Search

Gemifloxacin, a broad-spectrum antibacterial agent of the fluoroquinolone class, is used to treat bacterial infections, including acute bacterial exacerbation of chronic bronchitis and community-acquired pneumonia. This study aimed to develop a simple and robust analysis of gemifloxacin in human plasma by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). The sample was prepared using simple protein precipitation procedures with acetonitrile and separated using the Gemini C18 column with a mobile phase (0.1% formic acid: 0.1% formic acid in acetonitrile = 78: 22 (V/V)). Moxifloxacin was used as an internal standard. The mass spectrometer was operated in the positive ion mode using multiple reaction monitoring. Each precursor ion of gemifloxacin and moxifloxacin was monitored at m/z 390.1/402.1, and their product ions were monitored at m/z 372.3/384.4. The calibration curve showed linearity in 0.005–5 μg/mL with an appropriate correlation coefficient (≥0.99). The variation coefficient of intra- and interprecision values of gemifloxacin was

Background The ureteral access sheath (UAS) is an ancillary device widely used by urologists, but acute ureter injury may occur following its insertion. Preoperative selective oral α1-blockers can reduce intraureteral pressure, and prevent ureteral wall injury during UAS insertion. Objective To compare perioperative data of patients who underwent flexible ureterorenoscopy (fURS) with UAS with and without premedication with silodosin. Design, setting, and participants Single-blind, 100 patients from a single institution who underwent retrograde intrarenal surgery for kidney and upper ureter stone removal were prospectively allocated from May 2018 to March 2019. Intervention The experimental groups received silodosin for 3 d preoperatively. Outcome measurements and statistical analysis The primary endpoint included ureteral injuries after UAS insertion that were assessed according to endoscopic classification. The secondary endpoint was an evaluation of whether premedication with silodosin had any effect on postoperative outcomes. Results and limitations A total of 44 and 43 patients were randomly assigned to the control and experimental groups, respectively. Silodosin prevented significant postoperative ureteral injury involving the smooth muscle layer more successfully than in the control group (9.3% vs 27.3%; p = 0.031). There was no significant difference in the overall complication rate as determined by the modified Clavien-Dindo classification system and the computed tomography scan stone-free rate postoperatively. Patients who received silodosin before fURS reported lower pain scores than those in the control group using a visual analog scale (p = 0.009). Limitation included a lack of placebo comparison. Conclusions Our data suggest that preoperative silodosin protects against significant ureteral injury related to UAS insertion during fURS and decreases postoperative pain level. Silodosin premedication might be an effective and safe technique to replace prestenting. Patient summary We investigated the preventive effect of an α-blocker against perioperative complication caused by ureteral access sheath inserted during flexible ureterorenoscopy. Taking silodosin before surgery prevented ureter wall injury during surgery and immediately improved postoperative pain.

Purpose We evaluate the effect of audiovisual virtual reality (AVVR) stimulation through a virtual reality (VR) device on pain, anxiety, and patient relaxation during SWL.Materials and Methods A total of 86 patients from a single institution who underwent SWL for ureteral stone were prospectively allocated. Patients with tolerable pain were randomized 1:1 two groups (SWL with or without AVVR stimulation groups). Anxiety, vital sign, renal colic pain represented the primary outcomes and were measured before and after SWL using STAI, visual analogue scale (VAS). Secondary outcomes were pain due to SWL and stone free rate.Results Thirty-nine and 37 patients were randomly assigned to the AVVR and Control groups, respectively. In pre and post-SWL, SBP, DBP, HR, STAI, and pain due to renal colic were not statistically different between the two groups, but pain due to SWL showed a statistical difference of 1.79 ± 1.32 in the VR group, and 2.54 ± 1.26 in the control group (p = 0.014). In the VR group, significant decreases were shown in SBP (-4.97 ± 5.87 mmHg, p Conclusions AVVR reduces procedure-related pain and increases patient relaxation. The application of VR may be an effective and non-pharmacological technique to replace additional pain control during SWL. Developing specialized software for VR will maximize the advantages of these new instruments.

