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Abstract Chemical risk assessment is important for risk management, and estimates of chemical exposure must be as accurate as possible. Chemical concentrations in food below the limit of detection are known as nondetects and result in left‐censored data. During statistical analysis, the method used for handling values below the limit of detection is important. Many risk assessors employ widely used substitution methods to treat left‐censored data, as recommended by international organizations. The National Institute of Food and Drug Safety Evaluation of South Korea also recommends these methods, which are currently used for chemical exposure assessments. However, these methods have statistical limitations, and international organizations recommend more advanced alternative statistical approaches. In this study, we assessed the validity of currently used statistical methods for handling nondetects. To identify the most suitable statistical method for handling nondetection, we created virtual data and conducted simulation studies. Based on both simulation and case studies, the Maximum Likelihood Estimation (MLE) and Robust Regression on Order Statistics (ROS) methods were found to be the best options. The statistical values obtained from these methods were similar to those obtained from the commonly used 1/2 Limit of Detection (LOD) substitution method for nondetection treatment. In three case studies, we compared the various methods based on the root mean squared error. The data for all case studies were from the same source, to avoid heterogeneity. Across various sample sizes and nondetection rates, the mean and 95th percentile values for all treatment methods were similar. However, “lognormal maximum likelihood estimation” method was not suitable for estimating the mean. Risk assessors should consider statistical processing of monitoring data to reduce uncertainty. Currently used substitution methods are effective and easy to apply to large datasets with nondetection rates

This study was conducted to examine the operation statuses of on-site swine wastewater treatment facilities through surveys and field surveys on pig farms and to propose effective operation models. Field analyses and surveys of pig farms indicate that technical and financial support systems are required for both farms and on-site swine wastewater treatment facilities. Public environmental services have been proposed as an effective support system, in which private sewage treatment facilities are entrusted to professional environmental management agencies, and the costs are shared by local governments and facility owners. However, securing a stable budget represents a challenge to implementing public environmental services. Thus, this study proposes a collaborative manure management model composed of individual farms, professional environmental management agencies, and local governments to address the shortcomings of public environmental services. To effectively manage pig manure, the flexible application of discharge standards, diversification of pollutant reduction management techniques (e.g., feed management), and periodic review of permits must be considered. Additionally, the reinforcement of discharge standards for individual purification facilities, control of the livestock density and number, and impacts of livestock manure discharge on riverine ecosystems must be considered.

Background: Current guidelines consider atrial fibrillation (AF) type as the prognostic factor for a recommendation of catheter ablation. We aimed to determine whether LA and LA appendage (LAA) volumes measured using multislice computed tomography (MSCT) were related to long-term outcomes in AF following radiofrequency catheter ablation (RFCA). Methods: We evaluated 152 consecutive patients with drug-refractory AF (median age, 55.8 ± 9.6 years), including 110 male patients, who underwent RFCA in a single center. All patients underwent MSCT imaging for anatomical assessment. The endpoint of this study was documented AF recurrence after RFCA. Results: The overall procedure success rate was 77.6% (n = 118) during a mean follow-up period of 12.6 months. The LA volume was significantly larger for those who experienced AF recurrence after RFCA than for the patients without recurrent AF after the procedure (153.8 ± 29.9 mL vs. 139.2 ± 34.1 mL, p = 0.025). However, LAA volumes were nearly equivalent between the patients with and without AF recurrence after RFCA (16.2 ± 6.3 mL and 14.7 ± 6.5 mL, respectively; p = 0.235). LA volume ≥ 153.2 mL was the optimal cutoff value for estimating AF recurrence after RFCA, with 94% sensitivity and 66% specificity. LA volume remained an independent predictor of both AF recurrence and permanent AF. Conclusions: LA volume as assessed by MSCT might be helpful for identifying patients likely to achieve successful AF ablation. LA volume ≥ 153.2 mL, but not LAA volume, showed good accuracy in predicting AF recurrence after RFCA.

