Follow-up of the joint function and quality of life after total joint arthroplasty

As the population ageing, more and more patients suffer from joint disease in Taiwan. Joint replacement surgery performedin Taiwan is about 10,000 to 20,000 cases yearly. The purpose of this study was to investigate the Quality of life and jointfunctions of TKR (total knee replacement) and THR (total hip replacement) patients 6 weeks and 3 months after surgery. Convenience sampling was used and a total 126 patients were recruited. Average age was 72.75 (SD = 9.046). THR surgery was 21(16.7 %) and TKR surgery was 105 (83.3 %). One hundred and twenty patients (95.2 %) lived with family and six (4.8 %) was lived alone. Mean score of perceived the convenience of home environment was 3.90 (SD = .74) , with 18.7% of patients felt a little inconvenience or very inconvenience, 81.7% felt convenience or very convenience. The patients had moderate satisfaction about the surgery, with mean score 17.68 (SD = 2. 13) 6 weeks and 17.75(SD = 2.55) 3 months after surgery. There was significant difference between TKR patients and THR patients on pre-operation (t = 3.225 , p \u3c.05) and 6 weeks after surgery(t = 2.32 , p \u3c.05) on EQ5D utility index. Repeated measures ANOVA was used to analyze TKR patients on joint function (F = 61.38 , p = .000) and perceived health score (F = 3.74 , p \u3c.05) on pre-operation, 6 weeks and 3 months after surgery. Repeated measures ANOVA was used to analyze THR patients on joint function and perceived health score on pre-operation, 6 weeks and 3 months after surgery, it showed no significant difference (p \u3e .05). Because of small sample size of THR patients, it May affect the results of inference. It is recommended to keep track of longer surgical outcomes, and increase the number of THR patients, to improve the results of inferential

Effectiveness of music listening on patients with total knee replacement during CPM rehabilitation

Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: Aims: This study investigated the effects of music listening on the anxiety, heart rate variability (HRV), and range of motion of joints in patients who were implementation of continuous passive motion (CPM). Methods: An experimental design was adopted, and the participants were patients who received total knee replacement (TKR) surgery (experimental group = 49 patients; control group = 42 patients). The experimental group began listening to music 10 min before receiving CPM at 10 AM until the end of CPM (25 min in total) on the first and second days after the surgery, whereas the control group was required to rest in bed. Results: (1) the experimental group exhibited significantly lower anxiety levels than the control group did (p \u3c .05); (2) the experimental group had significantly higher increase in angles for each CPM implementation compared with the control group (p \u3c .05), and the active flexion angles of the experimental group were higher than those of the control group (p \u3c .05) at discharge; and (3) the low frequency/high frequency power (LH/HF) ratio, normalized low frequency (nLH), and normalized high frequency (nHF) HRV of the two groups differed statistically significantly, indicating that compared with the control group, the experimental group had superior parasympathetic nervous regulation. Conclusions: Music listening can effectively lower patient anxiety levels and enhances the range of motion of joints during postoperative rehabilitation. Therefore, this study suggested that music be included as one of the routine practices for postoperative rehabilitation of orthopedic surgeries. Keywords: total knee replacement, music listening, anxiety, range of motion Submission for: Poster presentation Presenting Author Bio: Pi-Chu Lin, EdD, RN, Professor, School of Nursing and Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan

Outcomes of and factors associated with the development of bronchopulmonary dysplasia with pulmonary hypertension in very low birth weight infants: A retrospective study in a medical center