This study aimed to evaluate the optimal dosage of topical tranexamic acid (TXA) considering the efficacy and safety for controlling bleeding after total knee arthroplasty (TKA). This prospective randomized double-blinded placebo-controlled comparative study included 325 patients scheduled to undergo TKA, who were randomly assigned to five groups based on the topical TXA injection (n = 65 per group): control; group 1, 0.5 g TXA; group 2, 1.0 g TXA; group 3, 2.0 g TXA; and group 4, 3.0 g TXA. The primary outcome was decrease in postoperative hemoglobin levels. The secondary outcomes were blood loss calculated using Good’s method, drainage volume, frequency of transfusion, and range of motion (ROM). Plasma TXA levels and complications were also evaluated. Significant differences were noted in the decrease in hemoglobin levels between the control group and groups 2 (p = 0.0027), 3 (p = 0.005), and 4 (p = 0.001). No significant differences were shown among the experimental groups. Significant differences in total blood loss and frequency of transfusion were noted between the control group and groups 2 (p = 0.004, 0.002, respectively), 3 (p = 0.007, 0.001, respectively), and 4 (p = 0.001, 0.009, respectively) without showing significant differences among the experimental groups. With respect to drainage volume, no significant differences were observed among the groups. The serum TXA levels increased proportionally with the applied dose of topical TXA immediately and at 3 and 6 h postoperatively. Symptomatic deep vein thrombosis or pulmonary embolism was not observed in any group. Other complications related to TXA administration were not detected. Topical application of 1.0 g or more of TXA shows significant bleeding control without a dose–response relationship. Blood TXA levels increase with the TXA dose following topical TXA application. Therefore, to prevent overdosing and reduce potential complications with ensuring the effectiveness, 1.0 g of TXA is recommended as a topical application. I.

Overuse of the nonparetic upper extremity can lead to entrapment neuropathies in chronic stroke patients. However, little is known about the effects of cane use in subacute stage of stroke. The aim of this study was to investigate the short-term effects of cane use on the upper extremity nerves in subacute stroke patients recovering from a bedridden state. Thirty subacute hemiparetic stroke patients who were initially bedridden participated when they were able to walk with a cane. Symptoms and signs related to the median or ulnar nerves were checked, and nerve conduction studies were performed. The largest cross-sectional area (CSA) of these nerves from the wrist to elbow was measured with ultrasound. After 3 weeks of cane use, electrophysiologic and ultrasonographic reevaluation was performed. Nerve conduction studies and CSA of the nerves at the nonparetic upper extremity showed significant changes, whereas those of the hemiparetic upper extremity did not. Walking with a cane for a short period can induce the enlargement of the median and ulnar nerves at the nonparetic extremity of subacute hemiparetic stroke patients. Attention should be placed on correct cane usage from the beginning of rehabilitation.

N-acetylcysteine (NAC) has been used as an antioxidant to prevent oxidative cell death. However, we found NAC itself to induce neuronal death in mouse cortical cultures. Therefore, the current study was performed to investigate the mechanism of neuronal death caused by NAC. Cell death was assessed by measuring lactate dehydrogenase efflux to bathing media after 24-48 h exposure to NAC. NAC (0.1-10 mM) induced neuronal death in a concentration- and exposure time-dependent manner. However, NAC did not injure astrocytes even at a concentration of 10 mM. Also, 10 mM NAC markedly attenuated oxidative astrocyte death induced by 0.5 mM diethyl maleate or 0.25 mM H

Background Repetitive transcranial magnetic stimulation (rTMS) is one of the effective treatments for neuropathic pain. Little is known about the effects of multi-session theta burst stimulation, one of the new paradigms of rTMS. Objective The aim of this study was to investigate the effects of multi-session intermittent theta burst stimulation (iTBS) on central neuropathic pain, using evaluation tools specific to neuropathic pain. Methods Patients with central neuropathic pain diagnosed using Neuropathic Pain Special Interest Group guidelines were recruited. Thirty patients were randomly assigned to either a real or sham iTBS group. Each patient underwent 5 sessions of iTBS; before and after completion of the 5 sessions, participants were evaluated using the self-completed Leeds assessment of neuropathic symptoms and signs (S-LANSS), the numeric rating scale (NRS), the neuropathic pain symptom inventory (NPSI), and the neuropathic pain scale (NPS). Results S-LANSS, NRS, NPSI, and 3 of 4 NPS combination scores decreased significantly in the real iTBS group but not in the sham iTBS group. No adverse effects were reported during or after iTBS sessions. Conclusions Multi-session iTBS was associated with a significant decrease in neuropathic pain, indicating its effectiveness as a treatment for patients with central neuropathic pain.

