society for Mechanical Engineers (ASME) evaluation criteria, demonstrating the promise of the proposed analysis method. Keywords: Nuclear reactor internals, Seismic analysis, Finite element analysis, Pump-pulsation, Turbulence, Displacement-based stress assessment

Studies have reported that protracted dexamethasone treatment induces resistance to nondepolarizing neuromuscular blocking agents (NMBAs) and the association with nicotinic acetylcholine receptors in the diaphragm of rats. Here, we investigated the effect of protracted dexamethasone administration on the sensitivity to rocuronium and the recovery profile when reversed by sugammadex; additionally, we observed the recovery period of pharmacodynamic change after withdrawal. Sprague-Dawley rats received daily intraperitoneal injections of dexamethasone or saline for 14 days. On days 1, 3, and 7 after the last dexamethasone treatment (Dexa1, Dexa3, and Dexa7, respectively) or 1 day after saline (control group), the phrenic nerve-hemidiaphragm preparation was dissected for assay. The dose-response curve of rocuronium in Dexa1 was shifted to the right compared to controls, but curves in Dexa3 and Dexa7 were not significantly different. Groups were not significantly different in attaining the train-of-four ratio ≥ 0.9, but the recovery index in Dexa7 was shorter than that in control and Dexa1. Recovery profiles (period of sugammadex reversal) were not correlated with resistance properties but rather with total administered drugs (binding capacity of NMBAs and sugammadex). Protracted dexamethasone exposure induced resistance to rocuronium but seemed to have no effect on sugammadex reversal in the rat diaphragm.

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.

Supramalleolar osteotomy (SMO) has been suggested as an effective salvage treatment for varus ankle osteoarthritis. To identify the prognostic factors affecting the correction angle changes after SMO, a total of 53 consecutive patients (58 ankles) were evaluated retrospectively. Clinical and radiologic outcomes were evaluated, and statistical analyses were performed to identify the prognostic factors associated with the clinical and radiologic outcomes. The mean visual analogue scale scores and the American Orthopaedic Foot and Ankle Society scores improved significantly at the final follow-up (both p