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Shin JY, McBride SM, Cuaron J, Gomez DR. Clinical Sequalae of Initial Insurance Denials in a Large Academic Radiation Oncology Center. Int J Radiat Oncol Biol Phys 2023; 117:S90. [PMID: 37784602 DOI: 10.1016/j.ijrobp.2023.06.418] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The objective of this study is to investigate the clinical sequalae of initial radiation oncology insurance denials. The hypothesis is that while the majority of initial insurance case denials are ultimately overturned, there are potential clinical implications to these initial denials. MATERIALS/METHODS Data were extracted from an institutional registry of patient cases initially denied authorization by their insurers from January 2022 to December 2022. Chi-Square tests using statistical software were employed. RESULTS Two hundred six cases from November 2021 to December 2022 were identified. The majority (n = 199 [96.6%]) of insurers were commercial payers, while 7 (3.4%) were Medicare/Medicare Advantage. 161 (78.1%) patients were <65 years of age, and 45 (21.8%) 65 or older. One hundred forty-one (68.4%) cases were metastatic, 60 (29.1%) definitive, and 5 (2.4%) were recurrent. Of the 206 cases, 127 (61.6%) cases were ultimately successful in authorization of the ordered treatment without any change to the requested treatment technique or prescription dose after P2P (Peer to Peer review), second-level appeal, comparison plan submission, employer request, insurance carrier change, and/or external appeal, and 56 (27.2%) cases were authorized though with insurer-requested modification to radiation treatment technique and/or prescription dose. Of 21 cases with a requested change in prescription dose, the median decrease in biologically effective dose (BED) was 24 Gy (range: 2.3-51). Of 58 cases with requested change in RT technique, 20 (34.5%) changed from IMRT to 3D-CRT, 16 (27.6%) SBRT to 3D, 15 (25.9%) SBRT to IMRT, 6 (10.3%) SBRT to 2D, and 1 (1.7%) 3D-CRT to 2D. 19 (9.2%) cases remained unauthorized by the insurer but proceeded with treatment via departmental administrative clearance. Of 196 cases which went on to treatment, 72 (36.7%) cases were delayed for a mean of 7.8 days and median of 5 days (range: 1-49). P2P was performed by the treating radiation oncologist in 169 (82.0%) cases, of which 78 (46.1%) were successful in authorization of the ordered treatment. Of the 91 unsuccessful cases, 62 (68.1%) second-level appeals were performed, of which 39 (62.9%) were successful in overturning denied authorization. Of the 23 cases not authorized either through P2P or second-level appeal, 3 (13.0%) cases were successful in authorization of the requested treatment via employer request, external appeal through an independent review organization, or insurance carrier change. CONCLUSION Our institutional analysis suggests that while the majority of initial insurance case denials are ultimately overturned without any change to the requested treatment technique or prescription dose through a number of requests made by the insurer to the radiation oncologist, there are clinical implications with a significant percentage of case denials leading to treatment delays, decrease in prescription BED, and less conformal treatment technique.
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Affiliation(s)
- J Y Shin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Cuaron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Kratochvil LB, Lebow ES, Eichholz J, Gelblum D, Simone CB, Shepherd AF, Wu AJ, Shin JY, Rimner A, Isbell J, Li BT, Shaverdian N, Gomez DR. Prospective, Cell-Free Circulating Tumor DNA (ctDNA) Profiling in Locally Advanced Lung Cancer Treated with Chemoradiation. Int J Radiat Oncol Biol Phys 2023; 117:e31. [PMID: 37785120 DOI: 10.1016/j.ijrobp.2023.06.716] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Liquid biopsy for cell-free circulating tumor DNA (ctDNA) allows for non-invasive, comprehensive genomic profiling. We explored the utility prospective liquid biopsy for (ctDNA) in among non-small cell lung cancer (NSCLC) patients treated with definitive chemoradiation. MATERIALS/METHODS This prospective clinical cohort consists of unresectable, locally advanced NSCLC patients who had liquid biopsy testing prior to initiation of cancer therapy. Liquid biopsy testing was performed using a next-generation sequencing assay (MSK-ACCESS) which includes 129 genes and paired white blood cell sequencing. An FDA-recognized database (OncoKB) was utilized to classify alterations associated with radiation resistance (including KEAP1, NFE2L2, STK11, and PIK3CA) and radiation sensitivity (including ATM, ATR, BRCA1/2, ARID1A, MLH1 and other DNA Damage Repair Pathway alterations). We evaluated progression-free survival (PFS) from the completion of chemoradiation using the Log-rank test. RESULTS Among 25 patients with prospective ctDNA testing prior to therapy initiation, 17 patients had stage III disease (68%), 8 patients had stage II disease (32%), 18 patients had adenocarcinoma (72%), 7 patients had squamous cell carcinoma (28%), and 23 (92%) were former or current smokers. The median radiation dose was 60 Gy in 30 fractions (range: 55 to 66 Gy in 20 to 33 fractions). 76% of patients (n = 18) had one or more alterations detected (median: 3 alterations, range: 1 - 8) including genomic markers of radiation response in 2 patients in BRCA1/2 (n = 2) and radiation resistance in 1 patient in KEAP1. The most common driver alteration detected was KRAS in 24% of the cohort (n = 6). Among patients with baseline detectable ctDNA, the median PFS was 21.3 months and was not reached among patients without baseline ctDNA detection (HR 4.54, p = 0.04). CONCLUSION Using an institutional assay, the presence of baseline cell-free ctDNA appeared prognostic in patients with unresectable, locally advanced NSCLC treated with definitive chemoradiation. We also detected driver alterations and potential markers of radiation resistance and response using ctDNA testing. Prospective cell-free ctDNA profiling may offer pathways to therapy personalization among patients with locally advanced unresectable lung cancer.
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Affiliation(s)
| | - E S Lebow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Eichholz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A F Shepherd
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Y Shin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Isbell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Shin JY, Choe JC, Ahn JH, Lee HW, Oh JH, Choi JH, Lee HC, Cha KS, Hong TJ, Park JS. Clinical outcomes of patients who received a lower dose of non-vitamin K antagonist oral anticoagulants for the medical management of acute pulmonary embolism. Acta Cardiol 2022; 77:122-129. [PMID: 33678134 DOI: 10.1080/00015385.2021.1878424] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOACs) are used to treat acute pulmonary embolism (PE). However, lower NOAC doses are often prescribed because of increased risk of NOAC complications. OBJECTIVE We sought to determine the incidence and clinical outcomes of patients with acute provoked PE receiving lower NOAC doses. METHOD 140 patients with acute PE with only NOACs used for medical management was enrolled and were followed up for 6 months. The composite primary endpoint was all-cause death, venous thromboembolism recurrence, and residual thrombus on follow-up computed tomography. RESULTS Of the 140 patients, 99 (70.7%) received the standard NOAC dose and 41 (29.3%) received the lower dose. The crude incidences of the primary endpoint were 19 (19.2%) in patients who received the standard NOAC dose and 13 (31.7%) in those who received the lower dose. Compared with patients who received the standard dose, those who received the lower dose had no differences in the rate of primary endpoints (hazard ratio 1.140, 95% confidence interval 0.536-2.423, p = 0.733) during a median of 185 days. CONCLUSION We found that up to 30% of patients received the lower dose of NOACs for acute PE in clinical practice. Clinical outcomes with appropriate underdoing of NOAC treated in acute PE might not increase compared to the standard NOAC doses.
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Affiliation(s)
- Ji Yeon Shin
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jeong Cheon Choe
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin Hee Ahn
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin Sup Park
- Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
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Shin JY, Chun JY, Chang SC, Roh SG, Lee NH. Association between non-vascularised bone graft failure and compartment of the defect in mandibular reconstruction: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:128-133. [PMID: 34815100 DOI: 10.1016/j.bjoms.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/23/2020] [Accepted: 03/16/2021] [Indexed: 01/11/2023]
Abstract
Controversy exists regarding the influence of the graft placement site in the mandible on the success of non-vascularised bone grafts. In this study, we examine the association between the compartment of the mandibular defect and the bone graft failure rate. A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Failure rates according to the compartment of mandibular defect were extracted and analysed by meta-analysis. The Newcastle-Ottawa Scale was used to assess the quality of the studies, and publication bias was evaluated using funnel plots. The search strategy identified 27 publications. After screening, five were selected for review. Based on the result of comparison among these five, we found no significant statistical association between the bone graft failure rate and compartment of mandibular defect, although further investigation of prospective randomised cohort studies is required.
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Affiliation(s)
- J Y Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
| | - J Y Chun
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
| | - S C Chang
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - S-G Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - N-H Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Choe JC, Cha KS, Lee JG, Kim J, Shin JY, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH. Long-Term Outcomes of Biodegradable Versus Second-Generation Durable Polymer Drug-Eluting Stent Implantations for Myocardial Infarction. JACC Cardiovasc Interv 2020; 13:97-111. [DOI: 10.1016/j.jcin.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
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Choe JC, Cha KS, Shin JY, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ. 3334Updated meta-analysis of biodegradable polymer drug-eluting stent versus second-generation durable polymer drug-eluting stent implantations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Data regarding clinical outcomes of biodegradable polymer drug-eluting stent (BP-DES) versus second-generation durable polymer drug-eluting stent (DP-DES) in patients undergoing percutaneous coronary intervention (PCI) are inconclusive.
