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Saygin D, DiRenzo D, Raaphorst J, de Groot I, Bingham CO, Lundberg IE, Regardt M, Sarver C, de Visser M, Maxwell LJ, Beaton D, Kim JY, Needham M, Alexanderson H, Christopher-Stine L, Mecoli CA, Park JK. Responsiveness and meaningful thresholds of PROMIS pain interference, fatigue, and physical function forms in adults with idiopathic inflammatory myopathies: Report from the OMERACT Myositis Working Group. Semin Arthritis Rheum 2024; 64:152339. [PMID: 38141522 DOI: 10.1016/j.semarthrit.2023.152339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND A series of qualitative studies conducted by the OMERACT Myositis Working Group identified pain interference, fatigue, and physical function as highly important life impact domains for adults with idiopathic inflammatory myositis (IIM). In this study, our goal was to assess the responsiveness and minimal important difference of PROMIS pain interference (6a), fatigue (7a), and physical function (8b). METHODS Adults with IIM from USA, Netherlands, Korea, Sweden, and Australia with two "clinical" visits were enrolled in this prospective study. Anchor questions on a Likert scale were collected at baseline, and manual muscle testing (MMT), physician and patient reported global disease activity, and PROMIS instruments were collected at both visits. Responsiveness was assessed with i) ANOVA, ii) paired t-test, effect size and standardized response mean, and iii) Pearson correlation. Minimal important difference (MID), minimal important change (MIC) and minimal detectable change (MDC) values were calculated. RESULTS 114 patients with IIM (median age 60, 60 % female) completed both visits. Changes in PROMIS instruments were significantly different among anchor categories. Patients who reported improvement had a significant improvement in their PROMIS scores with at least medium effect size, while patients who reported worsening and stability did not show a significant change with weak effect size. PROMIS instruments had weak to moderate correlations with MMT, patient and physician global disease activity. MID was approximately 2-3 points for Pain Interference and 3-4 points for Fatigue and Physical Function forms based on the method used. MIC was approximately 4-5 for improvement of all the instruments, while MDC was 1.7-2 points for Pain Interference and Physical Function and 3.2-3.9 for Fatigue. CONCLUSION This study provides evidence towards the responsiveness of the PROMIS instruments in a large international prospective cohort of adults with IIM supporting their use as PROMs in adult myositis.
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Affiliation(s)
- D Saygin
- Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - D DiRenzo
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - J Raaphorst
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | | | - C O Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University, Stockholm, Sweden
| | - M Regardt
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet and Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - M de Visser
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - D Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - J Y Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - M Needham
- Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and University of Notre Dame, Perth, Australia
| | - H Alexanderson
- Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital and Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - C A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - J K Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea.
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2
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Kwon M, Joung CI, Shin H, Lee CC, Song YS, Lee YJ, Kang S, Kim JY, Lee S. Detection of novel drug-adverse drug reaction signals in rheumatoid arthritis and ankylosing spondylitis: analysis of Korean real-world biologics registry data. Sci Rep 2024; 14:2660. [PMID: 38302579 PMCID: PMC10834537 DOI: 10.1038/s41598-024-52822-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
This study aimed to detect signals of adverse drug reactions (ADRs) associated with biological disease-modifying antirheumatic drugs (DMARDs) and targeted therapies in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients. Utilizing the KOrean College of Rheumatology BIOlogics & Targeted Therapy Registry (KOBIO) data, we calculated relative risks, excluded previously reported drug-ADR pairs, and externally validated remaining pairs using US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and single centre's electronic health records (EHR) data. Analyzing data from 2279 RA and 1940 AS patients, we identified 35 significant drug-ADR pairs in RA and 26 in AS, previously unreported in drug labels. Among the novel drug-ADR pairs from KOBIO, 15 were also significant in the FAERS data. Additionally, 2 significant drug-laboratory abnormality pairs were found in RA using CDM MetaLAB analysis. Our findings contribute to the identification of 14 novel drug-ADR signals, expanding our understanding of potential adverse effects related to biological DMARDs and targeted therapies in RA and AS. These results emphasize the importance of ongoing pharmacovigilance for patient safety and optimal therapeutic interventions.
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Affiliation(s)
- M Kwon
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
- Konyang University Myunggok Medical Research Institute, Daejeon, South Korea
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - C I Joung
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - H Shin
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
| | - C C Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y S Song
- Department of Pathology, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y J Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Department of Rehabilitation Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Kang
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - J Y Kim
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Lee
- Department of Computer Engineering, Gachon University, (13120) 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, South Korea.
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3
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Song S, Kim JY, Lee Y, Jeong H, Kim S, Lee EE. Effects of defoliant exposure and medication use on the development of Parkinson's disease in veterans. Age Ageing 2023; 52:afad192. [PMID: 37890520 DOI: 10.1093/ageing/afad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Vietnam-era veterans were exposed to Agent Orange (AO), which is associated with a high prevalence of Parkinson's disease (PD). However, little is known about the development of PD-like symptoms caused by drug-induced parkinsonism (DIP) in such populations. This study aimed to investigate PD incidence and PD risk following exposure to AO or DIP-risk drugs in veterans. METHODS A retrospective cohort study was conducted using 12 years (2009-2020) of electronic medical records of the Veterans Health Service Medical Center, the largest Veterans Affairs hospital in South Korea (n = 37,246; 100% male; age, 65.57 ± 8.12 years). Exposure to AO or DIP-risk drugs, including antipsychotic, prokinetic, anti-epileptic, dopamine-depleting and anti-anginal agents, was assessed in veterans with PD, operationally defined as having a PD diagnosis and one or more prescriptions for PD treatment. The PD risk was calculated using multiple logistic regression analysis adjusted for age and comorbidities. RESULTS The rates of DIP-risk drug use and AO exposure were 37.92% and 62.62%, respectively. The PD incidence from 2010 to 2020 was 3.08%; 1.30% with neither exposure, 1.63% with AO exposure, 4.38% with DIP-risk drug use, and 6.33% with both. Combined exposure to AO and DIP-risk drugs increased the PD risk (adjusted odds ratio = 1.68, 95% confidence interval, 1.36-2.08, P < 0.001). CONCLUSIONS The PD incidence was 1.31 times higher with AO exposure alone and 1.68 times higher with AO exposure and DIP-risk drug use. The results suggest the necessity for careful monitoring and DIP-risk drug prescription in patients with AO exposure.
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Affiliation(s)
- Seulki Song
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Pharmacy, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jun Y Kim
- Department of Physical Medicine and Rehabilitation, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Hyokeun Jeong
- Department of Pharmacy, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Seungyeon Kim
- College of Pharmacy, Dankook University, Cheonan, Republic of Korea
| | - Eunkyung E Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Kim JY, Hyun DY, Nam D, Shin HJ, Jung J, Cho SY, Jung K, Hwang D, Lee SW, Kim JY. Proteogenomic Analysis of Human Uterine Cervical Cancer (UCC) Reveals Treatment-Resistant Subtypes of UCC. Int J Radiat Oncol Biol Phys 2023; 117:S22. [PMID: 37784455 DOI: 10.1016/j.ijrobp.2023.06.277] [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) Locally advanced uterine cervical cancer (UCC) is treated by radiotherapy with concurrent chemotherapy, but heterogenous treatment responses are frequently observed. To better optimize therapeutic options based on molecular signatures, we performed proteogenomic analysis of UCC. MATERIALS/METHODS UCC tissue and blood samples were collected from patients who underwent primary radiotherapy ± chemotherapy at the National Cancer Center (NCC) in Korea from July 2004 to March 2020. Most samples were obtained via biopsy. Genomic DNA for WES was isolated from frozen biopsy tumor tissues and peripheral blood buffy-coat of patients. Both global proteome and phosphoproteome were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Whole exome sequencing, RNA sequencing, global proteomics and phosphoproteomics were performed using 253, 337, and 147 cervical cancer samples, respectively. Patient-derived xenograft were established using intratongue implantation using 2 primary cell lines from sub3 and sub5, and flow cytometric analysis was performed. RESULTS Fourteen significantly mutated genes (SMG) were found in our study cohort which include 5 newly identified SMGs. Mutation-phosphorylation analysis revealed association with apoptosis and actin cytoskeleton pathway. Proteogenomic analysis defined 6 molecular subtypes of UCC. Of those, 3 subtypes (i.e., Sub3, Sub5 and Sub6) were associated with treatment-resistant phenotypes. The cell-type deconvolution analysis suggested activated stroma with activation of cancer-associated fibroblast in Sub 3, while Sub5 showed low levels of activated stroma and high levels of myeloid immune cells. FACS analysis of UCC mouse models established from these 2 radio-resistant primary cell lines showed high component of PDGFRA+CAF infiltration in Sub 3, and high level of PVR+CD45+ immune cells mainly composed of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) in Sub5. For Sub6, genes and/or protein signatures represented mucin-related processes (e.g., mucin glycosylation/sugar metabolism), which are linked to metastasis-associated Tn antigen production. CONCLUSION The proteogenomic analysis thus suggests potential targets for radiotherapy-resistant subtypes of UCC; secretory factors from activated stroma and cancer-associated fibroblast (Sub3); RHOA signaling, PVR, and PMN-MDSCs (Sub5), and keratin/chondroitin sulfate proteoglycan and Tn antigen production (Sub6). Our study shows the importance of proteogenomic analysis in unveiling the subtype specific molecular pathways of UCC that are beyond reach by genomic data alone. The validity of our molecular pathway and cellular signatures linking these pathways should be further validated through detailed functional experiments and in larger UCC cohorts.
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Affiliation(s)
- J Y Kim
- National Cancer Center, Goyang, Korea, Republic of (South) Korea
| | - D Y Hyun
- School of Biological Sciences, Seoul National University, Seoul, Korea, Republic of (South) Korea
| | - D Nam
- Department of Chemistry and Center for Proteogenome Research, Korea University, Seoul, Korea, Republic of (South) Korea
| | - H J Shin
- Research Institute and Hospital, National Cancer Center, Korea, Goyang, Korea, Republic of (South) Korea
| | - J Jung
- Department of Anatomy and Cell Biology and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S Y Cho
- Research Institute and Hospital, National Cancer Center, Korea, Goyang-si, Korea, Republic of (South) Korea
| | - K Jung
- Department of Anatomy and Cell Biology and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - D Hwang
- School of Biological Sciences, Seoul National University, Seoul, Korea, Republic of (South) Korea
| | - S W Lee
- Department of Chemistry and Center for Proteogenome Research, Korea University, Seoul, Korea, Republic of (South) Korea
| | - J Y Kim
- Research Institute and Hospital, National Cancer Center, Korea, Goyang-si, Korea, Republic of (South) Korea
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5
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Kim JY, Koo B, Lim SY, Cha HH, Kim MJ, Chong YP, Choi SH, Lee SO, Kim YS, Shin Y, Kim SH. A non-invasive, sensitive assay for active TB: combined cell-free DNA detection and FluoroSpot assays. Int J Tuberc Lung Dis 2023; 27:790-792. [PMID: 37749833 PMCID: PMC10519393 DOI: 10.5588/ijtld.23.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/18/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- J Y Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - B Koo
- Department of Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - S Y Lim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - H H Cha
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - M J Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Y P Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - S-H Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - S-O Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Y S Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Y Shin
- Department of Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - S-H Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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6
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Kim JY, Park S, Kim EO, Chang E, Bae S, Kim MJ, Chong YP, Choi SH, Lee SO, Kim YS, Jung J, Kim SH. The seasonality of carbapenemase-producing Enterobacterales in South Korea. J Hosp Infect 2023; 140:87-89. [PMID: 37506769 DOI: 10.1016/j.jhin.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Affiliation(s)
- J Y Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - S Park
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - E O Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - E Chang
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - S Bae
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y P Chong
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Jung
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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7
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Kim TJ, Oh HK, Lee HS, Kim SE, Park J, Kim JY, Lee J, Song J, Hong JH, Seo SY, Ahn E, Lee SK, Lee J, Chung JW, Kim HC, Shin DH, Lee HY, Kim BJ, Seo WK, Park JM, Lee SJJ, Jung KH, Kwon SU, Hong YC, Kim HS, Kang HJ, LEE JUNEYOUNG, BAE HJ. Abstract WP40: Development Of The System For National Statistics Of Stroke And Acute Myocardial Infarction Using Claims-based Algorithms In Korea. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp40] [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: 02/05/2023]
Abstract
Background:
The epidemiology of stroke and acute myocardial infarction (AMI) in Korea is limited by inaccurate methods for estimating incidence. Therefore, this study aimed to build the system for national statistics of stroke and AMI in Korea using claims-based identification algorithms.
Methods:
We identified stroke and AMI using the claims-based algorithms based on the 2018 National Health Insurance Service (NHIS) data. The identification algorithms were validated using investigation of medical records of the sampled cases including the patient groups and the control groups based on a 2-stage stratified sampling method. The sampled cases were divided into 6 strata according to regions (capital and non-capital) and types of centers (tertiary hospitals, general hospitals, and hospitals). Based on the medical records results, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and weighted PPV and weighted NPV were calculated by applying strata-specific sampling rates. The incidence rate of stroke and AMI is the number of new cases of stroke and AMI, including recurrent events, which was calculated by applying the algorithms using weighted PPV and NPV to the claims data.
Results:
In total, 2,200 cases (1,086 cases in stroke [578 patients and 508 controls] and 1,114 cases in AMI [520 patients and 594 controls]) were sampled after applying algorithms for review of hospital records. In hospital record reviews, the stroke algorithm had 95.2% sensitivity, 99.6% specificity, 89.3% PPV, and 99.8% NPV, and AMI algorithms showed 97.7% sensitivity, 99.9% specificity, 90.0% PPV, and 99.9% NPV. We identified 94,994 stroke and 33,834 AMI cases including recurrent events using validated identification algorithms in 2018. The age- and sex-standardized incidence rate of stroke was 175.7 cases per 100,000 person-years and the incidence rate of AMI was 49.3 cases per 100,000 person-years in 2018.
Conclusion:
We developed the national statistical system to estimate the incidence of stroke and AMI using validated claims-based algorithms in Korea. By using this system, we expect that it will be possible to conduct nationwide epidemiological research and improve acute cardiovascular care in Korea.
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Affiliation(s)
- Tae Jung Kim
- Neurology, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Hyun-kyung Oh
- Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | | | | | - Jinju Park
- NeurologyCentral Div of Cardio-cerebrovascular Disease Management, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Jun Y Kim
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si
| | - Jiyoon Lee
- Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Jieun Song
- Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Jin-Hyuk Hong
- Central Div of Cardio-cerebrovascular Disease Management, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Soon-young Seo
- NeurologyChronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Eunmi Ahn
- NeurologyChronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Seon Kui Lee
- Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Joongyub Lee
- NeurologyPreventive Medicine, Seoul National Univ College of Medicine, Seoul, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Sun U Kwon
- Neurology, Asan Med Cntr, Seoul, Korea, Republic of
| | - Yun-Chul Hong
- Preventive Medicine, Seoul National Univ College of Medicine, Seoul, Korea, Republic of
| | - Hyo S Kim
- SEOUL NATIONAL UNIVERSITY HOSPITAL, Seoul
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8
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Kim J, Kim DY, BAE HJ, Kim JY, Kang J, Han MK, Jung C, Baik SH, Sunwoo L, Kim JH, Kim BJ. Abstract WMP81: Dynamic Changes In Intracranial Atherosclerotic Stenosis In Serial Follow-up Of High-resolution Magnetic Resonance Imaging. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp81] [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: 02/05/2023]
Abstract
Background:
Pathophysiology of intracranial atherosclerotic stenosis (ICAS) development and subsequent stroke occurrence is diverse, including cholesterol deposition, arterial dissection, and intrinsic vasculopathies. To differentiate these specific etiologies, performing high-resolution MRI (HR-MRI) has increased. However, the information on serial change of ICAS on HR-MRI was limited.
Methods:
Patients hospitalized at a tertiary university hospital for AIS and who took HR-MRI more than twice between 2015 and 2019 were collected. Two specialists manually segmented the contour of the culprit and reference vessel's inner lumen, outer wall, and plaque. The stenotic degree, remodeling index, and enhancement signal were measured for the culprit lesion at each examination.
Results:
A total of 202 HR-MRI examinations from 93 patients were analyzed. The Median follow-up was 270 days (118-390). The ranges of the serial change in stenotic degree (-86% to 41%), remodeling index (-83% to 266%), and enhancement signal (-85% to 71%) were very diverse. Changes in stenotic degree and enhancement according to the initial stenotic degree were insignificant. On the other hand, the change in enhancement signal was greater in the initially more enhanced lesions (0.1±23.0; mild vs. -23.1±22.6; moderate vs. -35.5±28; severe, p
difference
<.001) and in the other determined etiology (-14.6±22.8; large atherosclerosis vs. -30.7±30.8; other determined vs. -0.8±30.2; etc., p
difference
=.005).
Conclusions:
ICAS showed very dynamic changes in the follow-up HR-MRIs. To identify the underlying etiology, such as arterial dissection and Moyamoya disease, serial HR-MRI will be helpful.
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Affiliation(s)
- Jonguk Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Do Y Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Hee-joon BAE
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jun Y Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jihoon Kang
- Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Moon-Ku Han
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Cheolkyu Jung
- Dept of Radiology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Sung Hyun Baik
- Dept of Radiology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Leonard Sunwoo
- Dept of Radiology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jae Hyoung Kim
- Dept of Radiology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Beom J Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
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9
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Kim J, Kim JY, Kang J, Kim BJ, Han MK, Park TH, Lee JS, Lee KJ, Kim JT, Choi K, Park JM, Kang K, Lee SJ, Kim JG, Kim DH, Cha JK, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DEE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DII, Yum KS, Sohn SI, Hong JH, Lee S, Lee J, Bae HJ. Abstract WP207: Treatments Advanced, But Outcomes Stagnated In Young Adults With Acute Ischemic Stroke In Korea Between 2008 And 2019. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp207] [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: 02/05/2023]
Abstract
Background:
Outcome improvement in young stroke patients is of great interest given their long life expectancy and substantial societal burden. We aimed to investigate whether the treatment advancement has been made and translated into outcome improvement in young patients with acute ischemic stroke (AIS).
Methods:
From a prospective multicenter stroke registry in South Korea, young AIS patients (aged 18-50) hospitalized between 2008 and 2019 were identified. The study period was divided into 4 epochs. The secular trends of patient characteristics, treatments, and outcomes adjusted for potential confounders were analyzed.
Results:
This study included 7,050 young AIS patients (mean age 43.1; men 71.9%) from 70,567 enrolled during the period. The mean age decreased from 43.6 years in 2008-2010 to 42.9 years in 2017-19 (P
trend
=.009). Obesity increased (40.1% to 49.0%), but current smoking decreased (53.1% to 42.8%). Other vascular risk factors and sex proportions did not change (P
trend
’s > 0.5). Onset-to-arrival time and door-to-puncture time for mechanical thrombectomy did not change (P
trend
’s > 0.5), but door-to-needle time for intravenous thrombolysis improved (P
trend
<.001). Acute and secondary stroke prevention treatments including intravenous thrombolysis (9.5% to 13.8%), mechanical thrombectomy (3.2% to 9.2%), dual antiplatelet therapy for minor stroke (26.6% to 48.0%), direct oral anticoagulant for atrial fibrillation (0.0% to 56.2%) and statins (71.5% to 91.2%) improved significantly (P
trend
’s <.01). For stroke outcomes, for which data were available since 2011, the proportions of 3-month modified Rankin Scale 0-1 (68.3% to 69.1%) and 0-2 (87.6% to 86.2%), one-year mortality (2.5% to 2.4%), and one-year stroke recurrence (4.4% to 5.3%) did not improve (adjusted P
trend
’s > 0.2).
Conclusions:
This study shows that the treatment improvements did not lead to outcome improvements in young AIS patients. The findings indicate that we should not be complacent with the current advances.
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Affiliation(s)
- Jonguk Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jun Y Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jihoon Kang
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Beom J Kim
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Moon-Ku Han
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Tai H Park
- Dept of Neurology, Seoul Med Cntr, Seoul, Korea, Republic of
| | - Ji Sung Lee
- Clinical Rsch Cntr, Asan Med Cntr, Seoul, Korea, Republic of
| | - Keon-Joo Lee
- Dept of Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Joon-Tae Kim
- Dept of Neurology, Chonnam National Univ Hosp, Gwangju-si, Korea, Republic of
| | - Kangho Choi
- Dept of Neurology, Chonnam National Univ Hosp, Gwangju-si, Korea, Republic of
| | - Jong-moo Park
- Dept of Neurology, Uijeongbu Eulji Med Cntr, Eulji Univ, Seoul, Korea, Republic of
| | - Kyusik Kang
- Dept of Neurology, Nowon Eulji Med Cntr, Eulji Univ, Seoul, Korea, Republic of
| | - Soo Joo Lee
- Dept of Neurology, Eulji Univ Hosp, Daejon-si, Korea, Republic of
| | - Jae G Kim
- Dept of Neurology, Eulji Univ Hosp, Daejeon-si, Korea, Republic of
| | - Dae Hyun Kim
- Dept of Neurology, Dong-A Univ Hosp, Busan-si, Korea, Republic of
| | - Jae-kwan Cha
- Dept of Neurology, Dong-A Univ Hosp, Busan-si, Korea, Republic of
| | - Kyung Bok Lee
- Dept of Neurology, Soonchunhyang Univ Hosp, Seoul, Korea, Republic of
| | - Jun Lee
- Dept of Neurology, Yeungnam Univ Med Cntr, Daegu-si, Korea, Republic of
| | - Keun-sik Hong
- Dept of Neurology, Inje Univ Ilsan Paik Hosp, Goyang-si, Korea, Republic of
| | - Yong-Jin Cho
- Dept of Neurology, Inje Univ Ilsan Paik Hosp, Goyang-si, Korea, Republic of
| | - Hong-kyun Park
- Dept of Neurology, Inje Univ Ilsan Paik Hosp, Goyang-si, Korea, Republic of
| | - Byung-Chul Lee
- Dept of Neurology, Hallym Univ Sacred Heart Hosp, Anyang-si, Korea, Republic of
| | - Kyung-Ho Yu
- Dept of Neurology, Hallym Univ Sacred Heart Hosp, Anyang-si, Korea, Republic of
| | - Mi S Oh
- Dept of Neurology, Hallym Univ Sacred Heart Hosp, Anyang-si, Korea, Republic of
| | - Dong-Eog E Kim
- Dept of Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Korea, Republic of
| | - Wi-sun Ryu
- Dept of Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Korea, Republic of
| | - Jay Chol Choi
- Dept of Neurology, Jeju National Univ Hosp, Jeju-si, Korea, Republic of
| | - Jee-hyun Kwon
- Dept of Neurology, Ulsan Univ Hosp, Ulsan-si, Korea, Republic of
| | - Wook-joo Kim
- Dept of Neurology, Ulsan Univ Hosp, Ulsan-si, Korea, Republic of
| | - Dong Ick I Shin
- Dept of Neurology, Chungbuk National Univ & Hosp, Cheongju-si, Korea, Republic of
| | - Kyu Sun Yum
- Dept of Neurology, Chungbuk National Univ & Hosp, Cheongju-si, Korea, Republic of
| | - Sung-il Sohn
- Dept of Neurology, Keimyung Univ Dongsan Hosp, Daegu-si, Korea, Republic of
| | - Jeong-Ho Hong
- Dept of Neurology, Keimyung Univ Dongsan Hosp, Daegu-si, Korea, Republic of
| | - Sanghwa Lee
- Dept of Neurology, Hallym Univ Chuncheon Sacred Heart Hosp, Chuncheon-si, Korea, Republic of
| | - Juneyoung Lee
- Dept of Biostatistics, Korea Univ, Seoul, Korea, Republic of
| | - Hee-joon Bae
- Dept of Neurology, Seoul National Univ Bundang Hosp, Seongnam-si, Korea, Republic of
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10
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Kim DY, Kim J, Bae HJ, Kim JY, Kang J, Han MK, Jung C, Baik SH, Sunwoo L, Kim JH, Kim BJ. Abstract TMP62: High Levels Of Ldl Cholesterol And Hb A1c Hindering Mitigation Of Intracranial Arterial Diseases After Acute Ischemic Stroke. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp62] [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: 02/05/2023]
Abstract
Introduction:
Intracranial arterial disease (ICAD) may have dynamic temporal changes which high-resolution MR (HR-MR) images can visualize. Until now, there is only limited evidence on the risk factor for the evolution of ICAD after ischemic stroke.
Method:
We have collected acute ischemic stroke patients admitted to a single referral stroke center between 01/2015 and 06/2019 with baseline and follow-up HR-MR images on their ICAD lesions. A total of 246 patients were identified, and for the current pilot study, HR-MR images from 93 patients were used. Degree of stenosis on T1/gadolinium-enhanced (Gd) T1 sequences, remodeling index on proton-density sequence, and enhancement signal on Gd-T1 sequence were measured. Temporal changes were defined as (1-([parameters at the initial]/[parameters at the follow-up])*100. The temporal changes of image parameters were compared by bivariate baseline blood risk factors, such as LDLC (
≥
100 vs. <100 mg/dL) and HbA1c (
≥
6.5 vs. <6.5%).
Result:
A total of 93 patients were analyzed for the pilot study. Temporal changes in the degree of stenosis, remodeling index, and enhancement signal of ICAD lesion were -19.6
±
50.3%, 2.9
±
45.6%, and -15.0
±
31.6%, respectively. ICAD parameters were further mitigated in lower levels of selected markers, such as the degree of stenosis (-24.9±37.6% from lower vs. -16.0±57.5% from higher LDLC, P =0.37; -23.0±54.9% from lower Hb A1c vs. -9.3±32.3% from higher Hb A1c, P =0.16) and the enhancement signal (-18.0±29.1% from lower vs. -12.9±33.2% from higher LDLC, P=0.45; -17.1±32.2% from lower Hb A1c vs. -6.5±28.4% from higher Hb A1c, P=0.17). Linear associations between change in the enhancement signal and LDLC in higher LDLC (B=0.38, P=0.01) and degree of stenosis and Hb A1c in higher Hb A1c (B=0.49, P=0.02) were observed.
Conclusion:
ICAD lesions in acute ischemic stroke patients may have temporal appearance changes. Baseline LDLC and Hb A1c levels may be used as a marker for the evolution of ICAD.
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Affiliation(s)
- Do Yeon Kim
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Jonguk Kim
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Hee-Joon Bae
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Jun Y Kim
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Jihoon Kang
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Moon-Ku Han
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Cheolkyu Jung
- Radiology, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Sung Hyun Baik
- Radiology, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Leonard Sunwoo
- Radiology, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Jae Hyoung Kim
- Radiology, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Beom J Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
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11
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LEE JY, Kang K, Kim YS, Lee SJ, Kim JG, Cha JK, Kim DH, Yoon BA, Han MK, Kim BJ, Kang J, Kim JY, Park TH, Park SS, Choi JK, Lee KB, LEE JUN, Kwon DH, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Lee M, Kim JT, Choi K, Kim DE, Gwak DS, Choi JC, Kim J, Kang CH, Shin DI, Yum KS, Kim BK, Chae HY, Kwon JH, Kim WJ, Sohn SI, Hong JH, Park H, Jang SH, Kim CH, Lee S, LEE JUNEYOUNG, Lee JS, Park JM, BAE HJ. Abstract WP98: Utilization Of Perfusion Imaging For Acute Ischemic Stroke: Secular Trends And Effects On Outcomes Of Endovascular Treatment. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp98] [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: 02/05/2023]
Abstract
Introduction:
Perfusion imaging (PI) could guide decision-making for endovascular treatment (EVT) of acute ischemic stroke (AIS). However, PI was underused even in the US before the pivotal EVT trials proved its usefulness in 2018. This study aimed to describe the secular trends of PI utilization and investigate the effectiveness of PI-based EVT in real-world practice.
Methods:
Using a prospective multicenter (n=17) stroke registry in South Korea, we identified patients with AIS who presented within 24 hours from onset between 2011 and 2021. The study period was divided into 3 epochs: 2011-2014, 2015-2017, and 2018-2021. The study population was divided into the early (arrival within 6 hours) and late window (6-24 hours) groups.
Results:
A total of 51,650 patients (15,654 patients in 2011-2014, 14,432 patients in 2015-2017, and 21,564 patients in 2018-2021) were analyzed. Utilization of PI decreased in the overall population and early window group (
P
trend
<0.001); 43.3% and 54.1% in 2011-2014, 40.1% and 44.1% in 2015-2017, and 38.4% and 40.2% in 2018-2021, respectively; but increased in the late window group (
P
trend
<0.001); 31.3% in 2011-2014, 35.7% in 2015-2017, and 36.5% in 2018-2021. Of 10,872 patients with anterior large-vessel occlusion (aLVO), the EVT rate was not different between patients with and without PI (48.7% vs. 46.6%,
P
=0.08) in the early window but higher in those with PI than without PI in the late window (29.8% vs. 18.7%,
P
<0.001). The EVT outcome (3-month mRS 0-2) was not different between patients with and without PI in the early window (44.1% vs. 41.8%,
P
=0.21) and late window (38.4% vs. 39.2%,
P
=0.81). Propensity score analysis and instrumental variable analysis with PI rate per center as an instrument will be performed to adjust imbalances between patients with and without PI.
Conclusion:
Between 2011 and 2021 in South Korea, PI utilization has decreased in patients arriving within 6 hours from onset but has increased in those arriving between 6 and 24 hours. Among patients with aLVO, PI likely increased the EVT rate in the late window but did not in the early window. PI utilization did not seem to affect the EVT outcomes, but in-depth analysis is required.
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Affiliation(s)
- Jeong-Yoon LEE
- Neurology, Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Kyusik Kang
- Eulji General Hosp, Seoul, Korea, Republic of
| | | | | | - Jae G Kim
- EULJI UNIVERSITY HOSPITAL, Daejeon-si, Korea, Republic of
| | | | | | - Byeol-A Yoon
- Neurology, Dong-A Univ Hosp, Busan, Korea, Republic of
| | - Moon-Ku Han
- SEOUL NATL UNIV BUNDANG HOSP, Seongnam, Korea, Republic of
| | - Beom J Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do, Korea, Republic of
| | - Jihoon Kang
- Seoul National Univ Bundang Hospit, Seongnam, Korea, Republic of
| | - Jun Y Kim
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si, Korea, Republic of
| | - Tai H Park
- Seoul Med Cntr, Seoul, Korea, Republic of
| | | | - Jin-Kyo Choi
- Neurology, Seoul Med Cntr, Seoul, Korea, Republic of
| | | | - JUN LEE
- Yeungnam Univ Med Cntr, Daegu, Korea, Republic of
| | | | - Keun-sik Hong
- ILSAN PAIK HOSPITAL INJE UNIV, Goyang, Korea, Republic of
| | - Yong-jin Cho
- INJE UNIVERSITY ILSAN PAIK HOSPITAL, Goyang, Korea, Republic of
| | | | - Byung-Chul Lee
- HALLYM NEUROLOGICAL INSTITUTE, Anyang City, Korea, Republic of
| | - Kyung-Ho Yu
- Hallym Univ Sacred Heart Hosp, Anyang, Korea, Republic of
| | - Mi S Oh
- Hallym Sacred Heart Hosptial, Anyang, Korea, Republic of
| | - Minwoo Lee
- Hallym Univ Sacred Heart Hosp, anyang, Korea, Republic of
| | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Kangho Choi
- CHONNAM NATIONAL UNIVERSITY HOSPITAL, Gwangju, Korea, Republic of
| | - Dong-Eog Kim
- Neurology, Dongguk Univ Ilsan Hosp, Goyang, Korea, Republic of
| | - Dong-Seok Gwak
- Dongguk Univ Ilsan Hosp, Goyang-si Gyeonggi-do, Korea, Republic of
| | | | - Joonggoo Kim
- JEJU NATIONAL UNIVERSITY HOSPITAL, Jeju, Korea, Republic of
| | | | - Dong-Ick Shin
- Chungbuk National Univ Hosp, Cheongju, Korea, Republic of
| | - Kyu Sun Yum
- Chungbuk National Univ Hosp, Cheongju, Korea, Republic of
| | - Baik Kyun Kim
- Neurology, Chungbuk National Univ Hosp, Cheongju, Korea, Republic of
| | - Hee-Yoon Chae
- Neurology, Chungbuk National Univ Hosp, Cheongju, Korea, Republic of
| | - Jee-hyun Kwon
- DEPT NEUROLOGY ULSAN UNIV HOSPIT, Ulsan, Korea, Republic of
| | | | - Sung-il Sohn
- Keimyung Univ. Dongsan Hosp, Daegu, Korea, Republic of
| | - Jeong-Ho Hong
- KEIMYUNG UNIV DONGSAN HOSPITAL, Daegu, Korea, Republic of
| | | | - Seong Hwa Jang
- Keimyung Univ Dongsan hospital, Daegu, Korea, Republic of
| | - Chul Ho Kim
- Hallym Univ Chuncheon Sacred Heart Hosp, Chuncheon-si, Korea, Republic of
| | - Sanghwa Lee
- Hallym Univ Chuncheon Sacred Heart Hosp, Chuncheo -si, Korea, Republic of
| | | | | | | | - Hee-joon BAE
- Seoul Nat' Univ' Bundang Hosp, Seongnam, Korea, Republic of
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12
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Lee M, Lee BC, Yu KH, Oh MS, Kim BJ, Kim JY, Kang J, Park JM, Kang K, Park TH, Lee KB, Hong KS, Park HK, Cho YJ, Kim DEE, Lee SJ, Kim JG, Lee J, Cha JK, Kim DH, Kim JT, Choi K, Choi JC, Sohn SI, Hong JH, Lee S, Chul Ho K, Shin DII, Yum KS, LEE JUNEYOUNG, Lee JS, BAE HJ. Abstract 44: Impact Of Novel Oral Anticoagulant Use On Secular Trend Of Vascular Events Or Death After Atrial Fibrillation-related Acute Ischemic Stroke. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.44] [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: 02/05/2023]
Abstract
Introduction:
Now novel oral anticoagulants (NOAC) are strongly recommended for secondary stroke prevention in patients with atrial fibrillation (AF). However, it remains unclear to what extent the introduction of NOACs improved clinical outcomes in real-world practice.
Methods:
Using a nationwide prospective multi-center stroke registry database, we identified consecutive AIS patients with AF enrolled between Jan 2011 and Dec 2019, and analyzed one-year clinical events and NOAC prescription at discharge. The primary outcome was the composite of stroke, myocardial infarction, and all-cause death. To assess the mediation effect of NOAC on the outcomes, we performed natural effect models according to the calendar year. The exposure-mediator analysis, exposure-outcome analysis, and mediator-outcome analysis were performed using multivariate regression analysis according to the characteristics of the variables.
Results:
We analyzed 12,500 patients (mean age, 74.4 years; 51.3% male; median NIHSS at presentation, 8). From 2011 to 2019, the cumulative one-year incidence of the primary composite outcome (28.3% to 22.1%), all-cause mortality (23.8% to 17.9%), and stroke recurrence (8.3% to 5.1%) significantly decreased, while the NOAC prescription rate at discharge increased (0% to 75.6%). One-year increase in the calendar year was independently associated with a delayed occurrence of primary composite outcomes (Step 1: adjusted Time Ratio (aTR), 1.10; 95% confidence interval, 1.07-1.14) and with an increased NOAC prescription rate (Step 2: adjusted odds ratio, 2.20; 2.14-2.27). Increase in the NOAC prescription rate was significantly associated with the delayed occurrence of primary composite outcome (Step 3: aTR, 3.80; 3.15-4.58). However, after controlling for the NOAC prescription rate (mediator), the calendar year was no longer associated with the primary composite outcomes. (Step 4: aTR, 0.78; 95% CI 0.60-1.03). Thus, our results indicate full mediation of NOAC prescription in the association between the calendar year and primary composite outcomes.
Conclusion:
The reduced risk of major vascular events or death over time in AIS patients with AF was fully mediated by the increase in NOAC use.
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Affiliation(s)
- Minwoo Lee
- Hallym Univ Sacred Heart Hosp, anyang, Korea, Republic of
| | | | - Kyung-Ho Yu
- Hallym Univ Sacred Heart Hosp, anyang, Korea, Republic of
| | - Mi-Sun Oh
- Hallym Univ Sacred Heart Hosp, anyang, Korea, Republic of
| | - Beom J Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
| | - Jun Y Kim
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si
| | - Jihoon Kang
- Seoul National Univ Bundang Hospit, Seongnam
| | | | | | | | | | | | | | | | | | | | - Jae G Kim
- EULJI UNIVERSITY HOSPITAL, Daejeon-si
| | - Jun Lee
- YEUNGNAM UNIV MEDICAL CTR, Daegu
| | | | | | | | - Kangho Choi
- CHONNAM NATIONAL UNIVERSITY HOSPITAL, Gwangju
| | | | | | | | | | | | | | | | | | | | - Hee-joon BAE
- Seoul Nat' Univ' Bundang Hosp, Seongnam, Korea, Republic of
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13
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Kim DY, Baik SH, Jung C, Kim JY, Han SG, Kim BJ, Kang J, Bae HJ, Kim JH. Predictors and Impact of Sulcal SAH after Mechanical Thrombectomy in Patients with Isolated M2 Occlusion. AJNR Am J Neuroradiol 2022; 43:1292-1298. [PMID: 35902120 PMCID: PMC9451639 DOI: 10.3174/ajnr.a7594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Data on SAH after M2 mechanical thrombectomy are limited. We aimed to determine the prevalence of sulcal SAH after mechanical thrombectomy for M2 occlusion, its associated predictors, and the resulting clinical outcome. MATERIALS AND METHODS The study retrospectively reviewed the data of patients with acute ischemic stroke who underwent mechanical thrombectomy for isolated M2 occlusion. The patients were divided into 2 groups according to the presence of sulcal SAH after M2 mechanical thrombectomy. Angiographic and clinical outcomes were compared. Multivariable analysis was performed to identify independent predictors of sulcal SAH and unfavorable outcome (90-day mRS, 3-6). RESULTS Of the 209 enrolled patients, sulcal SAH was observed in 33 (15.8%) patients. The sulcal SAH group showed a higher rate of distal M2 occlusion (69.7% versus 22.7%), a higher of rate of superior division occlusion (63.6% versus 43.8%), and a higher M2 angulation (median, 128° versus 106°) than the non-sulcal SAH group. Of the 33 sulcal SAH cases, 23 (66.7%) were covert without visible intraprocedural contrast extravasation. Distal M2 occlusion (OR, 12.04; 95% CI, 4.56-35.67; P < .001), superior division (OR, 3.83; 95% CI, 1.43-11.26; P = .010), M2 angulation (OR, 1.02; 95% CI, 1.01-1.04; P < .001), and the number of passes (OR, 1.58; 95% CI, 1.22-2.09; P < .001) were independent predictors of sulcal SAH. However, covert sulcal SAH was not associated with an unfavorable outcome (P = .830). CONCLUSIONS After mechanical thrombectomy for M2 occlusion, sulcal SAH was not uncommon and occurred more frequently with distal M2 occlusion, superior division, acute M2 angulation, and multiple thrombectomy passes (≥3). The impact of covert sulcal SAH was mostly benign and was not associated with an unfavorable outcome.
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Affiliation(s)
- D Y Kim
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - S H Baik
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
| | - C Jung
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
| | - J Y Kim
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - S-G Han
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - B J Kim
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - J Kang
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - H-J Bae
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - J H Kim
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
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14
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Yoo JY, Kwak HJ, Ha EJ, Min SK, Kim JY. Comparison of McGrath videolaryngoscope-assisted insertion versus standard blind technique for flexible laryngeal mask airway insertion in adults. Singapore Med J 2022; 63:342-344. [DOI: 10.11622/smedj.2022080] [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: 11/18/2022]
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15
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Badreddine J, Lee MH, Mishra K, Pope R, Kim JY, Hong SH, Gupta S, Song JM, Shin JI, Ghayda RA. Continuing perioperative estrogen therapy does not increase venous thromboembolic events in transgender patients: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:2511-2517. [PMID: 35442466 DOI: 10.26355/eurrev_202204_28488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study is to compare the risk of venous thromboembolic events (VTE) between patients suspending and continuing estrogen therapy perioperatively, in male to female gender-affirming surgery (vaginoplasty). MATERIALS AND METHODS The authors conducted a systematic review and meta-analysis of existing research on male to female gender-affirming study, which compared the risk of VTE among the usage of estrogen perioperatively. RESULTS A total of 209 studies were identified as potentially eligible among PubMed, Embase, and Cochrane library databases. Among the studies, 191 studies were excluded due to their abstract inappropriateness. Out of the remaining 18 studies, only 3 articles were eligible and were finally included. Meta-analysis was performed and showed odds ratio of 0.77 (95% CI: 0.04, 14.01). CONCLUSIONS Perioperative estrogen therapy does not increase VTE risk on male to female gender-affirming surgery. Therefore, estrogen therapy may be continued perioperatively in vaginoplasty. More prospective studies are needed.
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Affiliation(s)
- J Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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16
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Kim B, Singh N, Menon BK, Almekhlafi MA, Ryu WS, Kang J, Baik SH, Kim JY, Lee KJ, Jung C, Han MKK, Bae HJ. Abstract WP8: Blood Pressure And EVT Outcomes By The Baseline Perfusion And Recanalization Timing. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Leptomeningeal collaterals help maintain cerebral perfusion after the large vessel occlusion (LVO), potentially regulated by systemic blood pressure (BP). We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by the baseline perfusions status and before and after recanalization.
Method:
From a prospective registry, we identified anterior circulation LVO patients who received EVT ≤24 hours after their onset, had baseline perfusion, and achieved post-EVT mTICI ≥2b. BPs were measured from arrival at 5-minute intervals in the ER and during the procedure. Systolic BPs (SBP) up to 24 hours after EVT were summarized as dropmax (the maximal decrement over two consecutive measurements), incmax (the maximal increment), mean, coefficient of variation, and standard deviation. Baseline perfusion images were quantified using Olea Sphere. Infarct proportion was defined as the volume of final infarct on DWI within the volume of Tmax>6 sec. Significant hemorrhage included PH2 or HBC class 3. 3-month mRS was prospectively collected.
Result:
A total of 388 LVO patients were included. Mean SBP at arrival was 153 ± 42 mm Hg; the average count of BP measurements was 47 ± 17 per patient.In the adequate baseline perfusion group, i.e., hypoperfusion intensity ratio (HIR) <0.5, SBP parameters were better associated with infarct proportion and functional outcome before the recanalization period; weaker associations were noted after recanalization. In the poor baseline perfusion group, i.e., HIR ≥0.5, SBP parameters before recanalization were partially associated with the infarct proportion but not functional status. No association between SBP parameters and significant hemorrhage was noted. (estimates in Table)
Conclusion:
Association between BP and patient outcomes differs by baseline perfusion status and before and after recanalization. BP management during the peri-EVT period may therefore need to be individualized.
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Affiliation(s)
- Beom Kim
- Seoul National Univ Bundang Hosp, Seongnam-si Gyeonggi-do, Korea, Republic of
| | | | | | | | | | | | - Sung Hyun Baik
- Radiology, Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Jun Y Kim
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si
| | | | | | | | - Hee-joon Bae
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
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17
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Choi MJ, Yang JW, Lee S, Kim JY, Oh JW, Lee J, Stubbs B, Lee KH, Koyanagi A, Hong SH, Ghayda RA, Hwang J, Dragioti E, Jacob L, Carvalho AF, Radua J, Thompson T, Smith L, Fornaro M, Stickley A, Bettac EL, Han YJ, Kronbichler A, Yon DK, Lee SW, Shin JI, Lee E, Solmi M. Suicide associated with COVID-19 infection: an immunological point of view. Eur Rev Med Pharmacol Sci 2021; 25:6397-6407. [PMID: 34730221 DOI: 10.26355/eurrev_202110_27013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.
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Affiliation(s)
- M J Choi
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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18
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Jeong DY, Lee J, Kim JY, Lee KH, Li H, Lee JY, Jeong GH, Yoon S, Park EL, Hong SH, Kang JW, Song TJ, Leyhe T, Eisenhut M, Kronbichler A, Smith L, Solmi M, Stubbs B, Koyanagi A, Jacob L, Stickley A, Thompson T, Dragioti E, Oh H, Brunoni AR, Carvalho AF, Kim MS, Yon DK, Lee SW, Yang JM, Ghayda RA, Shin JI, Fusar-Poli P. Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses. Eur Rev Med Pharmacol Sci 2021; 25:1536-1547. [PMID: 33629323 DOI: 10.26355/eurrev_202102_24862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available. MATERIALS AND METHODS We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval. RESULTS A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers. CONCLUSIONS Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.
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Affiliation(s)
- D Y Jeong
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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19
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Park GR, Kim HS, Kim YT, Chung HJ, Ha SJ, Kim DW, Kang DR, Kim JY, Lee MY, Lee JY. Waist circumference and the risk of lumbar and femur fractures: a nationwide population-based cohort study. Eur Rev Med Pharmacol Sci 2021; 25:1198-1205. [PMID: 33629289 DOI: 10.26355/eurrev_202102_24822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although obesity is known to have an influence on fracture, the relationship between lumbar and femur fractures and weight or waist circumference is controversial. We investigated the incidence of fracture with regards to waist circumference using the customised database of the Korean National Health Insurance Service (NHIS). Among 8,922,940 adults who participated at least twice in the NHIS National Health Check-up Program in South Korea between 2009 and 2011, 1,556,751 subjects (780,074 men and 776,677 women) were extracted. Over a mean follow-up of 6.5 years, multivariate-adjusted logistic regression analysis demonstrated that higher waist circumference was associated with an increased risk of femur fractures in both males and females. Moreover, the incidence of lumbar fractures was also positively associated with an increased waist circumference in males and females. An increased waist circumference showed a positive linear relationship with the risk of lumbar and femur fractures in both males and females.
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Affiliation(s)
- G R Park
- Department of Internal Medicine, Yonsei Wonju College of Medicine, Wonju, Republic of Korea.
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20
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Baik SH, Jung C, Kim JY, Shin DW, Kim BJ, Kang J, Bae HJ, Kim JH. Local Intra-arterial Thrombolysis during Mechanical Thrombectomy for Refractory Large-Vessel Occlusion: Adjunctive Chemical Enhancer of Thrombectomy. AJNR Am J Neuroradiol 2021; 42:1986-1992. [PMID: 34475193 DOI: 10.3174/ajnr.a7264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Data on adjunctive intra-arterial thrombolysis during mechanical thrombectomy for refractory thrombus are sparse. The aim of this study was to evaluate the efficacy and safety of local intra-arterial urokinase as an adjunct to mechanical thrombectomy for refractory large-vessel occlusion. MATERIALS AND METHODS We retrospectively evaluated patients with acute ischemic stroke who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion between January 2016 and December 2019. Patients were divided into 2 groups based on the use of intra-arterial urokinase as an adjunctive therapy during mechanical thrombectomy for refractory thrombus: the urokinase and nonurokinase groups. Herein, refractory thrombus was defined as the target occlusion with minimal reperfusion (TICI 0 or 1) despite >3 attempts with conventional mechanical thrombectomy. The baseline characteristics, procedural outcomes, and clinical outcome were compared between the 2 groups. RESULTS One hundred fourteen cases of refractory thrombus were identified. A total of 45 and 69 patients were in the urokinase and the nonurokinase groups, respectively. The urokinase group compared with the nonurokinase group showed a higher rate of successful reperfusion (82.2% versus 63.8%, P = .034), with lower procedural times (54 versus 69 minutes, P = .137). The rates of good clinical outcome, distal embolism, and symptomatic intracranial hemorrhage were similar between the 2 groups. The use of intra-arterial urokinase (OR = 3.682; 95% CI, 1.156-11.730; P = .027) was an independent predictor of successful reperfusion. CONCLUSIONS The use of local intra-arterial urokinase as an adjunct to mechanical thrombectomy may be an effective and safe method that provides better recanalization than the conventional mechanical thrombectomy for refractory thrombus in patients with embolic large-vessel occlusion.
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Affiliation(s)
- S H Baik
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - C Jung
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - J Y Kim
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - D-W Shin
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - B J Kim
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J Kang
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - H-J Bae
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J H Kim
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
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21
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Kim JY, Hwang D, Jang M, Rhee CS, Han DH. Clinical effectiveness of house dust mite immunotherapy in mono- versus poly-sensitised patients with allergic rhinitis: a systematic review and meta-analysis. Rhinology 2021; 59:352-359. [PMID: 34180463 DOI: 10.4193/rhin20.588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Selecting an appropriate allergen-specific immunotherapy (AIT) regimen for polysensitised allergic rhinitis (AR) patients is challenging for clinicians. Although previous studies showed comparable effectiveness of single-allergen AIT with house dust mite (HDM) extract between monosensitised and polysensitised AR patients, there is no systematic review and meta-analysis demonstrating the comparable effectiveness of HDM AIT. In this meta-analysis, we analysed nine studies to compare the clinical effectiveness of HDM AIT. The primary outcome was nasal symptom score and secondary outcomes were medication and quality of life scores. The changes in nasal symptom score after HDM AIT did not significantly differ between monosensitised and polysensitised patients. The clinical effectiveness of HDM AIT regarding medication and quality of life score was not significantly different between monosensitised and polysensitised patients). In conclusion, single-allergen AIT with HDM extract showed comparable clinical effectiveness between polysensitised and monosensitised patients with AR.
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Affiliation(s)
- J Y Kim
- Department of Otorhinolaryngology "Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea 2 Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - D Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - M Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - C S Rhee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea; Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, and Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Korea
| | - D H Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
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22
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Hong SN, Kim JK, Kim JA, Cha H, Kim JY, Lim HS, Eun KM, Kim DW. Viral stimulation modulates endotype-related ACE2 expression in eosinophilic chronic rhinosinusitis. Rhinology 2021; 59:460-469. [PMID: 34282808 DOI: 10.4193/rhin21.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme 2 (ACE2), a receptor targeted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed in the nasal mucosa. Chronic rhinosinusitis (CRS) shows diverse endotypes and is aggravated by viral infection. Whether viral stimulation and CRS endotype influence ACE2 expression remains unclear. We investigated the expression of ACE2 and the transmembrane protease, serine 2 (TMPRSS2), which mediate the entry of SARS-CoV-2 into cells, and assessed polyinosinic:polycytidylic acid (poly[I:C])-induced changes based on CRS endotype. METHODOLOGY ACE2 and TMPRSS2 expression was evaluated based on CRS phenotype, endotype, and tissue type. Correlations between ACE2/TMPRSS2 expression and inflammatory mediators in nasal polyps (NP) were examined. Air-liquid interface culture experiments were performed to assess the effects of major cytokines or poly(I:C) stimulation on ACE2/TMPRSS2 expression in primary epithelial cells from healthy nasal mucosa, eosinophilic NP (ENP), and non-eosinophilic NP (NENP). RESULTS In primary nasal epithelial cells, interleukin (IL)-13 decreased ACE2 expression but increased TMPRSS2. Eosinophilic CRS showed lower ACE2 expression than non-eosinophilic CRS, regardless of CRS phenotype. CRS endotype was an independent factor associated with ACE2/TMPRSS2 expression in NP. Serum and tissue eosinophilic marker levels were inversely correlated with ACE2 expression, whereas tissue neutrophilic marker levels and ACE2 expression were positively correlated in NP. ACE2 expression was suppressed in ENP tissues; however, a combination of poly(I:C) and IL-13 induced ACE2/TMPRSS2 upregulation in ENP. CONCLUSIONS ENP tissues have lower ACE2 expression than NENP; however, viral stimulation promotes ACE2/TMPRSS2 upregulation in ENP.
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Affiliation(s)
- S-N Hong
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - J K Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - J-A Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - H Cha
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - J Y Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - H-S Lim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - K M Eun
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
| | - D W Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea.,Sensory Organ Research Institute, Seoul National University Medical Research Center
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23
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Abou Ghayda R, Duck-Young Park D, Lee JY, Kim JY, Lee KH, Hong SH, Yang JW, Kim JS, Jeong GH, Kronbichler A, Koyanagi A, Jacob L, Oh H, Li H, Yang JM, Kim MS, Lee SW, Yon DK, Shin JI, Smith L. Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses. Eur Rev Med Pharmacol Sci 2021; 25:273-286. [PMID: 33506916 DOI: 10.26355/eurrev_202101_24393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases. MATERIALS AND METHODS We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval. RESULTS We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant. CONCLUSIONS Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.
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Affiliation(s)
- R Abou Ghayda
- Urology Institute, University Hospital System, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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24
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Park S, Lee EJ, Kim JY, Bae YJ, Oh SH. Blood high mobility group box 1 levels are not a suitable biomarker for disease activity or severity in nonsegmental vitiligo. Clin Exp Dermatol 2021; 46:1597-1599. [PMID: 34080225 DOI: 10.1111/ced.14782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- S Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - E J Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Y J Bae
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - S H Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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25
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Park JW, Kwon OS, Shim JM, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung BY, Lee MH, Kim YH, Pak HN. Artificial intelligence-predicted poor responders to catheter ablation for atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Although atrial fibrillation (AF) catheter ablation is effective for rhythm control, in some patients it is hard to maintain sinus rhythm in spite of repeated AF catheter ablation (AFCA) procedures and anti-arrhythmic drugs (AADs). We explored the pre-procedural predictors for poor responders to AFCA and tested whether artificial intelligence (AI) assists the prediction of poor responders in the independent cohort by determining the invasive parameters.
Methods
Among 1,214 patients who underwent AFCA and regular rhythm follow-up for 56.2 ± 33.8 months (59 ± 11 years, 73.5% male, 68.6% paroxysmal AF), we differentiated 92 poor responders defined as those with sustained AF despite repeat AFCAs, AADs, or electrical cardioversion. Using the Youden index, we identified advanced LA remodeling with lower LA voltage under 1.109mV. AI model, which was derived from development cohort using medical record, was applied to predict LA voltage <1.109mV in the independent cohort (n = 634, poor responders = 24) using a grad-cam score.
Results
The patients with lower LA voltage under 1.109mV showed significantly poorer rhythm outcomes (Log-rank p < 0.001). We determined invasive parameter LA voltage by using the multiple variables (age, female sex, AF type, CHA2DS2VASc score, LA dimension, E/em, hemoglobin, PR interval) and achieved relatively good prediction power of AI for LA voltage <1.109mV (AUC = 0.734, sensitivity 0.729, specificity 0.643) in the test cohort. In the independent cohort, the AI model showed good discrimination power for poor responders (AUC 0.751, p < 0.001) by estimating LA voltage, which is an invasive variable. The patients with predicted lower LA voltage (grad-cam score <0) showed poorer rhythm outcome after active rhythm control (Log-rank p < 0.001)
Conclusions
The patients with advanced atrial remodeling with low LA voltage, which can be predicted by an AI, showed significantly higher recurrence of AF after AFCA with AADs or cardioversion. AI may assist to select these poor responder patients before the AFCA procedure. Abstract Figure.
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Affiliation(s)
- JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - OS Kwon
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JM Shim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JY Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JI Choi
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - YH Kim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
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26
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Seo J, An ES, Park T, Hwang SY, Kim GY, Song K, Noh WS, Kim JY, Choi GS, Choi M, Oh E, Watanabe K, Taniguchi T, Park JH, Jo YJ, Yeom HW, Choi SY, Shim JH, Kim JS. Tunable high-temperature itinerant antiferromagnetism in a van der Waals magnet. Nat Commun 2021; 12:2844. [PMID: 33990589 PMCID: PMC8121823 DOI: 10.1038/s41467-021-23122-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Discovery of two dimensional (2D) magnets, showing intrinsic ferromagnetic (FM) or antiferromagnetic (AFM) orders, has accelerated development of novel 2D spintronics, in which all the key components are made of van der Waals (vdW) materials and their heterostructures. High-performing and energy-efficient spin functionalities have been proposed, often relying on current-driven manipulation and detection of the spin states. In this regard, metallic vdW magnets are expected to have several advantages over the widely-studied insulating counterparts, but have not been much explored due to the lack of suitable materials. Here, we report tunable itinerant ferro- and antiferromagnetism in Co-doped Fe4GeTe2 utilizing the vdW interlayer coupling, extremely sensitive to the material composition. This leads to high TN antiferromagnetism of TN ~ 226 K in a bulk and ~210 K in 8 nm-thick nanoflakes, together with tunable magnetic anisotropy. The resulting spin configurations and orientations are sensitively controlled by doping, magnetic field, and thickness, which are effectively read out by electrical conduction. These findings manifest strong merits of metallic vdW magnets as an active component of vdW spintronic applications. Metallic van der Waals magnets have considerable technological promise, due to their ability to be strongly coupled with electronic currents and integrated in two dimensional heterostructures. Here, Seo et al. demonstrate highly tunable itinerant antiferromagnetism in a van der Waals magnet.
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Affiliation(s)
- Junho Seo
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Eun Su An
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Taesu Park
- Department of Chemistry, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Soo-Yoon Hwang
- Department of Materials Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Gi-Yeop Kim
- Department of Materials Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Kyung Song
- Materials Modeling and Characterization Department, KIMS, Changwon, Korea
| | - Woo-Suk Noh
- MPPC-CPM, Max Planck POSTECH/Korea Research Initiative, Pohang, Korea
| | - J Y Kim
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea
| | - Gyu Seung Choi
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Minhyuk Choi
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Eunseok Oh
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Kenji Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Takashi Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, Tsukuba, Japan
| | - J -H Park
- Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea.,MPPC-CPM, Max Planck POSTECH/Korea Research Initiative, Pohang, Korea
| | - Youn Jung Jo
- Department of Physics, Kyungpook National University, Daegu, Korea
| | - Han Woong Yeom
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea.,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - Si-Young Choi
- Department of Materials Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Korea.
| | - Ji Hoon Shim
- Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea. .,Department of Chemistry, Pohang University of Science and Technology (POSTECH), Pohang, Korea.
| | - Jun Sung Kim
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science (IBS), Pohang, Korea. .,Department of Physics, Pohang University of Science and Technology (POSTECH), Pohang, Korea.
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Park JH, Jung J, Kim JY, Hong MJ, Kim EO, Jo KW, Shim TS, Kim SH. Airborne precautions based on Xpert ® MTB/RIF results for patients with presumptive TB. Int J Tuberc Lung Dis 2021; 25:244-246. [PMID: 33688817 DOI: 10.5588/ijtld.20.0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J H Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - J Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, Office for Infection Control, Republic of Korea
| | - J Y Kim
- Office for Infection Control, Republic of Korea
| | - M J Hong
- Office for Infection Control, Republic of Korea
| | - E O Kim
- Office for Infection Control, Republic of Korea
| | - K-W Jo
- Department of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T S Shim
- Department of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea, Office for Infection Control, Republic of Korea
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Chung H, Park CH, Kim YJ, Kim JY, Min PK, Yoon YW, Lee KA, Lee BK, Hong BK, Kim TH, Rim SJ, Kwon HM, Choi EY. Myocardial extracellular space expansion is related to burden of premature ventricular contractions in patients with hypertrophic cardiomyopathy without non-sustained ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.321] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Current guidelines suggest the presence of non-sustained ventricular tachycardia (NSVT) as a risk factor of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, high burden of premature ventricular contraction (PVC) may reflect myocardial fibrosis although the absence of NSVT.
Purpose
We investigated the association between PVC burden and myocardial extracellular space expansion in HCM patients without NSVT.
Methods
Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 patients were evaluated with both cardiac magnetic resonance and 24hr holter. Among them, 71 patients (58 males, mean age: 71 ± 13 years) have not been diagnosed with NSVT.
Results
Patients with NSVT (n = 13) showed more impaired LA functional indices and higher myocardial fibrosis burden compared with patients without NSVT (n = 71). Among patients who have not been diagnosed with NSVT, patients with late gadolinium enhancement (LGE, n = 46) had a higher total beats (109 ± 332 vs. 7 ± 13 beats per a day, p = 0.003) and burden (0.114 ± 0.225 vs. 0.008 ± 0.014 %, p = 0.003) of PVC during 24-hour compared with patients without LGE (n = 25). %LGE was correlated with total beats of PVC (r = 0.358, p = 0.002) and PVC burden (r = 0.377, p = 0.001). ECV also correlated with total beats of PVC (r = 0.387, p = 0.001) and PVC burden (r = 0.401, p = 0.001). The optimal cutoff value for PVC number was 45 (37.0% of sensitivity and 100% of specificity) with 0.733 of the area under the ROC curve (p < 0.001). Pathogenic or likely pathogenic sarcomere mutation was higher in NSVT group than no NSVT group (p < 0.05), and had a higher tendency in higher PVC burden group (0.05 < p < 0.1) than lower PVC burden group.
Conclusions
Total beats and burden of PVC are significantly related to increase in myocardial fibrosis in HCM patients without NSVT.
Abstract Figure. Mechanism of ventricular arrhythmia
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Affiliation(s)
- H Chung
- Kyung Hee Medical Center, Seoul, Korea (Republic of)
| | - CH Park
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - YJ Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - JY Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - PK Min
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - YW Yoon
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - KA Lee
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - BK Lee
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - BK Hong
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - TH Kim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - SJ Rim
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - HM Kwon
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
| | - EY Choi
- Gangnam Severance Hospital, Seoul, Korea (Republic of)
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Ohn J, Hur K, Cho Y, Park J, Kim JY, Lee SJ, Park H, Mun JH. Developing a predictive model for distinguishing invasive nail unit melanoma from nail unit melanoma in situ. J Eur Acad Dermatol Venereol 2020; 35:906-911. [PMID: 33205521 DOI: 10.1111/jdv.17036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical information that distinguishes invasive nail unit melanoma from nail unit melanoma in situ before surgery would aid physicians in the decision-making process and estimating prognosis. However, limited information is available on the detailed demographic and dermoscopic features of invasive nail unit melanoma and nail unit melanoma in situ for differential diagnosis. OBJECTIVE This study aimed to investigate the demographic data and dermoscopic features of invasive nail unit melanoma and nail unit melanoma in situ and establish a predictive model for differentiating these two forms of nail unit melanoma. METHODS A retrospective observational study of ninety-seven patients diagnosed with nail unit melanoma (59 in situ and 38 invasive cases) in four healthcare centres in South Korea (three tertiary referral hospitals and one second referral hospital) from March 2014 to December 2019. RESULTS A multivariable analysis revealed that ulcer (odds ratio = 21.6, confidence interval = 2.1-219.8, P = 0.009), total melanonychia (odds ratio = 17.6, confidence interval = 3.0-104.0, P = 0.002), nail plate destruction (odds ratio = 10.9, confidence interval = 2.0-59.4, P = 0.006) and polychromia (odds ratio = 5.3, confidence interval = 1.36-20.57, P = 0.016) were distinctive dermoscopic features of invasive nail unit melanoma. A predictive model with scores ranging from 0 to 6 points demonstrated a reliable diagnostic value (C-statistic = 0.902) in differentiating invasive nail unit melanoma from nail unit melanoma in situ. CONCLUSIONS Invasive nail unit melanoma and nail unit melanoma in situ have different dermoscopic features. A predictive model based on morphologic dermoscopic features could aid in differentiating invasive nail unit melanoma from nail unit melanoma in situ.
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Affiliation(s)
- J Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - K Hur
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Y Cho
- Department of Mathematical Sciences, College of Science, The University of Texas at El Paso, El Paso, TX, USA
| | - J Park
- Department of Dermatology, Jeonbuk National University Medical School, Jeonju, Korea
| | - J Y Kim
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - S-J Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - H Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea.,Department of Dermatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center (SMG-SNU), Seoul, Korea
| | - J-H Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
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30
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Choi JH, Jang HI, Jang JS, Jeon SH, Joo KK, Ju K, Jung DE, Kim JG, Kim JH, Kim JY, Kim SB, Kim SY, Kim W, Kwon E, Lee DH, