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Rho JH, Kim HJ, Joo JY, Lee JY, Lee JH, Park HR. Periodontal Pathogens Promote Foam Cell Formation by Blocking Lipid Efflux. J Dent Res 2021; 100:1367-1377. [PMID: 33899578 DOI: 10.1177/00220345211008811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Foam cells are one of the major cellular components of atherosclerotic plaques, within which the trace of periodontal pathogens has also been identified in recent studies. In line with these findings, the correlation between periodontitis and atherosclerotic cardiovascular incidences has been repetitively supported by evidence from a number of experimental studies. However, the direct role of periodontal pathogens in altered cellular signaling underlying such cardiovascular events has not been clearly defined. To determine the role of periodontal pathogens in the pathogenesis of atherosclerosis, especially in the evolution of macrophages into foam cells, we monitored the pattern of lipid accumulation within macrophages in the presence of periodontal pathogens, followed by characterization of these lipids and investigation of major molecules involved in lipid homeostasis. The cells were stained with the lipophilic fluorescent dye BODIPY 493/503 and Oil Red O to characterize the lipid profile. The amounts of Oil Red O-positive droplets, representing neutral lipids, as well as fluorescent lipid aggregates were prominently increased in periodontal pathogen-infected macrophages. Subsequent analysis allowed us to locate the accumulated lipids in the endoplasmic reticulum. In addition, the levels of cholesteryl ester in periodontal pathogen-infected macrophages were increased, implying disrupted lipid homeostasis. Further investigations to delineate the key messengers and regulatory factors involved in the altered lipid homeostasis have revealed alterations in cholesterol efflux-related enzymes, such as ABCG1 and CYP46A1, as contributors to foam cell formation, and increased Ca2+ signaling and reactive oxygen species (ROS) production as key events underlying disrupted lipid homeostasis. Consistently, a treatment of periodontal pathogen-infected macrophages with ROS inhibitors and nifedipine attenuated the accumulation of lipid droplets, further confirming periodontal pathogen-induced alterations in Ca2+ and ROS signaling and the subsequent dysregulation of lipid homeostasis as key regulatory events underlying the evolution of macrophages into foam cells.
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Adam J, Adamczyk L, Adams JR, Adkins JK, Agakishiev G, Aggarwal MM, Ahammed Z, Alekseev I, Anderson DM, Aparin A, Aschenauer EC, Ashraf MU, Atetalla FG, Attri A, Averichev GS, Bairathi V, Barish K, Behera A, Bellwied R, Bhasin A, Bielcik J, Bielcikova J, Bland LC, Bordyuzhin IG, Brandenburg JD, Brandin AV, Butterworth J, Caines H, Calderón de la Barca Sánchez M, Cebra D, Chakaberia I, Chaloupka P, Chan BK, Chang FH, Chang Z, Chankova-Bunzarova N, Chatterjee A, Chen D, Chen J, Chen JH, Chen X, Chen Z, Cheng J, Cherney M, Chevalier M, Choudhury S, Christie W, Chu X, Crawford HJ, Csanád M, Daugherity M, Dedovich TG, Deppner IM, Derevschikov AA, Didenko L, Dong X, Drachenberg JL, Dunlop JC, Edmonds T, Elsey N, Engelage J, Eppley G, Esumi S, Evdokimov O, Ewigleben A, Eyser O, Fatemi R, Fazio S, Federic P, Fedorisin J, Feng CJ, Feng Y, Filip P, Finch E, Fisyak Y, Francisco A, Fulek L, Gagliardi CA, Galatyuk T, Geurts F, Ghimire N, Gibson A, Gopal K, Gou X, Grosnick D, Guryn W, Hamad AI, Hamed A, Harabasz S, Harris JW, He S, He W, He XH, He Y, Heppelmann S, Heppelmann S, Herrmann N, Hoffman E, Holub L, Hong Y, Horvat S, Hu Y, Huang HZ, Huang SL, Huang T, Huang X, Humanic TJ, Huo P, Igo G, Isenhower D, Jacobs WW, Jena C, Jentsch A, Ji Y, Jia J, Jiang K, Jowzaee S, Ju X, Judd EG, Kabana S, Kabir ML, Kagamaster S, Kalinkin D, Kang K, Kapukchyan D, Kauder K, Ke HW, Keane D, Kechechyan A, Kelsey M, Khyzhniak YV, Kikoła DP, Kim C, Kimelman B, Kincses D, Kinghorn TA, Kisel I, Kiselev A, Kocan M, Kochenda L, Kosarzewski LK, Kramarik L, Kravtsov P, Krueger K, Kulathunga Mudiyanselage N, Kumar L, Kumar S, Kunnawalkam Elayavalli R, Kwasizur JH, Lacey R, Lan S, Landgraf JM, Lauret J, Lebedev A, Lednicky R, Lee JH, Leung YH, Li C, Li C, Li W, Li W, Li X, Li Y, Liang Y, Licenik R, Lin T, Lin Y, Lisa MA, Liu F, Liu H, Liu P, Liu P, Liu T, Liu X, Liu Y, Liu Z, Ljubicic T, Llope WJ, Longacre RS, Lukow NS, Luo S, Luo X, Ma GL, Ma L, Ma R, Ma YG, Magdy N, Majka R, Mallick D, Margetis S, Markert C, Matis HS, Mazer JA, Minaev NG, Mioduszewski S, Mohanty B, Mooney I, Moravcova Z, Morozov DA, Nagy M, Nam JD, Nasim M, Nayak K, Neff D, Nelson JM, Nemes DB, Nie M, Nigmatkulov G, Niida T, Nogach LV, Nonaka T, Nunes AS, Odyniec G, Ogawa A, Oh S, Okorokov VA, Page BS, Pak R, Pandav A, Panebratsev Y, Pawlik B, Pawlowska D, Pei H, Perkins C, Pinsky L, Pintér RL, Pluta J, Pokhrel BR, Porter J, Posik M, Pruthi NK, Przybycien M, Putschke J, Qiu H, Quintero A, Radhakrishnan SK, Ramachandran S, Ray RL, Reed R, Ritter HG, Rogachevskiy OV, Romero JL, Ruan L, Rusnak J, Sahoo NR, Sako H, Salur S, Sandweiss J, Sato S, Schmidke WB, Schmitz N, Schweid BR, Seck F, Seger J, Sergeeva M, Seto R, Seyboth P, Shah N, Shahaliev E, Shanmuganathan PV, Shao M, Sheikh AI, Shen WQ, Shi SS, Shi Y, Shou QY, Sichtermann EP, Sikora R, Simko M, Singh J, Singha S, Smirnov N, Solyst W, Sorensen P, Spinka HM, Srivastava B, Stanislaus TDS, Stefaniak M, Stewart DJ, Strikhanov M, Stringfellow B, Suaide AAP, Sumbera M, Summa B, Sun XM, Sun X, Sun Y, Sun Y, Surrow B, Svirida DN, Szymanski P, Tang AH, Tang Z, Taranenko A, Tarnowsky T, Thomas JH, Timmins AR, Tlusty D, Tokarev M, Tomkiel CA, Trentalange S, Tribble RE, Tribedy P, Tripathy SK, Tsai OD, Tu Z, Ullrich T, Underwood DG, Upsal