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Nordback PH, Sebastin SJ, Yong ZZ, Lee EY, Lim AYT. Scapular Elevation Sign - A New Sign in Evaluation of Thoracic Outlet Syndrome. J Hand Surg Asian Pac Vol 2024; 29:231-239. [PMID: 38726493 DOI: 10.1142/s2424835524500255] [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: 06/01/2024]
Abstract
Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic).
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Wu KY, Lee EY, Loosbrock MF, Bishop AT, Spinner RJ, Shin AY. Validation of the Root Analysis Score for C5 Viability in Patients With Pan-Brachial Plexus Injury. J Hand Surg Am 2024; 49:526-531. [PMID: 38430093 DOI: 10.1016/j.jhsa.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Pan-brachial plexus injury patients present a reconstructive challenge. The root analysis score, developed from parsimonious multivariable modeling of 311 pan-brachial plexus injury patients, determines the probability of having a viable C5 nerve based on four categories: positive C5 Tinel test, intact C5 nerve on computed tomography myelogram, lack of hemidiaphragmatic elevation, and absence of midcervical paraspinal fibrillations. METHODS Root analysis scores were calculated for a separate cohort of patients with pan-brachial plexus injuries. Scores were validated by the presence or absence of a graftable C5 root, based on supraclavicular exploration and intraoperative electrophysiologic testing. Receiver operating characteristic curve, accuracy, and concordance statistic of the scores were calculated. Patients were divided into three root analysis score cohorts: less than 50 (low), 50-75 (average), and 75-100 points (high) based on dividing the score into quartiles and combining the lowest two. The probability, sensitivity, and specificity of each cohort having an available C5 nerve were based on the intraoperative assessment. RESULTS Eighty patients (mean age, 33.1 years; 15 women and 65 men) were included. Thirty-one patients (39%) had a viable C5 nerve. The root analysis calculator had an overall accuracy of 82.5%, a receiver operating characteristic of 0.87, and a concordance statistic of 0.87, demonstrating high overall predictive value; 6.5% of patients with a score of less than 50 (94% sensitivity and 43% specificity), 16.1% of patients with a score of 50-75 (94% sensitivity and 67% specificity), and 77.4% of patients with a score of 75-100 (77% sensitivity and 90% specificity) had a graftable C5 nerve. CONCLUSIONS The root analysis score demonstrated high accuracy and predictive power for a viable C5 nerve. In patients with a score of less than 50, the necessity of supraclavicular root exploration should balance patient factors, presentation timing, and concomitant injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnosis II.
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Lee EY, Nelson AW, Sampson BP, Smither FC, Pulos N, Bishop AT, Spinner RJ, Shin AY. Evaluating the Ability of Brachial Plexus-Injured Patients to Control an Externally Powered (Myoelectric) Hand Prosthesis. J Bone Joint Surg Am 2024:00004623-990000000-01096. [PMID: 38728379 DOI: 10.2106/jbjs.23.00938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Restoration of hand function after traumatic brachial plexus injury (BPI) remains a formidable challenge. Traditional methods such as nerve or free muscle transfers yield suboptimal results. Advancements in myoelectric prostheses, characterized by novel signal acquisition and improved material technology, show promise in restoring functional grasp. This study evaluated the ability of adults with a BPI injury to control an externally powered prosthetic hand using nonintuitive signals, simulating the restoration of grasp with a myoelectric prosthesis. It also assessed the effectiveness of a comprehensive multidisciplinary evaluation in guiding treatment decisions. METHODS A multidisciplinary brachial plexus team assessed adults with compromised hand function due to BPI. The feasibility of amputation coupled with fitting of a myoelectric prosthesis for grasp reconstruction was evaluated. Participants' ability to control a virtual or model prosthetic hand using surface electromyography (EMG) as well as with contralateral shoulder motion-activated linear transducer signals was tested. The patient's input and injury type, along with the information from the prosthetic evaluation, were used to determine the reconstructive plan. The study also reviewed the number of participants