We examined the effect of fluoxetine, a selective serotonin reuptake inhibitor antidepressant, on neuronal viability in mouse cortical near-pure neuronal cultures. Addition of fluoxetine to the media for 24 hours induced neuronal death in a concentration-dependent manner. To delineate the mechanisms of fluoxetine-induced neuronal death, we investigated the effects of trolox, cycloheximide (CHX), BDNF, z-VAD-FMK, and various metal-chelators on fluoxetine-induced neuronal death. Neuronal death was assessed by MTT assay. The addition of 20 µM fluoxetine to the media for 24 hours induced 60-70% neuronal death, which was associated with the hallmarks of apoptosis, chromatin condensation and DNA laddering. Fluoxetine-induced death was significantly attenuated by CHX, BDNF, or z-VAD-FMK. Treatment with antioxidants, trolox and ascorbate, also markedly attenuated fluoxetine-induced death. Interestingly, some divalent cation chelators (EGTA, Ca-EDTA, and Zn-EDTA) also markedly attenuated the neurotoxicity. Fluoxetine-induced reactive oxygen species (ROS) generation was measured using the fluorescent dye 2',7'-dichlorofluorescin diacetate. Trolox and bathocuproine disulfonic acid (BCPS), a cell membrane impermeable copper ion chelator, markedly attenuated the ROS production and neuronal death. However, deferoxamine, an iron chelator, did not affect ROS generation or neurotoxicity. We examined the changes in intracellular copper concentration using a copper-selective fluorescent dye, Phen Green FL, which is quenched by free copper ions. Fluoxetine quenched the fluorescence in neuronal cells, and the quenching effect of fluoxetine was reversed by co-treatment with BCPS, however, not by deferoxamine. These findings demonstrate that fluoxetine could induce apoptotic and oxidative neuronal death associated with an influx of copper ions.

Purpose When performing lateral closing wedge high tibial osteotomy (LCWHTO), fibular untethering can be performed with either fibular shaft osteotomy (FSO) or proximal tibiofibular division (TFD). The aim of this study was to compare the degree of varus instability between the two methods after LCWHTO and to analyze the determinants of varus instability. Methods This study retrospectively analyzed 108 consecutive patients with medial compartment osteoarthritis who underwent LCWHTO and had > 2 years of follow-up. Patients who underwent unilateral LCWHTO without a previous history of ligament injury were included. Forty-five patients who received LCWHTO with TFD and 51 patients who received LCWHTO with FSO were finally analyzed. The mean follow-up duration was 5.3 years in LCWHTO with TFD and 4.1 years in LCWHTO with FSO. The shortest distance between the lateral tibial plateaus and the corresponding most distal subchondral bone surface of the lateral femoral condyle was measured on varus stress radiographs and compared with that on the unaffected contralateral knee. Multivariable logistic regression analyses were conducted to identify predictors of varus instability. Results Lateral joint space width showed no significant between-group difference. Multivariable logistic regression analysis revealed that the pre-operative hip-knee-ankle angle was positively correlated with the lateral joint space width. The type of fibular untethering procedure was not associated with postoperative varus instability. Conclusion The degree of pre-operative varus malalignment is associated with postoperative varus instability after LCWHTO. Proximal tibiofibular division is not a variable for postoperative varus instability after LCWHTO. Level of evidence Level III, Retrospective comparative study.

This study was conducted to evaluate the effects of dietary l -arginine supplementation on growth performance, nutrient digestibility, gas emission and meat quality. A total of 120 crossbred [(Landrace × Yorkshire) × Duroc] pigs with an average initial body weight (BW) of 53.80 ± 1.86 kg were used in this 10-week feeding trial. The pigs were randomly allotted to 1 of 3 dietary treatments (5 pigs/pen and 8 replicates/treatment) in a randomized complete block design according to their sex (2 gilts and 3 barrows) and BW. Dietary treatments included: 1) CON (basal diet); 2) LA0.5 (CON + 0.5 g/kg l -arginine); 3) LA1.0 (CON + 1.0 g/kg l -arginine). The result showed that l -arginine did not affect pig growth performance, nutrient digestibility, or gas emission. However, dietary l -arginine supplementation linearly increased (P l -arginine improved meat quality without any significant effect on growth performance in finishing pigs.

SummaryThis study was performed to improve production efficiency at the level of recipient pig and donor nuclei of transgenic cloned pigs used for xenotransplantation. To generate transgenic pigs, human endothelial protein C receptor (hEPCR) and human thrombomodulin (hTM) genes were introduced using the F2A expression vector into GalT–/–/hCD55+ porcine neonatal ear fibroblasts used as donor cells and cloned embryos were transferred to the sows and gilts. Cloned fetal kidney cells were also used as donor cells for recloning to increase production efficiency. Pregnancy and parturition rates after embryo transfer and preimplantation developmental competence were compared between cloned embryos derived from adult and fetal cells. Significantly higher parturition rates were shown in the group of sows (50.0 vs. 4.1%), natural oestrus (20.8 vs. 0%), and ovulated ovary (16.7 vs. 5.6%) compared with gilt, induced and non-ovulated, respectively (P < 0.05). When using gilts as recipients, final parturitions occurred in only the fetal cell groups and significantly higher blastocyst rates (15.1% vs. 21.3%) were seen (P < 0.05). Additionally, gene expression levels related to pluripotency were significantly higher in the fetal cell group (P < 0.05). In conclusion, sows can be recommended as recipients due to their higher efficiency in the generation of transgenic cloned pigs and cloned fetal cells also can be recommended as donor cells through correct nuclear reprogramming.

Compartmental load-sensing technology has been used in the attempt to achieve optimal soft tissue balance during total knee arthroplasty (TKA). This study was conducted to investigate the validity of such use of intraoperative sensing technology.Ninety-three knees scheduled to undergo total knee arthroplasty for knee osteoarthritis with a tibial sensor were prospectively enrolled. Measurements were divided into three groups according to the three different time points of intraoperative load testing: group Trial (with the trial components), group Final (with the definitive cemented implants and an open joint capsule), and group Closed (with the definitive cemented implants and a closed joint capsule). Load measurements and component rotational alignments were documented at 10°, 30°, 45°, 90°, and 120° of flexion for all three groups, and compared. One year postoperatively, the joint line obliquity angle was obtained radiographically in the valgus and varus stress views at 10° and 30° flexion to evaluate the clinical instability. The Knee Society, Hospital for Special Surgery, and Western Ontario McMaster Universities Osteoarthritis Index scores were used to determine functional outcomes. The correlations of the above outcomes with intraoperative load were evaluated.There were significant differences in medial and lateral loads at all flexion angles (except at a 120° lateral load) between group Trial and group Final (p 0.05). Tibial trays were internally rotated to a significantly higher degree in group Final than in group Trial (p = 0.010). The lateral compartmental load significantly decreased after patellar inversion (p = 0.037). There were no correlations of intraoperative load with clinical instability and functional outcomes.Significant variability was observed between the trial and final implant measurements and intraoperative sensing data were not correlated with instability or functional outcomes over a 1-year period. Therefore, intraoperative sensor technology provides limited feedback and clinical efficacy in the adjustment of the soft tissue balance during TKA.Level II.

Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5 ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.

The purposes of this study were to compare poststroke liquid swallowing methods by including a cup and a straw in videofluoroscopic swallowing studies (VFSS) and to test the hypothesis that increased aspiration would be observed with the cup compared to the straw. Eighty-five poststroke patients who had undergone VFSS using a spoon, cup, and straw were included. Penetration-aspiration scale and functional dysphagia scale (FDS) were used for assessment. These scores did not differ significantly between the cup and the straw. Higher FDS scores were found with the cup than with the straw in patients who had penetration/aspiration with both the cup and the straw and with the cup only. However, FDS scores did not differ significantly between the cup and the straw in patients who had penetration/aspiration with the straw only. Although advantages of the straw over the cup were clear, some patients showed penetration/aspiration only with the straw.

Although mesenchymal stem cells (MSCs) transplantation is reportedly a promising strategy for repairing damaged articular cartilage, MSCs-based cartilage tissue engineering has numerous limitations, including poor implanted cell adhesion, phenotypic alteration of cells, regulation of mechanical properties, and engraftment rates after implantation. This study aimed to investigate the efficacy of transplantation of synovium-derived mesenchymal stem cells (SDSCs) encapsulated in a hyaluronic acid/collagen/fibrinogen (HA/COL/FG) composite gel by supplementing recombinant human transglutaminase 4 (rhTG-4) in treating osteochondral defects. RhTG-4 treatment induced the expression of integrin β1 and dynamic actin fiber, enhancing SDSCs adhesion to fibronectin. Supplementation of rhTG-4 significantly induced the proliferation of SDSCs encapsulated in the HA/COL/FG composite gel and increased the hardness of the extracellular matrix. Furthermore, supplementation of rhTG-4 significantly upregulated aggrecan and type II collagen mRNA. Pretreatment with integrin β1 siRNA markedly suppressed TG4-induced actin remodeling, activation mitogen-activated protein kinase (MAPK), and eventually the chondrogenesis-related genes. Moreover, transplantation of SDSCs encapsulated in HA/COL/FG/rhTG-4 composite gel