Alien invasive species are posing conservation challenges worldwide. Pet trade, one of the many ways, is worsening the situation. Especially, pet turtles have been released into nature due to their longer life span and peoples’ religious and traditional beliefs. In addition, unwanted and undesired pets are also released. While information on the successful local establishment and subsequent dispersal into new habitats is required to designate an invasive and ecosystem-disturbing species, alien freshwater turtle nests have always been hard to find and identify in nature. Because one should identify nests by the eggs, which do not always guide properly, as adults abandon the sites quickly. We thought the recent advancement in DNA technology may help improve the situation. We studied Pseudemys peninsularis, one of the most traded freshwater turtle pet species, which has already been reported from a wide range of wild areas in South Korea. Yet, it is not designated as ecosystem-disturbing species due to a lack of adequate information on their local reproduction and establishment. We conducted surveys and found two nests in Jeonpyeongje Neighborhood Park, Maewol-dong, Seo-gu, Gwangju. We developed the methodology for extracting DNA from the eggshells and successfully identified the nests by phylogenetic analysis and verified through egg characteristics and morphological features of artificially hatched juveniles. This was the first successful initiative to extract DNA from freshwater turtle eggshells. We believe it will help future researchers identify the alien invasive turtle nests and develop their control and management policies. In addition, our study also included comparative descriptions and schematic diagrams of the eggs of eight freshwater turtles, including a native and three ecosystem-disturbing species, from South Korea. We urged an immediate designation of P. peninsularis as an ecosystem-disturbing species considering its local establishment, distribution range, and potential negative impact on native ecosystems.

Oral mucositis (OM) is a debilitating adverse event in patients undergoing treatment for cancer. This study aimed to evaluate the therapeutic effect of a novel handheld photobiomodulation therapy (PBMT) device on chemoradiation therapy (CRT)-induced OM in patients with head and neck cancer. Head and neck cancer patients undergoing CRT who developed moderate-to-severe OM during treatment were enrolled. After PBMT and at 2 and 4 weeks after PBMT, the mean value of OM grade decreased significantly from 2.63 to 2.13, 1.31, and 0.75, respectively (p < 0.05, p < 0.001, and p < 0.001). Moreover, we observed significant improvement in health-related quality of life (HRQoL) after PBMT compared to baseline through a validated questionnaire; EORTC QLQ-C30. In the present study, the use of this PBMT device in the management of CRT-induced OM in patients with head and neck cancer was generally well tolerated and resulted in the improvement of OM. However, evidence supporting its use remains lacking owing to limitations such as the small number of participants and lack of a control group. Therefore, further mechanistic studies and large-scale randomized controlled trials are needed to confirm the effectiveness of PBMT in the treatment of CRT-induced OM, as shown in our results.

This study was conducted to evaluate the effects of dietary supplementation of plant flavonoid (quercetin) on immune parameters, growth performance, and nutrient digestibility in growing pigs challenged with Escherichia coli lipopolysaccharide (LPS). A total of 40 crossbred ([Landrace × Yorkshire] × Duroc) growing pigs; initial body weight (BW) of 26.95 ± 1.26 kg were used in a six-week experimental trial. Pigs were randomly allocated into one of four treatment groups in a 2 × 2 factorial arrangement with the following factors; without LPS challenge and with LPS challenge (day 21) supplemented with or without 0.1% flavonoid according to BW (2 replicate pens per treatment with 2 gilts and 3 barrows per pen). The single- dose LPS (100 ug / kg BW) injection showed trends tended to be increased in interleukin-6 (IL-6) after 2 h and 6 h of challenge compared with unchallenged pigs. However, other measured immune indices (white blood cell, immunoglobulin G, lymphocyte, and tumor necrosis factor), growth performance, and nutrient digestibility were not significantly different between challenged and non-challenged animals. The supplementation of flavonoid significantly increased (p < 0.05) average daily gain (ADG) during day 0–21, tended to increase dry matter and nitrogen digestibility, significantly reduced IL-6, increased Ig-G and WBC concentrations and increased lymphocytes percentage regardless of LPS challenge.

