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Lee JA, Kim S, Cho Y, Kweon SH, Kang H, Byun JH, Kwon E, Seo S, Kim W, Ryu KH, Kwak SK, Hong S, Choi NS. Compositionally Sequenced Interfacial Layers for High-Energy Li-Metal Batteries. Adv Sci (Weinh) 2024:e2310094. [PMID: 38408139 DOI: 10.1002/advs.202310094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Indexed: 02/28/2024]
Abstract
Electrolyte additives with multiple functions enable the interfacial engineering of Li-metal batteries (LMBs). Owing to their unique reduction behavior, additives exhibit a high potential for electrode surface modification that increases the reversibility of Li-metal anodes by enabling the development of a hierarchical solid electrolyte interphase (SEI). This study confirms that an adequately designed SEI facilitates the homogeneous supply of Li+ , nonlocalized Li deposition, and low electrolyte degradation in LMBs while enduring the volume fluctuation of Li-metal anodes on cycling. An in-depth analysis of interfacial engineering mechanisms reveals that multilayered SEI structures comprising mechanically robust LiF-rich species, electron-rich P-O species, and elastic polymeric species enabled the stable charge and discharge of LMBs. The polymeric outer SEI layer in the as-fabricated multilayered SEI could accommodate the volume fluctuation of Li-metal anodes, significantly enhancing the cycling stability Li||LiNi0.8 Co0.1 Mn0.1 O2 full cells with an electrolyte amount of 3.6 g Ah-1 and an areal capacity of 3.2 mAh cm-2 . Therefore, this study confirms the ability of interfacial layers formed by electrolyte additives and fluorinated solvents to advance the performance of LMBs and can open new frontiers in the fabrication of high-performance LMBs through electrolyte-formulation engineering.
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Affiliation(s)
- Jeong-A Lee
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Saehun Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Yoonhan Cho
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seong Hyeon Kweon
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST), 50 UNIST-gil, Ulsan, 44919, Republic of Korea
| | - Haneul Kang
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jeong Hwan Byun
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Eunji Kwon
- CTO Advanced Battery Development, Hyundai motor company, 37 Cheoldobangmulgwan-ro, Uiwang-si, Gyeonggi-do, 16082, Republic of Korea
| | - Samuel Seo
- CTO Advanced Battery Development, Hyundai motor company, 37 Cheoldobangmulgwan-ro, Uiwang-si, Gyeonggi-do, 16082, Republic of Korea
| | - Wonkeun Kim
- CTO Advanced Battery Development, Hyundai motor company, 37 Cheoldobangmulgwan-ro, Uiwang-si, Gyeonggi-do, 16082, Republic of Korea
| | - Kyoung Han Ryu
- CTO Advanced Battery Development, Hyundai motor company, 37 Cheoldobangmulgwan-ro, Uiwang-si, Gyeonggi-do, 16082, Republic of Korea
| | - Sang Kyu Kwak
- Department of Chemical and Biological Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Seungbum Hong
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Nam-Soon Choi
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
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Lee J, Tsutsui M, Mochizuki N, Setogawa Y, Suzuki F, Narita M, Hirofuji A, Kunioka S, Shirasaka T, Ishikawa N, Yuzawa S, Kamiya H. Interventional Bridging Therapy for Radical Cardiac Surgery in a Patient Seemed to be Inoperable Due to Very Poor Left Ventricular Function: A Case Report. Heart Surg Forum 2023; 26:E676-E679. [PMID: 38178356 DOI: 10.59958/hsf.5779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/15/2023] [Indexed: 01/06/2024]
Abstract
Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a patient with complex cardiac disease in an inoperable state who underwent bridging therapy that led to successful surgical treatment. A 73-year-old male who received hemodialysis treatment and had severe aortic valve stenosis and coronary artery disease planned surgical treatment. However, he was deemed inoperable owing to his low cardiac function and hemodynamic instability. Therefore, to escape from a fatal condition, we first performed balloon aortic valvuloplasty and percutaneous coronary intervention as palliative procedures. Subsequently, his cardiac function and hemodynamic stability remarkably improved; therefore, after 1 month, we performed a successful radical surgical treatment. Even in inoperable patients, bridging therapy leading to radical treatment is possible.
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Affiliation(s)
- JeongA Lee
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Nobuhiro Mochizuki
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Yuki Setogawa
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Fumitaka Suzuki
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, 078-8510 Asahikawa, Hokkaido, Japan.
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, 078-8510 Asahikawa, Hokkaido, Japan.
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Park S, Kim S, Lee JA, Ue M, Choi NS. Correction: Liquid electrolyte chemistries for solid electrolyte interphase construction on silicon and lithium-metal anodes. Chem Sci 2023; 14:10610. [PMID: 37799996 PMCID: PMC10548529 DOI: 10.1039/d3sc90171h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
[This corrects the article DOI: 10.1039/D3SC03514J.].
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Affiliation(s)
- Sewon Park
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Saehun Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Jeong-A Lee
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Makoto Ue
- Research Organization for Nano & Life Innovation, Waseda University 513 Waseda-tsurumaki-cho, Shinjuku-ku Tokyo 162-0041 Japan
| | - Nam-Soon Choi
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
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Lee EH, Lee JA, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom JS, Song YG, Park SH, Kim JH. Association of body mass index and bloodstream infections in patients on extracorporeal membrane oxygenation: a single-centre, retrospective, cohort study. J Hosp Infect 2023; 140:117-123. [PMID: 37562593 DOI: 10.1016/j.jhin.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Obesity is associated with poor clinical outcomes in critically ill patients. However, under some clinical conditions, obesity has protective effects. Bloodstream infections (BSI) are among the most common nosocomial infections associated with extracorporeal membrane oxygenation (ECMO). BSI during ECMO is associated with higher mortality rates and poorer clinical outcomes. AIM To analyse whether body mass index (BMI) is associated with BSI during ECMO or with in-hospital mortality. METHODS All adult patients who had received ECMO support for >48 h were included in the analysis. The analysis of total duration of ECMO support, in-hospital mortality and BSI was stratified by BMI category. The Cox proportional hazards model was used to compare the risk of BSI among BMI categories. FINDINGS In total, 473 patients were enrolled in the study. The average age was 56.5 years and 65.3% were men. The total duration of ECMO was approximately 11.8 days, with a mortality rate of 47.1%. The incidence rates of BSI and candidaemia were 20.5% and 5.5%, respectively. The underweight group required ECMO for respiratory support, whereas the overweight and obese groups required ECMO for cardiogenic support (P<0.0001). No significant difference in BSI rate was found (P=0.784). However, after adjusting for clinical factors, patients in Group 4 (BMI 25.0-<30.0 kg/m2) exhibited lower mortality compared with patients in Group 2 (normal BMI) (P=0.004). CONCLUSION BMI was not associated with risk of BSI, but patients with higher BMI showed lower in-hospital mortality associated with ECMO support.
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Affiliation(s)
- E H Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J-S Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Y G Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S H Park
- Chaum Life Centre, CHA University, Seoul, South Korea.
| | - J H Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Park S, Kim S, Lee JA, Ue M, Choi NS. Liquid electrolyte chemistries for solid electrolyte interphase construction on silicon and lithium-metal anodes. Chem Sci 2023; 14:9996-10024. [PMID: 37772127 PMCID: PMC10530773 DOI: 10.1039/d3sc03514j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/14/2023] [Accepted: 08/11/2023] [Indexed: 09/30/2023] Open
Abstract
Next-generation battery development necessitates the coevolution of liquid electrolyte and electrode chemistries, as their erroneous combinations lead to battery failure. In this regard, priority should be given to the alleviation of the volumetric stress experienced by silicon and lithium-metal anodes during cycling and the mitigation of other problems hindering their commercialization. This review summarizes the advances in sacrificial compound-based volumetric stress-adaptable interfacial engineering, which has primarily driven the development of liquid electrolytes for high-performance lithium batteries. Besides, we discuss how the regulation of lithium-ion solvation structures helps expand the range of electrolyte formulations and thus enhance the quality of solid electrolyte interphases (SEIs), improve lithium-ion desolvation kinetics, and realize longer-lasting SEIs on high-capacity anodes. The presented insights are expected to inspire the design and synthesis of next-generation electrolyte materials and accelerate the development of advanced electrode materials for industrial battery applications.
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Affiliation(s)
- Sewon Park
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Saehun Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Jeong-A Lee
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
| | - Makoto Ue
- Research Organization for Nano & Life Innovation, Waseda University 513 Waseda-tsurumaki-cho Shinjuku-ku Tokyo 162-0041 Japan
| | - Nam-Soon Choi
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST) 291 Daehak-ro, Yuseong-gu Daejeon 34141 Republic of Korea
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Lee JA, Kim Y, Lee JY, Park S, Choi JY. Identifying the Unmet Medical Needs of HIV-Positive Subjects in Korea: Results of a Nationwide Online Survey. Infect Chemother 2023; 55:397-402. [PMID: 37794578 PMCID: PMC10551716 DOI: 10.3947/ic.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 10/06/2023] Open
Abstract
An online survey was conducted in Korea to identify the unmet medical needs of people living with human immunodeficiency virus (HIV) (PLWH). Participants (n = 105) were mostly male (93.3%), aged >40 years (75.2%), and treated for ≥6 years post-diagnosis (61.9%). Most PLWH (71.4%) were very satisfied/satisfied with their HIV management. Areas of concern were quality of life (QoL) and mental health. Characteristics of a long-term therapeutic agent were 'low risk of resistance', 'high long-term viral suppression efficacy', and 'high degree of safety'. Pre-consultation QoL and mental health screening would be beneficial for the long-term success of HIV management.