We evaluate the risks of various urological disorders that require treatments according to obesity and metabolic health status using a nationwide dataset of the Korean population. 3,969,788 patients who had undergone health examinations were enrolled. Participants were classified as “obese” (O) or “non-obese” (NO) using a BMI cut-off of 25 kg/m2. People who developed ≥ 1 metabolic disease component in the index year were considered “metabolically unhealthy” (MU), while those with none were considered “metabolically healthy” (MH). There were classified into the MHNO, MUNO, MHO, and MUO group. In BPH, chronic renal disease, neurogenic bladder, any medication related to voiding dysfunction, alpha-blocker, and antidiuretics, age and gender-adjusted hazard ratio (HR) was highest in MUO, but higher in MUNO than in MHO. In stress incontinence, prostate surgery, and 5alpha-reductase, HR increased in the order of MUNO, MHO, and MUO. In prostatitis, anti-incontinence surgery, and cystocele repair, HR was higher in MHO than MUNO and MUO. In cystitis, cystostomy, and anticholinergics, HR was higher in MUNO and MUO than MHO. In conclusion, obesity and metabolic health were individually or collaboratively involved in urological disorders related to voiding dysfunction. Metabolic healthy obesity needs to be distinguished in the diagnosis and treatment of urological disorders.

Lighter weight and lower modulus are potential advantages of titanium (Ti) implants over cobalt chrome (CoCr) implants in total knee arthroplasty (TKA). This study was conducted to determine whether Ti implants in TKA resulted in better clinical outcomes and radiologic results.One hundred and eight patients (216 knees) with knee arthritis warranting bilateral primary TKA were randomly allocated to undergo Ti rotating-platform TKA in one knee and CoCr rotating-platform TKA in the contralateral knee. The mean follow-up period was 5.3 years (range, 1-7 years). The weight of Ti implants was one-third lighter than that of CoCr implants (133.9 g vs 390.1 g, P.01). Clinical outcomes were evaluated using clinical scores, patient preferences (lightness, comfort, naturalness, and satisfaction), gait analysis (kinetic and kinematic data), range of motion, and degree of pain. Radiologic results were evaluated based on the radiolucent line (RLL), degree of medial tibial bone loss, and loosening as seen on X-ray.No significant differences were observed in clinical scores or patient preference. Regarding implant weight, approximately 70% of patients did not perceive the Ti implant as lighter. No significant differences were observed in gait analysis, range of motion, or degree of pain. The RLL was seen in 9% of the Ti implant group and 19% of the CoCr implant group.The lighter Ti implant did not show any clinical benefit over CoCr implants. The lightness of the Ti implant is not sufficient to matter or be noticeable. However, the Ti implant showed lower rate of RLL than the CoCr implant.level I, randomized controlled trial.

OBJECTIVES To provide surgical treatment trends for urinary stone disease in Korea. METHODS We analyzed medical service claim data of surgical treatments to urinary stone disease submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. RESULTS There was a significantly increasing trend among outpatients and inpatients for urinary stone disease from 2009 to 2016 (R2 = 0.643, P = 0.017; R2 = 0.575, P = 0.029). The number of shock wave lithotripsy for treating urinary stone disease increased by 16% from 89 553 in 2009 to 104 013 in 2016 (R2 = 0.684). The number of ureteroscopic lithotripsy increased by 97% from 6106 in 2009 to 12 057 in 2016 (R2 = 0.99). The number of flexible ureteroscopic lithotripsy increased by 16-fold from 219 in 2009 to 3712 in 2016 (R2 = 0.756). The number of percutaneous nephrolithotomy increased by 99.7% from 919 in 2009 to 1835 in 2016 (R2 = 0.987). The use of non-contrast and contrast-enhanced computed tomography in the diagnostic codes for urinary stone disease increased by 394.8% and 263.3% from 2009 to 2016, respectively (R2 = 0.83; R2 = 0.967). Conversely, the use of intravenous pyelography decreased 26.2% over the same period (R2 = 0.945). CONCLUSIONS Outpatient and inpatient procedures for urinary stone disease have increased over the past 8 years in Korea. Shock wave lithotripsy is the most widely used treatment modality for urinary stone disease, and endoscopic surgical procedures are rapidly being implemented. There has been a steep increase in the use of computed tomography, whereas conventional intravenous pyelography is declining.