Study Design Retrospective analysis of prospectively collected data. Purpose To evaluate the natural progression of segmental kyphosis in thoracic and thoracolumbar spine with advancing age. Overview of Literature To our knowledge, the evolution of segmental thoracic kyphosis (TK) in individuals aged >50 years has not been reported. Methods Total 179 normal, asymptomatic Korean men were divided in to three groups (6th, 7th, and 8th decade) according to their age. Standard sagittal spinopelvic parameters, including TK and thoracolumbar kyphosis, were measured and subdivided into the following four segments: A (C7 upper end plate [UEP]–T5 UEP), B (T5 UEP–T10 UEP), C (T10 UEP–T12 lower end plate [LEP]), and D (T12 LEP–L2 LEP). These segments of the three study groups were analyzed. Results In segment B, the segmental kyphosis of group 3 (20.2°±8.0°) showed a statistically larger value than that of group 1 (15.6°±6.8°) and group 2 (16.7°±8.8°) (p=0.017). In segment C, the segmental kyphosis of group 2 (12.9°±6.5°) and group 3 (12.2°±7.1°) showed statistically larger values than that of group 1 (9.5°±6.2°) (p=0.016). The A and D segments of the three groups were not significantly different. Conclusions Increased TK was observed in the middle (segment B) and lower (segment C) thoracic segments in normal asymptomatic male subjects with age. The results from the natural progression of segmental kyphosis with age would provide baseline reference data to help surgeons choose the optimal point of the upper instrumented vertebra level for preventing proximal junctional kyphosis.

This study aimed to evaluate the effects of dietary supplementation of lysolecithin emulsifier on growth performance, nutrient digestibility, and blood lipid profiles in growing broiler chickens. In total, 1,020 1-day-old male Ross 308 broiler chickens with an average initial live weight of 43±1.2 g were randomly allotted to five dietary treatments for a 35 d experiment. The treatments included: (1) NC, negative control (metabolizable energy (ME)=3,100 kcal/kg for phase 1 and phase 2), (2) PC, positive control (ME=3,200 kcal/kg), (3) T1, NC+0.03% lysolecithin, (4) T2, NC+0.06% lysolecithin, and (5) T3, NC+0.09% lysolecithin. During days 1–35, the feed conversion ratios (FCR) of broiler chickens fed with T2 and T3 diets were lower than those of broiler chickens fed with NC diet (P

This study was designed to investigate the effects of dietary fenugreek seed extract (FSE) supplementation on egg production, egg quality, blood profiles, cecal microflora, and excreta noxious gas emission in laying hens. A total of 384 laying hens (26-weeks old, Hyline-brown) were fed three different levels of FSE (0, 0.05, and 0.1%) in a cornsoybean diet for 6 weeks. The inclusion of FSE in the laying hen diet did not affect egg production, feed intake, or feed conversion among treatments; however, egg weight, eggshell breaking strength, eggshell thickness, and yolk color increased in FSE-fed groups (linear, P

A total of 150 crossbred weaned pigs [(Yorkshire × Landrace) × Duroc] with an average body weight of 6.75 ± 0.49 kg were used in a 6-wk trial to determine the effects of dietary supplementation of β-glucan on growth performance, nutrient digestibility, and characteristics of feces (fecal score, microbiota, moisture, and pH) in weaned pigs. The corn-soybean meal based dietary treatments included: 1) antibiotic (30 ppm Tiamulin), 2) 0% β-glucan, 3) 0.1% β-glucan, 4) 0.2% β-glucan, and 5) 0.4% β-glucan. Dietary supplementation with β-glucan resulted in no significant differences in growth performance, nutrient digestibility, or characteristics of feces compared with that of Tiamulin supplementation. Pigs fed β-glucan exhibited a linearly increasing average daily gain and feed/gain ratio. Dietary supplementation of β-glucan linearly increased apparent total tract digestibility of dry matter and energy during 1–14 and 1–42 d as dietary β-glucan increased from 0.1 to 0.4%. In addition, pigs fed β-glucan had linearly decreasing coliform bacterial counts. In conclusion, dietary supplementation with β-glucan from rice bran improved growth performance, nutrient digestibility and coliform bacteria in weaned pigs, and β-glucan had the same effect as Tiamulin supplementation on growth performance, nutrient digestibility, and characteristics of feces. Thus, we suggest that β-glucan from rice bran can be used as an alternative to antibiotics, and will improve productivity of weaned pigs.