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Affiliation(s)
| | - Yeni Kim
- Gilead Sciences Korea Ltd, Seoul, Korea
| | | | | | - Jun-Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Lee JA, Kim AR, Tak EY, Kim Y, Shin HJ, Mun GW, Kim SJ, Seol HJ. A single-center prospective study regarding time to return to activities of daily living after craniotomy for brain tumors. Acta Neurochir (Wien) 2023; 165:1389-1400. [PMID: 36977865 PMCID: PMC10047470 DOI: 10.1007/s00701-023-05533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND There are few studies on the time to return to activities of daily living (ADL) after craniotomy in patients with brain tumors. This study aimed to investigate the duration before returning to ADLs after craniotomy for brain tumors and present data that can provide information and guidelines on the appropriate time needed. METHODS Patients (n = 183 of 234) who underwent craniotomy for brain tumors between April 2021 and July 2021 capable of self-care upon discharge were enrolled, and data of 158 were collected. The start time of 85 ADL items was prospectively investigated for 4 months postoperatively, using the self-recording sheet. RESULTS Over 89% and 87% of the patients performed basic ADL items within a month and instrumental ADL items within 2 months (medians: within 18 days), except for a few. Regarding work, 50% of the patients returned within 4 months. Washing hair with a wound was performed at 18 days of median value, after 4 months of dyeing/perming hair, 6 days of drinking coffee/tea, after 4 months of air travel, and 40 days of complementary and alternative medicine. In patients with infratentorial tumors or surgical problems, return times were much later for various items. CONCLUSIONS It is possible to provide practical information and guidelines on the duration to return to ADL after craniotomy in brain tumor patients. These study findings also reduce uncertainty about recovery and daily life and help patients return to their daily life at the appropriate time, thereby maintaining function and daily well-being after surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Ae Ran Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Eun-Young Tak
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Yumin Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Hyun-Ju Shin
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Gyeong-Won Mun
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Sook-Jin Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-Gu, Seoul, 06351, Korea.
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Lee EH, Lee SK, Cheon JH, Koh H, Lee JA, Kim CH, Kim JN, Lee KH, Lee SJ, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yong DE, Yoon SS, Yeom JS, Choi JY. Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube. J Hosp Infect 2023; 131:234-243. [PMID: 36414164 DOI: 10.1016/j.jhin.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonizing MDRO. AIM To compare the efficacy of different FMT methods to optimize the success rate of decolonization in patients with MDRO carriage. METHODS This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube. FINDINGS A total of 57 patients underwent FMT for MDRO decolonization. The colonoscopy group required the shortest time for decolonization, whereas the EGD group required the longest (24.9 vs 190.4 days, P = 0.022). The decolonization rate in the oral capsule group was comparable to that in the EGD group (84.6% vs 85.7%, P = 0.730). An important clinical factor associated with decolonization failure was antibiotic use after FMT (odds ratio = 6.810, P = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT. CONCLUSION Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonization.
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Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Cheon
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - H Koh
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - C H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J N Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - D E Yong
- Division of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - S S Yoon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, South Korea
| | - J S Yeom
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Javaheri D, Gorgin S, Lee JA, Masdari M. Fuzzy Logic-Based DDoS Attacks and Network Traffic Anomaly Detection Methods: Classification, Overview, and Future Perspectives. Inf Sci (N Y) 2023. [DOI: 10.1016/j.ins.2023.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lee JA, Kong DS, Lee S, Park SK, Park K. Chronological Patterns of Long-Term Outcomes After Microvascular Decompression for Hemifacial Spasm Over 5 Years. World Neurosurg 2022; 166:e313-e318. [PMID: 35817354 DOI: 10.1016/j.wneu.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The postoperative course of hemifacial spasm (HFS) varies. We analyzed the clinical outcomes from 1 to ≥5 years after microvascular decompression (MVD) in patients with HFS. METHODS Between July 2004 and January 2015, 528 patients who were followed up for ≥5 years after MVD for HFS were included. We evaluated chronological patterns of clinical outcomes from 1 to ≥5 years. The outcomes at 2, 3, 4, and ≥5 years postoperatively were individually compared with those at 1 year postoperatively, and the relationships between clinical features, surgical findings, and outcomes over time were analyzed. RESULTS Eight groups were created according to the similarity in the pattern of clinical outcomes from 1 to ≥5 years postoperatively. Individual postoperative outcomes at 2-4 years were consistent with those at 1 year postoperatively, whereas postoperative outcomes at ≥5 years were not (P = 0.020). There was substantial to moderate agreement between the outcomes at 1 year and at 2-4 years postoperatively, but the agreement decreased over time. Patients without diabetes (P = 0.015), an intraoperative offending vessel without a vein (P = 0.005), and intraoperative discoloration of the facial nerve (P = 0.036) showed better outcomes at ≥5 years postoperatively. CONCLUSIONS Long-term outcomes from 1 to ≥5 years after MVD in patients with HFS were diverse. Nondiabetes, intraoperative offending vessel without a vein, and intraoperative discoloration of the facial nerve were better prognostic factors for outcomes at ≥5 years postoperatively. It is advisable to consider these results when evaluating the long-term outcomes of this surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea.
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Kim M, Park SK, Lee S, Lee JA, Park K. Prevention of Superior Petrosal Vein Injury during Microvascular Decompression for Trigeminal Neuralgia: Operative Nuances. Skull Base Surg 2022; 83:e284-e290. [DOI: 10.1055/s-0041-1725036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Abstract
Background The superior petrosal vein (SPV) often obscures the surgical field or bleeds during microvascular decompression (MVD) for the treatment of trigeminal neuralgia. Although SPV sacrifice has been proposed, it is associated with multiple complications. We have performed more than 4,500 MVDs, including approximately 400 cases involving trigeminal neuralgia. We aimed to describe our operative technique and nuances to avoid SPV injury.
Methods We have provided a detailed description of our institutional protocol, including the anesthesia technique, neurophysiologic monitoring, patient positioning, surgical approach, and SPV management. The surgical outcomes and treatment-related complications were retrospectively analyzed.
Results No SPVs were sacrificed intentionally or accidentally during our MVD protocol for trigeminal neuralgia. In the 344 operations performed during 2006 to 2020, 269 (78.2%) patients did not require medication postoperatively, 58 (16.9%) tolerated the procedure with adequate medication, and 17 (4.9%) did not respond to MVD. Postoperatively, 35 (10.2%), 1 (0.3%), and 0 patients showed permanent trigeminal, facial, or vestibulocochlear nerve dysfunction, respectively. Wound infection occurred in five (1.5%) patients, while cerebrospinal fluid leaks occurred in three (0.9%) patients. Hemorrhagic complications appeared in four (1.2%) patients but these were unrelated to SPV injury. No surgery-related mortalities were reported.
Conclusion MVD for the treatment of trigeminal neuralgia can be achieved safely without sacrificing the SPV. A key step is positioning the patient's vertex at a 10-degree elevation from the floor, which can ease venous return and loosen the SPV, making it less fragile to manipulation and providing a wider surgical corridor.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, The Republic of Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, The Republic of Korea
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12
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Cohilis M, Hong L, Janssens G, Rossomme S, Sterpin E, Lee JA, Souris K. Development and validation of an automatic commissioning tool for the Monte Carlo dose engine in myQA iON. Phys Med 2022; 95:1-8. [PMID: 35051680 DOI: 10.1016/j.ejmp.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 12/14/2022] Open
Abstract
Independent dose verification with Monte Carlo (MC) simulations is an important feature of proton therapy quality assurance (QA). However, clinical integration of such tools often generates an additional and complex workload for medical physicists. The preparation of the necessary clinical inputs, such as the machine beam model, should therefore be automated. In this work, a methodology for automatic MC commissioning has been devised, validated, and developed into a MATLAB tool for the users of myQA iON, the recent QA platform of IBA Dosimetry. With this workflow, all necessary parameters can easily be tuned using dedicated optimization methods. For the geometrical beam parameters (phase space), the assumption of a single or double Gaussian is made. To model the energy spectrum, a Gaussian function is assumed and parameters are optimized using either MC simulations or a library of pre-computed Bragg peaks. For the absolute dose calibration, commissioning fields can be reproduced with the dose engine to retrieve the necessary parameters. We discuss in a first time the tool efficiency and show that one can optimize all parameters in less than 4 min per energy with excellent accuracy. We then validate a beam model obtained with the tool by simulating homogeneous spread-out Bragg peaks (SOBPs) and patient QA plans previously measured in water. An average range agreement of 0.29 ± 0.34 mm is achieved for the SOBPs while 3%/3 mm local gamma passing rates reach 99.3% on average over all 62 measured patient QA planes, which is well within clinical tolerances.
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Affiliation(s)
- M Cohilis
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium
| | - L Hong
- University of Florida Proton Therapy Institute, Jacksonville, FL, USA
| | - G Janssens
- Ion Beam Applications, Louvain-la-Neuve, Belgium
| | - S Rossomme
- Ion Beam Applications, Louvain-la-Neuve, Belgium
| | - E Sterpin
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium; KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - J A Lee
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium
| | - K Souris
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium.
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13
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Lee JA, Kong DS, Kim SJ, Lee S, Park SK, Park K. Factors Influencing Patient Satisfaction after Microvascular Decompression for Hemifacial Spasm: A Focus on Residual Spasms. Stereotact Funct Neurosurg 2021; 100:26-34. [PMID: 34569537 DOI: 10.1159/000517954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with hemifacial spasm (HFS) experience improvement in symptoms after microvascular decompression (MVD); however, patient satisfaction is sometimes low. This study aimed to analyze the relationship between residual spasms and patient satisfaction, identify factors affecting satisfaction, and investigate the degree of improvement in spasms which result in patient satisfaction after surgery. METHODS 297 patients who completed a questionnaire after MVD for HFS between March 2020 and June 2020 were included. Information on surgical outcomes and patient satisfaction was collected using the questionnaire, and their relationships were analyzed. RESULTS Among the 297 patients, the mean residual spasm percentage and patient satisfaction score were negatively correlated with 14.0% and 8.8 points, respectively. In addition to residual spasms, discomfort caused by persistent spasms, psychological problem-solving, better social life, and interpersonal relationship improvement were associated with satisfaction. There was no significant association between the presence of complications and satisfaction. There was no significant difference in the satisfaction score at up to 30% residual spasm, and the patients with 0-30% residual spasm had a satisfaction score of 7 points or higher. CONCLUSION Residual spasms and discomfort from residual spasms decreased patient satisfaction after MVD for HFS. It is then necessary to perform accurate surgical resolution to improve surgical outcomes and provide adequate management to reduce postoperative discomfort and anxiety, and ultimately to enhance satisfaction. Residual spasms of up to 30% compared with the preoperative severity can be considered a good outcome when evaluating surgical outcomes.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jung Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
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Kim M, Park SK, Lee S, Lee JA, Park K. Lateral spread response of different facial muscles during microvascular decompression in hemifacial spasm. Clin Neurophysiol 2021; 132:2503-2509. [PMID: 34454279 DOI: 10.1016/j.clinph.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Interpreting lateral spread response (LSR) during microvascular decompression (MVD) for hemifacial spasm (HFS) is difficult when LSRs observed in different muscles do not match. We aimed to analyze LSR patterns recorded in both the orbicularis oris (oris) and mentalis muscles and their relationships with clinical outcomes. METHODS The data of 1288 HFS patients who underwent MVD between 2015 and 2018 were retrospectively reviewed. LSR was recorded in the oris and mentalis muscles through centrifugal stimulation of the temporal branch of the facial nerve after preoperative mapping. The disappearance of LSR following surgery, clinical outcomes, and the characteristics of LSR in oris were analyzed. RESULTS After surgery, LSR remained in 100 (7.7%) and 279 (21.6%) of the mentalis and oris muscles, respectively. The postoperative outcome correlated with LSR disappearance in the mentalis, not with that in the oris. CONCLUSION LSR patterns differed in each muscle and may not be correlated with clinical outcomes. LSR in the mentalis and oris muscles should be interpreted differently. SIGNIFICANCE We describe a monitoring protocol characterized by preoperative facial nerve mapping, antidromic stimulation, and recording from multiple muscles. We analyze differences in LSRs in the mentalis and oris muscles and suggest technical points for interpretation.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
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15
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Lee JA, Kong DS, Lee S, Park SK, Park K. Association of Thyroid Hypofunction with Clinical Outcomes after Microvascular Decompression for Hemifacial Spasm. Eur Neurol 2021; 84:288-294. [PMID: 34044397 DOI: 10.1159/000516135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data regarding the association between thyroid dysfunction and hemifacial spasm (HFS) are limited. We conducted a single-center, retrospective study to investigate the predictive value of thyroid dysfunction in patients with HFS after microvascular decompression (MVD). METHODS Between July 2004 and January 2015, 156 patients who were tested for thyroid hormones after MVD for HFS were enrolled in the present study. We assessed their detailed history, clinical manifestations, serum thyroid hormone levels, and surgical outcomes. The patients were classified into low and high groups based on thyroid hormone concentrations, and clinical outcomes were evaluated in each group. RESULTS In a total of 156 patients with a median follow-up period of 40.9 months, the improvement rate was 87.8%. The patients were classified into low (76, 48.7%) or high (80, 51.3%) groups based on serum thyroxine (T4) levels. There was a difference between the 2 groups in terms of postoperative outcomes following MVD (p = 0.020). There were no differences in the outcomes according to serum tri-iodothyronine (T3) levels as well as other factors associated with the outcomes. CONCLUSIONS We found that decreased serum T4 levels are associated with poor postoperative outcomes among patients with HFS. Further studies are needed to examine the clinical benefit of thyroid hormone replacement therapy for patients with suboptimal T4 concentrations as well as active thyroid hormone screening for patients with HFS.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
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16
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Steinl GK, Yeh R, McManus CM, Lee JA, Kuo JH. Variations in the Course of the Carotid Arteries in Patients with Retropharyngeal Parathyroid Adenomas. AJNR Am J Neuroradiol 2021; 42:749-752. [PMID: 33602744 DOI: 10.3174/ajnr.a6995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
The carotid arteries, classically described as taking a relatively straight course through the neck, deviate medially in a minority of patients. At the extreme, the internal carotid arteries may "kiss" in the midline, coming extremely close to the pharyngeal wall. In this clinical report, we describe 5 patients with primary hyperparathyroidism, all with ectopic retropharyngeal parathyroid adenomas but all with varying carotid artery anatomy. We describe these variations using a previously developed clinical grading system that highlights 1) the relationship between carotid artery location and risk of injury during pharyngeal procedures and 2) the importance of universal, objective criteria to classify carotid anatomy. Radiologists should be familiar with variations in carotid anatomy and communicate them to the operative team.
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Affiliation(s)
- G K Steinl
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - R Yeh
- Department of Radiology (R.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - C M McManus
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - J A Lee
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - J H Kuo
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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17
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Sterpin E, Rivas ST, Van den Heuvel F, George B, Lee JA, Souris K. Development of robustness evaluation strategies for enabling statistically consistent reporting. Phys Med Biol 2021; 66:045002. [PMID: 33296875 DOI: 10.1088/1361-6560/abd22f] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Robustness evaluation of proton therapy treatment plans is essential for ensuring safe treatment delivery. However, available evaluation procedures feature a limited exploration of the actual robustness of the plan and generally do not provide confidence levels. This study compared established and more sophisticated robustness evaluation procedures, with quantified confidence levels. We have evaluated several robustness evaluation methods for 5 bilateral head-and-neck patients optimized considering spot scanning delivery and with a conventional CTV-to-PTV margin of 4 mm. Method (1) good practice scenario selection (GPSS) (e.g. +/- 4 mm setup error 3% range uncertainty); (2) statistically sound scenario selection (SSSS) either only on or both on and inside isoprobability hypersurface encompassing 90% of the possible errors; (3) statistically sound dosimetric selection (SSDS). In the last method, the 90% best plans were selected according to either target coverage quantified by D 95 (SSDS_D 95) or to an approximation of the final objective function (OF) used during treatment optimization (SSDS_OF). For all methods, we have considered systematic setup and systematic range errors. A mix of systematic and random setup errors were also simulated for SSDS, but keeping the same conventional margin of 4 mm. All robustness evaluations have been performed using the fast Monte Carlo dose engine MCsquare. Both SSSS strategies yielded on average very similar results. SSSS and GPSS yield comparable values for target coverage (within 0.5 Gy). The most noticeable differences were found for the CTV between GPSS, on the one hand, and SSDS_D 95 and SSDS_OF, on the other hand (average worst-case D 98 were 2.8 and 2.0 Gy larger than for GPSS, respectively). Simulating explicitly random errors in SSDS improved almost all DVH metrics. We have observed that the width of DVH-bands and the confidence levels depend on the method chosen to sample the scenarios. Statistically sound estimation of the robustness of the plan in the dosimetric space may provide an improved insight on the actual robustness of the plan for a given confidence level.
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Affiliation(s)
- E Sterpin
- KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - Sara T Rivas
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - F Van den Heuvel
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
- Dept of Haematology/Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - B George
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - J A Lee
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - K Souris
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
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18
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Sanaullah, Baig H, Madsen J, Lee JA. A Parallel Approach to Perform Threshold Value and Propagation Delay Analyses of Genetic Logic Circuit Models. ACS Synth Biol 2020; 9:3422-3428. [PMID: 33225698 DOI: 10.1021/acssynbio.0c00379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Experiments with synthetic genetic logic circuits can be time-consuming and expensive. Accordingly, advances in the field of computer-aided design and simulation of genetic circuits have reduced the cost and time required for experimentation. D-VASim is the first genetic circuit simulation tool that allows users to interact with the model during run-time. In contrast to electronic circuits, genetic circuits have different threshold values for different circuits, which need to be estimated prior to simulation. D-VASim allows the user to perform threshold concentration and propagation delay analysis before simulating the circuit. The algorithm currently used in D-VASim has considerable scope for improvements. Thus, we propose a parallel implementation of the algorithm, significantly faster by up to 16 times. In adddition, we improve the algorithm for consistent runtimes across multiple simulation runs under the same parameter settings, reducing the worst-case standard deviation in runtime from 6.637 to 1.841. Our algorithm also estimates the threshold value more accurately, as evident from experimentation for long runtimes. With these modifications, the utility of D-VASim as a virtual laboratory environment has been significantly enhanced.
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Affiliation(s)
- Sanaullah
- Computer Engineering Department, Chosun University, Gwangju 61452, South Korea
| | - Hasan Baig
- Center for Quantitative Medicine, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-6033, United States
| | - Jan Madsen
- Applied Mathematics and Computer Science Department, Technical University of Denmark, Kongens Lyngby 2800, Denmark
| | - Jeong-A Lee
- Computer Engineering Department, Chosun University, Gwangju 61452, South Korea
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19
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Park SK, Joo BE, Kwon J, Kim M, Lee S, Lee JA, Park K. A prewarning sign for hearing loss by brainstem auditory evoked potentials during microvascular decompression surgery for hemifacial spasm. Clin Neurophysiol 2020; 132:358-364. [PMID: 33450558 DOI: 10.1016/j.clinph.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to define the prewarning sign of brainstem auditory evoked potentials (BAEPs) associated with cerebellar retraction (CR) during microvascular decompression surgery for hemifacial spasm. METHODS A total of 241 patients with a latency prolongation of 1 ms or an amplitude decrement of 50% of wave V were analyzed. According to BAEPs before significant changes during CR, patients were classified into Groups A (latency prolongation of wave I [≥0.5 ms] without prolongation of the I-III interpeak interval [<0.5 ms]) and B (no latency prolongation of wave I [<0.5 ms] with prolongation of the I-III interpeak interval [≥0.5 ms]). BAEPs and postoperative hearing loss (HL) were compared between the two groups. RESULTS Group B comprised 160 (66.4%) patients. With maximal changes in wave V, latency prolongation (≥1 ms) with amplitude decrement (≥50%) was more common in Group B (p < 0.018). At the end of the operation, wave V loss was observed in 11 patients, including 10 patients from Group B. Five patients developed postoperative HL; all were from Group B. CONCLUSIONS Latency prolongation of wave III during CR was associated with serious BAEPs changes and postoperative HL. SIGNIFICANCE Latency prolongation of wave III is a significant prewarning sign.
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Affiliation(s)
- Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - John Kwon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Minsoo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Jeong-A Lee
- Department of Nursing, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
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20
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Adeluyi O, Risco-Castillo MA, Liz Crespo M, Cicuttin A, Lee JA. A Computerized Bioinspired Methodology for Lightweight and Reliable Neural Telemetry. Sensors (Basel) 2020; 20:s20226461. [PMID: 33198191 PMCID: PMC7696551 DOI: 10.3390/s20226461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
Personalized health monitoring of neural signals usually results in a very large dataset, the processing and transmission of which require considerable energy, storage, and processing time. We present bioinspired electroceptive compressive sensing (BeCoS) as an approach for minimizing these penalties. It is a lightweight and reliable approach for the compression and transmission of neural signals inspired by active electroceptive sensing used by weakly electric fish. It uses a signature signal and a sensed pseudo-sparse differential signal to transmit and reconstruct the signals remotely. We have used EEG datasets to compare BeCoS with the block sparse Bayesian learning-bound optimization (BSBL-BO) technique-A popular compressive sensing technique used for low-energy wireless telemonitoring of EEG signals. We achieved average coherence, latency, compression ratio, and estimated per-epoch power values that were 35.38%, 62.85%, 53.26%, and 13 mW better than BSBL-BO, respectively, while structural similarity was only 6.295% worse. However, the original and reconstructed signals remain visually similar. BeCoS senses the signals as a derivative of a predefined signature signal resulting in a pseudo-sparse signal that significantly improves the efficiency of the monitoring process. The results show that BeCoS is a promising approach for the health monitoring of neural signals.