opting for amputation and a myoelectric prosthetic hand for grasp restoration, and a follow-up survey was conducted to assess the impact of the initial evaluation on decision-making. RESULTS Of 58 subjects evaluated, 47 (81%) had pan-plexus BPI and 42 (72%) received their initial assessment within 1 year post-injury. Forty-seven patients (81%) could control the virtual or model prosthetic hand using nonintuitive surface EMG signals, and all 58 could control it with contralateral uniscapular motion via a linear transducer and harness. Thirty patients (52%) chose and pursued amputation, and 20 (34%) actively used a myoelectric prosthesis for grasp. The initial evaluation was informative and beneficial for the majority of the patients, especially in demonstrating the functionality of the myoelectric prosthesis. CONCLUSIONS The study indicates that adults with traumatic BPI can effectively operate a virtual or model myoelectric prosthesis using nonintuitive control signals. The simulation and multidisciplinary evaluation influenced informed treatment choices, with a high percentage of patients continuing to use the myoelectric prostheses post-amputation, highlighting its long-term acceptance and viability. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Lee EY, Pulos N, Bishop AT, Spinner RJ, Shin AY. The failed adult traumatic brachial plexus reconstruction. J Hand Surg Eur Vol 2024:17531934241231170. [PMID: 38373612 DOI: 10.1177/17531934241231170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Traumatic adult brachial plexus injuries typically cause immediate loss of upper limb function. Timely multidisciplinary treatment in specialized centres often results in a useful helper arm. Both the patient and the surgical team can benefit from an open discussion to set realistic expectations. Surgical reconstruction is customized for each patient, considering their injury factors and functional objectives. Optimizing pain control, adherence to procedure indications and using meticulous surgical techniques help minimize the risk of failing to meet the patient's goals. The need for potential alternative treatment(s) if the desired result is not achieved should be detailed before the initial reconstruction. This review discusses late treatment options, including tendon transfers, joint fusions, free functioning muscle transfers and prosthetics, for managing the failed primary reconstruction of the traumatic adult brachial plexus.
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Lee EY, Shin AY. Osteolysis After Augmented Scapholunate Ligament Reconstruction: A Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202312000-00039. [PMID: 38048407 DOI: 10.2106/jbjs.cc.23.00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
CASE Augmented scapholunate ligament reconstruction using polyether ether ketone anchors and ultra-high molecular weight polyethylene synthetic tape has the theoretical advantage of improved stability, avoidance of K-wire fixation, and the potential for earlier mobilization. We present 3 cases of scaphoid and lunate osteolysis/fragmentation, operative and histologic findings at reoperation, and the sequelae of this technique. CONCLUSION If planning to use suture anchors and synthetic tapes in small carpal bones, we recommend advising patients about the risk of osteolysis and monitoring closely patients who complain of pain with motion after surgery.
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Lee EY, Spinner RJ, Mortazavi MM, Angius D, Adeeb N, Bishop AT, Shin AY. Stem cell therapy for traumatic brachial plexus injury. Acta Neurochir (Wien) 2023; 165:2011-2014. [PMID: 37389748 DOI: 10.1007/s00701-023-05675-7] [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: 03/22/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
Stem cell therapy is rapidly evolving, with preclinical studies showing various stem cell types successfully promoting peripheral nerve regeneration. Despite the lack of clinical studies demonstrating efficacy and safety, the number of commercial entities marketing and promoting this treatment direct to patients is also increasing. We describe three adult traumatic brachial plexus injury (BPI) patients who had stem cell therapies prior to consultation in a multidisciplinary brachial plexus clinic. No functional improvement was noted at long-term follow-up despite claims reported by the commercial entities. Considerations and implications of stem cell application in BPI patients are reviewed.