I, Van Buren G, Vanek J, Vasiliev AN, Vassiliev I, Videbæk F, Vokal S, Voloshin SA, Wang F, Wang G, Wang JS, Wang P, Wang Y, Wang Y, Wang Z, Webb JC, Weidenkaff PC, Wen L, Westfall GD, Wieman H, Wissink SW, Witt R, Wu Y, Xiao ZG, Xie G, Xie W, Xu H, Xu N, Xu QH, Xu YF, Xu Y, Xu Z, Xu Z, Yang C, Yang Q, Yang S, Yang Y, Yang Z, Ye Z, Ye Z, Yi L, Yip K, Yu Y, Zbroszczyk H, Zha W, Zhang C, Zhang D, Zhang S, Zhang S, Zhang XP, Zhang Y, Zhang Y, Zhang ZJ, Zhang Z, Zhang Z, Zhao J, Zhong C, Zhou C, Zhu X, Zhu Z, Zurek M, Zyzak M. Global Polarization of Ξ and Ω Hyperons in Au+Au Collisions at sqrt[s_{NN}]=200 GeV. PHYSICAL REVIEW LETTERS 2021; 126:162301. [PMID: 33961449 DOI: 10.1103/physrevlett.126.162301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Global polarization of Ξ and Ω hyperons has been measured for the first time in Au+Au collisions at sqrt[s_{NN}]=200 GeV. The measurements of the Ξ^{-} and Ξ[over ¯]^{+} hyperon polarization have been performed by two independent methods, via analysis of the angular distribution of the daughter particles in the parity violating weak decay Ξ→Λ+π, as well as by measuring the polarization of the daughter Λ hyperon, polarized via polarization transfer from its parent. The polarization, obtained by combining the results from the two methods and averaged over Ξ^{-} and Ξ[over ¯]^{+}, is measured to be ⟨P_{Ξ}⟩=0.47±0.10(stat)±0.23(syst)% for the collision centrality 20%-80%. The ⟨P_{Ξ}⟩ is found to be slightly larger than the inclusive Λ polarization and in reasonable agreement with a multiphase transport model. The ⟨P_{Ξ}⟩ is found to follow the centrality dependence of the vorticity predicted in the model, increasing toward more peripheral collisions. The global polarization of Ω, ⟨P_{Ω}⟩=1.11±0.87(stat)±1.97(syst)% was obtained by measuring the polarization of daughter Λ in the decay Ω→Λ+K, assuming the polarization transfer factor C_{ΩΛ}=1.
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Hong TH, Lee JH, Seo CH, Kim KH, Kim HY. Vibration reduction during milling of highly flexible workpieces using active workpiece holder system. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:045105. [PMID: 34243429 DOI: 10.1063/5.0046394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 06/13/2023]
Abstract
The milling of highly flexible workpieces, such as thin-walled structures used in turbine blades, aerospace equipment, and jet engine compressors, requires vibration compensation to improve the quality of the workpiece surface. Vibration can be reduced by selecting appropriate cutting parameters. However, this approach reduces system productivity. This paper presents an active workpiece holder that controls the vibration of general computer numerical control machine tools. The proposed holder, which comprises a flexible guide mechanism, driver, and sensor, measures vibration and actively controls it using piezoactuators. A high-rigidity flexure mechanism was designed for the holder, and finite element method simulation and modal analysis were performed. Finally, the proposed system was fabricated, and experimental verification indicated that the system reduced vibration. The surface quality obtained using the controlled system was ∼50% better than that obtained using the uncontrolled system.
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Harada K, Hwang H, Wang X, Abdelhakeem A, Iwatsuki M, Blum Murphy MA, Maru DM, Weston B, Lee JH, Rogers JE, Thomas I, Shanbhag N, Zhao M, Bhutani MS, Nguyen QN, Swisher SG, Ikoma N, Badgwell BD, Hofstetter WL, Ajani JA. Frequency and Implications of Paratracheal Lymph Node Metastases in Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma. Ann Surg 2021; 273:751-757. [PMID: 31188215 DOI: 10.1097/sla.0000000000003383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We aimed to evaluate the frequency of paratracheal lymph nodes (LN) metastases and their prognostic influence. SUMMARY BACKGROUND DATA Paratracheal LNs are considered regional nodes in the esophageal cancer classification, but their metastatic rate and influence on survival remain unclear. METHODS One thousand one hundred ninety-nine patients with resectable esophageal or gastroesophageal junction adenocarcinoma (EAC) (January 2002 and December 2016) in our Gastrointestinal Medical Oncology Database were analyzed. Paratracheal LNs were defined as1R, 1L, 2R, 2L, 4R, and 4L, according to the 8th American Joint Committee on Cancer classification. RESULTS Of 1199 patients, 73 (6.1%) had positive paratracheal LNs at diagnosis. The median overall survival (OS) of 73 patients with initial paratracheal LN involvement was 2.10 years (range 0.01-10.1, 5-yrs OS 24.2%). Of 1071 patients who were eligible for recurrence evaluation, 70 patients (6.5%) developed paratracheal LN metastases as the first recurrence. The median time to recurrence was 1.28 years (range 0.28-5.96 yrs) and the median OS following recurrence was only 0.95 year (range 0.03-7.88). OS in 35 patients who had only paratracheal LN recurrence was significantly longer than in patients who had other recurrences (median OS 2.26 vs 0.51 yrs, 5-yrs OS; 26.8% vs 0%, P < 0.0001). Higher T stage (T3/T4) was an independently risk factor for paratracheal LN recurrence (odds ratio 5.10, 95% confidence interval 1.46-17.89). We segregated patients in 3 groups based on the distance of tumor's proximal edge to esophagogastric junction (low; ≤2 cm, medium; 2.0-7.0 cm, and high; >7.0 cm). Paratracheal LN metastases were more frequent with the proximal tumors (low, 4.2%; medium, 12.0%; high, 30.3%; Cochran-Armitage Trend test, P < 0.001). CONCLUSION Paratracheal LN metastases were associated with a shorter survival in resectable EAC patients. Alternate approaches to prolong survival of this group of patients are warranted.
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Yoo JW, Kim J, Lee MW, Kang J, Ko WH, Oh SG, Ko J, Lee JH, Nam YU, Jung L, Park BH, Yoon SW. Fast-ion D α spectroscopy diagnostic at KSTAR. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:043504. [PMID: 34243446 DOI: 10.1063/5.0040559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
A fast-ion Dα (FIDA) diagnostics system was installed for core and edge measurements on KSTAR. This system has two tangential FIDA arrays that cover both blue- and redshifted Dα lines (cold: 656.09 nm) in active views along the neutral beam 1 A centerline. The spectral band is 647-662.5 nm, and it covers the Doppler shift of the emission from the maximum energy of the neutral beam (100 keV). A curved filter strip with a motorized stage adequately prevents saturation of the electron multiplying charge-coupled device signal by the cold Dα line from the plasma edge. From comparisons of the measured spectra and FIDASIM modeling code, the FIDA spectra are well matched quantitatively. Moreover, the first measurements show that the FIDA radiance agrees with the neutron rate in the time trace during external heating and perturbation. In addition, responses are observed in the core FIDA radiance during the edge-localized mode cycle.
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Yoo DS, Lee JH, Kim SC, Kim JH. Mortality and clinical response of patients with bullous pemphigoid treated with rituximab. Br J Dermatol 2021; 185:210-212. [PMID: 33657641 DOI: 10.1111/bjd.19890] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Indexed: 12/21/2022]
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Xu Y, Li Y, Jin J, Han G, Sun C, Pizzi MP, Huo L, Scott A, Wang Y, Ma L, Lee JH, Bhutani MS, Weston B, Vellano C, Yang L, Lin C, Kim Y, MacLeod AR, Wang L, Wang Z, Song S, Ajani JA. Correction to: LncRNA PVT1 up-regulation is a poor prognosticator and serves as a therapeutic target in esophageal adenocarcinoma. Mol Cancer 2021; 20:56. [PMID: 33766033 PMCID: PMC7992986 DOI: 10.1186/s12943-021-01351-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adam J, Adamczyk L, Adams JR, Adkins JK, Agakishiev G, Aggarwal MM, Ahammed Z, Alekseev I, Anderson DM, Aparin A, Aschenauer EC, Ashraf MU, Atetalla FG, Attri A, Averichev GS, Bairathi V, Barish K, Behera A, Bellwied R, Bhasin A, Bielcik J, Bielcikova J, Bland LC, Bordyuzhin IG, Brandenburg JD, Brandin AV, Butterworth J, Caines H, Calderón de la Barca Sánchez M, Cebra D, Chakaberia I, Chaloupka P, Chan BK, Chang FH, Chang Z, Chankova-Bunzarova N, Chatterjee A, Chen D, Chen J, Chen JH, Chen X, Chen Z, Cheng J, Cherney M, Chevalier M, Choudhury S, Christie W, Chu X, Crawford HJ, Csanád M, Daugherity M, Dedovich TG, Deppner IM, Derevschikov AA, Didenko L, Dong X, Drachenberg JL, Dunlop JC, Edmonds T, Elsey N, Engelage J, Eppley G, Esumi S, Evdokimov O, Ewigleben A, Eyser O, Fatemi R, Fazio S, Federic P, Fedorisin J, Feng CJ, Feng Y, Filip P, Finch E, Fisyak Y, Francisco A, Fulek L, Gagliardi CA, Galatyuk T, Geurts F, Gibson A, Gopal K, Gou X, Grosnick D, Guryn W, Hamad AI, Hamed A, Harabasz S, Harris JW, He S, He W, He XH, He Y, Heppelmann S, Heppelmann S, Herrmann N, Hoffman E, Holub L, Hong Y, Horvat S, Hu Y, Huang HZ, Huang SL, Huang T, Huang X, Humanic TJ, Huo P, Igo G, Isenhower D, Jacobs WW, Jena C, Jentsch A, Ji Y, Jia J, Jiang K, Jowzaee S, Ju X, Judd EG, Kabana S, Kabir ML, Kagamaster S, Kalinkin D, Kang K, Kapukchyan D, Kauder K, Ke HW, Keane D, Kechechyan A, Kelsey M, Khyzhniak YV, Kikoła DP, Kim C, Kimelman B, Kincses D, Kinghorn TA, Kisel I, Kiselev A, Kocan M, Kochenda L, Kosarzewski LK, Kramarik L, Kravtsov P, Krueger K, Kulathunga Mudiyanselage N, Kumar L, Kumar S, Kunnawalkam Elayavalli R, Kwasizur JH, Lacey R, Lan S, Landgraf JM, Lauret J, Lebedev A, Lednicky R, Lee JH, Leung YH, Li C, Li C, Li W, Li W, Li X, Li Y, Liang Y, Licenik R, Lin T, Lin Y, Lisa MA, Liu F, Liu H, Liu P, Liu P, Liu T, Liu X, Liu Y, Liu Z, Ljubicic T, Llope WJ, Longacre RS, Lukow NS, Luo S, Luo X, Ma GL, Ma L, Ma R, Ma YG, Magdy N, Majka R, Mallick D, Margetis S, Markert C, Matis HS, Mazer JA, Minaev NG, Mioduszewski S, Mohanty B, Mooney I, Moravcova Z, Morozov DA, Nagy M, Nam JD, Nasim M, Nayak K, Neff D, Nelson JM, Nemes DB, Nie M, Nigmatkulov G, Niida T, Nogach LV, Nonaka T, Nunes AS, Odyniec G, Ogawa A, Oh S, Okorokov VA, Page BS, Pak R, Pandav A, Panebratsev Y, Pawlik B, Pawlowska D, Pei H, Perkins C, Pinsky L, Pintér RL, Pluta J, Porter J, Posik M, Pruthi NK, Przybycien M, Putschke J, Qiu H, Quintero A, Radhakrishnan SK, Ramachandran S, Ray RL, Reed R, Ritter HG, Rogachevskiy OV, Romero JL, Ruan L, Rusnak J, Sahoo NR, Sako H, Salur S, Sandweiss J, Sato S, Schmidke WB, Schmitz N, Schweid BR, Seck F, Seger J, Sergeeva M, Seto R, Seyboth P, Shah N, Shahaliev E, Shanmuganathan PV, Shao M, Sheikh AI, Shen WQ, Shi SS, Shi Y, Shou QY, Sichtermann EP, Sikora R, Simko M, Singh J, Singha S, Smirnov N, Solyst W, Sorensen P, Spinka HM, Srivastava B, Stanislaus TDS, Stefaniak M, Stewart DJ, Strikhanov M, Stringfellow B, Suaide AAP, Sumbera M, Summa B, Sun XM, Sun X, Sun Y, Sun Y, Surrow B, Svirida DN, Szymanski P, Tang AH, Tang Z, Taranenko A, Tarnowsky T, Thomas JH, Timmins AR, Tlusty D, Tokarev M, Tomkiel CA, Trentalange S, Tribble RE, Tribedy P, Tripathy SK, Tsai OD, Tu Z, Ullrich T, Underwood DG, Upsal I, Van Buren G, Vanek J, Vasiliev AN, Vassiliev I, Videbæk F, Vokal S, Voloshin SA, Wang F, Wang G, Wang JS, Wang P, Wang Y, Wang Y, Wang Z, Webb JC, Weidenkaff PC, Wen L, Westfall GD, Wieman H, Wissink SW, Witt R, Wu Y, Xiao ZG, Xie G, Xie W, Xu H, Xu N, Xu QH, Xu YF, Xu Y, Xu Z, Xu Z, Yang C, Yang Q, Yang S, Yang Y, Yang Z, Ye Z, Ye Z, Yi L, Yip K, Yu Y, Zbroszczyk H, Zha W, Zhang C, Zhang D, Zhang S, Zhang S, Zhang XP, Zhang Y, Zhang Y, Zhang ZJ, Zhang Z, Zhang Z, Zhao J, Zhong C, Zhou C, Zhu X, Zhu