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Yoo WH, Ha GW, Kim KM, Choi Y. When treatment takes a turn: tocilizumab-induced bowel perforation in a patient with COVID-19-afflicted rheumatoid arthritis. Scand J Rheumatol 2024; 53:155-157. [PMID: 38198126 DOI: 10.1080/03009742.2023.2294580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
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Yoo DH, Sohn CH, Kang HS, Cho YD, Kim KM. Arterial Spin-Labeling MR Imaging for the Differential Diagnosis of Venous-Predominant AVMs and Developmental Venous Anomalies. AJNR Am J Neuroradiol 2023; 44:916-921. [PMID: 37385682 PMCID: PMC10411836 DOI: 10.3174/ajnr.a7922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Venous-predominant AVMs are almost identical in appearance to developmental venous anomalies on conventional MR imaging. Herein, we compared and analyzed arterial spin-labeling findings in patients with developmental venous anomalies or venous-predominant AVMs, using DSA as the criterion standard. MATERIALS AND METHODS We retrospectively collected patients with either DVAs or venous-predominant AVMs, each available on both DSA and arterial spin-labeling images. Arterial spin-labeling imaging was visually assessed for the presence of hyperintense signal. CBF measured at the most representative section was normalized to the contralateral gray matter. The temporal phase of developmental venous anomalies or venous-predominant AVMs was measured on DSA as a delay between the first appearance of the intracranial artery and the lesion. Correlation between the normalized CBF and the temporal phase was evaluated. RESULTS Analysis of 15 lesions (13 patients) resulted in categorization into 3 groups: typical venous-predominant AVMs (temporal phase, <2 seconds), intermediate group (temporal phase between 2.5 and 5 seconds), and classic developmental venous anomalies (temporal phase, >10 seconds). Arterial spin-labeling signal was markedly increased in the typical venous-predominant AVM group, while there was no discernible signal in the classic developmental venous anomaly group. In the intermediate group, however, 3 of 6 lesions showed mildly increased arterial spin-labeling signal. The normalized CBF on arterial spin-labeling and the temporal phase on DSA were moderately negatively correlated: r(13) = 0.66, P = .008. CONCLUSIONS Arterial spin-labeling may predict the presence and amount of arteriovenous shunting in venous-predominant AVMs, and using arterial spin-labeling enables confirmation of typical venous-predominant AVMs without DSA. However, lesions with an intermediate amount of shunting suggest a spectrum of vascular malformations ranging from purely vein-draining developmental venous anomalies to venous-predominant AVMs with overt arteriovenous shunting.
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Lee MO, Jeong KU, Kim KM, Song YG. Risk Factors Affecting Complications of Access Site in Vascular Intervention through Common Femoral Artery. Niger J Clin Pract 2022; 25:85-89. [PMID: 35046200 DOI: 10.4103/njcp.njcp_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Backgrounds Traditionally, vascular interventions have been performed through the femoral artery. Aims The purpose of this study was to evaluate risk factors affecting access-site complications in patients with hepatocellular carcinoma or peripheral arterial disease in lower extremity who underwent vascular intervention by accessing the common femoral artery (CFA). Patients and Methods From December 2015 to November 2018, 287 patients underwent transarterial chemoembolization (TACE) or peripheral vascular intervention with ultrasound (US)-guided CFA access. Standard 18-gauge (G) access was used in 127 patients and Micropuncture® 21-G needles in 160 patients. Most access sites were managed with vascular closure devices and several were managed with manual compression. Within 24 hours after the procedure, all patients underwent US to evaluate the puncture site. Results Access-site complications occurred in 55 of 287 patients: 34 hematomas (11.9%), 20 pseudoaneurysms (7.0%), and 1 dissection (0.4%). In the crude model, risk factors related to access-site complications were the usage of 18-G needles (OR, 2.18; 95% CI, 1.17-4.07; P = 0.014), smoking (OR, 2.23; 95% CI, 1.16-4.27; P = 0.016), and approach route (OR, 3.23; 95% CI, 1.33-7.82; P = 0.009). Needle size (OR, 2.13; 95% CI, 1.10-4.12; P = 0.025) was the only factor associated with access-site complications in the adjusted model. Conclusion Needle profile was the only factor associated with access-site complications in this study. Therefore, a needle with a smaller profile than an 18-G needle will reduce the incidence of complications at the access site.
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Kwan BS, Shim SG, Cho DH, Kim KM, Choi IS, Lee DG. Immune response to hepatitis B vaccination and factors associated with poor immune response among healthcare workers. Niger J Clin Pract 2021; 24:795-801. [PMID: 34121724 DOI: 10.4103/njcp.njcp_187_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Hepatitis B virus (HBV) infection is a major global health problem, and healthcare workers (HCWs) are at high risk for HBV infection. Current guidelines strongly recommend immunization and screening for high-risk groups. Aims We evaluated immunization and screening for HBV vaccination, assessed post-vaccination immune status of HCW's and characterized potential risk factors associated with poor immune response. Materials and Methods From January 2010 to December 2018, we retrospectively analyzed comprehensive health checkup data for a total of 303 HCWs who received an HBV vaccination. After vaccination, HBV surface antibody (anti-HBs) titers were collected and the distribution of immune response types was determined. Risk factors for poor immune responses were identified using logistic regression. Results A total of 213 HCWs were analyzed after exclusion based on the exclusion criteria. In total, 28 (13.2%) HCWs had anti-HBs titers <100 mIU/mL (hyporesponsive/nonresponsive groups), and 185 (86.8%) had anti-HBs titers ≥100 mIU/mL (hyperresponsive group). Follow-up observations found that 75% (21/28) of the hyporesponsive/nonresponsive groups did not have increased anti-HBs titers or did not maintain an increased response. A multivariate analysis showed that HBV antibody titers at the time of employment were a significant risk factor (OR, 6.12; CI, 1.34-27.93; P = 0.019). Conclusions More attention should be paid to groups that are hyporesponsive/nonresponsive after vaccination and to those with low anti-HBs titers at the beginning of employment. HCWs can be further protected from HBV if their results are discussed at postvaccination follow-ups.