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Coca KP, Lee EY, Chien LY, Souza ACP, Kittikul P, Hong SA, Chang YS. Postnatal women's breastfeeding beliefs, practices, and support during the COVID-19 pandemic: a cross-sectional comparative study across five countries. Int Breastfeed J 2022; 17:58. [PMID: 35978362 PMCID: PMC9385077 DOI: 10.1186/s13006-022-00497-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Women with COVID-19 experienced numerous concerns and doubts about the safety of breastfeeding their babies, and lack of support may have impacted breastfeeding practices. This study aims to compare breastfeeding beliefs, practices, and contact with healthcare professionals regarding the level of postnatal feeding support provided during the COVID-19 pandemic in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom. Methods A multi-country cross-sectional study was conducted with postnatal women in five countries. Women up to six months postpartum were invited to complete an online survey concerning the transmission of preventative measures, beliefs toward breastfeeding, infant feeding practices in the last 24 hours and experiences of postnatal infant feeding support between July to November 2021. Bivariate and multivariate analyses were performed to identify the association. Results Of the 3,253 eligible responses received, 39.5% of children were aged between one and two months, but in Taiwan (36%) and South Korea (42.8%) they were between three and four months. The mean of the belief score was significantly different among countries (p < 0.0001). Women in Brazil and the UK had a higher rate of breastfeeding at the breast (90.7% and 85.4%, respectively) compared to the three Asian countries (p < 0.0001) while feeding with expressed breastmilk in Thailand (59.9%), Taiwan (52.6%), and South Korea (50.4%) was higher than the others (p < 0.0001). Brazil and UK mothers (mean = 16.0 and 14.5 respectively) had a higher mean score for belief toward breastfeeding during the COVID-19 than the others. These results are inversely associated with breastfeeding but positively related to formula feeding practice. Postnatal feeding support during the COVID-19 pandemic was mainly provided by healthcare professionals (67.1%) and peers / family through face-to-face personal contact (51.6%) in all countries. Conclusion Some differences were found in breastfeeding beliefs during the COVID-19 pandemic in Asian countries. A positive breastfeeding belief was associated with the practice of breastfeeding at the breast. Women from all countries received postpartum infant feeding support from health professionals and peers / family through personal contacts. Governments need to emphasize and disseminate the importance of breastfeeding safety, especially in Asian countries.
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Leow ME, Lim AY, Lee EY, Chong AK. Prosthetic fitting in a double-digit amputation with concomitant postoperative shortening and contracture of the adjacent digits: optimizing aesthetic and functional outcomes. Prosthet Orthot Int 2022; 46:294-298. [PMID: 34932509 DOI: 10.1097/pxr.0000000000000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
This report discusses the considerations behind the special modifications made on the finger prostheses fitted for a patient with crushed index, middle, ring, and little fingers resulting in a double-digit amputation with significant postoperative scarring, discoloration, shortening, and contracture of the salvaged index and middle fingers. The deformity and discoloration of the salvaged fingers were factored into the approach taken in the planning, fabrication, and fitting of prosthesis for the amputated digits. Length reduction with increased flexion planned into the prostheses, in addition to color matching them in two different shades, contributed to good aesthetic and functional outcomes.
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Jo S, Lee JS, Nam B, Lee YL, Kim H, Lee EY, Park YS, Kim TH. SOX9 + enthesis cells are associated with spinal ankylosis in ankylosing spondylitis. Osteoarthritis Cartilage 2022; 30:280-290. [PMID: 34826571 DOI: 10.1016/j.joca.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing spondylitis (AS), no evident mechanisms are known. DESIGN To identify histopathological and physiological changes in enthesitis-related ankylosis in AS, we performed molecular characterization of transcription factors and surface markers, and transcriptome analysis with human tissues. Entheseal tissue containing subchondral bone was obtained from the facet joints of 9 patients with AS and 10 disease controls, and assessed by using differential staining techniques. Enthesis cells were isolated, characterized, stimulated with TNF and/or IL-17A, and analysed by cell-based experimental tools. RESULTS We found diffusely distributed granular tissue and cartilage in the subchondral bone in AS. Co-expression of SOX9, a specific transcription factor in cartilage, and matrix metalloproteinase 13 (MMP13) was found in the granular tissues within the subchondral bone from AS patients. Intriguingly, SOX9 expression was significantly higher in AS enthesis cells than controls and correlated with TNFR1 and IL-17RA expressions, which is important for high reactivity to TNF and IL-17A cytokines. Co-stimulation by TNF and IL-17A resulted in accelerated mineralization/calcification features, and increased OCN expression in AS enthesis cells. Furthermore, SOX9 overexpression in enthesis leads to promoting mineralization feature by TNF and IL-17A stimuli. Finally, OCN expression is elevated in the destructive enthesis of advanced AS. CONCLUSION These findings provide insight into the links between inflammation and the mineralization of entheseal tissue as the initiation of spinal ankylosis, emphasizing the importance of SOX9+ enthesis cells.
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Cheah A, Lee EY, Lim AYT. Upper Extremity Axon Counts and Clinical Implications for Motor Nerve Transfer. Plast Reconstr Surg 2019; 144:1044e-1050e. [PMID: 31764654 DOI: 10.1097/prs.0000000000006200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nerve transfers are planned based on the following parameters: location, number of branches, and axon count matching of the donor and recipient nerves. The authors have previously defined the former two in upper limb muscles. In the literature, axon counts are obtained from various sources, using different methods of histomorphometry. This study describes the axon counts of the same primary motor nerve branches from the authors' previous study using a uniform method of manual histomorphometry and completes the authors' blueprint of upper limb neuromuscular anatomy for reconstructive surgery. METHODS The distal ends of the primary nerve branches of 23 upper limb muscles were harvested from 10 fresh frozen cadaveric upper limbs. Manual quantitative histomorphometry was performed by two independent investigators, and the average was reported. RESULTS The primary nerve branches of the arm muscles had higher average axon counts (range, 882 to 1835) compared with those of the forearm muscles (range, 267 to 883). In the forearm, wrist flexor (range, 659 to 746) and extensor (range, 543 to 745) nerve branches had axons counts that were similar to those of potential donors (e.g., supinator, n = 602; pronator teres, n = 625; flexor digitorum superficialis, n = 883; and flexor digitorum profundus, n = 832). CONCLUSIONS Apart from describing the axon counts of the upper limb, the authors have found that the forearm axon counts are very comparable. This insight, when combined with information on the location and number of primary nerve branches, will empower surgeons to tailor bespoke nerve transfers for every clinical situation.
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Estrella EP, Lee EY. Risk Factors for Hand Wound Infections in People with Diabetes: A Case-control Study. Wound Manag Prev 2019; 65:38-43. [PMID: 31373566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED Hand infection has been associated with increased morbidity in people with diabetes mellitus. PURPOSE This study was conducted to determine risk factors for hand wound infection in patients with diabetes mellitus. METHODS A 1:3 matched prospective case-control study was conducted from December 2006 to December 2016. All study patients were consecutively identified through the inpatient records upon admission to the University of the Philippines Manila, Philippine General Hospital (Manila, Philippines), for a hand wound infection necessitating surgical treatment and were followed until hospital discharge, wound healing, or death. Adults (≥18 years old) with diabetes mellitus for at least 6 months and with (study group) or without (control group) a hand wound infection were eligible to participate. Persons with a history of amputation or who were in a chronic debilitated state were excluded. Infection was defined as the presence of inflammation and purulent discharge. Eligible control patients were consecutively recruited from the outpatient clinics and were matched to the study patients by age (± 5 years) and gender. Demographic (eg, age, gender, education, occupation, tobacco use) and clinical data (body mass index [BMI], duration of diabetes, HbA1c levels, wound location and duration, delay in treatment, neuropathy, surgical procedures, length of hospital stay, and presence of arteriovenous [AV] fistula) were collected from patient records and entered into Excel spreadsheets for analysis. Regression analysis was performed and reported as odds ratio (OR) with 95% confidence intervals (CI). Level of significance was set P <.05. RESULTS Participants included 30 study and 90 control patients. No significant differences between study and control patients were noted in terms of BMI, duration of diabetes, presence of peripheral neuropathy, occupation, or education. Significantly more study patients had elevated HbA1c (86 vs. 30; P = .0001), used tobacco (17 vs. 8; P = .0001), and had an AV fistula (3 vs. 0; P = .015). After multivariate analysis, HbA1c ≥48 mmoL/moL (OR = 18.8; 95% CI: 2.3-153.8; P = .006) and tobacco use (OR = 10.7; 95% CI: 3.5-32.7; P = .0001) were identified as independent risk factors for hand/upper extremity infection. CONCLUSION Patients with diabetes who smoked or exhibited elevated HbA1c levels were at higher risk of having a hand infection. Further research and efforts to help people with diabetes stop smoking and maintain good glycemic control may help decrease the burden of hand infection.