Purpose
We aimed to perform a meta-analysis to investigate the clinical outcomes of BP-DES compared with second-generation DP-DES in patients who have undergone PCI.
Methods
We searched PubMed, MEDLINE, EMBASE, and Cochrane databases through January 2019 for randomized controlled trials comparing BP-DES with second-generation DP-DES in patients treated with PCI. All-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), definite/probable stent thrombosis (ST) were compared between the groups. Additionally, a landmark analysis with the landmark set at 1 year and a subgroup analysis according to stent characteristics were performed.
Results
Data from 23 trials including 28802 randomized patients were analyzed. At a median follow up of 3.1 years, no significant differences were found in terms of all-cause death (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.95–1.16), cardiac death (OR 1.01, 95% CI 0.87–1.17), MI (OR 0.92, 95% CI 0.82–1.03), TVR (OR 0.97, 95% CI 0.86–1.11), TLR (OR 0.97, 95% CI 0.85–1.11), and definite/probable ST (OR 0.86, 95% CI 0.70–1.07) between the groups. Landmark analysis showed that there were similar risks in all-cause death (OR 1.04, 95% CI 0.93–1.17), cardiac death (OR 1.11, 95% CI 0.92–1.36), MI (OR 0.94, 95% CI 0.79–1.13), TVR (OR 0.95, 95% CI 0.73–1.23), TLR (OR 1.00, 95% CI 0.80–1.24), and definite/probable ST (OR 0.92, 95% CI 0.67–1.28) between the groups. The similar tendency of any study endpoints between the groups was consistent in the subgroup, including stent platform (stainless steel vs. alloy), the drug coating distribution (abluminal vs. circumferential), the polymer degradation period (<6 months vs. >6 months), or the drug release duration (<6 months vs. >6 months) of BP-DES, or the DAPT duration (≥6 months vs. ≥12 months). However, the uses of BP-DES with sirolimus-eluting (OR 0.84, 95% CI 0.72–0.98) or ultrathin strut (defined as <70μm; OR 0.81, 95% CI 0.68–0.97) were predictive for lower risk of MI.
Clinical outcomes
Conclusions
In our updated meta-analysis, BP-DES implantation was associated with comparable clinical outcomes compared with second-generation DP-DES implantation. However, PCI with ultrathin biodegradable polymer sirolimus-eluting stent could reduce the risk of MI.
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Affiliation(s)
- J C Choe
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - K S Cha
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J Y Shin
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J Ahn
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J S Park
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - H W Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J H Oh
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J H Choi
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - H C Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - T J Hong
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
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Choe JC, Cha KS, Shin JY, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ. P2799Long-term outcomes after percutaneous coronary intervention with biodegradable polymer drug-eluting stent versus second-generation durable polymer drug-eluting stent: evidence from a meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The true benefit of biodegradable polymer drug-eluting stent (BP-DES) over second-generation durable polymer drug-eluting stent (DP-DES) expected to be represented during late period of follow-up after percutaneous coronary intervention (PCI), but prior meta-analysis only evaluated short-term outcomes.
Purpose
We aimed to compare the long-term clinical outcomes after PCI with BP-DES versus second-generation DP-DES by a meta-analysis of randomized controlled trials.
Methods
Randomized controlled trials comparing BP-DES with second-generation DP-DES implantations were searched through PubMed, MEDLINE, EMBASE, and Cochrane databases. All-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), and definite/probable stent thrombosis (ST) were compared between the groups. In addition, a landmark analysis with the landmark set at 1-year and a subgroup analysis based on stent characteristics were performed.
Results
Fifteen trials that included a total of 21311 randomized patients with at least 2 years follow-up were analyzed. At a median follow-up of 4.2 years, no significant differences in the risks of all-cause death (odds ratio [OR] 1.03, 95% confidence interval [CI] 0.94–1.14), cardiac death (OR 1.03, 95% CI 0.88–1.20), MI (OR 0.90, 95% CI 0.79–1.01), TVR (OR 0.96, 95% CI 0.82–1.12), TLR (OR 0.97, 95% CI 0.85–1.11), and definite/probable ST (OR 0.84, 95% CI 0.67–1.05) were found between the groups. In the 1-year landmark analysis, the rates of all-cause death (OR 1.04, 95% CI 0.93–1.17), cardiac death (OR 1.11, 95% CI 0.92–1.36), MI (OR 0.94, 95% CI 0.79–1.13), TVR (OR 0.95, 95% CI 0.73–1.23), TLR (OR 1.00, 95% CI 0.80–1.24), and definite/probable ST (OR 0.94, 95% CI 0.67–1.31) were similar between the groups. There were comparable rates of any study endpoints between the groups regardless of stent platform (stainless steel vs. alloy), the polymer degradation period (<6 months vs. >6 months) or the drug release duration (<6 months vs. >6 months) of BP-DES, or the DAPT duration (≥6 months vs. ≥12 months). However, the use of BP-DES with sirolimus eluting (OR 0.82, 95% CI 0.70–0.97), circumferential drug distribution (OR 0.79, 95% CI 0.65–0.96), thin strut (defined as <100μm; OR 0.83, 95% CI 0.70–0.97), or ultrathin strut (defined as <70μm; OR 0.78, 95% CI 0.64–0.94) were associated with lower rates of MI than did second-generation DP-DES. Moreover, BP-DES with circumferential drug distribution (OR 0.82, 95% CI 0.69–0.98) was predictive for reduced rates of TVR.
Clinical outcomes
Conclusions
In this meta-analysis, long-term clinical outcomes were equivalent between BP-DES and second-generation DP-DES implantations. However, among BP-DESs, the improved risks of MI in those with sirolimus eluting, circumferential drug distribution, thin strut, or ultrathin strut and decreased rates of TVR in those with circumferential drug distribution were noted.
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Affiliation(s)
- J C Choe
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - K S Cha
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J Y Shin
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J Ahn
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J S Park
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - H W Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J H Oh
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - J H Choi
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - H C Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
| | - T J Hong
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea (Republic of)
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Ahn J, Shin SY, Shim J, Kim YH, Han SJ, Choi EK, Oh S, Shin JY, Choe JC, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Cha KS, Hong TJ, Lip GYH, Lim HE. Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:2209-2216. [PMID: 31502330 DOI: 10.1111/jce.14154] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long-term follow-up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. METHODS AND RESULTS We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed-up. During a follow-up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2 DS2 -VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri-atrial EAT volume. Multivariate regression analysis demonstrated larger peri-atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005-1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut-off value of peri-atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri-atrial EAT volume showed significantly higher ES-free survival. CONCLUSION Larger peri-atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2 DS2 -VASc score. (ClinicalTrials.gov number, NCT03479073).
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Affiliation(s)
- Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung Yong Shin
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeon Shin
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong Cheon Choe
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Sup Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Hye Won Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jun-Hyok Oh
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Han-Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Cho S, Shin JY, Kim HJ, Eun SJ, Kang S, Jang WM, Jung H, Kim Y, Lee JY. Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea. J Korean Med Sci 2019; 34:e190. [PMID: 31392852 PMCID: PMC6689488 DOI: 10.3346/jkms.2019.34.e190] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although effective care for type 2 diabetes (T2DM) is well known, considerable inadequate care has been still existed. Variations in achievement of the recommended quality indicators inT2DM care among small areas are not well known in Korea. This study examined the quality of care T2DM care and its geographical variations. METHODS We used the national health insurance database and national health screening database. Seven quality indicators were used to evaluate continuity of care (medication possession ratio), process of care (hemoglobin A1c test, lipid profile, microalbuminuria test, and eye examination), and intermediate outcome (blood pressure control, and low-density lipoprotein control). Crude and age-standardized proportions were calculated for each 252 districts in Korea. RESULTS All quality indicators failed to achieve the recommended level. Only about 3% and 15% of the patients underwent eye examination and microalbuminuria test, respectively. Other indicators ranged from 48% to 68%. Wide variation in the quality existed among districts and indicators. Eye examination and microalbuminuria test varied the most showing tenfold (0.9%-9.2%) and fourfold (6.3%-28.9%) variation by districts, respectively. There were 32.4 and 42.7 percentage point gap between the best and the worst districts in hemoglobin A1c test and blood pressure control, respectively. CONCLUSION Considerable proportion of T2DM patients were not adequately managed and quality of care varied substantially district to district. To improve the quality of diabetes care, it is necessary to identify the poor performance areas and establish a well-coordinated care system tailored to the need of the district.
