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Zhao YT, Guo S, Shang ZC, Ding HY, Jin JH, Chu KY, Ge BB, Xu PQ. Study on the recovery of bladder function in patients with cervical cancer after operation by portable ultrasound combined. Int J Artif Organs 2024:3913988241262593. [PMID: 39076041 DOI: 10.1177/03913988241262593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Postoperative urination dysfunction is a common complication after surgery in patients with cervical cancer. Portable bladder ultrasound are commonly utilized in clinical practice for measuring residual urine volume. This study aimed to the effect of bladder function training combined with portable ultrasound monitoring on bladder function recovery in patients with cervical cancer after training. METHODS A total of 40 postoperative patients with cervical cancer were randomly divided into a control group (A) and an experimental group (B) of 20 cases each. Group A was given routine postoperative care, while group B was given bladder function training. Urgent urine bladder volume were taken twice daily after removal of the urinary catheter and monitored for five consecutive days. The difference of urgent urine bladder volume and bladder filling rate were compared by t-test and chi-square test respectively. The 36-item Short Form Health Survey (SF-36) was used to evaluate the quality of life of patients before and after intervention, and compared by Mann-Whitney U test. RESULTS There was no significant difference in preoperative urgent urine volume between the two groups. After catheter removal, the bladder volume of patients in the B increased, while the bladder volume of patients in the A increased less and fluctuated greatly. The bladder filling rate in the A was significantly lower than that in the B (5/15 vs 17/18, p < 0.05). After intervention, the quality of life of the experimental group was better than that of the control group, including scores of general health, mental health, vitality, and physical role (p < 0.05). CONCLUSION Postoperative cervical cancer patients trained to hold urine by portable ultrasound monitoring are able to recover bladder function.
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Affiliation(s)
- Yu-Ting Zhao
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Shuai Guo
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Zai-Chun Shang
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Hong-Yi Ding
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Jian-Hua Jin
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Kai-Yue Chu
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Bin-Bin Ge
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Peng-Qin Xu
- Department of Radiotherapy, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
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Zhao Q, Feng P, Zhu J, Wang Y, Zhou X, Xia Z, Wang D, He Y, Wang P, Li X. A novel score for early prediction of urinary tract infection risk in patients with acute ischemic stroke: a nomogram-based retrospective cohort study. Sci Rep 2024; 14:10707. [PMID: 38730021 PMCID: PMC11087532 DOI: 10.1038/s41598-024-61623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
This study aimed to construct and externally validate a user-friendly nomogram-based scoring model for predicting the risk of urinary tract infections (UTIs) in patients with acute ischemic stroke (AIS). A retrospective real-world cohort study was conducted on 1748 consecutive hospitalized patients with AIS. Out of these patients, a total of 1132 participants were ultimately included in the final analysis, with 817 used for model construction and 315 utilized for external validation. Multivariate regression analysis was applied to develop the model. The discriminative capacity, calibration ability, and clinical effectiveness of the model were evaluated. The overall incidence of UTIs was 8.13% (92/1132), with Escherichia coli being the most prevalent causative pathogen in patients with AIS. After multivariable analysis, advanced age, female gender, National Institute of Health Stroke Scale (NIHSS) score ≥ 5, and use of urinary catheters were identified as independent risk factors for UTIs. A nomogram-based SUNA model was constructed using these four factors (Area under the receiver operating characteristic curve (AUC) = 0.810), which showed good discrimination (AUC = 0.788), calibration, and clinical utility in the external validation cohort. Based on four simple and readily available factors, we derived and externally validated a novel and user-friendly nomogram-based scoring model (SUNA score) to predict the risk of UTIs in patients with AIS. The model has a good predictive value and provides valuable information for timely intervention in patients with AIS to reduce the occurrence of UTIs.
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Affiliation(s)
- Qinqin Zhao
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Pinpin Feng
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Jun Zhu
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Yunling Wang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China
| | - Xiaojuan Zhou
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Zhongni Xia
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Danqing Wang
- School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, 311399, China
| | - Yueyue He
- School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, 311399, China
| | - Pei Wang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China.
| | - Xiang Li
- School of Basic Medical Sciences & Forensic Medicine, Hangzhou Medical College, No. 8 Yikang Street, Lin'an District, Hangzhou City, 311399, Zhejiang Province, China.
