• Journal of Chest Surgery
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• v.56 no.6
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• pp.374-386
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• 2023

Background: The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population. Methods: We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model. Results: We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05). Conclusion: The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.

• International Journal of Naval Architecture and Ocean Engineering
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• v.8 no.3
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• pp.262-276
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• 2016

Generally, the Safety Integrity Level (SIL) of a subsea Blowout Preventer (BOP) is evaluated by determining the Probability of Failure on Demand (PFD), a low demand mode evaluation indicator. However, some SIL results are above the PFD's effective area despite the subsea BOP's demand rate being within the PFD's effective range. Determining a Hazardous Event Frequency (HEF) that can cover all demand rates could be useful when establishing the effective BOP SIL. This study focused on subsea BOP functions that follow guideline 070 of the Norwegian Oil and Gas. Events that control subsea well kicks are defined. The HEF of each BOP function is analyzed and compared with the PFD by investigating the frequency for each event and the demand rate for the components. In addition, risk control options related to PFD and HEF improvements are compared, and the effectiveness of HEF as a SIL verification for subsea BOP is assessed.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.271-274
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• 2018

The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient's life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.

• CELLMED
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• v.5 no.2
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• pp.13.1-13.5
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• 2015

Many patients with psoriasis look for treatment options other than conventional treatment to control their disease with less side effects. We evaluated the prevalence and characteristics of herbal therapy usage among patients with psoriasis in Turkey. A self-prepared questionnaire about herbal therapies was applied to the psoriatic patients attended our dermatology clinic between October 2013 and December 2013. A total of 100 patients (55 male, 45 female; 7 - 80 years of age) were included in this study. Fortynine percent of patients used at least one form of herbal therapies. Juniperus oxycedrus and Aloe vera were found to be the most frequently used plants. 36.7% of the patients get benefit from herbal therapy. Only 12.2% of patients had informed their clinicians during or after herbal therapy usage. 22.4% of the patient had continued conventional treatment during herbal therapies. Side effects related with herbal therapy were developed in 26.5% of the patients. The risk of side effects was found to be 5.23 times more in patients using phytotherapies systemically compared with ones using topically. Our results show that herbal therapy usage is common among patients with psoriasis in Turkey. Since herbal therapies have the potential of interacting with the medical treatment modalities and causing life threatening allergic reactions, clinicians should be aware of plants used in psoriasis and possible adverse reactions related with them and also should not forget asking about herbal therapy history.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.633-639
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• 2022

Accurate diagnosis of trigeminal neuralgia (TN) is the starting point for optimal treatment. Gamma knife radiosurgery (GKRS) is currently regarded as one of the first-line treatment options for medically refractory TN. GKRS is a less invasive treatment with a low risk of complications than other surgical procedures that provides a favorable pain control Barrow Neurological Institute (BNI) I-IIIb rate of >75% at short-term follow-up. Drawbacks of GKRS include the latency period before pain relief and higher recurrence rate compared with microvascular decompression. Therefore, repeat treatment is necessary if the initial GKRS was effective but followed by recurrence. The concept of dose rate and the biologically effective dose of radiation has been actively studied in radiation oncology and is also applied in GKRS for TN to achieve high safety and efficacy by prescribing the optimal dose. Recent progress in functional imaging, such as diffusion tensor imaging, enables us to understand the pathophysiology of TN and predict the clinical outcome after GKRS. Here, we review TN, GKRS, and recent updates, especially in the concepts of radiation dose, diffusion tensor imaging studies, and repeat treatment in GKRS for TN.

• Physical Therapy Rehabilitation Science
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• v.12 no.1
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• pp.48-55
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• 2023