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Lee HW, Kim KM. Clinical significance of heat shock protein 90α expression as a biomarker of prognosis in patients with gastric cancer. Niger J Clin Pract 2020; 22:1698-1705. [PMID: 31793477 DOI: 10.4103/njcp.njcp_68_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Heat shock protein 90 (HSP90) possesses two major isoforms - HSP90α and HSP90β. They have essential roles in the protection against stressful conditions. They are also important for the re-establishment of cellular homeostasis. We investigated the clinical significance of HSP90α and HSP90β expression in patients with gastric cancer (GC). Methods HSP90α and HSP90β expression levels were examined immunohistochemically in surgical specimens obtained from 186 GC patients. The correlations between their expression levels and clinicopathological parameters including patient survival were analyzed. Results The frequencies of larger tumor size (maximum diameter ≥4 cm) and more prominent tumor invasion (≥pT3) in the high intensity HSP90α expression group were 73.4% and 68.8% higher, respectively, than those in the low intensity group (both P = 0.001). High HSP90α expression level was also significantly associated with lymphatic invasion, lymph node metastasis, and advanced stage (TNM stage ≥III) disease (P = 0.047, P = 0.046, and P = 0.004, respectively). Patients with high HSP90α expression levels demonstrated significantly worse survival than those with low HSP90α expression levels (P = 0.047). In contrast, survival did not differ significantly according to the intensity of HSP90β expression. Conclusions Our results showed that HSP90α overexpression might be associated with disease progression and poorer survival in patients with GC. Therefore, HSP90α could be used as possible biomarker for the prognosis of GC.
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Ki S, Kim KM, Lee YH, Bang JY, Choi BM, Noh GJ. Phase lag entropy as a hypnotic depth indicator during propofol sedation. Anaesthesia 2019; 74:1033-1040. [PMID: 31106853 DOI: 10.1111/anae.14704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
Phase lag entropy, an electro-encephalography-based hypnotic depth indicator, calculates diversity in temporal patterns of phase relationship. We compared the performance of phase lag entropy with the bispectral index™ in 30 patients scheduled for elective surgery. We initiated a target-controlled infusion of propofol using the Schnider model, and assessed sedation levels using the Modified Observer's Assessment of Alertness/Sedation scale every 30 s with each stepwise increase in the effect-site propofol concentration. Phase lag entropy and bispectral index values were recorded. The correlation coefficient and prediction probability between phase lag entropy or bispectral index and the sedation level or effect-site propofol concentration were analysed. We calculated baseline variabilities of phase lag entropy and bispectral index. In addition, we applied a non-linear mixed-effects model to obtain the pharmacodynamic relationships among the effect-site propofol concentration, phase lag entropy or bispectral index and sedation level. As sedation increased, phase lag entropy and bispectral index both decreased. The prediction probability values of phase lag entropy and bispectral index for sedation levels were 0.697 and 0.700 (p = 0.261) and for the effect-site concentration of propofol were 0.646 and 0.630 (p = 0.091), respectively. Baseline variability in phase lag entropy and bispectral index was 3.3 and 5.7, respectively. The predicted propofol concentrations, using the Schnider pharmacokinetic model, producing a 50% probability of moderate and deep sedation were 1.96 and 3.01 μg.ml-1 , respectively. Phase lag entropy was found to be useful as a hypnotic depth indicator in patients receiving propofol sedation.
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Soh JE, Kim KM, Kwon JW, Kim HY, Seo JH, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ, Shim JY. Recurrent wheeze and its relationship with lung function and airway inflammation in preschool children: a cross-sectional study in South Korea. BMJ Open 2017; 7:e018010. [PMID: 28993393 PMCID: PMC5640071 DOI: 10.1136/bmjopen-2017-018010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Relationship between recurrent wheeze and airway function and inflammation in preschool children is not fully known. OBJECTIVE To investigate the relationship between recurrent wheeze and airway inflammation, lung function, airway hyper-reactivity (AHR) and atopy in preschool children. DESIGN Observational study, comparing forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-forced expiratory flow (FEF25%-75%), dose-response slope (DRS), exhaled nitric oxide (eNO) and atopic sensitisation between children with recurrent wheeze and those without. SETTING Population-based, cross-sectional study in Seoul and the Gyeonggi province of Korea conducted as a government-funded programme to perform standardised measurement of the prevalence of allergic diseases, and related factors, in preschool children. PARTICIPANTS 900 children aged 4-6 years. PRIMARY AND SECONDARY OUTCOME MEASURES: eNO, FEV1/FVC, FEF25%-75%, DRS, atopic sensitisation and allergic diseases. METHODS Children completed the modified International Study of Asthma and Allergies in Childhood questionnaire and underwent eNO assessments, spirometry, methacholine bronchial provocation tests and skin prick tests. Recurrent wheeze was defined as having a lifetime wheeze of more than three episodes, based on the questionnaire. The frequency of hospitalisation and emergency room visits was also obtained by means of the questionnaire. 'Current' wheeze was defined as having symptoms or treatments within the past 12 months. RESULTS The prevalence of recurrent wheeze was 13.4%. Children with recurrent wheeze showed a higher prevalence of lifetime or current allergic rhinitis (p=0.01 and p=0.002, respectively) and lifetime atopic dermatitis (p=0.007). Children with recurrent wheeze showed lower FEV1/FVC (p=0.033) and FEF25%-75% (p=0.004), and higher eNO levels (p=0.013) than those without recurrent wheeze. However, the DRS, prevalence of atopic sensitisation and serum IgE levels were not significantly different between the two groups. CONCLUSIONS Recurrent wheeze in preschool children may be associated with airway inflammation and diminished airway function, but not with AHR or atopy.