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Chang WL, Lai SH, Cheng CF, Chiu V, Lin SK. Comparative Effectiveness of Two Models of Point-of-Care Ultrasound for Detection of Post-Void Residual Urine during Acute Ischemic Stroke: Preliminary Findings of Real-World Clinical Application. Diagnostics (Basel) 2023; 13:2599. [PMID: 37568961 PMCID: PMC10417127 DOI: 10.3390/diagnostics13152599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
We conducted a comparative study of two models of point-of-care ultrasound devices for measuring post-void residual urine (PVRU). We prospectively enrolled 55 stroke inpatients who underwent both real-time B-mode ultrasound (Device A) and automated three-dimensional (3D) scanning ultrasound (Device B), with a total of 108 measurements. The median PVRU volume of Device B was 40 mL larger than that of Device A. The PVRU difference between the devices was positively and linearly correlated with PVRU. The correlation of PVRU volume between the devices was strong, but the agreement level was only moderate. Measurement deviations were observed in 43 (40%) and 11 (10%) measurements with Device B and Device A, respectively. The PVRU volume was low in spherical bladder shapes but sequentially increased in triangular, undefined, ellipsoid, and cuboid bladder shapes. Further comparison of 60 sets of PVRU without measurement deviations revealed higher agreements between the devices at correction coefficients of 0.52, 0.66, and 0.81 for PVRU volumes of <100, 100-200, and >200 mL, respectively. The automated 3D scanning ultrasound is more convenient for learning and scanning, but it exhibits larger measurement deviations. Real-time B-mode ultrasound accurately visualizes the urinary bladder but tends to underestimate the urinary bladder when the PVRU volume is large. Hence, real-time B-mode ultrasound with automated PVRU-based adjustment of calculation formulas may be a better solution for estimating bladder volume.
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Affiliation(s)
- Wan-Ling Chang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
| | - Shu-Hui Lai
- Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Chu-Fang Cheng
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Shinn-Kuang Lin
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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4
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Cho H, Song I, Jang J, Yoo Y. A Lightweight Deep Learning Network on a System-on-Chip for Wearable Ultrasound Bladder Volume Measurement Systems: Preliminary Study. Bioengineering (Basel) 2023; 10:bioengineering10050525. [PMID: 37237594 DOI: 10.3390/bioengineering10050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Bladder volume assessments are crucial for managing urinary disorders. Ultrasound imaging (US) is a preferred noninvasive, cost-effective imaging modality for bladder observation and volume measurements. However, the high operator dependency of US is a major challenge due to the difficulty in evaluating ultrasound images without professional expertise. To address this issue, image-based automatic bladder volume estimation methods have been introduced, but most conventional methods require high-complexity computing resources that are not available in point-of-care (POC) settings. Therefore, in this study, a deep learning-based bladder volume measurement system was developed for POC settings using a lightweight convolutional neural network (CNN)-based segmentation model, which was optimized on a low-resource system-on-chip (SoC) to detect and segment the bladder region in ultrasound images in real time. The proposed model achieved high accuracy and robustness and can be executed on the low-resource SoC at 7.93 frames per second, which is 13.44 times faster than the frame rate of a conventional network with negligible accuracy drawbacks (0.004 of the Dice coefficient). The feasibility of the developed lightweight deep learning network was demonstrated using tissue-mimicking phantoms.
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Affiliation(s)
- Hyunwoo Cho
- Department of Electronic Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Ilseob Song
- Medical Solutions Institute, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
| | - Jihun Jang
- Medical Solutions Institute, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
| | - Yangmo Yoo
- Department of Electronic Engineering, Sogang University, Seoul 04107, Republic of Korea
- Edgecare Inc., TE1103, 35 Baekbeom-ro, Mapo-gu, Seoul 04107, Republic of Korea
- Department of Biomedical Engineering, Sogang University, Seoul 04107, Republic of Korea
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5
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Tsuda M, Fukawa T, Yamamoto Y, Daizumoto K, Sasaki Y, Ueno Y, Tomida R, Kusuhara Y, Yamaguchi K, Takahashi M, Kanayama HO. Impact of early urinary catheter removal on successful voiding and physical function in stroke patients. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:436-442. [PMID: 37940529 DOI: 10.2152/jmi.70.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. METHODS Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient's condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. RESULTS A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p<0.005). Interestingly, the early group also showed better improvements in physical function. CONCLUSION Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke. J. Med. Invest. 70 : 436-442, August, 2023.
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Affiliation(s)
- Megumi Tsuda
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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6
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Sartori AM, Padilla-Fernández B, 't Hoen L, Blok BFM, Castro-Díaz DM, Del Popolo G, Musco S, Hamid R, Ecclestone H, Groen J, Karsenty G, Phé V, Kessler TM, Pannek J. Definitions of Urinary Tract Infection Used in Interventional Studies Involving Neurourological Patients-A Systematic Review. Eur Urol Focus 2022; 8:1386-1398. [PMID: 34404618 DOI: 10.1016/j.euf.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurourological patients often encounter bacteriuria without any symptoms or may experience symptoms suspicious of urinary tract infections (UTIs). However, there is a lack of guidelines that unequivocally state the definition of UTIs in this specific patient group. OBJECTIVE To present all used definitions of UTIs in neurourological patients. EVIDENCE ACQUISITION This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were identified by electronic search of Medline, Embase, Cochrane controlled trials databases, and clinicaltrial.gov without a time limitation (last search September 2020) and by screening of reference lists and reviews. The occurrences of the various UTI definitions were counted and the frequencies calculated. EVIDENCE SYNTHESIS After screening 7164 abstracts, we included 32 studies enrolling a total of 8488 patients with a neurourological disorder who took part in an interventional clinical study. UTI definitions were heterogeneous. The concordance to predefined definitions was low. CONCLUSIONS Interventional clinical studies rarely report specific definitions for UTIs, and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed. PATIENT SUMMARY Patients suffering from neurological disorders often experience symptoms in their lower urinary tract that resemble urinary tract infections. Furthermore, they can have positive urine cultures without symptoms (the so-called asymptomatic bacteriuria). However, clinical studies rarely report specific definitions for urinary tract infections, and when it is done, they are heterogeneous. A generally accepted urinary tract infection definition for neurourological patients is urgently needed. TAKE HOME MESSAGE: Interventional clinical studies on neurourological patients rarely report specific definitions for urinary tract infections (UTIs), and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Rizwan Hamid
- Department of Neuro-urology, London Spinal Injuries Centre, Stanmore, UK
| | - Hazel Ecclestone
- Department of Neuro-urology, London Spinal Injuries Centre, Stanmore, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Veronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
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Yang L, Wenping X, Jinfeng Z, Jiangxia P, Jingbo W, Baojun W. Are beta blockers effective in preventing stroke associated infections? - a systematic review and meta-analysis. Aging (Albany NY) 2022; 14:4459-4470. [PMID: 35585021 PMCID: PMC9186777 DOI: 10.18632/aging.204086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Excessive sympathoexcitation could lead to stroke associated infection. Inhibiting sympathetic excitation may reduce the infection risk after stroke. Thus, the present study aimed to determine the protective effect of beta blockers on stroke associated infection through systematic review and meta-analysis. METHODS A systematic search of multiple databases were performed up to February 2022. The included studies required beta blockers therapy in stroke patients and assessed the incidence of stroke-associated infections. Outcomes of interest included infections, pneumonia, urinary tract infection and sepsis. Random-effects model was used for analysis. Heterogeneity was evaluated using I2 statistics and publication bias was evaluated by the funnel plot. RESULT A total of 83 potentially relevant publications was identified in the initial search. Six studies met the inclusion criteria for meta-analysis. The risk of bias in the included articles satisfies the quality requirement of meta-analysis. No significant associations between beta blockers therapy and the prevention of stroke associated infection, stroke associated pneumonia and septicemia were found, However, subgroup analyses revealed an association between beta blockers treatment and the increased risk of post-stroke urinary tract infection or stroke associated pneumonia in some stroke patients (OR = 1.69 [1.33, 2.14], P < 0.0001; OR = 1.85 [1.51, 2.26], P < 0.0001). CONCLUSION Due to the lack of robust evidence, this meta-analysis may not support the preventive effect of beta blockers on stroke associated infection. But beta blockers treatment may be associated with development of post-stroke urinary tract infection and stroke associated pneumonia in some stroke patients.
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Affiliation(s)
- Li Yang
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China.,School of Medicine, Inner Mongolia Medical University, Inner Mongolia, Hohhot, China
| | - Xiang Wenping
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Zhang Jinfeng
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Pang Jiangxia
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Wang Jingbo
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Wang Baojun
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
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Naganuma H, Ishida H. One-day seminar for residents for implementing abdominal pocket-sized ultrasound. World J Methodol 2021; 11:208-221. [PMID: 34322370 PMCID: PMC8299907 DOI: 10.5662/wjm.v11.i4.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/10/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Despite its proven high utility, integration of pocked-sized portable ultrasound (US) into internal medicine residency training remains inconsistent. For 10 years, we have held a 1-d seminar biannually, consisting of lecture (half-day) and hands-on training (half-day) on pocket-sized US of the abdomen and lungs. The lecture consists of training on US physics and clinical applications of pocket-sized US, followed by a lecture covering the basic anatomy of the abdomen and lungs and introducing the systemic scanning method. Given the simple structure of pocket-sized US devices, understanding the basic physics is sufficient yet necessary to operate the pocket-sized US device. It is important to understand the selection of probes, adjustment of B mode gain, adjustment of color gain, and acoustic impedance. Basic comprehension may have a significant positive impact on the overall utilization of pocket-sized US devices. The easiest and most reliable way to observe the whole abdomen and lungs is a combination of transverse, sagittal, and oblique scanning, pursuing the main vascular system from the center to the periphery of the organ in the abdomen and systemic scanning of the pleura. There is usually a marked change in knowledge and attitudes among the program participants, although skill gaps remain among them. We discuss the limitations and problems to this education system as well.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote 0138602, Akita, Japan
| | - Hideaki Ishida
- Department of Gastroenterology, Akita Red Cross Hospital, Akita-City 010-1495, Japan
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Abstract
BACKGROUND After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important. PROJECT DESCRIPTION This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL. RESULTS Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan. IMPLICATIONS FOR PRACTICE Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications. CONCLUSION Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.
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10
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Balch MH, Nimjee SM, Rink C, Hannawi Y. Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke. J Stroke 2020; 22:159-172. [PMID: 32635682 PMCID: PMC7341014 DOI: 10.5853/jos.2019.02978] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunodepression in conjunction with hyperstimulation of autonomic and neuroendocrine pathways and motor pathway impairment result in dysfunction of the respiratory, urinary, cardiovascular, gastrointestinal, musculoskeletal, and endocrine systems. These end organ abnormalities play a major role in the morbidity and mortality of acute ischemic stroke. Using a pathophysiology-based approach, this current review discusses the pathophysiological mechanisms following ischemic brain insult that result in end organ dysfunction. By characterizing stroke as a systemic disease, future research must consider bidirectional interactions between the brain and peripheral organs to inform treatment paradigms and develop effective, comprehensive therapeutics for acute ischemic stroke.
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Affiliation(s)
- Maria H.H. Balch
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shahid M. Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cameron Rink
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yousef Hannawi
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Correspondence: Yousef Hannawi Department of Neurology, The Ohio State University Wexner Medical Center, Graves Hall, Suite 3172C, 333 West 10th Ave, Columbus, OH 43210, USA Tel: +1-614-685-7234 Fax: +1-614-366-7004 E-mail:
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A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1396705. [PMID: 32090066 PMCID: PMC7008289 DOI: 10.1155/2020/1396705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), Conclusions Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.
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Matsumoto M, Tsutaoka T, Yabunaka K, Handa M, Yoshida M, Nakagami G, Sanada H. Development and evaluation of automated ultrasonographic detection of bladder diameter for estimation of bladder urine volume. PLoS One 2019; 14:e0219916. [PMID: 31487299 PMCID: PMC6728037 DOI: 10.1371/journal.pone.0219916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/03/2019] [Indexed: 12/01/2022] Open
Abstract
Bladder urine volume has been estimated using an ellipsoid method based on triaxial measurements of the bladder extrapolated from two-dimensional ultrasound images. This study aimed to automate this process and to determine the accuracy of the automated estimation method for normal and small amounts of urine. A training set of 81 pairs of transverse and longitudinal ultrasound images were collected from healthy volunteers on a tablet-type ultrasound device, and an automatic detection tool was developed using them. The tool was evaluated using paired transverse/longitudinal ultrasound images from 27 other healthy volunteers. After imaging, the participants voided and their urine volume was measured. For determining accuracy, regression coefficients were calculated between estimated bladder volume and urine volume. Further, sensitivity and specificity for 50 and 100 ml bladder volume thresholds were evaluated. Data from 50 procedures were included. The regression coefficient was very similar between the automatic estimation (β = 0.99, R2 = 0.96) and manual estimation (β = 1.05, R2 = 0.97) methods. The sensitivity and specificity of the automatic estimation method were 88.5% and 100.0%, respectively, for 100 ml and were 94.1% and 100.0%, respectively, for 50 ml. The newly-developed automated tool accurately and reliably estimated bladder volume at two different volume thresholds of approximately 50 ml and 100 ml.
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Affiliation(s)
- Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takuya Tsutaoka
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Imaging Technology Center, Research & Development Management Headquarters, FUJIFILM Corporation, Minato-ku, Tokyo, Japan
| | - Koichi Yabunaka
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mayumi Handa
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Marketing Planning Group, Ultrasound Promotion Department, FUJIFILM Medical Corporation, Minato-ku, Tokyo, Japan
| | - Mikako Yoshida
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Smith C, Almallouhi E, Feng W. Urinary tract infection after stroke: A narrative review. J Neurol Sci 2019; 403:146-152. [DOI: 10.1016/j.jns.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound. Int Urogynecol J 2019; 31:973-979. [PMID: 31309246 DOI: 10.1007/s00192-019-04045-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. METHODS Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). RESULTS Twenty women participated, with an average age of 27.95 ± 3.15 years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. CONCLUSIONS The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.
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