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Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis

  • Young-Soo Choi;Hi-Jin You;Tae-Yul Lee;Deok-Woo Kim
    • Archives of Plastic Surgery
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    • v.50 no.1
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    • pp.3-9
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    • 2023
  • Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

The Effects of Digital Therapy for Stroke Patients in Korea: Meta-analysis (국내 뇌졸중 환자를 위한 디지털 치료의 효과: 메타분석)

  • Jae-Hun Jung
    • Journal of The Korean Society of Integrative Medicine
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    • v.11 no.4
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    • pp.1-15
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    • 2023
  • Purpose : This study investigates the effectiveness of digital therapy for stroke patients in Korea. Methods : A comprehensive database search was performed using KCI, Science on, e-article, RISS, KISS and Korea OpenMed databases for randomized controlled trials (RCTs) that studied the effects of digital therapy on patients who had a stroke. This study includes RCTs published from January 2000 to July 15, 2022, which fulfilled the inclusion and exclusion criteria. A total 697 studies were screened and 30 studies were included in the final analysis. Methodological quality was assessed with the Cochrane's RoB (risk of bias) tool. Meta-analysis was performed using CMA 4.0 software. Results : A total of 56 effect sizes were calculated from the 30 selected studies. As a result of the analysis, the overall effect size of digital therapy was .59 (95 % CI=.43-.74). When classified according to type of intervention, VR (virtual reality) (g=.58, 95 % CI=.40-.75), and CACR (computer assisted cognitive rehabilitation) (g=.62, 95 % CI=.30-.95) were statistically significant. VR showed medium to large effect sizes in cognitive function (g=.78, 95 % CI=.20-1.37), psychosocial function (g=.63, 95 % CI=.20-1.07), and physical function (g=.61, 95 % CI=.38-.83). In the CACR, there was a large effect size in cognitive function (g=.84, 95 % CI=.52-1.15), but there was no significant difference in psychosocial function. Also, there was no significant difference between the two interventions in activities of daily living and no significant difference in the effect size of both interventions according to the intervention session. Furthermore, medium to large effect sizes were found for subacute and chronic stroke patients according to the duration of disease. Conclusion : This study presents evidence that digital therapy has a positive effect on various functions of stroke patients in Korea. The researchers expect to actively accept the new paradigm of digital therapy and continue to apply digital therapy in clinical practice.

Updated Primer on Generative Artificial Intelligence and Large Language Models in Medical Imaging for Medical Professionals

  • Kiduk Kim;Kyungjin Cho;Ryoungwoo Jang;Sunggu Kyung;Soyoung Lee;Sungwon Ham;Edward Choi;Gil-Sun Hong;Namkug Kim
    • Korean Journal of Radiology
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    • v.25 no.3
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    • pp.224-242
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    • 2024
  • The emergence of Chat Generative Pre-trained Transformer (ChatGPT), a chatbot developed by OpenAI, has garnered interest in the application of generative artificial intelligence (AI) models in the medical field. This review summarizes different generative AI models and their potential applications in the field of medicine and explores the evolving landscape of Generative Adversarial Networks and diffusion models since the introduction of generative AI models. These models have made valuable contributions to the field of radiology. Furthermore, this review also explores the significance of synthetic data in addressing privacy concerns and augmenting data diversity and quality within the medical domain, in addition to emphasizing the role of inversion in the investigation of generative models and outlining an approach to replicate this process. We provide an overview of Large Language Models, such as GPTs and bidirectional encoder representations (BERTs), that focus on prominent representatives and discuss recent initiatives involving language-vision models in radiology, including innovative large language and vision assistant for biomedicine (LLaVa-Med), to illustrate their practical application. This comprehensive review offers insights into the wide-ranging applications of generative AI models in clinical research and emphasizes their transformative potential.

A Meta-analysis of Intervention Studies on the Effects of Self Management and Education in Adult Asthmatic Patients (성인 천식환자의 자가관리교육 중재의 효과 메타분석)

  • Kim, Chae-Bong;Han, Min-Kyung;Jeong, Mi-Seon;Choi, Bo-Young;Choi, Kil-Yong;Kim, Moo-Young
    • The Korean Journal of Health Service Management
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    • v.9 no.3
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    • pp.175-185
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    • 2015
  • Objectives : This study was did a meta-analysis of emergency room visits decreased effectiveness of self management education interventions in asthma among adult patients with asthma. Methods : A search of the database PubMed resulted in identifying 8,619 studies done between January 1990 and November 2012. STATA version 10.0 was used to analyze the effect size, explore possible causes of heterogeneity, and determine publication bias with a funnel plot. Results : We included 7 cases on emergency room visits decreased effectiveness of self management and education. Asthmatic patients experienced fewer attacks (summary effect size, 0.75; 95% confidence interval [CI], 0.65-0.95). We found that emergency room visits decreased effectiveness of self management and education were associated with statistically significant effects. Conclusions : Based on these finding, self management and education on interventions are necessary to prevent asthmatic attacks in patients and to reduce the severity of the attacks, and self management and education programs are needed in Korea.

Altered Motor Control in Patients With Neck Pain and Prospective Research Work (경부통증 환자의 변형된 운동조절 특성 분석과 향후 활용 방안)

  • Lee, Min-young;Yoon, Bum-chul
    • Physical Therapy Korea
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    • v.23 no.2
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    • pp.20-34
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    • 2016
  • Background: It is necessary to find and develop the effective way of intervention for patients with neck pain, since the neck pain is becoming increasingly common throughout the world. To identify the altered motor control in patient with neck pain would be informative to find and develop the effective way of intervention. Objects: The aim of this study was to review literature regarding the altered motor control in patients with neck pain, measured by using surface electromyography (sEMG), ultrasonography, and functional magnetic resonance imaging (fMRI), and to suggest prospective research work on neck pain. Methods: Case-control (neck pain/healthy) studies published between 2004 and 2015 that investigated neck muscle activation, thickness, cross-sectional area, and fat infiltrate were searched in Scopus, PubMed, and ScienceDirect. Twenty-eight articles were included in this study. Results: sEMG, ultrasonography, and fMRI were used complementarily to investigate the altered superficial and deep neck muscle activation, thickness, cross-sectional area, and fat infiltrate in patients with neck pain. They showed the following altered motor control when compared retrospectively with healthy subjects or during specific functional tasks: (1) increased superficial muscle activation, (2) lesser deep muscle thickness, (3) smaller cross-sectional area of the deep muscle, and (4) greater fat infiltrate in deep muscles. In particular, among the women, the office workers showed higher muscle activation of superficial neck muscles during functional tasks, although they did not have neck pain, than those who were not office workers. Conclusion: Studies revealed that patients with neck pain showed an altered motor control when compared with healthy subjects by using various assessment modalities. Understanding this phenomenon would help researchers design an effective intervention for alleviating neck pain or to evaluate the effectiveness of the intervention. In addition, we recommend that female office workers take measures to care for their necks before developing neck pain.

Implant Fixture Installation in the Posterior Maxilla Using a Tooth-supported Surgical Template Based on Computer Assisted Treatment Planning (컴퓨터 보조 기반 치아 지지 서지컬 템프레이트를 이용한 상악구치부 임플란트 식립)

  • Kim, Soung Min;Kim, Myung Joo;Lee, Jee Ho;Myoung, Hoon;Lee, Jong Ho;Kim, Myung Jin
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.6
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    • pp.381-389
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    • 2013
  • Two patients with partial edentulous maxilla were scheduled to undergo installation of implant fixtures using a tooth-supported surgical template based on computer assisted treatment planning. After 3-dimensional (3D) computed tomographic scanning was transferred to the OnDemand3D (Cybermed Co., Seoul, Korea) software program for virtual planning, fixtures of MK III Groovy RP implant of the Br${\aa}$nemark System (Nobel Biocare AB Co., G$\ddot{o}$teborg, Sweden) was installed using the In2Guide (CyberMed Co., Seoul, Korea) tooth-supported surgical template with a Quick Guide Kit (Osstem Implant Co., Seoul, Korea) system in the posterior maxilla of each patient. Sinus floor elevation with a xenogenic bone graft procedure was also performed simultaneously in one patient. Fixture installations were completed successfully without complications, such as sinus mucosa perforation, bony bleedings, fenestrations, or others. During the last two-year follow-up period after prosthetics delivery, each implant was found to be fine with no other minor complications. The entire procedures are reported and the literatures on use of tooth-supported surgical template was reviewed.

Systematic Review and Meta-Analyses of Diagnostic Accuracy of Infrared Thermometer when Identifying Fever in Children (아동에서의 적외선 체온 측정의 진단정확도 연구 : 체계적 문헌 고찰과 메타분석)

  • Park, Young Joo;Park, Seong-Hi;Kang, Chang-Bum
    • Journal of Korean Academy of Nursing
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    • v.43 no.6
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    • pp.746-759
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    • 2013
  • Purpose: Infrared thermometers are increasingly used as a convenient, non-invasive assessment method for febrile children. However, the diagnostic accuracy of the infrared thermometer for children has been questioned, particularly in relation to sensitivity and specificity. The aim of this study was to evaluate diagnostic accuracy of infrared thermometers in febrile children. Methods: Articles published between 1966 and 2012 from periodicals indexed in the Ovid Medline, Embase, CINAHL, Cochrane, KoreaMed, NDSL, KERIS and other databases were selected, using the following keywords: 'infrared thermometer'. The QUADAS-II was applied to assess the internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4. Results: Nineteen diagnostic studies with high methodological quality, involving 4,304 children, were included. The results of meta-analysis showed that the pooled sensitivity, specificity and AUC (Area Under the Curve) of infrared tympanic thermometers in children over 1 year were 0.80 (95% CI 0.78, 0.81), 0.94 (95% CI 0.93, 0.95) and 0.95 respectively. However the diagnostic accuracy of infrared tympanic thermometers in children with hyperthermia was low. Conclusion: The diagnostic accuracy of infrared tympanic thermometer was similar to axillary and rectal thermometers indicating a need for further research to substantiate these findings in children with hyperthermia.