Z, Zurek M, Zyzak M. Nonmonotonic Energy Dependence of Net-Proton Number Fluctuations. PHYSICAL REVIEW LETTERS 2021; 126:092301. [PMID: 33750161 DOI: 10.1103/physrevlett.126.092301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/19/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Nonmonotonic variation with collision energy (sqrt[s_{NN}]) of the moments of the net-baryon number distribution in heavy-ion collisions, related to the correlation length and the susceptibilities of the system, is suggested as a signature for the quantum chromodynamics critical point. We report the first evidence of a nonmonotonic variation in the kurtosis times variance of the net-proton number (proxy for net-baryon number) distribution as a function of sqrt[s_{NN}] with 3.1 σ significance for head-on (central) gold-on-gold (Au+Au) collisions measured solenoidal tracker at Relativistic Heavy Ion Collider. Data in noncentral Au+Au collisions and models of heavy-ion collisions without a critical point show a monotonic variation as a function of sqrt[s_{NN}].
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Lee MK, Moon C, Lee MJ, Kwak YG, Lee E, Jeon JH, Park WB, Jung Y, Kim ES, Lee JH, Chun JY, Park SW. Risk factors for the delayed diagnosis of extrapulmonary TB. Int J Tuberc Lung Dis 2021; 25:191-198. [PMID: 33688807 DOI: 10.5588/ijtld.20.0788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.
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Park B, Bang CH, Lee C, Han JH, Choi W, Kim J, Park GS, Rhie JW, Lee JH, Kim C. 3D wide-field multispectral photoacoustic imaging of human melanomas in vivo: a pilot study. J Eur Acad Dermatol Venereol 2020; 35:669-676. [PMID: 33037671 DOI: 10.1111/jdv.16985] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Breslow depth is an important parameter to determine the excision margin and prognosis of melanoma. However, it is difficult to accurately determine the actual Breslow depth before surgery using the existing ocular micrometer and biopsy technique. OBJECTIVES To evaluate the use of 3D wide-field multispectral photoacoustic imaging to non-invasively measure depth and outline the boundary of melanomas for optimal surgical margin selection. METHODS Six melanoma patients were examined in vivo using the 3D multispectral photoacoustic imaging system. For five cases of melanomas (one in situ, three nodular, and one acral lentiginous type melanoma), the spectrally unmixed photoacoustic depths were calculated and compared against histopathological depths. RESULTS Spectrally unmixed photoacoustic depths and histopathological depths match well within a mean absolute error of 0.36 mm. In particular, the measured minimum and maximum depths in the in situ and nodular type of melanoma were 0.6 and 9.1 mm, respectively. In the 3D photoacoustic image of one metastatic melanoma, feeding vessels were visualized in the melanoma, suggesting the neovascularization around the tumour. CONCLUSIONS The 3D multispectral photoacoustic imaging not only provides well-measured depth and sizes of various types of melanomas, it also visualizes the metastatic type of melanoma. Obtaining accurate depth and boundary information of melanoma before surgery would play a useful role in the complete excision of melanoma during surgery.
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Park SH, Lim DH, Sohn TS, Lee J, Zang DY, Kim ST, Kang JH, Oh SY, Hwang IG, Ji JH, Shin DB, Yu JI, Kim KM, An JY, Choi MG, Lee JH, Kim S, Hong JY, Park JO, Park YS, Lim HY, Bae JM, Kang WK. A randomized phase III trial comparing adjuvant single-agent S1, S-1 with oxaliplatin, and postoperative chemoradiation with S-1 and oxaliplatin in patients with node-positive gastric cancer after D2 resection: the ARTIST 2 trial ☆. Ann Oncol 2020; 32:368-374. [PMID: 33278599 DOI: 10.1016/j.annonc.2020.11.017] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy and chemoradiotherapy are some of the standards of care for gastric cancer (GC). The Adjuvant chemoRadioTherapy In Stomach Tumors (ARTIST) 2 trial compares two adjuvant chemotherapy regimens and chemoradiotherapy in patients with D2-resected, stage II or III, node-positive GC. PATIENTS AND METHODS The ARTIST 2 compared, in a 1:1:1 ratio, three adjuvant regimens: oral S-1 (40-60 mg twice daily 4 weeks on/2 weeks off) for 1 year, S-1 (2 weeks on/1 week off) plus oxaliplatin 130 mg/m2 every 3 weeks (SOX) for 6 months, and SOX plus chemoradiotherapy 45 Gy (SOXRT). Randomization was stratified according to surgery type (total or subtotal gastrectomy), pathologic stage (II or III), and Lauren histologic classification (diffuse or intestinal/mixed). The primary endpoint was disease-free survival (DFS) at 3 years; a reduction of 33% in the hazard ratio (HR) for DFS with SOX or SOXRT, when compared with S-1, was considered clinically meaningful. The trial is registered at clinicaltrials.gov (NCT0176146). RESULTS A total of 546 patients were recruited between February 2013 and January 2018 with 182, 181, and 183 patients in the S-1, SOX, and SOXRT arms, respectively. Median follow-up period was 47 months, with 178 DFS events observed. Estimated 3-year DFS rates were 64.8%, 74.3%, and 72.8% in the S-1, SOX, and SOXRT arms, respectively. HR for DFS in the control arm (S-1) was shorter than that in the SOX and SOXRT arms: S-1 versus SOX, 0.692 (P = 0.042) and S-1 versus SOXRT, 0.724 (P = 0.074). No difference in DFS was found between SOX and SOXRT (HR 0.971; P = 0.879). Adverse events were as anticipated in each arm, and were generally well-tolerated and manageable. CONCLUSIONS In patients with curatively D2-resected, stage II/III, node-positive GC, adjuvant SOX or SOXRT was effective in prolonging DFS, when compared with S-1 monotherapy. The addition of radiotherapy to SOX did not significantly reduce the rate of recurrence after D2 gastrectomy.
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Van der Meer JMR, Maas RJA, Guldevall K, Klarenaar K, de Jonge PKJD, Evert JSHV, van der Waart AB, Cany J, Safrit JT, Lee JH, Wagena E, Friedl P, Önfelt B, Massuger LF, Schaap NPM, Jansen JH, Hobo W, Dolstra H. IL-15 superagonist N-803 improves IFNγ production and killing of leukemia and ovarian cancer cells by CD34 + progenitor-derived NK cells. Cancer Immunol Immunother 2020; 70:1305-1321. [PMID: 33140189 PMCID: PMC8053152 DOI: 10.1007/s00262-020-02749-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
Allogeneic natural killer (NK) cell transfer is a potential immunotherapy to eliminate and control cancer. A promising source are CD34 + hematopoietic progenitor cells (HPCs), since large numbers of cytotoxic NK cells can be generated. Effective boosting of NK cell function can be achieved by interleukin (IL)-15. However, its in vivo half-life is short and potent trans-presentation by IL-15 receptor α (IL-15Rα) is absent. Therefore, ImmunityBio developed IL-15 superagonist N-803, which combines IL-15 with an activating mutation, an IL-15Rα sushi domain for trans-presentation, and IgG1-Fc for increased half-life. Here, we investigated whether and how N-803 improves HPC-NK cell functionality in leukemia and ovarian cancer (OC) models in vitro and in vivo in OC-bearing immunodeficient mice. We used flow cytometry-based assays, enzyme-linked immunosorbent assay, microscopy-based serial killing assays, and bioluminescence imaging, for in vitro and in vivo experiments. N-803 increased HPC-NK cell proliferation and interferon (IFN)γ production. On leukemia cells, co-culture with HPC-NK cells and N-803 increased ICAM-1 expression. Furthermore, N-803 improved HPC-NK cell-mediated (serial) leukemia killing. Treating OC spheroids with HPC-NK cells and N-803 increased IFNγ-induced CXCL10 secretion, and target killing after prolonged exposure. In immunodeficient mice bearing human OC, N-803 supported HPC-NK cell persistence in combination with total human immunoglobulins to prevent Fc-mediated HPC-NK cell depletion. Moreover, this combination treatment decreased tumor growth. In conclusion, N-803 is a promising IL-15-based compound that boosts HPC-NK cell expansion and functionality in vitro and in vivo. Adding N-803 to HPC-NK cell therapy could improve cancer immunotherapy.
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Lee JH, Kim HT, Choi IJ, Heo YR, Jung YW. An unusual anatomical variant of the left phrenic nerve encircling the transverse cervical artery. Folia Morphol (Warsz) 2020; 80:1027-1031. [PMID: 33124034 DOI: 10.5603/fm.a2020.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
During educational dissection of cadavers, we encountered anatomical variability of the left phrenic nerve (PN). In this cadaver, nerve fibres from C3 and C4 descended and crossed behind the transverse cervical artery (TCA), a branch of the thyrocervical trunk, at the level of the anterior scalene muscle. On the other hand, nerve fibres from C5 descended obliquely above the TCA and then joined the fibres from C3-C4 on the medial side of the anterior scalene muscle to form the PN. To our knowledge, the encircling of the TCA by the left PN in the neck has not yet been reported and may pose a potential risk for nerve compression during movement of the neck. We discuss several types of anatomical variants of the PN and the associated risk during thorax and neck dissection procedures.
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Hou T, Stewart JM, Lee JH, Gan Q. Solid Tumor Metastases to the Pancreas Diagnosed Using Fine-Needle Aspiration. Am J Clin Pathol 2020; 154:692-699. [PMID: 32651950 DOI: 10.1093/ajcp/aqaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Solid tumor metastases to the pancreas are rare, and only limited literature on the topic is available. In this retrospective study, we reviewed 107 cases of solid tumor metastases to the pancreas diagnosed by fine-needle aspiration (FNA) from 2005 to 2019. METHODS Information including the patients' clinical histories, radiologic and pathologic findings, treatments, and follow-up were collected. RESULTS The mean age of the patients was 62.4 years. The mean tumor size was 2.64 cm with even distribution throughout the pancreas (head, neck and body, and tail). The most common primary site was the kidney, followed by the lung, skin, and breast and the gynecologic, gastrointestinal, and genitourinary tracts. The most common tumor type was carcinoma, followed by melanoma and sarcoma. In comparison to patients with nonkidney primary cancers, those with primary renal cell carcinoma had a longer median interval between primary diagnosis and metastasis (8.5 vs 4.0 years; P < .01), less often had metastasis outside the pancreas (38% vs 74%; P < .01), and had a significantly longer 5-year survival rate (65.7% vs 24.8%; P < .01). CONCLUSIONS FNA plays a crucial role in diagnosing metastases to the pancreas. Metastases originating from kidney and nonkidney primary tumors have distinct clinicopathologic features and prognoses.