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Go DJ, Lee JY, Kang MJ, Lee EY, Lee EB, Yi EC, Song YW. Urinary vitamin D-binding protein, a novel biomarker for lupus nephritis, predicts the development of proteinuric flare. Lupus 2018; 27:1600-1615. [PMID: 29958502 DOI: 10.1177/0961203318778774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Conventional biomarkers for assessing renal disease activity are imperfect in predicting clinical outcomes associated with LN. The aim of this study is to identify urinary protein biomarkers that reliably reflect the disease activity or predict clinical outcomes. A quantitative proteomic analysis was performed to identify protein biomarker candidates that can differentiate between SLE patients with and without LN. Selected biomarker candidates were further verified by enzyme-linked immunosorbent assay using urine samples from a larger cohort of SLE patients ( n = 121) to investigate their predictive values for LN activity measure. Furthermore, the association between urinary levels of a selected panel of potential biomarkers and prognosis of LN was assessed with a four-year follow-up study of renal outcomes. Urinary vitamin D-binding protein (VDBP), transthyretin (TTR), retinol binding protein 4 (RBP4), and prostaglandin D synthase (PTGDS) were significantly elevated in SLE patients with LN, especially in patients with active LN ( n = 21). Among them, VDBP well correlated with severity of proteinuria (rho = 0.661, p < 0.001) and renal SLE Disease Activity Index (renal SLEDAI) (rho = 0.520, p < 0.001). In the four-year follow-up, VDBP was a significant risk factor (hazard ratio 9.627, 95% confidence interval 1.698 to 54.571, p = 0.011) for the development of proteinuric flare in SLE patients without proteinuria ( n = 100) after adjustments for multiple confounders. Urinary VDBP correlated with proteinuria and renal SLEDAI, and predicted the development of proteinuria.
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Lee EY, Glassman SJ. Morphoea after using a cardiac loop monitor. Clin Exp Dermatol 2017; 42:820-822. [PMID: 28866867 DOI: 10.1111/ced.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/27/2022]
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Yang Y, Kang B, Lee EY, Yang HK, Kim HS, Lim SY, Lee JH, Lee SS, Suh BK, Yoon KH. Effect of an obesity prevention program focused on motivating environments in childhood: a school-based prospective study. Int J Obes (Lond) 2017; 41:1027-1034. [PMID: 28216643 DOI: 10.1038/ijo.2017.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES There has been an increasing global recognition of the need for effective strategies to prevent and control childhood obesity. In this study, we aimed to identify the effectiveness of an obesity prevention program focused on motivating environments in school. SUBJECTS/METHODS In this school-based, prospective, quasi-experimental study, we enrolled three elementary (fourth graders) and two middle (seventh graders) schools located in Chungju, Korea. We assigned three of the schools to the intervention group and two schools to the control group. The intervention group received 1 year of environmental intervention. Diet- and exercise-related educational video content was provided by internet protocol television services during rest time, and various design materials were painted along the school staircase and hallway to encourage physical activities. Overweight and obese students were recommended to join the summer vacation obesity care program. RESULTS The final number of total participants was 768 (control 350 and intervention 418). After 1 year of follow-up, there was no significant difference in the overweight/obesity incidence rates and remission rates between the two groups. However, the intervention group showed a greater decrease in the body mass index (BMI) z-score (-0.11 (95% confidence interval (CI) -0.16 to -0.06), P<0.001), increase in height (1.1 cm (95% CI 0.8 to 1.4), P<0.001), reduction of body fat, and increase in muscle mass compared with the control group. In addition, blood pressure (BP) was significantly reduced, and significant improvement in physical fitness followed. In subgroup analysis, students of normal weight, boys and younger participants showed the most beneficial results in weight-related outcomes. In addition, the BP reduction was more pronounced in the higher BMI group, boys and older children. CONCLUSIONS A simple environmental intervention could effectively influence children. By adding to previously studied strategies, we can develop a more effective obesity prevention program for children.