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Affiliation(s)
- Olufemi Adeluyi
- Ministry of Communications and Digital Economy, Federal Secretariat, Abuja 900001, Nigeria;
| | - Miguel A. Risco-Castillo
- Engineering Physics, Department of Science, National University of Engineering, Av. Tupac Amaru 210, Cercado de Lima 15333, Peru;
| | - María Liz Crespo
- Multidisciplinary Lab, International Centre for Theoretical Physics, Via Beirut 31, 34100 Trieste, Italy; (M.L.C.); (A.C.)
| | - Andres Cicuttin
- Multidisciplinary Lab, International Centre for Theoretical Physics, Via Beirut 31, 34100 Trieste, Italy; (M.L.C.); (A.C.)
| | - Jeong-A Lee
- Department of Computer Engineering, Chosun University, 309 Pilmun-Daero, Dong-Gu, Gwangju 61452, Korea
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21
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Kim M, Park SK, Lee S, Lee JA, Park K. Letter: The Utility of Intraoperative Lateral Spread Recording in Microvascular Decompression for Hemifacial Spasm: A Systematic Review and Meta-Analysis. Neurosurgery 2020; 87:E596-E597. [PMID: 32761204 DOI: 10.1093/neuros/nyaa339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
- Department of Medicine Graduate School Yonsei University College of Medicine Seoul, Korea
| | - Sang-Ku Park
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Jeong-A Lee
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
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22
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Usman M, Khan S, Lee JA. AFP-LSE: Antifreeze Proteins Prediction Using Latent Space Encoding of Composition of k-Spaced Amino Acid Pairs. Sci Rep 2020; 10:7197. [PMID: 32345989 PMCID: PMC7188683 DOI: 10.1038/s41598-020-63259-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/08/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Species living in extremely cold environments resist the freezing conditions through antifreeze proteins (AFPs). Apart from being essential proteins for various organisms living in sub-zero temperatures, AFPs have numerous applications in different industries. They possess very small resemblance to each other and cannot be easily identified using simple search algorithms such as BLAST and PSI-BLAST. Diverse AFPs found in fishes (Type I, II, III, IV and antifreeze glycoproteins (AFGPs)), are sub-types and show low sequence and structural similarity, making their accurate prediction challenging. Although several machine-learning methods have been proposed for the classification of AFPs, prediction methods that have greater reliability are required. In this paper, we propose a novel machine-learning-based approach for the prediction of AFP sequences using latent space learning through a deep auto-encoder method. For latent space pruning, we use the output of the auto-encoder with a deep neural network classifier to learn the non-linear mapping of the protein sequence descriptor and class label. The proposed method outperformed the existing methods, yielding excellent results in comparison. A comprehensive ablation study is performed, and the proposed method is evaluated in terms of widely used performance measures. In particular, the proposed method demonstrated a high Matthews correlation coefficient of 0.52, F-score of 0.49, and Youden’s index of 0.81 on an independent test dataset, thereby outperforming the existing methods for AFP prediction.
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Affiliation(s)
- Muhammad Usman
- Department of Computer Engineering, Chosun University, Gwangju, 61452, Republic of Korea
| | - Shujaat Khan
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jeong-A Lee
- Department of Computer Engineering, Chosun University, Gwangju, 61452, Republic of Korea.
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Liu M, Sum M, Cong E, Colon I, Bucovsky M, Williams J, Kepley A, Kuo J, Lee JA, Lazar RM, Marshall R, Silverberg S, Walker MD. Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy. J Endocrinol Invest 2020; 43:369-379. [PMID: 31621051 PMCID: PMC7275118 DOI: 10.1007/s40618-019-01128-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/09/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE There are cognitive changes in primary hyperparathyroidism (PHPT) that improve with parathyroidectomy, but the mechanism of cognitive dysfunction has not been delineated. We assessed if cerebrovascular function is impaired in PHPT, improves post-parathyroidectomy and is associated with PTH level and cognitive dysfunction. METHODS This is an observational study of 43 patients with mild hypercalcemic or normocalcemic PHPT or goiter. At baseline, cerebrovascular function (dynamic cerebral autoregulation and vasomotor reactivity) by transcranial Doppler and neuropsychological function were compared between all three groups. A subset underwent parathyroidectomy or thyroidectomy, and was compared 6 months post-operatively. RESULTS Mean cerebrovascular and neuropsychological function was normal and no worse in PHPT compared to controls preoperatively. Higher PTH was associated with worse intracerebral autoregulation (r = - 0.43, p = 0.02) and worse cognitive performance on some tests. Post-parathyroidectomy, mood improved significantly, but changes did not differ compared to those having thyroidectomy (p = 0.84). There was no consistent improvement in cognition or change in vascular function in either surgical group. CONCLUSIONS Although higher PTH was associated with worse intracerebral autoregulation, cerebrovascular function, cognition and mood were normal in mild PHPT. PTX did not improve vascular or cognitive function. The observed improvement in mood cannot be clearly attributed to PTX. Notwithstanding the small sample size, the results do not support changing current criteria for parathyroidectomy to include cognitive complaints. However, the associations between PTH, cognition and cerebral autoregulation merit future studies in those with more severe hyperparathyroidism.
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Affiliation(s)
- M Liu
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Sum
- Division of Endocrinology, Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA
| | - E Cong
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - I Colon
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J Williams
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - A Kepley
- Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - J Kuo
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - R M Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - R Marshall
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - S Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M D Walker
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
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Park JS, Lee S, Park SK, Lee JA, Park K. Facial motor evoked potential with paired transcranial magnetic stimulation: prognostic value following microvascular decompression for hemifacial spasm. J Neurosurg 2019; 131:1780-1787. [DOI: 10.3171/2018.8.jns18708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEMicrovascular decompression (MVD) is widely considered the treatment of choice for hemifacial spasm (HFS), but not all patients immediately benefit from it. Numerous electrophysiological tests have been employed to monitor the integrity of the facial nerve prior to, during, and after MVD treatment. The authors sought to verify if facial motor evoked potential (FMEP) with paired transcranial magnetic stimulation (pTMS) can be utilized as a tool to predict prognosis following MVD for HFS.METHODSFMEP using pTMS was performed preoperatively and postoperatively for 527 HFS patients who underwent an MVD treatment. Various interstimuli intervals (ISIs), which included 2, 10, 20, 25, 30, 75, and 100 msec, were applied for each paired stimulation and pTMS(%) was obtained. A graph of pTMS(%) versus each ISI was drawn for every patient and its pattern was analyzed in accordance with patients’ clinical outcomes.RESULTSWith ISIs of 75 and 100 msec, pTMS(%) was physiologically further inhibited, whereas it was relatively facilitated under ISIs of 20, 25, and 30 msec; loss of this specific pattern, that is, further inhibition-relative facilitation, indicated impaired integrity of the facial nerve. Those patients who immediately benefited from an MVD and experienced no relapse tended to show proper restoration of this further inhibition-relative facilitation pattern (p = 0.01). Greater resemblance between the physiological pattern of pTMS(%) and postoperative pTMS(%) was correlated to better outcome (p = 0.019).CONCLUSIONSA simple linear graph of pTMS(%) versus each ISI may be a helpful tool to predict prognosis for HFS following an MVD.
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Affiliation(s)
- Jae Sung Park
- Departments of 1Neurosurgery and
- 3Department of Neurosurgery, Konkuk University School of Medicine, Chungju, South Korea
| | | | - Sang-Ku Park
- 2Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
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Lee JA, Kong DS, Lee S, Park SK, Park K. Clinical Outcome After Microvascular Decompression According to the Progression Rates of Hemifacial Spasm. World Neurosurg 2019; 134:e985-e990. [PMID: 31734426 DOI: 10.1016/j.wneu.2019.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The progression rate for clinical manifestations in hemifacial spasm (HFS) varies; however, little is known about the factors contributing to this. The purpose of this study was to identify independent factors affecting the rate of symptom progression and to evaluate clinical outcomes according to progression rates. METHODS The study enrolled 1335 patients who underwent microvascular decompression for HFS between July 2004 and January 2015. We assessed detailed history, clinical manifestations, and outcomes. Based on the duration and severity of symptoms, patients were classified into rapidly progressive and slowly progressive groups. We identified predisposing factors affecting the differences between the 2 groups and evaluated the clinical outcome in each group. RESULTS Of 1335 patients with HFS, 825 (61.8%) were classified as rapidly progressive, and 510 (38.2%) were classified as slowly progressive. In univariable and multivariable analyses, younger age at surgery, older age at symptom onset, and absence of intraoperative facial nerve indentation were significant predisposing factors for rapid progression. The rapidly progressive group had worse outcomes than the slowly progressive group following microvascular decompression. CONCLUSIONS In this study, patients with rapidly progressive HFS had worse clinical outcomes. Therefore, patients with rapidly progressive symptoms should be warned in advance that the prognosis may be worse after microvascular decompression. This study is also useful to understand the differences in symptom progression rates in HFS in order to inform patients about symptom progression.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee S, Park SK, Lee JA, Joo BE, Park K. Corrigendum to 'Missed Culprits in Failed Microvascular Decompression Surgery for Hemifacial Spasm and Clinical Outcomes of Redo Surgery' [World Neurosurgery 129 (2019) e627-e633]. World Neurosurg 2019; 133:483. [PMID: 31680047 DOI: 10.1016/j.wneu.2019.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Gyeonggi-do, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee JA, Park K. Short-term versus long-term outcomes of microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2019; 161:2027-2033. [PMID: 31392569 DOI: 10.1007/s00701-019-04032-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) is a useful treatment for hemifacial spasm (HFS), but the postoperative course is extremely diverse. The purpose of this study was to compare short- and long-term outcomes, find the earliest optimal time for determining the long-term outcomes, and investigate the prognostic factors involved in the outcomes over time. METHODS From July 2004 to January 2015, 1341 patients who underwent MVD for HFS were enrolled. Information on clinical features, operative findings, and surgical outcomes over time were collected by performing a review of electronic medical records, and their relationships were analyzed. The outcomes of MVD at 1, 3, 6, and 9 months were individually compared against those at > 12 months after surgery. RESULTS The mean follow-up period after surgery was 44.9 months (median, 36.8 months; range, 12.0-156.6 months). The overall improvement rate for the 1341 patients was 89.0%. Individual postoperative outcomes at 6 and 9 months showed no differences with those at > 12 months after surgery. Furthermore, in the uni- and multi-variable analyses, patients in whom the offending vessels were intraoperatively determined to be veins showed bad outcomes at 6, 9, and > 12 months (p = 0.048, p = 0.004, and p = 0.003, respectively). Patients with intraoperative indentation on the facial nerve showed good outcomes at 6, 9, and > 12 months (p = 0.005, p = 0.039, and p = 0.020, respectively). Patients with delayed facial palsy after surgery showed better outcomes at 6, 9, and > 12 months (p = 0.002, p = 0.003, and p = 0.028, respectively). CONCLUSIONS Short- and long-term outcomes of MVD in patients with HFS manifested differently, but the outcomes at 6 and 9 months showed similarities with those at > 12 months. In patients in whom the intraoperatively detected offending vessel was not a vein, and in patients with intraoperative indentation on the facial nerve and postoperative delayed facial palsy, good outcomes could be predicted after 6 months of surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea.