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Kim KM, Han OJ, Kang MS, Huh JY. HLA-A*02:687, a novel allele identified by sequence-based typing in cord blood from a Korean woman. HLA 2017; 90:246-247. [PMID: 28686327 DOI: 10.1111/tan.13088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/29/2022]
Abstract
A*02:687 showed one nucleotide difference with A*02:01:01:01 resulting in an amino acid change.
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Park KA, Oh YJ, Kim KM, Eum SY, Cho MH, Son YH, Park SH, Woo KM, Lee YS, Kim S, Chang HS, Park CS. Navigation programs, are they helpful for perioperative care with thyroid cancer patients? Eur J Cancer Care (Engl) 2016; 26. [PMID: 27726224 DOI: 10.1111/ecc.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to develop and evaluate a navigation program for patients with thyroid cancer. The navigation program was developed following an analysis of the unmet needs of patients who underwent surgery for thyroid cancer. Ninety-nine patients in the control group received usual care, and 95 in the navigation group were managed with a navigation program during the perioperative period. The effectiveness of the navigation program was assessed by administering a questionnaire to both groups. Overall satisfaction scores were significantly higher in the navigation than in the control group (p = .025), as were satisfaction scores on the continuity of information (p < .001), the continuity of management (p = .002), the continuity of relationships with healthcare providers (p<.001), and patient empowerment (p < .001). The newly developed navigation program for patients with thyroid cancer was effective in raising satisfaction levels and in actively managing the disease during the perioperative period.
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Lee SH, Gong HS, Kim DH, Shin HS, Kim KM, Kim J, Baek GH. Evaluation of vitamin D levels in women with carpal tunnel syndrome. J Hand Surg Eur Vol 2016; 41:643-7. [PMID: 26701973 DOI: 10.1177/1753193415622732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/23/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0.023) or patients with other upper limb conditions (P = 0.035). When women with carpal tunnel syndrome and healthy control women were pooled, the incidence of carpal tunnel syndrome was higher in vitamin D deficient women than in non-deficient women, especially in those younger than 50 years. This study suggests a potential link between vitamin D status and the occurrence of carpal tunnel syndrome in women younger than 50 years but causation is not established. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic Level III.
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Kim KM, Kim YJ, Choi SH, Lim S, Moon JH, Kim JH, Kim SW, Jang HC, Shin CS. The effects of body mass index on the hereditary influences that determine peak bone mass in mother-daughter pairs (KNHANES V). Osteoporos Int 2016; 27:2057-64. [PMID: 26809191 DOI: 10.1007/s00198-016-3487-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/06/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED A daughter's bone mineral density (BMD) is significantly correlated with her mother's BMD, but the daughter's body mass index (BMI) could modulate this association. Maternal inheritance dominantly affects daughters with a lower BMI, but BMI could compensate for hereditary influences in daughters with a higher BMI in terms of daughter's BMD. INTRODUCTION Achieving optimal peak bone mass at a young age is the best way to protect against future osteoporosis and subsequent fractures. Although environmental components influence bone mass accrual, but peak bone mass is largely programmed by inheritance. The aims of this study were to investigate the influence of maternal inheritance on the daughter's bone mass and to assess whether these influences differ according to the daughter's body mass index (BMI). METHODS We used data obtained from the 2010 Korean National Health and Nutrition Examination Survey V and included 187 mother-daughter pairs. Bone mineral density (BMD) was measured at the lumbar spine (LS), femur neck (FN), and total hip (TH) by using dual-energy X-ray absorptiometry (DXA). The daughter group was stratified into two groups according to the mean BMI (21.4 kg/m(2)). RESULTS The daughters' BMD correlated significantly with both their BMI and their mothers' Z-score for each skeletal site. In the daughters with a lower BMI (≤21.4 kg/m(2)), the BMDs at the FN and TH were affected more by the mothers' Z-score than by the daughters' BMI. Meanwhile, the influence of the daughters' BMI on their BMD was higher than that of their mothers' Z-score in daughters with a higher BMI (>21.4 kg/m(2)). Moreover, the mothers' Z-scores were a significant predictor of their daughters having Z-scores < -1.0 only in daughters with a lower BMI. CONCLUSIONS This study suggests that maternal inheritance is an important determinant of the daughters' bone mass, but that this hereditary factor may vary according to the daughters' BMI.
