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Park BH, Kim YN, Shin HS. New treatment for antibody-mediated rejection: interleukin-6 inhibitors. Clin Transplant Res 2024; 38:1-6. [PMID: 38725179 PMCID: PMC11075910 DOI: 10.4285/ctr.23.0069] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 05/14/2024]
Abstract
Following kidney transplantation, antibody-mediated rejection (AMR) occurs when the antibodies of the immune system attack the transplanted organ, leading to damage of the kidney tissue. De novo human leukocyte antigen donor-specific antibodies (HLA-DSAs) play a key role in AMR. Current therapeutic approaches include intravenous immunoglobulin, anti-CD20 antibodies, and plasmapheresis. In cases resistant to treatment, proteasome inhibitors and C5 inhibitors may be employed. Nevertheless, a pressing need exists for new medications to improve transplant survival and reduce complications. In the context of AMR, interleukin (IL)-6 is instrumental in the development and maturation of B cells into plasma cells, which then produce HLA-DSAs targeting the allograft. IL-6 inhibitors are currently under investigation and show promise due to the essential role of IL-6 in the immune response; however, additional research is necessary.
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Affiliation(s)
- Byung Hwa Park
- Division of Nephrology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, Korea
| | - Ye Na Kim
- Division of Nephrology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Division of Nephrology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, Korea
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Park BH, Kim YN, Shin HS, Jung Y, Rim H. Current use of antithymoglobulin as induction regimen in kidney transplantation: A review. Medicine (Baltimore) 2024; 103:e37242. [PMID: 38428847 PMCID: PMC10906612 DOI: 10.1097/md.0000000000037242] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024] Open
Abstract
Currently, various immunosuppressive drugs are used in organ transplantation. In particular, antithymoglobulin is a widely used drug in kidney transplantation in Korea, accounting for 20% of all induction therapy. According to existing studies, antithymoglobulin induction therapy has several advantages and disadvantages compared with other immunotherapies depending on the kidney transplant situation (dead donor, living donor, low-risk recipient, and high-risk recipient) or antithymoglobulin dose. In this review, we summarize the research conducted so far on antithymoglobulin and hope that antithymoglobulin research on kidney transplantation will be actively conducted in the future.
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Affiliation(s)
- Byung Hwa Park
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Yeonsoon Jung
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Kim Y, Lee N, Heo S, Kim YN, Shin HS, Jung Y, Rim H. The effect of gemigliptin treatment on immune parameters including regulatory T cells in patients with type 2 diabetes and moderate to very severe chronic renal impairment. Medicine (Baltimore) 2023; 102:e36455. [PMID: 38065905 PMCID: PMC10713170 DOI: 10.1097/md.0000000000036455] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
It is crucial to understand the impact of DPP-4 inhibitors on the immune system, particularly T cell differentiation, maturation, and proliferation, in patients with type 2 diabetes and CKD. This prospective observational study aimed to investigate the distribution of immune cells (particularly regulatory T cells), following the administration of gemigliptin, a DPP-4 inhibitor, in patients with type 2 diabetes mellitus and chronic kidney disease. We enrolled 28 patients with type 2 diabetes, aged 20 to 69, who had been taking a daily dose of 50mg gemigliptin for <3 months and had chronic kidney disease stages 3, 4, or 5, including that undergoing dialysis. T regulatory cells were defined as CD4 + CD25 high CD127 low/- FoxP3 + phenotype, and flow cytometry was used to examine the distribution of T regulatory cells. In the patient group, blood samples were collected at baseline, as well as at 3 and 6 months after initiating medication. Of the 28 patients, 17 (60.7%) were male and the mean age was 61.82 ± 8.03 years. Serum Cr ≥ 1.5 mg/dL was 16 (57%), and Cr < 1.5 mg/dL was 12 (43%). The number of CD4(+)/CD25(+) cells did not significantly increase or decrease in baseline, 3 months, and 6 months time changes, and the number of CD127(-/FoxP3(+) cells did not change significantly. Treatment with gemigliptin for 3 and 6 months did not significantly alter the number, percentage, or ratio of circulating Treg cells in patients with type 2 diabetes and CKD. Therefore, the administration of gemigliptin may help maintain regulatory T cells or have no significant impact.
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Affiliation(s)
- Yanghyeon Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Nagyeom Lee
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Sujung Heo
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Yeonsoon Jung
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Lee YH, Song SH, Song SH, Shin HS, Yang J, Kim MS, Hwang HS. Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study. Nephrol Dial Transplant 2023; 38:2743-2753. [PMID: 37243323 DOI: 10.1093/ndt/gfad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear. METHODS We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death. RESULTS Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17-4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12-5.63), but changes in the number of dysfunctional MetS components was not. CONCLUSION Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.
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Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea
| | - Seung Hwan Song
- Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Ho Sik Shin
- Division of Nephrology, Department of Internal Medicine, Kosin University College of Medicine, Pusan, Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Korea
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Lee YJ, Park KM, Heo CM, Park S, Kim YW, Lee D, Kim Y, Oh JS, Shin HS, Park BS. Changes in the glymphatic system before and after dialysis initiation in patients with end-stage kidney disease. Ren Fail 2023; 45:2265665. [PMID: 37795782 PMCID: PMC10557553 DOI: 10.1080/0886022x.2023.2265665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION The aims of this study were to evaluate 1) glymphatic system function in patients with end-stage kidney disease (ESKD) before initiating dialysis compared to healthy controls, and 2) changes in the glymphatic system function after kidney replacement therapy including dialysis in patients with ESKD using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method. MATERIALS AND METHODS This study was prospectively conducted at a single hospital. We enrolled 14 neurologically asymptomatic patients who first initiated hemodialysis or peritoneal dialysis for ESKD and 17 healthy controls. Patients had magnetic resonance imaging scans before initiating dialysis and again 3 months after initiating dialysis and the DTI-ALPS index was calculated. We compared the DTI-ALPS index before and after the initiation of dialysis and compared the DTI-ALPS index between the patients with ESKD and healthy control. RESULTS There were differences in the DTI-ALPS index between ESKD patients before initiating dialysis and healthy controls (1.342 vs. 1.633, p = 0.003). DTI-ALPS index between ESKD patients before initiating dialysis and those after dialysis were not different (1.342 vs. 1.262, p = 0.386). There was a positive correlation between DTI-ALPS index and phosphate (r = 0.610, p = 0.020) in patients with ESKD. CONCLUSION We confirmed the presence of glymphatic dysfunction in patients with ESKD. However, there was no difference in the glymphatic system before and after dialysis initiation. This finding may be related to uremic toxins that are not removed by dialysis in patients with ESKD. This study can be used for the development of pathophysiology of patients with ESKD.
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Affiliation(s)
- Yoo Jin Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chang Min Heo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sihyung Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dongyeol Lee
- Department of Internal Medicine, Good Gangan Hospital, Busan, Republic of Korea
| | - Yunmi Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Joon Seok Oh
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Republic of Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Bong Soo Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Lee YK, Kim YH, Kim DH, Kim JH, Lee JH, Park JH, Ko GJ, Hwang WM, Gil HW, Kang YS, Jin KB, Do JY, Kim SJ, Kim BS, Shin HS. Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5. Medicine (Baltimore) 2023; 102:e33695. [PMID: 37171361 PMCID: PMC10174414 DOI: 10.1097/md.0000000000033695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients' physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients' options for dialysis. METHODS SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method. RESULTS The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). CONCLUSIONS Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients' best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
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Affiliation(s)
- Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yang-Hyeon Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Do-Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jin-Heog Kim
- Department of Bigdata and Applied Statistics, College of Science and Technology, Dongguk University, Gyeongju, Republic of Korea
| | - Jeong-Hwan Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyeon Park
- Department of Internal Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won-Min Hwang
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hyo-Wook Gil
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | | | - Kyu-Bok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University Kidney Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | | | - Se-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | | | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Heo S, Kim Y, Lee N, Kim YN, Shin HS, Jung Y, Rim H. =?UTF-8?B?Q29tcGFyaXNvbiBvZiBjaXJjdWl0IHBhdGVuY3kgYW5kIGV4Y2hhbmdlIHJhdGVzIGJldHdlZW4gdGhlIG9yaWdpbmFsIGFuZCBnZW5lcmljIHZlcnNpb25zIG9mIG5hZmFtb3N0YXQgbWVzeWxhdGUgaW4gY3JpdGljYWxseSBpbGwgYWR1bHRzIHJlY2VpdmluZyBjb250aW51b3VzIHJlbmFsIHJlcGxhY2VtZW50IHRoZXJhcHk=?=. KMJ 2023. [DOI: 10.7180/kmj.22.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Paek JH, Kim YN, Shin HS, Jung Y, Rim H. Expansion and characterization of regulatory T cell populations from Korean kidney transplant recipients. Medicine (Baltimore) 2023; 102:e33058. [PMID: 36930095 PMCID: PMC10019245 DOI: 10.1097/md.0000000000033058] [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: 12/14/2022] [Accepted: 02/01/2023] [Indexed: 03/18/2023] Open
Abstract
The development of immunosuppressants has enabled remarkable progress in kidney transplantation (KT). However, current immunosuppressants cannot induce immune tolerance, and their nonspecific immunosuppressive effects result in many adverse effects. Regulatory T cells (Tregs) play crucial roles in controlling all specific immune responses. This study evaluated the distribution of Tregs and their effects on kidney allograft function in Korean KT recipients. We enrolled 113 KT recipients with stable graft function. The differentiation and expansion of Tregs were examined by flow cytometry to compare the Tregs subpopulations. Among the 113 patients, 73 (64.6%) were males, and the mean follow-up period from KT to Tregs collection was 147.5 + 111.3 months. Patients receiving lower doses of cyclosporine had higher proportions of Tregs than those with higher doses of cyclosporine (36.3 + 21.6 vs 17.0 + 12.7, P = .010, respectively). Patients taking cyclosporine tended to have higher Tregs numbers than those taking tacrolimus (94.7 + 158.1 vs 49.3 + 69.4, P = .095, respectively). However, no significant association was observed between Tregs and allograft dysfunction in the cox proportional hazard model. Tregs counts may be associated with the type and dose of immunosuppressants. However, no significant relationship was found between Tregs and kidney allograft function in stable KT recipients.
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Affiliation(s)
- Jin Hyuk Paek
- Renal Division, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Ye Na Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Yeonsoon Jung
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Lee YH, Song SH, Song SH, Shin HS, Yang J, Kim MS, Hwang HS. Transition of metabolic dysfunction after kidney transplantation and its association with transplant outcomes: a nationwide prospective cohort study. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-0681] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yu Ho Lee
- Department of Nephrology, Bundang CHA General Hospital, Seongnam, Korea
| | - Sang Heon Song
- Department of Nephrology, Pusan National University, Busan, Korea
| | | | - Ho Sik Shin
- Department of Nephrology, Kosin University, Busan, Korea
| | - Jaeseok Yang
- Department of Nephrology, Yonsei University, Seoul, Korea
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Lee YH, Kim JS, Song SH, Song SH, Shin HS, Yang J, Ahn C, Jeong KH, Hwang HS. Impact of donor hypertension on graft survival and function in living and deceased donor kidney transplantation: a nationwide prospective cohort study. J Hypertens 2022; 40:2200-2209. [PMID: 36093867 DOI: 10.1097/hjh.0000000000003246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hypertensive living donors are potential candidates to expand the kidney donor pool. However, the impact of donor hypertension on graft survival and function remains to be clarified. METHODS We analyzed 3907 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2018. Patients were divided by donor types and the presence of donor hypertension. The primary and secondary outcome was the occurrence of death-censored graft failure and renal allograft function, respectively. RESULTS The prevalence of hypertension was 9.4% (258/2740) and 19.9% (232/1167) in living and deceased donors, respectively. During a median follow-up of 21.8 months, death-censored graft survival rate was significantly worse in recipients of hypertensive living donors than in those of normotensive living donors ( P = 0.008). In multivariable analysis, recipients of hypertensive living donors had a significantly increased risk of graft loss (adjusted hazard ratio 2.91; P = 0.009). The risk of allograft loss was not different between recipients of hypertensive living and normotensive deceased donors. Propensity score-matched analyses had consistent worse graft survival rate in recipients of hypertensive living donors compared to those of normotensive living donors ( P = 0.027), while it was not different between recipients of hypertensive living and normotensive deceased donors. Hypertension in living donors had a significant negative impact on one-year graft function (adjusted unstandardized β -3.64; P = 0.011). CONCLUSIONS Hypertensive living donor recipients have significantly higher risks of renal allograft loss than normotensive living donor recipients, and showed similar outcomes compared to recipients of normotensive deceased donors.
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Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Jin Sug Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
| | - Sang Heon Song
- Biomedical Research Institute, Department of Internal Medicine, Pusan National University Hospital, Busan
| | - Seung Hwan Song
- Department of Surgery, Ewha Womans University College of Medicine, Seoul
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan
| | - Jaeseok Yang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul
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Heo S, Park Y, Lee N, Kim Y, Kim YN, Shin HS, Jung Y, Rim H, Rennke HG, Chandraker A. Lack of Efficacy and Safety of Eculizumab for Treatment of Antibody-Mediated Rejection Following Renal Transplantation. Transplant Proc 2022; 54:2117-2124. [PMID: 36192209 DOI: 10.1016/j.transproceed.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 10/07/2022]
Abstract
BACKGROUND We evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis and intravenous immunoglobulin therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR). METHODS This was a multicenter, open-label, prospective, randomized analysis. The patients were randomized by therapy type (eg, eculizumab infusions or standard of care [SOC]: plasmapheresis/intravenous immunoglobulin). The patients (ie, eculizumab arm: 7 patients, SOC arm: 4 patients) were evaluated for the continued presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histologic evidence, using repeat renal biopsy after treatment. RESULTS The allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Only 2 patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. After AMR treatment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm. CONCLUSIONS Eculizumab alone cannot treat AMR effectively and does not prevent acute AMR from progressing to chronic AMR or transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels.
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Affiliation(s)
- Sujung Heo
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Youngchan Park
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Nagyeom Lee
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Yanghyeon Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea.
| | - Yeonsoon Jung
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea; Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Helmut G Rennke
- Renal Pathology, Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil Chandraker
- Transplantation Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kim YN, Jung Y, Shin HS, Rim H, Park JG, Lee DY, Kim JK. The Natural Course of Total Kidney Volume in Patients with Autosomal Dominant Polycystic Kidney Disease undergoing Hemodialysis. KMJ 2021. [DOI: 10.7180/kmj.2021.36.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: The natural course of native kidneys after hemodialysis initiation in patients with autosomal dominant polycystic kidney disease (ADPKD) remains poorly understood.Methods: We measured the total volumes of native kidneys in 12 patients who had at least one enhanced computed tomography (CT) image both before and after initiation of hemodialysis (group 1) and in 18 patients who had no image before dialysis but more than two images after dialysis (group 2). In patients with images, the last image was used for analysis only after dialysis.Results: The mean total kidney volume (TKV) (± SD) before hemodialysis initiation was 3132 ± 1413 mL and the mean TKV of the last image was 3047 ± 1323 mL in group 1. The mean TKV change rate (%) was - 5.2 ± 27.4% (P > 0.05) during follow-up of 3.9 ± 1.9 years in group 1. The mean TKV change rate was 2.8 ± 34.4% (P > 0.05) in group 2. The follow-up period after dialysis initiation ranged from 4.2 ± 4.7 to 8.0 ± 5.2 years.Conclusions: The results suggest that the TKV of native polycystic kidneys decreases substantially after hemodialysis initiation. This reduction occurs mainly during the early post-hemodialysis period and followed by a slow enlargement of TKV.
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13
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Lim EY, Song EJ, Kim JG, Jung SY, Lee SY, Shin HS, Nam YD, Kim YT. Lactobacillus intestinalis YT2 restores the gut microbiota and improves menopausal symptoms in ovariectomized rats. Benef Microbes 2021; 12:503-516. [PMID: 34463192 DOI: 10.3920/bm2020.0217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are many studies focusing on the alleviation of menopausal symptoms; however, little is known about the role of gut microorganisms in menopausal symptoms. Ovariectomized (OVX) rats were administered a novel strain (YT2) of Lactobacillus intestinalis (a species with significantly reduced abundance in OVX rats) and the potential probiotic effect on the improvement of menopausal symptoms was evaluated. Of note, the gut microbial composition completely shifted after ovariectomy in rats. Treatment with L. intestinalis YT2 significantly alleviated menopausal symptoms, such as increased fat mass, decreased bone mineral density, increased pain sensitivity, depression-like behaviour, and cognitive impairment. Additionally, the administration of L. intestinalis YT2 restored the intestinal microbial composition, including an increased Firmicutes/Bacteroides ratio. L. intestinalis YT2 also promoted gut barrier integrity by increasing the mRNA levels of tight junction-related markers. In conclusion, L. intestinalis YT2 treatment alleviated menopausal symptoms via the modulation of the gut microbiota. Importantly, these results suggest that L. intestinalis YT2 should be considered as a therapeutic probiotic agent for menopausal women.
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Affiliation(s)
- E Y Lim
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea.,Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - E-J Song
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
| | - J G Kim
- Food Functional Evaluation Support Team, Technical Assistance Center, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
| | - S Y Jung
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea.,Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - S-Y Lee
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea.,Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - H S Shin
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea.,Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Y-D Nam
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
| | - Y T Kim
- Division of Food Functionality, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea.,Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
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Baek J, Park Y, Kim YN, Shin HS, Jung Y, Rim H. Expansion and characterization of regulatory T cell populations from korean kidney transplant recipients. Korean Journal of Transplantation 2021. [DOI: 10.4285/atw2021.po-1029] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jinhyuk Baek
- Department of Internal Medicine-Nephrology, Keimyung University School of Medicine, Daegu, Korea
| | - Youngchan Park
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Ye Na Kim
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
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15
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Park Y, Kim YN, Shin HS, Jung Y, Rim H. Expansion and characterization of regulatory T cell populations from acute kidney injury patients. Korean Journal of Transplantation 2021. [DOI: 10.4285/atw2021.po-1030] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Youngchan Park
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Ye Na Kim
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine-Nephrology, Kosin University Gospel Hospital, Busan, Korea
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16
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Yoon JG, Song SH, Choi S, Oh J, Jang IJ, Kim YJ, Moon S, Kim BJ, Cho Y, Kim HK, Min S, Ha J, Shin HS, Yang CW, Yoon HE, Yang J, Lee MG, Park JB, Kim MS. Unraveling the Genomic Architecture of the CYP3A Locus and ADME Genes for Personalized Tacrolimus Dosing. Transplantation 2021; 105:2213-2225. [PMID: 33654003 DOI: 10.1097/tp.0000000000003660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tacrolimus (TAC) is an immunosuppressant widely prescribed following an allogenic organ transplant. Due to wide interindividual pharmacokinetic (PK) variability, optimizing TAC dosing based on genetic factors is required to minimize nephrotoxicity and acute rejections. METHODS We enrolled 1133 participants receiving TAC from 4 cohorts, consisting of 3 with kidney transplant recipients and 1 with healthy males from clinical trials. The effects of clinical factors were estimated to appropriately control confounding variables. A genome-wide association study, haplotype analysis, and a gene-based association test were conducted using the Korea Biobank Array or targeted sequencing for 114 pharmacogenes. RESULTS Genome-wide association study verified that CYP3A5*3 is the only common variant associated with TAC PK variability in Koreans. We detected several CYP3A5 and CYP3A4 rare variants that could potentially affect TAC metabolism. The haplotype structure of CYP3A5 stratified by CYP3A5*3 was a significant factor for CYP3A5 rare variant interpretation. CYP3A4 rare variant carriers among CYP3A5 intermediate metabolizers displayed higher TAC trough levels. Gene-based association tests in the 61 absorption, distribution, metabolism, and excretion genes revealed that CYP1A1 are associated with additional TAC PK variability: CYP1A1 rare variant carriers among CYP3A5 poor metabolizers showed lower TAC trough levels than the noncarrier controls. CONCLUSIONS Our study demonstrates that rare variant profiling of CYP3A5 and CYP3A4, combined with the haplotype structures of CYP3A locus, provide additive value for personalized TAC dosing. We also identified a novel association between CYP1A1 rare variants and TAC PK variability in the CYP3A5 nonexpressers that needs to be further investigated.
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Affiliation(s)
- Jihoon G Yoon
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Seoul, Republic of Korea
| | - Seung Hwan Song
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Sungkyoung Choi
- Department of Applied Mathematics, Hanyang University (ERICA), Ansan, Republic of Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Young Jin Kim
- Division of Genome Research, Department of Precision Medicine, National Institute of Health, Chungcheongbuk-do, Republic of Korea
| | - Sanghoon Moon
- Division of Genome Research, Department of Precision Medicine, National Institute of Health, Chungcheongbuk-do, Republic of Korea
| | - Bong-Jo Kim
- Division of Genome Research, Department of Precision Medicine, National Institute of Health, Chungcheongbuk-do, Republic of Korea
| | - Yuri Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Kee Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Transplantation Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Sik Shin
- Division of Nephrology, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Hye Eun Yoon
- Divison of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jaeseok Yang
- Department of Surgery, Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Goo Lee
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim YN, Kim DH, Shin HS, Lee S, Lee N, Park MJ, Song W, Jeong S. The risk factors for treatment-related mortality within first three months after kidney transplantation. PLoS One 2020; 15:e0243586. [PMID: 33301510 PMCID: PMC7728215 DOI: 10.1371/journal.pone.0243586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022] Open
Abstract
Mortality at an early stage after kidney transplantation is a disastrous event. Treatment-related mortality (TRM) within 1 or 3 months after kidney transplantation has been rarely reported. We designed a cohort study using the national Korean Network for Organ Sharing database that includes information about kidney recipients between 2002 and 2016. Their demographic, and laboratory data were collected to analyze risk factors of TRM. A total of 19,815 patients who underwent kidney transplantation in any of 40 medical centers were included. The mortality rates 1 month (early TRM) and 3 months (TRM) after transplantation were 1.7% (n = 330) and 4.1% (n = 803), respectively. Based on a multivariate analysis, older age (hazard ratio [HR] = 1.044), deceased donor (HR = 2.210), re-transplantation (HR = 1.675), ABO incompatibility (HR = 1.811), higher glucose (HR = 1.002), and lower albumin (HR = 0.678) were the risk factors for early TRM. Older age (HR = 1.014), deceased donor (HR = 1.642), and hyperglycemia (HR = 1.003) were the common independent risk factors for TRM. In contrast, higher serum glutamic oxaloacetic transaminase (HR = 1.010) was associated with TRM only. The identified risk factors should be considered in patient counselling, and management to prevent TRM. The recipients assigned as the high-risk group require intensive management including glycemic control at the initial stage after transplant.
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Affiliation(s)
- Ye Na Kim
- Division of Nephrology/Transplantation, Department of Internal Medicine, Kosin University College of Medicine, Gospel Hospital, Busan, South Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, South Korea
| | - Ho Sik Shin
- Division of Nephrology/Transplantation, Department of Internal Medicine, Kosin University College of Medicine, Gospel Hospital, Busan, South Korea
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, South Korea
| | - Nuri Lee
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- * E-mail:
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Shin HS, Kim J, Jeon H, Kim YN, Jung Y, Rim H. P0638COMPARISON OF CIRCUIT PATENCY AND EXCHANGE RATES BETWEEN THE ORIGINAL PRODUCTS AND THE GENERIC VERSIONS OF NAFAMOSTAT MESILATE IN ACUTE KIDNEY INJURY RECEIVING CONTINOUS RENAL REPLACEMENT THERAPY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0638] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The generic versions have the same main component as the original products. But, due to the difference in additives or the level of impurities, it is questionable the the generic versions are completely identical to the original products. Nafamostat mesilate has been widely used as an anticoagulation in continuous renal replacement therapy (CRRT) with hemorrhagic diathesis. In this study, we performed comparison of circuit patency and exchange rates between the original products and the generic versions of Nafamostat mesilate in acute kidney injury patients receiving continuous renal replacement therapy
Method
We have conducted retrospective studies to compare the original product of nafamostat mesilate (n=732) with the generic version (n=328) on the CRRT running time.
Results
CRRT fiter life time of the generic version group was shorter than that of original product group although that was not significantly.
Conclusion
When generic versions of nafamostat mesilate are adopted in a hospital formulary, it must be emphasized that the effect these versions may be not completely identical to that of the original products.
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Affiliation(s)
- Ho Sik Shin
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Jisu Kim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Haesu Jeon
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Ye Na Kim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Yeonsoon Jung
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Hark Rim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
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Jung Y, Kim J, Jeon H, Kim YN, Shin HS, Rim H. P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1706] [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: 11/14/2022] Open
Abstract
Abstract
Background
African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes.
Methods
Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression).
Results
195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics
Conclusions
African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.
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Affiliation(s)
- Yeonsoon Jung
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Jisu Kim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Haesu Jeon
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Ye Na Kim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Ho Sik Shin
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
| | - Hark Rim
- Gospel Hospital, Internal Medicine, Busan, Korea, Rep. of South
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Kim SM, Choi JH, Son MJ, Rim H, Shin HS. Is Body Mass Index a Significant Independent Risk Factor for Graft Failure and Patient Death in the Modern Immunosuppressive Era? Transplant Proc 2020; 52:3058-3068. [PMID: 32475532 DOI: 10.1016/j.transproceed.2020.02.158] [Citation(s) in RCA: 2] [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] [Received: 11/04/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies have shown that kidney transplant recipients with a high body mass index (BMI) have inferior graft and patient outcomes compared to patients with a lower BMI. We hypothesized that there would be secular improvements in outcomes among high BMI recipients. We used data from the United Network for Organ Sharing (UNOS) to determine whether obesity affects patient and graft outcomes following kidney transplantation in the modern immunosuppressive era. METHODS The study sample consisted of 69,749 recipients from 1987 to 1999 and 197,986 recipients from 2000 to 2016. BMI values were categorized into 11 tiers: below 18 kg/m2, from 18 to 36 kg/m2 at 2 kg/m2-unit increments, and above 36 kg/m2. We created multivariate models to evaluate the independent effect of BMI on graft and patient outcomes, adjusting for factors known to affect graft success and patient survival. RESULTS Overall graft and patient survival has improved for all BMI categories. Cox regression modeling hazard ratios showed that the relative risk for graft loss, patient death, and patient death with a functioning graft in the modern immunosuppressive era (2000 to 2016) has significantly decreased compared to the earlier era (1987 to 1999), especially for living kidney transplant recipients. CONCLUSIONS The relative risk of graft failure and patient death with increasing BMI has appreciably decreased in the modern immunosuppressive era, especially for living donor transplant recipients. Withholding transplantation from patients with higher BMIs may no longer be justifiable on grounds of worse clinical outcomes.
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Affiliation(s)
- Sun Min Kim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Jae Hyuc Choi
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Mu Jin Son
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea.
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Abstract
It is increasingly recognized that calcineurin inhibitors (CNI) such as cyclosporine and tacrolimus are not ideal immunosuppressive agents. Side effects, including increased rates of infection, hypertension, and malignancy, can be severe. Thus, in the past decade, there has been much focus on the development of novel therapeutic agents and strategies designed to replace or minimize CNI exposure in transplant patients. This article reviews potential novel targets in T cells, alloantibody-producing B cells, plasma cells, and complement in transplantation.
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Affiliation(s)
- Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea
| | - Ivica Grgic
- Department of Internal Medicine and Nephrology, University Hospital, Giessen and Marburg, Philipps-University Marburg, Baldinger Strasse 1, Marburg 35033, Germany
| | - Anil Chandraker
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02215, USA.
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Shin HS, Cho DH, Kang SK, Kim HJ, Kim SY, Yang JW, Kang GH, Kim YN, Jung Y, Cheon BK, Rim H. Patterns of renal disease in South Korea: a 20-year review of a single-center renal biopsy database. Ren Fail 2018; 39:540-546. [PMID: 28722531 PMCID: PMC6014498 DOI: 10.1080/0886022x.2017.1348955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Several registries and centers have reported the results of renal biopsies from different parts of the world. As there are few data regarding the epidemiology of glomerulonephritis (GN) in South Korea, we conducted this study on renal biopsy findings during the last 20 years from a single center. Methods: Data for 818 patients who underwent renal biopsy at our center between 1992 and 2011 were collected retrospectively. All kidney specimens were examined with light microscopy (LM) and immunofluorescent microscopy (IF). Results: There were 818 cases of native kidney biopsies. In cases of primary GN, the most frequent type of renal pathology in adults (18–59 years) was mesangial proliferative GN (MsPGN, 34.5%) followed by IgA nephropathy (IgAN, 33.3%) and membranous GN (MGN, 8.8%). Indications in adults (18–59 years) were asymptomatic urinary abnormalities (75.3%) followed by nephrotic syndrome (19.8%) and acute kidney injury (AKI, 3.4%). Conclusions: Among 818 renal biopsy specimens, MsPGN and IgAN were the most frequent biopsy-proven renal diseases. MGN was the third most common cause of primary GN and lupus nephritis (LN) was the most common secondary glomerular disease. Our data contribute to the epidemiology of renal disease in South Korea.
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Affiliation(s)
- Ho Sik Shin
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Dae Hyeon Cho
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Soo Kyoung Kang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Hyun Jeong Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Soo Young Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Joung Wook Yang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Gyong Hoon Kang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Ye Na Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Yeonsoon Jung
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Bong-Kwon Cheon
- b Department of Pathology , Kosin University College of Medicine , Busan , Korea
| | - Hark Rim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
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Baek HK, Bae K, Jeon KN, Choi DS, Shin HS, Lee KH. Magnetic Resonance Imaging of Alcohol-induced Encephalopathies. Hong Kong J Radiol 2018. [DOI: 10.12809/hkjr1616412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yang JW, Kim YN, Shin HS, Jung Y, Rim H. Changes in Insulin Sensitivity and Lipid Profile in Renal Transplant Recipients Converted from Cyclosporine or Standard Release Tacrolimus to Once-Daily Prolonged Release Tacrolimus. Korean J Transplant 2017. [DOI: 10.4285/jkstn.2017.31.3.126] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joung Wook Yang
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Ye Na Kim
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Kim SY, Kim YN, Shin HS, Jung Y, Rim H. The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury. Kidney Res Clin Pract 2017; 36:240-249. [PMID: 28904875 PMCID: PMC5592891 DOI: 10.23876/j.krcp.2017.36.3.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/31/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT). METHODS We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT. RESULTS We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality. CONCLUSION APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT.
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Affiliation(s)
- Soo Young Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ye Na Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Kim YN, Shin HS. Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis. KMJ 2017. [DOI: 10.7180/kmj.2017.32.1.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Dialysis patients’ nutritional indicators are quite subjective and complex and cannot be easily measured in clinical settings. Based on previous reports that total lymphocyte count (TLC) and subpopulation lymphocyte counts (SLCs) are associated with nutritional status in patients with dialysis, we designed this study to examine the relationships of the TLC and SLCs with clinical outcome and nutritional status in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD). Methods In this prospective, observational study, we enrolled 66 patients (50 HD patients and 16 PD patients) receiving stable maintenance dialysis. We evaluated the baseline parameters of height; weight; TLC; SLCs expressing CD3, CD4, CD8 and CD19; CBC; iron profile (iron, TIBC, ferritin); BUN; Cr; Na; K; total CO2; Ca; P; iPTH; protein; albumin; total cholesterol; HDL; LDL; uric acid and CRP and calculated Onodera’s prognostic nutritional index (OPNI) and the Geriatric Nutritional Risk Index (GNRI) at baseline and three months. To analyze differences in the TLC and SLCs between the HD group and the PD group, we performed an independent samples t-test. Logistic regression analysis was performed to predict malnutrition in dialysis patients. In addition, to analyze changes in TLC, SLCs expressing each marker (CD3, CD4, CD8 and CD19) and other nutritional markers, we performed general linear model (GLM)-repeated measures ANOVA. Results Mean age was 55.8 ± 12.7 years in HD paitents and 49.8 ± 14.5 years in PD patients. The duration of dialysis was 59.7 ± 52.9 months in HD patients and 66.1 ± 33.6 years in PD patients. Logistic regression analysis revealed that patients aged 60 years or older, women, and those whose CD19 SLCs were lower than 100 had a higher risk of developing malnutrition. In GLM-repeated measures ANOVA, CD19 SLCs were significantly higher in women and in patients with a shorter period of dialysis. Conclusions Our results indicate that GNRI, OPNI, TLC and SLCs (especially CD19 count) may be significant nutritional markers in HD and PD patients.
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Shin HS. MP279HYPOPHOPHATEMIA ON OUTCOMES DURING CRRT. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx167.mp279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Radiation treatment often leads to irreversible damage to normal salivary glands (SGs) because of their proximity to head and neck cancers. Optimization of the in vitro model of irradiation (IR)-induced SG damage is warranted to investigate pathophysiology and monitor treatment outcome. Here, we present an organotypic spheroid culture model to investigate the impact of IR on SGs and the mechanisms underlying IR-induced structural and functional changes. Human parotid epithelial cells were obtained from human parotid glands and plated on either plastic plates or Matrigel. A number of 3-dimensional (3D) spheroids were assembled on Matrigel. After IR at 10 and 20 Gy, morphologic changes in cells in 2D monolayers and 3D spheroids were observed. As the structural integrity of the 3D spheroids was destroyed by IR, the expression levels of salivary epithelial and structural proteins and genes decreased proportionally with radiation dosage. Furthermore, the spheroid culture allowed better measurement of functional alterations following IR relative to the monolayer culture, in which IR-inflicted spheroids exhibited a loss of acinar-specific cellular functions that enable Ca2+ influx or secretion of α-amylase in response to cholinergic or β-adrenergic agonists. p53-mediated apoptotic cell death was observed under both culture conditions, and its downstream signals increased, such as p53 upregulated modulator of apoptosis (PUMA), Bax, cytochrome c, caspase 9, and caspase 3. These results suggest that the organotypic spheroid culture could provide a useful alternative model for exploration of radiobiology and mode of action of new therapies for prevention of radiation-induced salivary hypofunction.
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Affiliation(s)
- H S Shin
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea.,2 Translational Research Center, College of Medicine, Inha University, Incheon, Republic of Korea
| | - H Y An
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea.,2 Translational Research Center, College of Medicine, Inha University, Incheon, Republic of Korea
| | - J S Choi
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea.,2 Translational Research Center, College of Medicine, Inha University, Incheon, Republic of Korea
| | - H J Kim
- 3 Department of Radiation Oncology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - J Y Lim
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Incheon, Republic of Korea.,2 Translational Research Center, College of Medicine, Inha University, Incheon, Republic of Korea
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Kang GH, Kim YN, Shin HS. Relationship between geriatric nutritional risk index and subpopulation lymphocyte counts in patients undergoing hemodialysis and peritoneal dialysis. Ren Fail 2016; 38:1589-1593. [DOI: 10.3109/0886022x.2015.1128234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Gyong Hoon Kang
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ye Na Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Shin YH, Gong HS, Gang DH, Shin HS, Kim J, Baek GH. Evaluation of trabecular bone score in patients with a distal radius fracture. Osteoporos Int 2016; 27:3559-3565. [PMID: 27341808 DOI: 10.1007/s00198-016-3686-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/21/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We compared bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal women with a distal radius fracture older than 50 years with controls. Total hip BMD was significantly different, but TBS was not different between two groups, suggesting TBS does not reflect microarchitectural changes of the distal radius. INTRODUCTION The purpose of this study was to determine whether trabecular bone score (TBS) has additive value for discriminating distal radius fracture (DRF) independent of BMD. METHODS We compared BMD and TBS in 258 postmenopausal women with a DRF older than 50 years of age with age- and body mass index (BMI)-matched controls who had no history of osteoporotic fracture. BMD was measured at the lumbar spine and hip using dual energy X-ray absorptiometry scans (GE Lunar Prodigy). TBS was calculated on the same spine image. A multivariate logistic regression analysis was used to analyze the odds ratio (OR) for the occurrence of DRF using age, BMI, lumbar spine BMD, total hip BMD, and TBS. RESULTS Patients with a DRF had significantly lower BMDs at hip (neck, trochanter and total) than those of controls: 0.752 ± 0.097, 0.622 ± 0.089, and 0.801 ± 0.099 in patients and 0.779 ± 0.092, 0.648 ± 0.089, 0.826 ± 0.101 in controls. However, lumbar spine BMD and TBS were not significantly different between the groups (p = 0.400 and 0.864, respectively). The multivariate analysis indicated that only total hip BMD was significantly associated with the occurrence of DRF (OR, 10.231; 95 % confidence interval, 1.724-60.702; p = 0.010). CONCLUSIONS TBS was not different between women with a DRF and those without a history of osteoporotic fracture, suggesting that TBS measured at the lumbar spine does not reflect early microarchitectural changes of the distal radius. Only total hip BMD is associated with the risk of DRF in Korean women.
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Affiliation(s)
- Y H Shin
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea.
| | - D H Gang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
| | - H S Shin
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
| | - J Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - G H Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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Kim HJ, Park KW, Kim TE, Im JY, Shin HS, Kim S, Lee DH, Ye BS, Kim JH, Kim EJ, Park KH, Han HJ, Jeong JH, Choi SH, Park SA. Elevation of the Plasma Aβ40/Aβ42 Ratio as a Diagnostic Marker of Sporadic Early-Onset Alzheimer's Disease. J Alzheimers Dis 2016; 48:1043-50. [PMID: 26444752 DOI: 10.3233/jad-143018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although plasma amyloid-β (Aβ) levels have been evaluated as a possible diagnostic marker of Alzheimer's disease (AD), the findings are inconsistent. OBJECTIVE The present study aimed to validate plasma levels of Aβ40, Aβ42, and the Aβ40/Aβ42 ratio as biomarkers of AD in subjects with early-onset AD (EOAD) without familial AD genetic mutations. METHODS Patients with sporadic EOAD (sEOAD) were prospectively recruited by nine neurology clinics. Plasma levels of Aβ40 and Aβ42 were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) in 100 sEOAD (50-69 year-old) and 46 age-matched normal control subjects (50-72 year-old). Cerebrospinal fluid (CSF) was obtained from 32 sEOAD subjects and 25 controls. The integrity of the blood-brain barrier was assessed using the CSF/plasma albumin ratio. RESULTS The plasma levels of Aβ42 were significantly lower, while the Aβ40/Aβ42 ratio was significantly higher in sEOAD patients than in controls. The levels of Aβ40, Aβ42, and the Aβ40/Aβ42 ratio did not differ in relation to the APOEɛ4 allele. The CSF/plasma albumin ratio was comparable between the two groups, and the plasma parameters of Aβ proteins were not significantly associated. A multivariate analysis revealed that an increased Aβ40/Aβ42 ratio is valuable for the discrimination of sEOAD from controls (β=0.344, p=0.000). The area under the ROC curve for the Aβ40/Aβ42 ratio was 0.76, and a cut-off ratio of 5.87 was suggested to have 70% sensitivity and 68% specificity. CONCLUSION The plasma Aβ40/Aβ42 ratio had moderate validity for the discrimination of sEOAD patients from age-matched controls.
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Affiliation(s)
- Hyeong Jun Kim
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Korea
| | - Tae Eun Kim
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Young Im
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ho Sik Shin
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Saeromi Kim
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dong Hyun Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hun Kim
- Department of Neurology, Ilsan Hospital, National Health Insurance Corporation, Goyang, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Busan, Korea
| | - Kee Hyung Park
- Department of Neurology, Gachon University, College of Medicine, Incheon, Korea
| | - Hyun Jeong Han
- Department of Neurology, Myongii Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Sun Ah Park
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Lee SH, Gong HS, Kim DH, Shin HS, Kim KM, Kim J, Baek GH. Evaluation of vitamin D levels in women with carpal tunnel syndrome. J Hand Surg Eur Vol 2016; 41:643-7. [PMID: 26701973 DOI: 10.1177/1753193415622732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/23/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0.023) or patients with other upper limb conditions (P = 0.035). When women with carpal tunnel syndrome and healthy control women were pooled, the incidence of carpal tunnel syndrome was higher in vitamin D deficient women than in non-deficient women, especially in those younger than 50 years. This study suggests a potential link between vitamin D status and the occurrence of carpal tunnel syndrome in women younger than 50 years but causation is not established. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- S H Lee
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - H S Gong
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - D H Kim
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - H S Shin
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - K M Kim
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J Kim
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - G H Baek
- Department of Orthopedic Surgery and Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim YN, Jung YS, Rim H, Shin HS, Kim HJ. MP616THE RELATIONSHIP BETWEEN HYPOPHOSPHATEMIA AND OUTCOMES DURING TWO DIFFERENT INTENSITIES OF CONTINUOUS RENAL REPLACEMENT THERAPY RELATIONSHIP BETWEEN HYPOPHOSPHATEMIA AND OUTCOMES DURING TWO DIFFERENT INTENSITIES OF CONTINUOUS RENAL REPLACEMENT THERAPY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw198.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Juwon L, Jang G, Kim S, Kim D, Lee J, Park H, Lee J, Kim S, Kim Y, Kim SY, Yang JW, Gwoo S, Kim YN, Shin HS, Jung Y, Rim H. Outcomes of acute kidney injury patients with and without cancer. Ren Fail 2015; 37:332-7. [PMID: 26493378 DOI: 10.3109/0886022x.2015.1074489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/05/2023] Open
Abstract
Incidence of AKI in hospitalized patients with cancer is increasing, but there have been few studies on AKI in patients with cancer. We conducted a retrospective cohort study in a South Korean tertiary care hospital. A total of 2211 consecutive patients (without cancer 61.5%; with cancer 38.5%) were included over a 140-month period. Predictors of all-cause death were examined using the Kaplan-Meier method and the Cox proportional hazards model. The main contributing factors of AKI were sepsis (31.1%) and ischemia (52.7%). AKI was multifactorial in 78% of patients with cancer and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (42.8%) than in patients without cancer (22.5%) (p = 0.014). In multivariate analyses, diabetes mellitus (DM) and cancer diagnosis were associated with hospital mortality. Cancer diagnosis was independently associated with mortality [odds ratio = 3.010 (95% confidence interval, 2.340-3.873), p = 0.001]. Kaplan-Meier analysis revealed that subjects with DM and cancer (n = 146) had lower survival rates than subjects with DM and without cancer (n = 687) (log rank test, p = 0.001). The presence of DM and cancer was independently associated with mortality in AKI patients both with and without cancer. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
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Affiliation(s)
- Lee Juwon
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Gookhwan Jang
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Sunmin Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Dajung Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Jinwook Lee
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Hyunjoon Park
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Junyeob Lee
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Sangbin Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Yunkyung Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Soo Young Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Joung Wook Yang
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Sangeon Gwoo
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Ye Na Kim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Ho Sik Shin
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Yeonsoon Jung
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
| | - Hark Rim
- a Department of Internal Medicine , College of Medicine, Kosin University , Seo-gu, Busan , South Korea
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Ryu CW, Park S, Shin HS, Koh JS. Complications in Stent-Assisted Endovascular Therapy of Ruptured Intracranial Aneurysms and Relevance to Antiplatelet Administration: A Systematic Review. AJNR Am J Neuroradiol 2015; 36:1682-8. [PMID: 26138136 DOI: 10.3174/ajnr.a4365] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the increasing use of stent-assisted coiling for ruptured intracranial aneurysms, there is little consensus regarding the appropriate antiplatelet administration for this. The objectives of this systematic review were to provide an overview of complications and their association with the method of antiplatelet administration in stent-assisted coiling for ruptured intracranial aneurysms. MATERIALS AND METHODS A comprehensive search of the literature in the data bases was conducted to identify studies reporting complications of stent-assisted coiling for ruptured intracranial aneurysms. The pooled event rate of preprocedural thromboembolisms, hemorrhages, and mortality was estimated from the selected studies. Subgroup analyses were performed by the method of antiplatelet administration (pre-, postprocedural, and modified). Meta-analysis was conducted to compare periprocedural complications and mortality between ruptured intracranial aneurysms and unruptured intracranial aneurysms. RESULTS Of the 8476 studies identified, 33 with 1090 patients were included. The event rates of thromboembolism and intra- and postprocedural hemorrhage were 11.2% (95% CI, 9.2%-13.6%), 5.4% (95% CI, 4.1%-7.2%), and 3.6% (95% CI, 2.6%-5.1%), respectively. Subgroup analyses of thromboembolism showed a statistically significant difference between groups (P < .05). In the preprocedural and modified antiplatelet groups, the risk for thromboembolism in stent-assisted coiling for ruptured intracranial aneurysm was not significantly different from that for unruptured intracranial aneurysm, though this risk of the postprocedural antiplatelet group was significantly higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms. CONCLUSIONS On the basis of current evidence, complications of stent-assisted coiling for ruptured intracranial aneurysm may be affected by the method of antiplatelet administration.
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Affiliation(s)
- C-W Ryu
- From the Departments of Radiology (C.-W.R., S.P.)
| | - S Park
- From the Departments of Radiology (C.-W.R., S.P.)
| | - H S Shin
- Neurosurgery (H.S.S., J.S.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul, South Korea
| | - J S Koh
- Neurosurgery (H.S.S., J.S.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul, South Korea
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Kim SY, Yang JW, Kim YN, Shin HS, Jung YS, Rim H, Kim MS, Rhew HY. SuO044PREDICTORS OF HYPERKALEMIA RISK FOLLOWING HYPERTENSION CONTROL WITH ALDOSTERONE BLOCKADE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv164.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shin HS, Kim SY, Yang JW, Kim YN, Jung YS, Rim H, Kim MS, Rhew HY. FP784RELATIONSHIPS OF TOTAL LYMPHOCYTE COUNT AND SUBPOPULATION LYMPHOCYTE COUNTS WITH THE NUTRITIONAL STATUS IN PATIENTS UNDERGOING HEMODIALYSIS/PERITONEAL DIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv184.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Han YJ, Ock SY, Kim EJ, Shin HS, Jung YS, Rim H. Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report. SAO PAULO MED J 2015; 133:154-9. [PMID: 25424777 PMCID: PMC10496642 DOI: 10.1590/1516-3180.2013.6890002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/13/2013] [Revised: 03/13/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis and angina. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. CASE REPORT This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by micturition and angina as an initial manifestation. CONCLUSION This case study suggests that thunderclap headache and angina occurring concurrently with sudden blood pressure elevation during or immediately after micturition are important diagnostic clues for bladder pheochromocytoma.
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Affiliation(s)
- You Jin Han
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - So Young Ock
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - Eun Jung Kim
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - Ho Sik Shin
- MD. Assistant Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeon Soon Jung
- MD, PhD. Associate Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- MD, PhD. Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Gwoo S, Kim YN, Shin HS, Jung YS, Rim H. Predictors of hyperkalemia risk after hypertension control with aldosterone blockade according to the presence or absence of chronic kidney disease. Nephron Clin Pract 2015; 128:381-6. [PMID: 25572273 DOI: 10.1159/000369138] [Citation(s) in RCA: 12] [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] [Received: 01/08/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Aldosterone antagonists have been proven to be efficient in the management of hypertension and the reduction of proteinuria; however, they are not widely used because of the risk of hyperkalemia. We assessed the predictors of hyperkalemia risk following hypertension control using aldosterone blockade in the presence or absence of chronic kidney disease (CKD). METHODS A total of 6,575 patients with hypertension treated between January 1, 2000, and November 30, 2012, were evaluated for the safety of an aldosterone-blocking agent (spironolactone) added to preexisting blood pressure-lowering regimens. Hyperkalemia was defined as a serum potassium level ≥5.0 mEq/l. All patients used 3 mechanistically complementary antihypertensive agents, including a diuretic and a RAAS blocker. Patients were evaluated after 4 and 8 weeks of treatment. The incidence of hyperkalemia, significant renal dysfunction [a reduction of the estimated glomerular filtration rate (eGFR) ≥30%], and adverse effects was assessed. RESULTS The incidence of hyperkalemia in the presence or absence of CKD was 50.4 and 42.6% after 4 weeks (p = 0.001) and 3.8 and 3.0% after 8 weeks, respectively (p = 0.371). A logistic regression analysis revealed that medication, CKD, basal hyperkalemia, reduction in eGFR, and diabetes were all predictive of a hyperkalemia risk following spironolactone use. CONCLUSION Spironolactone was well tolerated by selected CKD patients. The risk of serious hyperkalemia or a significant reduction of eGFR appears to be low. Strict monitoring over the first month of treatment followed by standard surveillance for angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers is suggested.
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Affiliation(s)
- Sangeon Gwoo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
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Ryu CW, Jahng GH, Shin HS. Gadolinium enhancement of atherosclerotic plaque in the middle cerebral artery: relation to symptoms and degree of stenosis. AJNR Am J Neuroradiol 2014; 35:2306-10. [PMID: 25012673 DOI: 10.3174/ajnr.a4038] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging can depict intracranial arterial atherosclerotic plaques. Our aim was to evaluate the relationship between the degree of enhancement of MCA plaques on contrast-enhanced high-resolution MR imaging and ischemic stroke and stenosis severity. MATERIALS AND METHODS This study enrolled 36 patients diagnosed with moderate-to-severe atherosclerotic MCA stenosis. A contrast-enhanced T1-weighted volume isotropic turbo spin-echo acquisition sequence was acquired for assessing plaque enhancement. Plaque-to-CSF contrast ratio was calculated after the signal intensity of plaques at the stenotic segment was measured. Univariate comparison and multivariate logistic regression analyses were performed for symptomatic and asymptomatic groups to assess the relationship between symptomatic stenosis and independent variables, including plaque-to-CSF contrast ratio, degree of stenosis, and clinical risk factors. Plaque-to-CSF contrast ratio was compared between the moderate and severe stenosis groups. RESULTS Twenty-one patients had symptomatic MCA stenosis, and 15 had asymptomatic stenosis. The plaque-to-CSF contrast ratio was significantly higher in the symptomatic group than in the asymptomatic group (63.6 ± 10.6% versus 54.1 ± 13.5%, respectively; P < .05). The degree of stenosis also differed significantly between the 2 groups (P < .05). Multivariate analysis revealed that the degree of stenosis was the only independent predictor of ischemic stroke symptoms. The plaque-to-CSF contrast ratio of severe stenosis was significantly higher than that of moderate stenosis (66.8 ± 8.7% versus 55.9 ± 12.8%, respectively; P < .05). CONCLUSIONS Plaque enhancement was significantly higher in patients with symptomatic plaques and may have been affected by the degree of stenosis. A difference in plaque enhancement according to the degree of stenosis has implications for understanding the development of intracranial atherosclerotic plaques.
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Affiliation(s)
- C-W Ryu
- From the Departments of Radiology (C.-W.R., G.-H.J.)
| | - G-H Jahng
- From the Departments of Radiology (C.-W.R., G.-H.J.)
| | - H S Shin
- Neurosurgery (H.S.S.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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You G, Shin HS, Jung YS, Rim H. A Case of Hydrothorax Aggravated by Peritoneal Dialysate Leakage in Compensated Liver Cirrhosis Patient with Ascites. KMJ 2014. [DOI: 10.7180/kmj.2014.29.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuroperitoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.
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Kang GH, Yu GI, Kim YN, Shin HS, Jung YS, Rim H, Rhew HY. Relationship between Onodera׳s Prognostic Nutritional Index and Subpopulation Lymphocyte Counts in Hemodialysis and Peritoneal Dialysis Patients. Kidney Res Clin Pract 2014. [DOI: 10.1016/j.krcp.2014.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bae KH, Park JS, Jung HJ, Shin HS. Inguinal approach for the management of unilateral non-palpable testis: is diagnostic laparoscopy necessary? J Pediatr Urol 2014; 10:233-6. [PMID: 24206784 DOI: 10.1016/j.jpurol.2013.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE During the last decade laparoscopy has increasingly been advocated as the primary investigative procedure for the management of the non-palpable testis. We reviewed the medical records in a consecutive series of boys with non-palpable testis to examine the contribution of the initial inguinal approach in the management of unilateral non-palpable testis. MATERIALS AND METHODS Among the 183 consecutive patients with cryptorchidism from 2003 to 2012, there were 21 patients with unilateral and three with bilateral non-palpable testes. All unilateral patients then underwent inguinal and scrotal exploration through an inguinal incision. For those patients with an intra-abdominal peeping testis, the gonad was placed into the scrotum after meticulous cranial mobilization of the spermatic cord. RESULTS Patient age ranged from 11 months to 144 months (mean age: 23 months). Among the 21 unilateral cases, testicular absence or atrophy was confirmed in seven patients with a scrotal nubbin in six, and blind-ending vas and vessels at the external inguinal ring in one patient. Among the remaining 14 patients with sizeable testes, 12 testes were intra-abdominal peeping testes and two testicles were seen within the distal inguinal canal, which may be missed on physical examination owing to patient obesity. The intra-abdominal peeping testicle had the opened processus vaginalis entering the internal ring in which testicle was found. These were fixed into the scrotum successfully by cranial mobilization of spermatic vessel sometimes cutting the internal oblique muscle and by Prentiss and Fowler-Stephen's maneuver. Diagnostic laparoscopy was done on three patients with bilateral cases. CONCLUSIONS Given the result that most of nubbins are within the scrotum and testes with intra-abdominal peeping testes are fixed down safely into the scrotum, the inguinal approach may suffice for the management of unilateral non-palpable testis. Laparoscopy should be reserved for patients with bilateral non-palpable undescended testes.
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Affiliation(s)
- K H Bae
- Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - J S Park
- Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea.
| | - H J Jung
- Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - H S Shin
- Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
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Shin HS, Nam KC, Park H, Choi HU, Kim HY, Park CS. Effective doses from panoramic radiography and CBCT (cone beam CT) using dose area product (DAP) in dentistry. Dentomaxillofac Radiol 2014; 43:20130439. [PMID: 24845340 DOI: 10.1259/dmfr.20130439] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 11/05/2022] Open
Abstract
OBJECTIVES We compared the effective dose from panoramic radiography with that from cone beam CT (CBCT) using dose area product under adult and child exposure conditions. METHODS The effective doses of the cephalo, panorama, implant and dental modes of Alphard 3030 (Asahi Roentgen Ind., Co. Ltd, Kyoto, Japan) CBCT and the Jaw, Wide, Facial and temporomandibular joint modes of Rayscan Symphony (RAY Co., Ltd, Hwaseong, Republic of Korea) CBCT were compared with those of CRANEX(®) 3+ CEPH (Soredex Orion Corporation, Helsinki, Finland) panoramic radiography equipment under adult and child exposure conditions. Each effective dose was calculated using a conversion formula from dose area product meter measured values (VacuTec Messtechnik GmbH, Dresden, Germany). The conversion formulae used were suggested by Helmrot and Alm Carlsson and Batista et al, and they were applied with the tube voltage taken into consideration. RESULTS The maximum effective doses from the Alphard 3030 and Rayscan Symphony were 67 and 21 times greater than that from panoramic radiography, respectively. The ratios of the effective dose under the child setting to that under the adult condition were 0.60-0.62 and 0.84-0.95, and the maximum differences in effective doses between the adult and child exposure settings were equivalent to 27 and 4 times greater than a panoramic examination in the Alphard 3030 and Rayscan Symphony, respectively. CONCLUSIONS The effective CBCT doses were higher than those of panoramic radiography. The differences in effective doses between the adult and child CBCT settings were dependent on equipment type and exposure parameters. Therefore, adequate mode selection and control of exposure as well as further research are necessary to minimize the effective dose to patients, especially for radiosensitive children.
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Affiliation(s)
- H S Shin
- 1 Department of Oral and Maxillofacial Radiology, Yonsei University Dental Hospital, Seoul, Republic of Korea
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Noh JM, Park W, Suh CO, Keum KC, Kim YB, Shin KH, Kim K, Chie EK, Ha SW, Kim SS, Ahn SD, Shin HS, Kim JH, Lee HS, Lee NK, Huh SJ, Choi DH. Is elective nodal irradiation beneficial in patients with pathologically negative lymph nodes after neoadjuvant chemotherapy and breast-conserving surgery for clinical stage II-III breast cancer? A multicentre retrospective study (KROG 12-05). Br J Cancer 2014; 110:1420-6. [PMID: 24481403 PMCID: PMC3960607 DOI: 10.1038/bjc.2014.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 11/05/2013] [Revised: 12/29/2013] [Accepted: 01/08/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate the effects of elective nodal irradiation (ENI) in clinical stage II-III breast cancer patients with pathologically negative lymph nodes (LNs) (ypN0) after neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS) and radiotherapy (RT). METHODS We retrospectively analysed 260 patients with ypN0 who received NAC followed by BCS and RT. Elective nodal irradiation was delivered to 136 (52.3%) patients. The effects of ENI on survival outcomes were evaluated. RESULTS After a median follow-up period of 66.2 months (range, 15.6-127.4 months), 26 patients (10.0%) developed disease recurrence. The 5-year locoregional recurrence-free survival and disease-free survival (DFS) for all patients were 95.5% and 90.5%, respectively. Pathologic T classification (0-is vs 1 vs 2-4) and the number of LNs sampled (<13 vs ≥13) were associated with DFS (P=0.0086 and 0.0012, respectively). There was no significant difference in survival outcomes according to ENI. Elective nodal irradiation also did not affect survival outcomes in any of the subgroups according to pathologic T classification or the number of LNs sampled. CONCLUSIONS ENI may be omitted in patients with ypN0 breast cancer after NAC and BCS. But until the results of the randomised trials are available, patients should be put on these trials.
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Affiliation(s)
- J M Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - W Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - C-O Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - K C Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Y B Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - K H Shin
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - K Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - E K Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - S W Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - S S Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - S D Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - H S Shin
- Department of Radiation Oncology, Bundang CHA Hospital, School of Medicine, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-712, Republic of Korea
| | - J H Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea
| | - H-S Lee
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Republic of Korea
| | - N K Lee
- Department of Radiation Oncology, Korea Medical Center, Korea University School of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - S J Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - D H Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea
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Abstract
The gastrointestinal (GI) tract and specifically the most distal part of the small intestine, the ileum, has become a renewed focus of interest for mechanisms targeting appetite suppression. The 'ileal brake' is stimulated when energy-containing nutrients are delivered beyond the duodenum and jejunum and into the ileum, and is named for the feedback loop which slows or 'brakes' gastric emptying and duodeno-jejunal motility. More recently it has been hypothesized that the ileal brake also promotes secretion of satiety-enhancing GI peptides and suppresses hunger, placing a 'brake' on food intake. Postprandial delivery of macronutrients to the ileum, other than unavailable carbohydrates (CHO) which bypass absorption in the small intestine en route to fermentation in the large bowel, is an uncommon event and hence this brake mechanism is rarely activated following a meal. However the ability to place a 'brake' on food intake through delivery of protected nutrients to the ileum is both intriguing and challenging. This review summarizes the current clinical and experimental evidence for activation of the ileal brake by the three food macronutrients, with emphasis on eating behavior and satiety as well as GI function. While clinical studies have shown that exposure of the ileum to lipids, CHOs and proteins may activate GI components of the ileal brake, such as decreased gut motility, gastric emptying and secretion of GI peptides, there is less evidence as yet to support a causal relationship between activation of the GI brake by these macronutrients and the suppression of food intake. The predominance of evidence for an ileal brake on eating comes from lipid studies, where direct lipid infusion into the ileum suppresses both hunger and food intake. Outcomes from oral feeding studies are less conclusive with no evidence that 'protected' lipids have been successfully delivered into the ileum in order to trigger the brake. Whether CHO or protein may induce the ileal brake and suppress food intake has to date been little investigated, although both clearly have GI mediated effects. This review provides an overview of the mechanisms and mediators of activation of the ileal brake and assesses whether it may play an important role in appetite suppression.
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Affiliation(s)
- H S Shin
- Human Nutrition Unit, University of Auckland, Auckland, New Zealand; School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Jung YS, You G, Shin HS, Rim H. Relationship between Geriatric Nutritional Risk Index and total lymphocyte count and mortality of hemodialysis patients. Hemodial Int 2013; 18:104-12. [DOI: 10.1111/hdi.12077] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeon Soon Jung
- Department of Internal Medicine; Kosin University College of Medicine; Busan Korea
| | - Gain You
- Department of Internal Medicine; Kosin University College of Medicine; Busan Korea
| | - Ho Sik Shin
- Department of Internal Medicine; Kosin University College of Medicine; Busan Korea
| | - Hark Rim
- Department of Internal Medicine; Kosin University College of Medicine; Busan Korea
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Shin HS, Ingram JR, McGill AT, Poppitt SD. Lipids, CHOs, proteins: can all macronutrients put a 'brake' on eating? Physiol Behav 2013; 120:114-23. [PMID: 23911804 DOI: 10.1016/j.physbeh.2013.07.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/09/2013] [Accepted: 07/23/2013] [Indexed: 01/18/2023]
Abstract
The gastrointestinal (GI) tract and specifically the most distal part of the small intestine, the ileum, has become a renewed focus of interest for mechanisms targeting appetite suppression. The 'ileal brake' is stimulated when energy-containing nutrients are delivered beyond the duodenum and jejunum and into the ileum, and is named for the feedback loop which slows or 'brakes' gastric emptying and duodeno-jejunal motility. More recently it has been hypothesized that the ileal brake also promotes secretion of satiety-enhancing GI peptides and suppresses hunger, placing a 'brake' on food intake. Postprandial delivery of macronutrients to the ileum, other than unavailable carbohydrates (CHO) which bypass absorption in the small intestine en route to fermentation in the large bowel, is an uncommon event and hence this brake mechanism is rarely activated following a meal. However the ability to place a 'brake' on food intake through delivery of protected nutrients to the ileum is both intriguing and challenging. This review summarizes the current clinical and experimental evidence for activation of the ileal brake by the three food macronutrients, with emphasis on eating behavior and satiety as well as GI function. While clinical studies have shown that exposure of the ileum to lipids, CHOs and proteins may activate GI components of the ileal brake, such as decreased gut motility, gastric emptying and secretion of GI peptides, there is less evidence as yet to support a causal relationship between activation of the GI brake by these macronutrients and the suppression of food intake. The predominance of evidence for an ileal brake on eating comes from lipid studies, where direct lipid infusion into the ileum suppresses both hunger and food intake. Outcomes from oral feeding studies are less conclusive with no evidence that 'protected' lipids have been successfully delivered into the ileum in order to trigger the brake. Whether CHO or protein may induce the ileal brake and suppress food intake has to date been little investigated, although both clearly have GI mediated effects. This review provides an overview of the mechanisms and mediators of activation of the ileal brake and assesses whether it may play an important role in appetite suppression.
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Affiliation(s)
- H S Shin
- Human Nutrition Unit, University of Auckland, Auckland, New Zealand; School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Lee J, Shin HS, Jung YS, Rim H. Two cases of baclofen-induced encephalopathy in hemodialysis and peritoneal dialysis patients. Ren Fail 2013; 35:860-2. [DOI: 10.3109/0886022x.2013.794679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim JY, Lee SW, Lee JH, Suh C, Yoon DH, Lee BJ, Huh J, Choi EK, Kim JH, Song SY, Yoon SM, Kim YS, Kim SS, Park JH, Shin HS, Chang SK, Ahn SD. Stage IE/IIE extranodal NK/T-cell lymphoma arising in the nasal cavity: analysis of CT findings and their prognostic value. Clin Radiol 2013; 68:e384-90. [PMID: 23535315 DOI: 10.1016/j.crad.2012.11.023] [Citation(s) in RCA: 10] [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] [Received: 09/10/2012] [Revised: 11/08/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
AIM To investigate the computed tomography (CT) findings in patients with stage IE/IIE extranodal natural killer/T-cell lymphoma (ENKTL) arising in the nasal cavity and to evaluate whether imaging findings revealed by CT have prognostic value. MATERIALS AND METHODS The CT findings of 62 patients diagnosed with IE/IIE ENKTL arising in the nasal cavity were retrospectively reviewed. Imaging findings were investigated, and evaluated imaging findings were analysed for the prognostic value of overall survival (OS) and disease-free survival (DFS). RESULTS Of the 62 patients, 21 (34%) presented with a superficial infiltrative, 38 (61%) with a mass forming, and three (5%) with a combined pattern. Of all imaging findings, local invasiveness (n = 26, 42%), including bony destruction, erosion, or soft-tissue involvement, was the only independent prognostic factor for OS [p = 0.008; hazard ratio (HR): 3.85; 95% confidence intervals (CI): 1.42-10.44] and DFS (p = 0.001; HR: 4.25; 95% CI: 1.72-10.47). In a subgroup analysis of 36 cases with no local invasiveness, a superficial infiltrative pattern in one nasal cavity was a positive prognostic factor for OS (p = 0.028) and DFS (p = 0.008). CONCLUSION Imaging findings at CT provided clinically useful predictions for treatment outcomes. Local invasiveness revealed by CT findings was a strong prognostic factor for poor OS and DFS. In addition, in patients with no local invasiveness, a superficial infiltrative pattern in one nasal cavity predicted favourable OS and DFS.
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Affiliation(s)
- J Y Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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