The effect of prolonged breast-feeding on the development of postmenopausal osteoporosis in population with insufficient calcium intake and vitamin D level

Breast-feeding affects bone metabolism and calcium homeostasis, and prolonged breast-feeding may influence the development of postmenopausal osteoporosis, particularly in highly susceptible populations. The study determined that breast-feeding may be a risk factor for postmenopausal osteoporosis, especially in people with low calcium intakes and vitamin D deficiencies.

INTRODUCTION

The purpose of this study was to determine whether breast-feeding is a risk factor in the development of postmenopausal osteoporosis, especially in highly susceptible population.

METHODS

The study was performed using data from the 2010 to 2011 Korea National Health and Nutrition Examination Survey, and it included 1231 postmenopausal women who were aged between 45 and 70 years. Osteoporosis was defined using the World Health Organization's T-score criteria, namely, a T-score of ≤-2.5 at the femoral neck or the lumbar spine. The patients' ages, body mass indexes, daily calcium intakes, serum vitamin D levels, exercise levels, smoking histories, and reproductive factors relating to menarche, menopause, delivery, breast-feeding, hormone treatment, and oral contraceptive use were evaluated. Comparisons between the osteoporosis and non-osteoporosis groups were undertaken using Student's t test and the chi-square test, and logistic regression models were built.

RESULTS

A significant increase in the risk of osteoporosis was apparent in postmenopausal women with prolonged breast-feeding histories (≥24 months) (model 1: odds ratio [OR] = 2.489; 95 % confidence interval [CI] = 1.111 to 5.578, p = 0.027; model 2: OR = 2.503; 95 % CI = 1.118 to 5.602, p = 0.026; model 3: OR = 2.825; 95 % CI = 1.056 to 7.56, p = 0.039), particularly in those with inadequate serum vitamin D levels and calcium intakes (<800 mg/day).

CONCLUSIONS

Breast-feeding seems to increase the risk of postmenopausal osteoporosis; however, its impact may not be definitive in women with sufficient vitamin D levels and calcium intakes. Therefore, sufficient calcium intakes and adequate vitamin D levels may be important to prevent osteoporosis in postmenopausal women that is derived from breast-feeding.

Retinal vessel structure measurement using spectral-domain optical coherence tomography

PURPOSE

To assess the reliability and validity of spectral-domain optical coherence tomography (SD-OCT) measurements of retinal vessel lumen diameters and wall thicknesses.

METHODS

SD-OCT was used to characterize the circular region around the optic disc of 40 eyes (20 subjects). The inner and outer sides (vitreal and choroidal sides) of the vessel wall and the luminal diameter were measured using intensity graphs.

RESULTS

Mean arterial and venous luminal diameters were 95.1±16.1 and 132.6±17.8 μm, respectively. The wall thicknesses of inner and outer sides of the artery were 23.9±4.9 and 21.2±3.5 μm, respectively. The wall thicknesses of the inner and outer sides of the vein were 20.7±4.2 and 16.3±4.3 μm, respectively. There were significant differences between the inner and outer wall thicknesses in both the artery and vein (P<0.01). Intra- and interobserver intraclass correlation coefficients (ICCs) for lumen measurements were >0.95, and for wall thicknesses were >0.85, except for the outer wall thickness measurements. The mean value of outer and inner wall thicknesses showed good reproducibility, with ICCs of >0.85.

CONCLUSION

Intensity graph-assisted measurements using SD-OCT provided more objective information in finding boundaries of vessels. Luminal diameters and wall thicknesses obtained with OCT showed good overall reproducibility, with inner wall thicknesses being thicker, and with better reproducibility compared with outer wall thicknesses, where ICC values were the lowest among the inner wall thicknesses, mean thicknesses of inner and outer walls, and luminal diameters. When using SD-OCT measurements, caution is therefore advised when using only the outer wall as representative of the wall thicknesses.

Internal herniation due to an omphalomesenteric duct cyst in a 69-year-old man

Previous abdominal surgery is the most common cause of mechanical small bowel obstruction. However, in patients with no history of abdominal surgery, the diagnosis and treatment of mechanical small bowel obstruction is difficult. A persistent omphalomesenteric duct remnant is a rare finding that typically presents in the pediatric population and is extremely rare in patients aged > 60 years. In the present report, we describe the case of an omphalomesenteric duct cyst causing small bowel obstruction in a 69-year-old man with no history of a surgical procedure.

The Added Prognostic Value of Preoperative Dynamic Contrast-Enhanced MRI Histogram Analysis in Patients with Glioblastoma: Analysis of Overall and Progression-Free Survival

BACKGROUND AND PURPOSE

The prognostic value of dynamic contrast-enhanced MR imaging in patients with glioblastoma is controversial. We investigated the added prognostic value of dynamic contrast-enhanced MR imaging to clinical parameters and molecular biomarkers in patients with glioblastoma by using histogram analysis.

MATERIALS AND METHODS

This retrospective study consisted of 61 patients who underwent preoperative dynamic contrast-enhanced MR imaging for glioblastoma. The histogram parameters of dynamic contrast-enhanced MR imaging, including volume transfer constant, extravascular extracellular volume fraction, and plasma volume fraction, were calculated from entire enhancing tumors. Univariate analyses for overall survival and progression-free survival were performed with preoperative clinical and dynamic contrast-enhanced MR imaging parameters and postoperative molecular biomarkers. Multivariate Cox regression was performed to build pre- and postoperative models for overall survival and progression-free survival. The performance of models was assessed by calculating the Harrell concordance index.

RESULTS

In univariate analysis, patients with higher volume transfer constant and extravascular extracellular volume fraction values showed worse overall survival and progression-free survival, whereas plasma volume fraction showed no significant correlation. In multivariate analyses for overall survival, the fifth percentile value of volume transfer constant and kurtosis of extravascular extracellular volume fraction were independently prognostic in the preoperative model, and kurtosis of volume transfer constant and extravascular extracellular volume fraction were independently prognostic in the postoperative model. For progression-free survival, independent prognostic factors were minimum and fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction in the preoperative model and kurtosis of extravascular extracellular volume fraction in the postoperative model. The performance of preoperative models for progression-free survival was significantly improved when minimum or fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction were added.

CONCLUSIONS

Higher volume transfer constant and extravascular extracellular volume fraction values are associated with worse prognosis, and dynamic contrast-enhanced MR imaging may have added prognostic value in combination with preoperative clinical parameters, especially in predicting progression-free survival.

Discrimination of Tumorous Intracerebral Hemorrhage from Benign Causes Using CT Densitometry

BACKGROUND AND PURPOSE

Differentiation of tumorous intracerebral hemorrhage from benign etiology is critical in initial treatment plan and prognosis. Our aim was to investigate the diagnostic value of CT densitometry to discriminate tumorous and nontumorous causes of acute intracerebral hemorrhage.

MATERIALS AND METHODS

This retrospective study included 110 patients with acute intracerebral hemorrhage classified into 5 groups: primary intracerebral hemorrhage without (group 1) or with antithrombotics (group 2) and secondary intracerebral hemorrhage with vascular malformation (group 3), brain metastases (group 4), or primary brain tumors (group 5). The 5 groups were dichotomized into tumorous (groups 4 and 5) and nontumorous intracerebral hemorrhage (groups 1-3). Histogram parameters of hematoma attenuation on nonenhanced CT were compared among the groups and between tumorous and nontumorous intracerebral hemorrhages. With receiver operating characteristic analysis, optimal cutoffs and area under the curve were calculated for discriminating tumorous and nontumorous intracerebral hemorrhages.

RESULTS

Histogram analysis of acute intracerebral hemorrhage attenuation showed that group 1 had higher mean, 5th, 25th, 50th, and 75th percentile values than groups 4 and 5 and higher minimum and 5th percentile values than group 2. Group 3 had higher 5th percentile values than groups 4 and 5. After dichotomization, all histogram parameters except maximum and kurtosis were different between tumorous and nontumorous intracerebral hemorrhages, with tumors having lower cumulative histogram parameters and positive skewness. In receiver operating characteristic analysis, 5th and 25th percentile values showed the highest diagnostic performance for discriminating tumorous and nontumorous intracerebral hemorrhages, with 0.81 area under the curve, cutoffs of 34 HU and 44 HU, sensitivities of 65.6% and 70.0%, and specificities of 85.0% and 80.0%, respectively.

CONCLUSIONS

CT densitometry of intracerebral hemorrhage on nonenhanced CT might be useful for discriminating tumorous and nontumorous causes of acute intracerebral hemorrhage.

The predictors for continuous renal replacement therapy in liver transplant recipients

BACKGROUND

Acute renal failure (ARF) after liver transplantation requiring continuous renal replacement therapy (CRRT) adversely affects patient survival. We suggested that postoperative renal failure can be predicted if a clinically simple nomogram can be developed, thus selecting potential risk factors for preventive strategy.

METHODS

We retrospectively reviewed the medical records of 153 liver transplant recipients from January 2008 to December 2011 at Severance Hospital, Yonsei University Health System, in Seoul, Korea. There were 42 patients treated with CRRT (20 and 22 patients received transplants from living and deceased donors, respectively) and 115 were not. Univariate and stepwise logistic multivariate analyses were performed. A clinical nomogram to predict postoperative CRRT application was constructed and validated internally.

RESULTS

Hepatic encephalopathy (HEP; odds ratio OR, 5.47), deceased donor liver donations (OR, 3.47), Model for End-Stage Liver Disease (MELD) score (OR, 1.09), intraoperative blood loss (L; OR, 1.16), and tumor (hepatocellular carcinoma) as the indication for liver transplantation (OR, 0.11) were identified as independent predictive factors for postoperative CRRT on multivariate analysis. A clinical prediction model constructed for calculating the probability of CRRT post-transplantation was 1.7000 × HEP + [-4.5427 + 1.2440 × (deceased donor) + 0.0830 × (MELD score) + 0.000149 × the amount of intraoperative bleeding (L) - 2.1785 × tumor]. The validation set discriminated well with an area under the curve (AUC) of 0.90 (95% confidence interval, 0.85-0.95). The predicted and the actual probabilities were calibrated with the clinical nomogram.

CONCLUSIONS

We developed a predictive model of postoperative CRRT in liver transplantation patients. Perioperative strategies to modify these factors are needed.

Investigation of Werner protein as an early DNA damage response in actinic keratosis, Bowen disease and squamous cell carcinoma

BACKGROUND

Werner protein (WRN) has DNA helicase activity and participates in recombination, replication and repair of DNA. Loss-of-function mutations in WRN gives rise to genetic instability and diseases such as premature ageing and cancer. Upregulation of WRN promotes proliferation and survival of cancer cells.

AIM

To evaluate the expression pattern of WRN in closely related skin cancers and their correlation with age, sex and UV exposure.

METHODS

Immunohistochemistry was used to investigate expression of WRN in formalin-fixed, paraffin wax-embedded tissue specimens of 9 squamous cell carcinoma (SCC), 15 actinic keratosis (AK), 11 Bowen disease (BD) and 11 normal-appearing peripheral tissue samples, obtained from patients during surgical resections.

RESULTS

WRN expression was significantly increased in BD, AK and SCC compared with normal controls, with the mean WRN staining score being highest in BD, followed by AK and SCC. However, age, sex and sun exposure were not associated with WRN expression.

CONCLUSIONS

To our knowledge, this is the first report to date investigating the expression of WRN in skin cancers. The overtly high expression of WRN in premalignant lesions and in in situ cancer, with relatively low WRN expression in SCC, may indicate that WRN contributes as a checkpoint for early DNA damage response in skin tumorigenesis.

Association of metabolic syndrome with coronary atherosclerosis in non-diabetic postmenopausal women

OBJECTIVE

We investigated the possible association of metabolic syndrome with arterial stiffness and coronary atherosclerosis in non-diabetic, postmenopausal women.

METHODS

A total of 293 non-diabetic, postmenopausal women who visited the health promotion center for a routine health check-up were included in a cross-sectional study. Arterial stiffness was measured by brachial-ankle pulse wave velocity, and coronary atherosclerosis was detected using 64-row multi-detector computed tomography.

RESULTS

Women with coronary atherosclerosis had a significantly higher proportion of metabolic syndrome than those without coronary atherosclerosis. The brachial-ankle pulse wave velocity was significantly higher in women who had metabolic syndrome compared to those who had no metabolic syndrome (1567.71 ± 211.81 vs. 1336.75 ± 159.62 cm/s, p < 0.001). In addition, the brachial-ankle pulse wave velocity was shown to increase with increasing number of metabolic syndrome components (p for trend < 0.001). Metabolic syndrome was associated with increased risk of coronary atherosclerosis (adjusted odds ratio 2.38; 95% confidence interval 1.01-5.06), after adjusting for confounding factors.

CONCLUSIONS

Metabolic syndrome increases the risk of coronary atherosclerosis in postmenopausal women. Increased arterial stiffness may partly explain an increased risk of coronary atherosclerosis in postmenopausal women with metabolic syndrome.

Improved methods for selective cryolipolysis results in subcutaneous fat layer reduction in a porcine model

BACKGROUND/AIMS

Cryolipolysis is a noninvasive method for the selective reduction of localized fat tissues. It has demonstrated efficacy in both clinical and preclinical trials; however, despite its popularity, its mechanisms of action and evaluation methods are not yet fully defined. The purpose of this study was to improved methods for cryolipolysis using a porcine model.

METHODS

The abdomens of female PWG micro-pigs were treated with a cooling device (CRYOLIPO II(™)), and we examined the treatment effects using photography, three-dimensional photography, ultrasound, gross, and microscopic pathology, and serum lipid level analyses in order to determine the mechanism of action, efficacy, and safety of CRYOLIPO II(™).

RESULTS

CRYOLIPO II(™) successfully reduced abdominal fat in our porcine model. Gross and microscopic histological results confirmed the noninvasive cold-induced selective subcutaneous fat destruction, and showed increases in pre-adipocyte differentiation and in the activation of lipid catabolism. In particular, we found that CRYOLIPO II(™) may increase PPARδ (delta) levels in adipose tissue at 30-60 days post-treatment.

CONCLUSION

Fat reduction by cryolipolysis was successfully achieved in our porcine model. Thus, our findings indicate that CRYOLIPO II(™) may be a promising fat reduction device for body contouring and fat reduction in humans, and that cryolipolysis exerts its effects, at least partly, by targeting the PPARδ signaling pathway. These results show that both investigative and diagnostic potentials capacity.

Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods

BACKGROUND

Ischemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods.

METHODS

Patients were randomized to an NS group (n = 30) or a Plasmalyte group (n = 30). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis.

RESULTS

Compared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl(-)], free-water corrected Cl(-), BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups.

CONCLUSIONS

Both NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation. However, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period.

Effects of soy sauce on physicochemical and textural properties of tumbled chicken breast

The objective of this study was to evaluate the effects of soy sauce on the physicochemical and textural properties of tumbled chicken breasts. Chicken breasts marinated with distilled water (Con), 4% NaCl solution, 4% NaCl and lactic acid solution (pH 4.9), and soy sauce solution (4% salt concentration and pH 4.9) were vacuum tumbled at 3°C for 60 min. The chicken breast marinated with soy sauce solution showed lower lightness and higher redness and yellowness due to the color of the soy sauce. The acidic marinades led to a decrease in pH value of tumbled chicken breast. The acidic marinades increased collagen solubility of sample compared with 4% NaCl solution, resulting in decreased shear force. Water-holding capacity, marination and cooking yields, and solubility of myofibrillar proteins were mainly affected by the presence of salt in the marinade, rather than by pH alternation. Our results suggested that soy sauce marination can improve the tenderness of tumbled chicken breast.

Relationship between socioeconomic status and anemia prevalence in adolescent girls based on the fourth and fifth Korea National Health and Nutrition Examination Surveys

BACKGROUND/OBJECTIVES

We studied the relationship between socioeconomic status (SES), represented by household income, and the prevalence of anemia and iron deficiency anemia (IDA) among adolescent girls in Korea.

SUBJECTS/METHODS

The samples were based on the data from a four-year (2008-2011) collection for the Korea National Health and Nutrition Examination Survey (1312 girls, age 10-18 years). The survey included demographic, anthropometric, biochemical and nutritional parameters. A multiple regression analysis after adjusting for age, body mass index (BMI), red blood cell count, white blood cell count and red meat intake was performed. Anemia was defined as hemoglobin level lower than 11.5 g/dl for ages 10-11 years and 12.0 g/dl for ages 12-14 years. Iron deficiency was defined as serum ferritin level below 15 μg/l.

RESULTS

The prevalences of anemia and IDA in Korean girls were 5.3 and 4.2%, respectively. Girls with anemia were older, taller, weighed more, had higher BMI, had higher portion of menarche experience and consumed less red meat than girls without anemia. Girls with higher income had lower anemia prevalence and consumed more iron and vitamins. Logistic regression analysis showed a decreasing trend in anemia prevalence as household income increased. Correlation analysis demonstrated that there is a relationship between household income and serum hemoglobin and ferritin levels (P=0.003 and P=0.026, respectively).

CONCLUSIONS

Higher SES leads to lower prevalence of anemia and IDA in Korean adolescent girls. This may be due to the fact that higher SES individuals consume more iron and vitamin C.

Randomized controlled comparison of combined general and epidural anesthesia versus general anesthesia on diaphragmatic function after laparoscopic prostatectomy

BACKGROUND

Little is known about the effect of anesthetic technique on postoperative diaphragmatic function, which is associated with postoperative morbidity and recovery in patients undergoing laparoscopic pelvic surgery. The aim of this trial was to study the effect of combined general and epidural anesthesia versus general anesthesia on postoperative diaphragmatic function measured by ultrasonography in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP).

METHODS

Fifty-four patients undergoing RALRP were enrolled prospectively. Study population was randomized to receive general (group G, N.=27) or combined general and epidural (group GE, N.=27) anesthesia. Diaphragmatic inspiratory amplitude (DIA), and inspiration and expiration time (Ti and Te, respectively) were measured by M-mode ultrasonography during quiet/deep breathing and sniffing before the surgery and on postoperative days (POD) 1 and 2. Diaphragmatic inspiratory and expiratory velocities (DIV and DEV) were also calculated (DIA/Ti and DIA/Te, respectively). Spirometry was performed in addition to ultrasonography.

RESULTS

DIA during deep breathing and sniffing was significantly decreased on POD 1 in group G, while it was preserved in group GE. These reductions in diaphragmatic function were restored to preoperative values on POD 2 in both groups. Vital capacity and peak expiratory flow were diminished in group G on POD 1 and 2. However, spirometry revealed no impairment in group GE except for vital capacity on POD 1. The correlation coefficients (R2) between diaphragmatic function and spirometry variables ranged from 0.231 to 0.286. Postoperaitve pain was comparable.

CONCLUSION

Combined general and epidural anesthesia may attenuate the severity of postoperative diaphragmatic dysfunction after RALRP compared to conventional general anesthesia.

Effects of single-dose dexmedetomidine on the quality of recovery after modified radical mastectomy: a randomised controlled trial

BACKGROUND

Dexmedetomidine is a highly selective α2 agonist with analgesic, anxiolytic, and anti-inflammatory properties. We investigated the effect of a single dose of dexmedetomidine on patient-perceived quality of recovery and clinical recovery variables after modified radical mastectomy under general anesthesia in this randomized, double-blind, placebo-controlled study.

METHODS

After Institutional Review Board approval, ninety two female patients were randomly allocated to receive intravenously either saline (Group C, N.=46) or 0.5 μg/kg of dexmedetomidine (Group D, N.=46) five min before the end of surgery. The quality of recovery was assessed using a 40-item quality-of-recovery scoring system (QoR-40) preoperatively and 24 h after surgery. Pain intensity, rescue analgesics, and postoperative nausea and vomiting (PONV) were assessed at postanesthesia care unit (PACU), 1-6 h, and 6-24 h after surgery.

RESULTS

Postoperative global QoR-40 scores were higher in Group D compared with Group C (181 [175-187] vs. 174 [154.5-181.5], P=0.004); postoperative QoR-40 scores were improved in the dimensions of emotional state, physical comfort, and psychological support. Total amount of tramadol during 24 h after surgery was significantly lower in Group D than in Group C (54 vs. 76 mg, P=0.006). The incidence of PONV was lower in Group D than in Group C in PACU (21% vs. 43%, P=0.026) and 6-24 h period after surgery (10% vs. 41%, P=0.012). Heart rate and mean blood pressure were significantly lower in Group D as compared with Group C at 5 min after administration of dexmedetomidine, 1 min after extubation, and 20 min after arrival in PACU.

CONCLUSION

The use of a single dose dexmedetomidine improved the quality of recovery and reduced analgesic requirements and the incidence of PONV in the early postoperative period after modified radical mastectomy.

Evaluation of acid-base status in brain dead donors and the impact of metabolic acidosis on organ retrieval

BACKGROUND

Pathophysiologic changes after brain death can lead to acid-base disturbances. The primary aim of this study was to clarify the acid-base state and its source in brain dead donors using Stewart's approach. Additionally, we investigated whether the presence of metabolic acidosis affected the number of organs retrieved from donors.

METHODS

A retrospective review of electronic medical records was performed for brain dead donors who had undergone organ harvesting during the past 5 years in a tertiary medical center. The parameters related to acid-base disturbance and the number of organs retrieved from the donors was assessed.

RESULTS

Sixty one brain dead donors were evaluated in this study. Twenty three (37.7%) of these patients had metabolic acidosis at the initial diagnosis of brain death. Metabolic acidosis resulted from hyperchloremia and a large strong ion gap. The severity of metabolic acidosis was masked by hypernatremia and hypoalbuminemia. In addition, donors without metabolic acidosis also showed mixed acid-base disturbances in which metabolic acidosis induced by significant hyperchloremia was combined with metabolic alkalosis caused by hypoalbuminemia and hypernatremia. Although more organs were retrieved from the donors without metabolic acidosis than those with metabolic acidosis (P=0.012), serum albumin level (P=0.010) and donor age (P<0.001), rather than metabolic acid-base disturbances, significantly correlated with the number of organs retrieved in multivariate regression analysis.

CONCLUSION

Most brain dead donors exhibited metabolic acid-base disturbances. However, rather than metabolic acidosis, serum albumin level and donor age were well correlated with the number of organs retrieved.

Needs regarding care and factors associated with unmet needs in disease-free survivors of surgically treated lung cancer

BACKGROUND

To evaluate the long-term needs of lung cancer survivors and to explore factors associated with unmet need.

PATIENTS AND METHODS

We recruited lung patients treated with curative surgery from 2001 through 2006 at two centers in Korea. Needs in the domains of information, supportive care, education and counseling, and socioeconomic support were measured. We selected the four most frequently reported items of unmet need among 19 items in four domains.

RESULTS

The most frequently reported unmet needs were Complementary and alternative medicine (CAM) and folk remedies (59.8%) in the Information domain, Counseling and treatment of depression and anxiety (63.5%) in the Supportive care domain, diet, exercise and weight control (55.1%) in the Education and counseling domain and Financial support (90.4%) in the socioeconomic support domain. Unmet needs for psychological treatment was significantly greater in participants who were employed (adjusted odds ratio [aOR], 2.25; 95% confidential interval [CI], 1.12 to 4.53). Unmet needs for diet, exercise and weight control were significantly greater in participants who had not received chemotherapy (aOR, 1.76; 95% CI, 1.09 to 2.85). Unmet need for financial support was greater in participants who were married (aOR, 4.14, 95%CI, 1.12 to 15.22) and those who had not received chemotherapy (aOR, 5.91, 95%CI, 1.91 to 18.31).

CONCLUSION

There were substantial unmet needs for information regarding psychological support, education for diet and exercise, and financial support among lung cancer survivors.

Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in the lateral decubitus position

Prolonged inspiratory to expiratory (I:E) ratio ventilation may have both positive and negative effects on respiratory mechanics and oxygenation during one-lung ventilation (OLV), but definitive information is currently lacking. We therefore compared the effects of volume-controlled ventilation with I:E ratios of 1:1 and 1:2 on respiratory mechanics and oxygenation during OLV. Fifty-six patients undergoing thoracoscopic lobectomy were randomly assigned volume-controlled ventilation with an I:E ratio of 1:1 (group 1:1, n=28) or 1:2 (group 1:2, n=28) during OLV. Arterial and central venous blood gas analyses and respiratory variables were recorded 15 minutes into two-lung ventilation, at 30 and 60 minutes during OLV, and 15 minutes after two-lung ventilation was re-initiated. Peak and plateau airway pressures in cmH2O [standard deviation] during OLV were significantly lower in group 1:1 than in group 1:2 (P <0.01) (19 [3] and 23 [4]; 16 [3] and 19 [5], respectively). The arterial to end-tidal carbon dioxide tension difference was significantly lower in group 1:1 than in group 1:2 (P <0.01), (0.5 [0.3] and 1.1 [0.5]). There were no significant differences in PaO2 during OLV between the two groups (OLV30, P=0.856; OLV60, P=0.473). In summary, volume-controlled ventilation with an I:E ratio of 1:1 reduced peak and plateau airway pressures improved dynamic compliance and efficiency of alveolar ventilation, but it did not improve arterial oxygenation in a substantial manner. Furthermore, the associated increase in mean airway pressure might have reduced cardiac output, resulting in a lower central venous oxygen saturation.

Effects of rigor state, thawing temperature, and processing on the physicochemical properties of frozen duck breast muscle

The objectives of this study were to evaluate effects of rigor state, thawing temperature, and processing on the physicochemical properties of intact frozen duck breast muscle and homogenates prepared with the frozen-thawed muscles. Prerigor breast muscle was frozen at -25°C and thawed at 4 and 15°C, and the physicochemical properties of duck breast frozen prerigor compared with those in frozen postrigor and 4°C chilled postrigor muscles. The homogenates prepared with duck breast frozen prerigor showed similar physicochemical properties as the frozen-thawed postrigor muscle homogenate. The thawing temperature did not affect the physicochemical properties of homogenates prepared with duck breast muscle frozen prerigor. Also, no significant differences (P > 0.05) in the ultimate pH value and color parameters were observed among the frozen-thawed treatments despite the differences in rigor state and thawing temperature. However, a higher thawing temperature of the intact frozen prerigor muscle resulted in an increase in thawing loss and shear force due to excessive muscle shortening. In this study, the intact duck breast that has undergone thaw-rigor showed main problems associated with thaw-rigor, such as higher thawing loss and shear force, regardless of thawing temperature. However, the processing (grinding and salting) decreased the difference in physicochemical properties due to rigor state before freezing and thawing temperature. Therefore, the frozen-thawed duck breast muscle used to manufacture ground-type meat product may be frozen before rigor onset.

Histologically benign but clinically malignant neoplasms in the thorax: CT-pathological overview

The purpose of this article is to review the computed tomography (CT) and histopathological features of uncommon primary neoplasms of the thorax that can manifest clinically malignant features (multiplicity of pulmonary nodules, an invasive nature, and metastases or recurrence after surgery) with little evidence of histological malignancy.