BACKGROUND: The efficacy of palonosetron in preventing postoperative nausea and vomiting (PONV), as well as chemotherapy-induced nausea and vomiting, has already been demonstrated in multiple clinical studies. The purpose of this study was to determine whether continuous infusion of palonosetron following single injection could reduce PONV to a greater extent than single injection only of palonosetron. METHODS: In total, 132 women were enrolled in the study. All subjects were over the age of 20 years and were scheduled to undergo gynecologic laparoscopic surgery. Patients were randomly allocated into two groups. In both groups, patients received 0.075 mg of palonosetron intravenously, immediately before induction of anesthesia. In the continuous palonosetron infusion group, 0.075 mg (1.5 ml) of palonosetron was added to the patient-controlled analgesia device. In the single-injection palonosetron group, 1.5 ml of normal saline was added. RESULTS: The incidence of PONV 24 hours postoperatively was significantly lower in the continuous palonosetron infusion group than the single-injection palonosetron group (31.8 vs. 56.1%, P = 0.009). CONCLUSIONS: Continuous palonosetron infusion, following single injection, reduces the incidence of PONV compared with single injection only.
Analgesia, Patient-Controlled* ; Anesthesia ; Female ; Humans ; Incidence ; Laparoscopy ; Nausea ; Postoperative Nausea and Vomiting* ; Vomiting

PURPOSE: The objective of this study is to review the clinical manifestations and EEG findings of children with centro-temporal spikes. METHODS: We reviewed the clinical records of 38 patients showed epileptiform discharges on centro-temporal area and followed over 6 months at the Pediatric Neurology Clinic, Ghil hospital from February 1996 to July 1999. According to the EEG findings, they were classified into 2 groups : One was the group with epileptiform discharges on centro-temporal area only and the second was the group with other abnormal EEG findings besides centro-temporal epileptiform discharges. RESULTS: 1) The chief complaints included nocturnal convulsions in 30, diurnal convulsions in 4, headache in 2, febrile convulsion in 1 and self-mutilation in 1 patient. 2) According to seizure types, 3 patients had simple partial seizure, 17 had complex partial seizure and 14 had generalized seizure. 3) According to EEG findings, 20 showed centro-temporal spikes only, 18 revealed centro-temporal spikes and other abnormality. 4) The clinical seizure attacks prior to medication were observed in 34 patients, with 1 to 3 seizure attacks in 23, 4 to 10 attacks in 8 and over 10 attacks in 3 cases. 5) After medication 19 patients had no seizure attack and 11 had 1 to 3 attacks. Three patients had more than 10 attacks, but 2 of them were not adequately treated. CONCLUSION: It seems that the prognosis of the patients with centro-temporal spikes is good, but more rigorous studies based on more comprehensive data will be needed.
Child* ; Electroencephalography* ; Headache ; Humans ; Neurology ; Prognosis ; Seizures ; Seizures, Febrile

Computerized adaptive testing (CAT) has become a widely adopted test design for high-stakes licensing and certification exams, particularly in the health professions in the United States, due to its ability to tailor test difficulty in real time, reducing testing time while providing precise ability estimates. A key component of CAT is item response theory (IRT), which facilitates the dynamic selection of items based on examinees' ability levels during a test. Accurate estimation of item and ability parameters is essential for successful CAT implementation, necessitating convenient and reliable software to ensure precise parameter estimation. This paper introduces the irtQ R package (http://CRAN.R-project.org/), which simplifies IRT-based analysis and item calibration under unidimensional IRT models. While it does not directly simulate CAT, it provides essential tools to support CAT development, including parameter estimation using marginal maximum likelihood estimation via the expectation-maximization algorithm, pretest item calibration through fixed item parameter calibration and fixed ability parameter calibration methods, and examinee ability estimation. The package also enables users to compute item and test characteristic curves and information functions necessary for evaluating the psychometric properties of a test. This paper illustrates the key features of the irtQ package through examples using simulated datasets, demonstrating its utility in IRT applications such as test data analysis and ability scoring. By providing a user-friendly environment for IRT analysis, irtQ significantly enhances the capacity for efficient adaptive testing research and operations. Finally, the paper highlights additional core functionalities of irtQ, emphasizing its broader applicability to the development and operation of IRT-based assessments.

