• Title/Summary/Keyword: adjuncts

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The use of mobile computing devices in microsurgery

  • Pafitanis, Georgios;Hadjiandreou, Michalis;Miller, Robert;Mason, Katrina;Theodorakopoulou, Evgenia;Sadri, Amir;Taylor, Kirsten;Myers, Simon
    • Archives of Plastic Surgery
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    • v.46 no.2
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    • pp.102-107
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    • 2019
  • Mobile computing devices (MCDs), such as smartphones and tablets, are revolutionizing medical practice. These devices are almost universally available and offer a multitude of capabilities, including online features, streaming capabilities, high-quality cameras, and numerous applications. Within the surgical field, MCDs are increasingly being used for simulations. Microsurgery is an expanding field of surgery that presents unique challenges to both trainees and trainers. Simulation-based training and assessment in microsurgery currently play an integral role in the preparation of trainee surgeons in a safe and informative environment. MCDs address these challenges in a novel way by providing valuable adjuncts to microsurgical training, assessment, and clinical practice through low-cost, effective, and widely accessible solutions. Herein, we present a review of the capabilities, accessibility, and relevance of MCDs for technical skills acquisition, training, and clinical microsurgery practice, and consider the possibility of their wider use in the future of microsurgical training and education.

Isovitexin Protects Mice from Methicillin-Resistant Staphylococcus aureus-Induced Pneumonia by Targeting Sortase A

  • Tian, Lili;Wu, Xinliang;Yu, Hangqian;Yang, Fengying;Sun, Jian;Zhou, Tiezhong;Jiang, Hong
    • Journal of Microbiology and Biotechnology
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    • v.32 no.10
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    • pp.1284-1291
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    • 2022
  • The rise of methicillin-resistant Staphylococcus aureus (MRSA) has resulted in significant morbidity and mortality, and clinical treatment of MRSA infections has become extremely difficult. Sortase A (SrtA), a virulence determinant that anchors numerous virulence-related proteins to the cell wall, is a prime druggable target against S. aureus infection due to its crucial role in the pathogenicity of S. aureus. Here, we demonstrate that isovitexin, an active ingredient derived from a variety of traditional Chinese medicines, can reversibly inhibit SrtA activity in vitrowith a low dose (IC50=24.72 ㎍/ml). Fluorescence quenching and molecular simulations proved the interaction between isovitexin and SrtA. Subsequent point mutation experiments further confirmed that the critical amino acid positions for SrtA binding to isovitexin were Ala-92, Ile-182, and Trp-197. In addition, isovitexin treatment dramatically reduced S. aureus invasion of A549 cells. This study shows that treatment with isovitexin could alleviate pathological injury and prolong the life span of mice in an S. aureus pneumonia model. According to our research, isovitexin represents a promising lead molecule for the creation of anti-S. aureus medicines or adjuncts.

Unveiling the Gastrointestinal Microbiome Symphony: Insights Into Post-Gastric Cancer Treatment Microbial Patterns and Potential Therapeutic Avenues

  • Chan Hyuk Park
    • Journal of Gastric Cancer
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    • v.24 no.1
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    • pp.89-98
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    • 2024
  • This review delved into the intricate relationship between the gastrointestinal microbiome and gastric cancer, particularly focusing on post-treatment alterations, notably following gastrectomy, and the effects of anticancer therapies. Following gastrectomy, analysis of fecal samples revealed an increased presence of oral cavity aerotolerant and bile acid-transforming bacteria in the intestine. Similar changes were observed in the gastric microbiome, highlighting significant alterations in taxon abundance and emphasizing the reciprocal interaction between the oral and gastric microbiomes. In contrast, the impact of chemotherapy and immunotherapy on the gut microbiome was subtle, although discernible differences were noted between treatment responders and non-responders. Certain bacterial taxa showed promise as potential prognostic markers. Notably, probiotics emerged as a promising approach for postgastrectomy recovery, displaying the capacity to alleviate inflammation, bolster immune responses, and maintain a healthy gut microbiome. Several strains, including Bifidobacterium, Lactobacillus, and Clostridium butyricum, exhibited favorable outcomes in postoperative patients, suggesting their potential roles in comprehensive patient care. In conclusion, understanding the intricate interplay between the gastrointestinal microbiome and gastric cancer treatment offers prospects for predicting responses and enhancing postoperative recovery. Probiotics, with their positive impact on inflammation and immunity, have emerged as potential adjuncts in patient care. Continued research is imperative to fully harness the potential of microbiome-based interventions in the management of gastric cancer.