Objective: The purpose of this study is to compare the effects of extracorporeal shock wave therapy (ESWT) and injection therapy through qualitative and quantitative analysis by synthesizing randomized controlled trials (RCTs) conducted on patients with various shoulder diseases. Design: A systematic review and meta-analysis of randomized controlled trials Methods: This review conducted a literature search through international electronic databases in January 2023 to compare the effects of ESWT and injection therapy. Qualitative analysis was performed as a risk of bias tool, and quantitative analysis was synthesized with a random effect model to show the effect size as a standardized mean difference (SMD). Results: Five RCTs involving 298 individuals with shoulder disorders were included in this systematic review and meta-analysis. ESWT showed a moderate effect on pain (SMD=-0.44; 95% CI, -0.95 to 0.06) and a large effect on shoulder function (SMD =-0.81; 95% CI, -1.70 to 0.07) than injection therapy. A significant difference was found in the shoulder range of motion, showing a large effect size (SMD=1.50; 95% CI, 0.58 to 2.43). Conclusions: When considering treatment options for the management of patients complaining of shoulder disorders, it is appropriate to recommend ESWT first rather than injection therapy to increase the range of motion of the joint. In addition, ESWT is safe for pain control and shoulder function improvement, and a positive prognosis could be expected.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.218-222
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• 2023

A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients' emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient's perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient's emotional state. Tailoring the level of advice and diabetes targets based on a patient's personal and contextual factors requires mindfulness by clinicians.

• Journal of Korean Society of Water and Wastewater
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• v.25 no.2
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• pp.201-212
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• 2011

Nanotechnology is the applied science which develops new materials and systems sized within 1 to 100 nanometer, and improves their physical, chemical, and biological characteristics by manipulating on an atomic and molecular scale. This nanotechnology has been applied to wide spectrum of industries resulting in production of various nanoparticles. It is expected that more nanoparticles will be generated and enter to natural water bodies, imposing great threat to potable water resources. However their toxicity and treatment options have not been throughly investigated, despite the significant growth of nanotechnology-based industries. The objective of this study is to provide fundamental information for the management of nanoparticles in water supply systems through extensive literature survey. More specifically, two types of nanoparticles are selected to be a potential problem for drinking water treatment. They are carbon nanoparticles such as carbon nanotube and fullerene, and metal nanoparticles including silver, gold, silica and titanium oxide. In this study, basic characteristics and toxicity of these nanoparticles were first investigated systematically. Their monitoring techniques and treatment efficiencies in conventional water treatment plants were also studied to examine our capability to mitigate the risk associated with nanoparticles. This study suggests that the technologies monitoring nanopartilces need to be greatly improved in water supply systems, and more advanced water treatment processes should be adopted for better control of these nanoparticles.

• Journal of Digital Convergence
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• v.17 no.9
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• pp.127-133
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• 2019

A callable product is one of service derivatives using options to generate demand and reduce risk. This paper compares two booking admission controls for callable products, the online and the batch admission controls. To this end, the paper computes the optimal booking policy by using the backward dynamic programming and the stochastic optimization method. Intuitively, the provider should outperform under the batch control by utilizing demand information. The contribution of the paper is to show that the two controls are equivalent in terms of the booking strategy and the expected profit, which enables the provider to keep its current control method. The paper develops the closed-form solutions for the three fare classes. The future work is to extend the result to the model with complicated fare structures.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.867-872
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• 2016

Background: Esophageal cancer is one of the most serious malignancies. Due to the aggressive nature of this cancer, the prognosis is poor. A network meta-analysis with simultaneous comparison of multiple treatments can help determine better treatment options that have higher effects on overall survival of patients with lower adverse events. The aim of this review is to simultaneously compare efficacy and adverse events of treatment interventions for esophageal cancer. Materials and Methods: In this review, only randomized control trials (RCT) will be considered for network meta-analysis. All international electronic databases including Medline, Web of Sciences, Scopus, Cochran's library, EMBASE and Cancerlit will be searched to find randomized control trials which compared two or more treatment interventions for esophageal cancer. A network plot will be drawn for visual representation of all available treatment interventions. Bayesian approach will be used to combine the direct and indirect evidence. Treatment effects (e.g. hazard ratio for time to event outcomes, risk ratio for binary outcomes, and rate ratio for count outcomes with 95% credible interval) will be reported. Moreover, cumulative probability of the treatment ranks will be reported using the surface under the cumulative ranking (SUCRA) graphs. Consistency assumption will be assessed by the loop-specific and design-by-treatment interaction approaches. Conclusions: The results of this study may be helpful for the patients, clinicians and health policy makers in selecting treatments that have the best effect on survival and lowest adverse events.