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Affiliation(s)
- Sanghyun Cho
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sungchan Kang
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea
| | - Won Mo Jang
- Health Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Hyemin Jung
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Health Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Jin Yong Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Department of Public Health and Community Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
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10
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Seo DH, Shin JY, Roh SG, Chang SC, Lee NH. Non-tuberculous Mycobacterium infection after transfer of autologous fat to the face: a rare case. Br J Oral Maxillofac Surg 2019; 57:185-187. [PMID: 30612837 DOI: 10.1016/j.bjoms.2018.12.008] [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: 08/08/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
Autologous fat has long been used as a filler in the face, and has recently gained popularity in plastic surgery with a wound infection rate of 1% - 5%. The incidence of mycobacterial infections has increased over recent decades, which is attributed in part to the increased popularity of these procedures.2 Infections by non-tuberculosis mycobacteria often cause chronic inflammation and progressive infection that may eventually manifest themselves as severe scars, fistulas, and hollows, and irregular facial contours. However, few cases of mycobacterial infection have been reported to have been caused by plastic surgery. We present a rare case of non-tuberculosis mycobacterial infection after transfer of autologous fat to the face.
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Affiliation(s)
- D-H Seo
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - J Y Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital.
| | - S-G Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - S C Chang
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - N-H Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
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11
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Choe JC, Cha KS, Shin JY, Lee SH, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH. 1466Prognosis of biodegradable polymer drug-eluting stents versus second-generation durable polymer drug-eluting stents in acute myocardial infarction patients following percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1466] [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)
- J C Choe
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - K S Cha
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - J Y Shin
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - S H Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - J Ahn
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - J S Park
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - H W Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - J H Oh
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - J H Choi
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - H C Lee
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - T J Hong
- Pusan National University Hospital, Department of Cardiology, Pusan, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Department of Cardiology, Gwangju, Korea Republic of
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12
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Kim MJ, Shin JY, Oh JA, Jeong KE, Choi YS, Park Q, Song MS, Lee DH. Identification of transfusion-transmitted hepatitis A through postdonation information in Korea: results of an HAV lookback (2007-2012). Vox Sang 2018; 113:547-554. [PMID: 30003551 DOI: 10.1111/vox.12672] [Citation(s) in RCA: 3] [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: 04/26/2017] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite safety measures to minimize the risk of transfusion-transmitted infections, a residual risk remains. To trace and review some such cases, we ask donors to notify the blood centre if they are diagnosed with an infection after they donate blood. MATERIALS AND METHODS We analysed all data on postdonation cases of hepatitis A reported between 2007 and 2012. Archived specimens from these donors were tested for hepatitis A virus (HAV) using anti-HAV IgM/IgG and HAV-PCR as markers. If any of the test results were positive, we reviewed the medical records of the recipients and, if necessary, tested them for hepatitis A. RESULTS Fifteen blood donors notified the blood centres of having been diagnosed with hepatitis A after donation. All archived samples except for one were HAV-PCR-positive and anti-HAV IgM/IgG-negative. Of the donated components, four RBCs and 14 FFPs had not been transfused to patients and were recalled. Among 26 recipients of the implicated components, fourteen were still alive when they were notified. Two patients showed clinical symptoms of hepatitis A and had positive results with anti-HAV IgM. CONCLUSION Transfusion-transmitted hepatitis A is rare but exists. To reduce the risk, donors should be told to notify the blood centre if they are diagnosed with blood-borne diseases after they donate blood. Physicians should consider the possibility of transfusion-transmitted hepatitis A if a transfused patient has hepatitis A but no history of travel or route of faecal-oral infection.
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Affiliation(s)
- M J Kim
- Department of Laboratory Medicine, Myongji Hospital, Goyang, Korea
| | - J Y Shin
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - J A Oh
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - K E Jeong
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Y S Choi
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Q Park
- Armed Forces Medical Research Institute, Daejeon, Korea
| | - M S Song
- Department of Nursing, Konyang University College of Nursing, Daejeon, Korea
| | - D H Lee
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Osong, Korea
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13
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Shin JY, Kim BH, Kim YK, Kim TH, Kim EH, Lee MJ, Kim JH, Jeon YK, Kim SS, Kim IJ. Pheochromocytoma as a rare cause of hypertension in a 46 X, i(X)(q10) turner syndrome: a case report and literature review. BMC Endocr Disord 2018; 18:27. [PMID: 29747617 PMCID: PMC5946487 DOI: 10.1186/s12902-018-0253-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) presents the most serious health problems and contributes to the increased mortality in young women with Turner syndrome. Arterial hypertension in Turner syndrome patients is significantly more prevalent than that in a general age-matched control group. The aetiology of hypertension in Turner syndrome varies, even in the absence of cardiac anomalies and obvious structural renal abnormalities. Pheochromocytoma is an extremely rare cause among various etiologies for hypertension in patients with Turner syndrome. Here, we reported a pheochromocytoma as a rare cause of hypertension in Turner syndrome patient. CASE PRESENTATION A 21-year-old woman who has diagnosed with Turner syndrome with a karyotype of 46,X,i(X)(q10) visited for hypertension and mild headache. Transthoracic echography (TTE) showed no definite persistent ductus arteriosus shunt flow and cardiac valve abnormalities. Considering other important secondary causes like pheochromocytoma, hormonal studies were performed and the results showed increased serum norepinephrine, serum normetanephrine, and 24 h urine norepinephrine. We performed an abdominal computed tomography (CT) to confirm the location of pheochromocytoma. Abdominal CT showed a 1.9 cm right adrenal mass. I-131 meta-iodobenzylguanidine (MIBG) scintigraphy showed a right adrenal uptake. Laparoscopic adrenalectomy was performed and confirmed a pheochromocytoma. After surgery, blood pressure was within normal ranges and postoperative course was uneventful, and no recurrence developed via biochemical tests and abdominal CT until 24 months. CONCLUSION Our case and previous literatures suggest that hypertension caused by pheochromocytoma which is a rare but important and potentially lethal cause of hypertension in Turner syndrome. This case underlines the importance of early detection of pheochromocytoma in Turner syndrome. Clinicians should keep in mind that pheochromocytoma can be a cause of hypertension in patients with Turner syndrome.
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Affiliation(s)
- Ji Yeon Shin
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241 South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan, 602-739 South Korea
| | - Young Keum Kim
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, 49241 South Korea
| | - Tae Hwa Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Min Jin Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Jong Ho Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, 49241 South Korea
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14
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Shin JY, Lim JW, Shin DW, Kim SY, Yang HK, Cho J, Jeong A, Jo D, Yim CY, Park K, Park JH. Underestimated caregiver burden by cancer patients and its association with quality of life, depression and anxiety among caregivers. Eur J Cancer Care (Engl) 2018; 27:e12814. [PMID: 29333736 DOI: 10.1111/ecc.12814] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
This study examined how patients with cancer estimate caregiver burden (CB) and the association between their underestimation of CB and their caregivers' self-ratings of their quality of life (CQOLC-K; Korean version of the Caregiver Quality of Life Index-Cancer), depression and anxiety (Korean version of the Hospital Anxiety and Depression Scale). Participants consisted of 990 patient-caregiver dyads recruited from a nationwide cross-sectional survey conducted in South Korea. Medical baseline data were retrieved from the hospital information systems of the participating centres. The patients with cancer who underestimated CB ranged from 18.62% (for physical CB) to 23.33% (for social CB). They had less advanced cancer, a lower income, were the caregiver's spouse, reported higher levels of family avoidance of communication about cancer, and had female caregivers. The patients' underestimation of CB was significantly related to lower CQoL and higher levels of caregiver depression and anxiety. The current study provides empirical evidence for the link between the underestimation of CB by patients with cancer and compromised caregiving experiences of cancer caregivers. Open family communication about cancer was discussed as one of several practical strategies for decreasing patients' underestimation of CB.
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Affiliation(s)
- J Y Shin
- Graduate School of Education, Inha University, Incheon, Republic of Korea
| | - J-W Lim
- College of Social Welfare, Kangnam University, Yongin, Republic of Korea
| | - D W Shin
- Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea.,Supportive Care Center, Samsung Comprehensive Cancer Center, Seoul, Republic of Korea
| | - S Y Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.,Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - H-K Yang
- Cancer Survivoship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - J Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.,Departments of Epidemiology and Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Clinical Epidemiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - A Jeong
- Department of Psychology, University of Utah, Incheon, Republic of Korea
| | - D Jo
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - C-Y Yim
- Division of Hematology-Oncology, Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - K Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - J-H Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea
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15
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Kim EK, Shin JY, Castañeda AM, Lee SJ, Yoon HK, Kim YC, Moon JY. Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea. Korean J Pain 2017; 30:272-280. [PMID: 29123622 PMCID: PMC5665739 DOI: 10.3344/kjp.2017.30.4.272] [Citation(s) in RCA: 3] [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: 06/27/2017] [Revised: 08/19/2017] [Accepted: 08/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. Methods We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information. Results During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value (P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55–0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53–1.08] at 1 year, which was 126% of the baseline (P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy. Conclusions ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.
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Affiliation(s)
- Eun Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Ji Yeon Shin
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Anyela Marcela Castañeda
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Seung Jae Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Hyun Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea.,Integrated Cancer Management Center, Seoul National University Cancer Hospital, Seoul, Korea
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16
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Shin JY, Issenberg SB, Roh YS. The effects of neurologic assessment E-learning in nurses. Nurse Educ Today 2017; 57:60-64. [PMID: 28734188 DOI: 10.1016/j.nedt.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/06/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND A firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes. OBJECTIVES The purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses. DESIGN This study used a non-equivalent control group pretest-posttest design. SETTINGS Nurses working in the neurology and neurosurgery wards, Republic of Korea PARTICIPANTS: A convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26). METHODS The experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest. RESULTS There were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028). CONCLUSIONS Self-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.
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Affiliation(s)
- Ji Yeon Shin
- Chung-Ang University Hospital, Seoul, Republic of Korea.
| | - S Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, USA.
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul, 06974, Republic of Korea.
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17
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Shin JY, Bang KM, Song HK, Kim NK. Structural Studies of Peptide Binding Interaction of HCV IRES Domain IV. Journal of the Korean Magnetic Resonance Society 2017. [DOI: 10.6564/jkmrs.2017.21.3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Albers FC, Cockle S, Gunsoy N, Shin JY, Nelsen LM, Müllerová H. Eligibility for mepolizumab, omalizumab and reslizumab in the EU population: The IDEAL Study. Pneumologie 2017. [DOI: 10.1055/s-0037-1598374] [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: 10/20/2022]
Affiliation(s)
- FC Albers
- GlaxoSmithKline, Research Triangle Park
| | - S Cockle
- GlaxoSmithKline, Stockley Park, Uxbridge
| | - N Gunsoy
- GlaxoSmithKline, Stockley Park, Uxbridge
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19
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Lee DU, Je SH, Yoo SJ, Kwon T, Shin JY, Byun JJ, Park JH, Jeong KW, Ku JM, Lyoo YS. Hematological adverse effects and pharmacokinetics of ribavirin in pigs following intramuscular administration. J Vet Pharmacol Ther 2017; 40:561-568. [PMID: 28205288 DOI: 10.1111/jvp.12394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/14/2016] [Indexed: 11/28/2022]
Abstract
Ribavirin (RBV) is a synthetic guanosine analog that is used as a drug against various viral diseases in humans. The in vitro antiviral effects of ribavirin against porcine viruses were demonstrated in several studies. The purposes of this study were to evaluate the adverse effects and pharmacokinetics of ribavirin following its intramuscular (IM) injection in pigs. Ribavirin was formulated as a double-oil emulsion (RBV-DOE) and gel (RBV-Gel), which were injected into the pigs as single-dose IM injections. After injection of RBV, all of the pigs were monitored. The collected serum and whole blood samples were analyzed by liquid chromatography-tandem mass spectrometry and complete blood count analysis, respectively. All of the ribavirin-treated pigs showed significant decreases in body weight compared to the control groups. Severe clinical signs including dyspnea, anorexia, weakness, and depression were present in ribavirin-treated pigs until 5 days postinjection (dpi). The ribavirin-treated groups showed significant decrease in the number of red blood cells and hemoglobin concentration until 8 dpi. The mean half-life of the RBV-DOE and RBV-Gel was 27.949 ± 2.783 h and 37.374 ± 3.502 h, respectively. The mean peak serum concentration (Cmax ) and area under the serum concentration-time curve from time zero to infinity (AUCinf ) of RBV-DOE were 8340.000 ± 2562.577 ng/mL and 16 0095.430 ± 61 253.400 h·ng/mL, respectively. The Cmax and AUCinf of RBV-Gel were 15 300.000 ± 3764.306 ng/mL and 207526.260 ± 63656.390 h·ng/mL, respectively. The results of this study provided the index of side effect and pharmacokinetics of ribavirin in pigs, which should be considered before clinical application.
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Affiliation(s)
- D-U Lee
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - S H Je
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - S J Yoo
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - T Kwon
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - J Y Shin
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - J J Byun
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - J-H Park
- Center for FMD Vaccine Research, Animal and Plant Quarantine Agency, Gimcheon-si, South Korea
| | - K-W Jeong
- Bio-Center, Gyeonggi Institute of Science and Technology Promotion, Suwon-si, South Korea
| | - J-M Ku
- Bio-Center, Gyeonggi Institute of Science and Technology Promotion, Suwon-si, South Korea
| | - Y S Lyoo
- Department of Immunopathology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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20
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Moon JY, Choi JK, Shin JY, Chon SW, Dev S. A brief report on a technical description of ultrasound-guided lumbar sympathetic block. Korean J Pain 2016; 30:66-70. [PMID: 28119774 PMCID: PMC5256261 DOI: 10.3344/kjp.2017.30.1.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 11/09/2022] Open
Abstract
The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyu Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Shin
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sung Won Chon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sushmitha Dev
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Anesthesiology and Pain Medicine, Apollo Speciality Hospitals, OMR, Chennai, India
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Shin JY, Yoon SJ, Ahn HS, Yun YH. Effects of Per-diem payment on the duration of hospitalization and medical expenses according to the palliative care demonstration project in Korea. Int J Health Plann Manage 2016; 32:e206-e217. [PMID: 27412878 DOI: 10.1002/hpm.2366] [Citation(s) in RCA: 4] [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: 09/08/2015] [Revised: 02/17/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the impacts of a government-directed palliative care demonstration (PCD) project, Per-diem Payment System (PDPS), on length of stay (LOS), hospital costs, resource usage and healthcare quality during the searched period from January in 2009 to December in 2010. STUDY DESIGN A retrospective claim data review. METHODS Individuals who had been eligible for the palliative care payment policy, PDPS, during 2 years (from 2009 to 2010) were assigned to the case group including seven hospitals (n = 3117). Those (seven hospitals) who were not come eligible for the palliative care payment policy were assigned to the control group (n = 2347) with fee for service. The data used in this study were electronically submitted requests of payment to the Health Insurance Review Agency during the period January 2009 to December 2010. RESULTS After the PCD project, the length of stay for palliative patients with cancer diseases decreased by 2.56% (β = -0.026; p-value = 0.0001) among patients hospitalized in a PCD project compared with patients hospitalized in seven hospitals that was not designed as a PCD project. Compared with costs before the PCD project, costs decreased by 0.76% (β = 0.013; p-value = 0.0001). CONCLUSIONS We provided evidence regarding the change in the societal burden due to palliative care. Although there was a reduction of direct medical costs reported in limited number of hospitals, in the long term, we can anticipate an expanding impact on medical costs in all palliative hospitals. Copyright © 2016 John Wiley & Sons, Ltd.
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Yoon J, Lim G, Min J, Park G, Shin JY, Park SI, Cho YJ, Lee YJ. How much are family members satisfied with the intensive care unit in south korea? Intensive Care Med Exp 2015. [PMCID: PMC4798193 DOI: 10.1186/2197-425x-3-s1-a657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jin HS, Shin JY, Kim YC, Lee SC, Choi EJ, Lee PB, Moon JY. Predictive Factors Associated with Success and Failure for Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia. Pain Physician 2015; 18:537-545. [PMID: 26606005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Radiofrequency thermocoagulation (RFT) has been widely used to manage trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for managing TN with RFT can decrease morbidity and improve treatment efficacy. OBJECTIVES The goal of this study was to determine clinical variables related to the treatment outcome in patients with TN undergoing RFT. STUDY DESIGN Retrospective analysis. SETTING University hospital in Korea. METHODS Demographic and clinical data were garnered by billing records for patients with TN who received RFT by one pain physician between January 2005 and August 2014. A successful outcome was pre-defined as at least 50% pain relief on a 0-10 NRS pain score for longer than 6 months after RFT. Variables evaluated for their association with outcome included age, gender, baseline pain score, etiology, type of pain, co-existing psychopathology, and history of previous intervention. RESULTS Among 90 patients who underwent RFT for managing TN, 75 patients (83.3%) reported a successful outcome (> 50% pain relief at 6 months after RFT procedure). Pain characteristics was the most significant predictor associated with successful outcomes of RFT in both univariate and multivariate logistic analysis; odds ratio of provoked paroxysmal pain was 131.516 and mixed type of pain was 20.602 in multivariate analysis. LIMITATIONS Prospective studies are recommended to confirm our findings and ascertain which additional variables can be taken into account to improve the likelihood of a successful outcome for RFT in patients with TN. CONCLUSION A provoked paroxysmal pain or mixed pain condition was associated with a positive outcome for RFT in patients with TN. In addition, bilateral TN, high baseline NRS pain score, or co-morbid psychiatric condition was related with negative outcomes in univariate analysis. Pain clinicians should consider these findings when selecting patients for managing TN to increase the efficacy of RFT. CLINICAL TRIAL REGISTRATION IRB No. 1403-118-569.
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Affiliation(s)
| | - Ji Yeon Shin
- Seoul National University Hospital, Seoul, Korea
| | | | | | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Son ES, Kyung SY, Lee SP, Jeong SH, Shin JY, Ohba M, Yeo EJ, Park JW. Role of protein kinase C-η in cigarette smoke extract-induced apoptosis in MRC-5-cells. Hum Exp Toxicol 2015; 34:869-77. [PMID: 25504686 DOI: 10.1177/0960327114561343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cigarette smoke (CS) is a major risk factor for emphysema, which causes cell death in structural cells of the lung by mechanisms that are still not completely understood. We demonstrated previously that CS extract (CSE) induces caspase activation in MRC-5 human lung fibroblasts, activated protein kinase C-η (PKC-η), and translocated PKC-η from the cytosol to the membrane. The objective of this study was to investigate the involvement of PKC-η activation in a CSE-induced extrinsic apoptotic pathway. We determined that CSE increases expression of caspase 3 and 8 cleavage in MRC-5 cells and overexpression of PKC-η significantly increased expression of caspase 3 and 8 cleavage compared with control LacZ-infected cells. In contrast, dominant negative (dn) PKC-η inhibited apoptosis in MRC-5 cells exposed to CSE and decreased expression of caspase 3 and 8 compared with control cells. Exposure to 10% CSE for >8 h significantly increased lactate dehydrogenase release in PKC-η-infected cells compared with LacZ-infected cells. Additionally, PKC-η-infected cells had an increased number of Hoechst 33342 stained nuclei compared with LacZ-infected cells, while dn PKC-η-infected cells exhibited fewer morphological changes than LacZ-infected cells under phase-contrast microscopy. In conclusion, PKC-η activation plays a pro-apoptotic role in CSE-induced extrinsic apoptotic pathway in MRC-5 cells. These results suggest that modulation of PKC-η may be a useful tool for regulating the extrinsic apoptosis of MRC-5 cells by CSE and may have therapeutic potential in the treatment of CS-induced lung injury.
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Affiliation(s)
- E S Son
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - S Y Kyung
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - S P Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - S H Jeong
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - J Y Shin
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - M Ohba
- Institute of Molecular Oncology, Showa University, Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - E J Yeo
- Department of Biochemistry, School of Medicine, Gachon University, Yeonsu-Gu, Incheon, Republic of Korea
| | - J W Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Gachon University, Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
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Park JS, Kim NK, Kim SH, Lee KY, Lee KY, Shin JY, Kim CN, Choi GS. Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg 2015; 102:1567-73. [PMID: 26312601 DOI: 10.1002/bjs.9914] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/22/2015] [Accepted: 07/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a lack of information regarding the oncological safety of robotic intersphincteric resection (ISR) with coloanal anastomosis. The objective of this study was to compare the long-term feasibility of robotic compared with laparoscopic ISR. METHODS Between January 2008 and May 2011, consecutive patients who underwent robotic or laparoscopic ISR with coloanal anastomosis from seven institutions were included. Propensity score analyses were performed to compare outcomes for groups in a 1 : 1 case-matched cohort. The primary endpoint was 3-year disease-free survival. RESULTS A total of 334 patients underwent ISR with coloanal anastomosis, of whom 212 matched patients (106 in each group) formed the cohort for analysis. The overall rate of conversion to open surgery was 0.9 per cent in the robotic ISR group and 1.9 per cent in the laparoscopic ISR group. Nine patients (8.5 per cent) in the laparoscopic group and three (2.8 per cent) in the robotic ISR group still had a stoma at last follow-up (P = 0.075). Total mean hospital costs were significantly higher for robotic ISR (€ 12,757 versus € 9223 for laparoscopic ISR; P = 0.037). Overall 3-year local recurrence rates were similar in the two groups (6.7 per cent for robotic and 5.7 per cent for laparoscopic resection; P = 0.935). The combined 3-year disease-free survival rates were 89.6 (95 per cent c.i. 84.1 to 95.9) and 90.5 (85.4 to 96.6) per cent respectively (P = 0.298). CONCLUSION Robotic ISR with coloanal anastomosis for rectal cancer has reasonable oncological outcomes, but is currently too expensive with no short-term advantages.
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Affiliation(s)
- J S Park
- Departments of Surgery, Kyungpook National University Medical Centre, Kyungpook National University School of Medicine, Daegu, Korea
| | - N K Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - S H Kim
- Korea University Anam Hospital, Seoul, Korea
| | - K Y Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - K Y Lee
- Kyung Hee University, Seoul, Korea
| | - J Y Shin
- Inje University Paik-Hospital, Pusan, Korea
| | - C N Kim
- Eulji University Hospital, Daejeon, Korea
| | - G-S Choi
- Departments of Surgery, Kyungpook National University Medical Centre, Kyungpook National University School of Medicine, Daegu, Korea
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Cho HS, Lee SW, Kim ES, Mo EY, Shin JY, Moon SD, Han JH. Clinical significance of serum bilirubin and gamma-glutamyltransferase levels on coronary atherosclerosis assessed by multidetector computed tomography. Nutr Metab Cardiovasc Dis 2015; 25:677-685. [PMID: 26026212 DOI: 10.1016/j.numecd.2015.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 01/19/2015] [Accepted: 03/26/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Low bilirubin and high gamma-glutamyltransferase (GGT), which are endogenous markers of oxidative stress, confer a higher risk of cardiovascular disease (CVD). We investigated associations between serum concentrations of bilirubin, GGT and coronary atherosclerosis. METHODS AND RESULTS A cross-sectional analysis was performed on 1520 subjects who underwent multidetector computed tomography scans. Coronary atherosclerosis was assessed by coronary artery calcium score (CACS) and obstructive coronary artery disease (OCAD), was defined as the presence of coronary artery stenosis of ≥50%. Total bilirubin (TB) level was negatively correlated with CACS and coronary stenosis whereas GGT level was positively correlated with CACS in men. However, there was no correlation between TB, GGT levels and either CACS or coronary artery stenosis in women. In a multivariate-adjusted model, TB level was inversely associated with a CACS > 100 [odds ratio (OR) per log standard deviation (SD), 0.67; 95% confidence interval (CI), 0.52-0.87], and OCAD (OR per log SD, 0.77; 95% CI, 0.62-0.95) in men. By contrast, GGT level was positively associated with a CACS > 100 (OR per log SD, 1.35; 95% CI, 1.05-1.73) but not with OCAD. Adding TB and GGT to the conventional risk factors increased predictive accuracy for CACS > 100 (net reclassification improvement index [NRI] = 13.1%, P = 0.026; integrated discrimination index [IDI] = 0.024, P = 0.001) and for OCAD (NRI = 12.6%, P = 0.026; IDI = 0.010, P = 0.013). CONCLUSIONS Low TB and high GGT levels were concomitantly associated with coronary atherosclerosis in Korean men. Future studies are needed to elucidate the causal associations of TB and GGT with CVD.
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Affiliation(s)
- H S Cho
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Health Promotion Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - S W Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - E S Kim
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
| | - E Y Mo
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - J Y Shin
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Health Promotion Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - S D Moon
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - J H Han
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea
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Shin JY, Cho BK, Park HJ. A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines. Ann Dermatol 2014; 26:280-3. [PMID: 24882996 PMCID: PMC4037694 DOI: 10.5021/ad.2014.26.2.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/06/2013] [Accepted: 05/21/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ji Yeon Shin
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Baik Kee Cho
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Choi ES, Shin JY, Oh AY, Park HP, Hwang JW, Lim YJ, Jeon YT. Sevoflurane versus propofol for interventional neuroradiology: a comparison of the maintenance and recovery profiles at comparable depths of anesthesia. Korean J Anesthesiol 2014; 66:290-4. [PMID: 24851164 PMCID: PMC4028556 DOI: 10.4097/kjae.2014.66.4.290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 05/28/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022] Open
Abstract
Background Sevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia. Methods The patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 µg/ml), alfentanil (5 µg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded. Results Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05). Conclusions The use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.
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Affiliation(s)
- Eun-Su Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Yeon Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Shin JY, Kim DW, Park CW, Seo SJ, Park YL, Lee JR, Kim MB, Kim KH, Ro YS, Cho SH. An educational program that contributes to improved patient and parental understanding of atopic dermatitis. Ann Dermatol 2014; 26:66-72. [PMID: 24648688 PMCID: PMC3956797 DOI: 10.5021/ad.2014.26.1.66] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
Background Providing an educational program as part of a health care program for the management of atopic dermatitis (AD) patients has rapidly become popular. AD educational programs can be of benefit in measured outcomes for both dermatology specialists and patients. Objective To determine the effects of programmed education delivered by dermatology specialists on the management and knowledge of AD, we assessed the effectiveness of patient/parental education at improving AD knowledge, and determined the usefulness of the education. Methods The program consisted of five, 20-minutes sessions which were prepared, discussed, reviewed, and delivered by professors of dermatology. At the end of the program, AD knowledge was assessed using a standardized questionnaire. A total of 148 people were included. Fifty-eight patients/parents received the programmed education and the remaining 90 did not receive the programmed education. Results The mean questionnaire scores from both groups were compared. Mean knowledge scores were significantly higher for those who received the education (p=0.00). We analyzed the knowledge score according to factors such as gender, education level, marital status, and occupation. The data indicated that education level influences the subjects' knowledge level of AD, but gender, occupation, and marital status do not. Conclusion An educational program can be an effective tool to improve patient quality of life and treatment compliance by providing psychological support to the patients and their parents.