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Jung SA, Lee DH, Moon JH, Hong SW, Shin JS, Hwang IY, Shin YJ, Kim JH, Gong EY, Kim SM, Lee EY, Lee S, Kim JE, Kim KP, Hong YS, Lee JS, Jin DH, Kim T, Lee WJ. Corrigendum to 'L-Ascorbic acid can abrogate SVCT-2-dependent cetuximab resistance mediated by mutant KRAS in human colon cancer cells': [Free Radic. Biol. Med. 95 (2016) 200-208]. Free Radic Biol Med 2016; 97:620. [PMID: 27476024 DOI: 10.1016/j.freeradbiomed.2016.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim JE, Shin JS, Moon JH, Hong SW, Jung DJ, Kim JH, Hwang IY, Shin YJ, Gong EY, Lee DH, Kim SM, Lee EY, Kim YS, Kim D, Hur D, Kim TW, Kim KP, Jin DH, Lee WJ. Foxp3 is a key downstream regulator of p53-mediated cellular senescence. Oncogene 2016; 36:219-230. [DOI: 10.1038/onc.2016.193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 11/09/2022]
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Choi YY, Min J, Lee DS, Min H, Lee EY, Lim G, Kim Y, Kang H, Song I, Cho YJ, Lee YJ. Incidence of Cardiopulmonary Arrests After Implementation of a Rapid Response System During Operation Time Vs Non-Operation Time. Intensive Care Med Exp 2015. [PMCID: PMC4798082 DOI: 10.1186/2197-425x-3-s1-a527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Xu S, Nam SM, Kim JH, Das R, Choi SK, Nguyen TT, Quan X, Choi SJ, Chung CH, Lee EY, Lee IK, Wiederkehr A, Wollheim CB, Cha SK, Park KS. Palmitate induces ER calcium depletion and apoptosis in mouse podocytes subsequent to mitochondrial oxidative stress. Cell Death Dis 2015; 6:e1976. [PMID: 26583319 PMCID: PMC4670935 DOI: 10.1038/cddis.2015.331] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 12/14/2022]
Abstract
Pathologic alterations in podocytes lead to failure of an essential component of the glomerular filtration barrier and proteinuria in chronic kidney diseases. Elevated levels of saturated free fatty acid (FFA) are harmful to various tissues, implemented in the progression of diabetes and its complications such as proteinuria in diabetic nephropathy. Here, we investigated the molecular mechanism of palmitate cytotoxicity in cultured mouse podocytes. Incubation with palmitate dose-dependently increased cytosolic and mitochondrial reactive oxygen species, depolarized the mitochondrial membrane potential, impaired ATP synthesis and elicited apoptotic cell death. Palmitate not only evoked mitochondrial fragmentation but also caused marked dilation of the endoplasmic reticulum (ER). Consistently, palmitate upregulated ER stress proteins, oligomerized stromal interaction molecule 1 (STIM1) in the subplasmalemmal ER membrane, abolished the cyclopiazonic acid-induced cytosolic Ca2+ increase due to depletion of luminal ER Ca2+. Palmitate-induced ER Ca2+ depletion and cytotoxicity were blocked by a selective inhibitor of the fatty-acid transporter FAT/CD36. Loss of the ER Ca2+ pool induced by palmitate was reverted by the phospholipase C (PLC) inhibitor edelfosine. Palmitate-dependent activation of PLC was further demonstrated by following cytosolic translocation of the pleckstrin homology domain of PLC in palmitate-treated podocytes. An inhibitor of diacylglycerol (DAG) kinase, which elevates cytosolic DAG, strongly promoted ER Ca2+ depletion by low-dose palmitate. GF109203X, a PKC inhibitor, partially prevented palmitate-induced ER Ca2+ loss. Remarkably, the mitochondrial antioxidant mitoTEMPO inhibited palmitate-induced PLC activation, ER Ca2+ depletion and cytotoxicity. Palmitate elicited cytoskeletal changes in podocytes and increased albumin permeability, which was also blocked by mitoTEMPO. These data suggest that oxidative stress caused by saturated FFA leads to mitochondrial dysfunction and ER Ca2+ depletion through FAT/CD36 and PLC signaling, possibly contributing to podocyte injury.