Medical Management of Patients With Heart Failure and Reduced Ejection Fraction

  • Barry Greenberg
    • Korean Circulation Journal
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    • v.52 no.3
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    • pp.173-197
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    • 2022
  • Treatment options for patients with heart failure (HF) with reduced ejection fraction (HFrEF) have expanded considerably over the past few decades. Whereas neurohormonal modulation remains central to the management of patients with HFrEF, other pathways have been targeted with drugs that have novel mechanisms of action. The angiotensin receptor-neprilysin inhibitors (ARNIs) which enhance levels of compensatory molecules such as the natriuretic peptides while simultaneously providing angiotensin receptor blockade have emerged as the preferred strategy for inhibiting the renin angiotensin system. Sodium glucose cotransporter 2 (SGLT2) inhibitors which were developed as hypoglycemic agents have been shown to improve outcomes in patients with HF regardless of their diabetic status. These agents along with beta blockers and mineralocorticoid receptor antagonists are the core medical therapies for patients with HFrEF. Additional approaches using ivabradine to slow heart rate in patients with sinus rhythm, the hydralazine/isosorbide dinitrate combination to unload the heart, digoxin to provide inotropic support and vericiguat to augment cyclic guanosine monophosphate production have been shown in well-designed trials to have beneficial effects in the HFrEF population and are used as adjuncts to the core therapies in selected patients. This review provides an overview of the medical management of patients with HFrEF with focus on the major developments that have taken place in the field. It offers prospective of how these drugs should be employed in clinical practice and also a glimpse into some strategies that may prove to be useful in the future.

Application of MMP-7 and MMP-10 in Assisting the Diagnosis of Malignant Pleural Effusion

  • Cheng, Daye;Liang, Bin;Li, Yun-Hui
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.2
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    • pp.505-509
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    • 2012
  • Background: Matrix metalloproteinases (MMP) are proteolytic enzymes that are essentially involved in turnover of the extracellular matrix (ECM). The aim was to investigate the diagnostic value of MMP-7 and MMP-10 as tumor markers in pleural effusion (PE) and evaluate the value of combining MMP-7, MMP-10 and carcinoembryonic antigen (CEA) assays as diagnostic aids for malignant cells. Materials and Methods: A total of 179 patients with PE (87 malignant and 92 benign) were included in this study. The levels of MMP-7 and MMP-10 were measured using ELISA. Results: Values for MMP-7 and MMP-10 were significantly higher in malignant PE than those in benign PE (P<0.01). Among all variables evaluated, logistic regression found that MMP-7 and MMP-10 were significantly correlated with the presence of malignant disease (P<0.01). Analysis of receiver operating characteristics (ROC) curves showed that the area under the curve of MMP-10 (0.806) was significantly larger than that of MMP-7 (0.771) and CEA (0.789) (P<0.01). With parallel interpretation, the combination of MMP-10 and CEA achieved the higher sensitivity of 94.6%. The combination of MMP-7 and CEA in serial interpretation was able to boost the specificity to 95.7%. The combination of MMP-7, MMP-10 and CEA produced better sensitivity, specificity, PPV and NPV than MMP-7 and MMP-10 alone. Conclusion: MMP-7 and MMP-10 in PE may represent helpful adjuncts to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.

SHOCK-ABSORBING BEHAVIOR OF TEMPORARY SOFT DENTURE LINERS (임시 연성 의치상 이장재의 충격 흡수에 관한 연구)

  • Chun, Yong-Suk;Cho, In-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.34 no.1
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    • pp.151-167
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    • 1996
  • Temporary soft liners can be used to prevent chronic soreness from dentures or to aid in its treatment are as adjuncts in tissue conditioning, for temporary obturators, and to stabilize baseplate or surgical stent. The purpose of this study was to evaluate the shock absorption properties of several temporary soft denture liners using a free drop test with an accelerometer. The materials tested inclued Coe-comfort, Softone, Tissue conditioner and Viscogel. The specimens were fabricated with the thickness of 1, 2, 3mm and were stored in distilled water at $37^{\circ}C$ for a day, 1, 2, and 3 weeks. Six samples were made with each material for each test condition and the shock-absorbing behavior was evaluated according to material, thickness and duration. The results were as following : 1. Softone of 3mm thickness stored for a day showed the most excellent shock absorbability. 2. The shock absorbing behavior of duration according to materials and thickness showed a day to be the highest and decreased in 1 week, 2 weeks and 3 weeks in that order(p<0.05). And there was no significant difference between durations in Tissue conditioner. 3. The shock absorbability of thickness according to materials and duration showed 3mm to be highest and decreased in the order of 2mm, 1mm(p<0.05). 4. In comparison of the shock absorbability of temporary soft denture liners according to thickness, there was statistically significant difference between Softone and Visocgel, Tissue conditioner, Coe-comfort / Viscogel and Tissue conditioner, Coe-comfort in 1,2mm thickness, and between Softone, Viscogel and Tissue conditioner, Coe-comfort in 3mm thickness (p<0.05).

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Interventions for anesthetic success in symptomatic irreversible pulpitis: A network meta-analysis of randomized controlled trials

  • Sivaramakrishnan, Gowri;Alsobaiei, Muneera;Sridharan, Kannan
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.19 no.6
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    • pp.323-341
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    • 2019
  • Background: Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials. Methods: Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality. Results: Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia. Conclusion: Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.

Dialysis Related Treatment to Increase Elimination of Toxic Agent (독성 물질 제거에 있어서 투석과 연관된 치료)

  • Kim, Heung-Soo;Shin, Gyu-Tae
    • Journal of The Korean Society of Clinical Toxicology
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    • v.1 no.1
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    • pp.6-11
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    • 2003
  • Various forms of dialytic techniques are available for detoxification. Hemodialysis, hemoperfusion and hemofiltration (hemodialfiltration) are the main treatment modalities. Because these modalities are rather invasive and expensive, it must be decided in balance of the risk and benefit to the patient. The prime consideration in the decision is based on the clinical features of poisoning; hemodialysis or hemoperfusion should be considered in general if the patient's condition progressively deteriorates despite intensive supportive therapy. The hemodialysis technique relies on passage of the toxic agent through a semipermeable membrane so that it can equilibrate with the dialysate and subsequently removed. It needs a blood pump to pass blood next to a dialysis membrane, which allows agents permeable to the membrane to pass through and reach equilibrium. Solute (or drug) removal by dialysis has numerous determinants such as solute size, its lipid solubility, the degree to which it is protein bound, its volume of distribution etc. The technique of hemoperfusion is similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. The patient's blood is pumped through a perfusion cartridge, where it is in direct contact with adsorptive material (usually activated charcoal) that has a coating material such as cellulose. This method can be used successfully with lipid-soluble compounds and with higher-molecular-weight compounds than for hemodialysis. Protein binding does not significantly interfere with removal by hemoperfusion. In conclusion, hemodialysis, hemoperfusion and hemofiltration can be used effectively as adjuncts to the management of severely intoxicated patients.

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Changes of [A-a] gas Gradient in Rabbits with Oxygen Toxicity (산소중독시 가토의 [A-a] gas Gradient 의 변화)

  • 이두연
    • Journal of Chest Surgery
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    • v.20 no.1
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    • pp.1-12
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    • 1987
  • Respiratory care with oxygen inhalation is often a necessity to maintain life, and it is one of the important therapeutic adjuncts in respiratory disease and in intensive care after surgery. However, it has been reported that oxygen toxicity occurs after prolonged exposure to 100% 0, [Smith, 1899; Kistler et al. 1967; Schaffner et al. 1967; Rowland and Newman, 1969. Subjective symptoms of oxygen toxicity include tracheal irritation, frequent cough, some burning sensation in the trachea, tachypnea, severe dyspnea, etc. [Welch, 1963; Fisher et al, 1968; Milier et al, 1970; Clark and Lambertsen, 1971; Sackner, 1975]. Pathologic findings are atelectasis, injuries to the pulmonary capillaries and hemorrhage in the alveoli in gross specimens. There can be inflammation, proliferation of fibrin, thickening of alveolar membranes, degeneration of collagen fibers and interstitial edema in the microscopic findings. [Penrod, 1956; Cedergren, 1959; Bean, 1965; Schaffner, 1967]. Dubois and colleagues [1961] found that the amount of pulmonary surfactant was decreased in oxygen toxicity and atelectasis followed by the decreased pulmonary surfactant. Many authors reported that vital capacity, inspiratory force, pulmonary compliance, pulmonary capillary blood flow and pulmonary elasticity were deceased and arteriovenous shunting increased. [Comroe et al, 1945; Fuson et al, 1965; Kistler et al, 1966; Knowles and Blenner-hassett, 1967; Barber et al, 1978]. Many human volunteers were examined after prolonged exposure in a high oxygenated chamber and there were a few reports on animals with oxygen toxicity, subjects including rabbits. Gas partial pressures of alveoli and arteries were measured in rabbits exposed to 100% $O_2$ and the alveolar-arterial gas gradients were analyzed, which is the basis for the study of oxygen toxicity. These rabbits were divided into two groups; rabbits under natural respiration, and second group under artificial respiration with a respirator. The alveolar $PO_2$ [$P]AO_2$] and $PCO_2$ [$PACO_2$], and the arterial $PO_2$ [$PaO_2$] were measured under varying $O_2$ pressures; 15% $O_2$, 21% $O_2$ and 100% $O_2$.

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Adjacent Effect of Oriental Medical Therapy on Aphasia after Stroke (뇌졸중 환자의 실어증에 대한 언어치료시 한방치료가 병행되었을 때의 효과)

  • Kwon, Seung-Won;Park, Joo-Young;Byeon, Hyung-Sik;Yoon, Seung-Kyu;Seo, Yu-Ri;Jung, Woo-Sang;Moon, Sang-Kwan;Cho, Ki-Ho;Kim, Young-Suk
    • The Journal of Korean Medicine
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    • v.31 no.4
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    • pp.129-140
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    • 2010
  • Objective: The aim of this study was to prove adjacent effect of Oriental Medical Therapy on aphasia after stroke. Method: We studied patients who took K-WAB (AQ; aphasia quotient) twice during their language therapy at Kyunghee University Hospital & Oriental Medicine Hospital to retrospectively investigate the effect of Oriental medical therapy on aphasia. 18 patients with post-stroke aphasia were assigned to receive one of the following adjuncts: Group A that received language therapy with Oriental medical therapy (n=12) and Group B (n=6) that received language therapy only; AQ score of Group A was compared against Group B. Result: Total AQ score and most partial scores, except 'Contents delivery', were better in Group A. 'Total AQ score', 'Fluency', and 'Auditory verbal comprehension score' presented statistical significance. Conclusion: In this study, we demonstrated the effect of Oriental medical therapy on aphasia after stroke through AQ score improvement.