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Pemberton CJ, Lee JA, Aldous S, Skelton L, Frampton CM, Than M, Troughton RW, Adamson P, Richards AM. P1756The protein APRIL predicts adverse outcomes in DAPT patients better than NT-proBNP and troponin. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Dual antiplatelet therapy (DAPT) is a mainstay of post-ACS treatment. However, prediction of adverse events in these patients needs improving. We show here that the TNFα-related protein APRIL (which is produced in platelets and atherosclerotic plaque) is a superior predictor of MACE and new MI in DAPT recipients post-ACS.
Methods
We prospectively recruited 518 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated to have ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for APRIL measurements using a two site ELISA. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP were also measured. Statistical assessments were made using SPSS v23 (IBM). Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative diagnostic abilities of APRIL, hsTnT, NT-proBNP and hsTnI were assessed using receiver operator curve (ROC) area under the curve (AUC) analysis. The comparative power of each biomarker (log values) to predict new MACE, MI, bleeding and mortality in 1) the whole group and in 2) DAPT recipients alone, within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT, with APRIL and NT-proBNP each included in additional multivariate analyses.
Results
Of the 518 recruited patients (median age 63 (IQR: 54–73, 35% female), 152 were adjudicated to have ACS (29%, 115 MI, 37 UAP). Presentation APRIL levels were higher in those with a cardiac versus non-cardiac cause for presentation (3.0, (2.0–4.7) vs. 2.4, (1.6–3.8) ng/mL, P=0.001) and positively correlated with hsTnT and NT-proBNP (all P<0.001), but it did not add to the hsTnI (ROC = 0.96) or hsTnT (ROC =0.92) assisted diagnosis of ACS. In all 518 patients, in the multivariate regression model, APRIL was a significant independent predictor of mortality (n=54, P=0.032), new MI (n=43, P=0.006), new ADHF (n=24, P=0.016) and MACE (n=71, P=0.005) that was additive to NT-proBNP and troponin. In DAPT recipients alone (n=156), APRIL was the only biomarker to independently predict new MI (n=27, 95% CI: 1.125–3.982, P=0.020) and MACE (n=37, 95% CI: 1.058–3.389, P=0.031). None of the markers, only age, predicted bleeding episodes.
Conclusion
APRIL is an platelet/plaque derived marker that provides independent risk assessment in ACS patients. In DAPT recipients, the ability of APRIL to predict new MI and MACE is superior to that of cardiac troponins and NT-proBNP and could be used to identify high risk individuals.
Acknowledgement/Funding
Health Research Council of New Zealand; Heart Foundation of New Zealand
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Affiliation(s)
- C J Pemberton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J A Lee
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - L Skelton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - C M Frampton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - R W Troughton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - P Adamson
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - A M Richards
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
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Pemberton CJ, Lee JA, Aldous S, Appleby S, Chew-Harris J, Than M, Troughton RW, Richards AM. P3408The signal peptide of CNP is a novel predictor of MI, MACE and bleeding risk in chest pain patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
CNP is an important vascular and cardiac derived member of the natriuretic peptide family. We have previously provided the first reports that the signal peptide of CNP (CNPsp) is present in the human circulation and is elevated in those with chest pain suspicious of ACS. Here, show that CNPsp levels are highly predictive of new MI, MACE and post-index bleeding in patients presenting with potential ACS.
Methods
We prospectively recruited 493 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated as ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for CNPsp measurements using our validated, specific assay. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP (both Roche Cobas e411) were also measured. Statistical assessments were made using SPSS v23. Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative abilities of CNPsp, hsTnT, NT-proBNP and hsTnI (log values) to predict new MACE, MI, bleeding and mortality within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT and NT-proBNP, with CNPsp added to into the multivariate analyses.
Results
Of the 493 recruited patients (median age 63 (IQR: 54–73, 35% female), 148 were adjudicated to have ACS (30%, 109 MI, 39 UAP). Presentation CNPsp levels were not higher in those with adjudicated ACS versus non-ACS (51, (45–65) vs. 50, (42–63) pmol/L, P=0.412), did not correlate with hsTnI, hsTnT or NT-proBNP, but were significantly lower in those with a history of MI (49, (42–59) vs. 51, (43–64) pmol/L, P=0.044). In contrast, they were significantly higher in those with ECG ST-depression (56, (47–85) vs. 50 (42–62) pmol/L, P=0.038). In the multivariate regression model of all 493 patients, lower values of CNPsp were a significant multivariate predictor of new MI (n=37, 95% CI: 0.06–0.89, P=0.038), MACE (n=64, 95% CI: 0.08–0.81, P=0.020) and new bleeding (n=40, 95% CI: 0.05–0.63, P=0.005) within 2 years of presentation. This predictive ability was additive and independent from NT-proBNP and troponin.
Conclusion
This is the first report that CNPsp measurement provides meaningful and independent risk assessment of important outcomes in ACS patients. In particular, the fact that lower levels of CNPsp are predictive of negative MI, MACE and bleeding outcomes suggests that CNPsp may have an unappreciated protective role in the cardiovascular system.
Acknowledgement/Funding
Health Research Council of New Zealand; Heart Foundation of New Zealand
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Affiliation(s)
- C J Pemberton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J A Lee
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - S Appleby
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J Chew-Harris
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - R W Troughton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - A M Richards
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
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Lee MH, Lee JA, Park K. Different Roles of Microvascular Decompression in Hemifacial Spasm and Trigeminal Neuralgia. Skull Base Surg 2019; 80:511-517. [PMID: 31534894 DOI: 10.1055/s-0038-1676377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Objectives Microvascular decompression (MVD) involves the same procedure for both hemifacial spasm (HFS) and trigeminal neuralgia (TN), the resulting clinical courses are different. The aim of this study was to compare differences in MVD operations for HFS and TN and to determine the consequences of these differences on the clinical courses of the two diseases. Methods The medical records of patients who underwent an MVD operation between January 1998 and March 2013 were reviewed. Results A total of 2,263 patients were enrolled, 222 had TN and 2,040 had HFS. In the HFS group, the estimated cure rates at postoperative years 1, 2, and 3 were 92.0, 93.4, and 93.6%. In the TN group, the estimated cure rates at postoperative years 1, 2, and 3 were 88.4, 89.4, and 91.4%. Comparison of the initial treatment response between the HFS and TN groups did not reveal any statistically significant difference ( p = 0.338). Among the 1,749 HFS patients initially cured by MVD, 57 were worsened. Among the 181 TN patients treated by MVD, 43 were worsened, with ≥ BNI III (Barrow Neurological Institute pain intensity score III) 12 worsened to a BNI score of IV. Comparing the recurrence rate between the HFS and TN groups, there was a statistically significant difference for cases with ≥ BNI III ( p < 0.001), but not in cases with ≥ BNI IV ( p = 0.498). Conclusion MVD is a promising treatment for HFS. In contrast, MVD-treated TN had a risk of recurrence. The MVD operation should be carefully considered when applied as a treatment for TN patients.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
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Abba S, Wadumi Namkusong J, Lee JA, Liz Crespo M. Design and Performance Evaluation of a Low-Cost Autonomous Sensor Interface for a Smart IoT-Based Irrigation Monitoring and Control System. Sensors (Basel) 2019; 19:E3643. [PMID: 31438597 PMCID: PMC6749291 DOI: 10.3390/s19173643] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022]
Abstract
Irrigation systems are becoming increasingly important, owing to the increase in human population, global warming, and food demand. This study aims to design a low-cost autonomous sensor interface to automate the monitoring and control of irrigation systems in remote locations, and to optimize water use for irrigation farming. An internet of things-based irrigation monitoring and control system, employing sensors and actuators, is designed to facilitate the autonomous supply of adequate water from a reservoir to domestic crops in a smart irrigation systems. System development lifecycle and waterfall model design methodologies have been employed in the development paradigm. The Proteus 8.5 design suite, Arduino integrated design environment, and embedded C programming language are commonly used to develop and implement a real working prototype. A pumping mechanism has been used to supply the water required by the soil. The prototype provides power supply, sensing, monitoring and control, and internet connectivity capabilities. Experimental and simulation results demonstrate the flexibility and practical applicability of the proposed system, and are of paramount importance, not only to farmers, but also for the expansion of economic activity. Furthermore, this system reduces the high level of supervision required to supply irrigation water, enabling remote monitoring and control.