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Jung KY, Kim KM, Ku EJ, Kim YJ, Lee DH, Choi SH, Jang HC, Shin CS, Park KS, Lim S. Age- and sex-specific association of circulating osteocalcin with dynamic measures of glucose homeostasis. Osteoporos Int 2016; 27:1021-1029. [PMID: 26373983 DOI: 10.1007/s00198-015-3315-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/03/2015] [Indexed: 01/01/2023]
Abstract
SUMMARY Our study showed that serum osteocalcin levels are closely related to glucose metabolism in men of all ages and younger women. This association disappeared in postmenopausal women in which increases bone turnover rates. The association between serum osteocalcin levels and glucose homeostasis should be interpreted according to age and sex. INTRODUCTION Osteocalcin, a marker of bone formation, appears to be associated with glucose homeostasis. We investigated the age- and sex-specific association of serum osteocalcin level with variables related to glucose metabolism. METHODS This study was based on cross-sectional analysis from 719 participants aged 20-85 years after excluding patients taking antidiabetic or antiosteoporotic drugs. The subjects were divided into four groups according to age and sex as follows: men <50 years (n = 131), men ≥50 years (n = 191), women <50 years (n = 108), and women ≥50 years (n = 279). Anthropometric and biochemical variables including insulin resistance (HOMA-IR) and β cell function (HOMA-β) from a 75-g oral glucose tolerance test, and serum 25-OH-vitamin D and parathyroid hormone levels were measured. RESULTS The serum osteocalcin level was significantly higher in women aged ≥50 years compared with women <50 years (20.4 ± 7.8 vs. 17.9 ± 6.8 ng/ml, p < 0.001), but there was no difference between men aged ≥50 years and men <50 years (16.4 ± 5.9 vs. 16.8 ± 6.0 ng/ml, p = 0.905). The participants diagnosed with diabetes had lower serum osteocalcin levels than normal or prediabetic participants. Multivariable regression analyses including HOMA-IR and HOMA-β indicated that serum osteocalcin levels had a negative and independent association with HbA1c levels in men and women aged <50 years, but not in women ≥50 years. CONCLUSIONS Low osteocalcin levels are associated with impaired glucose metabolism in men and premenopausal women. The osteocalcin levels may be determined by factors related to bone metabolism in postmenopausal women. Our data suggest that the serum levels of osteocalcin associated with glucose homeostasis should be interpreted according to age and sex.
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Kim JH, Choi HJ, Ku EJ, Hong AR, Kim KM, Kim SW, Cho NH, Shin CS. Regional body fat depots differently affect bone microarchitecture in postmenopausal Korean women. Osteoporos Int 2016; 27:1161-1168. [PMID: 26475286 DOI: 10.1007/s00198-015-3329-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/16/2015] [Indexed: 12/25/2022]
Abstract
SUMMARY In a prospective community-based cohort study, we investigated the relationship between trabecular bone score (TBS) and regional fat depots in 1474 Korean postmenopausal women. TBS was positively related with subcutaneous fat and negatively related with visceral fat. INTRODUCTION The effect of fat distribution (visceral/subcutaneous) on bone quality or microarchitecture has rarely been investigated due to measurement difficulty. We aimed to investigate the relationship between TBS reflecting bone microarchitecture and regional fat depots in Korean women. METHODS Cross-sectional data evaluation was made from subjects participating in an ongoing prospective community-based cohort study since 2001. A total of 1474 postmenopausal women in the Ansung cohort were analyzed. Regional body fat mass, bone mineral density (BMD) at the lumbar spine, and total hip and lumbar spine TBS were measured by dual energy X-ray absorptiometry (DXA). RESULTS In an age-adjusted partial correlation analysis, TBS was not associated with total fat mass, but negatively associated with trunk fat mass. However, TBS was positively related with leg (r = 0.102, P < 0.05) and gynoid fat mass (r = 0.086, P < 0.05) and negatively related with android fat mass (r = -0.106; P < 0.05). In linear regression models controlling age, BMI, and physical activity, android fat was inversely associated with TBS (β = -0.595, P < 0.001), whereas gynoid fat was positively associated with TBS (β = 0.216, P < 0.001). Lumbar spine and total hip BMDs revealed positive associations with total and all regional fat depots regardless of fat distribution. CONCLUSION Our findings suggest that relatively large visceral fat and small subcutaneous fat may have a detrimental effect on TBS, a bone microarchitecture index.