Background and Objectives: Phase lag entropy, an electroencephalographic monitor, evaluates the variety in temporal patterns of phase relationship between frontal and prefrontal brain region. Phase lag entropy can reflect the depth of anesthesia induced by propofol, but the association between sevoflurane and phase lag entropy has not been elucidated. This study examined the effect of sevoflurane on phase lag entropy during induction of general anesthesia. We also explored the pharmacodynamic model between end-tidal anesthetic concentration and electroencephalographic monitor. Materials and Methods: A total of 20 patients were enrolled. General anesthesia was produced by escalating the sevoflurane (1 vol% up to 8 vol%). The relationship between phase lag entropy and end-tidal anesthetic concentration was analyzed. A non-linear mixed-effects model was used to get the relationship of pharmacodynamics between the end-tidal sevoflurane concentration and phase lag entropy. Mean blood pressure, heart rate, and the modified observer’s assessment of alertness/sedation scale were also recorded during sevoflurane anesthesia. Results: As level of sedation increased, phase lag entropy decreased. A significant correlation was showed between phase lag entropy and end-tidal sevoflurane concentration (r = −0.759, p < 0.001). The correlation coefficient between the modified observer’s assessment of alertness/sedation scale and phase lag entropy was 0.731 (p < 0.001). The pharmacodynamic factors assessed by the sigmoid Emax model were E0 = 84.9, Emax = 42, Ce50 = 1.81, γ = 4.78, and ke0 = 0.692. The prediction probability of phase-lag entropy for measuring the modified observer’s assessment of alertness/sedation scale and end-tidal sevoflurane concentration were 0.764 and 0.789, respectively. With the increasing concentration of sevoflurane, mean blood pressure decreased, but heart rate did not change. Conclusions: The continuing escalation in end-tidal sevoflurane concentration caused a decline in phase lag entropy. Phase lag entropy can serve as an indicator of hypnotic depth in patients receiving sevoflurane anesthesia.

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.

Sixty broilers (initially 1.6 kg and 35 d-old) were used to determine the effect of Bacillus subtilis C14 and RX7 strains on growth performance, blood parameter, and intestinal microbiota in response to experimental challenge with Salmonell gallinarum. Broilers were distributed to 4 treatment groups include: C1 (control group; no challenge, no B. subtilis), C2 (Salmonella-challenged group; S. gallinarum 108 cfu/bird), T1 (C2+supplemented with of B. subtilis C14 (1.0×109 cfu/g) at 0.1% in diet) and T2 (C2+supplemented with of B. subtilis RX7 (1.0×109 cfu/g) at 0.1% in diet). Results indicated that inclusion of B. subtilis (T1, T2) in the diet increased (P

Purpose: To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. Materials and Methods: This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Results: Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Conclusions: Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital.

Dry-cured pork neck samples were stored at 10°C for 90 days under vacuum packaging (VP) or modified atmosphere packaging (MAP; 25% CO2+75% N2) conditions. The pH, moisture, water activity, total aerobic bacteria, and Enterobacteriaceae counts of dry-cured pork neck products with MAP were significantly lower than those with VP (p60 days of storage were lower than those at Day 1. In conclusion, despite presenting higher lipid oxidation, the samples stored in packages containing 25% CO2 for 90 days at 10°C have lower bacterial counts than vacuum-packed samples. Therefore, further studies should be performed on the packaging of dry-cured meat at adjusted concentrations of CO2.

Drynariae rhizoma has been used to prevent bone loss that occurs with increasing age. However, the chemical compounds in extracts that act on bone metabolism in herbal medicine are poorly understood. This study aimed to investigate and compare the extraction efficacy of polyphenolic compounds, antioxidant activity, and in vitro anti-osteoporosis properties of water extract (DR-DW) and ethanol extract (DR-EtOH) from D. rhizoma. Total phenolics and flavonoids were better extracted with 70% EtOH, and this extraction method also resulted in higher antioxidant activity and in vitro anti-osteoporosis properties in these extracts. In particular, the contents of phloroglucinol, protocatechuic acid ethyl ester, 2-amino-3,4-dimethyl-benzoic acid, 3-(3,5-dimethyl-pyrazol-1-yl)-benzoic acid, chlorogenic acid, syringic acid, trans-ferulic acid, (−)-epigallocatechin, epigallocatechin gallate, quercetin dehydrate, luteolin and emodin in DR-EtOH were higher than those in DR-DW. These results indicated that DR-EtOH could be a good source of natural herbs with anti-osteoporosis properties.