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Affiliation(s)
- Sani Abba
- Department of Mathematical Sciences (Computer Science), Faculty of Science, Yelwa Campus, Abubakar Tafawa Balewa University (Federal University of Technology), Dass Road, P.M.B. 0248, Bauchi, Nigeria.
| | - Jonah Wadumi Namkusong
- Department of Mathematical Sciences (Computer Science), Faculty of Science, Yelwa Campus, Abubakar Tafawa Balewa University (Federal University of Technology), Dass Road, P.M.B. 0248, Bauchi, Nigeria
| | - Jeong-A Lee
- Computer Systems Laboratory, Department of Computer Engineering, Chosun University, Dongku SeoSukDong 375, Gwangju 501-759, Korea.
| | - Maria Liz Crespo
- Multi-disciplinary Laboratory (MLab), Abdussalam International Centre for Theoretical Physics (ICTP), Via Beirut 31, 34014 Trieste, Italy
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Lee S, Park SK, Joo BE, Lee JA, Park K. Vascular Complications in Microvascular Decompression: A Survey of 4000 Operations. World Neurosurg 2019; 130:e577-e582. [PMID: 31254687 DOI: 10.1016/j.wneu.2019.06.155] [Citation(s) in RCA: 3] [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: 03/25/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vascular complications in posterior fossa surgery, even in microvascular decompression (MVD) involving a small cranial opening, can have catastrophic consequences. We analyzed these complications to determine the incidence, risk factors, prognosis, and preventive measures involved. METHODS Between April 1997 and March 2018, 4000 consecutive patients with neurovascular compression syndrome were admitted and underwent MVD. We reviewed the medical records of patients who developed vascular complications after MVD, focusing on their past medical history, perioperative laboratory findings and images, surgical findings, and postoperative progress. RESULTS Vascular complications developed in 28 patients (0.7%), including 24 with hemifacial spasm and 4 with trigeminal neuralgia. Twenty-two hemorrhagic (78.6%) and 6 ischemic (21.4%) complications occurred, with epidural hematoma the most frequent type identified. Ten patients (35.7%) patients were asymptomatic and 18 (64.3%) were symptomatic. Six patients (21.4%) underwent revision surgery, such as hematoma removal, craniectomy, or extraventricular drainage insertion. At the last follow-up, dizziness was the most commonly reported sequela from vascular complications. No deaths had occurred. CONCLUSIONS Vascular complications are rare, but can be the most devastating adverse outcome of MVD surgery. Unusual signs and symptoms after MVD should prompt special attention to early management and patient safety.
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Affiliation(s)
- Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Goyang, Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee JA, Kim GW, Kim HY, Choe J. Influences of Red Pepper Seed Powder on the Physicochemical Properties of a Meat Emulsion Model System. Food Sci Anim Resour 2019; 39:286-295. [PMID: 31149670 PMCID: PMC6533404 DOI: 10.5851/kosfa.2019.e23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/26/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022] Open
Abstract
Red pepper seed (RPS) is commonly removed during the production of red pepper
powder, which is contains large amounts of dietary fibers and is abundant in
nutrients, readily available. In this study, we determined the effects of adding
RPS powder on the physicochemical properties of emulsified meat products. Meat
emulsion samples were prepared with pork hind leg meat (60%) and back fat
(20%), iced water (20%), various additives, and RPS powder at
different concentrations [0% (control), 1%, 2%, 3%,
and 4%]. For the physicochemical properties, moisture and fat content, pH
value, color, emulsion stability, cooking yield, appearance viscosity, and
textural properties were examined. Addition of RPS induced significantly higher
values in moisture content, pH, cooking yield, and a* values of the meat
emulsion samples, regardless of the amount added. However, lower values were
obtained for emulsion stability, cooking yield, and viscosity in samples with
RPS powder at 3% or 4% among all groups. In general, addition of
RPS powder at 1% and 2% led to the greatest values in viscosity of
the meat emulsion samples. Higher values (p<0.05) in hardness and
springiness were observed in samples with RPS powder at 4% and 3%,
respectively. For gumminess, chewiness, and cohesiveness, the addition of RPS
powder at 1%, 2%, and 3% induced the highest values
(p<0.05) in the meat emulsion samples. These results showed that addition
of RPS powder at optimum levels (2%) could be utilized to improve quality
properties of emulsified meat products as a non-meat ingredient.
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Affiliation(s)
- Jeong-A Lee
- Department of Animal Resources Science, Kongju National University, Yesan 32439, Korea
| | - Gye-Woong Kim
- Department of Animal Resources Science, Kongju National University, Yesan 32439, Korea
| | - Hack-Youn Kim
- Department of Animal Resources Science, Kongju National University, Yesan 32439, Korea
| | - Juhui Choe
- Department of Animal Resources Science, Kongju National University, Yesan 32439, Korea
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Lee MH, Lee S, Park SK, Lee JA, Park K. Delayed hearing loss after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2019; 161:503-508. [PMID: 30569226 DOI: 10.1007/s00701-018-3774-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to analyze cases of delayed hearing loss after microvascular decompression (MVD) for hemifacial spasm and identify the characteristic features of these patients. METHODS We retrospectively reviewed the medical records of 3462 patients who underwent MVD for hemifacial spasm between January 1998 and August 2017. RESULTS Among these, there were 5 cases in which hearing was normal immediately postoperatively but delayed hearing loss occurred. None of the 5 patients reported any hearing disturbance immediately after the operation. However, they developed hearing problems suddenly after some time (median, 22 days; range 10-45 days). On examination, sensorineural hearing loss was confirmed. High-dose corticosteroid treatment was prescribed. Preoperative hearing levels were restored after several months (median duration from the time of the operation, 45 days; range 22-118 days). Interestingly, the inter-peak latency of waves I-III in the brainstem auditory evoked potential (BAEP) was prolonged during the surgery, but recovered within a short time. CONCLUSION Delayed hearing loss may occur after MVD for HFS. Prolongation of the inter-peak latency of waves I-III seems to be associated with the occurrence of delayed hearing loss. It is possible that BAEP changes may predict delayed hearing loss, but confirmatory evidence is not available as yet. Analysis of more cases is necessary to determine the utility of BAEP monitoring to predict delayed hearing loss after MVD and to identify its exact cause.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Pemberton CJ, Lee JA, Jardine R, Skelton L, Frampton CM, Troughton RW, Richards AM. P2791The TNF receptor TACI is a novel inflammatory predictor of heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C J Pemberton
- University of Otago Christchurch, Christchurch, New Zealand
| | - J A Lee
- University of Otago Christchurch, Christchurch, New Zealand
| | - R Jardine
- University of Otago Christchurch, Christchurch, New Zealand
| | - L Skelton
- University of Otago Christchurch, Christchurch, New Zealand
| | - C M Frampton
- University of Otago Christchurch, Christchurch, New Zealand
| | - R W Troughton
- University of Otago Christchurch, Christchurch, New Zealand
| | - A M Richards
- University of Otago Christchurch, Christchurch, New Zealand
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Lee S, Park SK, Lee JA, Joo BE, Kong DS, Seo DW, Park K. A new method for monitoring abnormal muscle response in hemifacial spasm: A prospective study. Clin Neurophysiol 2018; 129:1490-1495. [DOI: 10.1016/j.clinph.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/07/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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Lee S, Park SK, Joo BE, Lee JA, Kong DS, Park K. A surgical strategy to prevent delayed epidural hematoma after posterior fossa surgery using lateral suboccipital retrosigmoid approach. J Clin Neurosci 2018; 52:156-158. [PMID: 29602606 DOI: 10.1016/j.jocn.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
Although non-traumatic postoperative delayed epidural hematoma (EDH) after posterior fossa surgery is rare, measures to prevent it need to be pursued due to its catastrophic results. In this report, we describe a surgical strategy to prevent delayed EDH after posterior fossa surgery. Key dural tacking sutures were performed at the medial and cephalic margin of the dura. We have performed key dural tacking sutures on 454 patients with neurovascular compression syndrome during microvascular decompression surgeries since April 2016, and no hemorrhagic complication, including delayed EDH, occurred. We discovered that key dural tacking sutures can be helpful in preventing postoperative posterior fossa delayed EDH.
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Affiliation(s)
- Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Gyeonggi-do, Republic of Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Chang SH, Freeman NLB, Lee JA, Stoll CRT, Calhoun AJ, Eagon JC, Colditz GA. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev 2018; 19:529-537. [PMID: 29266740 PMCID: PMC5880318 DOI: 10.1111/obr.12647] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/05/2017] [Accepted: 10/23/2017] [Indexed: 01/06/2023]
Abstract
The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m-2 . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
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Affiliation(s)
- S-H Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - N L B Freeman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Center for Advanced Methods Development, RTI International, NC, USA
| | - J A Lee
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, AR, USA
| | - C R T Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - A J Calhoun
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - J C Eagon
- Minimally Invasive and Bariatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - G A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Lee S, Park SK, Joo BE, Lee JA, Kong DS, Park K. The pathogenesis of delayed epidural hematoma after posterior fossa surgery. J Clin Neurosci 2017; 47:223-227. [PMID: 29037935 DOI: 10.1016/j.jocn.2017.10.006] [Citation(s) in RCA: 4] [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: 09/08/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to analyze the pathogenesis of delayed epidural hematoma (EDH) after posterior fossa surgery. Non-traumatic, non-arterial origin delayed EDH after posterior fossa surgery is extremely rare. Moreover, the pathogenesis of its supratentorial extension is obscure. Between April 1997 and June 2016, over 3300 patients underwent microvascular decompression (MVD) for neurovascular compression syndrome. The medical chart of four patients with delayed EDH were retrospectively reviewed. The median time from MVD to re-CT scan was 58 h (range, 33-100). All patients underwent hematoma evacuations. Intraoperative findings during hematoma evacuation revealed only an oozing hemorrhage from the transverse sinus with no definitive bleeding focus. The patients spent a median of 21.5 days (range, 11-39) at the hospital. At the last follow-up, all patients had fully recovered without significant neurological deficits and exhibited complete relief or minimal symptoms from hemifacial spasm (HFS). Postoperative uncontrolled bleeding from the dural venous sinus can sometimes cause an insidious-onset or delayed posterior fossa EDH.
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Affiliation(s)
- Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Seonam University School of Medicine, Gyeonggi-do, South Korea
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Brousmiche S, Souris K, de Xivry JO, Lee JA, Macq B, Seco J. Combined influence of CT random noise and HU-RSP calibration curve nonlinearities on proton range systematic errors. Phys Med Biol 2017; 62:8226-8245. [PMID: 28817383 DOI: 10.1088/1361-6560/aa86e9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Proton range random and systematic uncertainties are the major factors undermining the advantages of proton therapy, namely, a sharp dose falloff and a better dose conformality for lower doses in normal tissues. The influence of CT artifacts such as beam hardening or scatter can easily be understood and estimated due to their large-scale effects on the CT image, like cupping and streaks. In comparison, the effects of weakly-correlated stochastic noise are more insidious and less attention is drawn on them partly due to the common belief that they only contribute to proton range uncertainties and not to systematic errors thanks to some averaging effects. A new source of systematic errors on the range and relative stopping powers (RSP) has been highlighted and proved not to be negligible compared to the 3.5% uncertainty reference value used for safety margin design. Hence, we demonstrate that the angular points in the HU-to-RSP calibration curve are an intrinsic source of proton range systematic error for typical levels of zero-mean stochastic CT noise. Systematic errors on RSP of up to 1% have been computed for these levels. We also show that the range uncertainty does not generally vary linearly with the noise standard deviation. We define a noise-dependent effective calibration curve that better describes, for a given material, the RSP value that is actually used. The statistics of the RSP and the range continuous slowing down approximation (CSDA) have been analytically derived for the general case of a calibration curve obtained by the stoichiometric calibration procedure. These models have been validated against actual CSDA simulations for homogeneous and heterogeneous synthetical objects as well as on actual patient CTs for prostate and head-and-neck treatment planning situations.
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Affiliation(s)
- S Brousmiche
- Ion Beam Applications, Louvain-la-Neuve, Belgium
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Seo YB, Lee J, Kim YK, Lee SS, Lee JA, Kim HY, Uh Y, Kim HS, Song W. Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli. BMC Infect Dis 2017; 17:404. [PMID: 28592240 PMCID: PMC5463388 DOI: 10.1186/s12879-017-2502-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/30/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Due to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. We conducted a prospective, randomized, open-label comparison of the therapeutic efficacy of piperacillin-tazobactam (PTZ), cefepime, and ertapenem in febrile nosocomial urinary tract infection with ESBL-producing Escherichia coli (ESBL-EC). METHODS This study was conducted at three university hospitals between January 2013 and August 2015. Hospitalized adult patients presenting with fever were screened for healthcare-associated urinary tract infection (HA-UTI). When ESBL-EC was solely detected and susceptible to a randomized antibiotic in vitro, the case was included in the final analysis. Participants were treated for 10-14 days with PTZ, cefepime, or ertapenem. RESULTS A total of 66 participants were evenly assigned to the PTZ and ertapenem treatment groups. After the recruitment of six participants, assignment to the cefepime treatment group was stopped because of an unexpectedly high treatment failure rate. The baseline characteristics of these participants did not differ from participants in other treatment groups. The clinical and microbiological response to PTZ treatment was estimated to be 94% and was similar to the response to ertapenem treatment. The efficacy of cefepime was 33.3%. In the cefepime group, age, Charlson comorbidity index, genotype, and minimal inhibitory concentration (MIC) did not significantly affect the success of treatment. Similarly, genotype seemed to be irrelevant with respect to clinical outcome in the PTZ group. Expired cases tended to involve septic shock with a high Charlson comorbidity index and high MIC. CONCLUSION Results from this study suggest that PTZ is effective in the treatment of urinary tract infection caused by ESBL-EC when the in vitro test indicates susceptibility. In addition, cefepime should not be used as an alternative treatment for urinary tract infection caused by ESBL-EC. TRIAL REGISTRATION The trial was registered with the Clinical Research Information Service of Korea Centers for Disease Control and Prevention. (KCT0001895).
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Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seung Soon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jeong-A Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Shingil-ro, Youngdeungpo-gu, Seoul, 150-950, Korea.
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Lee JA, Kim KH, Park K. Natural History of Untreated Hemifacial Spasm: A Study of 104 Consecutive Patients over 5 Years. Stereotact Funct Neurosurg 2017; 95:21-25. [DOI: 10.1159/000453276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022]
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Lee JA, Kim MK, Song JH, Jo MR, Yu J, Kim KM, Kim YR, Oh JM, Choi SJ. Biokinetics of food additive silica nanoparticles and their interactions with food components. Colloids Surf B Biointerfaces 2016; 150:384-392. [PMID: 27842933 DOI: 10.1016/j.colsurfb.2016.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
Abstract
Nanomaterials have been widely utilized in the food industry in production, packaging, sensors, nutrient delivery systems, and food additives. However, research on the interactions between food-grade nanoparticles and biomolecules as well as their potential toxicity is limited. In the present study, the in vivo solubility, oral absorption, tissue distribution, and excretion kinetics of one of the most extensively used food additives, silica (SiO2) were evaluated with respect to particle size (nano vs bulk) following single-dose oral administration to rats. Intestinal transport mechanism was investigated using a 3D culture system, in vitro model of human intestinal follicle-associated epithelium (FAE). The effect of the presence of food components, such as sugar and protein, on the oral absorption of nanoparticles was also evaluated with focus on their interactions. The results obtained demonstrated that the oral absorption of nanoparticles (3.94±0.38%) was greater than that of bulk materials (2.95±0.37%), possibly due to intestinal transport by microfold (M) cells. On the other hand, particle size was found to have no significant effect on in vivo dissolution property, biodistribution, or excretion kinetics. Oral absorption profile of silica nanoparticles was highly dependent on the presence of sugar or protein, showing rapid absorption rate in glucose, presumably due to their surface interaction on nanoparticles. These findings will be useful for predicting the potential toxicity of food-grade nanoparticles and for understanding biological interactions.
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Affiliation(s)
- Jeong-A Lee
- Department of Applied Food System, Major of Food Science and Technology, Seoul Women's University, Seoul 01797, Republic of Korea
| | - Mi-Kyung Kim
- Department of Applied Food System, Major of Food Science and Technology, Seoul Women's University, Seoul 01797, Republic of Korea
| | - Jae Ho Song
- Department of Chemistry and Medical Chemistry, College of Science and Technology, Yonsei University, Wonju, Gangwondo 26493, Republic of Korea
| | - Mi-Rae Jo
- Department of Applied Food System, Major of Food Science and Technology, Seoul Women's University, Seoul 01797, Republic of Korea
| | - Jin Yu
- Department of Applied Food System, Major of Food Science and Technology, Seoul Women's University, Seoul 01797, Republic of Korea
| | - Kyoung-Min Kim
- Department of Chemistry and Medical Chemistry, College of Science and Technology, Yonsei University, Wonju, Gangwondo 26493, Republic of Korea
| | - Young-Rok Kim
- Department of Food Science and Biotechnology, Kyung Hee University, Yongin 17104, Republic of Korea.
| | - Jae-Min Oh
- Department of Chemistry and Medical Chemistry, College of Science and Technology, Yonsei University, Wonju, Gangwondo 26493, Republic of Korea.
| | - Soo-Jin Choi
- Department of Applied Food System, Major of Food Science and Technology, Seoul Women's University, Seoul 01797, Republic of Korea.
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Walker MD, Saeed I, Lee JA, Zhang C, Hans D, Lang T, Silverberg SJ. Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism. Osteoporos Int 2016; 27:3063-71. [PMID: 27198233 PMCID: PMC5555733 DOI: 10.1007/s00198-016-3637-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 01/31/2023]
Abstract
UNLABELLED Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS). INTRODUCTION The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT. METHODS This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively. RESULTS In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p = 0.05), were less likely to use vitamin D supplementation (p < 0.01), and had better renal function (p = 0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20-29 ng/ml (p = 0.002) and 25OHD ≥30 ng/ml (p < 0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20-29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p < 0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status. CONCLUSION In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - I Saeed
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C Zhang
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - D Hans
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - T Lang
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - S J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Abstract
The concentration of the dose delivered by protons at the end of their path, the Bragg peak, has the potential to improve external radiotherapy treatments. Unfortunately, the main strength of the protons, their finite range, is also their greatest weakness. Any uncertainty on the range may lead to inadequate target coverage or excessive toxicity. The uncertainties have multiple origins and include, among others, ballistic errors, morphological modifications or inaccurate estimations of the physical quantities necessary to predict the proton range. Uncertainties have been part of daily practice in conventional radiotherapy with X-rays for a long time. However, dose distributions delivered with X-rays are much less sensitive to uncertainties than the ones delivered with protons. This relative insensitivity enabled the management of uncertainties through safety margins using a simple formalism. The conditions of validity of this formalism are much more restrictive for proton therapy, leading to the need of developing new tools and adapted strategies to manage accurately these uncertainties. The objective of this paper is to present a vision for the management of uncertainties in proton therapy in the continuity of formalisms established for X-rays. The latter are first summarized before discussing the necessary developments in order to consistently apply them to protons.
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Affiliation(s)
- E Sterpin
- Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, O&N I Herestraat 49, 3000 Leuven, Belgique; Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique.
| | - A Barragan
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - K Souris
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - J A Lee
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
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Kim MK, Lee JA, Jo MR, Choi SJ. Bioavailability of Silica, Titanium Dioxide, and Zinc Oxide Nanoparticles in Rats. J Nanosci Nanotechnol 2016; 16:6580-6. [PMID: 27427756 DOI: 10.1166/jnn.2016.12350] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Inorganic nanoparticles have been widely applied to various industrial fields and biological applications. However, the question as to whether nanoparticles are more efficiently absorbed into the systemic circulation than bulk-sized materials remains to be unclear. In the present study, the physico-chemical and dissolution properties of the most extensively developed inorganic nanoparticles, such as silica (SiO2), titanium dioxide (TiO2), and zinc oxide (ZnO), were analyzed, as compared with bulk-sized particles. Furthermore, the bioavailability of nanoparticles versus their bulk counterparts was evaluated in rats after a single oral administration and intravenous injection, respectively. The results demonstrated that all bulk materials had slightly higher crystallinity than nanoparticles, however, their dissolution properties were not affected by particle size. No significant difference in oral absorption and bioavailability of both SiO2 and TiO2 was found between nano- and bulk-sized materials, while bulk ZnO particles were more bioavailable in the body than ZnO nanoparticles. These finding will provide critical information to apply nanoparticles with high efficiency as well as to predict their toxicity potential.
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Chyu MC, Austin T, Calisir F, Chanjaplammootil S, Davis MJ, Favela J, Gan H, Gefen A, Haddas R, Hahn-Goldberg S, Hornero R, Huang YL, Jensen Ø, Jiang Z, Katsanis JS, Lee JA, Lewis G, Lovell NH, Luebbers HT, Morales GG, Matis T, Matthews JT, Mazur L, Ng EYK, Oommen KJ, Ormand K, Rohde T, Sánchez-Morillo D, Sanz-Calcedo JG, Sawan M, Shen CL, Shieh JS, Su CT, Sun L, Sun M, Sun Y, Tewolde SN, Williams EA, Yan C, Zhang J, Zhang YT. Healthcare Engineering Defined: A White Paper. J Healthc Eng 2016; 6:635-47. [PMID: 27010831 DOI: 10.1260/2040-2295.6.4.635] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/01/2015] [Indexed: 11/03/2022]
Abstract
Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.