The aim of this study was to develop and validate a decision support model using a machine learning algorithm to predict treatment success after single session shock wave lithotripsy in ureteral stone cases.Of the 1,803 patients treated with shock wave lithotripsy we selected those with ureteral stones who had preoperative computerized tomography available. Treatment success after single session shock wave lithotripsy was defined as freedom from stones or residual stone fragments less than 2 mm long on computerized tomography or plain x-ray of the kidneys, ureters and bladder 2 weeks later. Decision tree analysis was done using a machine learning algorithm to identify relevant parameters. A decision support model was developed to calculate the probability of treatment success.A total of 791 patients were enrolled in study. Mean ± SD stone length was 5.9 ± 2.3 mm and mean stone volume was 89.3 ± 140.0 mmWe applied a machine learning algorithm, a subfield of artificial intelligence, to predict the outcome after single session shock wave lithotripsy for ureteral stones. A 92.29% accurate decision model was developed with 15 factors and an average ROC AUC of 0.951.

We compared the outcomes of SWL to treat distal ureter stones with regard to the conventional prone and supine positions using the transgluteal approach through the greater sciatic foramen. A prospective, randomized, single-blind, and multicenter study was conducted between October 2014 and July 2015. The inclusion criteria were radio-opaque distal ureter stones with a maximum diameter of 0.5−2 cm as measured on a CT scan. The included 160 patients were randomly assigned to two groups: the prone group (n = 80; treated in the conventional prone position) and the transgluteal group (n = 80; treated in the supine position using a transgluteal approach). In the latter group, the focused shock wave was transmitted through the greater sciatic foramen with the head positioned at a 40° angle to the vertical. “Stone-free” was defined as the complete clearance of stone fragments, assessed using a CT scan at 2 weeks after treatment. Overall satisfaction was self-reported using a 0–5 Likert scale. The overall efficacy was 66.9%. The stone-free rate was significantly higher in the transgluteal group (72.6%) than in the prone group (54.7%; odds ratio 2.413, 95% CI 1.010−5.761, P = 0.023). No serious adverse events due to treatment were observed in either group. The satisfaction score of the transgluteal group was 4.21 ± 0.81, and 83.6% were willing to repeat the same procedure if necessary. SWL using the transgluteal approach via a supine position through the greater sciatic foramen was more effective than via the conventional prone position. Furthermore, this approach provided a comparably safe and satisfactory procedure.

One hundred twenty crossbred[(Yorkshire × Landrace) × Duroc] weanling pigs (8.36 ± 1.64 kg; 21 d) were used in a 42-day trial. Pigs were randomly distributed (6 replicate pens/treatment; 5 pigs/pen) to 1 of 4 dietary treatments: 1) CON, basal diet; 2) A1, CON + antibiotic (39 ppm tiamulin); 3) BG1, basal diet + 5 g kg−1(β-glucan); and 4) BG2, basal diet + 10 g kg−1(β-glucan). On overall, average daily gain of pigs fed with A1(385 g) and BG1(388 g) was significantly higher (P

This study was conducted to evaluate the effects of dietary ratios of n-6:n-3 polyunsaturated fatty acids (PUFA) on reproductive performance, fecal microbiota and nutrient digestibility of gestation-lactating sows and suckling piglets. Fifteen primiparous sows (Landrace × Yorkshire) were randomly allotted into three treatments. Fed diets contained different ratios of n-6:n-3 PUFA, including 20:1, 15:1 and 10:1. No differences were detected among the treatments for average daily feed intake (ADFI) of sows and the back fat levels during lactation (P 0.05). Body weight (BW) loss of sows after farrowing to weanling was greater in the 10:1 treatment compared with 15:1 or 20:1 (P 0.05). In piglets, a great significant difference for BW was observed at 4 weeks (P 0.01). Furthermore, average daily gain (ADG) of piglets in the 10:1 treatment was higher (P 0.05). No difference was observed among treatments in nutrient digestibility of sows (P 0.05). A great significant difference for fecal microbiota was in the 10:1 treatment compared with 20:1 and 15:1 treatments (P 0.01). In conclusion, altering the ratio of n-6:n-3 PUFA in gestation-lactating sow diet had no difference on nutrient digestibility in gestation-lactating sows, but it can partially improve reproductive performance.