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Affiliation(s)
- Ji Yeon Shin
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, School of Medicine, Incheon, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chun Wook Park
- Department of Dermatology, Hallym University College of Medicine, Chuncheon, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Rok Lee
- Department of Dermatology, Gachon University of Medicine and Science, Incheon, Korea
| | - Moon Bum Kim
- Department of Dermatology, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, School of Medicine, Incheon, Korea
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Park SY, Ahn SK, Kim HY, Shin JY, Min S. Referred pain in right arm from abdominal wall pseudoaneurysm. Korean J Pain 2013; 26:191-4. [PMID: 23614085 PMCID: PMC3629350 DOI: 10.3344/kjp.2013.26.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 12/30/2012] [Indexed: 11/26/2022] Open
Abstract
Pseudoaneurysm of the abdominal wall is a possible but very rare clinical entity. It is a known complication of surgery, trauma, or arterial puncture, but it is rarely spontaneous. Even though it can usually present with a wide range of local symptoms, it can cause referred pain via spinal cord, which is cross-excited with afferent sympathetic nervous system. We report a case of right arm pain which was referred from a small abdominal pseudoaneurysm like a referred pain from gall bladder. This rare entity should be considered in the differential for pain management in case that the pain does not resolve with medication or interventional pain management.
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Affiliation(s)
- Soo Young Park
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Seoul, Korea
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Shin JY, Lee YB, Cho BK, Park HJ. New world cutaneous leishmaniasis treated with intralesional injection of pentavalent antimony. Ann Dermatol 2013; 25:80-3. [PMID: 23467266 PMCID: PMC3582933 DOI: 10.5021/ad.2013.25.1.80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 01/24/2011] [Accepted: 02/16/2011] [Indexed: 11/08/2022] Open
Abstract
Cutaneous leishmaniasis is a skin infection caused by the Leishmania species, an intracellular protozoan parasite that is transmitted by various species of female sandflies. According to the geographic distribution and vectors, leishmaniasis is classified as Old World or New World cutaneous leishmaniasis. In Korea, 24 cases of Old World cutaneous leishmaniasis have been reported, but New World cutaneous leishmaniasis has not been reported as yet. A 37-year-old man presented with a 3-month history of a painful and erythematous nodule with two satellite papules on the left postauricular area and a papule on the left arm after traveling to the Amazon region in Brazil. After we performed skin biopsies of the lesions, diagnosis of cutaneous leishmaniasis was made by the histopathological findings. After intralesional injection of sodium stibogluconate (Pentostam®, GlaxoSmithKline) twice a week for 4 weeks, the lesions improved with scarring. Herein, we discuss this case of New World cutaneous leishmaniasis that was successfully treated with intralesional injection of sodium stibogluconate (Pentostam®) in Korea.
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Affiliation(s)
- Ji Yeon Shin
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Deferral of blood donors taking teratogenic drugs is critical. From March 2008 to January 2009, we analysed stored blood specimens from donors who had taken teratogenic drugs and whose blood was transfused to women of childbearing age to determine the plasma concentration at the time of donation using high-performance liquid chromatography. In total, 167 specimens were examined. The numbers of specimens exceeding the quantification limit were 7, 39, 4, 2 and 1 for finasteride, isotretinoin, acitretin, etretinate and dutasteride, respectively. Finasteride was beyond the recommended drug deferral period in one specimen. These results may help create practical deferral policies.
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Affiliation(s)
- S Y Shin
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, South Korea
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Abstract
This paper is about a glass-type wireless bio-signal transmitter that can monitor the user's health state in daily life. The device implemented in this study consists of the transmission part and the receiving part. The transmission part includes a photoplethysmography(PPG) sensor for detecting pulse wave signals, accelerometer for detecting kinetic signals, and a wireless controller for transmitting acquired bio-information. The receiving part is designed to check and process transmitted data through interoperation with a PC. In the experiments, we collected data during a sitting posture and repeated sit-to-stand motion in laboratory environment, and analyzed the data. As to accuracy, the correlation between the peak-to-peak intervals in the signals of the Biopac equipment and the developed device measured in a sitting posture was 97.5%, and that measured in sit-to-stand motion was 87%. In addition, when bio-signals were transmitted through wireless communication, the transmission was successful 100% without any error. When pulse wave signals and kinetic signals were obtained and compared, the results proved the accuracy and daily applicability of the developed device, and the glass-type wireless bio-signal transmission system is expected to be applicable to unobtrusive health monitoring for the user.
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Affiliation(s)
- E M Lee
- Department of Biomedical Engineering, College of Medicine, Chungbuk National University, South Korea.
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Abstract
Heart sound occurs when the heart contracts and expands. It provides information on myocardial contractility and blood vessels, which is not obtainable from ECG. For this reason, stethoscopy of heart sound in anesthesiology is a very crucial means for acquiring cardiac information and preventing intraoperative medical accidents, and it requires a system for precise objective measurement and analysis of heart sound and murmur. Thus, this study purposed to develop portable digital esophageal stethoscope (PDES) that can objectify and quantify heart sound and murmur. In this study, we designed PDES for precise measurement and analysis of heart sound and murmur data. Heart sound information obtained by inserting the sensor of the PDES into the patient's esophagus can be transmitted to a terminal or a PC and displayed on the screen The amplitude and waveform of heart sound are displayed using self-developed software Heart Sound 1.0. The results of experiment with the developed PDES showed that data on the amplitude and waveform of heart sound and murmur were produced stably in real-time. In addition, when heart sound was heard using a headphone, the sound was clear without external murmur. The PDES developed in this study, which complements the disadvantages of traditional esophageal stethoscope while preserving its advantages, could not only examine heart sound and murmur using an esophageal catheter but also display the amplitude and waveform of heart sound and murmur and measure the patient's body temperature. Accordingly, the developed PDES is expected to be useful in the continuous stethoscopy of heart sound during operation and to contribute to research on heart sound by providing heart sound data.
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Affiliation(s)
- J Y Shin
- Department of Biomedical Engineering, College of Medicine, Chungbuk, National University, Cheongju, South Korea.
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Kim JH, Kim JH, Yu YS, Shin JY, Lee HY, Kim KW. Deguelin inhibits retinal neovascularization by down-regulation of HIF-1alpha in oxygen-induced retinopathy. J Cell Mol Med 2009; 12:2407-15. [PMID: 18208562 PMCID: PMC4514118 DOI: 10.1111/j.1582-4934.2008.00243.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Retinal neovascularization is the most common cause of blindness; Retinopathy of pre-maturity (ROP) for children and diabetic retinopathy for young age group. ROP still remains as the most serious cause of vision loss in children. We provided that deguelin significantly reduces retinal neovascularization in a mouse model of ROP. Deguelin never affected the transcriptional activity of hypoxia inducible factor (HIF)-1, however, reduced HIF-1 expression, which led to the decrease of vascular endothelial growth factor expression. Deguelin effectively suppressed endothelial cell proliferation without cytotoxic effect under therapeutic concentration range. In addition, deguelin demonstrated no reduction or retardation in normal retinal development and no retinal toxicity. These data suggest deguelin is a potent inhibitor of retinal neovascularization and may be applied in the treatment of other vasoproliferative retinopathies.
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Affiliation(s)
- J H Kim
- Department of Ophthalmology, College of Medicine, Seoul National University & Seoul Artifical Eye Center Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Shin JY, Nhan NV, Lee SB, Crittenden KS, Flory M, Hong HTD. The effects of a home-based intervention for young children with intellectual disabilities in Vietnam. J Intellect Disabil Res 2009; 53:339-352. [PMID: 19309420 DOI: 10.1111/j.1365-2788.2008.01151.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study was conducted to examine the impact of a 1-year intervention for children with intellectual disabilities (ID) in Vietnam. METHOD Subjects were 30 preschool-aged children with ID (ages 3 to 6 years). Sixteen were assigned to an intervention group and 14 to a control group. Based on the Portage Curriculum (CESA 5 2003), the intervention trained parents to work with their children through modelling and coaching by teachers during weekly home visits. RESULTS Comparison of pre-, mid- and post-intervention assessments of the children based on the Vineland Adaptive Behavior Scales (Sparrow et al. 1984a) indicated that the intervention was promising: children in the intervention group improved significantly in most domains of adaptive behaviours, and also performed significantly better than the control group in the areas of personal care and motor skills. CONCLUSIONS The results from the Vietnam programme are discussed in terms of its implications and strategies for developing programmes for children with disabilities in developing countries.
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Affiliation(s)
- J Y Shin
- Department of Psychology, Hofstra University, Hempstead, New York, USA.
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Kim HY, Lee SB, Chung YH, Lim CH, Yu IJ, Park SC, Shin JY, Kim SH, Shin DH, Kim JC. Evaluation of Subchronic Inhalation Toxicity of Dimethyl Disulfide in Rats. Inhal Toxicol 2008; 18:395-403. [PMID: 16513596 DOI: 10.1080/08958370500516291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study was carried out to investigate the potential subchronic inhalation toxicity of dimethyl disulfide (DMDS) via whole-body exposure in F344 rats. Groups of 10 rats of each sex were exposed to DMDS vapor by whole-body exposure at concentrations of 0, 5, 25, or 125 ppm for 6 h/day, 5 days/wk for 13 wk. All the rats were sacrificed at the end of treatment period. During the test period, clinical signs, mortality, body weights, food consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, gross findings, organ weights, and histopathology were examined. At 25 ppm, a decrease in the body weight gain, food intake, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and blood urea nitrogen (BUN) was observed in the males, but not in the females. However, at 125 ppm, a decrease in the body weight gain, food intake, and thymus weight and an increase in the weights of adrenal glands were observed in both genders. Serum biochemical investigations revealed a decrease in the AST, ALT, BUN, creatine phosphokinase (CPK), and triglyceride levels and an increase in the glucose level. In contrast, no treatment-related effects were observed in the 5 ppm group. The toxic potency of DMDS was slightly higher in males than that in females. In these experimental conditions, the target organ was not determined in rats. The no-observed-adverse-effect concentration (NOAEC) was found to be 5 ppm, 6 h/day for male rats and 25 ppm, 6 h/day for female rats.
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Affiliation(s)
- H Y Kim
- Industrial Chemicals Research Center, Industrial Safety and Health Research Institute, Korea Industrial Safety Corporation, Daejeon, South Korea
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Lee MY, Koh SB, Koh JH, Nam SM, Shin JY, Shin YG, Kong ID, Ryu SY, Lee TY, Park JK, Chung CH. Relationship between gamma-glutamyltransferase and metabolic syndrome in a Korean population. Diabet Med 2008; 25:469-75. [PMID: 18346161 DOI: 10.1111/j.1464-5491.2008.02415.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate associations between gamma-glutamyltransferase (GGT) and components of metabolic syndrome (MS), insulin resistance and inflammatory markers in the Korean population. METHODS The 3508 subjects enrolled in this survey participated in the Korean Rural Genomic Cohort (KRGC) study. Written consent was obtained from the local ethical committee. Of these participants, 1437 were men (mean age 56.9 +/- 7.9 years) and 2071 were women (mean age 55.8 +/- 8.1 years). We measured GGT levels and various biochemical markers. To examine insulin resistance status, we used the homeostasis assessment method for insulin resistance (HOMA-IR). For inflammatory marker, we used C-reactive protein (CRP) levels. RESULTS Serum GGT levels were significantly higher in the MS group compared to the healthy patient group [23 (5-1403) vs. 19 (5-1920) IU/l; P = 0.01]. The prevalence of MS and adjusted relative risk were both significantly increased from the lowest to highest GGT quartiles; these results persisted after adjustments for multiple confounders. Positive correlations were established between GGT and HOMA-IR or CRP. CONCLUSION These results suggest that GGT levels may be a surrogate marker of insulin resistance, inflammation and MS.
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Affiliation(s)
- M Y Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Abstract
The roles of particles and natural organic matter (NOM) in determining coagulant (alum) doses in potable water treatment were investigated at two pH conditions (6 and 7). The concentrations of NOM and colloidal silica particles in raw water were systematically varied separately and in combination, and the impacts of these two classes of contaminants on the minimum effective alum doses were investigated using observations of turbidity and dissolved organic carbon (DOC) in laboratory jar tests. At both pHs, coagulant requirements for the removal of these contaminants by sedimentation and filtration were dominated by the DOC concentration in the raw water. The presence of low NOM concentrations (0.75-1.5 mg of C/L) decreased the minimum effective alum dose dramatically for waters low in silica particles, possibly by promoting the precipitation of aluminum hydroxide and/or Al-NOM solids, whose removal would otherwise be limited by low collision opportunities. Strong stoichiometric relationships were observed between DOC and coagulant demand at both pHs regardless of silica particle concentration. Silica contributed to coagulant demand only at very high particle concentrations.
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Affiliation(s)
- J Y Shin
- Geography and Environmental Engineering, The Johns Hopkins University, Baltimore, Maryland 21218, USA
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Chan JK, Kapp DS, Cheung MK, Osann K, Shin JY, Cohn D, Seid PL. The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients. Br J Cancer 2007; 97:605-11. [PMID: 17667929 PMCID: PMC2360356 DOI: 10.1038/sj.bjc.6603898] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of the study was to determine the impact of the absolute number and ratio of positive lymph nodes on the survival in node-positive endometrioid uterine cancer. Data were obtained from the National Cancer Institute Registry from 1988 to 2001. Analyses were performed using Kaplan–Meier and Cox proportional hazard methods. A total of 1222 women were diagnosed with stage IIIC-IV node-positive endometrioid corpus cancer. The 5-year disease-specific survival of women with 1, 2–5, and >5 positive nodes were 68.1, 55.1, and 46.1%, respectively (P<0.001). Increasing lymph node ratio, expressed as a percentage of positive nodes to total nodes identified (⩽10, >10–⩽50, and >50%), was associated with a decrease in survival from 77.3 to 60.7 to 40.9%, respectively (P<0.001). The absolute number of positive nodes and the lymph node ratio remained significant after adjusting for stage (IIIC vs IV) and the extent of lymphadenectomy (⩽20 vs >20 nodes). On multivariate analysis, the absolute number of positive nodes and lymph node ratio were significant independent prognostic factors for survival. Increasing absolute number of positive nodes and lymph node ratio are associated with a poorer survival in women with node-positive uterine cancers. The stratification of node-positive uterine cancer for prognostic and treatment purposes warrants further investigation.
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Affiliation(s)
- J K Chan
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco Comprehensive Cancer Center, San Francisco, CA 94143, USA.
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Chan JK, Urban R, Hu JM, Shin JY, Husain A, Teng NN, Berek JS, Osann K, Kapp DS. The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13918 patients. Br J Cancer 2007; 96:1817-22. [PMID: 17519907 PMCID: PMC2359970 DOI: 10.1038/sj.bjc.6603803] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of the study is to determine the role of lymphadenectomy in advanced epithelial ovarian cancer. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program reported between 1988 and 2001. Kaplan–Meier estimates and Cox proportional hazards regression models were used for analysis. Of 13 918 women with stage III–IV epithelial ovarian cancer (median age: 64 years), 87.9% were Caucasian, 5.6% African Americans, and 4.4% Asians. A total of 4260 (30.6%) underwent lymph node dissections with a median number of six nodes reported. For all patients, a more extensive lymph node dissection (0, 1, 2–5, 6–10, 11–20, and >20 nodes) was associated with an improved 5-year disease-specific survival of 26.1, 35.2, 42.6, 48.4, 47.5, and 47.8%, respectively (P<0.001). Of the stage IIIC patients with nodal metastases, the extent of nodal resection (1, 2–5, 6–10, 11–20, and >20 nodes) was associated with improved survivals of 36.9, 45.0, 47.8, 48.7, and 51.1%, respectively (P=0.023). On multivariate analysis, the extent of lymph node dissection and number of positive nodes were significant independent prognosticators after adjusting for age, year at diagnosis, stage, and grade of disease. The extent of lymphadenectomy is associated with an improved disease-specific survival of women with advanced epithelial ovarian cancer.
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Affiliation(s)
- J K Chan
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, 1600 Divisadero Street, Box 1702, San Francisco, CA 94143, USA.
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Chan JK, Urban R, Cheung MK, Osann K, Husain A, Teng NN, Kapp DS, Berek JS, Leiserowitz GS, Shin JY. Erratum: Ovarian cancer in younger vs older women: a population-based analysis. Br J Cancer 2007. [PMCID: PMC2360018 DOI: 10.1038/sj.bjc.6603601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kim JC, Shin JY, Yang YS, Shin DH, Moon CJ, Kim SH, Park SC, Kim YB, Kim HC, Chung MK. Evaluation of developmental toxicity of amitraz in Sprague-Dawley rats. Arch Environ Contam Toxicol 2007; 52:137-44. [PMID: 17083001 DOI: 10.1007/s00244-006-0021-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 07/12/2006] [Indexed: 05/12/2023]
Abstract
This study investigated the potential adverse effects of amitraz on the initiation and maintenance of pregnancy in Sprague-Dawley rats as well as its effects on embryo-fetal development after maternal exposure during the entire pregnancy period. Amitraz was administered to pregnant rats by gavage from days 1 to 19 of gestation at dose levels of 0, 3, 10, and 30 mg/kg/day. All dams underwent a caesarean section on day 20 of gestation and their fetuses were examined for any external, visceral, and skeletal abnormalities. At 30 mg/kg, maternal toxicity manifested as an increase in the incidence of abnormal clinical signs and a lower body weight gain and food intake. Developmental toxicity included an increase in the fetal death rate, a decrease in the litter size, and a reduction in the fetal body weight. In addition, there was an increase in the incidence of fetal external, visceral, and skeletal abnormalities. At 10 mg/kg, maternal toxicity observed included a decrease in the body weight gain and a decrease in food intake. In addition, minimal developmental toxicity, including a decrease in the fetal body weight, an increase in the visceral and skeletal aberrations, and a delay in fetal ossification. There were no signs of either maternal toxicity or developmental toxicity at 3 mg/kg. These results show that amitraz administered during the entire pregnancy period in rats is embryotoxic and teratogenic at the maternally toxic dose (i.e., 30 mg/kg/day) and is minimally embryotoxic at a minimally maternally toxic dose (i.e., 10 mg/kg/day). Under these experimental conditions, the no-observed-adverse-effect level of amitraz for both dams and embryo-fetal development is estimated to be 3 mg/kg/day.
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Affiliation(s)
- J C Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju, 500-757, South Korea.
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Chan JK, Urban R, Cheung MK, Osann K, Shin JY, Husain A, Teng NN, Kapp DS, Berek JS, Leiserowitz GS. Ovarian cancer in younger vs older women: a population-based analysis. Br J Cancer 2006; 95:1314-20. [PMID: 17088903 PMCID: PMC2360593 DOI: 10.1038/sj.bjc.6603457] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan–Meier estimates. Of 28 165 patients, 400 were <30 years (very young), 11 601 were 30–60 (young), and 16 164 were >60 (older) years of age. Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I–II disease, respectively (P<0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P<0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16–40 years) women with stage I–II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P=0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients.
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Affiliation(s)
- J K Chan
- Division of Gynecologic Oncology, Stanford, CA 94305, USA.
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Abstract
Laboratory dual media filtration experiments were conducted (a) in direct filtration mode using model raw water moderate in turbidity and low in DOC, and (b) in conventional filtration mode treating water moderate in turbidity and high in DOC. Model simulations of filter performance for the removal of particles provided hypotheses for the experimental studies of dual media filtration. An increase in alum dose in direct filtration mode, while improving filter performance, also showed some disadvantages, including rapid development of head loss. Suboptimal dose in direct filtration significantly impaired the filter performance. In conventional mode, the effect of alum dose on the filter performance, while obvious, was not as dramatic as in direct filtration. Ripening indicated by particle counts occurred earlier than by turbidity and breakthrough of particle counts started earlier than breakthrough of turbidity, suggesting that turbidity can be used as a more conservative monitor of filter performance during the ripening period to minimise the risk of passage of small particles, while particle counts can be considered a more sensitive indicator of deteriorating filter performance during the breakthrough period. The lower sand layer served as a multiple barrier for particle when the performance of the anthracite layer was not effective.
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Affiliation(s)
- J Y Shin
- Washington Suburban Sanitary Commission, Laurel, Maryland 20707, USA.
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Abstract
The intracellular proteinase of Lactobacillus casei ssp. casei LLG was isolated in the cytoplasmic fraction with 0.05 M Tris-HCl buffer (pH 7.5). The enzyme was purified by the fast protein liquid chromatography system equipped with ion-exchange and gel filtration chromatographies. This proteinase comprised a single monomeric form and had a molecular weight of about 55 kDa and an isoelectric point near pH 4.9. The optimum pH and temperature for the enzyme activity were determined to be pH 6.5 and 37 degrees C, respectively. The enzyme was inactivated by metal-chelating compounds (EDTA, 1,10-phenanthroline) and less affected by serine proteinase inhibitors (diisopropylfluorophosphate, phenylmethylsulfonyl fluoride). Proteinase activity was increased by Ca++, Mn++, and Co++, and inhibited by Cu++, Mg++, and Zn++. The activity of this enzyme to hydrolyze casein appeared to be more active on beta-casein than alphas1-casein and kappa-casein as monitored by polyacrylamide gel electrophoresis.
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Affiliation(s)
- J Y Shin
- Department of Food Science and Agricultural Chemistry, McGill University, 21,111 Lakeshore Road, Ste-Anne-de-Bellevue, Quebec Canada H9X 3V9
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Kim J, Suh SW, Shin JY, Kim JH, Choi YS, Kim H. Replacement of a tracheal defect with a tissue-engineered prosthesis: early results from animal experiments. J Thorac Cardiovasc Surg 2004; 128:124-9. [PMID: 15224031 DOI: 10.1016/j.jtcvs.2003.09.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The major problems in the development of tracheal prosthesis are anastomotic dehiscence and stenosis, caused by poor epithelialization of the prosthetic graft. We developed a novel tracheal prosthesis with viable mucosa transplanted from the oral cavity and reported excellent long-term results after thoracic tracheal replacements in dogs. In the current study, we used tissue-engineering techniques to construct a mucosal prosthetic lining from skin cells and evaluated its usefulness in tracheal replacement. METHODS Abdominal skin patches (5 x 10 cm) were harvested from 10 adult mongrel dogs. The epithelial cells were separated, cultured in vitro for 4 weeks, and then seeded onto a porous polylactic glycolic acid scaffold (6 x 8 cm) to construct a lining mucosa. This was then mounted onto the prosthesis framework, made with polypropylene mesh reinforced with polypropylene rings. The mucosa-lined prosthesis was wrapped with the greater omentum of the same dog and placed in the peritoneal cavity for 1 week. Complete surgical resection and replacement of a thoracic tracheal segment (5 cm in length, just above the carina) was then performed using the prosthesis. RESULTS The animals regained full activity and survived with normal activity. Bronchoscopy at 1 week and at 1 and 2 months revealed no stenosis in the anastomosis. CONCLUSIONS This highly biocompatible tracheal prosthesis could prove useful for the reconstruction of large, circumferential tracheal defects.
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Affiliation(s)
- Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
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Shin JY, Lee SK, Kang CD, Chung JS, Lee EY, Seo SY, Lee SY, Baek SY, Kim BS, Kim JB, Yoon S. Antitumor effect of intratumoral administration of dendritic cell combination with vincristine chemotherapy in a murine fibrosarcoma model. Histol Histopathol 2003; 18:435-47. [PMID: 12647794 DOI: 10.14670/hh-18.435] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A new antitumor therapeutic strategy utilizing the combined effect of chemotherapy and DC (dendritic cell)-based immunotherapy was designed, and the effect of intratumoral injections of unpulsed, immature DCs was evaluated after in vivo pretreatment of vincristine on tumor growth in a murine fibrosarcoma tumor model. Vincristine exerted a much more potent apoptosis/necrosis-inducing effect on MCA-102 tumor cells than on DCs both in vitro and in vivo. Moreover, CD11c, CD40, CD80 and CD86 molecules on DCs were not downregulated after treatment with vincristine either in vitro or in vivo. The growth of tumor significantly regressed in the group which received the combined vincristine chemotherapy with intratumoral administration of DCs in contrast to the untreated group, the group treated with DCs alone, and the group treated with vincristine alone. In particular, an upregulated expression of CD40, CD80 and CD86 molecules on DCs was found in the combination treatment group. Furthermore, the number of CD4+ and CD8+ T cells and the staining intensity of their CD4 and CD8 surface molecules also increased after the combination treatment. Therefore, our results indicate the feasibility of this combination therapy with vincristine chemotherapy and DC-based immunotherapy as an efficient antitumor strategy for the treatment of fibrosarcoma.
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Affiliation(s)
- J Y Shin
- Department of Anatomy, College of Medicine, Pusan National University, Seo-Gu, Pusan, South Korea
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Nam JH, Yu CH, Hwang KA, Kim S, Ahn SH, Shin JY, Choi WY, Joo YR, Park KY. Application of cDNA microarray technique to detection of gene expression in host cells infected with viruses. Acta Virol 2003; 46:141-6. [PMID: 12580375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
cDNA microarray technique was used to monitor changes in mRNA levels in cells after Hantaan virus (HTNV) infection. The values of the ratio of medians for HTNV and Japanese encephalitis virus (JEV) at the early stage of infection were compared and found similar, suggesting that the same or similar genes are associated with the early events of infection with either virus. The reproducibility of values of the "ratio of medians" for HTNV was examined. We found that applying cluster analysis to the gene expression data groups efficiently together genes with the same function. Therefore, in analyzing the effects of viral infection on host cells by the cDNA microarray technique, clustering data appear to be necessary for gaining biological meaning from a dump of gene expression profiles obtained from virus-infected cells.
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Affiliation(s)
- J H Nam
- Department of Virology, Korean National Institute of Health, 5 Nokbun-dong, Eunpyung-gu, Seoul, 122-701, Korea.
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Kim HS, Shin JY, Yun JY, Ahn DK, Le JY. Immortalization of human embryonic fibroblasts by overexpression of c-myc and simian virus 40 large T antigen. Exp Mol Med 2001; 33:293-8. [PMID: 11795494 DOI: 10.1038/emm.2001.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
SV40 large T antigen, a viral oncoprotein, is known to immortalize human diploid fibroblast by soaking up cellular RB and p53, but its frequency is extremely low. Additional genetic alteration is necessary for single-step immortalization. We attempted to find out what this alteration is by overexpressing cellular signal mediator genes; c-myc and cyclin D frequently amplified in many cancer cells. Overexpression of cyclin D did not affect the immortalization, but, overexpression of c-myc along with T antigen could immortalize normal human diploid fibroblast. Several cellular markers tested during immortalization process showed that p21, a cyclin-dependent kinase inhibitor and a marker of cellular senescence, disappeared in the life span-extended cells by T antigen and in the immortalized cells by c-myc. p21 was, however, elevated in the senescent cells and in the cells of crisis. Interestingly, p16 was upregulated whenever T antigen is overexpressed. Telomerase activity was also activated only in the immortalized cells. These results suggest that overexpression of c-myc contributes to immortalization of human diploid fibroblast by activating telomerase activity and suppressing p21 activity.
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Affiliation(s)
- H S Kim
- Department of Biochemistry, College of Medicine, Hallym University, Chunchon, Kangwon-do, Korea
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