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Kumar S, Youn YH, Lee JH. Life on a knife edge: the optimal approach to the management of perforations during endoscopic submucosal dissection (ESD). Expert Rev Gastroenterol Hepatol 2020; 14:965-973. [PMID: 32658593 DOI: 10.1080/17474124.2020.1791085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) is a well-established procedure that can provide curative resection of malignant and premalignant lesions endoscopically, thereby offering patients an effective non-operative option. Though ESD is safe and highly effective when performed in appropriately selected patients by an experienced ESD expert, it carries risks including intraprocedural and delayed perforation. AREAS COVERED This review provides a practical approach to the initial management of perforation to minimize subsequent complications. The importance of prompt recognition of perforation and early intervention cannot be overstated. This review summarizes indications for closure, anatomic considerations impacting closure, and closure techniques. This article also highlights the do's and don'ts of various closure devices, focusing particularly on advanced closure methods, the-over-the-scope clips (OTSCs) and endoscopic suturing. EXPERT OPINION As ESD offers surgery-sparing alternatives to patients, advanced closure techniques allow endoscopists to effectively and promptly manage associated complications, improving the possibility of the widespread implementation of ESD in the US. With continued improvements in OTSCs and endoscopic suturing, ESD will become a stalwart of endoscopic management of malignant and premalignant gastrointestinal lesions.
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Androić D, Armstrong DS, Asaturyan A, Bartlett K, Beaufait J, Beminiwattha RS, Benesch J, Benmokhtar F, Birchall J, Carlini RD, Cornejo JC, Dusa SC, Dalton MM, Davis CA, Deconinck W, Dowd JF, Dunne JA, Dutta D, Duvall WS, Elaasar M, Falk WR, Finn JM, Forest T, Gal C, Gaskell D, Gericke MTW, Grames J, Gray VM, Grimm K, Guo F, Hoskins JR, Jones D, Jones MK, Jones RT, Kargiantoulakis M, King PM, Korkmaz E, Kowalski S, Leacock J, Leckey JP, Lee AR, Lee JH, Lee L, MacEwan S, Mack D, Magee JA, Mahurin R, Mammei J, Martin JW, McHugh MJ, Meekins D, Mei J, Mesick KE, Michaels R, Micherdzinska A, Mkrtchyan A, Mkrtchyan H, Morgan N, Narayan A, Ndukum LZ, Nelyubin V, van Oers WTH, Owen VF, Page SA, Pan J, Paschke KD, Phillips SK, Pitt ML, Radloff RW, Rajotte JF, Ramsay WD, Roche J, Sawatzky B, Seva T, Shabestari MH, Silwal R, Simicevic N, Smith GR, Solvignon P, Spayde DT, Subedi A, Subedi R, Suleiman R, Tadevosyan V, Tobias WA, Tvaskis V, Waidyawansa B, Wang P, Wells SP, Wood SA, Yang S, Zang P, Zhamkochyan S. Precision Measurement of the Beam-Normal Single-Spin Asymmetry in Forward-Angle Elastic Electron-Proton Scattering. PHYSICAL REVIEW LETTERS 2020; 125:112502. [PMID: 32976004 DOI: 10.1103/physrevlett.125.112502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
A beam-normal single-spin asymmetry generated in the scattering of transversely polarized electrons from unpolarized nucleons is an observable related to the imaginary part of the two-photon exchange process. We report a 2% precision measurement of the beam-normal single-spin asymmetry in elastic electron-proton scattering with a mean scattering angle of θ_{lab}=7.9° and a mean energy of 1.149 GeV. The asymmetry result is B_{n}=-5.194±0.067(stat)±0.082 (syst) ppm. This is the most precise measurement of this quantity available to date and therefore provides a stringent test of two-photon exchange models at far-forward scattering angles (θ_{lab}→0) where they should be most reliable.
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Weston BR, Patel JM, Pande M, Lum PJ, Ross WA, Raju GS, Lynch PM, Coronel E, Ge PS, Lee JH. Efficacy of uncovered colonic stents for extrinsic versus intrinsic malignant large bowel obstruction. Surg Endosc 2020; 35:4511-4519. [PMID: 32909212 DOI: 10.1007/s00464-020-07965-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies evaluating self-expandable metal stents (SEMS) for management of malignant extrinsic colon obstruction have yielded conflicting results. We evaluated the efficacy of uncovered SEMS for extrinsic colon malignancy (ECM) versus intrinsic colon malignancy (ICM). METHODS Retrospective review of all patients referred for colonic SEMS at a tertiary cancer center between 2007 and 2018 was performed. Primary outcome measures were technical success, clinical success, intervention rate, and overall survival. RESULTS 138 patients with ECM and 119 patients with ICM underwent attempted stent placement. The rectum and/or sigmoid colon was the most common stricture site. Technical success was lower in the ECM group [86% vs 96% (p = .009)]. Clinical success was lower in the ECM group both at 7 days [82% vs 95% (p = .004)] and at 90 days [60% vs 86% (p < .001)]. Subsequent intervention was required more frequently [44% vs 35%; p = .23] and earlier [median 9 vs 132 days; p < .001] in the ECM group. Median overall survival in the ECM group was 92 vs 167 days. Among predictive variables analyzed, the ECM group had a higher frequency of peritoneal metastasis (87% vs 32%; p < .001), multifocal strictures with requirement for multiple stents (20% vs 6%; p = .002), sharp angulated strictures (39% vs 25%; p = .04) , and radiation therapy (21% vs 10%; p = .02). CONCLUSIONS Colonic SEMS for ECM is associated with lower technical and clinical success with earlier intervention rates compared with ICM. Our findings can be used to better inform patients and referring providers as well as guide new stent design to enhance efficacy in this population.
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Lee GR, Lee JH. The impact of the policy of expanding coverage for 4 major diseases on out-of-pocket payments. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In South Korea, Cancers, cardiac disease, cerebrovascular diseases and rare incurable disease cause high medical expenses which are putting a heavy burden on the household economy. They are called '4 Major Severe Diseases'. The government has established the plan of Expanding Coverage for Four Major Severe Diseases. The Policy of Expanding Coverage for the 4 Major Severe Diseases is to apply the necessary medical services including coverage for uncovered services to national health insurance payments in stages. This study aims to evaluate the effects of the policy implemented from 2013 to 2015 by comparing the changes in the out-of-pocket payments before and after the policy. Using the data from the Korea Health Panel(2012, 2016), the policy effect was evaluated by the Difference-In-Difference analysis. A total of 4,686 patients (2,343 in 2012 and 2,343 in 2016) were included, who are enrolled in National Health Insurance, and have at least one chronic disease. People who are under 20 years old were excluded. In addition, severity of disease was adjusted by CCI(Charson's comorbidity index). Compared to before the policy was implemented, the Out-of-pocket payments significantly decreased. In addition, there were significant differences in gender, types of health care system, disabled, economic activity, income level, and CCI. According to previous studies, the policy of Expanding health insurance coverage since 2005 has been criticized for its low effectiveness. However, It is revealed that the Policy of Expanding Coverage for 4 Major Severe Diseases has an effect in this study. Given that the policy needs time to work, this study showed the effect of the policy more comprehensively compared to previous studies evaluating the effectiveness for just one year.