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Moon JH, Moon JH, Kim KM, Choi SH, Lim S, Park KS, Kim KW, Jang HC. Sarcopenia as a Predictor of Future Cognitive Impairment in Older Adults. J Nutr Health Aging 2016; 20:496-502. [PMID: 27102786 DOI: 10.1007/s12603-015-0613-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the association between the indices of sarcopenia and future risk of cognitive impairment in older adults. DESIGN Community-based prospective cohort study. SETTING Community. PARTICIPANTS A total of 297 participants aged ≥65 years without cognitive impairment at baseline (mean age, 71.9 ± 6.6 years; men:women, 158:139) and who underwent cognitive evaluation at the 5-year follow-up. MEASUREMENTS Sarcopenia parameters including appendicular lean mass (ALM), handgrip strength, and the Short Physical Performance Battery (SPPB) score at baseline were compared according to the later progression of mild cognitive impairment (MCI) and/or dementia. The operational criteria suggested by the Foundation for the National Institutes of Health Sarcopenia Project were used. We performed multivariate logistic regression analysis to identify the independent indicators of the progression of cognitive impairment. RESULTS Among the 297 participants, 242 (81.5%) remained cognitively normal (nonprogression group), whereas 55 (18.5%) showed progression of cognitive impairment (50 subjects (16.8%) to MCI and 5 subjects (1.7%) to dementia) (progression group). Compared with the nonprogression group, subjects in the progression group were older, had a lower educational level, and had lower physical function as assessed by the SPPB; a higher percentage were depressed. Other baseline markers of sarcopenia, including the ALM-to-body mass index ratio and handgrip strength did not differ significantly between the groups. The association between a low SPPB score (<9) and progression of cognitive impairment was maintained after adjustment for conventional risk factors for cognitive impairment (hazard ratio 2.222, 95% confidence interval 1.047-4.716, P = 0.038). CONCLUSION Decreased physical performance, as assessed by the SPPB, but not other markers of sarcopenia, was independently associated with the risk of later cognitive impairment in older adults.
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Kim YA, Kim KM, Lim S, Choi SH, Moon JH, Kim JH, Kim SW, Jang HC, Shin CS. Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int 2015; 26:2329-37. [PMID: 25906241 DOI: 10.1007/s00198-015-3138-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/07/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED Dietary vitamin C intake showed significant positive associations with BMD in postmenopausal women, especially with vitamin D deficiency. INTRODUCTION Although there is a positive role of vitamin C in osteoblastogenesis, debate remains about the contribution of vitamin C to bone mineral density (BMD) in humans. METHODS Data were derived from the Fourth Korean National Health and Nutrition Examination Survey. Dietary information was assessed using a 24-h dietary recall questionnaire. BMD was measured by dual-energy X-ray absorptiometry at the lumbar and hip. RESULTS A total of 1,196 postmenopausal women aged 50 years and older were stratified into tertiles by daily dietary vitamin C intake. After adjusting for traditional confounders, dietary vitamin C intake tertile was significantly positively associated with BMD at all sites (R = 0.513 for lumbar spine (LS) and R = 0.657 for femoral neck (FN), P < 0.05 for each). The subjects with osteoporosis had significantly lower dietary vitamin C intake than did subjects without osteoporosis (74.4 ± 66.2 vs 94.1 ± 78.6 mg/day for LS and 65.5 ± 56.6 vs 94.3 ± 79.2 mg/day for FN, respectively, P < 0.001). The multiple-adjusted odds ratio for osteoporosis for dietary vitamin C <100 mg/day was 1.790 (95 % CI 1.333-2.405, P < 0.001). However, the significant association between vitamin C intake and BMD was only observed in subjects with vitamin D deficiency and aged 50-59 years or >70 years. CONCLUSION Dietary vitamin C intake was positively associated with BMD in postmenopausal women, and inadequate vitamin C intake could increase the risk of osteoporosis.
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Oyungerel B, Chung S, Yoon DY, Han TY, Han IY, Kweon KT, Kim KM, Jeon GJ, Choi KD. C5 Extract Induces Apoptosis in B16F10 Murine Melanoma Cells through Extrinsic and Intrinsic Apoptotic Pathways and Sub-G1 Phase Arrest. TROP J PHARM RES 2015. [DOI: 10.4314/tjpr.v14i6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Moon JH, Lim S, Han JW, Kim KM, Choi SH, Kim KW, Jang HC. Serum 25-hydroxyvitamin D level and the risk of mild cognitive impairment and dementia: the Korean Longitudinal Study on Health and Aging (KLoSHA). Clin Endocrinol (Oxf) 2015; 83:36-42. [PMID: 25641087 DOI: 10.1111/cen.12733] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/09/2015] [Accepted: 01/28/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The association of low vitamin D status with mild cognitive impairment (MCI), a preclinical condition that can lead to dementia, has not yet been fully explored. Our aim was to investigate the association between vitamin D status and the future risk of MCI and dementia in older adults. DESIGN, SETTING AND PARTICIPANTS We conducted a population-based prospective study as a part of the Korean Longitudinal Study on Health and Aging. Four hundred and twelve elderly participants who completed evaluations of cognitive function and metabolic parameters in 2005-2006 and 2010-2011 were analysed. MAJOR OUTCOME MEASURE The rate of development of MCI or dementia during the study period was compared according to baseline vitamin D status. Binary logistic regression analysis was performed to investigate any independent association between vitamin D status and the risks of MCI or dementia. RESULTS Among 405 subjects that remained after excluding seven demented subjects at baseline, 338 subjects remained unchanged or improved in their diagnosis for cognitive function during the study period, whereas 67 subjects showed progression to MCI or dementia. When analyzing 236 subjects whose baseline mini-mental state examination (MMSE) scores were <27, severe vitamin D deficiency at baseline, defined as <25 nmol/l, was independently associated with the progression of cognitive impairment. Among 297 subjects who were normal at baseline, 50 acquired MCI and 247 remained normal. Severe vitamin D deficiency was also independently associated with the development of MCI when analyzing 145 subjects whose baseline MMSE scores were <27. CONCLUSION Severe vitamin D deficiency was independently associated with the future risk of MCI as well as dementia, especially in older adults whose baseline MMSE scores had decreased only modestly.
