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Papatheodoridi M, Pallini G, Aithal G, Lim HK, Cobbold J, Plaz Torres MC, Misas MG, Ryan J, Tomlinson J, Allison M, Longworth L, Tsochatzis EA. Health-related Quality of Life in Patients With Nonalcoholic Fatty Liver Disease: A Prospective Multi-center UK Study. Clin Gastroenterol Hepatol 2023; 21:3107-3114.e3. [PMID: 37880933 DOI: 10.1016/j.cgh.2023.04.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/20/2023] [Accepted: 04/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND & AIMS It is unclear whether health-related quality of life (HRQoL) is impaired in patients with nonalcoholic fatty liver disease (NAFLD) without advanced fibrosis and how this compares with the general population. We aimed to assess HRQoL in patients with NAFLD in comparison to the general population and any associations of fibrosis severity and metabolic comorbidities with impairments in HRQoL. METHODS We prospectively enrolled 513 consecutive patients with NAFLD who completed the EuroQol 5-dimensional questionnaire (EQ-5D) and Chronic Liver Disease Questionnaires (CLDQ). Demographic and clinical information, liver biopsy results, and/or liver stiffness (LS) by transient elastography were recorded. A general population sub-cohort of the Health Survey for England 2018 was used as a comparator (n = 5483), and a 1:1 propensity-score (PS) matching was performed, according to age, sex, body mass index, and type 2 diabetes mellitus (T2DM). RESULTS EQ-5D-5L utility was significantly lower in 466 PS-matched patients with NAFLD compared with PS-matched controls (0.77 ± 0.27 vs 0.84 ± 0.19; P < .001), even in those without advanced fibrosis (F ≤2 or LS <8kPa) (0.80 ± 0.24 vs 0.84 ± 0.19; P = .024). HRQoL measures (EQ-5D-5L, EQ-VAS, CLDQ) did not differ between patients with NAFLD with and without advanced fibrosis. LS was independently associated with lower EQ-5D-5L in all patients with NAFLD but not in those without advanced fibrosis. In the latter, lower EQ-5D-5L was associated with female sex, T2DM, and depression. CONCLUSIONS Patients with NAFLD, even those without advanced fibrosis, have worse HRQoL compared with the general population. In patients with NAFLD without advanced fibrosis, HRQoL is independently associated with non-liver comorbidities but not LS. Multi-disciplinary management is therefore required in NAFLD, irrespective of fibrosis severity.
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Affiliation(s)
- Margarita Papatheodoridi
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Giada Pallini
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Guruprasad Aithal
- Nottingham Digestive Diseases Centre, Queen's Medical Centre, Nottingham, United Kingdom
| | - Hong Kai Lim
- Liver Unit, Department of Medicine, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jeremy Cobbold
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Maria Corina Plaz Torres
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Marta Guerrero Misas
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - John Ryan
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Michael Allison
- Liver Unit, Department of Medicine, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom.
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Spillman LN, Madden AM, Richardson H, Imamura F, Jones D, Nash M, Lim HK, Hellawell HN, Rennie KL, Oude Griep LM, Allison M, Griffin SJ. Nutritional Intake after Liver Transplant: Systematic Review and Meta-Analysis. Nutrients 2023; 15:2487. [PMID: 37299450 PMCID: PMC10255417 DOI: 10.3390/nu15112487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/10/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disease and its concurrent risk factors are prevalent after liver transplant (LT). Most of these risk factors are modifiable by diet. We aimed to synthesise the literature reporting the nutritional intake of liver transplant recipients (LTR) and the potential determinants of intake. We performed a systematic review and meta-analyses of studies published up until July 2021 reporting the nutritional intake of LTR. The pooled daily mean intakes were recorded as 1998 (95% CI 1889, 2108) kcal, 17 (17, 18)% energy from protein, 49 (48, 51)% energy from carbohydrates, 34 (33, 35)% energy from total fat, 10 (7, 13)% energy from saturated fat, and 20 (18, 21) g of fibre. The average fruit and vegetable intake ranged from 105 to 418 g/day. The length of time post-LT and the age and sex of the cohorts, as well as the continent and year of publication of each study, were sources of heterogeneity. Nine studies investigated the potential determinants of intake, time post-LT, gender and immunosuppression medication, with inconclusive results. Energy and protein requirements were not met in the first month post-transplant. After this point, energy intake was significantly higher and remained stable over time, with a high fat intake and low intake of fibre, fruits and vegetables. This suggests that LTR consume a high-energy, low-quality diet in the long term and do not adhere to the dietary guidelines for cardiovascular disease prevention.
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Affiliation(s)
- Lynsey N. Spillman
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
- Liver Transplant Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Angela M. Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (A.M.M.); (H.R.)
| | - Holly Richardson
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (A.M.M.); (H.R.)
| | - Fumiaki Imamura
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Danielle Jones
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Marilyn Nash
- Department of Nutrition and Dietetics, East Suffolk and North Essex NHS Foundation Trust, Colchester CO4 5JL, UK
| | - Hong Kai Lim
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (H.K.L.); (H.N.H.)
| | - Holly N. Hellawell
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (H.K.L.); (H.N.H.)
| | - Kirsten L. Rennie
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Linda M. Oude Griep
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Michael Allison
- Liver Transplant Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Simon J. Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
- Department of Public Health and Primary Care, Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SR, UK
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Kang H, Lee EB, Lee S, Go TH, Lee JY, Lee SH, Song SA, Lim HK, Hong SP. Dipeptidyl peptidase-4 inhibitors increase the risk of bullous pemphigoid in older patients with diabetes: A retrospective analysis using the Korean National Health Insurance Database. J Eur Acad Dermatol Venereol 2023. [PMID: 36799763 DOI: 10.1111/jdv.18975] [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] [Received: 11/01/2022] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Affiliation(s)
- H Kang
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - E B Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - S Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - T-H Go
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - J Y Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - S-H Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - S A Song
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - H K Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - S-P Hong
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea.,Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
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Lim HK, Lau AZ, Charles WN, Khajuria A. Efficacy and Complications of External and Internal Pediatric Blepharoptosis Repair Techniques: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:1-7. [PMID: 33782331 DOI: 10.1097/iop.0000000000001974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/26/2022]
Abstract
PURPOSE To review and evaluate the efficacy and complication rates of external and internal blepharoptosis repair techniques in pediatric patients. METHODS The systematic review protocol was published on PROSPERO (CRD42020197343). Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched without date limitations. Two independent reviewers evaluated the articles for inclusion. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool, respectively. RESULTS Of 2,228 articles screened, 23 studies involving 730 patients were included. There were 20 case series and 3 retrospective cohort studies, but no randomized controlled studies. Overall study quality was low with serious risk of bias according to the GRADE and ROBINS-I criteria, respectively. External levator resection was the most studied procedure, evaluated in 18 studies. Seven studies investigated internal approaches including the Fasanella-Servat procedure. There was no standardized evaluation of surgical efficacy. Reoperation rates were 16.6% (range 3.6-50.9%) for external levator resection compared with 22.2% (range 0.0-25.8%) for internal approaches. The commonest postoperative complications were not sight-threatening. The most consistently reported complication was undercorrection, occurring at rates of 8.4% (range 2.4-16.7%) and 15.3% (range 2.7-75.0%) for external levator resection and internal approaches, respectively. There were no consistently applied, validated patient-reported outcomes or cosmetic outcomes. CONCLUSIONS External and internal approaches have been successfully employed in pediatric blepharoptosis repair. However, noncomparative designs and risk-of-bias limit existing studies. Thus, prospectively designed studies with standardized outcome measures are required to minimize reporting bias, facilitate evidence synthesis, and support clinical decision making.
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Affiliation(s)
- Hong Kai Lim
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, United Kingdom
| | - Ashton Z Lau
- The Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Nuffield Department of Surgical Sciences, Kellogg College, University of Oxford, Oxford, United Kingdom
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5
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Charles RC, Lim HK, Charles WN. Clarity and confidence in managing infective conjunctivitis. J Prim Health Care 2021; 13:121-123. [PMID: 34620293 DOI: 10.1071/hc21042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Hong Kai Lim
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK; and Corresponding author.
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, UK
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Im YR, Hunter H, de Gracia Hahn D, Duret A, Cheah Q, Dong J, Fairey M, Hjalmarsson C, Li A, Lim HK, McKeown L, Mitrofan CG, Rao R, Utukuri M, Rowe IA, Mann JP. A Systematic Review of Animal Models of NAFLD Finds High-Fat, High-Fructose Diets Most Closely Resemble Human NAFLD. Hepatology 2021; 74:1884-1901. [PMID: 33973269 DOI: 10.1002/hep.31897] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Animal models of human disease are a key component of translational hepatology research, yet there is no consensus on which model is optimal for NAFLD. APPROACH AND RESULTS We generated a database of 3,920 rodent models of NAFLD. Study designs were highly heterogeneous, and therefore, few models had been cited more than once. Analysis of genetic models supported the current evidence for the role of adipose dysfunction and suggested a role for innate immunity in the progression of NAFLD. We identified that high-fat, high-fructose diets most closely recapitulate the human phenotype of NAFLD. There was substantial variability in the nomenclature of animal models: a consensus on terminology of specialist diets is needed. More broadly, this analysis demonstrates the variability in preclinical study design, which has wider implications for the reproducibility of in vivo experiments both in the field of hepatology and beyond. CONCLUSIONS This systematic analysis provides a framework for phenotypic assessment of NAFLD models and highlights the need for increased standardization and replication.
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Affiliation(s)
- Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dana de Gracia Hahn
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Qinrong Cheah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Alice Li
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lorcán McKeown
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Raunak Rao
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ian A Rowe
- Leeds Institute for Medical Research and Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jake P Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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7
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Teo K, Abeysekera KWM, Adams L, Aigner E, Anstee QM, Banales JM, Banerjee R, Basu P, Berg T, Bhatnagar P, Buch S, Canbay A, Caprio S, Chatterjee A, Ida Chen YD, Chowdhury A, Daly AK, Datz C, de Gracia Hahn D, DiStefano JK, Dong J, Duret A, Emdin C, Fairey M, Gerhard GS, Guo X, Hampe J, Hickman M, Heintz L, Hudert C, Hunter H, Kelly M, Kozlitina J, Krawczyk M, Lammert F, Langenberg C, Lavine J, Li L, Lim HK, Loomba R, Luukkonen PK, Melton PE, Mori TA, Palmer ND, Parisinos CA, Pillai SG, Qayyum F, Reichert MC, Romeo S, Rotter JI, Im YR, Santoro N, Schafmayer C, Speliotes EK, Stender S, Stickel F, Still CD, Strnad P, Taylor KD, Tybjærg-Hansen A, Umano GR, Utukuri M, Valenti L, Wagenknecht LE, Wareham NJ, Watanabe RM, Wattacheril J, Yaghootkar H, Yki-Järvinen H, Young KA, Mann JP. rs641738C>T near MBOAT7 is associated with liver fat, ALT and fibrosis in NAFLD: A meta-analysis. J Hepatol 2021; 74:20-30. [PMID: 32882372 PMCID: PMC7755037 DOI: 10.1016/j.jhep.2020.08.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS A common genetic variant near MBOAT7 (rs641738C>T) has been previously associated with hepatic fat and advanced histology in NAFLD; however, these findings have not been consistently replicated in the literature. We aimed to establish whether rs641738C>T is a risk factor across the spectrum of NAFLD and to characterise its role in the regulation of related metabolic phenotypes through a meta-analysis. METHODS We performed a meta-analysis of studies with data on the association between rs641738C>T genotype and liver fat, NAFLD histology, and serum alanine aminotransferase (ALT), lipids or insulin. These included directly genotyped studies and population-level data from genome-wide association studies (GWAS). We performed a random effects meta-analysis using recessive, additive and dominant genetic models. RESULTS Data from 1,066,175 participants (9,688 with liver biopsies) across 42 studies were included in the meta-analysis. rs641738C>T was associated with higher liver fat on CT/MRI (+0.03 standard deviations [95% CI 0.02-0.05], pz = 4.8×10-5) and diagnosis of NAFLD (odds ratio [OR] 1.17 [95% CI 1.05-1.3], pz = 0.003) in Caucasian adults. The variant was also positively associated with presence of advanced fibrosis (OR 1.22 [95% CI 1.03-1.45], pz = 0.021) in Caucasian adults using a recessive model of inheritance (CC + CT vs. TT). Meta-analysis of data from previous GWAS found the variant to be associated with higher ALT (pz = 0.002) and lower serum triglycerides (pz = 1.5×10-4). rs641738C>T was not associated with fasting insulin and no effect was observed in children with NAFLD. CONCLUSIONS Our study validates rs641738C>T near MBOAT7 as a risk factor for the presence and severity of NAFLD in individuals of European descent. LAY SUMMARY Fatty liver disease is a common condition where fat builds up in the liver, which can cause liver inflammation and scarring (including 'cirrhosis'). It is closely linked to obesity and diabetes, but some genes are also thought to be important. We did this study to see whether one specific change ('variant') in one gene ('MBOAT7') was linked to fatty liver disease. We took data from over 40 published studies and found that this variant near MBOAT7 is linked to more severe fatty liver disease. This means that drugs designed to work on MBOAT7 could be useful for treating fatty liver disease.
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Affiliation(s)
- Kevin Teo
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Leon Adams
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University Salzburg, Austria
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jesus M Banales
- Department on Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Ali Canbay
- Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sonia Caprio
- Yale University, Department of Pediatrics, New Haven, CT, USA
| | | | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abhijit Chowdhury
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
| | | | - Johanna K DiStefano
- Diabetes and Fibrotic Disease Unit Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Connor Emdin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, MA, USA
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Matthew Hickman
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Lena Heintz
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Christian Hudert
- Department of Pediatric Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Joel Lavine
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Lin Li
- BioStat Solutions LLC, Frederick, MD, USA
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, CA, USA
| | - Panu K Luukkonen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Yale University School of Medicine, New Haven, CT, USA
| | - Phillip E Melton
- School of Global Population Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Trevor A Mori
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Constantinos A Parisinos
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Faiza Qayyum
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nicola Santoro
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of Medicine and Health Sciences 'V. Tiberio' University of Molise, Campobasso, Italy
| | - Clemens Schafmayer
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | - Elizabeth K Speliotes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stefan Stender
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Pavel Strnad
- Medical Clinic III, University Hospital RWTH Aachen, Aachen, Germany
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Giuseppina Rosaria Umano
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of the Woman, the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Richard M Watanabe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Julia Wattacheril
- Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hannele Yki-Järvinen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Jake P Mann
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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8
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Hunter H, de Gracia Hahn D, Duret A, Im YR, Cheah Q, Dong J, Fairey M, Hjalmarsson C, Li A, Lim HK, McKeown L, Mitrofan CG, Rao R, Utukuri M, Rowe IA, Mann JP. Weight loss, insulin resistance, and study design confound results in a meta-analysis of animal models of fatty liver. eLife 2020; 9:56573. [PMID: 33063664 PMCID: PMC7647398 DOI: 10.7554/elife.56573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
The classical drug development pipeline necessitates studies using animal models of human disease to gauge future efficacy in humans, however there is a low conversion rate from success in animals to humans. Non-alcoholic fatty liver disease (NAFLD) is a complex chronic disease without any established therapies and a major field of animal research. We performed a meta-analysis with meta-regression of 603 interventional rodent studies (10,364 animals) in NAFLD to assess which variables influenced treatment response. Weight loss and alleviation of insulin resistance were consistently associated with improvement in NAFLD. Multiple drug classes that do not affect weight in humans caused weight loss in animals. Other study design variables, such as age of animals and dietary composition, influenced the magnitude of treatment effect. Publication bias may have increased effect estimates by 37-79%. These findings help to explain the challenge of reproducibility and translation within the field of metabolism.
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Affiliation(s)
- Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dana de Gracia Hahn
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Qinrong Cheah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Alice Li
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lorcan McKeown
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Raunak Rao
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ian A Rowe
- Leeds Institute for Medical Research & Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jake P Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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9
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Trigg RM, Lee LC, Prokoph N, Jahangiri L, Reynolds CP, Amos Burke GA, Probst NA, Han M, Matthews JD, Lim HK, Manners E, Martinez S, Pastor J, Blanco-Aparicio C, Merkel O, de Los Fayos Alonso IG, Kodajova P, Tangermann S, Högler S, Luo J, Kenner L, Turner SD. The targetable kinase PIM1 drives ALK inhibitor resistance in high-risk neuroblastoma independent of MYCN status. Nat Commun 2019; 10:5428. [PMID: 31780656 PMCID: PMC6883072 DOI: 10.1038/s41467-019-13315-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 02/05/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022] Open
Abstract
Resistance to anaplastic lymphoma kinase (ALK)-targeted therapy in ALK-positive non-small cell lung cancer has been reported, with the majority of acquired resistance mechanisms relying on bypass signaling. To proactively identify resistance mechanisms in ALK-positive neuroblastoma (NB), we herein employ genome-wide CRISPR activation screens of NB cell lines treated with brigatinib or ceritinib, identifying PIM1 as a putative resistance gene, whose high expression is associated with high-risk disease and poor survival. Knockdown of PIM1 sensitizes cells of differing MYCN status to ALK inhibitors, and in patient-derived xenografts of high-risk NB harboring ALK mutations, the combination of the ALK inhibitor ceritinib and PIM1 inhibitor AZD1208 shows significantly enhanced anti-tumor efficacy relative to single agents. These data confirm that PIM1 overexpression decreases sensitivity to ALK inhibitors in NB, and suggests that combined front-line inhibition of ALK and PIM1 is a viable strategy for the treatment of ALK-positive NB independent of MYCN status.
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Affiliation(s)
- Ricky M Trigg
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Functional Genomics, Medicinal Science & Technology, GlaxoSmithKline, Stevenage, SG1 2NY, UK
| | - Liam C Lee
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Amgen, Thousand Oaks, CA, 91320, USA
| | - Nina Prokoph
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Leila Jahangiri
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - C Patrick Reynolds
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 79430, USA
| | - G A Amos Burke
- Department of Paediatric Oncology, Box 181, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicola A Probst
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Miaojun Han
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,OncoSec, San Diego, CA, 92121, USA
| | - Jamie D Matthews
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Hong Kai Lim
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Eleanor Manners
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Sonia Martinez
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Joaquin Pastor
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Carmen Blanco-Aparicio
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Olaf Merkel
- Department of Experimental Pathology and Laboratory Animal Pathology, Institute of Clinical Pathology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Ines Garces de Los Fayos Alonso
- Department of Experimental Pathology and Laboratory Animal Pathology, Institute of Clinical Pathology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Petra Kodajova
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, 1210, Austria
| | - Simone Tangermann
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, 1210, Austria
| | - Sandra Högler
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, 1210, Austria
| | - Ji Luo
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Lukas Kenner
- Department of Experimental Pathology and Laboratory Animal Pathology, Institute of Clinical Pathology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.,Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, 1210, Austria.,Christian Doppler Laboratory for Applied Metabolomics (CDL-AM), Boltzmanngasse 20, Medical University of Vienna, Vienna, 1090, Austria
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Lab Block level 3, Box 231, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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10
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Lim HK, Millar ZA, Zaman R. CADASIL and Bipolar Affective Disorder. Psychiatr Danub 2019; 31:591-594. [PMID: 31488796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare monogenic disorder caused by mutations in the NOTCH3 gene. The clinical features are primarily neurological, which include recurrent transient ischaemic attacks, strokes, and migraines. However, psychiatric manifestations which mainly include mood disturbances have also been reported in CADASIL. Manic symptoms and bipolar disorders are rarely documented in CADASIL and existing reports generally lack detailed descriptions of the psychiatric evaluation. We discuss a case of Bipolar Affective Disorder (BD) in a British woman with a family history of CADASIL. This case provides insight into the diagnosis and management of BD as well as the possible underlying aetiologies that should be considered. The similarities between BD and CADASIL in terms of imaging, genetic, and therapeutic aspects raise the possibility of common dysfunctional pathways. BD in CADASIL may warrant greater consideration by both psychiatrists as well as non-psychiatric specialists and further studies are required to understand the pathological significance.
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Affiliation(s)
- Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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11
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Lee HG, Agpoon KJ, Besana AN, Lim HK, Jang HS, Lee ES. Re: re: Mandibular stability using sliding compared with conventional four-hole plates for fixation after bilateral sagittal split ramus osteotomy for mandibular setback. Br J Oral Maxillofac Surg 2017; 56:80-81. [PMID: 29183648 DOI: 10.1016/j.bjoms.2017.10.004] [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] [Received: 09/08/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- H G Lee
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - K J Agpoon
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - A N Besana
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - H K Lim
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - H S Jang
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - E S Lee
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
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12
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Tog C, Liu DS, Lim HK, Stiven P, Thompson SK, Watson DI, Aly A. Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias. BJS Open 2017; 1:75-83. [PMID: 29951609 PMCID: PMC5989959 DOI: 10.1002/bjs5.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/28/2017] [Indexed: 01/20/2023] Open
Abstract
Background Delayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes. Methods Data collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery. Results Delayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery. Conclusion Delayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.
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Affiliation(s)
- C Tog
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - D S Liu
- Department of Surgery Austin Hospital Heidelberg Victoria Australia.,Division of Cancer Surgery Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - H K Lim
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - P Stiven
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - S K Thompson
- University of Adelaide Discipline of Surgery Royal Adelaide Hospital Adelaide South Australia Australia
| | - D I Watson
- Flinders University Department of Surgery Flinders Medical Centre Bedford Park South Australia Australia
| | - A Aly
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
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13
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Lee HG, Agpoon KJ, Besana AN, Lim HK, Jang HS, Lee ES. Mandibular stability using sliding or conventional four-hole plates for fixation after bilateral sagittal split ramus osteotomy for mandibular setback. Br J Oral Maxillofac Surg 2016; 55:378-382. [PMID: 27931722 DOI: 10.1016/j.bjoms.2016.11.318] [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] [Received: 08/24/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
Our aim was to compare the postoperative stability of the mandible when two different fixation methods had been used after bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. The study included 23 patients who had two-jaw BSSRO mandibular setback at the Department of Oromaxillofacial Surgery, Korea University Guro Hospital, between January 2011 and June 2014. The first group (four-hole (control) group, n=13) comprised patients whose bony segments were fixed with conventional four-hole plates, and the second (sliding plate (experimental) group, n=10) included patients whose bone segments were fixed with sliding plates. Lateral cephalograms were taken and analysed at three time points: preoperatively (T1), and one week (T2), and 1year (T3) postoperatively. The Mann-Whitney U test was used to compare the postoperative stability of the mandible in each group. There were no significant differences between the two groups in changes in the horizontal and vertical positions of point B and pogonion postoperatively, nor were there any significant differences between them in ramal inclination and inclination of the SN plane with point B at the given time points (p=>0.05 in surgical changes in the mandible immediately after surgery and 0.397, 0.616, 0.082, 0.951, 0.901, 0.476 in postoperative changes in the mandible 1 week to 1 year after surgery). Like the conventional four-hole plate, the sliding plate can also be used to achieve stability in the fixation of mandibular bone segments after BSSRO.
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Affiliation(s)
- H G Lee
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - K J Agpoon
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - A N Besana
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - H K Lim
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - H S Jang
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
| | - E S Lee
- Department of Oral and Maxillofacial Surgery, Korea University Graduate School of Clinical Dentistry, Seoul, Republic of Korea.
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14
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McKay WB, Lim HK, Priebe MM, Stokic DS, Sherwood AM. Clinical Neurophysiological Assessment of Residual Motor Control in Post-Spinal Cord Injury Paralysis. Neurorehabil Neural Repair 2016; 18:144-53. [PMID: 15375274 DOI: 10.1177/0888439004267674] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 11/16/2022]
Abstract
Objective. This study was designed to characterize the rudimentary residual lower-limb motor control that can exist in clinically paralyzed spinal-cord-injured individuals. Methods. Sixty-seven paralyzed spinal-cord-injured subjects were studied using surface electromyography recorded from muscles of the lower limbs and analyzed for responses to a rigidly administered protocol of reinforcement maneuvers, voluntary movement attempts, vibration, or the ability to volitionally suppress withdrawal evoked by plantar surface stimulation. Results. Markers for the subclinical discomplete motor syndrome were found in 64% of the subjects. The tonic vibration response was recorded in 37%, volitional plantar surface stimulation response suppression in 27%, and reinforcement maneuver responses in 6% of the subjects. Three subjects, 4%, produced reliable but very low amplitude surface electromyography during the voluntary movement segment of the protocol. Surface electromyography recorded during passive leg movement was related to Ashworth scores as was the tonic vibration response marker (P < 0.05). Conclusions. Multimuscle surface electromyography patterns recorded during a rigidly administered protocol of motor tasks can be used to differentiate between clinically paralyzed spinal-cord-injured individuals using subclinical motor output to identify the translesional neural connections that remain available for intervention testing and treatment planning after spinal cord injury.
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Affiliation(s)
- W B McKay
- Michael E DeBakey VA Medical Center, Houston, TX, USA.
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15
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Lim HK, Ha HI, Hwang HJ, Lee K. Feasibility of high-pitch dual-source low-dose chest CT: Reduction of radiation and cardiac artifacts. Diagn Interv Imaging 2016; 97:443-9. [PMID: 26896374 DOI: 10.1016/j.diii.2016.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the radiation dose and image quality, focused mainly on cardiac pulsation artifact, between high-pitch low-dose chest computed tomography (HP-LDCT) and standard low-dose chest CT (LDCT). PATIENTS AND METHODS One hundred patients underwent HP-LDCT (50 patients) or LDCT (50 patients). Scan parameters were the same except for the pitch and gantry rotation time: 3.0 vs. 1.2 and 0.28s vs. 0.5s, respectively. Objective image noise at five regions and subjective image quality, such as noise, artifacts, cardiac pulsation artifacts, and overall diagnostic acceptability, were evaluated using a five-point scale. The significance level for all tests was set at P<0.05. RESULTS The dose-length products (DLPs) with HP-LDCT and LDCT were 90.2±4.3mGycm and 103.1±6.4mGycm, respectively (P<0.01). DLP of HP-LDCT showed a 13% reduction versus LDCT. Objective image noise was not significantly different. Cardiac pulsation artifacts showed a significant reduction on HP-LDCT (P<0.01). Other subjective image quality parameters of HP-LDCT were similar to those of LDCT. The overall diagnostic acceptability of HP-LDCT was better than that of LDCT (P<0.01). CONCLUSIONS HP-LDCT showed a 13% mean radiation dose reduction with no deterioration in image quality due to cardiac pulsation artifacts.
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Affiliation(s)
- H K Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
| | - H I Ha
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
| | - H J Hwang
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
| | - K Lee
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
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16
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Park HJ, Lee MW, Rhim H, Cha DI, Kang TW, Lim S, Song KD, Lim HK. Percutaneous ultrasonography-guided radiofrequency ablation of hepatocellular carcinomas: usefulness of image fusion with three-dimensional ultrasonography. Clin Radiol 2015; 70:387-94. [PMID: 25582889 DOI: 10.1016/j.crad.2014.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/25/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the usefulness of fusion imaging with real-time ultrasonography (US) and three-dimensional (3D) US for the guidance of radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) 2-5 cm in diameter. MATERIALS AND METHODS This study was conducted as a retrospective cohort study. It was approved by the institutional review board and informed consent was waived. During percutaneous RFA of HCCs, targeting was performed under conventional fusion imaging guidance, whereas monitoring and controlling were conducted under fusion with 3D US guidance. Technical success, technique effectiveness, incidence of major complications, and local tumour progression rate were evaluated. According to tumour size (small: <3 cm versus medium: 3-5 cm), the roundness indexes of the ablation zones and local tumour progression rates were compared. RESULTS There were 29 small-sized HCCs (2.5 ± 0.3 cm) and 17 medium-sized HCCs (3.4 ± 0.5 cm). All RFA procedures were performed in a single RFA session. Both the technical success and technique effectiveness rates were 100%. One patient with medium-sized HCC developed a hepatic abscess (n = 1) as a major complication. The local tumour progression rate was 8.7% (4/46) with a mean follow-up period of 18.2 months. The roundness indexes of the ablation zone were not significantly different between small- and medium-sized HCCs, and the local tumour progression rates were also not significantly different between the two groups [3.4% (1/29) versus 17.6% (3/17); p = 0.135]. CONCLUSION Image fusion with real-time US and 3D US is useful for the guidance of percutaneous RFA for HCCs 2-5 cm in diameter.