Key messages
Due to the Policy of Expanding Coverage for 4 Major Severe Diseases, the out-of-pocket health expenditure were reduced in the policy group. Given that the policy needs time to work, this study has shown more comprehensive results than previous studies that evaluated the effect of policy carried out over a short period.
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Chung SR, Lee JH, Yoon RK, Sung TY, Song DE, Pfeuffer J, Kim IS. Differentiation of follicular carcinomas from adenomas using histogram obtained from diffusion-weighted MRI. Clin Radiol 2020; 75:878.e13-878.e19. [PMID: 32838926 DOI: 10.1016/j.crad.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/06/2020] [Indexed: 01/21/2023]
Abstract
AIM To evaluate the role of histogram analysis of apparent diffusion coefficient (ADC) maps from diffusion-weighted imaging (DWI) in the differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) in nodules indeterminate on ultrasound-guided core needle biopsy (USCNB). MATERIALS AND METHODS This study was performed with institutional review board approval. Seventeen patients who were planned to undergo diagnostic lobectomy for an indeterminate thyroid nodule (atypical of unknown significance/follicular lesion of undetermined significance [AUS/FLUS] or suspicious for follicular neoplasm/follicular neoplasm [SFN]) on USCNB were enrolled prospectively. All patients underwent DWI on the day before surgery. Histogram parameters were derived from ADC values obtained from the whole extent of the tumours. The parameters were compared with the final diagnosis based on histopathological examination after surgery. The accuracy of the parameters in differentiating FTC from FA was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Twelve patients were confirmed as having FA and five patients as having FTC. Histogram parameters including the 10th (ADC10), 25th (ADC25), and 50th (ADC50) percentiles of the ADC values were significantly lower in FA than in FTC (p < 0.05, all). ROC curve analysis revealed that ADC25 resulted in the highest AUC (0.867; confidence interval, 0.616-0.980), with a cut-off value of 0.352×10-3 mm2/s. CONCLUSION Histogram parameters from ADC maps could differentiate FTC from FA effectively in indeterminate nodules on USCNB, with ADC25 being the most promising parameter.
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Kim D, Choi YJ, Song Y, Chung SR, Baek JH, Lee JH. Thin-Section MR Imaging for Carotid Cavernous Fistula. AJNR Am J Neuroradiol 2020; 41:1599-1605. [PMID: 32819900 DOI: 10.3174/ajnr.a6757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid-cavernous fistulas are abnormal vascular shunts that can cause various neurologic or orbital symptoms. The purpose of this retrospective study was to evaluate the diagnostic performance of thin-section MR imaging for carotid cavernous fistula in patients with clinically suspected carotid cavernous fistula, and to identify possible imaging predictors of carotid cavernous fistula. MATERIALS AND METHODS A total of 98 patients who were clinically suspected of having carotid cavernous fistula (according to their symptoms and physical examinations) between January 2006 and September 2018 were included in this study. The patients underwent pretreatment thin-section MR imaging and DSA. Thin-section MR imaging consisted of 2D coronal T1- and T2WI with 3-mm thickness and 3D contrast-enhanced T1WI with 0.6 mm thickness. The diagnostic performance of thin-section MR imaging for carotid cavernous fistula was evaluated with the reference standard of DSA. Univariate logistic regression analysis was performed to determine possible imaging predictors of carotid cavernous fistula. RESULTS Among the 98 patients, DSA confirmed 38 as having carotid cavernous fistula. The overall accuracy, sensitivity, and specificity of thin-section MR imaging were 88.8%, 97.4%, and 83.3%, respectively. Possible imaging predictors on thin-section MR imaging included abnormal contour of the cavernous sinus (OR: 21.7), internal signal void of the cavernous sinus (OR: 15.3), prominent venous drainage flow (OR: 54.0), and orbital/periorbital soft tissue swelling (OR: 40.4). CONCLUSIONS Thin-section MR imaging provides high diagnostic performance and possible imaging predictors of carotid cavernous fistula in patients with clinically suspected carotid cavernous fistula. Thin-section MR imaging protocols could help decide appropriate management plans for patients with clinically suspected carotid cavernous fistula.
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Lee MK, Lee JH, Kim JH, Kim H, Joo L, Kim M, Cho SJ, Suh CH, Chung SR, Choi YJ, Baek JH. Diagnostic Accuracy of MRI-Based Morphometric Parameters for Detecting Olfactory Nerve Dysfunction. AJNR Am J Neuroradiol 2020; 41:1698-1702. [PMID: 32763901 DOI: 10.3174/ajnr.a6697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Although olfactory dysfunction is a common cranial nerve disorder, there are no simple objective morphometric criteria to assess olfactory dysfunction. The aim of this study was to evaluate the diagnostic performance of MR imaging morphometric parameters for detecting olfactory dysfunction. MATERIALS AND METHODS This prospective study enrolled patients from those presenting with olfactory symptoms who underwent both an olfactory function test and MR imaging. Controls without olfactory dysfunction were recruited during the preoperative work-up for pituitary adenoma. Two independent neuroradiologists measured the olfactory bulb in 3D and assessed olfactory bulb concavity on MR imaging while blinded to the clinical data. Diagnostic performance was assessed using receiver operating characteristic curve analysis. RESULTS Sixty-four patients and 34 controls were enrolled. The patients were significantly older than the controls (mean age, 57.8 ± 11.9 years versus 47.1 ± 12.1 years; P < .001). Before age adjustment, the olfactory bulb height was the only olfactory bulb parameter showing a significant difference between patients and controls (1.6 ± 0.3 mm versus 2.0 ± 0.3 mm, P < .001). After age adjustment, all parameters and olfactory bulb concavity showed significant intergroup differences, with the olfactory bulb height having the highest area under the curve (0.85). Olfactory bulb height was confirmed to be the only significant parameter showing a difference in the detection of olfactory dysfunction in 22 pairs after matching for age and sex (area under the curve = 0.87, P < .001). Intraclass correlation coefficients revealed moderate-to-excellent degrees of inter- and intrareader agreement. CONCLUSIONS MR imaging morphometric analysis can differentiate patients with olfactory dysfunction, with the olfactory bulb height having the highest diagnostic performance for detecting olfactory dysfunction irrespective of age.
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Harada K, Wu CC, Wang X, Mizrak Kaya D, Amlashi FG, Iwatsuki M, Blum Murphy MA, Maru DM, Weston B, Lee JH, Rogers JE, Thomas I, Shanbhag N, Bhutani MS, Hofstetter WL, Nguyen QN, Ajani JA. Total Lesion Glycolysis Assessment Identifies a Patient Fraction With a High Cure Rate Among Esophageal Adenocarcinoma Patients Treated With Definitive Chemoradiation. Ann Surg 2020; 272:311-318. [PMID: 32675544 DOI: 10.1097/sla.0000000000003228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to determine whether tumor metabolism could be prognostic of cure in L-EAC patients who receive definitive chemoradiation. SUMMARY BACKGROUND DATA Patients with inoperable localized esophageal adenocarcinoma (L-EAC) often receive definitive chemoradiation; however, biomarkers and/or imaging variables to prognosticate cure are missing. METHODS Two hundred sixty-six patients with L-EAC who had chemoradiation but not surgery were analyzed from the prospectively maintained EAC databases in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center (Texas, USA) between March 2002 and April 2015. Maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) from the positron emission tomography data were evaluated. RESULTS Of 266 patients, 253 (95%) were men; the median age was 67 years (range 20-91 yrs) and 153 had poorly differentiated L-EAC. The median SUVmax was 10.3 (range 0-87) and the median TLG was 85.7 (range 0-3227). Both SUVmax and TLG were higher among those with: tumors >5 cm in length, high clinical stage, and high tumor and node categories by TNM staging (all P < 0.0001). Of 234 patients evaluable for cure, 60 (25.6%) achieved cure. In the multivariable logistic regression model, low TLG (but not low SUVmax) was associated with cure (continuous TLG value: odds ratio 0.70, 95% confidence interval (CI) 0.54-0.92). TLG was quantified into 4 quartile categorical variables; first quartile (Q1; <32), second quartile (Q2; 32.0-85.6), third quartile (Q3; 85.6-228.4), and fourth quartile (Q4; >228.4); the cure rate was only 10.3% in Q4 and 5.1% in Q3 but increased to 28.8% in Q2, and 58.6% in Q1. The cross-validation resulted in an average accuracy of prediction score of 0.81 (95% CI, 0.75-0.86). CONCLUSIONS In this cross-validated model, 59% of patients in the 1st quartile were cured following definitive chemoradiation. Baseline TLG could be pursued as one of the tools for esophageal preservation.
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Lee JH. How far have we come in the design of biliary stents: Are biodegradable stents ready for prime time? Gastrointest Endosc 2020; 92:412-414. [PMID: 32703372 DOI: 10.1016/j.gie.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
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Angsuwatcharakon P, Ahmed O, Lynch PM, Lum P, Gonzalez GN, Weston B, Coronel E, Katz MHG, Folloder J, Lee JH. Management of ampullary adenomas in familial adenomatous polyposis syndrome: 16 years of experience from a tertiary cancer center. Gastrointest Endosc 2020; 92:323-330. [PMID: 32145286 DOI: 10.1016/j.gie.2020.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The management of ampullary adenomas in familial adenomatous polyposis (FAP) is challenging due to multiple adenomas in the duodenum, history of previous major abdominal surgery, and desmoid lesions. In this study, we aim to define the optimum management for ampullary adenomas, particularly in FAP. METHODS This is a retrospective study of all patients with pathology-confirmed ampullary adenomas in M.D. Anderson Cancer Center from 2002 to 2018. Relevant data were extracted, including patient demographics, treatments, outcomes, and adverse events. RESULTS There were 137 patients with ampullary adenomas who underwent 159 procedures; 95 of the 137 patients had FAP and were placed under close observation, 29 underwent endoscopic ampullectomy, 4 underwent surgical ampullectomy, and 31 underwent panreaticoduodenectomy (PD). In the close observation group, 12.6% progressed to advanced adenoma and subsequently underwent resection. There was no ampullary cancer detected in this group. The endoscopic ampullectomy group had a postprocedure adverse event rate of 10.2%. Eleven patients had residual/recurrent disease after endoscopic ampullectomy, 3 of whom needed surgery. Four patients underwent initial surgical ampullectomy and 2 subsequently needed PD. Patients who underwent PD had an adverse event rate of 29%. In this group, there were no cases of residual disease or recurrence. CONCLUSIONS The management of ampullary adenomas in FAP should be carefully considered for the best outcome. Although these patients can be managed by endoscopic ampullectomy, careful surveillance for recurrence should be followed along with prompt management of the recurrence when detected. Although PD provides a definitive treatment, it is limited by the patient's comorbid conditions and high adverse event rates.
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Lee JH, Yoon CJ, Choi WS, Lee CH. Benign postoperative hepaticojejunostomy stricture: percutaneous recanalisation using the reverse end of a microwire. Clin Radiol 2020; 75:879.e1-879.e6. [PMID: 32727657 DOI: 10.1016/j.crad.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the technical feasibility and safety of percutaneous recanalisation of benign postoperative hepaticojejunostomy strictures using the reverse end of a microwire. MATERIALS AND METHODS Twenty-one patients with benign postoperative hepaticojejunostomy strictures that had failed to recanalise following management with conventional percutaneous techniques from January 2012 to March 2019 were included in the study. The stricture was punctured by the reverse end of a microwire. Subsequently, serial balloon dilatation and covered stent placement was performed. Technical as well as clinical success, complications, and patency of the hepaticojejunostomy were evaluated. RESULTS Technical success was achieved in 19 of 21 (90.5%) patients. The mean number of treatment sessions was 1.2 (range, 1-2). The obstructive symptoms were resolved within 3 days after the procedure in 19 patients (100%). There were no major complications. The 1-year and 3-year patency rates were 76.9% and 61.5%, respectively. CONCLUSION Percutaneous recanalisation using the reverse end of a microwire is technically feasible and safe in the treatment of benign postoperative hepaticojejunostomy strictures. This technique is useful when the conventional percutaneous technique cannot be used to cross the stricture.
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