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Leal NTB, de Araújo NM, Silva SDO, Cabral MAL, da Silva BVS, Pinheiro TBM, Dantas RAN, Dantas DV. Pain management in the postoperative period of amputation surgeries: A scoping review. J Clin Nurs 2023; 32:7718-7729. [PMID: 37605033 DOI: 10.1111/jocn.16846] [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] [Received: 09/22/2022] [Revised: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. PURPOSES AND OBJECTIVES The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries. DESIGN Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist. METHODS The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected. RESULTS Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales. CONCLUSIONS The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced. RELEVANCE TO CLINICAL PRACTICE The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery. PATIENT OR PUBLIC CONTRIBUTION To patient or public involvement in this scoping review.
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Starr MR, Patel LG, Ammar M, Yonekawa Y. Opioids and ophthalmology: review of the current literature. Curr Opin Ophthalmol 2021; 32:209-213. [PMID: 33710008 DOI: 10.1097/icu.0000000000000753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than five-fold from 1999 to 2016. Although surgeons only write 10% of opioid prescriptions annually, with ophthalmologists writing only a fraction of this amount, all physicians need to be cognizant of the current opioid epidemic and ways to decrease unnecessary opioid prescriptions. RECENT FINDINGS Previous work within ophthalmology has shown that retrobulbar anesthesia along with peri-operative intravenous or oral nonopioid analgesics can lead to decreased postoperative opioid use following ophthalmic surgery. Recent literature has shifted focus towards the use of opioid prescription guidelines in managing postoperative pain and decreasing the number of unnecessary opioids being prescribed by ophthalmologists. Overall, the frequency of opioid prescriptions may have gradually declined the past few years with such efforts, increased awareness, and new healthcare policies to monitor opioid prescriptions. However, ophthalmologists still continue to prescribe a substantial number of opioid medications, much of which may not be necessary. SUMMARY This review serves as a tool to aid all ophthalmologists in managing postoperative pain. There is a recent trend in addressing the opioid epidemic and efforts are being made to limit the overprescribing of opioids. Continued efforts are still required by all ophthalmologists to address the current opioid epidemic.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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Chen P, Chen F, Lei J, Zhou B. Physical Compatibility and Chemical Stability of Fentanyl and Naloxone Hydrochloride in 0.9% Sodium Chloride Injection Solution for Patient-Controlled Analgesia Administration. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:4179-4187. [PMID: 33116406 PMCID: PMC7553636 DOI: 10.2147/dddt.s248209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022]
Abstract
Background and Objective The combination of naloxone hydrochloride (NH) and fentanyl citrate (FC) in patient-controlled analgesia (PCA) is examined to reduce the risk of opioid-induced nausea and vomiting. However, there are no such commercially available drug mixtures, and there is also no published evidence on the compatibility and stability of NH and FC. Thus, the primary purpose of the current research is to investigate the physical compatibility and chemical stability of NH when mixed with FC over a 72-h period in a 0.9% sodium chloride injection solution for PCA administration under storage at 4°C and 25°C. Methods Test solutions of 20 μg/mL FC and 4 μg/mL NH were prepared and stored in polyvinyl chloride (PVC) bags or glass bottles with a 0.9% sodium chloride injection solution as the diluent. During the 72-h storage period at 4°C or 25°C without light protection, the concentrations of the test drugs were assayed via high-performance liquid chromatography (HPLC), and the physical compatibility was determined with the naked eye. Furthermore, pH measurement of each sample was also performed with a pH meter. Results The percentages of the initial concentrations of FC and NH in the various solutions were maintained at a minimum of 98% over the 72-h study period. All of the mixtures remained clear and colourless throughout the observation period, and no precipitation or turbidity was observed in any of the batches. Conclusion The 20 μg/mL FC test solution was physically compatible and chemically stable with the 4 μg/mL NH test solution when stored at 4°C or 25°C in PVC bags or glass bottles containing the 0.9% sodium chloride injection solution.
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Affiliation(s)
- Peng Chen
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Fuchao Chen
- Department of Pharmacy, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, People's Republic of China
| | - Jiexin Lei
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Benhong Zhou
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
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Wladis EJ, Rothschild MI, Rubinstein TJ. Management of postoperative pain in ophthalmic plastic surgery: a major review. Orbit 2020; 40:269-273. [PMID: 32669009 DOI: 10.1080/01676830.2020.1793373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Clinicians are becoming increasingly aware of the risks of opioid analgesics, and, consequently, are searching for alternatives to these agents. This review considers the existing literature regarding the management of pain after ophthalmic plastic surgery. METHODS A literature search was performed through the PubMed database. Articles were assessed for relevance, and the appropriate data was extracted from the medical literature regarding pain management strategies after oculoplastic procedures. RESULTS An emerging body of literature suggests the efficacy of a variety of non-narcotic agents in post-operative pain management. Many of these medications prevent the development of pain, and several have been studied in randomized trials. Specifically, pregabalin, ketorolac, acetaminophen, memantine, local anesthetics, and alternative therapies all have documented benefit in this setting. CONCLUSIONS Several medications may prevent and treat pain after ophthalmic plastic surgery. These agents are well-tolerated, and many decrease the requirement for opioid analgesics. Clinicians should be aware of these therapies when considering non-narcotic pain management.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, USA
| | - Michael I Rothschild
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, USA
| | - Tal J Rubinstein
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, USA
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Rezaei B, Salimi R, Kalantari A, Astaraki P. Comparison of efficacy nebulized fentanyl with intravenous ketorolac for renal colic in patients over 12 years old. Am J Emerg Med 2020; 44:358-361. [PMID: 32345561 DOI: 10.1016/j.ajem.2020.04.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Acute renal colic is one of the common causes of referral to the hospitals. The aim of this study is to compare the efficacy of nebulized fentanyl with that of intravenous ketorolac in renal colic patients. MATERIALS & METHODS This double-blinded clinical study included 186 patients with acute renal colic who were referred to the emergency department of Besat Hospital, Iran. PATIENT SELECTION After selecting patients, according to study inclusion and exclusion criteria, they were divided into 2 groups of 93 using random block allocation method. The patients in the groups were treated with either nebulized fentanyl or intravenous ketorolac. The severity of pain was measured using the Numeric Pain Rating Scale (NPRS) of pain. The severity of pain at different times and demographic data were recorded. RESULTS One hundred and thirty four males and 52 females with a mean age of 42.95 ± 13.13 years were included in the study. The two groups were matched in terms of age, sex, and the severity of the pain before the treatment. Fifteen minutes following the treatment, the severity of pain was decreased in the ketorolac group but did not change in the nebulized fentanyl group. Thirty minutes after the administration of the drug, the severity of pain in the nebulized fentanyl group decreased. At any time, the severity of pain in the ketorolac group was lower than that of the nebulized fentanyl group. CONCLUSION Intravenous ketorolac had better analgesic effects in renal colic patients compared with nebulized fentanyl. Further studies that include complications and combinational therapy are required.
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Affiliation(s)
- Bareza Rezaei
- Clinical Research Development Center of Taleghani, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Salimi
- Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
| | - Alireza Kalantari
- Department of Emergency Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Peyman Astaraki
- Faculty of Medicine, Department of Internal Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Kolomeyer AM, Yu Y, VanderBeek BL. Association of Opioids With Incisional Ocular Surgery. JAMA Ophthalmol 2019; 137:1283-1291. [PMID: 31536096 DOI: 10.1001/jamaophthalmol.2019.3694] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Opioid abuse has been declared a public health emergency. Currently, little is known about the association between opioids and ocular surgery. Objective To characterize rates of filled opioid prescriptions after incisional ocular surgeries. Design, Setting, and Participants This cohort study included patients with incisional ocular surgeries within a large national US insurer's administrative medical claims database. All incisional ocular surgeries from January 2000 through December 2016 were evaluated. An opioid prescription was eligible if it occurred from 1 day before to 7 days after a surgery. Any surgery on a patient who was younger than 18 years, had more than 30 consecutive days of an opioid prescription in the prior 6 months, or had less than 6 months of data in the database prior to surgery was excluded. Data analysis occurred from May 2018 through November 2018. Main Outcomes and Measures The rate of opioid prescriptions filled for all incisional ocular surgeries from 2000 through 2016. Primary analysis looked at the rate of filled opioid prescriptions for each ophthalmic subspecialty surgery over time. Secondary analysis assessed which patient or surgical characteristics (ie, age, sex, race/ethnicity, geographic locations, yearly income, educational level, and type of eye surgery) were associated with filling an opioid prescription. Multivariate logistic regression using generalized estimating equations was used to determine odds ratios (ORs) of filling an opioid prescription. Results A total of 2 407 962 incisional ocular surgeries were included, of which 45 776 (1.90%) were associated with an opioid prescription. The rate of filled opioid prescriptions varied considerably over time, with the lowest rate occurring in the 2000-2001 cohort year (671 of 45 776 [1.24%]) and the highest in 2014 (5559 of 45 776 [2.51%]). An increasing trend was seen over the course of the study (2000-2001: 671 of 45 776 [1.24%]; 2016: 5851 of 45 776 [2.07%]; P < .001). Multivariate logistic regression showed that year of surgery was significantly associated with filling an opioid prescription, with the highest odds in 2014 (OR, 3.71 [95% CI, 3.33-4.1]), 2015 (OR, 3.33 [95% CI, 2.99-3.70]), and 2016 (OR, 3.27 [95% CI, 2.94-3.63]) compared with 2000 to 2001 (P < .001). Conclusions and Relevance These findings suggest the rate of filled opioid prescriptions are increasing for all types of incisional ocular surgery over time. Given the ongoing national opioid epidemic, understanding patterns of use can help in reversing the epidemic.
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Affiliation(s)
- Anton M Kolomeyer
- Scheie Eye Institute, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian L VanderBeek
- Scheie Eye Institute, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Keilani C, Baus A, Tick S, Sahel JA, Boumendil J. Effectiveness and safety comparison of three eye and orbital reconstruction techniques in facial plastic surgery. ANN CHIR PLAST ESTH 2019; 64:351-361. [DOI: 10.1016/j.anplas.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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Blanco ME, Encinas E, González O, Rico E, Vozmediano V, Suárez E, Alonso RM. Quantitative determination of fentanyl in newborn pig plasma and cerebrospinal fluid samples by HPLC-MS/MS. Drug Test Anal 2015; 7:804-11. [PMID: 25755165 DOI: 10.1002/dta.1778] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 11/07/2022]
Abstract
In this study, a selective and sensitive high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method requiring low sample volume (≤100 μL) was developed and validated for the quantitative determination of the opioid drug fentanyl in plasma and cerebrospinal fluid (CSF). A protein precipitation extraction with acetonitrile was used for plasma samples whereas CSF samples were injected directly on the HPLC column. Fentanyl and (13) C6 -fentanyl (Internal Standard) were analyzed in an electrospray ionization source in positive mode, with multiple reaction monitoring (MRM) of the transitions m/z 337.0/188.0 and m/z 337.0/105.0 for quantification and confirmation of fentanyl, and m/z 343.0/188.0 for (13) C6 -fentanyl. The respective lowest limits of quantification for plasma and CSF were 0.2 and 0.25 ng/mL. Intra- and inter-assay precision and accuracy did not exceed 15%, in accordance with bioanalytical validation guidelines. The described analytical method was proven to be robust and was successfully applied to the determination of fentanyl in plasma and CSF samples from a pharmacokinetic and pharmacodynamic study in newborn piglets receiving intravenous fentanyl (5 µg/kg bolus immediately followed by a 90-min infusion of 3 µg/kg/h).
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Affiliation(s)
- M E Blanco
- Analytical Chemistry Department, Science and Technology Faculty, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - E Encinas
- Pharmacology Department, Faculty of Medicine, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - O González
- Analytical Chemistry Department, Science and Technology Faculty, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain.,Analytical Bioscience Division, LACDR, Leiden University, Leiden, the Netherlands
| | - E Rico
- Analytical Chemistry Department, Science and Technology Faculty, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - V Vozmediano
- Drug Modeling & Consulting, Dynakin, SL, Bilbao, Basque Country, Spain
| | - E Suárez
- Pharmacology Department, Faculty of Medicine, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - R M Alonso
- Analytical Chemistry Department, Science and Technology Faculty, University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
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Choi YY, Park JS, Park SY, Kim HJ, Yeo J, Kim JC, Park S, Choi GS. Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer? Ann Surg Treat Res 2015; 88:86-91. [PMID: 25692119 PMCID: PMC4325645 DOI: 10.4174/astr.2015.88.2.86] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/11/2014] [Accepted: 09/18/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. Methods Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. Results Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). Conclusion Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.
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Affiliation(s)
- Young Yeon Choi
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinseok Yeo
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Chan Kim
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sungsik Park
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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