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Affiliation(s)
- H J Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - M W Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - H Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K D Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H K Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Park HJ, Lee MW, Song KD, Cha DI, Rhim H, Kang TW, Lim S, Lim HK. Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes. Br J Radiol 2014; 87:20130534. [PMID: 24646182 DOI: 10.1259/bjr.20130534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare the ablation volume, local tumour progression rate and complication rate of radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) using 15-G and 17-G single electrodes. METHODS This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed percutaneous RFA cases for HCCs using 15-G or 17-G electrodes without multiple overlapping ablations. A total of 36 pairs of HCCs matched according to tumour size and active tip length were included. We compared ablation volume and complication rate between the two electrode groups. Cumulative local tumour progression rates were estimated using the Kaplan–Meier method and compared using the log-rank test. RESULTS Tumour size and ablation time were not significantly different between the 15-G and 17-G groups (p50.661 and p50.793, respectively). However, ablation volume in the 15-G electrode group was larger than that in the 17-G group (14.465.4cm3 vs 8.762.5cm3; p,0.001). No statistical difference in complication rates between the two electrode groups was found. The 10- and 20-month local tumour progression rates were not significantly different between the two groups (2.8% and 5.6% vs 11.1% and 19.3%; p50.166). CONCLUSION Ablation volume by the 15-G electrode was larger than that by the 17-G electrode. However, local tumour progression rate and complication rate were not significantly different between the two electrode groups. ADVANCES IN KNOWLEDGE RFA of HCC using a 15-G electrode is useful to create larger ablation volumes than a 17-G electrode.
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18
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Kang TW, Lee MW, Hye MJ, Song KD, Lim S, Rhim H, Lim HK, Cha DI. Percutaneous radiofrequency ablation of hepatic tumours: factors affecting technical failure of artificial ascites formation using an angiosheath. Clin Radiol 2014; 69:1249-58. [PMID: 25149600 DOI: 10.1016/j.crad.2014.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 01/15/2023]
Abstract
AIM To evaluate the technical feasibility of artificial ascites formation using an angiosheath before percutaneous radiofrequency ablation (RFA) for hepatic tumours and to determine predictive factors affecting the technical failure of artificial ascites formation. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. One hundred and thirteen patients underwent percutaneous RFA of hepatic tumours after trying to make artificial ascites using an angiosheath to avoid collateral thermal damage. The technical success rate of making artificial ascites using an angiosheath and conversion rate to other techniques after initial failure of making artificial ascites were evaluated. The technical success rate for RFA was assessed. In addition, potential factors associated with technical failure including previous history of transcatheter arterial chemoembolization (TACE) or RFA, type of abdominal surgery, and adjacent perihepatic structures were reviewed. Predictive factors for the technical failure of artificial ascites formation were analysed using multivariate analysis. RESULTS The technical success rates of artificial ascites formation by angiosheath and that of RFA were 84.1% (95/113) and 97.3% (110/113), respectively. The conversion rate to other techniques after the failure of artificial ascites formation using an angiosheath was 15.9% (18/113). Previous hepatic resection was the sole independent predictive factor affecting the technical failure of artificial ascites formation (p<0.001, odds ratio = 29.03, 95% confidence interval: 4.56-184.69). CONCLUSION Making artificial ascites for RFA of hepatic tumours using an angiosheath was technically feasible in most cases. However, history of hepatic resection was a significant predictive factor affecting the technical failure of artificial ascites formation.
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Affiliation(s)
- T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - M W Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - M J Hye
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - K D Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - S Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - H Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - H K Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
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Kim MS, Kim YJ, Lim HK, Park CS. Xenoreactive antibody response following pulmonary valve replacement using porcine bioprosthesis in the young. J Cardiothorac Surg 2013. [PMCID: PMC3844493 DOI: 10.1186/1749-8090-8-s1-o138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol 2013; 68:e641-51. [PMID: 23973161 DOI: 10.1016/j.crad.2013.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/30/2013] [Accepted: 07/10/2013] [Indexed: 01/25/2023]
Abstract
AIM To compare the long-term local control of hepatocellular carcinoma (HCC) and risk of peritoneal seeding via percutaneous radiofrequency ablation (RFA) using artificial ascites with those of RFA without artificial ascites. MATERIALS AND METHODS The Institutional Review Board approved this retrospective study. From April 2005 to February 2008, 160 patients (121 men, 39 women; age range 36-79 years) with a single subcapsular HCC (mean size 2.19 cm) were treated with ultrasonography-guided percutaneous RFA as a first-line therapy. Forty-four patients were treated with RFA using artificial ascites, whereas the other 116 patients were treated without artificial ascites. The cumulative local tumour progression (LTP) and peritoneal seeding were compared in both groups using follow-up computed tomography (CT). Cumulative LTP rates were analysed using the Kaplan-Meier method and the log-rank test. Risk of peritoneal seeding was investigated by means of multivariate analysis. RESULTS The overall median follow-up period was 52.5 months (range 13-76 months). The 1, 2, 4, and 6 year cumulative LTP rates were 17.1, 27.6, 35.2, and 35.2%, respectively, in the group with artificial ascites, and 8, 15.2, 26.6, and 34.4% in the group without artificial ascites, without significant difference (p = 0.332). The rates of peritoneal seeding were 6.8% (3/44) in the group with artificial ascites and 2.6% (3/116) in the group without artificial ascites, a non-significant difference (p = 0.347). The biopsy prior to RFA was the independent risk factor of peritoneal seeding regardless of the use of artificial ascites. CONCLUSION Long-term local tumour control and risk of peritoneal seeding were comparable for RFA with or without artificial ascites when used as a first-line therapy for subcapsular HCC.
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Affiliation(s)
- T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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21
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Lim HK, Hong SC, Jung WS, Ahn KJ, Won WY, Hahn C, Kim IS, Lee CU. Automated segmentation of hippocampal subfields in drug-naïve patients with Alzheimer disease. AJNR Am J Neuroradiol 2012; 34:747-51. [PMID: 23042923 DOI: 10.3174/ajnr.a3293] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although a few automated hippocampal subfield segmentation methods have been developed, there is no study on the effects of the diagnosis of Alzheimer disease on the hippocampal subfield volume with in vivo MR imaging. The aim of this study was to investigate hippocampal subfield volume differences between drug-naïve subjects with AD and healthy elderly controls by using an automated hippocampal subfield segmentation technique. MATERIALS AND METHODS Thirty-one drug-naïve subjects with AD and 33 group-matched healthy control subjects underwent 3T MR imaging, and hippocampal subfield volume was measured and compared between the groups. RESULTS Subjects with AD had significantly smaller volumes of the presubiculum, subiculum, CA2-3, and CA4 DG compared with healthy subjects (uncorrected, P<.001). In addition, we found significant positive correlations between the presubiculum and the subicular volumes and the MMSE-K and the CERAD-K verbal delayed recall scores in the AD group. CONCLUSIONS We are unaware of previous imaging studies of automated hippocampal subfield segmentation in AD. These structural changes in the hippocampal presubiculum, subiculum, and CA2-3 might be at the core of underlying neurobiologic mechanisms of hippocampal dysfunction and their relevance to verbal delayed recall impairments in AD.
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Affiliation(s)
- H K Lim
- Department of Psychiatry, Saint Vincent Hospital, and College of Medicine, Catholic University of Korea, Suwon, Korea
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Kim SJ, Lim HK, Lee HY, Choi CG, Lee DH, Suh DC, Kim SM, Kim JK, Krauss B. Dual-energy CT in the evaluation of intracerebral hemorrhage of unknown origin: differentiation between tumor bleeding and pure hemorrhage. AJNR Am J Neuroradiol 2012; 33:865-72. [PMID: 22241388 DOI: 10.3174/ajnr.a2890] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH. MATERIALS AND METHODS Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared. RESULTS Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA (P = .006) and combined EA and TNC (P = .011) images. CONCLUSIONS DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH.
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Affiliation(s)
- S J Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Lim HK, Choi CG, Kim SM, Kim JL, Lee DH, Kim SJ, Suh DC. Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T. Br J Radiol 2012; 85:1064-9. [PMID: 22294705 DOI: 10.1259/bjr/30618275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of four-dimensional MR angiography (4D-MRA) at 3.0 T for detecting residual arteriovenous malformations (AVMs) after Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) radiosurgery (GKRS). METHODS We assessed 36 angiographically confirmed AVMs in 36 patients who had been treated with GKRS. 4D-MRA was performed after GKRS and the time intervals were 39.4 ± 26.0 months [mean ± standard deviation (SD)]. 4D-MRA was obtained at 3.0 T after contrast injection, with a measured voxel size of 1 × 1 × 1 mm and a temporal resolution of 1.1 s (13 patients) or a voxel size of 1 × 1 × 2 mm and a temporal resolution of 0.98 s (23 patients). X-ray angiography was performed as the standard reference within 53 ± 47 days (mean ± SD) after MRA. To determine a residual AVM, the 4D-MRA results were independently reviewed by two readers blinded to the X-ray angiography results. We evaluated diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 4D-MRA for detection of a residual AVM. RESULTS A residual AVM was identified in 13 patients (13/36, 36%) on X-ray angiography. According to Readers 1 and 2, 4D-MRA had a sensitivity of 79.6% and 64.3%, a specificity of 90.9% and 100%, a PPV of 84.6% and 100% and an NPV of 90% and 81.5%, respectively, and a diagnostic accuracy of 86.1% for Readers 1 and 2, for detecting residual AVMs after GKRS. CONCLUSION The diagnostic accuracy of 4D-MRA at 3.0 T seems high, but there is still the possibility of further improving the spatiotemporal resolution of this technique.