Computerized adaptive testing (CAT) has become a widely adopted test design for high-stakes licensing and certification exams, particularly in the health professions in the United States, due to its ability to tailor test difficulty in real time, reducing testing time while providing precise ability estimates. A key component of CAT is item response theory (IRT), which facilitates the dynamic selection of items based on examinees' ability levels during a test. Accurate estimation of item and ability parameters is essential for successful CAT implementation, necessitating convenient and reliable software to ensure precise parameter estimation. This paper introduces the irtQ R package (http://CRAN.R-project.org/), which simplifies IRT-based analysis and item calibration under unidimensional IRT models. While it does not directly simulate CAT, it provides essential tools to support CAT development, including parameter estimation using marginal maximum likelihood estimation via the expectation-maximization algorithm, pretest item calibration through fixed item parameter calibration and fixed ability parameter calibration methods, and examinee ability estimation. The package also enables users to compute item and test characteristic curves and information functions necessary for evaluating the psychometric properties of a test. This paper illustrates the key features of the irtQ package through examples using simulated datasets, demonstrating its utility in IRT applications such as test data analysis and ability scoring. By providing a user-friendly environment for IRT analysis, irtQ significantly enhances the capacity for efficient adaptive testing research and operations. Finally, the paper highlights additional core functionalities of irtQ, emphasizing its broader applicability to the development and operation of IRT-based assessments.

Computerized adaptive testing (CAT) has become a widely adopted test design for high-stakes licensing and certification exams, particularly in the health professions in the United States, due to its ability to tailor test difficulty in real time, reducing testing time while providing precise ability estimates. A key component of CAT is item response theory (IRT), which facilitates the dynamic selection of items based on examinees' ability levels during a test. Accurate estimation of item and ability parameters is essential for successful CAT implementation, necessitating convenient and reliable software to ensure precise parameter estimation. This paper introduces the irtQ R package (http://CRAN.R-project.org/), which simplifies IRT-based analysis and item calibration under unidimensional IRT models. While it does not directly simulate CAT, it provides essential tools to support CAT development, including parameter estimation using marginal maximum likelihood estimation via the expectation-maximization algorithm, pretest item calibration through fixed item parameter calibration and fixed ability parameter calibration methods, and examinee ability estimation. The package also enables users to compute item and test characteristic curves and information functions necessary for evaluating the psychometric properties of a test. This paper illustrates the key features of the irtQ package through examples using simulated datasets, demonstrating its utility in IRT applications such as test data analysis and ability scoring. By providing a user-friendly environment for IRT analysis, irtQ significantly enhances the capacity for efficient adaptive testing research and operations. Finally, the paper highlights additional core functionalities of irtQ, emphasizing its broader applicability to the development and operation of IRT-based assessments.

Purpose: To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex®) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. Methods: We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. Results: At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 μm for the IVD group versus 349.00 ± 112.18 μm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. Conclusions In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.

Purpose: To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex®) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. Methods: We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. Results: At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 μm for the IVD group versus 349.00 ± 112.18 μm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. Conclusions In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding.
Melanosis/*pathology ; Melanocytes/pathology ; Humans ; Female ; Epidermis/pathology ; Dermis/pathology ; Adult

Fasciotomy wounds are a major contributor to prolonged hospital stay and can lead to amputation. Although it is generally recommended to close the fasciotomy wound as early as possible, it is usually challenging. Primary closure is more favorable because it commences more functional and esthetic results with less morbidity. But primary closure is difficult to achieve due to skin edema, retraction and necrosis. Topical negative pressure care (TNP) has been used in other areas of wound care, such as mediastinitis and burn wounds. TNP has recently gained popularity and has shown promising outcomes. Topical negative pressure systems are commercially available but very expensive. We designed a modified negative pressure system with wall-suction and applied it to a complicated fasciotomy wound. We herein report our experience with a review of related literatures.
Amputation ; Burns ; Edema ; Length of Stay ; Mediastinitis ; Necrosis ; Skin ; Vacuum