IntroductionBronchopulmonary dysplasia (BPD) with pulmonary hypertension (PH) leads to increased morbidity and mortality in extremely preterm infants. Recent studies have analyzed factors associated with development of PH in BPD; however, this research remains inconclusive, and controversy exists regarding the correlation between BPD and PH. This study aimed to investigate potential associated factors, clinical characteristics, and outcomes of BPD with pulmonary hypertension in very low birth weight (VLBW) preterm infants.MethodsWe conducted a retrospective study, reviewing the records of infants with gestational age (GA) <32 weeks and birth weight <1,500 g admitted to a tertiary neonatal intensive care unit between January 2020 and October 2021 who were diagnosed with moderate to severe BPD. Echocardiogram was performed at the postmenstrual age of 36 weeks or before discharge. The diagnosis of PH was based on the findings of echocardiogram. Prenatal and postnatal characteristics, demographic data, treatment details, and outcomes were collected and analyzed.ResultsA total of 139 VLBW infants with BPD were enrolled and divided into a PH group (n = 25) and a non-PH group (n = 114). The mean GA was 27.3 ± 2.3 weeks and the mean birth weight of infants with BPD was 927.3 ± 293.3 g. A multivariate logistic regression model revealed that a high positive end-expiratory pressure (PEEP) setting (OR: 2.105; 95% CI: 1.472–3.011; p < 0.001) in established BPD and surgical closure of patent ductus arteriosus (PDA; OR: 6.273; 95% CI: 1.574–24.977; p = 0.009) were associated with BPD–PH. Neonates with BPD who developed pulmonary hypertension remained hospitalized for longer (p < 0.001), received invasive mechanical ventilation support for longer (p < 0.001), had a higher incidence of retinopathy of prematurity (ROP; OR: 4.201; 95% CI: 1.561–11.304; p = 0.003), were more likely to require oxygen support at discharge (OR: 5.600; 95% CI: 2.175–14.416; p < 0.001), and were more likely to undergo tracheostomy (OR: 35.368; 95% CI: 4.03–310.43; p < 0.001).ConclusionPDA ligation and a higher PEEP setting were associated with BPD–PH in our cohort study. Compared with VLBW infants with BPD but without PH, infants with BPD and PH were hospitalized for longer, and also had a higher incidence of oxygen support after discharge, ROP, and tracheostomy

Feasibility of intraoperative neuromonitoring during thyroid surgery using transcartilage surface recording electrodes

Background: Intraoperative neural monitoring (IONM) has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN) during thyroid surgery. Currently, laryngeal electromyography (EMG) recording during IONM is almost always performed using endotracheal tube (ETT) surface electrodes placed adjacent to vocal folds originating from the inner surface of the thyroid cartilage (TC). Therefore, we hypothesized that surface recording electrodes placed on the outer surface of the TC should enable access to the EMG response of the vocal folds during IONM. The aims of this experimental study were to evaluate the feasibility of the transcartilage approach for laryngeal EMG recording during IONM. Methods: A porcine model (12 pigs and 24 RLN sides) with well-established applicability in IONM research was used for the experiments. Both ETT electrodes adjacent to vocal folds and adhesive pre-gelled electrodes on the TC were used for EMG recording during IONM. Electrically evoked EMG signals detected by both electrode types were recorded and analyzed. EMG changes during tracheal displacement and RLN traction injury were compared. Results: Both the ETT and TC electrodes recorded typical laryngeal EMG waveforms evoked by a 1 mA stimulus current applied on both sides of the RLNs and vagus nerves (VNs). Under RLN stimulation, the mean EMG amplitudes recorded with the ETT and TC electrodes were 973μV (±179) and 695μV (±150), respectively. Under VN stimulation, the mean amplitudes were 841μV (± 163) and 607μV (± 162), respectively. When upward displacement of the trachea was experimentally induced, the TC electrodes showed less variation in recorded EMG signals compared to ETT electrodes. When RLN traction stress was experimentally induced, both the ETT and TC electrodes accurately recorded the typical EMG pattern of progressively degrading amplitude and gradual recovery after release of traction. Conclusions: This study confirmed the feasibility of using transcartilage surface electrodes for recording of laryngeal EMG signals evoked during IONM in an animal model. Before practical application of this approach in clinical thyroid surgery, however, further studies are needed to improve electrode designs by optimizing their shapes and sizes, and increasing their adhesive stability and sensitivity

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Localization and Broadband Follow-Up of the Gravitational-Wave Transient GW150914

A gravitational-wave (GW) transient was identified in data recorded by the Advanced Laser InterferometerGravitational-wave Observatory (LIGO) detectors on 2015 September 14. The event, initially designated G184098and later given the name GW150914, is described in detail elsewhere. By prior arrangement, preliminary estimatesof the time, significance, and sky location of the event were shared with 63 teams of observers covering radio,optical, near-infrared, X-ray, and gamma-ray wavelengths with ground- and space-based facilities. In this Letter wedescribe the low-latency analysis of the GW data and present the sky localization of the first observed compactbinary merger. We summarize the follow-up observations reported by 25 teams via private Gamma-rayCoordinates Network circulars, giving an overview of the participating facilities, the GW sky localizationcoverage, the timeline, and depth of the observations. As this event turned out to be a binary black hole merger,there is little expectation of a detectable electromagnetic (EM) signature. Nevertheless, this first broadbandcampaign to search for a counterpart of an Advanced LIGO source represents a milestone and highlights the broadcapabilities of the transient astronomy community and the observing strategies that have been developed to pursueneutron star binary merger events. Detailed investigations of the EM data and results of the EM follow-upcampaign are being disseminated in papers by the individual teams

Isotretinoin Oil-Based Capsule Formulation Optimization

The purpose of this study was to develop and optimize an isotretinoin oil-based capsule with specific dissolution pattern. A three-factor-constrained mixture design was used to prepare the systemic model formulations. The independent factors were the components of oil-based capsule including beeswax (X1), hydrogenated coconut oil (X2), and soybean oil (X3). The drug release percentages at 10, 30, 60, and 90 min were selected as responses. The effect of formulation factors including that on responses was inspected by using response surface methodology (RSM). Multiple-response optimization was performed to search for the appropriate formulation with specific release pattern. It was found that the interaction effect of these formulation factors (X1X2, X1X3, and X2X3) showed more potential influence than that of the main factors (X1, X2, and X3). An optimal predicted formulation with Y10 min, Y30 min, Y60 min, and Y90 min release values of 12.3%, 36.7%, 73.6%, and 92.7% at X1, X2, and X3 of 5.75, 15.37, and 78.88, respectively, was developed. The new formulation was prepared and performed by the dissolution test. The similarity factor f2 was 54.8, indicating that the dissolution pattern of the new optimized formulation showed equivalence to the predicted profile

A model for predicting physical function upon discharge of hospitalized older adults in Taiwan—a machine learning approach based on both electronic health records and comprehensive geriatric assessment

BackgroundPredicting physical function upon discharge among hospitalized older adults is important. This study has aimed to develop a prediction model of physical function upon discharge through use of a machine learning algorithm using electronic health records (EHRs) and comprehensive geriatrics assessments (CGAs) among hospitalized older adults in Taiwan.MethodsData was retrieved from the clinical database of a tertiary medical center in central Taiwan. Older adults admitted to the acute geriatric unit during the period from January 2012 to December 2018 were included for analysis, while those with missing data were excluded. From data of the EHRs and CGAs, a total of 52 clinical features were input for model building. We used 3 different machine learning algorithms, XGBoost, random forest and logistic regression.ResultsIn total, 1,755 older adults were included in final analysis, with a mean age of 80.68 years. For linear models on physical function upon discharge, the accuracy of prediction was 87% for XGBoost, 85% for random forest, and 32% for logistic regression. For classification models on physical function upon discharge, the accuracy for random forest, logistic regression and XGBoost were 94, 92 and 92%, respectively. The auROC reached 98% for XGBoost and random forest, while logistic regression had an auROC of 97%. The top 3 features of importance were activity of daily living (ADL) at baseline, ADL during admission, and mini nutritional status (MNA) during admission.ConclusionThe results showed that physical function upon discharge among hospitalized older adults can be predicted accurately during admission through use of a machine learning model with data taken from EHRs and CGAs

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery