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Kim H, Kang MJ, Baek JK, Lee JK, Choi EA, Yun BH, Kim EH, Seo SK. Relationship between menopausal hormone therapy and incidence of fractures in postmenopausal women. Climacteric 2024; 27:165-170. [PMID: 37947171 DOI: 10.1080/13697137.2023.2273528] [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: 07/19/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Long-term protective effects of menopausal hormone therapy (MHT) at fractures with different doses and components are controversial. We analyzed the effect of MHT on the incidence of spine and femur fractures according to MHT type, age at commencement, duration and dose of hormones in Korean women. METHOD This retrospective study evaluated propensity score-matched patients with MHT from the Korean National Health Insurance Service database. Among women aged ≥50 years with menopause between 2004 and 2007, spine and femur fracture incidence until 2017 was analyzed in 36,446 women who had received MHT for >1 year. Estrogen-progesterone therapy (EPT), estrogen-only therapy (ET) or tibolone therapy was conducted. RESULTS EPT significantly lowered the incidence of spine and femur fractures with a conventional dose, but not with a low dose. Tibolone significantly decreased the incidence of spine fractures in women aged 50-59 years when used for >5 years, and the incidence of femur fractures in women older than 60 years when used for >3 years. ET significantly lowered the risk of femur fractures when estradiol was used for >5 years. CONCLUSION In menopausal women, all MHT including conventional-dose EPT, ET and tibolone tended to lower the incidence of fractures. The effects, however, varied with the type of fracture and type of MHT.
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Affiliation(s)
- Heeyon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jin Kang
- Department of Health Insurance Research, National Health Insurance Service, Ilsan Hospital, Goyang, Republic of Korea
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jin Kyung Baek
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyung Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun A Choi
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, Ilsan Cha Hospital, Goyang, Republic of Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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Cho J, Kim EM, Kim J, Shin JY, Kim EH, Park JH, Kwon SL, Kwon GY, Shin SA, Kim J. Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of South Korean adolescent girls. Epidemiol Health 2024:e2024040. [PMID: 38549356 DOI: 10.4178/epih.e2024040] [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: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 04/17/2024] Open
Abstract
Objectives The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through South Korea's National Immunization Program. Methods This retrospective cohort study included individuals who were 12 to 13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database. Results The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cutoff years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52). Conclusion Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.
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Affiliation(s)
- Jaeyoung Cho
- Department of Big Data Strategy, National Health Insurance Services, Wonju, Korea
| | - Eun Mi Kim
- Department of Big Data Strategy, National Health Insurance Services, Wonju, Korea
| | - Jihye Kim
- Department of Big Data Strategy, National Health Insurance Services, Wonju, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics & Gynecology, CHA Ilsan Medical Center, Goyang, Korea
| | - Jong Heon Park
- Department of Big Data Strategy, National Health Insurance Services, Wonju, Korea
| | - Seunghyun Lewis Kwon
- Division of Immunization, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Geun-Yong Kwon
- Division of Immunization Planning, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Soon-Ae Shin
- Health Insurance Research Institute, National Health Insurance Services, Wonju, Korea
| | - Jaiyong Kim
- Department of Big Data Strategy, National Health Insurance Services, Wonju, Korea
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Sohn Y, Choi HK, Yun J, Kim EH, Kim YK. Clinical Characteristics and Risk of Hypoxemia Development in Women Infected with SARS-CoV-2 during Pregnancy. Yonsei Med J 2024; 65:27-33. [PMID: 38154477 PMCID: PMC10774648 DOI: 10.3349/ymj.2023.0270] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE There is limited information on the clinical characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and risk factors for hypoxemia development were investigated in pregnant women with coronavirus disease-2019 (COVID-19). MATERIALS AND METHODS From August 2020 to February 2022, we performed a retrospective cohort study of 410 pregnant women with COVID-19. The clinical characteristics and prognoses were compared between pregnant COVID-19 patients requiring oxygen and those who did not. RESULTS Of 410 patients, 100 (24.4%) required oxygen therapy. Among them, fever [163 (52.6%) vs. 81 (81.0%), p<0.001] and cough [172 (56.4%) vs. 73 (73.0%), p=0.003] were more frequently observed than in non-oxygen group. The proportion of unvaccinated women was higher in oxygen group than in non-oxygen group [264 (85.2%) vs. 98 (98.0%), p=0.003]. During the Omicron wave, patients were more likely to have no oxygen requirement [98 (31.6%) vs. 18 (18.0%), p=0.009]. The risk of hypoxemic respiratory difficulty increased if SARS-CoV-2 infection occurred during the third trimester [adjusted odds ratio (aOR) 5.083, 95% confidence interval (CI): 1.095-23.593, p=0.038] and C-reactive protein (CRP) was elevated (≥1.0 mg/dL) at admission (aOR 5.878, 95% CI: 3.099-11.146, p<0.001). The risk was higher in unvaccinated patients (aOR 5.376, 95% CI: 1.193-24.390, p=0.028). However, the risk was lower in patients during the Omicron wave (aOR 0.498, 95% CI: 0.258-0.961, p=0.038). CONCLUSION A quarter of SARS-CoV-2-infected women developed hypoxemic respiratory difficulty during pregnancy. SARS-CoV-2 infection during the third trimester, CRP elevation at admission, and no vaccination increased the risk of hypoxemia in pregnant women.
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Affiliation(s)
- Yujin Sohn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Kyoung Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea.
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Moon H, Lee JM, Kim EH. SARS-CoV-2-Infected Pregnant Woman Requiring 38 Days of Extracorporeal Membrane Oxygenation Experiences Rectal Ulcer Bleeding: A Case Report. Yonsei Med J 2023; 64:66-70. [PMID: 36579381 PMCID: PMC9826960 DOI: 10.3349/ymj.2022.0259] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 12/27/2022] Open
Abstract
Pregnancy has been shown to be associated with an adverse clinical course and symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Extracorporeal membrane oxygenation (ECMO) is rarely used in pregnant or postpartum women with severe coronavirus disease 2019 (COVID-19). Here, we report the rare case of a pregnant woman diagnosed with SARS-CoV-2 infection placed on ECMO postpartum who subsequently received treatment for active rectal ulcer bleeding. Despite being placed on ECMO for 38 days and receiving a massive transfusion of 95 packs of red blood cells, she recovered and was discharged on hospital day 112. ECMO can be used in most patients with severe COVID-19, including pregnant patients, although potential coagulopathy complications must be considered.
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Affiliation(s)
- Hanna Moon
- Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Korea
| | - Jung Mo Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea.
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Lee S, Cha DH, Park CW, Kim EH. Maternal and Neonatal Outcomes of Elective Induction of Labor at 39 or More Weeks: A Prospective, Observational Study. Diagnostics (Basel) 2022; 13:diagnostics13010038. [PMID: 36611330 PMCID: PMC9818553 DOI: 10.3390/diagnostics13010038] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of our study is to compare the maternal and neonatal outcomes of induction of labor (IOL) versus expectant management at 39 weeks of gestation. We conducted a single-centered, prospective, observational study of nulliparous singleton women at 39 weeks or more. We compared the maternal and perinatal outcomes. Of 408 nulliparous women, 132 women were IOL group and 276 women were expectant management group. IOL and expectant group had similar cesarean delivery rate (18.2% vs. 15.9%, p = 0.570). The delivery time from admission was longer in IOL group (834 ± 527 vs. 717 ± 469 min, p = 0.040). The IOL group was less likely to have Apgar score at 5 min < 7 than in expectant group (0.8% vs. 5.4%, p = 0.023). Multivariate analysis showed that IOL at 39 weeks was not an independent risk factor for cesarean delivery (relative risk 0.64, 95% confidence interval: 0.28−1.45, p = 0.280). Maternal and neonatal adverse outcomes, including cesarean delivery rate, were similar to women in IOL at 39 weeks of gestation compared to expectant management in nulliparous women. IOL at 39 weeks of gestation could be recommended even when the indication of IOL is not definite.
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Affiliation(s)
- Soobin Lee
- CHA Bundang Medical Center, Department of Obstetrics and Gynecology, College of Medicine, CHA University, Seongnam-si 13496, Republic of Korea
| | - Dong Hyun Cha
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University School of Medicine, Seoul 06135, Republic of Korea
| | - Cho Won Park
- CHA Bundang Medical Center, Department of Obstetrics and Gynecology, College of Medicine, CHA University, Seongnam-si 13496, Republic of Korea
| | - Eui Hyeok Kim
- CHA Ilsan Medical Center, Department of Obstetrics and Gynecology, CHA University School of Medicine, Goyang 10414, Republic of Korea
- Correspondence: ; Tel.: +82-31-782-8916
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Kim YK, Kim EH, Choi HK. 1081. Clinical Characteristics and Predictive Factors for the Development of Hypoxemia in SARS-CoV-2 Infected Women during Pregnancy. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.922] [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] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
There is limited information describing the clinical characteristics and prognosis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and the predictive factors for development of hypoxemia were investigated in SARS-Cov-2 infected women during pregnancy.
Methods
From August 2020 to February 2022, 410 pregnant women were infected with SARS-CoV-2 who admitted to two hospitals, the National Health Insurance Service Ilsan Hospital in Goyang or the Wonju Severance Christian Hospital in Wonju, Korea. The clinical characteristics and prognosis were compared between pregnant women who required oxygen or not during hospitalization.
Results
The mean age of the patients was 33.3 years. The hospitalized pregnant women were categorized into two groups such as no oxygen group and oxygen group. Of 410 patients, 100 (24.4%) required oxygen therapy (81 low-flow, 15 high-flow oxygen and 4 mechanical ventilation including 2 extracorporeal membrane oxygenation). In oxygen group, the symptoms such as fever [163 (52.6%) vs 81 (81.0%), p< 0.001] and cough [172 (56.4%) vs 73 (73.0%), p=0.003] were frequently observed. In oxygen group, the frequency of whom were not vaccinated was more [264 (85.2%) vs 98 (98.0%), p=0.003], however, that of the SARS-CoV-2 omicron variant infected patients was lower [98 (31.6%) vs 18 (18.0%), p=0.009]. The risk for the development of hypoxemic respiratory difficulty was increased if the SARS-CoV-2 infection during third trimester (OR 5.083, 95% CI 1.095-23.593, p=0.038) and elevated C-reactive protein (≥1.0 mg/dL) at admission (OR 5.878, 95% CI 3.099-11.146, p< 0.001) in the SARS-CoV-2 infected pregnant women. However, the risk was decreased with vaccination (OR 0.186, 95% CI 0.041-0.838, p=0.028) and omicron variant infection (OR 0.498, 95% CI 0.258-0.961, p=0.038).
Conclusion
A quarter of SARS-CoV-2 infected women during pregnancy developed hypoxemic respiratory difficulty. The SARS-CoV-2 infection during third trimester and no vaccination increased the risk for the development of hypoxemic respiratory difficulty in pregnant women.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Young Keun Kim
- Yonsei University Wonju College of Medicine , Wonju, Kangwon-do , Republic of Korea
| | - Eui Hyeok Kim
- National Health Insurance Service Ilsan Hospital , Goyang, Kyonggi-do , Republic of Korea
| | - Hee Kyoung Choi
- National Health Insurance Service Ilsan Hospital , Goyang, Kyonggi-do , Republic of Korea
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Abstract
Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance with onset or first recognition occurring during pregnancy and GDM could be risk factor for various maternal fetal complications. This study aimed to investigate risks of maternal and neonatal outcomes according to GDM and normal glucose tolerance. This retrospective, observational study included singleton pregnant women who had received a 50-g oral glucose challenge test in 2nd trimester of gestation and gave birth at National Health Insurance Service Ilsan Hospital. Maternal and neonatal complications were compared between GDM and non-GDM groups. Among the 682 women, 56 were diagnosed with GDM and 626 were non-GDM group. Maternal age was older and prepregnant body mass index was higher in GDM. The rate of cesarean delivery, preeclampsia, and transfusion was similar; however, the incidence of preterm birth was higher in GDM. Multivariate analysis, however, showed that GDM was independent risk factor only for preterm birth in <37 weeks (adjusted odds ratio, 2.25; 95% confidence interval, 1.16-4.36). Regarding neonatal morbidities, APGAR score <7 at 5 minutes and the rate of macrosomia were similar; however, the rates of neonatal intensive care unit (NICU) admission, large for gestational age (LGA), and intubation were higher in GDM. Multivariate analysis, however, showed that GDM was not independent risk factor for LGA, NICU admission, and intubation rate. Compared with the non-GDM group, GDM was associated with an increased likelihood of preterm birth <37 weeks, however, did not increase cesarean delivery, postpartum hemorrhage, LGA, and NICU admission rate. This study showed that the majority of women with GDM delivered with similar maternal and neonatal outcomes in non-GDM women.
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Affiliation(s)
- Yun Soo Chung
- Department of Obstetrics and Gynecology, Yonsei University Institute of Women’s Life Medical Science, Seoul, South Korea
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hanna Moon
- Department of Obstetrics and Gynecology, Yonsei University Institute of Women’s Life Medical Science, Seoul, South Korea
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- *Correspondence: Eui Hyeok Kim, Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea (e-mail: ; )
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Kim EH, Lee SA, Min S, Jung YW. Author Correction: Seasonal variations in the occurrence of preeclampsia and potential implication of upper respiratory infections in South Korea. Sci Rep 2022; 12:12808. [PMID: 35896567 PMCID: PMC9329331 DOI: 10.1038/s41598-022-16500-z] [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] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sang Ah Lee
- Korea Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seunggi Min
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea.
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Kim EH, Lee SA, Min S, Jung YW. Seasonal variations in the occurrence of preeclampsia and potential implication of upper respiratory infections in South Korea. Sci Rep 2022; 12:10791. [PMID: 35750780 PMCID: PMC9232506 DOI: 10.1038/s41598-022-14942-z] [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: 12/17/2021] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to examine the effect of seasonal changes on the incidence of preeclampsia (PE) in South Korea and East Asian populations, and to evaluate the relationship between upper respiratory infection (URI) during pregnancy and the development of PE. This cohort study included women who had singleton births between 2012 and 2018 in South Korea. A total of 548,080 first singleton births were analyzed, and 9311 patients (1.70%) were diagnosed with PE. Multivariate analysis showed that older age (≥ 30 years old), low income, residing in the southern part of South Korea, history of cigarette smoking, heavy drinking, higher body mass index, hypertension, or diabetes mellitus were risk factors for PE. Univariate analysis showed that URI was associated with the incidence of PE (P = 0.0294). However, this association was not statistically significant in the multivariate analysis (aOR 1.01; 95% CI 0.95-1.07). After adjusting for confounding variables, the occurrence of PE was the highest in December (aOR 1.21; 95% CI 1.10-1.34) and lowest in July and August. This study demonstrated that there are seasonal variations in the occurrence of PE in South Korea. Moreover, URI may be associated with the development of PE.
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Affiliation(s)
- Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sang Ah Lee
- Korea Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seunggi Min
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea.
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Baek JK, Kim HI, Kang MJ, Seon KE, Kim EH, Seo SK. Relationship between the type of hormone replacement therapy and incidence of breast cancer in Korea. Climacteric 2022; 25:516-522. [PMID: 35674251 DOI: 10.1080/13697137.2022.2077096] [Citation(s) in RCA: 6] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between hormone replacement therapy (HRT) types and breast cancer (BC) incidence in postmenopausal women in Korea. METHODS The nested case-control study used data from the National Health Insurance Service database. Among the women aged ≥50 years who menopaused between 2004 and 2007, BC incidence up to 2017 was analyzed in 36,446 women using or having used HRT for >1 year and in 36,446 women who did not use any HRT for more than 1 year. HRT types and duration were classified into three categories. RESULTS BC risk (BCR) decreased with tibolone use for all ages. With HRT initiation in women aged ≥50 years, BCR was lower with tibolone and estrogen-progestogen therapy. HRT for <3 years showed lower BCR with tibolone, while higher BCR was observed with estrogen-only therapy. BCR was lower in women of all ages on HRT for >5 years than in the control group. CONCLUSIONS For women in their 50s, tibolone use lowers BCR; for all ages, the use of any HRT for >5 years showed lower BCR in Korea. These divergent results from western countries could be associated with the specific characteristics of BC in Korea.
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Affiliation(s)
- J K Baek
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H I Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M J Kang
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - K E Seon
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - E H Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - S K Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim EH, Lee J, Lee SA, Jung YW. Impact of Maternal Age on Singleton Pregnancy Outcomes in Primiparous Women in South Korea. J Clin Med 2022; 11:jcm11040969. [PMID: 35207240 PMCID: PMC8880198 DOI: 10.3390/jcm11040969] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 12/01/2022] Open
Abstract
We aimed to determine the association between maternal age and pregnancy outcomes in singleton primigravidae in South Korea. We reviewed the medical data of singleton primigravidae women who gave birth between 2013 and 2018 and underwent the National Health Screening Examination using the administrative database from the National Health Insurance claims data. As advanced maternal age is associated with various comorbidities that could affect pregnancy outcomes, we divided the patients according to their age and comparatively analyzed the prevalence of high-risk pregnancy complications including rates of cesarean delivery, after adjusting for maternal demographics. Perinatal and postpartum complications according to maternal age were also investigated. Overall, 548,080 women were included in this study: 441,902 were aged <35 years; 85,663, 35–39 years; 20,515, ≥40 years. Patients’ demographics differed according to their age. Increasing maternal age was significantly associated with higher income levels and higher rates of obesity, pre-existing diabetes, and hypertension. With the increasing maternal age, the rate of obstetric complications, including gestational diabetes, preeclampsia, placenta previa, placental abruption, and cesarean delivery, increased. Maternal age was also positively correlated with perinatal morbidity including preterm birth and low birth weight. Additionally, advanced maternal age was a risk factor for hospitalization before delivery, more frequent outpatient visits, and readmission after delivery. These observations were maintained in the multivariate analysis results. Advanced maternal age appears to be associated with various adverse obstetric outcomes for primigravidae women, and the frequency of hospitalizations was higher in this group. Considering the current social environment of late pregnancies and childbirth in South Korea, effective policy consideration is required to support safe childbirth in women with advanced maternal age.
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Affiliation(s)
- Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si 10444, Korea;
| | - Jaekyung Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, Seoul 03722, Korea;
| | - Sang Ah Lee
- Big DATA Strategy Department, National Health Insurance Service, Wonju-si 26464, Korea;
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea
- Correspondence: ; Tel.: +82-2-3468-2813
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Park HS, Kim HS, Lee SA, Yoon J, Kim EH. Prophylactic Cerclage to Prevent Preterm Birth after Conization: A Cohort Study Using Data from the National Health Insurance Service of Korea. Yonsei Med J 2021; 62:1083-1089. [PMID: 34816638 PMCID: PMC8612859 DOI: 10.3349/ymj.2021.62.12.1083] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/25/2021] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate potential differences in the frequency of preterm births (PTB) between pregnancies with or without prophylactic cerclage in women with a history of conization. MATERIALS AND METHODS We identified women who had their first singleton delivery after conization between 2013 and 2018 using records in the National Health Insurance Service of Korea claims database. We only included women who had undergone a health examination and interview within 2 years before delivery. We used timing of maternal serum alpha-fetoprotein (MSAFP) tests to differentiate early (before) from late (after the MSAFP test) cerclage. The frequency of adverse pregnancy outcomes, including PTB, preterm labor and premature rupture of membranes, antibiotics and tocolytics use, cesarean delivery, and number of admissions before delivery, were compared. RESULTS A total of 8322 women was included. Compared to the no cerclage group (n=7147), the risks of adverse pregnancy outcomes were higher in the cerclage group (n=1175). After categorizing patients with cerclage into two groups, the risk of PTB was still higher in the early cerclage group than in the no cerclage group after adjusting for baseline factors (4.48%, 30/669 vs. 2.77%, 159/5749, odds ratio 2.42, 95% confidence interval 1.49, 3.92). Other adverse pregnancy outcomes were also more frequent in the early cerclage group than the no cerclage group. CONCLUSION Early cerclage performed before MSAFP testing does not prevent PTB in pregnancy with a history of conization, but increases the risk of adverse pregnancy outcomes, including PTB.
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Affiliation(s)
- Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hee-Sun Kim
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Ah Lee
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jisun Yoon
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Kim HI, Kim MK, Lee I, Yun J, Kim EH, Seo SK. Efficacy and Safety of a Standardized Soy and Hop Extract on Menopausal Symptoms: A 12-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Altern Complement Med 2021; 27:959-967. [PMID: 34399063 DOI: 10.1089/acm.2021.0027] [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] [Indexed: 11/12/2022] Open
Abstract
Objectives: Soy and hop extracts have been investigated as alternatives for hormone replacement therapy. However, their combined efficacy is not known. We investigated the efficacy and safety of a combined soy and hop extract on postmenopausal symptoms. Design: Double-blinded, randomized controlled trial. Settings/Location: Gynecological outpatient clinic of tertiary hospital. Subjects: Seventy-eight women with moderate or severe menopausal symptoms assessed as modified Kupperman Menopoausal Index (KMI) scores >20. Interventions: They received either a combined soy and hop extract (n = 38) or placebo (n = 40). Outcome measures: Menopausal symptoms were evaluated through self-reporting of modified Kupperman Menopausal Index (KMI) scores at baseline and after 6 and 12 weeks. We assessed serum levels of bone metabolism biomarkers, ultrasonographic parameters, hormone profiles, compliance, and safety. Results: After 12 weeks of the treatment, treatment group scores decreased by 20.61 points compared with 14.80 points in the placebo group (p < 0.05). Fatigue, paresthesia, arthralgia, and myalgia, palpitation and vaginal dryness significantly improved more in the treatment group compared with the placebo group after 12 weeks (p < 0.05). Urine N-telopeptide in participants ≥50 years in the treatment group showed a reduced increase. Endometrial thickness and hormonal profiles did not show significant changes in either group. No serious adverse events were reported. Conclusion: The results suggest that 190 mg of combined soy and hop extract is safe and effective for improvement of menopausal symptoms. CRIS No.: KCT0006019.
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Affiliation(s)
- Hye In Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kim
- Institute of Women's Life Medical Science, CHA University School of Medicine, Seoul, Republic of Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jeong Y, Choo SP, Yun J, Kim EH. Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae. Medicine (Baltimore) 2021; 100:e27063. [PMID: 34449499 PMCID: PMC10545166 DOI: 10.1097/md.0000000000027063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55-5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ± 1.25 vs 2.02 ± 1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.
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Jin JH, Kim Y, Yoo J, Kim EH, Yoon SW. Two Cases of SARS-CoV-2-Positive Mothers and Their Newborns in Korea. Infect Chemother 2021; 54:372-377. [PMID: 34405595 PMCID: PMC9259912 DOI: 10.3947/ic.2021.0027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
It is unclear how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects pregnant women and their fetuses or newborns. We report two infants born to mothers with coronavirus disease 2019 (COVID-19) in Korea. The first case was a healthy female baby born at 39+3 weeks' gestation from a mother diagnosed with COVID-19. The second case was a female baby born at 38+0 weeks' gestation. The newborn in the second case had symptoms of respiratory distress immediately after birth, and nasal continuous positive airway pressure support was applied for 8 hours. Real-time polymerase chain reaction test results for SARS-CoV-2 using amniotic fluid, neonatal nasopharyngeal and oropharyngeal swabs, blood, urine, stool, and rectal swab were all negative in the 1st and 2nd days of life in both cases. Placental pathology showed acute necrotizing deciduitis and intervillous fibrin deposition with acute intervillositis. Although clinical evidence of vertical transmission was not found in our cases, with the possibility of placental inflammation, close monitoring of SARS-CoV-2 positive mothers and their newborn is required.
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Affiliation(s)
- Ju Hyun Jin
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yeejeong Kim
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Shin Won Yoon
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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16
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Lee JS, Kim EH, Lee SH. Endoscopically assisted malarplasty: L-rotation technique. J Stomatol Oral Maxillofac Surg 2020; 122:229-234. [PMID: 32810601 DOI: 10.1016/j.jormas.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Endoscopically assisted malarplasty with a greenstick fracture is a method for preserving the body eminence and improving arch protrusion. However, this technique is inadequate when malar body reduction is required. To compensate for these limitations, we developed a new surgical technique using the endoscope to reduce body protrusion. MATERIAL AND METHODS We enrolled 261 patients who visited our clinic for zygoma reduction from January 2017 to December 2018. Their mean age was 31 (range 17-63) years. After a scalp incision, an incomplete osteotomy was created from the most prominent portion of the zygoma body to the zygomaticomaxillary suture line. A complete osteotomy was performed on the arch. These osteotomies resulted in an L-shaped zygoma segment after tapping the bone with a mallet. RESULTS Of the 261 patients who underwent our L-rotation technique, 242 also received a corticotomy. Of those patients, 15 underwent a different degree of zygoma reduction on both sides. A floating zygomatic segment occurred in four cases, although no further surgery was required. One patient's zygomatic segment dropped on one side, requiring rigid fixation through the intraoral approach. Most patients were satisfied and there were no specific complications. CONCLUSIONS Endoscopically assisted malarplasty using an L-rotation technique enables the protrusion of both the arch and body to be reduced. The zygoma reduction can be modified based on the location of the incomplete osteotomoy line and the number of corticotomies required.
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Affiliation(s)
- J S Lee
- Youtiful Vom Aesthetic Plastic Clinic, 326 Dosan-daero, Gangnam-gu, Seoul, Republic of Korea
| | - E H Kim
- Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Goyang-si, Gyeonggi-do, Republic of Korea
| | - S H Lee
- Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Goyang-si, Gyeonggi-do, Republic of Korea.
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17
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Kim YN, Kwon JY, Kim EH. Predicting labor induction success by cervical funneling in uncomplicated pregnancies. J Obstet Gynaecol Res 2020; 46:1077-1083. [PMID: 32390283 PMCID: PMC7384017 DOI: 10.1111/jog.14270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/10/2019] [Revised: 03/21/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022]
Abstract
Aim Predictive accuracy of cervical funneling for successful vaginal delivery prior to labor induction was compared to that of conventional methods such as Bishop score and cervical length. Methods Prospective observational study was conducted on nulliparous women at 38 gestational weeks or more with intact membranes who delivered vaginally following labor induction. Transvaginal ultrasound was performed prior to labor induction to evaluate the cervix, to determine the cervical length and to check for the presence of funneling. Following pelvic examinations, the Bishop score was calculated. Predictive accuracy of the three different methods, namely cervical funneling, cervical length and Bishop, were compared. Results A total of 235 nulliparous women with intact membranes were recruited. Of these, 194 women (82.6%) had successful vaginal deliveries following induction. Cervical funneling was observed in 105 women (44.7%). The rate of successful vaginal delivery was significantly higher in women with cervical funneling than in those without funneling (90.5% vs 76.2%, P < 0.004). Multivariable analysis showed that cervical funneling, similar to traditional measures such as the Bishop score and cervical length, was an independent predictor of successful vaginal delivery following labor induction (odds ratio = 2.95; 95% confidence interval: 1.38–6.47; P = 0.007). Conclusions Similar to the conventional methods of cervical evaluation, such as the Bishop score and cervical length, cervical funneling may serve as a useful and valid predictor of successful vaginal deliveries prior to labor induction.
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Affiliation(s)
- Yoo-Na Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ja Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
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18
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Salganik MJ, Lundberg I, Kindel AT, Ahearn CE, Al-Ghoneim K, Almaatouq A, Altschul DM, Brand JE, Carnegie NB, Compton RJ, Datta D, Davidson T, Filippova A, Gilroy C, Goode BJ, Jahani E, Kashyap R, Kirchner A, McKay S, Morgan AC, Pentland A, Polimis K, Raes L, Rigobon DE, Roberts CV, Stanescu DM, Suhara Y, Usmani A, Wang EH, Adem M, Alhajri A, AlShebli B, Amin R, Amos RB, Argyle LP, Baer-Bositis L, Büchi M, Chung BR, Eggert W, Faletto G, Fan Z, Freese J, Gadgil T, Gagné J, Gao Y, Halpern-Manners A, Hashim SP, Hausen S, He G, Higuera K, Hogan B, Horwitz IM, Hummel LM, Jain N, Jin K, Jurgens D, Kaminski P, Karapetyan A, Kim EH, Leizman B, Liu N, Möser M, Mack AE, Mahajan M, Mandell N, Marahrens H, Mercado-Garcia D, Mocz V, Mueller-Gastell K, Musse A, Niu Q, Nowak W, Omidvar H, Or A, Ouyang K, Pinto KM, Porter E, Porter KE, Qian C, Rauf T, Sargsyan A, Schaffner T, Schnabel L, Schonfeld B, Sender B, Tang JD, Tsurkov E, van Loon A, Varol O, Wang X, Wang Z, Wang J, Wang F, Weissman S, Whitaker K, Wolters MK, Woon WL, Wu J, Wu C, Yang K, Yin J, Zhao B, Zhu C, Brooks-Gunn J, Engelhardt BE, Hardt M, Knox D, Levy K, Narayanan A, Stewart BM, Watts DJ, McLanahan S. Measuring the predictability of life outcomes with a scientific mass collaboration. Proc Natl Acad Sci U S A 2020; 117:8398-8403. [PMID: 32229555 PMCID: PMC7165437 DOI: 10.1073/pnas.1915006117] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
How predictable are life trajectories? We investigated this question with a scientific mass collaboration using the common task method; 160 teams built predictive models for six life outcomes using data from the Fragile Families and Child Wellbeing Study, a high-quality birth cohort study. Despite using a rich dataset and applying machine-learning methods optimized for prediction, the best predictions were not very accurate and were only slightly better than those from a simple benchmark model. Within each outcome, prediction error was strongly associated with the family being predicted and weakly associated with the technique used to generate the prediction. Overall, these results suggest practical limits to the predictability of life outcomes in some settings and illustrate the value of mass collaborations in the social sciences.
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Affiliation(s)
| | - Ian Lundberg
- Department of Sociology, Princeton University, Princeton, NJ 08544
| | | | - Caitlin E Ahearn
- Department of Sociology, University of California, Los Angeles, CA 90095
| | | | - Abdullah Almaatouq
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02142
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Drew M Altschul
- Mental Health Data Science Scotland, Department of Psychology, The University of Edinburgh, Edinburgh EH8 9JZ, United Kingdom
| | - Jennie E Brand
- Department of Sociology, University of California, Los Angeles, CA 90095
- Department of Statistics, University of California, Los Angeles, CA 90095
| | | | - Ryan James Compton
- Human Computer Interaction Lab, University of California, Santa Cruz, CA 95064
| | - Debanjan Datta
- Discovery Analytics Center, Virginia Polytechnic Institute and State University, Arlington, VA 22203
| | - Thomas Davidson
- Department of Sociology, Cornell University, Ithaca, NY 14853
| | | | - Connor Gilroy
- Department of Sociology, University of Washington, Seattle, WA 98105
| | - Brian J Goode
- Social and Decision Analytics Laboratory, Fralin Life Sciences Institute, Virginia Polytechnic Institute and State University, Arlington, VA 22203
| | - Eaman Jahani
- Institute for Data, Systems and Society, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ridhi Kashyap
- Department of Sociology, University of Oxford, Oxford OX1 1JD, United Kingdom
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford OX2 6PE, United Kingdom
| | - Antje Kirchner
- Program for Research in Survey Methodology, Survey Research Division, RTI International, Research Triangle Park, NC 27709
| | - Stephen McKay
- School of Social and Political Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Allison C Morgan
- Department of Computer Science, University of Colorado, Boulder, CO 80309
| | - Alex Pentland
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Kivan Polimis
- Center for the Study of Demography and Ecology, University of Washington, Seattle, WA 98105
| | - Louis Raes
- Department of Economics, Tilburg School of Economics and Management, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Daniel E Rigobon
- Department of Operations Research and Financial Engineering, Princeton University, Princeton, NJ 08544
| | - Claudia V Roberts
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Diana M Stanescu
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Yoshihiko Suhara
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Adaner Usmani
- Department of Sociology, Harvard University, Cambridge, MA 02138
| | - Erik H Wang
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Muna Adem
- Department of Sociology, Indiana University, Bloomington, IN 47405
| | - Abdulla Alhajri
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Bedoor AlShebli
- Computational Social Science Lab, Social Science Division, New York University Abu Dhabi, 129188 Abu Dhabi, United Arab Emirates
| | - Redwane Amin
- Bendheim Center for Finance, Princeton University, Princeton, NJ 08544
| | - Ryan B Amos
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Lisa P Argyle
- Department of Political Science, Brigham Young University, Provo, UT 84602
| | | | - Moritz Büchi
- Department of Communication and Media Research, University of Zurich, Zurich, Switzerland, ZH-8050
| | - Bo-Ryehn Chung
- Center for Statistics & Machine Learning, Princeton University, Princeton, NJ 08544
| | - William Eggert
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544
| | - Gregory Faletto
- Statistics Group, Department of Data Sciences and Operations, Marshall School of Business, University of Southern California, Los Angeles, CA 90089
| | - Zhilin Fan
- Department of Statistics, Columbia University, New York, NY 10027
| | - Jeremy Freese
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Tejomay Gadgil
- Center for Data Science, New York University, New York, NY 10011
| | - Josh Gagné
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Yue Gao
- Department of Industrial Engineering and Operations Research, Columbia University, New York, NY 10027
| | | | - Sonia P Hashim
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Sonia Hausen
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Guanhua He
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544
| | - Kimberly Higuera
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Bernie Hogan
- Oxford Internet Institute, University of Oxford, Oxford OX1 3JS, United Kingdom
| | - Ilana M Horwitz
- Graduate School of Education, Stanford University, Stanford, CA, 94305
| | - Lisa M Hummel
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Naman Jain
- Department of Operations Research and Financial Engineering, Princeton University, Princeton, NJ 08544
| | - Kun Jin
- Department of Computer Science, Ohio State University, Columbus, OH 43210
| | - David Jurgens
- School of Information, University of Michigan, Ann Arbor, MI 48104
| | - Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN 47405
- Center for Complex Networks and Systems Research, Indiana University, Bloomington, IN 47405
| | - Areg Karapetyan
- Department of Computer Science, Masdar Institute, Khalifa University, 127788 Abu Dhabi, United Arab Emirates
- Research Institute for Mathematical Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - E H Kim
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Ben Leizman
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Naijia Liu
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Malte Möser
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Andrew E Mack
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Mayank Mahajan
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Noah Mandell
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544
| | - Helge Marahrens
- Department of Sociology, Indiana University, Bloomington, IN 47405
| | | | - Viola Mocz
- Department of Neuroscience, Princeton University, Princeton, NJ 08544
| | | | - Ahmed Musse
- Department of Electrical Engineering, Princeton University, Princeton, NJ, 08544
| | - Qiankun Niu
- Bendheim Center for Finance, Princeton University, Princeton, NJ 08544
| | | | - Hamidreza Omidvar
- Department of Civil and Environmental Engineering, Princeton University, Princeton, NJ 08544
| | - Andrew Or
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Karen Ouyang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Katy M Pinto
- Department of Sociology, California State University, Dominguez Hills, Carson, CA 90747
| | - Ethan Porter
- School of Media and Public Affairs, George Washington University, Washington, DC 20052
| | | | - Crystal Qian
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Tamkinat Rauf
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Anahit Sargsyan
- Social Science Division, New York University Abu Dhabi, 129188 Abu Dhabi, United Arab Emirates
| | - Thomas Schaffner
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Landon Schnabel
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Bryan Schonfeld
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Ben Sender
- Department of Economics, Princeton University, Princeton, NJ 08544
| | - Jonathan D Tang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Emma Tsurkov
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Austin van Loon
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Onur Varol
- Center for Complex Network Research, Northeastern University Networks Science Institute, Boston, MA 02115
- Luddy School of Informatics, Computing, & Engineering, Indiana University, Bloomington, IN 47408
| | - Xiafei Wang
- School of Social Work, David B. Falk College of Sport and Human Dynamics, Syracuse University, NY 13244
| | - Zhi Wang
- Luddy School of Informatics, Computing, & Engineering, Indiana University, Bloomington, IN 47408
- School of Public Health, Indiana University, Bloomington, IN 47408
| | - Julia Wang
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Flora Wang
- Department of Economics, Princeton University, Princeton, NJ 08544
| | - Samantha Weissman
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Kirstie Whitaker
- The Alan Turing Institute, London NW1 2DB, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom
| | - Maria K Wolters
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, United Kingdom
| | - Wei Lee Woon
- Department of Marketplaces & Yield Data Science, Expedia Group, Seattle, WA 98119
| | - James Wu
- Department of the Applied Statistics, Social Science, and Humanities, New York University, New York, NY 10003
| | - Catherine Wu
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | - Kengran Yang
- Department of Civil and Environmental Engineering, Princeton University, Princeton, NJ 08544
| | - Jingwen Yin
- Department of Statistics, Columbia University, New York, NY 10027
| | - Bingyu Zhao
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, United Kingdom
| | - Chenyun Zhu
- Department of Statistics, Columbia University, New York, NY 10027
| | - Jeanne Brooks-Gunn
- Department of Human Development, Teachers College, Columbia University, New York, NY 10027
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Barbara E Engelhardt
- Department of Computer Science, Princeton University, Princeton, NJ 08544
- Center for Statistics & Machine Learning, Princeton University, Princeton, NJ 08544
| | - Moritz Hardt
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720
| | - Dean Knox
- Department of Politics, Princeton University,Princeton, NJ, 08544
| | - Karen Levy
- Department of Information Science, Cornell University, Ithaca, NY 14853
| | - Arvind Narayanan
- Department of Computer Science, Princeton University, Princeton, NJ 08544
| | | | - Duncan J Watts
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA 19104
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA 19104
- Operations, Information and Decisions Department, University of Pennsylvania, Philadelphia, PA 19104
| | - Sara McLanahan
- Department of Sociology, Princeton University, Princeton, NJ 08544;
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19
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Abstract
Morbidity and complications are higher with caesarean delivery after labour induction. We aimed to evaluate which maternal/neonatal pregnancy characteristics and ultrasound parameters are useful in predicting successful vaginal delivery following labour induction. In this retrospective observational study, several maternal and foetal characteristics were studied in 197 primigravidae women at 38 or more gestational weeks before induction. Multivariate analysis showed that maternal age (odds ratio [OR] 0.907, 95% confidence intervals [CI] 0.826-0.995, p = .038), term body mass index (BMI; OR 0.909, 95% CI 0.828-0.997, p = .044), and foetal engagement (OR 3.295, 95% CI 1.232-8.810, p = .017) were independent predictors for a successful vaginal delivery in an induced labour. An older maternal age, high term BMI and un-engagement were associated with a failed labour induction.IMPACT STATEMENTWhat is already known on this subject? Labour induction is being used more frequently worldwide, but it is not always easy to predict those patients who will progress to a vaginal delivery and those who will require a caesarean section. Because caesarean sections are associated with a higher mortality and morbidity in patients who have undergone a labour induction, it is important to identify the factors predictive of successful vaginal delivery after labour induction.What do the results of this study add? Multivariate analysis showed that maternal age, term BMI, and foetal engagement were independent predictors for successful vaginal delivery in an induced labour.What are the implications of these findings for clinical practice and/or further research? We found that maternal age, term body mass index and foetal engagement were important variables to consider when predicting a successful labour induction. A comprehensive assessment of these variables should be done before inducing labour to limit any unnecessary mortality and morbidity associated with a failed induction. Women should be given accurate information regarding the risks of induction based on their individual characteristics.
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Affiliation(s)
- Young Bin Won
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Sang Won Han
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
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Jeon MJ, Choo SP, Kwak YH, Kim DW, Kim EH. The effect of diagnosis-related group payment system on the quality of medical care for pelvic organ prolapse in Korean tertiary hospitals. PLoS One 2019; 14:e0220895. [PMID: 31430319 PMCID: PMC6701833 DOI: 10.1371/journal.pone.0220895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess changes in clinical practice patterns after implementing diagnosis-related group (DRG) payment system in July 2013 and its effect on the quality of care for pelvic organ prolapse (POP). MATERIALS AND METHODS Using the 2011-2016 administrative database from National Health Insurance claim data, we reviewed medical information of 7362 patients who underwent hysterectomies for POP in Korean tertiary hospitals. We compared changes in several variables including length of stay, concomitant procedures, outpatient visits and readmission within 30 days after discharge, and retreatment for POP or stress urinary incontinence within postoperative 1 year before and after DRG system. RESULTS After the introduction of DRG system, the average length of stay decreased (7.74 ± 2.88 to 6.63 ± 2.18 days, p<0.001) without increasing readmission rates. However, the number of outpatient visits increased (2.78±2.33 to 2.98±2.47, p<0.001). Regarding concomitant procedures, the rates of colpopexy and midurethral slings significantly decreased (7.87% and 9.84% to 4.93% and 2.93%, respectively, all p<0.001). Even though there was no difference in the reoperation rates, pessary insertion for recurrent POP significantly increased after the introduction of DRG system (0.10% to 0.38%, p = 0.015). CONCLUSION The implementation of DRG in Korean tertiary hospitals has led to increase of outpatient visits and reduced surgical management for POP, which indicates that the uniform application of DRG influences the quality of care for POP patients.
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Affiliation(s)
- Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Pil Choo
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Hwa Kwak
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
- * E-mail:
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Jung YW, Pak H, Lee I, Kim EH. The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals. Yonsei Med J 2018; 59:539-545. [PMID: 29749137 PMCID: PMC5949296 DOI: 10.3349/ymj.2018.59.4.539] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care. MATERIALS AND METHODS Using the 2012-2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs. RESULTS DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p<0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p<0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased. CONCLUSION Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.
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Affiliation(s)
- Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Gangnam Medical Center, Seoul, Korea
| | - Haeyong Pak
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Park YW, Han K, Ahn SS, Choi YS, Chang JH, Kim SH, Kang SG, Kim EH, Lee SK. Whole-Tumor Histogram and Texture Analyses of DTI for Evaluation of IDH1-Mutation and 1p/19q-Codeletion Status in World Health Organization Grade II Gliomas. AJNR Am J Neuroradiol 2018. [PMID: 29519794 DOI: 10.3174/ajnr.a5569] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of the isocitrate dehydrogenase 1 (IDH1)-mutation and 1p/19q-codeletion status of World Health Organization grade ll gliomas preoperatively may assist in predicting prognosis and planning treatment strategies. Our aim was to characterize the histogram and texture analyses of apparent diffusion coefficient and fractional anisotropy maps to determine IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas. MATERIALS AND METHODS Ninety-three patients with World Health Organization grade II gliomas with known IDH1-mutation and 1p/19q-codeletion status (18 IDH1 wild-type, 45 IDH1 mutant and no 1p/19q codeletion, 30 IDH1-mutant and 1p/19q codeleted tumors) underwent DTI. ROIs were drawn on every section of the T2-weighted images and transferred to the ADC and the fractional anisotropy maps to derive volume-based data of the entire tumor. Histogram and texture analyses were correlated with the IDH1-mutation and 1p/19q-codeletion status. The predictive powers of imaging features for IDH1 wild-type tumors and 1p/19q-codeletion status in IDH1-mutant subgroups were evaluated using the least absolute shrinkage and selection operator. RESULTS Various histogram and texture parameters differed significantly according to IDH1-mutation and 1p/19q-codeletion status. The skewness and energy of ADC, 10th and 25th percentiles, and correlation of fractional anisotropy were independent predictors of an IDH1 wild-type in the least absolute shrinkage and selection operator. The area under the receiver operating curve for the prediction model was 0.853. The skewness and cluster shade of ADC, energy, and correlation of fractional anisotropy were independent predictors of a 1p/19q codeletion in IDH1-mutant tumors in the least absolute shrinkage and selection operator. The area under the receiver operating curve was 0.807. CONCLUSIONS Whole-tumor histogram and texture features of the ADC and fractional anisotropy maps are useful for predicting the IDH1-mutation and 1p/19q-codeletion status in World Health Organization grade II gliomas.
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Affiliation(s)
- Y W Park
- From the Department of Radiology (Y.W.P.), Ewha Womans University College of Medicine, Seoul, Korea.,Departments of Radiology and Research Institute of Radiological Science (Y.W.P., K.H., S.S.A., Y.S.C., S.-K.L.)
| | - K Han
- Departments of Radiology and Research Institute of Radiological Science (Y.W.P., K.H., S.S.A., Y.S.C., S.-K.L.)
| | - S S Ahn
- Departments of Radiology and Research Institute of Radiological Science (Y.W.P., K.H., S.S.A., Y.S.C., S.-K.L.)
| | - Y S Choi
- Departments of Radiology and Research Institute of Radiological Science (Y.W.P., K.H., S.S.A., Y.S.C., S.-K.L.)
| | - J H Chang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - S H Kim
- Pathology (S.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S-G Kang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - E H Kim
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - S-K Lee
- Departments of Radiology and Research Institute of Radiological Science (Y.W.P., K.H., S.S.A., Y.S.C., S.-K.L.)
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Jung YS, Kim EH, Park CH. Editorial: replacing standard proton pump inhibitors with vonoprazan may breathe new life into triple therapy for Helicobacter pylori-authors' reply. Aliment Pharmacol Ther 2017; 46:551-552. [PMID: 28776746 DOI: 10.1111/apt.14206] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Y S Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - E H Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - C H Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Jung YS, Kim EH, Park CH. Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther 2017; 46:106-114. [PMID: 28497487 DOI: 10.1111/apt.14130] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [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: 02/09/2017] [Revised: 03/05/2017] [Accepted: 04/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND In order to increase eradication rates, vonoprazan, a novel potassium-competitive acid blocker, has been used in Helicobacter pylori eradication therapy. AIM To summarise the results of the efficacy of vonoprazan-based triple therapy, helping clinicians to better understand the benefit of vonoprazan in the treatment of H. pylori infection. METHODS We conducted a systematic literature search on MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "vonoprazan," "takecab", "TAK-438," "potassium," "competitive," "potassium-competitive," "Helicobacter," and "pylori." Studies were included if they evaluated the eradication rate between the vonoprazan-based and proton pump inhibitor (PPI)-based triple therapies. RESULTS Ten studies and 10 644 patients were evaluated. The crude H. pylori eradication rate determined by intention-to-treat analysis was 87.9% and 72.8% in the vonoprazan-based triple therapy and PPI-based triple therapy respectively. The eradication rate of the vonoprazan-based triple therapy was superior to that of the PPI-based triple therapy (pooled risk ratio [RR] [95% confidence interval (CI)]=1.19 [1.15-1.24]) In addition, there was no significant difference in dropout rate due to adverse event between the regimens (pooled RR of the vonoprazan-based triple therapy [95% CI]=0.69 [0.23-2.03]). The incidence of any adverse events also did not differ between the regimens (pooled RR [95% CI]=1.02 [0.78-1.34]). CONCLUSIONS The vonoprazan-based triple therapy showed superior efficacy in terms of H. pylori eradication as compared to the PPI-based triple therapy. In addition, the vonoprazan-based triple therapy showed comparable tolerability and incidence of adverse events.
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Affiliation(s)
- Y S Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - E H Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - C H Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Choi YS, Ahn SS, Lee HJ, Chang JH, Kang SG, Kim EH, Kim SH, Lee SK. The Initial Area Under the Curve Derived from Dynamic Contrast-Enhanced MRI Improves Prognosis Prediction in Glioblastoma with Unmethylated MGMT Promoter. AJNR Am J Neuroradiol 2017. [PMID: 28642265 DOI: 10.3174/ajnr.a5265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Although perfusion and permeability MR parameters have known to have prognostic value, they have reproducibility issues. Our aim was to evaluate whether the initial area under the time-to-signal intensity curve (IAUC) derived from dynamic contrast-enhanced MR imaging can improve prognosis prediction in patients with glioblastoma with known MGMT status. MATERIALS AND METHODS We retrospectively examined 88 patients with glioblastoma who underwent preoperative dynamic contrast-enhanced MR imaging. The means of IAUC values at 30 and 60 seconds (IAUC30mean and IAUC60mean) were extracted from enhancing tumors. The prognostic values of IAUC parameters for overall survival and progression-free survival were assessed with log-rank tests, according to the MGMT status. Multivariate overall survival and progression-free survival models before and after adding the IAUC parameters as covariates were explored by net reclassification improvement after receiver operating characteristic analysis for 1.5-year overall survival and 1-year progression-free survival and by random survival forest. RESULTS High IAUC parameters were associated with worse overall survival and progression-free survival in the unmethylated MGMT group, but not in the methylated group. In the unmethylated MGMT group, 1.5-year overall survival and 1-year progression-free survival prediction improved significantly after adding IAUC parameters (overall survival area under the receiver operating characteristic curve, 0.86; progression-free survival area under the receiver operating characteristic curve, 0.74-0.76) to the model with other prognostic factors (overall survival area under the receiver operating characteristic curve, 0.81; progression-free survival area under the receiver operating characteristic curve, 0.69; P < .05 for all) except in the case of IAUC60mean for 1-year progression-free survival prediction (P = .059). Random survival forest models indicated that the IAUC parameters were the second or most important predictors in the unmethylated MGMT group, except in the case of the IAUC60mean for progression-free survival. CONCLUSIONS IAUC can be a useful prognostic imaging biomarker in patients with glioblastoma with known MGMT status, improving prediction of glioblastoma prognosis with the unmethylated MGMT promoter status.
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Affiliation(s)
- Y S Choi
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - S S Ahn
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - H-J Lee
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - J H Chang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S-G Kang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - E H Kim
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S H Kim
- Departments of Pathology (S.H.K.)
| | - S-K Lee
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
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Movafagh S, Raj D, Sanaei-Ardekani M, Bhatia D, Vo K, Mahmoudieh M, Rahman R, Kim EH, Harralson AF. Hypoxia Inducible Factor 1: A Urinary Biomarker of Kidney Disease. Clin Transl Sci 2017; 10:201-207. [PMID: 28181420 PMCID: PMC5421733 DOI: 10.1111/cts.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/24/2016] [Accepted: 01/03/2017] [Indexed: 01/22/2023] Open
Abstract
Identifying noninvasive biomarkers of kidney disease is valuable for diagnostic and therapeutic purposes. Hypoxia inducible factor 1 (HIF-1) expression is known to be elevated in the kidneys in several renal disease pathologies. We hypothesized that the urinary HIF-1a mRNA level may be a suitable biomarker for expression of this protein in chronic kidney disease (CKD). We compared HIF-1a mRNA levels from urine pellets of CKD and healthy subjects. To ensure that urinary HIF-1a mRNA is of kidney origin, we examined colocalization of HIF-1a mRNA with two kidney specific markers in urine cells. We found that HIF-1a mRNA is readily quantifiable in urine pellets and its expression was significantly higher in CKD patients compared with healthy adults. We also showed that the urinary HIF-1a mRNA comes primarily from cells of renal origin. Our data suggest that urinary HIF-1a mRNA is a potential biomarker in CKD and can be noninvasively assessed in patients.
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Affiliation(s)
- S Movafagh
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - D Raj
- Department of Nephrology, George Washington University Division of Kidney Diseases and Hypertension, Washington, DC, USA
| | | | - D Bhatia
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - K Vo
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - M Mahmoudieh
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
| | - R Rahman
- Kidney and Hypertension Specialists, Manassas, Virginia, USA
| | - E H Kim
- Kidney and Hypertension Specialists, Manassas, Virginia, USA
| | - A F Harralson
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Shenandoah University, Ashburn, Virginia, USA
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Burk CM, Kulis M, Leung N, Kim EH, Burks AW, Vickery BP. Utility of component analyses in subjects undergoing sublingual immunotherapy for peanut allergy. Clin Exp Allergy 2016; 46:347-53. [PMID: 26362760 DOI: 10.1111/cea.12635] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 04/15/2015] [Revised: 08/07/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) with peanut changes clinical and immune responses in most peanut-allergic individuals, but the response is highly variable. OBJECTIVE We sought to examine the component-specific effects of peanut SLIT and determine whether peanut component testing could predict the outcome of a double-blind, placebo-controlled food challenge (DBPCFC) after 12 months of peanut SLIT. METHODS We included 33 subjects who underwent peanut SLIT with a DBPCFC of 2500 mg of peanut protein performed after 12 months of therapy. Plasma samples from baseline and after 12 months of peanut SLIT were assayed using ImmunoCAP for IgE and IgG4 against whole peanut, Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9. RESULTS Following 12 months of SLIT, 10 subjects (30%) passed the DBPCFC without symptoms and were considered desensitized. Subjects that failed the DBPCFC tolerated a median of 460 mg peanut protein (range: 10-1710 mg). The desensitized group had significantly lower baseline levels of IgE against peanut (median 40.8 vs. 231 kUA /L, P = 0.0082), Ara h 2 (median 17 vs. 113 kUA /L, P = 0.0082), and Ara h 3 (median 0.3 vs. 8.5 kUA /L, P = 0.0396). ROC curves indicated that baseline IgE against peanut and Ara h 2 were equally effective at discriminating between the two groups (AUC = 0.7957, P = 0.007752 for both). CONCLUSION AND CLINICAL RELEVANCE In this cohort of subjects undergoing SLIT for peanut allergy, lower baseline levels of IgE against Ara h 2, Ara h 3, and peanut were associated with successful desensitization.
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Affiliation(s)
- C M Burk
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Kulis
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Leung
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E H Kim
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A W Burks
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B P Vickery
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Müller H, Haag I, Jessen F, Kim EH, Klaus J, Konkol C, Bechdolf A. [Cognitive Behavioral Therapy and Assertive Community Treatment Reduces Days in Hospital and Delays Hospital Admission in Severe Psychotic Disorders]. Fortschr Neurol Psychiatr 2016; 84:76-82. [PMID: 26953546 DOI: 10.1055/s-0042-102055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The primary aim of this study was to assess the effectiveness of integrated home treatment (IV, i. e. intensive cognitive behavioral therapy and pharmacotherapy provided within a framework of assertive community treatment) in individuals with severe mental disorders (n = 13) within the German healthcare system. A treatment-as-usual group (TAU, n = 13) was identified by propensity score matching. Symptoms (CGI), functioning (GAF) and service engagement (SES) were assessed. Quality of life (MSLQ-R) was rated by the IV patients. A reduction of days spent in hospital [IV: 2.3 (6.1); TAU: 33.6 (53.6); Z = 45; p = 0.044], time to admission (IV: 384 days 95% CI 309 - 459.1; TAU: 234.9 days 95% CI 127.2 - 342.5; log rank: Chi-square = 4.31, p < 0.05), severity of the illness (p < 0.01), positive symptoms (p < 0.001), and cognitive symptoms (p < 0.05), as well as functioning (p < 0.05) and service engagement (p < 0.05) was observed in IV patients. Despite differences on a descriptive level, differences in total admissions (IV: 15.3%; TAU: 53.8%; odds ratio = 0.155, 95% CI 0.0243 - 1.00) were not significant. A methodological limitation is that symptom ratings were not performed by independent and blinded raters.
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Affiliation(s)
- H Müller
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - I Haag
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - F Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - E H Kim
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - J Klaus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - C Konkol
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - A Bechdolf
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
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Kim EH, Song SH, Kim GS, Ko JS, Gwak MS, Lee SK. Evaluation of "flat-line" thromboelastography after reperfusion during liver transplantation. Transplant Proc 2015; 47:457-9. [PMID: 25769590 DOI: 10.1016/j.transproceed.2014.11.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 08/27/2014] [Revised: 11/04/2014] [Accepted: 11/19/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND "Flat-line" (no clot formation) thromboelastography (TEG) is frequently observed after graft reperfusion during liver transplantation (LT). We aimed to evaluate the incidence and causes of flat-line TEG after graft reperfusion during LT. METHODS With institutional review board approval, data of 208 consecutive recipients who underwent LT from May 2010 to May 2012 were retrospectively reviewed. We performed 3 different types of TEG measurements at 5 minutes after graft reperfusion: native TEG (nTEG), tranexamic acid-added TEG (tTEG), and protamine-added TEG (pTEG). The flat-line TEG was defined as having no trace at all at 60 minutes of TEG. We examined the incidence and causes of flat-line nTEG. We also compared recipients with flat-line nTEG (F group) and clot-forming nTEG (C group). RESULTS One hundred eighty-two recipients were included in the final analysis. The incidence of flat-line nTEG was 27% (49/182 cases). Among 49 recipients in the F group, 28 recipients showed clot formation in both tTEG and pTEG, 19 recipients in only tTEG, and 1 recipient in only pTEG; 1 recipient showed no clot formation in any TEGs. Graft from the deceased donor was more frequently observed in the F group than in the C group (P = .039). The F group showed decreased platelet count (P = .001), increased prothrombin time (P = .002), and decreased fibrinogen (P = .009) compared with the C group. CONCLUSIONS No clot formation was relatively common after reperfusion during LT, and the main causes were hyperfibrinolysis and heparin effect. Liver graft from deceased donors was associated more frequently with no clot formation after reperfusion during LT.
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Affiliation(s)
- E H Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S H Song
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - G S Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - J S Ko
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M S Gwak
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S K Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi YS, Kim DW, Lee SK, Chang JH, Kang SG, Kim EH, Kim SH, Rim TH, Ahn SS. The Added Prognostic Value of Preoperative Dynamic Contrast-Enhanced MRI Histogram Analysis in Patients with Glioblastoma: Analysis of Overall and Progression-Free Survival. AJNR Am J Neuroradiol 2015; 36:2235-41. [PMID: 26338911 DOI: 10.3174/ajnr.a4449] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of dynamic contrast-enhanced MR imaging in patients with glioblastoma is controversial. We investigated the added prognostic value of dynamic contrast-enhanced MR imaging to clinical parameters and molecular biomarkers in patients with glioblastoma by using histogram analysis. MATERIALS AND METHODS This retrospective study consisted of 61 patients who underwent preoperative dynamic contrast-enhanced MR imaging for glioblastoma. The histogram parameters of dynamic contrast-enhanced MR imaging, including volume transfer constant, extravascular extracellular volume fraction, and plasma volume fraction, were calculated from entire enhancing tumors. Univariate analyses for overall survival and progression-free survival were performed with preoperative clinical and dynamic contrast-enhanced MR imaging parameters and postoperative molecular biomarkers. Multivariate Cox regression was performed to build pre- and postoperative models for overall survival and progression-free survival. The performance of models was assessed by calculating the Harrell concordance index. RESULTS In univariate analysis, patients with higher volume transfer constant and extravascular extracellular volume fraction values showed worse overall survival and progression-free survival, whereas plasma volume fraction showed no significant correlation. In multivariate analyses for overall survival, the fifth percentile value of volume transfer constant and kurtosis of extravascular extracellular volume fraction were independently prognostic in the preoperative model, and kurtosis of volume transfer constant and extravascular extracellular volume fraction were independently prognostic in the postoperative model. For progression-free survival, independent prognostic factors were minimum and fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction in the preoperative model and kurtosis of extravascular extracellular volume fraction in the postoperative model. The performance of preoperative models for progression-free survival was significantly improved when minimum or fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction were added. CONCLUSIONS Higher volume transfer constant and extravascular extracellular volume fraction values are associated with worse prognosis, and dynamic contrast-enhanced MR imaging may have added prognostic value in combination with preoperative clinical parameters, especially in predicting progression-free survival.
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Affiliation(s)
- Y S Choi
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
| | - D W Kim
- Department of Policy Research Affairs (D.W.K.), National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea
| | - S-K Lee
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
| | - J H Chang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - S-G Kang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - E H Kim
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | | | - T H Rim
- Ophthalmology (T.H.R.), Yonsei University College of Medicine, Seoul, Korea
| | - S S Ahn
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
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Tai DS, Hu C, Lee CCI, Martinez M, Cantero G, Kim EH, Tarantal AF, Lipshutz GS. Development of operational immunologic tolerance with neonatal gene transfer in nonhuman primates: preliminary studies. Gene Ther 2015; 22:923-30. [PMID: 26333349 DOI: 10.1038/gt.2015.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 05/22/2015] [Accepted: 06/18/2015] [Indexed: 02/05/2023]
Abstract
Achieving persistent expression is a prerequisite for effective genetic therapies for inherited disorders. These proof-of-concept studies focused on adeno-associated virus (AAV) administration to newborn monkeys. Serotype rh10 AAV expressing ovalbumin and green fluorescent protein (GFP) was administered intravenously at birth and compared with vehicle controls. At 4 months postnatal age, a second injection was administered intramuscularly, followed by vaccination at 1 year of age with ovalbumin and GFP. Ovalbumin was highest 2 weeks post administration in the treated monkey, which declined but remained detectable thereafter; controls demonstrated no expression. Long-term AAV genome copies were present in myocytes. At 4 weeks, neutralizing antibodies to rh10 were present in the experimental animal only. With AAV9 administration at 4 months, controls showed transient ovalbumin expression that disappeared with the development of strong anti-ovalbumin and anti-GFP antibodies. In contrast, increased and maintained ovalbumin expression was noted in the monkey administered AAV at birth, without antibody development. After vaccination, the experimental monkey maintained levels of ovalbumin without antibodies, whereas controls demonstrated high levels of antibodies. These preliminary studies suggest that newborn AAV administration expressing secreted and intracellular xenogenic proteins may result in persistent expression in muscle, and subsequent vector administration can result in augmented expression without humoral immune responses.
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Affiliation(s)
- D S Tai
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - C Hu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - C C I Lee
- California National Primate Research Center and Departments of Pediatrics and Cell Biology and Human Anatomy, University of California, Davis, CA, USA
| | - M Martinez
- California National Primate Research Center and Departments of Pediatrics and Cell Biology and Human Anatomy, University of California, Davis, CA, USA
| | - G Cantero
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - E H Kim
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - A F Tarantal
- California National Primate Research Center and Departments of Pediatrics and Cell Biology and Human Anatomy, University of California, Davis, CA, USA
| | - G S Lipshutz
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Intellectual and Developmental Disabilities Research Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Chung SH, Kong MK, Kim EH, Han SW. Sonographically accessed funneling of the uterine cervix as a predictor of successful labor induction. Obstet Gynecol Sci 2015; 58:188-95. [PMID: 26023667 PMCID: PMC4444514 DOI: 10.5468/ogs.2015.58.3.188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/26/2014] [Revised: 10/06/2014] [Accepted: 10/13/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The Bishop score and length of the uterine cervix are good predictors of successful labor induction. However, little is known about the association between the funneling of the uterine cervix and successful labor induction. The study aimed to evaluate cervical funneling as a predictor of successful labor induction. METHODS This study was designed as a prospective observational study. Subjects who delivered a baby by labor induction were enrolled in the study from July 2011 to August 2013. Cervical funneling and length were examined with transvaginal ultrasonography. The Bishop score was rated by digital pelvic examination. RESULTS A total of 163 primigravida women were recruited for the study. Of these, 137 participants (84.0%) delivered vaginally by labor induction. Cervical funneling was observed in 93 women (57.1%). Successful labor induction was significantly higher in patients with cervical funneling than those without it (91.4% vs. 74.3%, P<0.01), and was significantly associated with cervical funneling, as well as the Bishop score and cervical length. In a multivariate analysis, cervical funneling was an independent predictor for successful vaginal delivery by labor induction ( odd ratio, 2.70; 95% confidence interval, 1.02 to 7.10; P=0.04). However, the Bishop score and cervical length had no association with successful vaginal delivery. CONCLUSION This study showed that cervical funneling could be a predictive marker for vaginal delivery during labor induction.
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Affiliation(s)
- Seon Hwa Chung
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Mi Kyung Kong
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang Won Han
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Song TJ, Kim J, Lee HS, Nam CM, Nam HS, Kim EH, Lee KJ, Song D, Heo JH, Kim YD. Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation. Thromb Haemost 2014; 112:1312-8. [PMID: 25231184 DOI: 10.1160/th14-02-0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/26/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
There has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with non-valvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Y D Kim
- Young Dae Kim, MD, PhD, Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel.: +82 2 2228 1605, Fax: +82 2 393 0705, E-mail:
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Kim EH. Characterizing topological order in superconductors via entanglement. J Phys Condens Matter 2014; 26:205602. [PMID: 24786467 DOI: 10.1088/0953-8984/26/20/205602] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We investigate/characterize topological order in superconducting systems using entanglement. Demonstrating/utilizing the directional dependence of the entanglement, results are shown for two-dimensional [Formula: see text] and [Formula: see text] +idxy spin-singlet superconductors, comparing the results to those for a spin-polarized px+ipy superconductor; we also discuss the topological properties of a one-dimensional spin-polarized p-wave superconductor threaded by a magnetic flux. In carrying out these investigations, we establish an efficient approach to investigate entanglement in superconductors or, more generally, in quadratic fermionic Hamiltonians with pairing interactions.
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Affiliation(s)
- E H Kim
- Department of Physics, University of Windsor, Windsor, Ontario N9B 3P4, Canada
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Roh JL, Kim EH, Park HB, Park JY. The Hsp90 inhibitor 17-(allylamino)-17-demethoxygeldanamycin increases cisplatin antitumor activity by inducing p53-mediated apoptosis in head and neck cancer. Cell Death Dis 2013; 4:e956. [PMID: 24336076 PMCID: PMC3877559 DOI: 10.1038/cddis.2013.488] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 10/04/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 12/26/2022]
Abstract
The tumor suppressor p53 is often inactivated in head and neck cancer (HNC) through TP53 mutations or overexpression of mouse double minute 2 or mouse double minute X. Restoration of p53 function by counteracting these p53 repressors is a promising strategy for cancer treatment. The present study assessed the ability of a heat shock protein 90 (Hsp90) inhibitor, 17-(Allylamino)-17-demethoxygeldanamycin (17AAG), to induce apoptosis in HNC by restoring p53 function. The effect of 17AAG, alone or in combination with Nutlin-3a or cisplatin, was assessed in HNC cells using growth and apoptosis, immunoblotting, quantitative reverse transcription-polymerase chain reaction, and preclinical tumor xenograft models. 17AAG activated and stabilized p53 in HNC cells bearing wild-type TP53 by disrupting the p53–MDMX interaction. 17AAG upregulated p21 and proapoptotic gene expression, and promoted apoptosis in a concentration-dependent manner. Growth inhibition by 17AAG was highest in tumor cells with MDMX overexpression. The apoptotic response was blocked by inhibition of p53 expression, demonstrating that the effect of 17AAG depended on p53 and MDMX. 17AAG synergized in vitro with Nutlin-3a and in vitro and in vivo with cisplatin to induce p53-mediated apoptosis. 17AAG effectively induced p53-mediated apoptosis in HNC cells through MDMX inhibition and increased the antitumor activity of cisplatin synergistically, suggesting a promising strategy for treating HNC.
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Affiliation(s)
- J-L Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E H Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H B Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Y Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ahn SH, Lee SH, Kim BJ, Lim KH, Bae SJ, Kim EH, Kim HK, Choe JW, Koh JM, Kim GS. Higher serum uric acid is associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in healthy postmenopausal women. Osteoporos Int 2013; 24:2961-70. [PMID: 23644878 DOI: 10.1007/s00198-013-2377-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/19/2013] [Indexed: 12/13/2022]
Abstract
UNLABELLED Higher serum uric acid (UA) was associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in postmenopausal women. Furthermore, UA suppressed osteoclastogenesis and decreased production of reactive oxygen species in osteoclast precursors, indicating UA may have beneficial effects on bone metabolism as an antioxidant. INTRODUCTION UA is known to play a physiological role as an antioxidant, and oxidative stress has detrimental effects on bone metabolism. In the present study, we investigated the association of serum UA level with the osteoporosis-related phenotypes and its direct effect on bone-resorbing osteoclasts using in vitro systems. METHODS This is a large cross-sectional study, including 7,502 healthy postmenopausal women. Bone mineral density (BMD) and serum UA concentrations were obtained from all subjects. Data on bone turnover markers and lateral thoracolumbar radiographs were available for 1,023 and 6,918 subjects, respectively. An in vitro study investigated osteoclastogenesis and reactive oxygen species (ROS) levels according to UA treatment. RESULTS After adjusting for multiple confounders, serum UA levels were positively associated with BMD at all sites (all p < 0.001). Compared with the participants in the highest UA quartile, the odds for osteoporosis were 40 % higher in those in the lowest quartile. The serum UA levels were inversely related to both serum C-terminal telopeptide of type I collagen and osteocalcin levels (p < 0.001 and p = 0.004, respectively). Consistently, subjects with vertebral fracture had lower serum UA levels, compared with those without it (p = 0.009). An in vitro study showed that UA decreased osteoclastogenesis in a dose-dependent manner and reduced the production of ROS in osteoclast precursors. CONCLUSION These results provide epidemiological and experimental evidence that serum UA may have a beneficial effect on bone metabolism as an antioxidant in postmenopausal women.
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Affiliation(s)
- S H Ahn
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap2-Dong, Songpa-Gu, Seoul, 138-736, Republic of Korea
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Kim CH, Kim HK, Kim EH, Bae SJ, Park JY. Relative contributions of insulin resistance and β-cell dysfunction to the development of Type 2 diabetes in Koreans. Diabet Med 2013; 30:1075-9. [PMID: 23600561 DOI: 10.1111/dme.12201] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/31/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022]
Abstract
AIMS Controversies still exist regarding the relative contributions of insulin resistance and β-cell dysfunction to the pathogenesis of Type 2 diabetes in different populations. We examined the associations of baseline insulin resistance and β-cell function indices with the development of Type 2 diabetes in Koreans. METHODS We analysed the clinical and laboratory data of 17 878 Korean adults (age 20-79 years) who underwent routine medical examinations with a median interval of 3.5 years (range 2.5-4.7 years). Using the homeostasis model assessment, insulin resistance (HOMA-IR) and β-cell function (HOMA-%B) indices at baseline were assessed. RESULTS Those who developed diabetes (n = 732, 4.1%) had significantly higher fasting serum insulin level (53.4 ± 31.2 vs. 41.4 ± 23.4 pmol/l) and HOMA-IR (2.38 ± 1.45 vs. 1.65 ± 1.02) and lower HOMA-%B (74 ± 47 vs. 85 ± 48) at baseline (P < 0.001 for all). Both high HOMA-IR and low HOMA-%B were independently associated with an increased odds ratio of incident Type 2 diabetes. Among the participants who developed diabetes, 29% demonstrated predominant β-cell dysfunction (HOMA-%B < 25th percentile) and 51% had predominant insulin resistance (HOMA-IR > 75th percentile). When we divided the participants according to the median BMI of the whole population (23.7 kg/m²), 49% of participants in the low BMI group demonstrated predominant β-cell dysfunction and 26% had predominant insulin resistance, whilst 21% in the high BMI group demonstrated mainly β-cell dysfunction and 60% had mainly insulin resistance. CONCLUSIONS In individuals with low BMI, β-cell dysfunction is the predominant defect, whereas insulin resistance is the predominant pathogenetic factor in individuals with high BMI in the development of Type 2 diabetes in Koreans.
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Affiliation(s)
- C-H Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon
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Kim BJ, Ahn SH, Bae SJ, Kim EH, Kim TH, Lee SH, Kim HK, Choe JW, Kim SY, Koh JM, Kim GS. Association between metabolic syndrome and bone loss at various skeletal sites in postmenopausal women: a 3-year retrospective longitudinal study. Osteoporos Int 2013; 24:2243-52. [PMID: 23389696 DOI: 10.1007/s00198-013-2292-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/03/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED Although the presence of metabolic syndrome (MetS) and increasing numbers of MetS components were associated with attenuated bone loss at various skeletal sites in postmenopausal women, this beneficial effect of MetS on bone mass can be mainly explained by higher mechanical loading in the affected subjects. INTRODUCTION Previous cross-sectional epidemiological studies reported the inconsistent results regarding the combined effects of MetS on bone mass. In our present report, we performed a large, longitudinal study to evaluate MetS in relation to annualized bone mineral density (BMD) changes in postmenopausal Korean women. METHODS The study cohort consisted of 1,218 postmenopausal women who had undergone comprehensive routine health examinations with an average follow-up interval of 3 years. The BMD at the lumbar spine and proximal femur sites was measured with dual-energy X-ray absorptiometry using the same equipment at baseline and at follow-up. RESULTS Following adjustment for age, baseline BMD, and lifestyle factors, the women with MetS had 21.7, 17.0, 26.7, and 31.1 % less bone loss at the total femur, femur neck, trochanter, and lumbar spine, respectively, compared with MetS-free women (P = 0.004 to 0.041). Consistently, the rates of bone loss at all skeletal sites were linearly attenuated with increasing numbers of MetS components (P = 0.004 to <0.001). Importantly, when weight and height were added as confounding factors, the differences and trends of annualized BMD changes according to the MetS status disappeared. CONCLUSION Our current results indicate that the beneficial effects of MetS on bone mass can be mainly explained by higher mechanical loading in the affected subjects. Consequently, MetS per se may not be a meaningful concept for predicting future bone loss and for explaining associations between osteoporosis and cardiovascular diseases.
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Affiliation(s)
- B-J Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap2-Dong, Songpa-Gu 138-736, Seoul, Korea
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Kim EH, Park BH, Lim JW, Jung SW. Late diagnosis of Henoch-Schönlein purpura following detection of jejunal ischemia on conventional endoscopy. Endoscopy 2013; 44 Suppl 2 UCTN:E393-4. [PMID: 23139038 DOI: 10.1055/s-0032-1310247] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- E H Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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Park SH, Hong H, Han YM, Kangwan N, Kim SJ, Kim EH, Hahm KB. Nonsteroidal anti-inflammatory drugs (NSAID) sparing effects of glucosamine hydrochloride through N-glycosylation inhibition; strategy to rescue stomach from NSAID damage. J Physiol Pharmacol 2013; 64:157-165. [PMID: 23756390] [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] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/05/2013] [Indexed: 06/02/2023]
Abstract
Gastrointestinal or cardiovascular complications limit nonsteroidal anti-inflammatory drugs (NSAID) prescription. Glucosamine hydrochloride (GS-HCl) alternatively chosen, but debates still exist in its clinical efficiency. COX-2 instability through inhibiting COX-2 N-glycosylation of GS-HCl raised the possibility of NSAID sparing effect. Study was done to determine whether combination treatment of glucosamine and NSAID contributes to gastric safety through NSAID sparing effect. IEC-6 cells were stimulated with TNF-α and compared the expressions of inflammatory mediators after indomethacin alone or combination of indomethacin and GS-HCl by Western blotting and RT-PCR. C57BL/6 mice injected with type II collagen to induce arthritis were treated with indomethacin alone or combination of reduced dose of indomethacin and GS-HCl after 3 weeks. TNF-α increased the expression of COX-2, iNOS and inflammatory cytokines, but GS-HCl significantly attenuated TNF-α-induced COX-2 expression. Decreased COX-2 after GS-HCl was caused by N-glycosylation inhibition as much as tunicamycin. Combination of reduced dose of indomethacin and GS-HCl significantly reduced the expressions of ICAM-1, VCAM-1, IL-8, IL-1β, MMP-2, MMP-7, MMP-9, and MMP-11 mRNA as well as NF-κB activation better than high dose indomethacin alone. These NSAID sparing effect of GS-HCl was further proven in collagen-induced arthritis model. Combination of GS-HCl and 2.5 mg/kg indomethacin showed significant protection from gastric damages as well as efficacious anti-arthritic effect. Taken together, COX-2 N-glycosylation inhibition by GS-HCl led to indomethacin sparing effects, based on which combination of GS-HCl and reduced dose of NSAID can provide the strategy to secure stomach from NSAID-induced gastric damage as well as excellent anti-arthritic effects.
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Affiliation(s)
- S H Park
- CHA Cancer Prevention Research Center, CHA Cancer Institute, CHA University, Seoul, Korea
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Heo JS, Choi SM, Kim HO, Kim EH, You J, Park T, Kim E, Kim HS. Neural transdifferentiation of human bone marrow mesenchymal stem cells on hydrophobic polymer-modified surface and therapeutic effects in an animal model of ischemic stroke. Neuroscience 2013; 238:305-18. [PMID: 23454369 DOI: 10.1016/j.neuroscience.2013.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/01/2013] [Accepted: 02/05/2013] [Indexed: 01/01/2023]
Abstract
Human bone marrow-derived mesenchymal stem cells (MSCs) have multi-lineage differentiation potential and can become cells of mesodermal and neural lineages. These stem cells thus hold considerable clinical promise for the treatment of neurodegenerative diseases. For successful regeneration of damaged neural tissues, directed differentiation of neural or neuronal precursor cells from MSCs and integration of transplanted cells are pivotal factors. We induced MSCs into neurogenesis using a modified protocol. The therapeutic potency of the resulting neural progenitor cells in a rat model of ischemic stroke was analyzed. Using a highly hydrophobic diphenylamino-s-triazine-bridged p-phenylene (DTOPV)-coated surface and adopting a procedure for propagation of neural stem cells, we efficiently converted MSCs into neurosphere-like cellular aggregates (NS-MSCs). The spherical cells were subsequently induced to differentiate into neural cells expressing neuroectodermal markers. To determine whether these cells had neuronal fates and induced neuro-protective effects in vivo, NS-MSCs were intra-cerebrally administered to rats 48h after permanent middle cerebral artery occlusion (pMCAo). The results showed a remarkable attenuation of ischemic damage with significant functional recovery, although the cells were not fully incorporated into the damaged tissues on post-operative day 26. Improvement in the NS-MSC-transplanted rats was faster than in the MSC group and suppression of inflammation was likely the key factor. Thus, our culture system using the hydrophobic surface of a biocompatible DTOPV coating efficiently supported neural cell differentiation from MSCs. Neural-primed MSCs exhibited stronger therapeutic effects than MSCs in rat brains with pMCAo.
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Affiliation(s)
- J S Heo
- Cell Therapy Center, Severance Hospital, Seoul, Republic of Korea
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Alam S, Katakura Y, Yoshida H, Kim EH, Shirahata S. Functional characterization of human T cells immortalized by oncogene transfection. Cytotechnology 2012; 23:185-92. [PMID: 22358534 DOI: 10.1023/a:1007928021139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have succeeded in immortalizing human lymphocytes derived from the peripheral blood of a healthy donor and of an atopic patient, and from the lymph node of a cancer patient by oncogene transfection (Alam et al., 1996). All immortalized human lymphocytes were shown to be CD3+ and CD19-, indicating that these immortalized human lymphocytes were all T cells. We established 317, 154 and 692 individual immortalized human T cell lines derived from the healthy donor, the atopic patient and the cancer patient, respectively. The ratios of CD4+ and CD8+ subpopulations within the set containing immortalized T cells derived from the healthy donor were shown to be varied depending on the combinations of transfected oncogenes used. However, CD8+ cells were found to be the dominant subpopulation of immortalized T cells derived from the atopic patient and the cancer patient. These immortalized T cells showed different proliferative responses in the presence of exogenous human IL-2 depending on their origin, and was consistent with the surface expression of the IL-2 receptor. Furthermore, the cytokine secretion patterns of these immortalized T cells stimulated with mitogen were investigated. The results showed that the immortalized T cells from the healthy donor is able to secrete various kinds of cytokines such as IL-2, IL-10, β-IFN and GM-CSF. However, immortalized T cells from the cancer patient was shown to only secrete IL-2 and GM-CSF. These results suggest that depending on the origin, the immortalized T cells came from different subsets or from cells in different activated states. Mixed lymphocytes reactions demonstrated that these immortalized T cells are able to proliferate in the presence of allogenic or xenogenic stimulator cells, suggesting that they maintain the ability to recognize specific antigens on the stimulator cells and can proliferate even after the immortalization. Furthermore, immortalized T cells derived from the healthy donor and the cancer patient strongly responded to K562 cells, suggesting that MHC-nonrestricted killer T cells were also immortalized.Abbreviations IL-2R - interleukin 2 receptor; MLR - mixed lymphocyte reaction.
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Affiliation(s)
- S Alam
- Graduate School of Genetic Resources Technology, Kyushu University, Hakozaki 6-10-1, Higashi-ku, Fukuoka, 812-81, Japan
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Abstract
BACKGROUND Peer assisted learning (PAL) has been rarely investigated in surgical skills training. AIMS Describe feedback residents give peers on surgical skills with and without guidelines, determine the association between feedback and actual performance, evaluate resident satisfaction with PAL. METHOD Participants evaluated peers using a validated knot-tying checklist and provided feedback on suturing without a guideline. Feedback comments were coded by type and an expert scored performance of each participant. Residents completed a satisfaction questionnaire. RESULTS Comments were generally specific. Feedback was twice as likely with the use of a guideline. Specific feedback correlated significantly with expert knot-tying score but not suturing score. Most participants felt peer feedback was helpful and were motivated to practice surgical skills after PAL sessions. CONCLUSIONS Surgical residents can provide high quality specific feedback to peers on surgical skills using performance guidelines. Further exploration of effective PAL methodology in surgical skills laboratory training is needed.
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Suh DC, Kim JL, Kim EH, Kim JK, Shin JH, Hyun DH, Lee HY, Lee DH, Kim JS. Carotid baroreceptor reaction after stenting in 2 locations of carotid bulb lesions of different embryologic origin. AJNR Am J Neuroradiol 2012; 33:977-81. [PMID: 22268083 DOI: 10.3174/ajnr.a2891] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The carotid bulb is innervated by the sinus nerve of Hering, a branch of the glossopharyngeal nerve, derived from the third pharyngeal arch. The aim of this study was to determine the frequency, predictors, and outcome of the carotid BR after carotid stent placement according to the location of the plaque lesion. MATERIALS AND METHODS Atherosclerotic carotid plaques of apical versus body lesions were prospectively analyzed in 95 consecutive patients who underwent carotid stent placement. Patients with hypertension after stent placement were excluded, and transient (<3 hours) and prolonged (3-24 hours) BR, together with AEs such as strokes and death, were assessed in the 2 lesion locations (apical versus body). Other factors known to affect the carotid baroreceptor were also investigated, and the results were analyzed by χ(2) or Mann-Whitney U tests. RESULTS Transient BR occurred in 30% of apical lesions in contrast to 70% of body lesions (P = .001). Transient BR showed a significant relationship to lesion location (P = .001), occurring most frequently in body lesions, and to the distance of maximum stenosis from the ICA ostium (P = .001). Hyperperfusion and AE rates (P = .076) in 1 month occurred more frequently in apical lesions. CONCLUSIONS The frequency of transient BR after carotid stent placement was lower in the apical region of the carotid bulb. Different cardiovascular disturbances after carotid stent placement can be attributed to anatomically different areas of the carotid bulb.
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Affiliation(s)
- D C Suh
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea.
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Nam HS, Cha MJ, Kim YD, Kim EH, Park E, Lee HS, Nam CM, Heo JH. Use of a handheld, computerized device as a decision support tool for stroke classification. Eur J Neurol 2011; 19:426-30. [PMID: 21951521 DOI: 10.1111/j.1468-1331.2011.03530.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification has been widely used to determine etiology of ischemic stroke. However, interrater reliability is known to be modest. The complexity of abstraction and the interpretation of various clinical and laboratory data might limit the accuracy of the TOAST classification. In this study, we developed a computerized clinical decision support system for stroke classification that can be used in a handheld device and tested whether this system can improve diagnostic accuracy and reliability. METHODS Based on the TOAST classification, a logical algorithm was developed and implemented on a handheld device, named iTOAST. After answering six questions using the touch interface, the stroke subtype result is displayed on the screen. Four neurology residents were randomly assigned to classify stroke subtypes using iTOAST or the conventional method (cTOAST). Using a crossover design, they classified the stroke subtypes of 70 patients. The standard subtypes were determined by three stroke experts. Correlated kappa coefficients using iTOAST compared with cTOAST were determined. RESULTS The kappa (SE) value of iTOAST [0.790 (0.041), 95% CI: 0.707-0.870] was higher than that of cTOAST [0.692 (0.046), 95% CI: 0.600-0.782] (P<0.001). Neither sequence (P=0.857) nor period effect (P=0.999) was observed. CONCLUSIONS The stroke classification tool using a handheld, computerized device was easy, accurate, and reliable over the conventional method. It may have additional benefit because a handheld, computerized device is accessible anytime and anywhere.
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Affiliation(s)
- H S Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Yamashita M, Ichikawa A, Katakura Y, Mochizuki Y, Teruya K, Kim EH, Shirahata S. Induction of basophilic and eosinophilic differentiation in the human leukemic cell line KU812. Cytotechnology 2011; 36:179-86. [PMID: 19003329 DOI: 10.1023/a:1014001322272] [Citation(s) in RCA: 7] [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: 11/12/2022] Open
Abstract
We have demonstrated that an immature prebasophilic cell line,KU812 cells can be induced to differentiate into basophil-like cells when cultured with hydrocortisone (HC) with enhanced cell surface expression of FcepsilonRI, a high affinity IgE receptor. In this study, we report that sodium nitroprusside (SNP), an intracellular NO donor, also induces cell surface expression of FcepsilonRI on KU812 cells. Cell surface FcepsilonRI expression was detected in about 20% of KU812 cells treated with SNP for 14 days as well as the cells treated with HC for 7 days, while non-treated KU812 cells did not express FcepsilonRI on their cell surface. However, Wright-Giemsa staining and flowcytometry analysis of CD13 and CD15 antigens on HC and SNP treated KU812 cells demonstrated that SNP induced eosinophilic differentiation in KU812 cells differently from HC which induced basophilic differentiation. To further confirm this result, we performed RT-PCR against mRNAs specific for eosinophils, such as eosinophil-derived neurotoxin (EDN) and eosinophil peroxidase(EPO). SNP treated KU812 cells but not HC treated cells expressed EDN and EPO mRNA depending upon the induction of differentiation,clearly demonstrating that SNP induces eosinophilic differentiation in KU812 cells. To clarify that different signaling cascades were activated in HC and SNP treated KU812 cells, we analyzed activities of AP-1, NF-AT and NF-kappaB transcription factors by EMSA, which are known to be involved in signal transduction pathways downstream from the FcepsilonRI molecule of basophils. All these three transcription factors were activated in HC treated KU812 cells,but not in non-treated and SNP treated KU812 cells. These results indicate that KU812 cells are multi-potent precursor cells which can be induced to differentiate into basophils and eosinophils upon exogenous signals, and that NO is an important factor to decide the eosinophilic differentiation in KU812 cells with enhanced surface expression of FcepsilonRI, and further suggest that different signaling cascades can be activated between basophilic and eosinophilic differentiation in KU812 cells.
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Affiliation(s)
- M Yamashita
- Department of Genetic Resources Technology, Faculty of Agriculture, Graduate School of Kyushu University, Fukuoka, 812-8581, Japan
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Miura T, Katakura Y, Yamamoto K, Uehara N, Tsuchiya T, Kim EH, Shirahata S. Neural stem cells lose telomerase activity upon differentiating into astrocytes. Cytotechnology 2011; 36:137-44. [PMID: 19003324 DOI: 10.1023/a:1014016315003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Serum-free mouse embryo (SFME) cells were established by D. Barnes et al., and are known to be a neural stem cell line, which differentiate into astrocytes upon treatment with TGF-beta. Therefore, SFME cells is thought to be a model well suited to analyze the differentiation mechanism of neural stem cells. Until now, we have investigated the regulation mechanisms of telomerase activity and telomere length in human cancer and normal cells. Telomerase is the enzyme responsible for the synthesis and maintenance of telomere repeats located at chromosomal ends and is normally expressed in embryonic and germline cells, but not in most normal cells. Here, using SFME cells, we attempted to analyze the regulation mechanism of telomerase activity in neural stem cells and to detect a change upon differentiation into astrocytes. When SFME cells were cultured in the presence of TGF-beta, cells showed anelongated morphology and decreased its growth to 50% of control culture. Cells also expressed the glial fibrillary acidic protein (GFAP), a marker for astrocytes,indicating that TGF-beta induced differentiation in SFME cells from neural stem cells into astrocytes. At the same time,TGF-beta also inhibited telomerase activity and repressed the expression of the mouse telomerase reverse transcriptase(mTERT), demonstrating that SFME cells was vested with a finite replicative life span upon treatment with TGF-beta. To understand the mechanisms regulating mTERT levels during differentiation into astrocytes, we have estimated the expression level of c-myc, which is known to be a key molecule in activating the TERT promoter. As a result, TGF-beta-treated SFME cells were shown to repress the expression of c-myc. Furthermore, promoter analysis, using the 5'-region of the mTERT gene, which possess two E-box elements bound to c-Myc/Max, demonstrated that mTERT promoter activity greatly decreased in TGF-beta-treated SFME cells as compared to non-treated SFME cells. These suggest that c-myc might play a critical role in the expression of mTERT, and that down-regulation of c-myc dependent upon the astrocytic differentiation in SFME cells might cause the repression of mTERT in TGF-beta-treated SFME cells.
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Affiliation(s)
- T Miura
- Department of Genetic Resources Technology, Kyushu University, Fukuoka, 812-8581, Japan
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Alam S, Katakura Y, Yoshida H, Kim EH, Shirahata S. Improvement of a method to reproducibly immortalize human T cells by oncogene transfection. Cytotechnology 2011; 33:71-81. [PMID: 19002813 DOI: 10.1023/a:1008171109981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The method to immortalize human T cells efficiently and reproduciblyby oncogene transfection was improved. T cells were first grown selectively from peripheralblood lymphocytes population of healthy donors andatopic asthma patients, and from lymph nodelymphocytes population of lung cancer patients byactivating with mitogens (phytohemagglutinin andconcanavalin A) and recombinant human interleukin-2(rhIL-2) for five days. Plasmids expressingoncogenes, such as c-Ha-ras, c-myc,c-fos, v-myb and v-jun under the controlof human cytomegalovirus promoter, were then introducedinto these stimulated lymphocytes either separately orin various combinations by electropolation. Afterculturing these transfected lymphocytes for recoveryfor 1 day, they were fed every 3-4 days. Although all the control cells died within one month,oncogene-transfected lymphocytes continued toproliferate actively even for more than severalmonths, indicating that oncogene-transfectedlymphocytes were successfully immortalized. Flowcytometric analyses revealed that most of theimmortalized lymphocytes were T cells expressingCD3(+) surface antigen. The ratios of CD4(+)and CD8(+) subpopulations in immortalized T cellsderived from healthy donors varied, depending onthe kinds of oncogenes used. However, CD8(+)subpopulation in immortalized T cells derived fromcancer patients and atopic asthma patients weredominant, independent of the kinds of oncogenes. These immortalized T cells showed differentproliferative responses in the presence or absence ofexogenous human rhIL-2, depending on their origin ofdonors. Furthermore, immortalized T cells derivedfrom healthy donors showed stronger cytotoxicityagainst K562 cells, suggesting that MHC-nonrestrictedkiller T cells in T cell population were alsoimmortalized. Immortalized T cell lines, whichproliferate continuously without stimulation of amitogen or antigen in medium containing a lowconcentration of rhIL-2, have been maintained for morethan 2 years without any growth rate decrease.
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Affiliation(s)
- S Alam
- Laboratory of Cellular Regulation Technology, Graduate School of Genetic Resources Technology, Kyushu University, 6-10-1 Hakozaki, Higashi-ku, Fukuoka, 812-81, Japan
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Lee SA, Lee WJ, Kim EH, Yu JH, Jung CH, Koh EH, Kim MS, Park JY, Lee KU. Progression to insulin deficiency in Korean patients with Type 2 diabetes mellitus positive for anti-GAD antibody. Diabet Med 2011; 28:319-24. [PMID: 21309840 DOI: 10.1111/j.1464-5491.2010.03186.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the rate of progression to insulin deficiency in Korean patients with Type 2 diabetes mellitus positive for anti-GAD antibody (GADA) and to determine the factors related to progression to insulin deficiency. METHODS We retrospectively analysed data on 87 GADA-positive and 87 age- and sex-matched GADA-negative patients with Type 2 diabetes. GADA-positive patients were further subclassified into high-titre (≥ 250 WHO units/ml) (n = 24) and low-titre (< 250 WHO units/ml) (n = 63) subgroups. Cox proportional hazard analysis was used to identify factors associated with progression to insulin deficiency. RESULTS Over a period of 6 years, two of 87 (2.3%) GADA-negative and 37 of 87 (42.5%) GADA-positive patients had progressed to insulin deficiency. The rate of progression to insulin deficiency was higher in the high-titre than in the low-titre subgroup (75.0 vs. 30.2%). Multivariate analysis in GADA-positive patients showed that high-titre GADA and low BMI at diagnosis were independent factors significantly related to progression to insulin deficiency. CONCLUSIONS The presence of GADA predicted the progression to insulin deficiency in Korean patients with Type 2 diabetes. In GADA-positive patients, high-titre GADA and low BMI were associated with this progression.
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Affiliation(s)
- S A Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
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Cha MJ, Kim SW, Kim EH, Kim YD, Nam HS, Heo JH. Teaching NeuroImages: isolated sensory loss of the arm sparing the hand in cortical infarction. Neurology 2011; 76:e3. [PMID: 21205685 DOI: 10.1212/wnl.0b013e318203e98b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M-J Cha
- Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemoon-ku, 120-752, Seoul, Korea
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