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Affiliation(s)
- Ming-Chien Chyu
- Department of Mechanical Engineering; Coordinator, Healthcare Engineering Graduate Program, Texas Tech University, Lubbock, Texas, USA
| | | | - Fethi Calisir
- Industrial Engineering Department; Dean, Management Faculty, Istanbul Technical University, Turkey
| | - Samuel Chanjaplammootil
- Texas Tech University Health Sciences Center - Permian Basin (Odessa, Midland, Abilene and Dallas), Texas, USA
| | - Mark J Davis
- Operational & Clinical Excellence Leader, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Jesus Favela
- Computer Science Department, Center for Scientific Research and Higher Education of Ensenada, Ensenada, Mexico
| | - Heng Gan
- Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | - Ram Haddas
- Texas Back Institute Research Foundation, Plano, Texas, USA
| | | | - Roberto Hornero
- Biomedical Engineering Group, E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
| | | | | | - Zhongwei Jiang
- Department of Mechanical Engineering, Yamaguchi University, Japan
| | - J S Katsanis
- Department of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Jeong-A Lee
- Department of Computer Engineering, Chosun University, Korea
| | | | - Nigel H Lovell
- University of New South Wales, Graduate School of Biomedical Engineering, Sydney, NSW, Australia
| | - Heinz-Theo Luebbers
- Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,University Hospital and Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - George G Morales
- Physical Plant & Support Services, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Timothy Matis
- Department of Industrial Engineering, Texas Tech University, Texas, USA
| | - Judith T Matthews
- School of Nursing and University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, USA
| | - Lukasz Mazur
- Healthcare Engineering Division, School of Medicine, University of North Carolina - Chapel Hill, North Carolina, USA
| | - Eddie Yin-Kwee Ng
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore
| | - K J Oommen
- Epilepsy Clinics, Covenant Medical Group; Chief, Section of Internal Medicine, Covenant Hospital, Lubbock, Texas, USA
| | | | - Tarald Rohde
- SINTEF, Technology and Society, Hospital Planning, Oslo, Norway
| | | | | | - Mohamad Sawan
- Polystim Neurotechnology Lab, Polytechnique, University of Montreal, Canada
| | - Chwan-Li Shen
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Institute of Mechanical Engineering, Yuan Ze University, Taiwan
| | - Chao-Ton Su
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Lilly Sun
- School of Systems Engineering, University of Reading, UK
| | - Mingui Sun
- Department of Neurosurgery, Department of Electrical Engineering; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi Sun
- 3D Surgical Planning Lab - Oral and Maxillofacial Surgery, Department of Imaging & Pathology/OMFS-IMPATH Research Group, University Hospitals Leuven, Leuven, Belgium
| | - Senay N Tewolde
- HJF Advancement of Military Medicine, Navy Medical Research Unit, San Antonio, Texas, USA
| | - Eric A Williams
- Chief Quality Officer-Medicine, Texas Children's Hospital; Associate Professor of Pediatrics, Sections of Critical Care and Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Chongjun Yan
- College of Management Science & Engineering, Dongbei University of Finance and Economic, Dalian, China
| | - Jiajie Zhang
- Dean, Glassell Family Foundation Distinguished Chair, Dr. Doris L. Ross Professor, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Abstract P3-12-17: Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: Although modern radiotherapy such as field-in-field technique decreased the radiation toxicity, skin reaction is still frequent and main problem during adjuvant whole breast irradiation. Our study investigated various radiation dosimetric and clinical parameters as the risk factors of severe skin reaction.
Methods: From January 2012 to December 2014, total 219 patients with breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients took both whole breast irradiation (50 Gy/25 fractions) and boost to the tumor bed (10 - 15 Gy). Skin reaction was measured by comparing the photography of radiation field between the first day of whole breast irradiation and boost therapy. For each axilla and inferior fold, the intensity (score 1 to 5) and extent (score 0 to 1) of erythema were recorded and summed. The severe skin reaction was defined as score 5 or 6. The relations of various radiation dosimetric parameters for radiotherapy planning, personal breast characteristics and clinical factors to severe skin reaction were evaluated using the Logistic regression tests.
Results: Total 75 (34%) and 57 (26%) patients showed the severe skin reaction to axilla and inferior fold, respectively. The variables of P < 0.2 in univariate analyses including age, the body mass index, the breast height, the V100, the calculated point dose in radiation planning system, the breast separation, the field size, and the gradient of inferior fold entered the multivariate analyses. Age (P=0.013 (OR = 0.950, 95% CI 0.913 - 0.989)), the body mass index (P = 0.015 (OR = 1.123, 95% CI 1.023 - 1.233)), the calculated axilla point dose (P = 0.091 (OR = 1.064, 95% CI 0.990 - 1.142)), and the gradient of inferior fold (P = 0.073 (OR = 1.029, 95% CI 0.997 - 1.063)) were risk factors for severe axilla skin reaction, whereas age (P = 0.018 (OR = 0.948, 95% CI 0.907 - 0.991)) and the V100 (P < 0.001 (OR = 1.005, 95% CI 1.003 - 1.007)) were for severe inferior fold skin reaction.
Conclusion: In addition to clinical factor and personal breast characteristics, the radiation dosimetric parameters such as calculated point dose and V100 could be another predictive factors of severe skin reaction.
Citation Format: Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-17.
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Affiliation(s)
- WS Yoon
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - NK Lee
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - JA Lee
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - DS Yang
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - CY Kim
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - GS Son
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - YW Chang
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
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Barragán AM, Differding S, Janssens G, Lee JA, Sterpin E. Feasibility and robustness of dose painting by numbers in proton therapy with contour-driven plan optimization. Med Phys 2015; 42:2006-17. [PMID: 25832091 DOI: 10.1118/1.4915082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To prove the ability of protons to reproduce a dose gradient that matches a dose painting by numbers (DPBN) prescription in the presence of setup and range errors, by using contours and structure-based optimization in a commercial treatment planning system. METHODS For two patients with head and neck cancer, voxel-by-voxel prescription to the target volume (GTVPET) was calculated from (18)FDG-PET images and approximated with several discrete prescription subcontours. Treatments were planned with proton pencil beam scanning. In order to determine the optimal plan parameters to approach the DPBN prescription, the effects of the scanning pattern, number of fields, number of subcontours, and use of range shifter were separately tested on each patient. Different constant scanning grids (i.e., spot spacing = Δx = Δy = 3.5, 4, and 5 mm) and uniform energy layer separation [4 and 5 mm WED (water equivalent distance)] were analyzed versus a dynamic and automatic selection of the spots grid. The number of subcontours was increased from 3 to 11 while the number of beams was set to 3, 5, or 7. Conventional PTV-based and robust clinical target volumes (CTV)-based optimization strategies were considered and their robustness against range and setup errors assessed. Because of the nonuniform prescription, ensuring robustness for coverage of GTVPET inevitably leads to overdosing, which was compared for both optimization schemes. RESULTS The optimal number of subcontours ranged from 5 to 7 for both patients. All considered scanning grids achieved accurate dose painting (1% average difference between the prescribed and planned doses). PTV-based plans led to nonrobust target coverage while robust-optimized plans improved it considerably (differences between worst-case CTV dose and the clinical constraint was up to 3 Gy for PTV-based plans and did not exceed 1 Gy for robust CTV-based plans). Also, only 15% of the points in the GTVPET (worst case) were above 5% of DPBN prescription for robust-optimized plans, while they were more than 50% for PTV plans. Low dose to organs at risk (OARs) could be achieved for both PTV and robust-optimized plans. CONCLUSIONS DPBN in proton therapy is feasible with the use of a sufficient number subcontours, automatically generated scanning patterns, and no more than three beams are needed. Robust optimization ensured the required target coverage and minimal overdosing, while PTV-approach led to nonrobust plans with excessive overdose. Low dose to OARs can be achieved even in the presence of a high-dose escalation as in DPBN.
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Affiliation(s)
- A M Barragán
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - S Differding
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - G Janssens
- Ion Beam Applications S.A., Louvain-la-Neuve 1348, Belgium
| | - J A Lee
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - E Sterpin
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
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Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ, Bilezikian JP, Silverberg SJ. Low vitamin D levels have become less common in primary hyperparathyroidism. Osteoporos Int 2015; 26:2837-43. [PMID: 26084258 PMCID: PMC4793903 DOI: 10.1007/s00198-015-3199-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED We compared temporal trends in serum 25-hydroxyvitamin D and parathyroid hormone (PTH) in two primary hyperparathyroidism (PHPT) cohorts recruited 20 years apart. The prevalence of 25-hydroxyvitamin D levels <20 and <30 ng/mL declined by 30-50 %, respectively, and was accompanied by lower PTH. In the older cohort, higher PTH may be due to lower 25-hydroxyvitamin D. INTRODUCTION Vitamin D deficiency may exacerbate PHPT. Whether there have been temporal trends in 25-hydroxyvitamin D (25OHD) levels in PHPT is unclear. The prevalence of low vitamin D levels (25OHD <20 and <30 ng/mL) and associated biochemical and bone mineral density (BMD) profiles were assessed in two PHPT cohorts recruited over 20 years apart. METHODS This is a cross-sectional comparison of serum 25OHD levels, calciotropic hormones, and BMD between two PHPT cohorts recruited at the same hospital: the "old" (N = 103) and "new" (N = 100) cohorts were enrolled between 1984 and 1991 and between 2010 and 2014, respectively. RESULTS Mean 25OHD levels were 26 % higher in the new cohort (23 ± 10 vs. 29 ± 10 ng/mL, p < 0.0001). Levels of 25OHD <20 and <30 ng/mL declined from 46 and 82 %, respectively, to 19 and 54 % (both p < 0.0001). Supplemental vitamin D use was common in the new (64 %) but not the old cohort (0 %). The new cohort demonstrated 33 % lower serum PTH levels (p < 0.0001). Neither serum nor urine calcium differed. BMD was higher in the new cohort at all skeletal sites (all p < 0.001). CONCLUSION With the rise in vitamin D supplementation over the last two decades, low 25OHD levels are no longer common in PHPT patients in the New York area. Those with 25OHD <20 and <30 ng/mL have declined by over 50 and 30 %, respectively. The lower mean PTH levels in the new cohort are most likely accounted for by higher vitamin D intake. Whether improved vitamin D status also underlies the relatively higher BMD in the more vitamin D replete cohort of PHPT patients is unknown.
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Affiliation(s)
- M D Walker
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA.
| | - E Cong
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - J A Lee
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - A Kepley
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - C Zhang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - D J McMahon
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - J P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - S J Silverberg
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
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