Bereavement Care for Parents in the Neonatal Intensive Care Unit: A Literature Review (신생아 집중치료실 기반 사별 간호의 문헌고찰)

  • Seo, Wonjin;Lee, Hyejung;Oh, Sumi;Sa, Hyoeun;Kim, Hyoyeong
    • Child Health Nursing Research
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    • v.26 no.2
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    • pp.286-295
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    • 2020
  • Purpose: The purpose of this study was to review studies investigating the effect of bereavement care provided for parents in the neonatal intensive care unit. Methods: We conducted a literature review of databases (MEDLINE, Embase, Cochrane Library, and CINAHL) for studies published in English and four databases (RISS, KISS, NANET, and KoreaMed) for Korean studies. The selection criteria included original articles that evaluated the parents' perceptions or responses to bereavement care provided in the neonatal intensive care unit. Of 889 articles from the initial screening, 66 articles underwent full-text review and five articles were finally selected for analysis. Results: None of the studies was conducted in Korea. Only one study used a randomized control trial design. The forms of bereavement care reviewed included a provision of a memory package, grief information, and emotional and/or social support from peers or health care providers. The effectiveness of bereavement care was measured by including grief, social support, and depression. Conclusion: Bereavement care can be considered to be beneficial for relieving grief reactions and enhancing the personal growth of bereaved parents. Future research should assess the needs of bereaved parents in Korea. Nurses may play a role in developing the bereavement care for parents.

Analyses of the Studies on Cardiovascular Disease-Specific Quality of Life Reported in Korea (심혈관질환자 삶의 질에 대한 국내 연구논문 분석)

  • Lee, Eun-Hyun;Tak, Seung Jai;Song, Yeoungsuk
    • Korean Journal of Adult Nursing
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    • v.17 no.3
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    • pp.452-463
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    • 2005
  • Purpose: The purpose of the present study was to analyze and evaluate prior studies published in Korea on the cardiovascular disease-related quality of life, in order to make recommendations for further research. Methods: A total of 15 studies were selected from four databases(Digital library of Research Information Center for Health, Korea Medical Database, MedRic, and National Assembly Library). The selected studies were analyzed according to criteria, such as diagnosis/operation, used instrument, generic/specific instrument, dimension of quality of life, translation/ back-translation, sample size, reliability, validity, responsiveness, number of items, type of scale, time required, and independent variables. Results: Of the 15 cardiovascular disease-related quality of life studies, approximately half of them were conducted with hypertension or ischemic heart disease patients. All studies asserted that the concept of quality of life had multidimensional attributes. With respect to the questionnaire used for measuring the quality of life, only one study used a cardiovascular disease specific-instrument and most studies did not consider whether or not the validity of their instrument had been established. In addition, when using questionnaires developed in other languages, only one study employed a translation/back-translation technique. The types of variables tested for their influence on quality of life were quite limited. Conclusion: It is recommended to develop a reliability and validity established cardiovascular disease specific-quality of life for Korean patients and to identify associated new variables.

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Fine localization of a new cataract locus, Kec, on mouse chromosome 14 and exclusion of candidate genes as the gene that causes cataract in the Kec mouse

  • Kang, Min-Ji;Cho, Jae-Woo;Kim, Jeong-Ki;Kim, Eun-Min;Kim, Jae-Young;Cho, Kyu-Hyuk;Song, Chang-Woo;KimYoon, Sun-Joo
    • BMB Reports
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    • v.41 no.9
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    • pp.651-656
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    • 2008
  • A mouse with cataract, Kec, was generated from N-ethyl-N-nitrosourea (ENU) mutagenesis. Cataract in the Kec mouse was observable at about 5 weeks after birth and this gradually progressed to become completely opaque by 12 weeks. Dissection microscopy revealed that vacuoles with a radial or irregular shape were located primarily in the cortex of the posterior and equatorial regions of the lens. At the late stage, the lens structure was distorted, but not ruptured. This cataract phenotype was inherited in an autosomal recessive manner. We performed a genetic linkage analysis using 133 mutant and 67 normal mice produced by mating Kec mutant (BALB/c) and F1 (C57BL/6 $\times$ Kec) mice. The Kec locus was mapped to the 3 cM region encompassed by D14Mit34 and D14Mit69. In addition we excluded coding sequences of 9 genes including Rcbtb2, P2ry5, Itm2b, Med4, Nudt15, Esd, Lcp1, Slc25a30, and 2810032E02Rik as the candidate gene that causes cataract in the Kec mouse.