This study investigated on the effects of adding mechanically deboned chicken meat (MDCM) hydrolysates on the quality properties of imitation fish paste (IFP) during storage. IFP was prepared from Alaska Pollack, spent laying hens surimi and protein hydrolysates which were enzymatically extracted from MDCM. The study was designed as a 3×4 factorial design with three MDCM hydrolysate content groups (0%, 0.4%, and 0.8%) and four storage times (0, 2, 4, and 6 weeks). Addition of MDCM hydrolysates increased crude fat content but lowered water content (p

PurposeTo investigate the association between necrotizing enterocolitis (NEC) and red blood cell transfusions in very low birth weight (VLBW) preterm infants.MethodsWe studied were 180 VLBW preterm infants who were admitted to the neonatal intensive care unit of CHA Gangnam Hospital from January of 2006 to December of 2009. The subjects were divided into 2 groups: an NEC group (greater than stage II on the modified Bell's criteria) and a control group (less than stage II on the modified Bell's critieria). We defined red blood cell transfusion before NEC diagnosis as the frequency of transfusion until NEC diagnosis (mean day at NEC diagnosis, day 18) in the NEC group and the frequency of transfusion until 18 days after birth in the control group.ResultsOf the 180 subjects, 18 (10%) belonged to the NEC group, and 14 (78%) of these 18 patients had a history of transfusion before NEC diagnosis. The NEC group received 3.1±2.9 transfusions, and the control group received 1.0±1.1 transfusions before the NEC diagnosis (P=0.005). In a multivariate logistic regression corrected for gestational age, Apgar score at 1 minute, the presence of respiratory distress syndrome, patent ductus arteriosus, premature rupture of membrane, disseminated intravascular coagulopathy and death were confounding factors. The risk of NEC increased 1.63 times (95% confidence interval, 1.145 to 2.305; P=0.007) with transfusion before the NEC diagnosis.ConclusionThe risk for NEC increased significantly with increased transfusion frequency before the NEC diagnosis.

The dorsal approach allows better central screw placement along the long axis of the scaphoid compared with the volar approach in managing acute scaphoid fractures. However, it is unclear whether the dorsal approach leads to better clinical outcomes than the volar approach. This meta-analysis compared clinical outcomes, including the incidence of nonunion, postoperative complications, overall functional outcome, postoperative pain, grip strength, and range of wrist motion, between the dorsal and volar percutaneous approaches for the management of acute scaphoid fractures. Seven studies met the criteria for inclusion in the meta-analysis. The proportion of patients who developed nonunion (OR 0.74, 95% CI: 0.21 to 2.54; P = 0.63) and postoperative complications (OR 1.05, 95% CI: 0.45 to 2.44; P = 0.91) did not differ significantly between the dorsal and volar approaches. Both approaches also led to similar results in terms of overall functional outcome (95% CI: -0.39 to 0.22; P = 0.57), postoperative pain (95% CI: -0.52 to 0.46; P = 0.92), grip strength (95% CI: -4.56 to 1.02; P = 0.21), flexion (95% CI: -2.86 to 1.13; P = 0.40), extension (95% CI: -1.17 to 2.67; P = 0.44), and radial deviation (95% CI: -1.94 to 2.58; P = 0.78). However, ulnar deviation (95% CI: -7.48 to 0.05; P = 0.05) was significantly greater with the volar approach. Thus, orthopedic surgeons need to master both the dorsal and volar percutaneous approaches because not all acute scaphoid fractures can be dealt with completely with one approach.