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Kim KM, Kim GS, Ko JS, Gwak MS, Lee SK, Son MG. Factors associated with consciousness recovery time after liver transplantation in recipients with hepatic encephalopathy. Transplant Proc 2015; 46:712-5. [PMID: 24767331 DOI: 10.1016/j.transproceed.2013.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/30/2013] [Accepted: 12/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hepatic encephalopathy (HE) occurs as a result of liver failure and is often considered to be a clinical indication for liver transplantation (LT). An assessment of post-transplantation consciousness level in recipients with HE is crucial, because recovery of consciousness implies reestablishment of transplant liver function and lack of perioperative brain damage. The purpose of this study is to evaluate factors associated with consciousness recovery time after LT in recipients with HE. METHODS Out of 633 adult recipients who underwent LT, recipients who exhibited HE at the time of LT were analyzed retrospectively. The time between graft reperfusion and postoperative consciousness recovery was determined, and recipients were divided into 2 groups: group E with recovery of consciousness early (≤48 hours), and group L with recovery of consciousness late (>48 hours). Analyzed variables included recipient sex, age, graft type, Model for End-Stage Liver Disease score, HE history/duration/type/grade, and preoperative laboratory values, including blood ammonia concentration. RESULTS HE was present at the time of LT in 69 (10.9%) of 633 recipients. Among the 69 recipients, 11 recipients who died or underwent reoperation before consciousness recovery were excluded, and 58 recipients (group E: n = 32; group L: n = 26) were enrolled into analysis. Multivariate analysis showed that HE duration >5 days (odds ratio [OR], 15.58; 95% confidence interval [CI], 1.35-179.56; P = .028) and HE type C (OR, 30.90; 95% CI, 1.67-573.48; P = .021) were the independent factors associated with late recovery from HE after LT. CONCLUSIONS We suggest that recipients with long-duration or type C HE should be carefully managed during the post-transplantation period to prevent deterioration of HE.
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Hwang S, Choi HS, Kim KM, Rhee Y, Lim SK. Associations between serum 25-hydroxyvitamin D and bone mineral density and proximal femur geometry in Koreans: the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2009. Osteoporos Int 2015; 26:163-71. [PMID: 25262060 DOI: 10.1007/s00198-014-2877-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/26/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED The association between 25-hydroxyvitamin D (25(OH)D) levels and bone mineral density (BMD) and proximal femur bone geometry was examined in the Korean population. A positive relationship between skeletal health and 25(OH)D levels was observed. However, there were no significant differences in skeletal health between the groups with 25(OH)D level of 50-75 nmol/L and greater than 75 nmol/L. INTRODUCTION Vitamin D plays an important role in calcium and phosphate homeostasis and normal mineralization of bone. However, the optimal level of vitamin D for skeletal health has not been clearly established. We analyzed the associations between serum 25(OH)D and BMD and proximal femur bone geometry and determined the optimal 25(OH)D level. METHODS This was a cross-sectional study of 10,062 participants (20-95 years, 4,455 men, 5,607 women) in the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) conducted from 2008 to 2009. Participants were divided into groups according to 25(OH)D level (<25, 25-50, 50-75, and ≥75 nmol/L). BMD and proximal femur geometric indices were measured. RESULTS The group with 25(OH)D levels of 50-75 nmol/L had greater bone density values, with the exception of the lumbar spine, and also had greater femur neck cortical thickness, cross-sectional area, and cross-sectional moment of inertia, as well as a lesser buckling ratio than the groups with 25(OH)D level of 25-50 nmol/L and less than 25 nmol/L. However, there were no significant differences in BMD and proximal femur geometry properties between the groups with 50-75 nmol/L and greater than 75 nmol/L of 25(OH)D. CONCLUSION The skeletal outcomes, including BMD and proximal femur geometric indices observed in this study, suggest that serum 25(OH)D levels of 50 to <75 nmol/L are optimal for skeletal health.
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Min C, Zheng M, Zhang X, Caron MG, Kim KM. Novel roles for β-arrestins in the regulation of pharmacological sequestration to predict agonist-induced desensitization of dopamine D3 receptors. Br J Pharmacol 2014; 170:1112-29. [PMID: 23992580 DOI: 10.1111/bph.12357] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/24/2013] [Accepted: 08/18/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE In addition to typical GPCR kinase (GRK)-/β-arrestin-dependent internalization, dopamine D3 receptor employed an additional GRK-independent sequestration pathway. In this study, we investigated the molecular mechanism of this novel sequestration pathway. EXPERIMENTAL APPROACH Radioligand binding, flow cytometry and cell surface biotinylation assay were used to characterize trafficking properties of D2 and D3 receptors. Serine/threonine and N-linked glycosylation mutants of the D3 receptor were utilized to locate receptor regions involved in pharmacological sequestration and desensitization. Various point mutants of the D2 and D3 receptors, whose sequestration and desensitization properties were altered, were combined with knockdown cells of GRKs or β-arrestins to functionally correlate pharmacological sequestration and desensitization. KEY RESULTS The D3 receptor, but not the D2 receptor, showed characteristic trafficking behaviour in which receptors were shifted towards the more hydrophobic domains within the plasma membrane without translocation into other intracellular compartments. Among various amino acid residues tested, S145/S146, C147 and N12/19 were involved in pharmacological sequestration and receptor desensitization. Both pharmacological sequestration and desensitization of D3 receptor required β-arrestins, and functional relationship was observed between two processes when it was tested for D3 receptor variants and agonists. CONCLUSIONS AND IMPLICATIONS Pharmacological sequestration of D3 receptor accompanies movement of cell surface receptors into a more hydrophobic fraction within the plasma membrane and renders D3 receptor inaccessible to hydrophilic ligands. Pharmacological sequestration is correlated with desensitization of the D3 receptor in a Gβγ- and β-arrestin-dependent manner. This study provides new insights into molecular mechanism governing GPCR trafficking and desensitization.