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Lee EY, Choi EJ, Kim JA, Hwang YL, Kim CD, Lee MH, Roh SS, Kim YH, Han I, Kang S. Malva verticillata seed extracts upregulate the Wnt pathway in human dermal papilla cells. Int J Cosmet Sci 2015; 38:148-54. [PMID: 26249736 DOI: 10.1111/ics.12268] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Mesenchymal-epithelial interactions are important in controlling hair growth and the hair cycle. The β-catenin pathway of dermal papilla cells (DPCs) plays a pivotal role in morphogenesis and normal regeneration of hair follicles. Deletion of β-catenin in the dermal papilla reduces proliferation of the hair follicle progenitor cells that generate the hair shaft and induces an early onset of the catagen phase. In this study, a modulator of the Wnt/β-catenin activity was studied in oriental herb extracts on cultured human DPCs. METHODS The effect of Malva verticillata (M. verticillata) seeds on human DPCs was investigated by a Wnt/β-catenin reporter activity assay system (β-catenin-TCF/LEF reporter gene) and cell proliferation analysis. The synthesis of the factors related to hair growth and cycling was measured at both the mRNA and the protein level by semi-quantitative PCR and Western blot analysis, respectively. RESULTS An extract from M. verticillata seeds increased Wnt reporter activity in a concentration-dependent manner and also led to increased β-catenin levels in cultured human DPCs. Myristoleic acid, identified as an effective compound of M. verticillata seeds, stimulated the proliferation of DPCs in a dose-dependent manner and increased transcription levels of the downstream targets: IGF-1, KGF, VEGF and HGF. Myristoleic acid also enhanced the phosphorylation of MAPKs (Akt and p38). CONCLUSION Overall, the data suggest that this extract of M. verticillata seeds could be a good candidate for treating hair loss by modulating the Wnt/β-catenin pathway in DPCs.
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Lee EY, Karjalainen TV, Sebastin SJ, Lim AYT. The value of the tender muscle sign in detecting motor recovery after peripheral nerve reconstruction. J Hand Surg Am 2015; 40:433-7. [PMID: 25708431 DOI: 10.1016/j.jhsa.2014.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Squeezing a denervated muscle a few weeks after nerve repair produces a characteristic response in patients. This response is observed before any clinical evidence of motor recovery. We called this response the tender muscle sign (TMS) and wanted to determine whether this sign was related to the recovery of motor power. METHODS We studied 31 adults with unilateral brachial plexus injuries who underwent 50 procedures for reinnervation of the supraspinatus, deltoid, and biceps. Follow-up was monthly for the first year and at 3-monthly intervals thereafter. Average duration of follow-up was 3.3 years. The TMS was sought at each visit. The presence of the TMS, when it was first observed, and time to Medical Research Council (MRC) grade 1 and 3 recoveries were recorded. The sensitivity, specificity, and predictive values of TMS for motor recovery were calculated. RESULTS The TMS was always detected earlier than palpable muscle contraction. It was significantly associated with recovery of MRC grade 1 and 3 motor power. The sensitivity of TMS for MRC grade 1 recovery was 96% and specificity was 100%. For MRC grade 3 recovery, it had 97% sensitivity and 27% specificity. The positive predictive value was 100% for MRC grade 1 recovery and 83% for MRC grade 3. The negative predictive value was 50% for MRC grade 1 recovery and 75% for MRC grade 3. CONCLUSIONS Previous studies have demonstrated the presence of nocioceptive receptors in human skeletal muscle. The reinnervation of these receptors by the regenerating axons results in cramp-like tenderness when the muscle is squeezed. This response is specific to a reinnervated muscle and cannot be elicited in denervated or normally innervated muscle. The TMS is a simple, clear, and early indicator of muscle reinnervation that is useful in monitoring motor recovery after nerve regeneration. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Park JK, Park EA, Lee W, Kim YK, Lee EY, Song YW, Lee EB. Baseline MRA predicts the treatment response to vasodilator udenafil in patients with secondary Raynaud's phenomenon. Clin Exp Rheumatol 2014; 32:S-167-70. [PMID: 25189168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES High-resolution MR angiography (HR-MRA) demonstrates blood flow in the digital arteries, which correlates with the severity of Raynaud's phenomenon (RP). This study investigates whether baseline HR-MRA of the hand can predict the treatment response to udenafil, a new PDE5-inhibitor, in patients with secondary RP. METHODS Baseline MRA and Doppler ultrasound were obtained in 12 patients with secondary RP. The patients were treated with udenafil 100 mg/day for 4 weeks and changes in blood flow were measured. Blood flow on MRA was scored on a 4-point scale: 0, no visible flow; 1, visible flow to the proximal phalanx; 2, to the middle phalanx; and 3, to the distal phalanx. Peak systolic velocity (PSV) was measured to determine blood flow. Paired t-test and ANOVA were used to determine the treatment response of the different MRA scores. RESULTS On baseline MRA, 53.3% of digital arteries had an MRA score of 0, 25.8% MRA score of 1, 9.2% MRA score of 2, and 11.6% MRA score of 3. Overall, 4-week udenafil treatment improved digital flow (p<0.05) in all MRA scores. Digital arteries with MRA score 2 showed the best response with improvement in PSV by 14.5 mm/sec (p<0.01), whereas improvement in arteries of MRA scores 1 and 3 were not better than an MRA score of 0 (all, p>0.05). CONCLUSIONS Digital arteries with moderate blood flow observed on MRA respond best to treatment with udenalfil. Therefore, baseline MRA may help predict treatment response in patients with secondary RP.
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Lee SH, Lee EY, Kim HJ. Gastrointestinal Risk Factors and Treatment Pattenrs of Rheumatoid Arthritis Versus Osteoarthritis Patients in Korea. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A390. [PMID: 27200895 DOI: 10.1016/j.jval.2014.08.2667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Gill H, Au WY, Cheung WW, Lee EY, Kwong YL. Oral arsenic trioxide-based regimen as salvage treatment for relapsed or refractory mantle cell lymphoma. Ann Oncol 2014; 25:1391-1397. [PMID: 24728036 DOI: 10.1093/annonc/mdu142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is aggressive, and relapsed/refractory disease has poor outcomes. PATIENTS AND METHODS Thirty-nine patients (men = 34, women = 5) at 64 (41-82) years of age with relapsed/refractory MCL, ineligible for high-dose chemotherapy and had received 2 (1-5) prior regimens, were treated with a continuous oral regimen, comprising oral arsenic trioxide (oral-As2O3), chlorambucil and ascorbic acid. RESULTS Overall response rate was 49% (complete response, CR = 28%; partial response, PR = 21%). Only grade 1/2 toxicities were observed (hematologic: 56%, hepatic: 8%). Response was maintained in 11 patients (CR = 8; PR = 3), after a median of 24 (2-108) months. Independent prognostic factors for response were increased lactate dehydrogenase (P = 0.04) and unfavorable MCL international prognostic index (P = 0.04). At a median follow-up of 21 (1-118) months, the median progression-free survival (PFS) was 16 months, and overall survival (OS) 38 months. Independent prognostic factors for PFS were female gender (P = 0.002), and Eastern Cooperative Oncology Group (ECOG) performance score of 2 (P = 0.009). Independent prognostic factors for OS were female gender (P < 0.001), ECOG performance score of 2 (P = 0.03), non-response (P < 0.001), and disease progression after initial response (P = 0.05). CONCLUSION An oral regimen of oral-As2O3, chlorambucil and ascorbic acid was active with minimal toxicity in relapsed/refractory MCL, achieving durable responses in ∼30% of cases.
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Cho JH, Chang SH, Shin NH, Choi BY, Oh HJ, Yoon MJ, Lee EY, Lee EB, Lee TJ, Song YW. Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea. Lupus 2014; 23:949-57. [PMID: 24563501 DOI: 10.1177/0961203314524849] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea. METHOD Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression. RESULTS The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.
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Nguyen V, Lee EY, Couldwell D, Packham D. Education and Imaging: gastrointestinal: outbreak; proctocolitis mimicking inflammatory bowel disease. J Gastroenterol Hepatol 2012; 27:1760. [PMID: 23106370 DOI: 10.1111/j.1440-1746.2012.07253.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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