Ski protein is implicated in proliferation/differentiation in a variety of cells. We had previously reported that Ski protein is present in granulosa cells of atretic follicles, but not in preovulatory follicles, suggesting that Ski has a role in apoptosis of granulosa cells. The alternative fate of granulosa cells other than apoptosis is to differentiate to luteal cells; however, it is unknown whether Ski is expressed and has a role in granulosa cells undergoing luteinization. Thus, the aim of the present study was to locate Ski protein in the rat ovary during luteinizationto predict the possible role of Ski. In order to examine the expression pattern of Ski protein along with the progress of luteinization, follicular growth was induced by administration of equine chorionic gonadtropin to immature female rats, and luteinization was induced by human chorionic gonadtropin treatment to mimic luteinizing hormone (LH) surge. While no Ski-positive granulosa cells were present in preovulatory follicle, Ski protein expression was induced in response to LH surge, and was maintained after the formation of the corpus luteum (CL). Though Ski protein is absent in granulosa cells of preovulatory follicle, its mRNA (c-Ski) was expressed and the level was unchanged even after LH surge. Taken together, these results demonstrated that Ski protein expression is induced in granulosa cells upon luteinization, and suggests that its expression is regulated post-transcriptionally.

The effects of betaine supplementation on productivity, egg quality, blood components, and liver amino acid concentration were examined in laying hens using a diet with differing levels of CP. A total of 540 Hy-Line Brown laying hens were allotted to 6 treatments with 5 replications for 24 weeks. Treatments were designed with 3 levels of CP (14, 16 and 18%) and 2 levels of betaine supplementation (0 and 600 ppm) in the diet. Egg production, egg mass, and feed conversion were found to be improved significantly as dietary levels of protein increased (P

Background: Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia. Methods: In this prospective randomized controlled trial, participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR- 15) score at 24-h postoperatively. Results: Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups. Conclusions: Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background Globus pharyngeus, or globus, is characterised by the sensation of a lump or tightness in the throat. Symptoms can be persistent, difficult to treat and often reoccur. Globus is a common issue in the community, with lifetime prevalence occurring in up to 45% of the population. Objective This article aims to provide a narrative review of potential causes of globus, as well as a suggested guideline for work-up and management in the primary care setting. Discussion Causes for globus remain uncertain; however, current opinion focuses on a mixture of muscle tension and mucosal irritation. It is estimated that globus makes up 4% of all primary care referrals to otolaryngologists. There are a handful of proposed causes, with treatments often able to be initiated in the primary care setting. Although most causes are benign, it is important for clinicians to maintain suspicion for malignancy, because this is often the patient's main concern. [ABSTRACT FROM AUTHOR]

Background/Aims: The recent update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease initiative has added normal growth in children as an intermediate target in Crohn’s disease and ulcerative colitis. We aimed to investigate factors associated with reaching midparental height (MPH) in patients diagnosed with inflammatory bowel disease in childhood and the adolescent period. Methods: This multicenter retrospective observational study included pediatric patients with inflammatory bowel disease that had reached adult height. Factors associated with reaching MPH were investigated by logistic regression analyses. Results: A total of 166 patients were included in this study (128 Crohn’s disease and 38 ulcerative colitis). Among them, 54.2% (90/166) had reached their MPH. Multivariable logistic regression analysis revealed that height Z-score at diagnosis and MPH Z-score were independently associated with reaching MPH (odds ratio [OR], 8.45; 95% confidence interval [CI], 4.44 to 17.90; p<0.001 and OR, 0.11; 95% CI, 0.04 to 0.24; p<0.001, respectively). According to the receiver operating characteristic curve analysis, the optimal cutoff level of "height Z-score at diagnosis minus MPH Z-score" that was associated with reaching MPH was –0.01 with an area under the curve of 0.889 (95% CI [0.835 to 0.944], sensitivity 88.9%, specificity 84.2%, positive predictive value 87.0%, negative predictive value 86.5%, p<0.001). Conclusions: Height Z-score at diagnosis and MPH Z-score were the only factors associated with reaching MPH. Efforts should be made to restore growth in pediatric patients who present with a negative “height Z-score at diagnosis minus MPH Z-score.” [ABSTRACT FROM AUTHOR]