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Jang KM, Kim SH, Lee SJ, Lee MW, Choi D, Kim KM. Upper abdominal gadoxetic acid-enhanced and diffusion-weighted MRI for the detection of gastric cancer: Comparison with two-dimensional multidetector row CT. Clin Radiol 2014; 69:827-35. [PMID: 24837701 DOI: 10.1016/j.crad.2014.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 01/15/2023]
Abstract
AIM To evaluate the diagnostic performance of abdominal magnetic resonance imaging (MRI) for the detection of gastric cancer in comparison with that of two-dimensional (2D) multidetector row computed tomography (CT). MATERIALS AND METHODS The study included 189 patients with 170 surgically confirmed gastric cancers and 19 patients without gastric cancer, all of whom underwent gadoxetic acid-enhanced MRI with diffusion-weighted (DW) imaging, and multidetector contrast-enhanced abdominal CT imaging. Two observers independently analysed three sets of images (CT set, conventional MRI set, and combined conventional and DW MRI set). A five-point scale for likelihood of gastric cancer was used. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were evaluated. Quantitative [apparent diffusion coefficient (ADC) analyses with Mann-Whitney U-test were conducted for gastric cancers and the nearby normal gastric wall. RESULTS The diagnostic accuracy and sensitivity for detection of gastric cancer were significantly higher on combined conventional and DW MRI set (77.8-78.3%; 75.3-75.9%) than the CT imaging set (67.7-71.4%; 64.1-68.2%) or the conventional MRI set (72-73%; 68.8-70%; p < 0.01). In particular, for gastric cancers with pT2 and pT3, the combined conventional and DW MRI set (91.6-92.6%) yielded significantly higher sensitivity for detection of gastric cancer than did the CT imaging set (76.8-81.1%) by both observers (p < 0.01). The mean ADC of gastric cancer lesions (1 ± 0.23 × 10(-3) mm(2)/s) differed significantly from that of normal gastric wall (1.77 ± 0.25 × 10(-3) mm(2)/s; p < 0.01). CONCLUSION Abdominal MRI with DW imaging was more sensitive for the detection of gastric cancer than 2D-multidetector row CT or conventional MRI alone.
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Kim KM, Park W, Oh SY, Kim HJ, Nam W, Lim SK, Rhee Y, Cha IH. Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw. Osteoporos Int 2014; 25:1625-32. [PMID: 24554340 DOI: 10.1007/s00198-014-2622-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/09/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. We also found that underlying vitamin D levels might influence the response to TPTD treatment. INTRODUCTION Treatment of BRONJ is quite challenging and there are no standard treatment modalities. In this retrospective, longitudinal study, we examined whether additional TPTD administration could be beneficial for the resolution of BRONJ lesions compared to conservative management, such as antimicrobial treatment with or without surgery, and also studied the factors influencing the response to TPTD. METHODS Twenty-four cases of intractable BRONJ were included: 15 subjects were assigned to the TPTD group and the other 9 subjects, who refused TPTD administration, were assigned to the non-TPTD group. All subjects in both groups continued calcium and vitamin D supplementation and the TPTD group additionally received a daily subcutaneous injection of 20 μg TPTD for 6 months. RESULTS While 60.0% of the non-TPTD group showed one stage of improvement in BRONJ, 40.0% of the group did not show any improvement in disease status. In the TPTD group, 62.5% of the treated subjects showed one stage of improvement and the other 37.5% demonstrated a marked improvement, including two stages of improvement or complete healing, and there was not a single case that did not improve. The clinical improvement of BRONJ was statistically better in the TPTD group after the 6-month treatment (p < 0.05). Moreover, patients with higher baseline serum 25(OH)D levels showed better clinical therapeutic outcomes with TPTD. CONCLUSIONS We observed the beneficial effects of TPTD on BRONJ, and subjects with optimal serum vitamin D concentrations seemed to reap the maximum therapeutic effects of TPTD. A prospective, randomized, controlled trial should be needed to further evaluate the therapeutic efficacy of TPTD in the resolution of BRONJ.
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Kim KM, Ko JS, Gwak MS, Kim GS, Cho HS. Comparison of mixed venous oxygen saturation after in vitro calibration of pulmonary artery catheter with that of pulmonary arterial blood in patients undergoing living donor liver transplantation. Transplant Proc 2014; 45:1916-9. [PMID: 23769072 DOI: 10.1016/j.transproceed.2012.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/23/2012] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mixed venous saturation (SvO2) reflects the balance between oxygen delivery and consumption throughout the body. A multifunction pulmonary artery catheter (PAC) can monitor continuous SvO2 after in vitro calibration (CSvO2), obviating the need for in vivo calibration with pulmonary arterial blood. In critically ill patients CSvO2 has shown a good correlation with measured SvO2 of pulmonary arterial blood using co-oximetry (MSvO2). The aim of this study was to compare CSvO2 and MSvO2 in liver transplantation (OLT) recipients. METHODS We enrolled 44 OLT recipients for comparison with 24 coronary artery bypass graft (CABG) controls free of end-stage liver disease. After anesthetic induction, the PAC was inserted after in vitro calibration and CSvO2 and MSvO2 simultaneously measured. In OLT recipients, additional measurements of CSvO2 and MSvO2 were performed at anhepatic and postreperfusion phases. Pearson's correlation analysis was used to evaluate the correlation between the 2 measurements. A Bland-Altman analysis was used to determine precision of and bias between the 2 measurements. With ±3% regarded to be interchangeable. RESULTS Cardiac output and intrapulmonary shunt in CABG patients were lower than among OLT recipients. OLT recipients, showed a significant correlation between CSvO2 and MSvO2, but the coefficients were different during the three phases of OLT (r = 0.597, 0.753, and 0.756). In addition, bias values between the two measurements were 6.0%, 6.4%, and 2.9% for the preanhepatic, anhepatic, and postreperfusion phases, respectively, with 29.5%, 31.8%, and 50% of them being interchangeable. In contrast CABG patients showed bias in -0.17% with 75% of measurements interchangeable. CONCLUSION While in vitro calibration of the PAC can be used in CABG patients, MSvO2 is higher than CSvO2 in OLT recipients. Therefore, in vivo calibration with pulmonary arterial blood is necessary for accurate monitoring of SvO2 in OLT recipients.
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Park JC, Kwon BJ, Kang HS, Kim JE, Kim KM, Cho YD, Han MH. Single-stage extracranial carotid artery stenting and intracranial aneurysm coiling: technical feasibility and clinical outcome. Interv Neuroradiol 2013; 19:228-34. [PMID: 23693048 DOI: 10.1177/159101991301900213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/24/2013] [Indexed: 11/15/2022] Open
Abstract
The coexistence of carotid artery stenosis and cerebral aneurysm in a patient presents challenges for treatment decision-making. The purpose of this study was to evaluate the technical feasibility and clinical outcome after single-stage extracranial carotid artery stenting (CAS) and ipsilateral intracranial aneurysm coiling in a single institution. From March 2005 to February 2011, 17 patients with 21 aneurysms underwent single-stage CAS and coiling for ipsilateral aneurysms. There were symptomatic atherosclerotic carotid stenoses with unruptured aneurysms in eight, ruptured or symptomatic aneurysms with simultaneous asymptomatic carotid stenoses in two and asymptomatic lesions in seven. CAS was followed by aneurysm coiling in all 17 patients. Clinical and radiological data were reviewed. There were two procedure-related complications: acute in-stent thrombosis in one and premature aneurysmal rupture in the other. After aneurysm coiling, complete occlusion was demonstrated in 17 aneurysms and near-total occlusion in four. No neurological deficit was found at discharge and follow-up outcomes were excellent in all the patients (mean, 32.9 months). Follow-up imaging studies were performed in all the patients, including neck CT angiography in 14 (mean, 26.1 months), brain MR angiography in 14 (mean, 31.2 months), and conventional angiography in three (mean, 14.7 months). They revealed two asymptomatic, mild carotid re-stenoses and one major aneurysmal recanalization requiring re-coiling. A single-stage CAS and coiling procedure appears to be feasible and the complication rate seems to be reasonable. We suggest that there is no need for separate therapeutic procedures when a patient has carotid artery stenosis and accompanying ipsilateral intracranial aneurysm.
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Cho YD, Lee WJ, Kim KM, Kang HS, Kim JE, Han MH. Stent-assisted coil embolization of posterior communicating artery aneurysms. AJNR Am J Neuroradiol 2013; 34:2171-6. [PMID: 23660292 DOI: 10.3174/ajnr.a3541] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement. MATERIALS AND METHODS From a prospective data repository, we retrieved records of 32 consecutive patients with 33 posterior communicating artery aneurysms, all of which were treated by stent-assisted coil embolization between June 2008 and August 2012. Outcomes were analyzed in terms of aneurysm configuration and clinical status. RESULTS Stents were positioned entirely in the ICA (n = 26), from the ICA to the posterior communicating artery (n = 2), in the posterior communicating artery only (n = 3), and retrograde from the posterior communicating artery to the ICA terminus (n = 2). Procedure-related complications occurred in 3 patients (9.1%), but only 1 (3.0%) had mild neurologic sequelae (Glasgow Outcome Score 4). Using coil embolization, we achieved successful occlusion in 24 aneurysms (72.7%), and in 9 others, subtotal occlusion was conferred. During a mean follow-up of 15.7 ± 10.7 months, imaging of 27 aneurysms documented stable occlusion in 19 (70.4%), whereas angiography of 15 aneurysms (39.5%) disclosed 2 instances of in-stent stenosis (13.3%) and a solitary occurrence of stent migration (6.7%). CONCLUSIONS In posterior communicating artery aneurysms, stent protection during coil embolization is feasible by adjusting the procedural strategy to accommodate differing configurations of the aneurysm and its vascular source.
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