Purpose: To analyze the efficacy and safety of standard-dose antimuscarinic treatment on male patients with overactive bladder (OAB) symptoms showing poor efficacy after low-dose antimuscarinics. Materials and Methods: We retrospectively reviewed the data of 566 male patients aged ≥40 with OAB symptoms between January 2017 and June 2018. They were treated with low-dose antimuscarinics for at least 4 weeks and showed poor efficacy; therefore, they were switched to standard dose antimuscarinic treatment (5 mg of solifenacin) for ≥12 weeks. The international prostate symptom score (IPSS) and overactive bladder symptom score (OABSS) at baseline (V0), 4 weeks (V1), and 12 weeks (V2) were analyzed. Post void residual urine volume (PVR) was also recorded. Results: The median age, body mass index, and prostate-specific antigen levels were 69.0 years, 24.2 kg/m2, and 1.24 ng/dL, respectively. The mean value of the total IPSS and OABSS significantly decreased between V0 and V2 (from 16.73 to 13.69 and 7.33 to 5.34, respectively, all p

Systemic steroid has been used to control pain and nausea in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on 1 day postoperatively.Patients who were scheduled to undergo TKA were randomly assigned to the following groups: control group, receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (IV) 1 hour before surgery; group 2, receiving 0.1 mg/kg dexamethasone (IV) 24 hours after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (IV) 24 hours after surgery (n = 44-46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein, range of motion, and complications.Postoperative pain and nausea remained high for 48 hours post-TKA. Group 1 had lower pain and nausea VAS scores than did the control group (P.01) for only 24 hours post-TKA. Groups 2 and 3 had lower pain and nausea VAS scores than did the control group and group 1 (P.01) 48 hours post-TKA. Analgesic and antiemetic administration were significantly lower in groups 2 and 3 than in the control group during 48 hours after TKA. There were no differences in C-reactive protein level and range of motion, and complications were not detected.The effect of preoperative and postoperative administration of dexamethasone for controlling pain and nausea was observed only for 24 hours. Considering that severe pain and nausea persisted for more than 48 hours after TKA, additional administration of dexamethasone at 1 day postoperatively is suggested.Level I.

The aim of this study was to evaluate the diagnostic performance of shear wave elastography (SWE) in human meniscus degeneration, with histology serving as the standard of reference. This comparative in vivo and ex vivo study was performed in 15 medial and 15 lateral menisci from 13 patients undergoing total knee arthroplasty (TKA) for primary osteoarthritis with varus deformity. Patients underwent in vivo coronal measurement with SWE for meniscus before surgery. Then, ex vivo assessment of meniscus stiffness with SWE was performed with the tissue obtained after TKA. SWE measurements were made in coronal and sagittal views with respect to the meniscus. Samples were analyzed histologically on a 0-18 scale according to the level of degeneration based on surface integrity, cellularity, fiber organization, collagen alignment and Safranin O staining intensity. The correlation between SWE measurement scale and histology was analyzed using Spearman's correlation. The area under the receiver operating characteristic curve (AUROC) was used to calculate the diagnostic performance of SWE in evaluating meniscus degeneration. Significant increases in stiffness were observed with increasing histologic degeneration in both in vivo and ex vivo coronal SWE. AUROCs were 0.79 (95% confidence interval [CI]: 0.49-1.00) for in vivo coronal SWE, 0.73 (95% CI: 0.53-0.95) for ex vivo coronal SWE and 0.56 (95% CI: 0.27-0.84) for ex vivo sagittal SWE. The medial meniscus, which exhibited more degeneration on histologic analysis, had greater stiffness than the lateral meniscus on ex vivo coronal SWE. The values of meniscus stiffness measured with SWE are correlated with the degree of meniscus degeneration. Further large-scale prospective studies may confirm the diagnostic performance of SWE as a non-invasive tool to assess meniscus degeneration.