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Affiliation(s)
- H K Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Lim HK, Lee JH, Hyun D, Park JW, Kim JL, Lee HY, Park S, Ahn JH, Baek JH, Choi CG. MR diagnosis of facial neuritis: diagnostic performance of contrast-enhanced 3D-FLAIR technique compared with contrast-enhanced 3D-T1-fast-field echo with fat suppression. AJNR Am J Neuroradiol 2011; 33:779-83. [PMID: 22207300 DOI: 10.3174/ajnr.a2851] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Current MRI with the CE T1-weighted sequence plays a limited role in the evaluation of facial neuritis due to prominent normal facial nerve enhancement. Our purpose was to retrospectively investigate the usefulness of the CE 3D-FLAIR sequence compared with the CE 3D-T1-FFE sequence in facial neuritis patients. MATERIALS AND METHODS We assessed 36 consecutive patients who underwent temporal bone MR imaging at 3T for idiopathic facial palsy. Two readers independently reviewed CE 3D-T1-FFE and CE 3D-FLAIR images to determine the degree of enhancement in each of 5 segments of the facial nerve. We compared AUCs using the Z-test, compared diagnostic performance of 2 MR techniques with the McNemar test, and evaluated interobserver agreement. The Pearson χ(2) test was used for each segment of the facial nerve. RESULTS The AUC of CE 3D-FLAIR (reader 1, 0.754; reader 2, 0.746) was greater than that of CE 3D-T1-FFE (reader 1, 0.624; reader 2, 0.640; P < .001). The diagnostic sensitivities, specificities, and accuracies were 97.2%, 86.1%, and 91.7%, respectively, for CE 3D-FLAIR, and 100%, 56.9%, and 78.5%, respectively, for CE 3D-T1-FFE. The specificity and accuracy of CE 3D-FLAIR were greater than those of CE 3D-T1-FFE (specificity, P = .029; accuracy, P = .008). The interobserver agreements for CE 3D-FLAIR (κ-value, 0.831) and CE 3D-T1-FFE (κ-value, 0.694) were excellent. Enhancement of the canalicular and anterior genu segments on CE 3D-FLAIR were significantly correlated with the occurrence of facial neuritis (P < .001 for canalicular; P = .032 and 0.020 for anterior genu by reader 1 and reader 2, respectively). CONCLUSIONS CE 3D-FLAIR can improve the specificity and overall accuracy of MR imaging in patients with idiopathic facial palsy.
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Affiliation(s)
- H K Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee KMT, Chan HN, Cheah B, Gentica GFC, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P, Yeo HN. Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore Med J 2011; 52:456-8; quiz 459. [PMID: 21732000] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Ministry of Health (MOH) has published clinical practice guidelines on Management of Gambling Disorders to provide doctors and patients in Singapore with evidence-based guidance on the management of gambling disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Management of Gambling Disorders for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=26136). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
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Affiliation(s)
- K M T Lee
- MOH Clinical Practice Guidelines Workgroup on Management of Gambling Disorders.
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Lim HK, Keniston LP, Shin JH, Allman BL, Meredith MA, Cios KJ. Connectional parameters determine multisensory processing in a spiking network model of multisensory convergence. Exp Brain Res 2011; 213:329-39. [PMID: 21484394 DOI: 10.1007/s00221-011-2671-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 03/30/2011] [Indexed: 02/02/2023]
Abstract
For the brain to synthesize information from different sensory modalities, connections from different sensory systems must converge onto individual neurons. However, despite being the definitive, first step in the multisensory process, little is known about multisensory convergence at the neuronal level. This lack of knowledge may be due to the difficulty for biological experiments to manipulate and test the connectional parameters that define convergence. Therefore, the present study used a computational network of spiking neurons to measure the influence of convergence from two separate projection areas on the responses of neurons in a convergent area. Systematic changes in the proportion of extrinsic projections, the proportion of intrinsic connections, or the amount of local inhibitory contacts affected the multisensory properties of neurons in the convergent area by influencing (1) the proportion of multisensory neurons generated, (2) the proportion of neurons that generate integrated multisensory responses, and (3) the magnitude of multisensory integration. These simulations provide insight into the connectional parameters of convergence that contribute to the generation of populations of multisensory neurons in different neural regions as well as indicate that the simple effect of multisensory convergence is sufficient to generate multisensory properties like those of biological multisensory neurons.
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Affiliation(s)
- H K Lim
- Department of Computer Science, School of Engineering, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Kim SM, Baek JH, Kim YS, Sung JY, Lim HK, Choi H, Lee JH. Efficacy and safety of ethanol ablation for thyroglossal duct cysts. AJNR Am J Neuroradiol 2010; 32:306-9. [PMID: 21087937 DOI: 10.3174/ajnr.a2296] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE TGDC is a common congenital neck lesion, which has been treated by surgery. Although surgery is curative, it has drawbacks such as scars and surgical morbidity. Therefore, we applied EA as an alternative treatment technique. The purpose of this study was the evaluation of the efficacy and safety of EA for TGDC. MATERIALS AND METHODS Between May 2005 and July 2008, we performed EA in 11 patients with TGDC who refused surgery. All patients were confirmed as having benign lesions before treatment. US-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%). The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. We evaluated the therapeutic outcome, including volume reduction of the TGDC, improvement of cosmetic problems and symptoms, and complications. RESULTS The initial volume of the cysts ranged from 0.67 to 29.39 mL (mean, 6.0 mL). The procedure was performed in 1-3 sessions (mean, 1.4 sessions). Follow-up US was performed in 10 patients from 3 to 29 months (mean, 13.6 months). The mean volume of the cyst was 6.0 ± 8.4 mL, and volume reduction was 43.9%-100% (mean, 81.3%, P = .005) at last follow-up. Therapeutic success (volume reduction of >50%) was observed in 8 patients (8/10, 80%). Significant improvement of symptom- (P = .005) and cosmetic-grading scores (P = .003) was observed at last follow-up. No significant complications were observed during the procedure or follow-up periods. CONCLUSIONS EA seems to be an effective and safe treatment method for TGDC.
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Affiliation(s)
- S M Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
Hepatic haemangiomas with fluid-fluid levels are known to be rare with only five cases reported in the English literature. According to the previous reports, the presence of fluid-fluid level could attribute to the separation of blood cells and serous fluid because of the extremely slow flow in cavernous haemangioma of the liver. We describe the imaging features of multiple hepatic haemangiomas with fluid-fluid levels, which was pathologically proven with ultrasonography guided biopsy.
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Affiliation(s)
- J Lee
- Department of Diagnostic Radiology, Guro Hospital of Korea University, Guro2-Dong, Guro-Ku, Seoul, Korea
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Abstract
Mucocele of the appendix is characterized by distension of the appendiceal lumen due to abnormal accumulation of mucoid substance. Among the known complications of appendiceal mucocele, it is known to be unusual for the appendiceal mucocele to be a cause of ureteral obstruction. Only a few reports have been published in the English literature. We describe a case of right hydronephroureterosis secondary to appendiceal mucocele diagnosed with multidetector-row CT.
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Affiliation(s)
- J Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Dunlop J, Marquis KL, Lim HK, Leung L, Kao J, Cheesman C, Rosenzweig-Lipson S. Pharmacological profile of the 5-HT(2C) receptor agonist WAY-163909; therapeutic potential in multiple indications. CNS Drug Rev 2007; 12:167-77. [PMID: 17227285 PMCID: PMC6506193 DOI: 10.1111/j.1527-3458.2006.00167.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The 5-HT(2C) receptor subtype has been implicated in a wide variety of conditions including obesity, anxiety, depression, obsessive compulsive disorder, schizophrenia, migraine and erectile dysfunction and as a consequence has received considerable attention as a target for drug discovery. Here we review the pharmacological, pharmacokinetic and toxicological profile of WAY-163909 {(7bR,10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1hi]indole}, a novel 5-HT(2C) receptor selective agonist. Consistent with a potential therapeutic utility in obesity, schizophrenia and depression WAY-163909 was found to have robust dose-dependent effects in animal models of obesity, psychotic-like behavior or depression.
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Affiliation(s)
- John Dunlop
- Discovery Neuroscience, Wyeth Research, Princeton, NJ 08543, USA.
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Kim HY, Choi GJ, Lee HB, Lee SW, Lim HK, Jang KS, Son SW, Lee SO, Cho KY, Sung ND, Kim JC. Some fungal endophytes from vegetable crops and their anti-oomycete activities against tomato late blight. Lett Appl Microbiol 2007; 44:332-7. [PMID: 17309513 DOI: 10.1111/j.1472-765x.2006.02093.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 11/26/2022]
Abstract
AIMS To isolate endophytic fungi from vegetable plants and examine their in vivo anti-oomycete activity against Phytophthora infestans in tomato plants. METHODS AND RESULTS Endophytic fungi were isolated from surface-sterilized plant tissues and anti-oomycete activity was measured by in vivo assay using tomato seedlings. Endophytic fungi showing potent anti-oomycete activity were identified by morphological characteristics and nuclear ribosomal ITS1-5.8S-ITS2 sequence analysis. A total of 152 isolates were obtained from 66 healthy tissue samples of cucumber, red pepper, tomato, pumpkin and Chinese cabbage and the fermentation broths of 23 isolates showed potent in vivo anti-oomycete activity against tomato late blight with control values over 90%. The Fusarium oxysporum strain EF119, which was isolated from roots of red pepper, showed the most potent disease control efficacy against tomato late blight. In dual-culture tests, it inhibited the growth of Pythium ultimum, P. infestans and Phytophthora capsici. CONCLUSIONS Among endophytic fungi isolated from healthy tissues of vegetable plants, F. oxysporum EF119 showed the most potent in vivo anti-oomycete activity against tomato late blight and in vitro anti-oomycete activity against several oomycete pathogens. SIGNIFICANCE AND IMPACT OF THE STUDY Endophytic fungi showing anti-oomycete activity in vitro and in vivo may be used as biocontrol agents particularly of tomato late blight.
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Affiliation(s)
- H-Y Kim
- Biological Function Research Team, Korea Research Institute of Chemical Technology, Taejon, Korea
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Lim JH, Kim SH, Lee WJ, Choi D, Kim SH, Lim HK. Ultrasonographic detection of hepatocellular carcinoma: correlation of preoperative ultrasonography and resected liver pathology. Clin Radiol 2006; 61:191-7. [PMID: 16439225 DOI: 10.1016/j.crad.2005.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 10/13/2005] [Accepted: 10/17/2005] [Indexed: 11/18/2022]
Abstract
AIM The aim of this study was to determine the sensitivity of ultrasonography for detecting hepatocellular carcinoma in patients who underwent surgical liver resection. MATERIALS AND METHODS The preoperative ultrasonography reports of 103 patients who underwent hepatic resection surgery were retrospectively reviewed. The patients had chronic liver disease with good liver function and a relatively normal liver echo-texture. The presence of a mass or masses in the resected part of the liver segments on preoperative ultrasonography was regarded as possible hepatocellular carcinoma, and these results were compared with the surgically resected hepatic lobes or segments. Accuracy for detection was assessed on a lesion-by-lesion basis, on a segment-by-segment basis, and on a patient basis. RESULTS One hundred and fifty-seven hepatocellular carcinomas were found in 244 hepatic segments of 103 patients. One hundred and one of 157 hepatocellular carcinomas were detected using ultrasonography in 97 patients resulting in a sensitivity of 64%. In six patients, a solitary hepatocellular carcinoma was missed in each patient, a patient sensitivity being 94%. Using ultrasonography, 87 of 100 (87%) hepatocellular carcinomas larger than 2 cm in diameter, and 14 of 57 (25%) hepatocellular carcinomas 2 cm or smaller in diameter were revealed. On the basis of segment-by-segment analysis, the sensitivity was 78% (99 of 127 segments), specificity was 97% (114 of 117 segments), accuracy was 87% (213 of 244 segments), positive predictive value was 97% (99 of 102 segments), and negative predictive value was 80% (114 of 142 segments). CONCLUSION In patients with chronic liver disease and good hepatic function, ultrasonography has a sensitivity of 94% in the identification of affected patients, but for individual lesions, the sensitivity is only 64%.
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Affiliation(s)
- J H Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea.
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Abstract
A 61-year-old man with intermittent periumbilical pain and high liver enzyme levels underwent spiral computed tomography of the abdomen with intravenous contrast medium enhancement. Abdominal computed tomogram showed wall thickening of both intrahepatic ducts and proximal common hepatic duct with enhancement. Direct cholangiogram showed severe smooth strictures from the common hepatic duct to both intrahepatic ducts. The findings were interpreted as hilar cholangiocarcinoma. The pathologic findings after surgical resection were consistent with follicular cholangitis.
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Affiliation(s)
- J Y Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lim HK, Lee DC, McKay WB, Priebe MM, Holmes SA, Sherwood AM. Neurophysiological assessment of lower-limb voluntary control in incomplete spinal cord injury. Spinal Cord 2005; 43:283-90. [PMID: 15672098 DOI: 10.1038/sj.sc.3101679] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional retrospective study of a neurophysiological method of voluntary motor control characterization. OBJECTIVES This study was undertaken to validate the surface electromyography (sEMG)-based voluntary response index (VRI) as an objective, quantitative, laboratory measure of spinal cord injury severity in terms of voluntary motor control disruption. SETTING VA Medical Centers in Houston and Dallas Texas, USA. METHODS A total of 67 subjects with incomplete spinal cord injury (iSCI), American Spinal Injury Association Impairment Scale (AIS)-C (n = 32) and -D (n = 35) were studied. sEMG recorded during a standardized protocol including eight lower-limb voluntary motor tasks was analyzed using the VRI method that relates multi-muscle activation patterns of SCI persons to those of healthy-subject prototypes (n = 15). The VRI is composed of a measure of the amount of the sEMG activity (magnitude) and the distribution of activity across muscle groups compared to that of healthy subjects for each motor task (similarity index, SI). These resulting VRI components, normalized magnitude and SI, were compared to AIS clinical findings in this study. Receiver operating characteristic analysis was performed to determine the SI values best separating AIS-C and AIS-D subjects. RESULTS Magnitude and SI for AIS-C subjects had mean values of 0.27 +/- 0.32 and 0.65 +/- 0.21, respectively. Both parameters were significantly larger in the AIS-D subjects (0.78 +/- 0.43 and 0.93 +/- 0.06), respectively (P < 0.01). An SI value of 0.85 was found to separate AIS-C and AIS-D groups with a sensitivity of 0.89 and a specificity of 0.81. Further, the VRI of each leg strongly correlated with the respective AIS motor score (0.80, r < 0.01). CONCLUSIONS In the domains of voluntary motor control, the sEMG-based VRI demonstrated adequate face validity and sensitivity to injury severity as currently measured by the AIS. SPONSORSHIP Veterans Affairs Medical Center.
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Affiliation(s)
- H K Lim
- Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
The purpose of this study was to determine the sensitivity of triple phase helical dynamic CT for detecting dysplastic nodules in patients with liver cirrhosis. 76 dysplastic nodules were confirmed by histopathological examination of the liver specimens after surgical resection in 21 patients or after explantation of the whole liver in 20 patients. Triple phase helical dynamic CT including arterial, portal venous and delayed phases was performed as a pre-operative evaluation for hepatocellular carcinoma. Two readers retrospectively evaluated the images. The presence of dysplastic nodules was determined by one-to-one correlation of the CT images and the pathological results in terms of the anatomical location and size of each nodule. Helical dynamic triple phase CT depicted eight of 76 dysplastic nodules (10%): five of 35 high grade dysplastic nodules (14%) and three of 41 low grade dysplastic nodules (7%). Triple phase helical dynamic CT is insensitive for detection of dysplastic nodules in cirrhotic livers.
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Affiliation(s)
- J H Lim
- Departments of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, Korea 135-710
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McKay WB, Lee DC, Lim HK, Holmes SA, Sherwood AM. Neurophysiological examination of the corticospinal system and voluntary motor control in motor-incomplete human spinal cord injury. Exp Brain Res 2004; 163:379-87. [PMID: 15616810 DOI: 10.1007/s00221-004-2190-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 10/06/2004] [Indexed: 10/26/2022]
Abstract
This study employed neurophysiological methods to relate the condition of the corticospinal system with the voluntary control of lower-limb muscles in persons with motor-incomplete spinal cord injury. It consisted of two phases. In a group of ten healthy subjects, single and paired transcranial magnetic stimulation (TMS) of the motor cortex was used to study the behavior of the resulting motor evoked potentials (MEP) in lower-limb muscles. Interstimulus intervals (ISIs) of 15-100 ms were examined for augmentation of test MEPs by threshold or subthreshold conditioning stimuli. The second phase of this study examined eight incomplete spinal cord injured (iSCI) subjects, American Spinal Injury Association Impairment Scale C (n = 5) and D (n = 3) in whom voluntary motor control was quantified using the surface EMG (sEMG) based Voluntary Response Index (VRI). The VRI is calculated to characterize relative output patterns across ten lower-limb muscles recorded during a standard protocol of elementary voluntary motor tasks. VRI components were calculated by comparing the distribution of sEMG in iSCI subjects with prototype patterns collected from 15 healthy subjects using the same rigidly administered protocol, The resulting similarity index (SI) and magnitude values provided the measure of voluntary motor control. Corticospinal system connections were characterized by the thresholds for MEPs in key muscles. Key muscles were those that function as the prime-movers, or agonists for the voluntary movements from which the VRI data were calculated. Results include healthy-subject data that showed significant increases in conditioned MEP responses with paired stimuli of 15-50 ms ISI. Stimulus pairs of 75 and 100 ms showed no increase in MEP peak amplitude over that of the single-pulse conditioning stimulus alone, usually no response. For the iSCI subjects, 42% of the agonists responded to single-pulse TMS and 25% required paired-pulse TMS to produce an MEP. American Spinal Injury Association Impairment Scale component motor scores for agonist muscles, Quadriceps, Tibialis Anterior, and Triceps Surae, were significantly lower where MEPs could not be obtained (p < 0.05). VRI values were also significantly lower for motor tasks with agonists that had no resting MEP (p < 0.01). Therefore, the presence of a demonstrable connection between the motor cortex and spinal motor neurons in persons with SCI was related to the quality of post-injury voluntary motor control as assessed by the VRI.
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Affiliation(s)
- W B McKay
- Baylor College of Medicine, Houston, TX, USA
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Chang S, Lim HK, Lee WJ, Choi D, Jang KT. Arteriovenous malformation of the pancreas in a patient with gastrointestinal bleeding: helical CT findings. ACTA ACUST UNITED AC 2004; 29:259-62. [PMID: 15290955 DOI: 10.1007/s00261-003-0093-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dynamic computed tomographic (CT) findings of arteriovenous malformation (AVM) of the pancreas include strong enhancement or conglomeration of small hypervascular spots in the pancreas and early contrast filling of the portal vein during the arterial phase. We describe a case with pancreatic AVM in which we identified enlarged arterial feeders and draining veins as supportive findings of the diagnosis and ulceration into the pancreatic duct as a possible cause of gastrointestinal bleeding at contrast-enhanced CT.
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Affiliation(s)
- S Chang
- Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea
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Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center and Center for Imaging Science, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-ku, Seoul, Korea 135-710.
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Lee DC, Lim HK, McKay WB, Priebe MM, Holmes SA, Sherwood AM. Toward an objective interpretation of surface EMG patterns: a voluntary response index (VRI). J Electromyogr Kinesiol 2004; 14:379-88. [PMID: 15094151 DOI: 10.1016/j.jelekin.2003.10.006] [Citation(s) in RCA: 54] [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] [Received: 05/26/2003] [Revised: 10/17/2003] [Accepted: 10/21/2003] [Indexed: 11/30/2022] Open
Abstract
Individuals with incomplete spinal cord injuries (SCI) retain varying degrees of voluntary motor control. The complexity of the motor control system and the nature of the recording biophysics have inhibited efforts to develop objective measures of voluntary motor control. This paper proposes the definition and use of a voluntary response index (VRI) calculated from quantitative analysis of surface electromyographic (sEMG) data recorded during defined voluntary movement as a sensitive measure of voluntary motor control in such individuals. The VRI is comprised of two numeric values, one derived from the total muscle activity recorded for the voluntary motor task (magnitude), and the other from the sEMG distribution across the recorded muscles (similarity index (SI)). Calculated as a vector, the distribution of sEMG from the test subject is compared to the average vector calculated from sEMG recordings of the same motor task from 10 neurologically intact subjects in a protocol called brain motor control assessment (BMCA). To evaluate the stability of the VRI, a group of five healthy subjects were individually compared to the prototype, average healthy-subject vectors for all of the maneuvers. To evaluate the sensitivity of this method, the VRI was obtained from two SCI subjects participating in other research studies. One was undergoing supported treadmill ambulation training, and the other a controlled withdrawal of anti-spasticity medications. The supported treadmill training patient's VRI, calculated from pre- and post-training BMCA recordings, reflected the qualitative changes in sEMG patterns and functional improvement of motor control. The VRI of the patient followed by serial BMCA during medication withdrawal also reflected changes in the motor control as a result of changes in anti-spasticity medication. To validate this index for clinical use, serial studies using larger numbers of subjects with compromised motor control should be performed.
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Affiliation(s)
- D C Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106-4912, USA
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Kim E, Choi D, Lim HK, Lim JH. Multiple infarcted regenerative nodules in liver cirrhosis after systemic hypotension due to septic shock: radiologic findings. ACTA ACUST UNITED AC 2004; 29:208-10. [PMID: 15290947 DOI: 10.1007/s00261-003-0121-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a case of multiple infarcted regenerative nodules in a patient with advanced liver cirrhosis who had experienced an episode of septic shock. Sonography showed multiple hypoechoic or isoechoic nodules; contrast-enhanced computed tomography showed multiple, low-attenuating nodules with rim enhancement; and magnetic resonance imaging showed multiple nodules of low, iso-, or high signal intensity. Explanted liver showed coagulation necrosis of multiple regenerative nodules. Peribiliary cysts in chronic liver diseases, liver abscesses, spontaneous necrosis of hepatocellular carcinomas, and metastasis should be differentiated.
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Affiliation(s)
- E Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea
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Abstract
We present a case of a completely isolated enteric duplication cyst in a 28-year-old man. Computed tomography showed a large complex cystic mass with curvilinear and nodular calcifications near the anterior aspect of the left kidney. It had no connection to the pancreas, stomach, small bowel, or large bowel. We found no report describing computed tomographic findings of completely isolated enteric duplication cyst in the English-language literature.
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Affiliation(s)
- S K Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Paine MF, Leung LY, Lim HK, Liao K, Oganesian A, Zhang MY, Thummel KE, Watkins PB. Identification of a novel route of extraction of sirolimus in human small intestine: roles of metabolism and secretion. J Pharmacol Exp Ther 2002; 301:174-86. [PMID: 11907172 DOI: 10.1124/jpet.301.1.174] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Using Caco-2 cell monolayers expressing CYP3A4, we investigated the interplay between metabolism and transport on the first-pass intestinal extraction of the immunosuppressant sirolimus, a CYP3A4/P-glycoprotein (P-gp) substrate. Modified Caco-2 cells metabolized [(14)C]sirolimus to the predicted amounts of CYP3A4-mediated products based on CYP3A4 content, which was approximately 20% of that measured in human small intestinal mucosal homogenate. [(14)C]Sirolimus also degraded to the known ring-opened product, seco-rapamycin. Unexpectedly, a ring-opened dihydro metabolite (M2) was the major product detected in cells at all sirolimus concentrations examined (2-100 microM). Greater M2 formation after apical versus basolateral dosing (1.6-fold) was explained by higher intracellular content of sirolimus after apical dosing. M2 was not detected in incubations with human liver and intestinal microsomes but was readily detected with corresponding homogenates. M2 formation was NADPH-dependent but unaffected by the CYP3A4 inhibitors ketoconazole and troleandomycin. Although M2 was formed from purified seco-rapamycin (20 microM) in the homogenates, it was not detected in cells when seco-rapamycin was added to the apical compartment, because seco-rapamycin was essentially impermeable to the apical membrane. Sirolimus, seco-rapamycin (basolaterally dosed), and M2 were all actively secreted across the apical membrane, and secretion of each was inhibited by the P-gp inhibitor LY335979 [(2R)-anti-5-[3-[4-(10,11-difluoromethanodibenzo-suber-5-yl)piperazin-1-yl]-2-hydroxypropoxy]quinoline trihydrochloride]. Along with CYP3A4-mediated metabolism and P-gp-mediated secretion, we conclude that the following novel pathway, which occurs at least in the intestine, may contribute significantly to the first-pass extraction of sirolimus in humans: intracellular degradation of sirolimus to seco-rapamycin, metabolism of seco-rapamycin to M2 by an unidentified non-microsomal enzyme, and P-gp-mediated secretion of M2 and seco-rapamycin.
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Affiliation(s)
- Mary F Paine
- General Clinical Research Center and Division of Pharmacotherapy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
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Affiliation(s)
- H K Lim
- Department of Radiology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea
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Lim HK, Kim HS, Choi HS, Choi J, Kim SH, Chang MJ. Effects of bergenin, the major constituent of Mallotus japonicus against D-galactosamine-induced hepatotoxicity in rats. Pharmacology 2002; 63:71-5. [PMID: 11490198 DOI: 10.1159/000056115] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/19/2022]
Abstract
The hepatoprotective effects of bergenin, a major constituent of Mallotus japonicus, were evaluated against D-galactosamine (GalN)-induced liver damage in rats. Bergenin (50, 100 and 200 mg/kg) was given orally once daily for 7 successive days and then GalN 400 mg/kg was injected intraperitoneally to rats at 24 and 96 h after the final administration of bergenin. Pretreatment with bergenin reduced the increased enzyme activities of alanine/aspartate aminotransferase, sorbitol dehydrogenase, gamma-glutamyltransferase and the elevated level of malondialdehyde induced by GalN. Bergenin restored the decreased hepatic contents of glutathione as well as the decreased activities of glutathione S-transferase and glutathione reductase by GalN towards normalization, suggesting that the hepatoprotective effects of bergenin may consist in maintaining adequate levels of hepatic glutathione for the removal of xenobiotics. The present results indicate that bergenin has hepatoprotective effects against GalN-induced hepatotoxicity in rats.
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Affiliation(s)
- H K Lim
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
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Lim HK, Choi D, Lee WJ, Kim SH, Lee SJ, Jang HJ, Lee JH, Lim JH, Choo IW. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 2001; 221:447-54. [PMID: 11687689 DOI: 10.1148/radiol.2212010446] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.6] [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: 12/12/2022]
Abstract
PURPOSE To determine serial changes in hepatocellular carcinomas (HCCs) treated with percutaneous radio-frequency (RF) ablation at long-term follow-up multiphase helical computed tomography (CT). MATERIALS AND METHODS There were 43 nodular HCCs in 40 patients at follow-up CT performed not less than 12 months after RF ablation. All patients underwent follow-up multiphase helical CT immediately, 1 month, and then every 3 months after percutaneous RF ablation. The serial changes in attenuation, enhancement pattern, shape, other findings, and volume of the ablated lesions were analyzed at follow-up CT. RESULTS Thirty-eight (88%) of 43 ablated lesions were of low attenuation, with absence of contrast material enhancement at immediate and 1-month follow-up CT, which is suggestive of successful treatment. The remaining five lesions (12%) showed peripheral nodular enhancement, suggesting residual viable tumor. Compared with volume changes at immediate follow-up CT, the mean percentages of volume change at 1, 4, 10, 16, and 19 months were 79%, 50%, 27%, 11%, and 6%, respectively. Of 43 ablated lesions, 24 (56%) were mostly round at immediate CT and remained unchanged at subsequent follow-up CT. Peripheral rim enhancement was seen in 34 (79%) of 43 lesions at immediate CT but resolved in all 34 lesions at 1-month follow-up CT. Other associated findings included iatrogenic arteriovenous shunt in 10 patients, perihepatic hemorrhage in three, and pneumothorax in one. CONCLUSION Follow-up multiphase helical CT of HCCs treated with percutaneous RF ablation showed variable findings in the treated lesions and surrounding liver parenchyma.
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Affiliation(s)
- H K Lim
- Department of Radiology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea.
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Lee WJ, Lim HK, Jang KM, Kim SH, Lee SJ, Lim JH, Choo IW. Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics 2001; 21 Spec No:S97-S116. [PMID: 11598251 DOI: 10.1148/radiographics.21.suppl_1.g01oc12s97] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [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: 12/15/2022]
Abstract
Most cholangiocarcinomas are ductal adenocarcinomas that arise from both intra- and extrahepatic bile duct epithelium, and their typical growth pattern can be classified as exophytic, infiltrative, polypoid, or a combination of these. Those of unusual histologic type (eg, mucin-hypersecreting cholangiocarcinoma, squamous adenocarcinoma, biliary cystadenocarcinoma, and mucinous carcinoma) show a growth pattern different from that of the typical ones (ie, ductal). Cholangiocarcinomas frequently develop in patients with any of a variety of preexisting bile duct diseases, some of which are considered precursors of cholangiocarcinoma (eg, biliary lithiasis, clonorchiasis, recurrent pyogenic cholangitis, and primary sclerosing cholangitis). Some bulky hepatic tumors of either primary or secondary origin mimic exophytic peripheral cholangiocarcinoma. Some variants of hepatocellular carcinoma, such as sclerosing, fibrolamellar, and cholangiohepatocellular carcinoma, resemble exophytic peripheral cholangiocarcinoma, while that with intraductal growth resembles polypoid cholangiocarcinoma. Among benign bile duct diseases, tumorous conditions (eg, benign biliary tumors) may mimic polypoid cholangiocarcinoma, whereas benign stricture of various causes (eg, cholangitides, traumatic and postsurgical sequelae, chronic pancreatitis, papillary stenosis) usually mimics infiltrative cholangiocarcinoma.
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Affiliation(s)
- W J Lee
- Department of Radiology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea
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Rhim H, Goldberg SN, Dodd GD, Solbiati L, Lim HK, Tonolini M, Cho OK. Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 2001; 21 Spec No:S17-35; discussion S36-9. [PMID: 11598245 DOI: 10.1148/radiographics.21.suppl_1.g01oc11s17] [Citation(s) in RCA: 226] [Impact Index Per Article: 9.8] [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: 12/20/2022]
Abstract
Radio-frequency thermal ablation is one of the most promising minimally invasive techniques for the treatment of nonresectable hepatic tumors. Essential technical tips to successful radio-frequency ablation therapy were collected from five international experts. They were organized into five categories: understanding the mechanisms and principles of radio-frequency ablation, modulation of tissue physiologic characteristics to increase tumor destruction, strategies of overlapping ablations, strategies to improve ablation according to tumor location, and imaging strategies after ablation to ensure adequate therapy. Established factors for optimal ablation, as well as emerging technical tips, are addressed with illustrations in each section. These essential tips will be very helpful for physicians performing radio-frequency ablation of hepatic tumors.
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Affiliation(s)
- H Rhim
- Department of Diagnostic Radiology, Hanyang University Hospital, 17 Haengdang-Dong, Sungdong-Ku, 133-792 Seoul, Korea.
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Lim JH, Choi D, Cho SK, Kim SH, Lee WJ, Lim HK, Park CK, Paik SW, Kim YI. Conspicuity of hepatocellular nodular lesions in cirrhotic livers at ferumoxides-enhanced MR imaging: importance of Kupffer cell number. Radiology 2001; 220:669-76. [PMID: 11526265 DOI: 10.1148/radiol.2203001777] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [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: 12/20/2022]
Abstract
PURPOSE To correlate the conspicuity of hepatocellular carcinomas and dysplastic nodules on ferumoxides-enhanced magnetic resonance (MR) images with the number of Kupffer cells in the hepatic lesions, as compared with that in background liver in histopathologic findings. MATERIALS AND METHODS Sixty-nine histopathologically proved moderately or poorly differentiated hepatocellular carcinomas, 10 well-differentiated hepatocellular carcinomas, and 19 dysplastic nodules were retrospectively studied in 68 patients with cirrhosis who underwent ferumoxides-enhanced MR imaging. The contrast-to-noise ratio between the nodules and surrounding parenchyma was calculated at T2-weighted fast spin-echo imaging, and the difference in the number of Kupffer cells between the nodules and surrounding hepatic tissue was calculated histopathologically. The results of MR imaging and histopathologic examination were correlated. RESULTS All 69 moderately or poorly differentiated hepatocellular carcinomas had high contrast-to-noise ratios at MR imaging and large differences in the number of Kupffer cells. Six of the 10 well-differentiated hepatocellular carcinomas had contrast-to-noise ratios of zero or nearly zero, and five of these had little difference in the number of Kupffer cells. All 19 dysplastic nodules had contrast-to-noise ratios of zero or nearly zero, and there were virtually no differences in the number of Kupffer cells. CONCLUSION Hepatocellular nodule conspicuity at ferumoxides-enhanced MR imaging depends on differences in the number of Kupffer cells within a nodule and the surrounding cirrhotic liver; moderately or poorly differentiated hepatocellular carcinomas can be distinguished from well-differentiated hepatocellular carcinomas and dysplastic nodules.
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Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea
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Choi D, Kim SH, Lim JH, Cho JM, Lee WJ, Lee SJ, Lim HK. Detection of hepatocellular carcinoma: combined T2-weighted and dynamic gadolinium-enhanced MRI versus combined CT during arterial portography and CT hepatic arteriography. J Comput Assist Tomogr 2001; 25:777-85. [PMID: 11584240 DOI: 10.1097/00004728-200109000-00018] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [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: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the preoperative detectability of hepatocellular carcinomas (HCCs) using combined T2-weighted and dynamic gadolinium-enhanced MRI and combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA). METHOD Thirty-three patients with 43 HCCs underwent T2-weighted and dynamic gadolinium-enhanced MRI and combined CTAP and CTHA. The diagnosis was established by pathologic examination following surgical resection in 26 patients and by biopsy in 7 patients. The MR protocol included fast SE with two TEs (including T2-weighted imaging) and precontrast and gadolinium-enhanced T1-weighted fast multiplanar spoiled gradient-recalled echo images with dynamic study. The MR images of all sequences and the paired CTAP and CTHA images were independently reviewed by three radiologists. Image review was conducted on a segment-by-segment basis. Diagnostic accuracy was evaluated with receiver operating characteristic analysis. RESULTS The accuracies (Az values) of MRI of all sequences and combined CTAP and CTHA for all observers were 0.960 and 0.959, respectively. The mean sensitivities of MRI and CT were 90 and 94%, respectively. The differences were not statistically significant. The mean specificity of MRI (99%) was significantly higher than that of combined CTAP and CTHA (92%). CONCLUSION Combined T2-weighted and dynamic gadolinium-enhanced MRI is as accurate as combined CTAP and CTHA for preoperative detection of HCCs.
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Affiliation(s)
- D Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gu M, Lim HK. An intelligent data acquisition system for simultaneous screening of microsomal stability and metabolite profiling by liquid chromatography/mass spectrometry. J Mass Spectrom 2001; 36:1053-1061. [PMID: 11599083 DOI: 10.1002/jms.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes the development of a mass spectrometer-based, intelligent, programmable, sample-selection data acquisition system with two unique features. One is that the system allows automatic determination of the mass to charge ratio (m/z) of an unknown compound and the utilization of the molecular ion information to perform selective ion monitoring (SIM) experiments for quantitation. The other is its decision-making capability to select intelligently different samples and perform different experiments during data acquisition. These features were demonstrated by the application of the system to simultaneous screening for the microsomal stability and metabolite profiling of adatanserin. In this application, the data acquisition system continuously calculated the peak areas of adatanserin from SIM analyses of a batch of microsomal incubates stopped at various time points. Once the peak area of adatanserin had dropped to an arbitrarily predefined 60% of the initial value, the system made a decision to perform metabolite profiling of the sample. This decision initiated a series of automated operations, such as selecting a sample for re-analysis, changing the data acquisition time and liquid chromatographic gradient and switching the SIM mode to the data-dependent product ion scanning mode. The completed analysis of the batch of samples provided information both on the microsomal stability and on the metabolic profile of adatanserin. This simultaneous approach to investigating microsomal stability and metabolite profiling significantly increases the throughput for drug discovery support.
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Affiliation(s)
- M Gu
- Wyeth-Ayerst Research, CN 8000, Princeton, New Jersey 08543, USA.
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