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Lee CH, Wang SL. Oral mirtazapine decreases the gastrointestinal adverse effects in cats on doxorubicin chemotherapy. Vet J 2024; 304:106087. [PMID: 38395251 DOI: 10.1016/j.tvjl.2024.106087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Anorexia, depression, and vomiting are the common adverse effects of chemotherapy in humans and animals. Mirtazapine is primarily used as an appetite stimulant and antiemetic in dogs and cats. Therefore, we evaluated the efficacy of mirtazapine in reducing the gastrointestinal adverse effects in cats receiving doxorubicin chemotherapy. This single-masked, placebo-controlled crossover study enrolled 11 cats with malignant mammary gland tumors. The cats were randomly assigned to receive either mirtazapine (1.88 mg/cat) or placebo every 48 h for 2 weeks from the first initiation of doxorubicin chemotherapy. Each cat was then crossed over to the alternate group on the subsequent chemotherapy with a 1-week wash-out period. The owners were asked to record appetite score, activity score, episodes of vomiting and diarrhea for 2 weeks after each doxorubicin administration. Cats treated with mirtazapine showed significantly increased bodyweight compared with those on placebo (P = 0.010). The appetite and activity scores during mirtazapine treatment was significantly higher than those during placebo treatment (P = 0.005 and 0.018, respectively). Furthermore, the prevalence of episodes of vomiting during mirtazapine treatment was significantly lower than that during placebo treatment (P = 0.026). Our results demonstrate that mirtazapine can significantly increase bodyweight, appetite, and activity and reduce vomiting in cats after doxorubicin chemotherapy.
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Affiliation(s)
- C H Lee
- Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - S L Wang
- Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; National Taiwan University Veterinary Hospital, National Taiwan University, Taipei 10617, Taiwan.
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Yuh WT, Kim JH, Han J, Kim TS, Won YI, Choi Y, Noh HJ, Lee CH, Kim CH, Chung CK. The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases. J Neurosurg Spine 2024; 40:301-311. [PMID: 38064696 DOI: 10.3171/2023.10.spine23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups. METHODS Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003-2011) and post-current ERAS (2012-2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs. RESULTS The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively). CONCLUSIONS Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.
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Affiliation(s)
- Woon Tak Yuh
- 1Department of Neurosurgery, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
- 2Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Jun-Hoe Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Junghoon Han
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Tae-Shin Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Young Il Won
- 4Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong-si, Republic of Korea
| | - Yunhee Choi
- 5Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Jung Noh
- 6Pediatric Intensive Care Unit, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Chi Heon Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- 8Department of Medical Device Development, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea; and
| | - Chun Kee Chung
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- 9Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Science, Gwanak-gu, Seoul, Republic of Korea
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Park H, Lee J, Choi Y, Kim JH, Kim S, Kim YR, Lee CH, Park SB, Kim KT, Rhee JM, Kim CH. Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study. Sci Rep 2024; 14:1295. [PMID: 38221532 PMCID: PMC10788335 DOI: 10.1038/s41598-024-51861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024] Open
Abstract
This study aims to identify healthcare costs indicators predicting secondary surgery for degenerative lumbar spine disease (DLSD), which significantly impacts healthcare budgets. Analyzing data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database of Republic of Korea (ROK), the study included 3881 patients who had surgery for lumbar disc herniation (LDH), lumbar spinal stenosis without spondylolisthesis (LSS without SPL), lumbar spinal stenosis with spondylolisthesis (LSS with SPL), and spondylolysis (SP) from 2006 to 2008. Patients were categorized into two groups: those undergoing secondary surgery (S-group) and those not (NS-group). Surgical and interim costs were compared, with S-group having higher secondary surgery costs ($1829.59 vs $1618.40 in NS-group, P = 0.002) and higher interim costs ($30.03; 1.86% of initial surgery costs vs $16.09; 0.99% of initial surgery costs in NS-group, P < 0.0001). The same trend was observed in LDH, LSS without SPL, and LSS with SPL (P < 0.0001). Monitoring interim costs trends post-initial surgery can effectively identify patients requiring secondary surgery.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Juhee Lee
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sum Kim
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young-Rak Kim
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Park S, Kim JH, Ahn Y, Lee CH, Kim YG, Yuh WT, Hyun SJ, Kim CH, Kim KJ, Chung CK. Multi-pose-based convolutional neural network model for diagnosis of patients with central lumbar spinal stenosis. Sci Rep 2024; 14:203. [PMID: 38168665 PMCID: PMC10761871 DOI: 10.1038/s41598-023-50885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
Although the role of plain radiographs in diagnosing lumbar spinal stenosis (LSS) has declined in importance since the advent of magnetic resonance imaging (MRI), diagnostic ability of plain radiographs has improved dramatically when combined with deep learning. Previously, we developed a convolutional neural network (CNN) model using a radiograph for diagnosing LSS. In this study, we aimed to improve and generalize the performance of CNN models and overcome the limitation of the single-pose-based CNN (SP-CNN) model using multi-pose radiographs. Individuals with severe or no LSS, confirmed using MRI, were enrolled. Lateral radiographs of patients in three postures were collected. We developed a multi-pose-based CNN (MP-CNN) model using the encoders of the three SP-CNN model (extension, flexion, and neutral postures). We compared the validation results of the MP-CNN model using four algorithms pretrained with ImageNet. The MP-CNN model underwent additional internal and external validations to measure generalization performance. The ResNet50-based MP-CNN model achieved the largest area under the receiver operating characteristic curve (AUROC) of 91.4% (95% confidence interval [CI] 90.9-91.8%) for internal validation. The AUROC of the MP-CNN model were 91.3% (95% CI 90.7-91.9%) and 79.5% (95% CI 78.2-80.8%) for the extra-internal and external validation, respectively. The MP-CNN based heatmap offered a logical decision-making direction through optimized visualization. This model holds potential as a screening tool for LSS diagnosis, offering an explainable rationale for its prediction.
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Affiliation(s)
- Seyeon Park
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Youngbin Ahn
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Young-Gon Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Choi S, Kim YJ, Oh H, Yuh WT, Lee CH, Yang SH, Kim CH, Chung CK, Park HP. Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2024; 36:45-52. [PMID: 36006663 DOI: 10.1097/ana.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position. METHODS Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel. RESULTS Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI. CONCLUSIONS The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.
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Affiliation(s)
| | | | | | - Woon Tak Yuh
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Heon Yang
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lee CH. Meta-Analysis and Machine Learning: Advancement of Analytic Methodology. Korean J Neurotrauma 2023; 19:407-408. [PMID: 38222840 PMCID: PMC10782107 DOI: 10.13004/kjnt.2023.19.e63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
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Lee CH, Jo DJ, Oh JK, Hyun SJ, Park JH, Kim KH, Bae JS, Moon BJ, Lee CK, Shin MH, Jang HJ, Han MS, Kim CH, Chung CK, Moon SM. Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning. Neurospine 2023; 20:1272-1280. [PMID: 38171294 PMCID: PMC10762414 DOI: 10.14245/ns.2342434.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision. METHODS Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator. RESULTS From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/). CONCLUSION An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Bong Ju Moon
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Chang-Kyu Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Hoon Shin
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyun Jun Jang
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Myung Moon
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - for the Korean Spinal Deformity Society
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Wooridul Spine Hospital, Seoul, Korea
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Lee S, Choi YS, Do SH, Lee W, Lee CH, Lee M, Vojta M, Wang CN, Luetkens H, Guguchia Z, Choi KY. Kondo screening in a Majorana metal. Nat Commun 2023; 14:7405. [PMID: 37974022 PMCID: PMC10654600 DOI: 10.1038/s41467-023-43185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Kondo impurities provide a nontrivial probe to unravel the character of the excitations of a quantum spin liquid. In the S = 1/2 Kitaev model on the honeycomb lattice, Kondo impurities embedded in the spin-liquid host can be screened by itinerant Majorana fermions via gauge-flux binding. Here, we report experimental signatures of metallic-like Kondo screening at intermediate temperatures in the Kitaev honeycomb material α-RuCl3 with dilute Cr3+ (S = 3/2) impurities. The static magnetic susceptibility, the muon Knight shift, and the muon spin-relaxation rate all feature logarithmic divergences, a hallmark of a metallic Kondo effect. Concurrently, the linear coefficient of the magnetic specific heat is large in the same temperature regime, indicating the presence of a host Majorana metal. This observation opens new avenues for exploring uncharted Kondo physics in insulating quantum magnets.
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Affiliation(s)
- S Lee
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science, Pohang, 37673, Republic of Korea
| | - Y S Choi
- Department of Physics, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - S-H Do
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, 37831, USA
| | - W Lee
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science, Pohang, 37673, Republic of Korea
- Rare Isotope Science Project, Institute for Basic Science, Daejeon, 34000, Republic of Korea
| | - C H Lee
- Department of Physics, Chung-Ang University, 84 Heukseok-ro, Seoul, 06974, Republic of Korea
| | - M Lee
- National High Magnetic Field Laboratory, Los Alamos National Laboratory, Los Alamos, New Mexico, 87545, USA
| | - M Vojta
- Institut für Theoretische Physik, Technische Universität Dresden, 01062, Dresden, Germany
| | - C N Wang
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - H Luetkens
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - Z Guguchia
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - K-Y Choi
- Department of Physics, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
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Kim JH, Yuh WT, Han J, Kim T, Lee CH, Kim CH, Choi Y, Chung CK. Impact of C3 laminectomy on cervical sagittal alignment in cervical laminoplasty: a prospective, randomized controlled trial comparing clinical and radiological outcomes between C3 laminectomy with C4-C6 laminoplasty and C3-C6 laminoplasty. Spine J 2023; 23:1674-1683. [PMID: 37473811 DOI: 10.1016/j.spinee.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND CONTEXT C3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2-C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes. PURPOSE To assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes. DESIGN A single-center, patient-blinded, randomized controlled trial. PATIENT SAMPLE We included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020. OUTCOME MEASURES The primary outcome measures were C2-C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2-C3 interlaminar fusion. METHODS Patients were randomly allocated to either the C3 laminectomy with C4-C6 laminoplasty group (LN group) or the C3-C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done. RESULTS Among 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2-C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8±1.0 in the LN group vs 8.6±1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2-C3 CA was significantly greater in the LN group (7.1±0.5° in LN group vs 3.2±0.5° in LP group, p<.001) while C4-C7 CA was significantly smaller in the LN group (3.9±0.8° in LN group vs 7.7±0.7° in LP group, p<.001) with greater cSVA in the LN group (31.6±1.4 mm in LN group vs 25.5±1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables. CONCLUSION The impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3-C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis.
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Affiliation(s)
- Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, College of Medicine, Hallym University, 1, Hallymdaehak-gil, Chuncheon, 24252, South Korea; Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, 18450, South Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Taeshin Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea.
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Lee S, Lee SH, Yoon JH, Kim CH, Park JH, Lee SH, Lee CH, Hyun SJ, Jeon SR, Kim KJ, Kim ES, Chung CK. Revisiting En Bloc Resection Versus Piecemeal Resection for the Treatment of Giant Cell Tumor of the Spine. World Neurosurg 2023; 178:e165-e173. [PMID: 37451361 DOI: 10.1016/j.wneu.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Surgery for spinal giant cell tumors (GCTs) is challenging because these tumors often exhibit a poor clinical course owing to their locally aggressive features. This study aimed to investigate the prognostic factors of GCT recurrence in the spine by focusing on surgical factors. METHODS We retrospectively reviewed patients who underwent surgery for spinal GCTs between January 2005 and December 2016. Using the Kaplan-Meier method, surgical variables were evaluated for disease-free survival (DFS). Since tumor violation may occur at the pedicle during en bloc resection of the spine, it was further analyzed as a separate variable. Multivariate Cox proportional hazard regression analysis was performed for other clinical and radiographic variables. A total of 28 patients (male:female = 8:20) were included. The mean follow-up period was 90.5 months (range, 15-184 months). RESULTS Among the 28 patients, gross total resection (GTR) was the most important factor for DFS (P = 0.001). Any form of tumor violation was also correlated with DFS (P = 0.049); however, use of en bloc resection technique did not show a significant DFS gain compared to piecemeal resection (P = 0.218). In the patient group that achieved GTR, the mode of resection was not a significant factor for DFS (P = 0.959). In the multivariate analysis, the extent of resection was the only significant variable that affected DFS (P = 0.016). CONCLUSIONS Conflicting results on tumor violation from univariate and multivariate analyses suggest that GTR without tumor violation should be the treatment goal for spinal GCTs. However, when tumor violation is unavoidable, it would be important to prioritize GTR over adhering to en bloc resection.
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Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Joon Ho Yoon
- Department of Neurosurgery, Hyundai UVIS Hospital, Incheon, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Kim TS, Yuh WT, Han J, Kim J, Lee CH, Kim CH, Chung CK. Is laminectomy necessary for C1-C2 epidural schwannomas? Acta Neurochir (Wien) 2023; 165:3065-3076. [PMID: 37400543 DOI: 10.1007/s00701-023-05707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy. METHODS Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured. RESULTS The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86 mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery. CONCLUSION The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86 mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates.
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Affiliation(s)
- Tae-Shin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Brain and Cognitive Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Park TH, Kim SK, Phi JH, Park CK, Kim YH, Paek SH, Lee CH, Park SH, Koh EJ. Survival and Malignant Transformation of Pineal Parenchymal Tumors: A 30-Year Retrospective Analysis in a Single-Institution. Brain Tumor Res Treat 2023; 11:254-265. [PMID: 37953449 PMCID: PMC10641322 DOI: 10.14791/btrt.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aims to elucidate clinical features, therapeutic strategies, and prognosis of pineal parenchymal tumors (PPT) by analyzing a 30-year dataset of a single institution. METHODS We reviewed data from 43 patients diagnosed with PPT at Seoul National University Hospital between 1990 and 2020. We performed survival analyses and assessed prognostic factors. RESULTS The cohort included 10 patients with pineocytoma (PC), 13 with pineal parenchymal tumor of intermediate differentiation (PPTID), and 20 with pineoblastoma (PB). Most patients presented with hydrocephalus at diagnosis. Most patients underwent an endoscopic third ventriculostomy and biopsy, with some undergoing additional resection after diagnosis confirmation. Radiotherapy was administered with a high prevalence of gamma knife radiosurgery for PC and PPTID, and craniospinal irradiation for PB. Chemotherapy was essential in the treatment of grade 3 PPTID and PB. The 5-year progression-free survival rates for PC, grade 2 PPTID, grade 3 PPTID, and PB were 100%, 83.3%, 0%, and 40%, respectively, and the 5-year overall survival rates were 100%, 100%, 40%, and 55%, respectively. High-grade tumor histology was associated with lower survival rates. Significant prognostic factors varied among tumor types, with World Health Organization (WHO) grade and leptomeningeal seeding (LMS) for PPTID, and the extent of resection and LMS for PB. Three patients experienced malignant transformations. CONCLUSION This study underscores the prognostic significance of WHO grades in PPT. It is necessary to provide specific treatment according to tumor grade. Grade 3 PPTID showed a poor prognosis. Potential LMS and malignant transformations necessitate aggressive multimodal treatment and close-interval screening.
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Affiliation(s)
- Tae-Hwan Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jung Koh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
- Center of Hospital Medicine, Seoul National University Hospital, Seoul, Korea.
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Lee SH, Jung Y, Lee MJ, Lee CH. Development of metal radioactive liquid reference material for proficiency test. Appl Radiat Isot 2023; 200:110970. [PMID: 37540991 DOI: 10.1016/j.apradiso.2023.110970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
This study developed liquid reference materials containing various metals, to be used for quality assurance of radiation measurements of the most common metallic wastes generated during the operation or decommissioning of nuclear power plants. The liquid reference materials were prepared by assuming the dissolution of stainless-steel using acid and melting of the major metals present in the stainless steel, namely Fe, Ni, Cr, and Mn, along with the standard sources (134Cs, 137Cs, 60Co, 90Sr). The theoretical massic activity of the standard sources added to the samples and the measured reference values of the gamma and beta emitters in the samples were compared, and they showed good agreement within a one-sigma confidence interval (k = 1). Using the developed reference materials, a proficiency test was conducted on three domestic labs, and the results were evaluated using Z-score. While the evaluation results showed good agreement between the reference values and the reported values for 137Cs and 60Co, all participating labs reported lower values than the reference value for 134Cs. For 90Sr, two out of the three labs reported significantly higher values than the reference value. Based on the results of this study, the developed metal radioactive liquid reference material is expected to be registered as certified reference material (CRM) in the future. They will be used as the CRM for measuring and ensuring the quality of radioactive metal waste.
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Affiliation(s)
- S H Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea.
| | - Y Jung
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - M J Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - C H Lee
- Nuclear Decommissioning Research Institute (NDRI), 17 Techno 4-ro, Yuseong-gu, Daejeon, 34013, Republic of Korea
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Han J, Ha CM, Yuh WT, Ko YS, Kim JH, Kim TS, Lee CH, Lee S, Lee SH, Khan A, Chung CK, Kim CH. Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position. PLoS One 2023; 18:e0291114. [PMID: 37708151 PMCID: PMC10501584 DOI: 10.1371/journal.pone.0291114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con. METHODS We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space. RESULTS Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004). CONCLUSION Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location.
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Affiliation(s)
- Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Shin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Asfandyar Khan
- School of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yuh WT, Han J, Lee CH, Kim CH, Kang HS, Chung CK. The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis. J Korean Neurosurg Soc 2023:jkns.2022.0204. [PMID: 37315576 DOI: 10.3340/jkns.2022.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/06/2023] [Indexed: 06/16/2023] Open
Abstract
Objective Preoperative transarterial embolization (TAE) of tumor feeders in hypervascular spine metastasis is known to reduce intraoperative estimated blood loss (EBL) during surgery. The effect of TAE varies for several reasons, and one controllable factor is the timing between embolization and surgery. However, the adequate timing remains unclear. This study aimed to evaluate the timing and other factors that reduce EBL in spinal metastasis surgery through a meta-analysis. Methods A comprehensive database search was performed to identify direct comparative studies of EBL stratified by the timing of surgery after TAE for spinal metastasis. EBL was analyzed according to the timing of surgery and other factors. Subgroup analyses were also performed. The difference in EBL was calculated as the mean difference (MD) and 95% confidence interval (CI). Results Among seven studies, 196 and 194 patients underwent early and late surgery after TAE, respectively. The early surgery was defined as within 1-2 days after TAE, while the late surgery group received surgery at least 1 day after TAE. Overall, the MD in EBL was not different according to the timing of surgery (MD, 86.3 mL; 95% CI, -95.5 to 268.1 mL; p=0.35). A subgroup analysis of the complete embolization group demonstrated that patients who underwent early surgery within 24 hours after TAE had significantly less bleeding (MD, 233.3 mL; 95% CI, 76.0 to 390.5 mL; p=0.004). In cases of partial embolization, EBL was not significantly different regardless of the time interval. Conclusion Complete embolization followed by early spinal surgery within 24 hours may reduce intraoperative bleeding for the patients with hypervascular spinal metastasis.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, Seoul, Korea
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Kim CH, Choi Y, Chung CK, Yang SH, Lee CH, Park SB, Kim K, Chung SG. Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system. PLoS One 2023; 18:e0287092. [PMID: 37319283 PMCID: PMC10270587 DOI: 10.1371/journal.pone.0287092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Full-endoscopic lumbar discectomy (FELD) is a type of minimally invasive spinal surgery for lumbar disc herniation (LDH). Sufficient evidence exists to recommend FELD as an alternative to standard open microdiscectomy, and some patients prefer FELD due to its minimally invasive nature. However, in the Republic of Korea, the National Health Insurance System (NHIS) controls the reimbursement and use of supplies for FELD, but FELD is not currently reimbursed by the NHIS. Nonetheless, FELD has been performed upon patients' request, but providing FELD for patients' sake is inherently an unstable arrangement in the absence of a practical reimbursement system. The purpose of this study was to conduct a cost-utility analysis of FELD to suggest appropriate reimbursements. METHOD This study was a subgroup analysis of prospectively collected data including 28 patients who underwent FELD. All patients were NHIS beneficiaries and followed a uniform clinical pathway. Quality-adjusted life years (QALYs) were assessed with a utility score using the EuroQol 5-Dimension (EQ-5D) instrument. The costs included direct medical costs incurred at the hospital for 2 years and the price of the electrode ($700), although it was not reimbursed. The costs and QALYs gained were used to calculate the cost per QALY gained. RESULT Patients' mean age was 43 years and one-third (32%) were women. L4-5 was the most common surgical level (20/28, 71%) and extrusion was the most common type of LDH (14, 50%). Half of the patients (15, 54%) had jobs with an intermediate level of activity. The preoperative EQ-5D utility score was 0.48±0.19. Pain, disability, and the utility score significantly improved starting 1 month postoperatively. The average EQ-5D utility score during 2 years after FELD was estimated as 0.81 (95% CI: 0.78-0.85). For 2 years, the mean direct costs were $3,459 and the cost per QALY gained was $5,241. CONCLUSION The cost-utility analysis showed a quite reasonable cost per QALY gained for FELD. A comprehensive range of surgical options should be provided to patients, for which a practical reimbursement system is a prerequisite.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Borame Medical Center, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
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17
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Yuh WT, Kim M, Choi Y, Han J, Kim J, Kim T, Chung CK, Lee CH, Park SB, Kim KT, Rhee JM, Park MS, Kim CH. Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery. Sci Rep 2023; 13:6317. [PMID: 37072455 PMCID: PMC10113194 DOI: 10.1038/s41598-023-33588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/15/2023] [Indexed: 05/03/2023] Open
Abstract
Surgical outcomes of degenerative cervical spinal disease are dependent on the selection of surgical techniques. Although a standardized decision cannot be made in an actual clinical setting, continued education is provided to standardize the medical practice among surgeons. Therefore, it is necessary to supervise and regularly update overall surgical outcomes. This study aimed to compare the rate of additional surgery between anterior and posterior surgeries for degenerative cervical spinal disease using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) nationwide patient database. The NHIS-NSC is a population-based cohort with about a million participants. This retrospective cohort study included 741 adult patients (> 18 years) who underwent their first cervical spinal surgery for degenerative cervical spinal disease. The median follow-up period was 7.3 years. An event was defined as the registration of any type of cervical spinal surgery during the follow-up period. Event-free survival analysis was used for outcome analysis, and the following factors were used as covariates for adjustment: location of disease, sex, age, type of insurance, disability, type of hospital, Charles comorbidity Index, and osteoporosis. Anterior cervical surgery was selected for 75.0% of the patients, and posterior cervical surgery for the remaining 25.0%. Cervical radiculopathy due to foraminal stenosis, hard disc, or soft disc was the primary diagnosis in 78.0% of the patients, and central spinal stenosis was the primary diagnosis in 22.0% of them. Additional surgery was performed for 5.0% of the patients after anterior cervical surgery and 6.5% of the patients after posterior cervical surgery (adjusted subhazard ratio, 0.83; 95% confidence interval, 0.40-1.74). The rates of additional surgery were not different between anterior and posterior cervical surgeries. The results would be helpful in evaluating current practice as a whole and adjusting the health insurance policy.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Minjung Kim
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Taeshin Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Moon Soo Park
- Department of Orthopedics, Hallym University Dongtan Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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18
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Sung TS, Ryoo SB, Lee CH, Choi SM, Nam JW, Kim HB, Lee JY, Lim JD, Park KJ, Lee HT. Prokinetic Activity of Mulberry Fruit, Morus alba L. Nutrients 2023; 15:nu15081889. [PMID: 37111108 PMCID: PMC10143206 DOI: 10.3390/nu15081889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The fruit of Morus alba L. (MAF) has been consumed as a food worldwide. MAF has also been widely used in traditional medicine for thousands of years in East Asia, and its diverse bioactivities have been reported in numerous publications. However, no prokinetic activity has been reported for MAF or its components. In the present study, therefore, we investigated the effects of MAF on gastrointestinal motor function by measuring the intestinal transit rate (ITR) of Evans blue in mice in vivo. The ITR values accelerated by MAF were significantly higher than those accelerated by cisapride or metoclopramide, suggesting that MAF has potential as a new prokinetic agent to replace cisapride and metoclopramide. We also investigated the effects of MAF on myogenic and neurogenic contractions in human intestinal smooth muscles by measuring spontaneous contractions of smooth muscle strips, smooth muscle contractions induced by neural stimulation, and migrating motor complexes from intestinal segments in the human ileum and sigmoid colon in situ. MAF increased both myogenic and neurogenic contractions to enhance ileal and colonic motility in the human intestine. Taken together, these results indicate that MAF enhanced intestinal motility by increasing both myogenic and neurogenic contractions, thereby accelerating the ITR.
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Affiliation(s)
- Tae Sik Sung
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chang-Hyun Lee
- Biopharmaceutical Engineering Major, Division of Applied Bioengineering, College of Engineering, Dong-Eui University, Busan 47340, Republic of Korea
| | - Seon-Min Choi
- Biopharmaceutical Engineering Major, Division of Applied Bioengineering, College of Engineering, Dong-Eui University, Busan 47340, Republic of Korea
| | - Joo-Won Nam
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Hyun-Bok Kim
- National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Ji Young Lee
- Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jung-Dae Lim
- Department of Herbal Medicine Resource, Kangwon National University, Samcheok 25949, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyun-Tai Lee
- Biopharmaceutical Engineering Major, Division of Applied Bioengineering, College of Engineering, Dong-Eui University, Busan 47340, Republic of Korea
- Core-Facility Center for Tissue Regeneration, Dong-Eui University, Busan 47340, Republic of Korea
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19
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Oh H, Sohn JY, Ma S, Choi S, Kim YJ, Lee HC, Lee CH, Kim CH, Chung CK, Park HP. High peak inspiratory pressure may be associated with intraoperative coughing during neurosurgery under general anesthesia without neuromuscular blockade: a retrospective study. BMC Anesthesiol 2023; 23:123. [PMID: 37059969 PMCID: PMC10103441 DOI: 10.1186/s12871-023-02080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The endotracheal cuff pressure depends on the airway pressure during positive-pressure ventilation. A high endotracheal cuff pressure may be related to intraoperative coughing, which can be detrimental during neurosurgery. We investigated the incidence of intraoperative coughing and its association with peak inspiratory pressure (PIP) during neurosurgery under general anesthesia without neuromuscular blockade. METHODS This retrospective study divided 1656 neurosurgical patients who underwent total intravenous anesthesia without additional neuromuscular blockade after tracheal intubation into high (PIP > 21.6 cmH2O, n = 318) and low (PIP ≤ 21.6 cmH2O, n = 1338) PIP groups. After propensity score matching, 206 patients were selected in each group. Demographic, preoperative, surgical, and anesthetic data were collected retrospectively from electronic medical records and continuous ventilator, infusion pump, and bispectral index data from a data registry. RESULTS Intraoperative coughing occurred in 30 (1.8%) patients, including 9 (0.5%) during the main surgical procedure. Intraoperative coughing was more frequent in the high PIP group than in the low PIP group before (14/318 [4.4%] vs. 16/1338 [1.2%], P < 0.001) and after (13/206 [6.3%] vs. 1/206 [0.5%], P = 0.003) propensity score matching. In multivariable logistic regression analysis after propensity score matching, a high PIP (odds ratio [95% confidence interval] 14.22 [1.81-111.73], P = 0.012), tidal volume divided by predicted body weight (mL/kg, 1.36 [1.09-1.69], P = 0.006), and surgical duration (min, 1.01 [1.00-1.01], P = 0.025) predicted intraoperative coughing. CONCLUSION The incidence of intraoperative coughing was 1.8% in neurosurgical patients undergoing general anesthesia without neuromuscular blockade and might be associated with a high PIP.
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Affiliation(s)
- Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seoyoung Ma
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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20
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Sari NY, Li TYW, Yeo S, Ngiam NJH, Lee CH, Evangelista LKM, Lee ECY, Yeo TC, Yip JWL, Poh KK, Kong WKF, Lin WQ, Lim YC, Sia CH, Wong RCC. Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme
Background
The optimal method of risk stratification of hypertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM.
Methods
This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization.
Results
The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness >30mm, significant left ventricular outflow tract (LVOT) gradient of > 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p<0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively].
Conclusion
LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.
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Affiliation(s)
- N Y Sari
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S Yeo
- National University of Singapore, Cardiology , Singapore , Singapore
| | - N J H Ngiam
- National University Health System, Medicine , Singapore , Singapore
| | - C H Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - L K M Evangelista
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - E C Y Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - J W L Yip
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W Q Lin
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Y C Lim
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Cardiology , Singapore , Singapore
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21
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Oh MJ, Lee HB, Yoo G, Park M, Lee CH, Choi I, Park HY. Anti-obesity effects of red pepper ( Capsicum annuum L.) leaf extract on 3T3-L1 preadipocytes and high fat diet-fed mice. Food Funct 2023; 14:292-304. [PMID: 36504043 DOI: 10.1039/d2fo03201e] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with obesity mostly have metabolic syndrome and this can lead to multiple health problems. In the present study, we evaluated the anti-obesity effect of water-soluble red pepper (Capsicum annuum L.) leaf extract (PLE) on 3T3-L1 adipocytes and high-fat diet (HFD)-fed mice. The adipocyte lipid content was determined using Oil Red O staining, which revealed that 100 μg mL-1 PLE markedly reduced fat accumulation without affecting the cell viability. PLE exhibited high prebiotic activity scores by modulating probiotic strains, contributing to host health improvement. In vivo investigation in HFD-fed mice revealed that PLE supplementation significantly decreased the HFD-induced increases in the body weight, amount of white adipose tissue, and serum triglyceride, total cholesterol, leptin, and insulin levels. Consistent with its effects on reduced lipid droplet formation in the liver, PLE supplementation suppressed the expression of lipid synthesis-related proteins including SREBP-1, FAS, and PPAR-γ in the liver and increased that of PGC-1α, CPT1, and adiponectin in epididymal WAT. PLE treatment improved intestinal barrier function and inflammation and reduced harmful intestinal enzyme activities in the feces. Collectively, these results indicate that PLE inhibits fat accumulation in HFD-fed mice via the suppression of adipogenesis and lipogenesis, suggesting its potential in preventing obesity.
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Affiliation(s)
- Mi-Jin Oh
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Hye-Bin Lee
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Guijae Yoo
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Miri Park
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Chang-Hyun Lee
- Department of Anatomy, Woosuk University, Jeollabuk-do 55338, Republic of Korea
| | - Inwook Choi
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Ho-Young Park
- Research Division of Food Functionality, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
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22
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Paik S, Choi Y, Chung CK, Won YI, Park SB, Yang SH, Lee CH, Rhee JM, Kim KT, Kim CH. Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis. PLoS One 2023; 18:e0281926. [PMID: 36809260 PMCID: PMC9942978 DOI: 10.1371/journal.pone.0281926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. METHODS Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months). RESULTS Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. CONCLUSION Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.
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Affiliation(s)
- Seungyoon Paik
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young Il Won
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - John Min Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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23
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Won YI, Kim CH, Park HP, Chung SG, Yuh WT, Kwon SW, Yang SH, Lee CH, Choi Y, Park SB, Rhee JM, Kim KT, Chung CK. A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance. Sci Rep 2022; 12:20408. [PMID: 36437360 PMCID: PMC9701767 DOI: 10.1038/s41598-022-24784-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Lumbar spinal stenosis (LSS) and sagittal imbalance are relatively common in elderly patients. Although the goals of surgery include both functional and radiological improvements, the criteria of correction may be too strict for elderly patients. If the main symptom of patients is not forward-stooping but neurogenic claudication or pain, lumbar decompression without adding fusion procedure may be a surgical option. We performed cost-utility analysis between lumbar decompression and lumbar fusion surgery for those patients. Elderly patients (age > 60 years) who underwent 1-2 levels lumbar fusion surgery (F-group, n = 31) or decompression surgery (D-group, n = 40) for LSS with sagittal imbalance (C7 sagittal vertical axis, C7-SVA > 40 mm) with follow-up ≥ 2 years were included. Clinical outcomes (Euro-Quality of Life-5 Dimensions, EQ-5D; Oswestry Disability Index, ODI; numerical rating score of pain on the back and leg, NRS-B and NRS-L) and radiological parameters (C7-SVA; lumbar lordosis, LL; the difference between pelvic incidence and lumbar lordosis, PI-LL; pelvic tilt, PT) were assessed. The quality-adjusted life year (QALY) and incremental cost-effective ratio (ICER) were calculated from a utility score of EQ-5D. Postoperatively, both groups attained clinical and radiological improvement in all parameters, but NRS-L was more improved in the F-group (p = 0.048). ICER of F-group over D-group was 49,833 US dollars/QALY. Cost-effective lumbar decompression may be a recommendable surgical option for certain elderly patients, despite less improvement of leg pain than with fusion surgery.
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Affiliation(s)
- Young Il Won
- grid.254230.20000 0001 0722 6377Department of Neurosurgery, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong, 30099 Republic of Korea
| | - Chi Heon Kim
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hee-Pyoung Park
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine and Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Sun Gun Chung
- grid.31501.360000 0004 0470 5905Department of Rehabilitation Medicine, Seoul National University College of Medicine and Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Woon Tak Yuh
- grid.488450.50000 0004 1790 2596Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 Republic of Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Incheon Veterans Hospital, 138, Inju-daero, Michuhol-gu, Incheon, 22182 Republic of Korea
| | - Seung Heon Yang
- grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412480.b0000 0004 0647 3378Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Chang-Hyun Lee
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Yunhee Choi
- grid.412484.f0000 0001 0302 820XDivision of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Sung Bae Park
- grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412479.dDepartment of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea
| | - John M. Rhee
- grid.189967.80000 0001 0941 6502Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Kyoung-Tae Kim
- grid.411235.00000 0004 0647 192XDepartment of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea ,grid.258803.40000 0001 0661 1556Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Chun Kee Chung
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Brain and Cognitive Sciences, Seoul National University, 101, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
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Lee CH, Wu MZ, Lui DTW, Fong CHY, Ren QW, Yu SY, Yuen MMA, Chow WS, Huang JY, Xu A, Yiu KH, Lam KSL. Prospective associations of circulating thrombospondin-2 level with heart failure hospitalization, left ventricular remodeling and diastolic function in type 2 diabetes. Cardiovasc Diabetol 2022; 21:231. [PMID: 36335340 PMCID: PMC9637303 DOI: 10.1186/s12933-022-01646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Circulating thrombospondin-2 (TSP2) levels were associated with the development of heart failure (HF) in recent studies. However, these studies included only a minority of patients with type 2 diabetes, which is associated with an increased HF risk. As hyperglycemia induces TSP2 expression and its tissue expression increases in type 2 diabetes, we investigated the prospective association of circulating TSP2 with incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in type 2 diabetes. Methods Baseline serum TSP2 levels were measured in 4949 patients with type 2 diabetes to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 levels were measured in another 146 patients with type 2 diabetes but without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year. Results Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 levels were independently associated with the development of HHF (HR 1.31, 95%CI 1.06–1.62, p = 0.014) after adjustments for baseline conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, loop-diuretics, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. Moreover, baseline serum TSP2 levels were independently associated with increase in average E/e’ and left atrial volume index (p = 0.04 and < 0.01, respectively). Conclusion Serum TSP2 levels were independently associated with both incident HHF and deterioration in diastolic function in type 2 diabetes. Trial registration Not Applicable Supplementary information The online version contains supplementary material available at 10.1186/s12933-022-01646-x.
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Teo Y, Yong CL, Ou YH, Tam WW, Koo CY, Lee CH. Sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In coronary artery bypass grafting (CABG), despite re-establishing coronary reperfusion, myocardial recovery and restoration of contractility often occur later, and the risk of adverse cardiovascular events persists during the post-CABG period. The occurrence of adverse cardiovascular events is linked to abnorm-al cardiac repolarisation that can be measured by surface electrocardiograms (ECGs). Sleep apnoea is an emerging cardiovascular risk factor. The relationship between sleep apnoea, abnorm-al cardiac repolarisation, and the occurrence of adverse cardiovascular events is not well studied.
Purpose
We investigated the impact of sleep apnoea on the change in repolarisation after CABG, and if the change in repolarisation is associated with the occurrence of major adverse cardiac and cerebrovascular events (MACCE).
Methods
Between November 2013 and December 2018, 1007 patients from 4 hospitals underwent an overnight sleep study prior to a non-emergent CABG. ECGs were acquired prospectively within 48h before the CABG (T1), and within 24h after the CABG (T2). QTc intervals were measured in three consecutive heart beats in one lead - the preferential lead measurements were lead II, followed by lead V5. QTc intervals were measured using the BRAVO algorithm by Analysing Medical Parameters for Solutions (AMPS) LLC. The change of T2 from T1 for QTc (ΔQTc) was derived. The mean follow-up duration was 2.1 years. MACCE was a composite of cardiovascular death, myocardial infarction, stroke, and unplanned revascularisation.
Results
A total of 954 patients (median age: 62 years; male: 86%) survived the initial 24 hours and had quality ECGs for analysis. Lead II and V5 were measured in 72% and 25% of the cohort, respectively. A total of 115 patients developed MACCE (MACCE group). Compared with the non-MACCE group, the MACCE group was older, had (a) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease, (b) higher apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI), and (c) a smaller ΔQTc (Table). In Cox regression analysis, a smaller ΔQTc was independently associated with occurrence of MACCE (HR: 1.003; 95% CI: 1.000–1.006; p=0.032).
Older age, history of previous stroke, chronic kidney disease, more severe sleep apnoea (higher AHI, ODI, and severe oxygen desaturation) were associated with smaller ΔQTc. After adjusting for the effects of confounding variables, a higher ODI was independently associated with a smaller ΔQTc (correlation coefficient: −0.58; p<0.001).
Conclusions
In patients undergoing a non-emergent CABG, a smaller ΔQTc during the first 24 hours after the CABG is associated with a higher incidence of MACCE. A higher pre-operative ODI based on a sleep study is an independent predictor of a smaller ΔQTc. This suggests that change in QTc within 24 hours after CABG could be due to sleep apnoea, and it is a novel predictor of occurrence of MACCE at medium term follow-up.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Transition Award and Clinician Scientist Award from the National Medical Research Council of Singapore (award numbers: NMRC/TA/012/2012; NMRC/CSA-INV/002/2015)
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Affiliation(s)
- Y Teo
- National University of Singapore , Singapore , Singapore
| | - C L Yong
- National University of Singapore , Singapore , Singapore
| | - Y H Ou
- National University of Singapore , Singapore , Singapore
| | - W W Tam
- National University of Singapore , Singapore , Singapore
| | - C Y Koo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University of Singapore , Singapore , Singapore
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Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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Chew NWS, Ng CH, Xiao JL, Chan KH, Loh PH, Low A, Lee CH, Tan HC, Chan MY. Coronary artery bypass grafting versus percutaneous coronary intervention with stenting for multivessel coronary artery disease without left main coronary disease:reconstructed individual patient data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease.
Methods
Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints.
Results
We screened 1496 studies and included six randomized controlled trials with 7181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118–1.469, p<0.001) compared with CABG. In patients with low SYNTAX score, 10-year all-cause mortality after PCI was comparable to CABG (HR: 1.102, 0.822–1.479, p=0.516). However, in patients with moderate to high SYNTAX score, 10-year all-cause mortality was significantly higher after PCI compared with CABG (HR: 1.444, 1.122–1.858, p<0.001; HR: 1.856, 1.380–2.497, p<0.001 respectively).
Conclusion
This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - J L Xiao
- National University of Singapore , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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29
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Chew N, Teo V, Tan C, Kong G, Chin YH, Ambhore A, Low A, Lee CH, Chan MY, Tan HC, Ph LOH. A 10-year cohort on prognostic outcomes in patients presenting with acute myocardial infarction complicated by cardiogenic shock and/or cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) and cardiac arrest (CA) complicating acute myocardial infarction (AMI) portend unfavourable outcomes. This study examined the prognosis of patients presenting with AMI complicated by CS and/or CA.
Methods
Consecutive patients presented with AMI to a percutaneous coronary intervention-capable tertiary institution between 2011 and 2021 were studied. Patients were stratified based on the presence or absence of CS (CS+ or CS−) and CA (CA+ or CA−). The primary outcome was 30-day cardiovascular-related mortality. Subgroup analyses based on AMI-type and sex were conducted. Kaplan-Meier curves for cardiovascular-related mortality based on the AMI-type and sex were constructed.
Results
The study included 11,608 AMI patients, 283 of whom had CS+/CA+, 1,068 had CS+/CA−, 54 had CS−/CA+ and 10,203 had CS−/CA−. Cardiovascular-related mortality was significantly higher for CS+/CA+ (57.6%), followed by CS+/CA− (41.6%), CS−/CA+ (20.4%) and CS−/CA− (2.4%). Kaplan-Meier curves demonstrated CS+/CA+ group had the highest mortality (HR=36.26; 95% CI: 29.71–44.25, p<0.001), followed by CS+/CA− (HR=21.59; 95% CI: 18.47–25.24, p<0.001) and CS−/CA+ (HR=9.18; 95% CI: 5.02–16.80, p<0.001), with CS−/CA− as the reference. Those with NSTEMI had consistently higher cardiovascular-related mortality rates than their STEMI counterparts for all groups, apart from the CS+/CA+ group. The sex-specific analysis demonstrated that the survival curves for females with CS+/CA+, CS+/CA− and CS−/CA+ converged, whilst the survival curves for males diverged over time. The multivariable Cox regression revealed the presence of CS and CA are independent predictors of cardiovascular-related mortality, but not NSTEMI, when adjusted for age, gender, diabetes, left ventricular ejection fraction, chronic renal failure, and culprit vessel.
Conclusions
AMI associated with CA and CS portends the least favourable survival, followed by those with CS or CA alone. Excess mortality was observed in the traditionally perceived lower-risk groups, particularly in women. This calls for increased awareness amongst clinicians when managing this subset of high-risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - V Teo
- National University of Singapore , Singapore , Singapore
| | - C Tan
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - A Ambhore
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - L O H Ph
- National University Heart Centre , Singapore , Singapore
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30
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Chen CY, Li YH, Lee CH, Lin HW, Lin SH. Legacy effects of infection in patients with heart failure: a national cohort study of 31,318 patients in Taiwan. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although infection is a common cause of hospitalization in patients (pts) with heart failure (HF), the long-term cardiovascular (CV) prognosis in HF after infection is not well studied.
Methods and results
From 2009 to 2015, 310,485 pts with their first HF admissions and survival to discharge were identified from the National Health Insurance Research Database. Among the pts, 103,505 (33.3%) were readmitted within 1 year after HF discharge for infection, including pneumonia (44.2%), urinary tract infection (UTI) (37.9%), skin and soft tissue infections (9.7%), and others (8.1%). Those without admission for any infection were controls. We compared the primary composite endpoint, including all-cause death, acute myocardial infarction (AMI), stroke, and hospitalization for HF (HHF) between the 2 groups after the infection episode. After propensity score matching, the clinical characteristics (age 71.7±13.9 years, male 52.0%) and treatment were similar between the groups (n=15,659 in each group). In a mean follow-up time of 4.3±2.9 years, 86.2% pts with a history of infection admission and 63.6% pts in the control group met the primary endpoint. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of the primary composite endpoint (HR 1.760, 95% CI 1.714–1.807), including all-cause death (HR 1.587, 95% CI: 1.540–1.636), HHF (HR 1.993, 95% CI 1.922–2.066), AMI (HR 1.332, 95% CI 1.224–1.450), and stroke (HR 1.769, 95% CI 1.664–1.882). In infection group, HHF was the earliest outcome event with a mean time of 17.5 months and mortality is the second early event with a mean time of 23 months after discharge from the infection episode. Pneumonia carried a higher risk than UTI for the primary composite endpoint (HR 1.140, 95% CI 1.104–1.178).
Conclusions
One-third of HF pts discharged from the hospital experienced acute infection that required readmission. The pts had worse CV prognosis after readmission for infectious disease compared to those without infection
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This study is supported by National Cheng Kung University Hospital and Tainan Hospital, Ministry of Health and Welfare, Taiwan.
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Affiliation(s)
- C Y Chen
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - Y H Li
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - C H Lee
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - H W Lin
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - S H Lin
- National Cheng Kung University , Tainan , Taiwan
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31
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Chew NWS, Zhang A, Koh S, Ong JL, Kong G, Lim O, Kuntjoro I, Kong W, Low A, Lee CH, Chan MY, Yeo TC, Tan HC, Poh KK, Loh PH. Higher long-term mortality in patients with concomitant acute coronary syndrome and aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular risk factors, and their concomitant presentation is increasing in incidence with the aging population. Yet literature regarding the prognosis of patients with concomitant ACS and AS remains scarce.
Methods
This retrospective cohort study examined consecutive patients presenting with ACS (ST-segment elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and concomitant AS between 1 January 2011 and 31 March 2021 in a tertiary hospital. The cohort was divided into mild, moderate and severe AS based on index echocardiogram. The primary outcome was all-cause mortality. Kaplan-Meier curves were constructed to compare all-cause mortality among the three groups of patients, based on ACS type and left ventricular ejection fraction (LVEF). Multivariable Cox regression was performed to identify independent predictors of all-cause mortality.
Results
Of a total of 563 patients, 264 had mild (46.9%), 193 moderate (34.3%) and 106 severe AS (18.8%). The mean follow-up duration was 2.5 (± 2.4) years. Majority of patients (72.5%) presented with NSTEMI. Patients with moderate and severe AS had higher rates of all-cause mortality compared to those with mild AS (49.7% vs. 51.4% vs. 35.6% respectively, p=0.002). Concomitant moderate (HR 1.439, 95% CI 1.012–2.048, p=0.043) and severe AS (HR 1.844, 95% CI 1.159–2.933, p=0.010) were independent predictors of all-cause mortality after adjusting for age, gender, LVEF, ACS type, chronic kidney disease, diabetes, hypertension, coronary artery bypass grafting and aortic valve replacement as a time-dependent variable. The Kaplan-Meier curves demonstrated excess mortality in moderate and severe AS, compared to the mild AS group (p<0.001), with similar survival trends observed in the STEMI and the NSTEMI groups, as well as those with preserved LVEF.
Conclusion
Regardless of the ACS presentation type, long-term excess mortality in those with concomitant moderate or severe AS was observed. The adverse prognosis typically observed in patients with concomitant severe AS, in the setting of ACS, extends to patients with moderate AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Heart Centre , Singapore , Singapore
| | - S Koh
- National University Heart Centre , Singapore , Singapore
| | - J L Ong
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - O Lim
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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Li F, Choi J, Zhang X, Rajaraman PK, Lee CH, Ko H, Chae KJ, Park EK, Comellas AP, Hoffman EA, Lin CL. Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach. Int J Environ Res Public Health 2022; 19:11894. [PMID: 36231196 PMCID: PMC9565839 DOI: 10.3390/ijerph191911894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Around nine million people have been exposed to toxic humidifier disinfectants (HDs) in Korea. HD exposure may lead to HD-associated lung injuries (HDLI). However, many people who have claimed that they experienced HD exposure were not diagnosed with HDLI but still felt discomfort, possibly due to the unknown effects of HD. Therefore, this study examined HD-exposed subjects with normal-appearing lungs, as well as unexposed subjects, in clusters (subgroups) with distinct characteristics, classified by deep-learning-derived computed-tomography (CT)-based tissue pattern latent traits. Among the major clusters, cluster 0 (C0) and cluster 5 (C5) were dominated by HD-exposed and unexposed subjects, respectively. C0 was characterized by features attributable to lung inflammation or fibrosis in contrast with C5. The computational fluid and particle dynamics (CFPD) analysis suggested that the smaller airway sizes observed in the C0 subjects led to greater airway resistance and particle deposition in the airways. Accordingly, women appeared more vulnerable to HD-associated lung abnormalities than men.
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Affiliation(s)
- Frank Li
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
- IIHR—Hydroscience & Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Jiwoong Choi
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, KS 66045, USA
| | - Xuan Zhang
- IIHR—Hydroscience & Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Prathish K. Rajaraman
- IIHR—Hydroscience & Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Chang-Hyun Lee
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, College of Medicine, Seoul National University, Seoul 100-011, Korea
| | - Hongseok Ko
- Department of Radiology, Kangwon National University Hospital, Chuncheon 200-010, Korea
| | - Kum-Ju Chae
- Department of Radiology, Jeonbuk National University Hospital, Jeonju 560-011, Korea
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan 600-011, Korea
| | | | - Eric A. Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ching-Long Lin
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
- IIHR—Hydroscience & Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
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Lee CH, Yang HY, Seon JK. Increased medial meniscus extrusion led to worse clinical outcomes after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1614-1622. [PMID: 36083355 DOI: 10.1007/s00167-022-07148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Given that no studies have assessed the correlation between improvements in medial meniscus extrusion (MME) and clinical outcomes after medial opening-wedge high tibial osteotomy (MOWHTO), the present study aimed to measure the improvement in MME after MOWHTO and to investigate the correlation between the remaining postoperative MME and MOWHTO clinical outcomes by subgroup analysis. METHODS This study included 79 patients (80 knees) who underwent MOWHTO with a minimum follow-up of 2 years. MME was measured pre- and postoperatively through magnetic resonance imaging after an average of 19.8 months following MOWHTO surgery. Clinical outcomes were evaluated according to the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Activity Scale, and the Short-Form 36 questionnaire. In subgroup analysis, postoperative MME was classified into non-pathologic (≤ 3 mm) and pathologic (> 3 mm) groups. The clinical outcomes of the two groups were compared using Mann-Whitney U tests. A regression analysis was performed to determine the preoperative and postoperative characteristics associated with the improvement of MME. RESULTS The mean (± standard deviation) values for pre- and postoperative MME were 3.6 (± 1.8) mm and 2.8 (± 1.5) mm, respectively (p < 0.001). In the subgroup analysis of postoperative MME, the non-pathologic group showed better improvement of KOOS than the pathologic group. Preoperative hip-knee-ankle angle was correlated with the improvement of medial meniscal extrusion in both univariate (p = 0.049) and multivariate (p = 0.015) analyses. CONCLUSION The MME improved after MOWHTO, and the clinical outcomes were better for patients with a postoperative MME of less than 3 mm than for those with more than 3 mm. MME improvement after MOWHTO was correlated with preoperative varus alignment of the lower extremities. LEVEL OF EVIDENCE III (Retrospective cohort study).
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Affiliation(s)
- Chang-Hyun Lee
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-gun, 58128, Republic of Korea
| | - Hong-Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-gun, 58128, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-gun, 58128, Republic of Korea.
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Ho JC, Wen HJ, Sun CW, Tsai SF, Su PH, Chang CL, Sun HL, Wang SL, Lee CH. Prenatal exposure to nickel and atopic dermatitis at age 3 years: a birth cohort study with cytokine profiles. J Eur Acad Dermatol Venereol 2022; 36:2414-2422. [PMID: 35841308 DOI: 10.1111/jdv.18425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nickel, the fifth most common element on Earth, is the leading inducer of contact allergies in humans, with potent immunological effects. Nickel-induced contact allergies predominantly affect females. Maternal exposure to nickel has been associated with several developmental abnormalities. However, how a maternal nickel exposure affects the development of atopic diathesis and immune abnormalities in children has never been addressed. OBJECTIVES We aimed to determine whether maternal Ni exposure affects the development of atopic dermatitis and immune abnormalities in their children. METHODS Using a birth cohort study, we analysed 140 mother-child pairs recruited in 2012-2015 from central Taiwan. Maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma mass spectrometry (ICP-MS). The serum levels of 65 analytes and IgE in 3-year-old children were profiled with a multiplex ELISA. The correlation between the maternal urinary nickel concentration and serum analyte levels was assessed using Spearmen's correlation. Multivariant regression analysis was performed to evaluate the association between maternal urinary nickel levels and serum analyte concentrations in their children. RESULTS The geometric means of the maternal urinary nickel and the children's serum IgE levels were 2.27 μg/L and 69.71 IU/ml, respectively. The maternal nickel exposure was associated with increased serum levels of IL-1β, IL-2, TNF-α, and leukaemia inhibitory factor (LIF) but with decreased serum levels of matrix metalloproteinase-1 (MMP-1), IL-2R, and eotaxin-1 in the children. In addition, the development of childhood atopic dermatitis at 3 years old was significantly associated with the child's serum levels of IgE and IL-2R, but it was negatively associated with the maternal nickel exposure. CONCLUSIONS This is the first study showing the potential immunological effects of maternal nickel exposure in their children at an early developmental stage.
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Affiliation(s)
- J C Ho
- Department of Dermatology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - H J Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan.,Institute of Earth Science, Academia Sinica, Taipei, Taiwan
| | - C W Sun
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
| | - S F Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
| | - P H Su
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C L Chang
- Department of Pediatrics, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - H L Sun
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - S L Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan.,Department of Public Health, National Defence Medical Centre, Taipei, Taiwan.,Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan
| | - C H Lee
- Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Won YI, Lee CH, Yuh WT, Kwon SW, Kim CH, Chung CK. Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review. Neurospine 2022; 19:299-306. [PMID: 35793933 PMCID: PMC9260552 DOI: 10.14245/ns.2244038.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Chang-Hyun Lee Department of Neurosurgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul 03080, Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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36
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Oh MJ, Lee HHL, Lee HB, Do MH, Park M, Lee CH, Park HY. A water soluble extract of radish greens ameliorates high fat diet-induced obesity in mice and inhibits adipogenesis in preadipocytes. Food Funct 2022; 13:7494-7506. [PMID: 35686604 DOI: 10.1039/d1fo04152e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Radish (Raphanus sativus L.) is a rich source of nutrients and its greens have reported functionalities. This study aimed to investigate the effects of a water-soluble extract from radish greens (WERG) on adipogenesis in 3T3-L1 adipocytes and high-fat diet-induced obesity in model mice. We also quantified the phytochemical composition of WERG such as glucoraphenin and ferulic acid. These findings show that treatment with 100 μg mL-1 WERG reduced lipid accumulation in 3T3-L1 adipocytes, whereas in mice, the administration of 100 mg kg-1 WERG reduced weight gain and hepatic lipid accumulation and improved the levels of serum lipid biomarkers. Furthermore, WERG treatment improved intestinal permeability and suppressed the activities of harmful intestinal enzymes in feces, thus improving gut health. It also inhibited metabolic endotoxemia and inflammatory marker levels in serum. Moreover, WERG reduced the expression of lipid-metabolism-related proteins in the liver and white adipose tissue. Collectively, these results indicate that WERG may potentiate the anti-obesity effect by improving gut health and regulating lipid metabolism.
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Affiliation(s)
- Mi-Jin Oh
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Hyun Hee L Lee
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Hye-Bin Lee
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Moon Ho Do
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Miri Park
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
| | - Chang-Hyun Lee
- Department of Anatomy, Woosuk University, Jeollabuk-do 55338, Republic of Korea.
| | - Ho-Young Park
- Food Functionality Research Division, Korea Food Research Institute, Jeollabuk-do 55365, Republic of Korea.
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37
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Kim DH, Hyun SJ, Lee CH, Kim KJ. The Last Touched Vertebra on Supine Radiographs Can Be the Optimal Lower Instrumented Vertebra in Adolescent Idiopathic Scoliosis Patients. Neurospine 2022; 19:236-243. [PMID: 35378591 PMCID: PMC8987554 DOI: 10.14245/ns.2143224.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To determine whether the last touched vertebra (LTV) on supine radiographs is suitable for the lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) correction surgery.
Methods In total, 57 patients were included in the study following posterior instrumentation and fusion. The average follow-up period was 2.2 years. Patients were classified into 4 groups according to the relationship of the location of LIV, LTV, and the last substantially touched vertebra (LSTV) on upright radiographs and the LTV on supine radiographs. In group 1, the upright LTV and supine LTV were the same. Group 1 was subdivided into group 1A and group 1B according to whether the LTV and LSTV were different or the same, respectively. In group 2, the upright LTV was selected as the LIV, whereas in group 3, the supine LTV was selected as the LIV. The baseline characteristics and the preoperative and postoperative radiographic/clinical outcomes of the groups were analyzed.
Results No differences were found in the preoperative clinical and radiographic baseline characteristics of the 4 groups except the LIV-central sacral vertical line distance. The immediate, 6-month, 1-year, and 2-year postoperative outcomes were not significantly different among the 4 groups. One patient (4.3%) in group 1A experienced radiographic adding-on without clinical symptoms. No patients underwent revision surgery.
Conclusion The group in whom the LIV was selected as the LTV on supine x-rays showed similar postoperative radiographic and clinical results to other groups. The LTV on preoperative supine radiographs is acceptable as the LIV in AIS surgery to maximize motion segments.
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Affiliation(s)
- Do-Hyoung Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Corresponding Author Seung-Jae Hyun https://orcid.org/0000-0003-2937-5300 Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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38
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Kim HB, Shim JK, Ko SH, Kim HR, Lee CH, Kwak YL. Effect of iron deficiency without anaemia on days alive and out of hospital in patients undergoing valvular heart surgery. Anaesthesia 2022; 77:562-569. [PMID: 35262180 DOI: 10.1111/anae.15681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
Comprehensive evidence regarding the treatment of non-anaemic iron deficiency in patients undergoing valvular heart surgery is lacking. This study aimed to investigate the association between non-anaemic iron deficiency and postoperative outcomes in these patients. We retrospectively analysed 321 patients of which 180 (56%) had iron deficiency (defined as serum ferritin < 100 ng.ml-1 or < 300 ng.ml-1 with transferrin saturation < 20%). While the iron-deficient group had lower pre-operative haemoglobin levels than the non-iron deficient group (median (IQR [range]) 134 (127-141 [120-172]) g.l-1 , 143 (133-150 [120-179]) g.l-1 , p = 0.001), there was no between-group difference in allogeneic red blood cell transfusion. Median (IQR [range]) days alive and out of hospital at postoperative day 90 was 1 day shorter in the iron-deficient group (80 (77-82 [9-85]) days vs. 81 (79-83 [0-85]) days, p = 0.026). In multivariable analysis, only cardiopulmonary bypass duration (p = 0.032) and intra-operative allogeneic red blood cell transfusion (p = 0.011) were significantly associated with reduced days alive and out of hospital at postoperative day 90. Iron deficiency did not exert any adverse influence on secondary outcomes except length of hospital stay. Our findings indicate that non-anaemic iron deficiency alone is not associated with adverse effects in patients undergoing valvular heart surgery when it does not translate into an increased risk of allogeneic transfusion.
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Affiliation(s)
- H B Kim
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J K Shim
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Ko
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H R Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C H Lee
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y L Kwak
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Leung TP, Lee CH, Chang EWY, Lee QJ, Wong YC. Clinical outcomes of fast-track total knee arthroplasty for patients aged >80 years. Hong Kong Med J 2022; 28:7-15. [DOI: 10.12809/hkmj208911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- TP Leung
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | - CH Lee
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | | | - QJ Lee
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | - YC Wong
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
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40
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Yang HY, Kwak WK, Lee CH, Kang JK, Song EK, Seon JK. Extent of Preoperative Medial Meniscal Extrusion Influences Intermediate-Term Outcomes After Medial Opening-Wedge High Tibial Osteotomy. J Bone Joint Surg Am 2022; 104:316-325. [PMID: 34767542 DOI: 10.2106/jbjs.21.00456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to determine the relationship between preoperative medial meniscal extrusion, as classified according to magnetic resonance imaging (MRI), and medial opening-wedge high tibial osteotomy outcomes at intermediate-term follow-up. METHODS We reviewed the records for 212 patients who had undergone medial opening-wedge high tibial osteotomy for the treatment of medial compartment osteoarthritis between January 2009 and September 2014, with a minimum duration of follow-up of 5 years. Patients were divided into 2 groups according to the presence of pathologic medial meniscal extrusion (>3 mm). Moreover, patients were divided into 4 groups according to MRI Osteoarthritis Knee Score (MOAKS) criteria and relative medial meniscal extrusion values. Associations between the extent of preoperative medial meniscal extrusion and clinical outcomes over a mean duration of follow-up of 8.1 years were evaluated with use of Spearman rank correlation analysis. Regression analyses were performed to determine preoperative characteristics relevant to medial meniscal extrusion. Clinical outcomes were assessed with use of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner activity scale score. RESULTS Postoperative KOOS pain scores were significantly different in the pathologic and non-pathologic medial meniscal extrusion groups (69.9 ± 18.0 versus 79.2 ± 11.4, respectively; p < 0.001). Additionally, the degree of preoperative medial meniscal extrusion based on both classification methods and the postoperative KOOS pain score were significantly correlated (r = -0.404 and -0.364; p < 0.001). Despite the inferior clinical outcomes associated with greater preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with significant improvement in all outcome measures between the preoperative and latest follow-up assessments (p < 0.001). Preoperative meniscal patterns, including horizontal flap, complex, and root tears (p = 0.001), and increased Kellgren-Lawrence grade (p < 0.001) were related to the severity of medial meniscal extrusion. The survival rate was 94.8% at a mean of 8.1 years, and survival was not associated with the grade of medial meniscal extrusion as assessed with either classification scheme. CONCLUSIONS At intermediate-term follow-up, greater preoperative medial meniscal extrusion was related to inferior postoperative clinical outcomes, specifically pain, after medial opening-wedge high tibial osteotomy. Despite the inferior results associated with preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with a satisfactory survival rate after a mean of 8.1 years, regardless of the extent of medial meniscal extrusion. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hong-Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
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Abstract
The global prevalence of non‐alcoholic fatty liver disease (NAFLD) is rising, along with the epidemic of diabesity. NAFLD is present in >70% of individuals with type 2 diabetes. Although the mutually detrimental relationship between NAFLD and type 2 diabetes has been well established, a multitude of recent studies have further shown that type 2 diabetes is closely linked to the development of cirrhosis, hepatocellular carcinoma, liver‐related morbidity and mortality. In contrast, NAFLD also negatively impacts type 2 diabetes both in terms of its incidence and related adverse clinical outcomes, including cardiovascular and chronic kidney diseases. In response to these global health threats, clinical care pathways for NAFLD and guidelines for metabolic dysfunction‐associated fatty liver disease have been developed. Several antidiabetic agents have been evaluated for their potential hepatic benefits with promising results. Furthermore, type 2 diabetes patients are increasingly represented in clinical trials of novel therapeutics for NAFLD. However, despite the wealth of knowledge in NAFLD and type 2 diabetes, lack of awareness of the disease and the potential weight of this problem remains a major challenge, especially among clinicians who are outside the field of hepatology and gastroenterology. This review therefore aimed to provide all diabetes care providers with a summary of the latest evidence that supports NAFLD as an emerging diabetic complication of increasing importance, and to present the current recommendations, focusing on the assessment and therapeutic strategies, on the management of NAFLD among type 2 diabetes patients.
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Affiliation(s)
- C H Lee
- Department of Medicine, University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong SAR
| | - Dtw Lui
- Department of Medicine, University of Hong Kong, Hong Kong SAR
| | - Ksl Lam
- Department of Medicine, University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong SAR
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Kim T, Kim YG, Park S, Lee JK, Lee CH, Hyun SJ, Kim CH, Kim KJ, Chung CK. Diagnostic triage in patients with central lumbar spinal stenosis using a deep learning system of radiographs. J Neurosurg Spine 2022; 37:1-8. [PMID: 35061993 DOI: 10.3171/2021.11.spine211136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is the gold-standard tool for diagnosing lumbar spinal stenosis (LSS), but it is difficult to promptly examine all suspected cases with MRI considering the modality's high cost and limited accessibility. Although radiography is an efficient screening technique owing to its low cost, rapid operability, and wide availability, its diagnostic accuracy is relatively poor. In this study, the authors aimed to develop a deep learning model with a convolutional neural network (CNN) for diagnosing severe central LSS using radiography and to evaluate radiological diagnostic features using gradient-weighted class activation mapping (Grad-CAM). METHODS Patients who had undergone both spinal MRI and radiography in the period from May 1, 2005, to December 31, 2017, were screened. According to the formal MRI report, participants were consecutively included in the severe central LSS or healthy control group, and radiographs for both groups were collected. A CNN-based transfer learning algorithm was developed to classify radiographic findings as LSS or normal (binary classification). The proposed models were evaluated using six performance metrics: area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and positive and negative predictive values. RESULTS The VGG19 model achieved the highest accuracy with an AUROC of 90.0% (95% CI 89.8%-90.3%) by training 12,442 images. Accuracy was 82.8% (95% CI 82.5%-83.1%) by averaging 5-fold models. Feature points on Grad-CAM were reasonable, and the features could be categorized into reduced disc height, narrow foramina, short pedicle, and hyperdense facet joint. The AUROC in the extra validation was 89.3% (95% CI 88.7%-90.0%). Accuracy was 81.8% (95% CI 80.6%-83.0%) by averaging 5-fold models. Multivariate logistic regression analysis showed that a combination of demographic factors (age and sex) did not improve the model performance. CONCLUSIONS The algorithm trained by a CNN to identify central LSS on radiographs showed high diagnostic accuracy and is expected to be useful as a triage tool. The algorithm could accurately localize the stenotic lesion to assist physicians in the identification of LSS.
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Affiliation(s)
- Tackeun Kim
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
| | - Young-Gon Kim
- 2Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul
- 3AI Institute, Seoul National University, Seoul
| | - Seyeon Park
- 2Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul
| | - Jae-Koo Lee
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
| | - Chang-Hyun Lee
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Seung-Jae Hyun
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
- 5Seoul National University College of Medicine, Seoul; and
| | - Chi Heon Kim
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul
- 5Seoul National University College of Medicine, Seoul; and
| | - Ki-Jeong Kim
- 1Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
- 5Seoul National University College of Medicine, Seoul; and
| | - Chun Kee Chung
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul
- 5Seoul National University College of Medicine, Seoul; and
- 6Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Lee CH, Kim KT, Kim CH, Lee EY, Lee SG, Seo ME, Kim JH, Chung CK. Unveiling the genetic variation of severe continuous/mixed-type ossification of the posterior longitudinal ligament by whole-exome sequencing and bioinformatic analysis. Spine J 2021; 21:1847-1856. [PMID: 34273568 DOI: 10.1016/j.spinee.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is known as a rare, complex genetic disease, its complexity being partly because OPLL is diagnosed by radiological findings regardless of clinical or genetic evaluations. Although many genes associated with susceptibility have been reported, the exact causative genes are still unknown. PURPOSE We performed an analysis using next-generation sequencing and including only patients with a clear involved phenotype. STUDY DESIGN/SETTING This was a case control study. PATIENT SAMPLE A total of 74 patients with severe OPLL and 26 healthy controls were included. OUTCOME MEASURES Causal single-nucleotide variant (SNV), gene-wise variant burden (GVB), and related pathway METHOD: We consecutively included the severe OPLL patients with continuous-/mixed-type and an occupying ratio of ≥ 40%, and performed whole-exome sequencing (WES) and bioinformatic analysis. Then, a validation test was performed for candidate variations. Participants were divided into 4 groups (rapidly-growing OPLL, growing rate ≥ 2.5%/y; slow-growing, < 2.5%/y; uncertain; and control). RESULTS WES was performed on samples from 74 patients with OPLL (rapidly-growing, 33 patients; slow-growing, 37; and uncertain, 4) with 26 healthy controls. Analysis of 100 participants identified a newly implicated SNV and 4candidate genes based on GVB. The GVB of CYP4B1 showed a more deleterious score in the OPLL than the control group. Comparison between the rapidly growing OPLL and control groups revealed seven newly identified SNVs. We found significant association for 2 rare missense variants; rs121502220 (odds ratio [OR] = infinite; minor allele frequency [MAF] = 0.034) in NLRP1 and rs13980628 (OR= infinite; MAF = 0.032) in SSH2. The 3 genes are associated with inflammation control and arthritis, and SSH2 and NLRP1 are also related to vitamin D modulation. CONCLUSIONS Identification of unique variants in novel genes such as CYP4B1 gene may induce the development of OPLL. In subgroup analysis, NLRP1 and SSH2 genes coding inflammation molecules may related with rapidly-growing OPLL.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
| | - Ki Tae Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul; Department of Laboratory Medicine, Korea University Anam Hospital, Seoul
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul; Department of Neurosurgery, Seoul National University College of Medicine
| | - Eun Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sang Gu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Seongnam
| | - Myung-Eui Seo
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul; Department of Neurosurgery, Seoul National University College of Medicine; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, The Republic of Korea.
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Kim BJ, Park JI, Nam JH, Lee JH, Lee CH, Son JW, Park JS, Shin DG, Kim U, Her SH, Chang KY, Ahn TH, Jeong MH, Rha SW, Kim HS. Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI).
Methods
From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST).
Results
IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251).
Conclusion
This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B J Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J I Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Nam
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - C H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J W Son
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J S Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - D G Shin
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - U Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - S H Her
- St. Vincent's Hospital, College of Medicine, Suwon, Korea (Republic of)
| | - K Y Chang
- The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea (Republic of)
| | - T H Ahn
- Gachon University Gil Medical Center, Incheon, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Hospital, Gwangju, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Cho HJ, Ko YS, Won YI, Lee CH, Yang SH, Kim CH, Chung CK. The Efficacy of Lumbar Hybrid Fusion for the Prevention of Adjacent Segment Disease: Fact or Artifact? A Meta-analysis. Clin Spine Surg 2021; 34:260-268. [PMID: 33044274 DOI: 10.1097/bsd.0000000000001097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A systematic literature review and meta-analysis. OBJECTIVE The aim of this study is to compare hybrid constructs with traditional fusion-only constructs for the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes in patients with degenerative lumbar diseases. SUMMARY OF BACKGROUND DATA Spinal fusion is a standard surgery for various pathologies of the lumbar spine, which results in changes to the biomechanics of the spine, potentially leading to ASDeg. Although ASDeg can occur slowly as a natural course, early-onset ASDeg is regarded to be related to fusion surgery. MATERIALS AND METHODS A systematic search was conducted to identify studies that match the purpose. Included studies were compared using the incidence of ASDeg, Oswestry Disability Index, Visual Analog Score, and perioperative outcomes. We calculated the Peto odds ratio and mean difference (MD) for the continuous variables, respectively. In the hybrid group, subgroup analysis was also performed among devices. RESULTS Among 10 papers involving 767 patients, 372 patients underwent hybrid fusion and 395 patients underwent fusion-only. ASDeg occurred in 10.2% in the hybrid and 21.5% in the fusion-only group [Peto odds ratio, 0.39; 95% confidence interval (CI), 0.23-0.64]. The MD for Visual Analog Score were 0.45 (95% CI, 0.05-0.85) between 2 groups, which was statistically significant but was too small to have clinical significance. The MD for Oswestry Disability Index was 0.93 (95% CI, -1.016 to 2.872), which was not statistically different between 2 groups. The hybrid is superior for 18 minutes (95% CI, 5.78-30.72) shorter than typical surgery. CONCLUSIONS Hybrid lumbar surgery decreased the incidence of early-onset ASDeg for about 2 years of follow-up. Among the hybrid constructs, the interspinous devices group accomplished favorable results with a lower risk. Adjacent segment disease was not as statistically significant as ASDeg, but adjacent segment disease may show a substantial difference for >2-year follow-up.
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Affiliation(s)
- Hyun-Jae Cho
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Young San Ko
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam-si
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Seoul National University College of Medicine
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Seoul National University College of Medicine.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Hyun SJ, Yoon SH, Kim JH, Oh JK, Lee CH, Shin JJ, Kang J, Ha Y. A Prospective, Multi-Center, Double-Blind, Randomized Study to Evaluate the Efficacy and Safety of the Synthetic Bone Graft Material DBM Gel with rhBMP-2 versus DBM Gel Used during the TLIF Procedure in Patients with Lumbar Disc Disease. J Korean Neurosurg Soc 2021; 64:562-574. [PMID: 33906347 PMCID: PMC8273782 DOI: 10.3340/jkns.2020.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objective This study is to evaluate the efficacy and safety of demineralized bone matrix (DBM) gel versus DBM gel with recombinant human bone morphogenetic protein-2 (rhBMP-2) used in transforaminal lumbar interbody fusion (TLIF).
Methods This study was designed as a prospective, multi-center, double-blind method, randomized study. All randomized subjects underwent TLIF with DBM gel with rhBMP-2 group (40 patients) as an experimental group or DBM gel group (36 patients) as a control group. Post-operative observations were performed at 12, 24, and 48 weeks. The spinal fusion rate on computed tomography scans and X-rays films, Visual analog scale pain scores, Oswestry disability index and SF-36 quality of life (QOL) scores were used for the efficacy evaluation. The incidence rate of adverse device effects (ADEs) and serious adverse device effects (SADEs) were used for safety evaluation.
Results The spinal fusion rate at 12 weeks for the DBM gel with rhBMP-2 group was higher with 73.68% compared to 58.82% for the DBM gel group. The 24 and 48 weeks were 72.22% and 82.86% for the DBM gel with rhBMP-2 group and 78.79% and 78.13%, respectively, for the DBM gel group. However, there were no significant differences between two groups in the spinal fusion rate at 12, 24, and 48 weeks post-treatment (p=0.1817, p=0.5272, p=0.6247). There was no significant difference between the two groups in the incidence rate of ADEs (p=0.3836). For ADEs in the experimental group, ‘Pyrexia’ (5.00%) was the most common ADE, followed by ‘Hypesthesia’, ‘Paresthesia’, ‘Transient peripheral paralysis’, ‘Spondylitis’ and ‘Insomnia’ (2.50%, respectively). ADEs reported in control group included ‘Pyrexia’, ‘Chest discomfort’, ‘Pain’, ‘Osteoarthritis’, ‘Nephropathy toxic’, ‘Neurogenic bladder’, ‘Liver function analyses’ and ‘Urticaria’ (2.86%, respectively). There was no significant difference between the two groups in the incidence rate of SADEs (p=0.6594). For SADE in the experimental group, ‘‘Pyrexia’ and ‘Spondylitis’ were 2.50%. SADE reported in the control group included 'Chest discomfort’, ‘Osteoarthritis’ and ‘Neurogenic bladder’. All SADEs described above were resolved after medical treatment.
Conclusion This study demonstrated that the spinal fusion rates of DBM gel group and DBM gel with rhBMP-2 group were not significantly different. But, this study provides knowledge regarding the earlier postoperative effect of rhBMP-2 containing DBM gel and also supports the idea that the longer term follow-up results are essential to confirm the safety and effectiveness.
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Affiliation(s)
- Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Yongin, Korea
| | - Jiin Kang
- Department of Neurosurgery, Yongin Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Kim YR, Lee CH, Yang SH, Hyun SJ, Kim CH, Park SB, Kim KJ, Chung CK. Accuracy and precision of the spinal instability neoplastic score (SINS) for predicting vertebral compression fractures after radiotherapy in spinal metastases: a meta-analysis. Sci Rep 2021; 11:5553. [PMID: 33692442 PMCID: PMC7947012 DOI: 10.1038/s41598-021-84975-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy has played an important role in the treatment of spinal metastases. One of the major complications of radiotherapy is vertebral compression fracture (VCF). Although the spinal instability neoplastic score (SINS) was developed for evaluating spinal instability in patients with spinal metastases, it is also commonly used to predict VCF after radiotherapy in patients with spinal metastases. However, its accuracy for predicting radiotherapy-induced VCF and precision remain controversial. The aim of this study was to clarify the diagnostic value of the SINS to predict radiotherapy-induced VCF and to make recommendations for improving its diagnostic power. We searched core databases and identified 246 studies. Fourteen studies were analyzed, including 7 studies (with 1269 segments) for accuracy and 7 studies (with 280 patients) for precision. For accuracy, the area under the summary receiver operating characteristic curve was 0.776. When a SINS cut-off value of 7 was used, as was done in the included studies, the pooled sensitivity was 0.790 and the pooled specificity was 0.546. For precision, the summary estimate of interobserver agreement was the highest dividing 2 categories based on a cut-off value of 7, and the value was 0.788. The body collapse showed moderate relationship and precision with the VCF. The lytic tumor of bone lesion showed high accuracy and fair reliability, while location had excellent reliability, but low accuracy. The SINS system can be used to predict the occurrence of VCF after radiotherapy in spinal metastases with moderate accuracy and substantial reliability. Increasing the cut-off value and revising the domains may improve the diagnostic performance to predict the VCF of the SINS.
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Affiliation(s)
- Young Rak Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lui DTW, Lee CH, Chau VWK, Fong CHY, Yeung KMY, Lam JKY, Lee ACH, Chow WS, Tan KCB, Woo YC, Lam KSL. Potential role of fibroblast growth factor 21 in the deterioration of bone quality in impaired glucose tolerance. J Endocrinol Invest 2021; 44:523-530. [PMID: 32602078 DOI: 10.1007/s40618-020-01337-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Findings on trabecular bone score (TBS), an index of bone quality, have been reported in prediabetes defined by impaired fasting glucose or HbA1c. Here, we assessed the bone mineral density (BMD) and TBS in prediabetes individuals with impaired glucose tolerance (IGT), and investigated the association of these bone parameters with serum levels of fibroblast growth factor 21 (FGF21), a hormone implicated in bone metabolism and with higher levels in IGT. METHODS Chinese postmenopausal women aged 55-80 years, without diabetes, were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study in 2016-2018. Normal glucose tolerance (NGT) was defined by fasting glucose < 5.6 mmol/L and 2-h plasma glucose (2hG) < 7.8 mmol/L, and IGT by 2hG 7.8-11 mmol/L. Serum levels of FGF21 and other bone metabolism regulators were measured. Insulin sensitivity was assessed by the Matsuda index. Independent determinants of TBS were evaluated using multivariable stepwise linear regression. RESULTS 173 individuals with NGT and 73 with IGT were included. TBS was lower in those with IGT compared to those with NGT, while BMD was comparable. Individuals with IGT had significantly higher serum FGF21 levels, which in turn showed an independent inverse relationship with TBS, attenuated after inclusion of the Matsuda index. Serum FGF21 levels, however, did not correlate with BMD. CONCLUSION Among Chinese postmenopausal women, bone quality was worse in IGT, despite comparable bone density. FGF21 levels showed a significant independent inverse relationship with TBS, partly attributed to insulin resistance. Whether FGF21 contributes to the impaired bone quality in IGT remains speculative.
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Affiliation(s)
- D T W Lui
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C H Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - V W K Chau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C H Y Fong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K M Y Yeung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - J K Y Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - A C H Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - W S Chow
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K C B Tan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Y C Woo
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
| | - K S L Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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49
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Kim HM, Lee CH, Kwon J, Kim J, Kim B. Fabrication of Transparent Superhydrophobic Surface from ZnO Nanorods. J Nanosci Nanotechnol 2021; 21:1772-1778. [PMID: 33404446 DOI: 10.1166/jnn.2021.18907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A transparent superhydrophobic surface was fabricated from ZnO nanorods grown on Si and glass substrates in a thermal furnace for industrial applications such as surface coating. Two types of glasses were used for the substrates: slide glass and Corning glass. The ZnO nanorods were then coated with PTFE using existing sputtering technology and then grown on the glasses. The optical transparency and processing temperature of the nanorods on the substrates with and without a ZnO buffer layer were investigated, for comparison. The superhydrophobic surface formed on Corning glass with a 50-nm-thick ZnO buffer layer exhibited a transparency of 80% or higher and a water contact angle of 150° or higher in the visible light region. High optical transmittance of the superhydrophobic surface was achieved by controlling the size and growth direction of the nanorods. X-ray diffraction and scanning electron microscopy images showed that the nanorods on the glass substrates were thicker than those on Si, and the nanorods predominantly grew in the vertical direction on the buffer layer. However, the growth direction did not affect the wettability of the surface. Vertically grown nanorods can still affect optical transmittance because they facilitate the propagation of light. In the case of Corning glass, superhydrophobic surfaces with contact angles of 150° and 152.3° were formed on both samples with buffer layers of 50 nm and 100 nm, respectively. Therefore, a buffer layer thickness in the range of 50-100 nm is suitable for realizing a transparent superhydrophobic surface on a glass substrate.
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Affiliation(s)
- Hwa-Min Kim
- Department of Advanced Materials and Chemical Engineering, Daegu Catholic University, Gyeongbuk, 38430, Korea
| | - Chang-Hyun Lee
- School of Electronic and Electrical Engineering, Daegu Catholic University, Gyeongbuk, 38430, Korea
| | - Jiseon Kwon
- School of Electronic and Electrical Engineering, Daegu Catholic University, Gyeongbuk, 38430, Korea
| | - Jongjae Kim
- School of Electronic and Electrical Engineering, Daegu Catholic University, Gyeongbuk, 38430, Korea
| | - Bonghwan Kim
- School of Electronic and Electrical Engineering, Daegu Catholic University, Gyeongbuk, 38430, Korea
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50
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Lee CH, Ng PY, Pang SYY, Lam DCL, Lau CS. Successfully conducting an objective structured clinical examination with real patients during the COVID-19 pandemic. Hong Kong Med J 2021; 27:61-63. [PMID: 33558443 DOI: 10.12809/hkmj208839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- C H Lee
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - P Y Ng
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - S Y Y Pang
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - D C L Lam
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - C S Lau
- Department of Medicine, The University of Hong Kong, Hong Kong
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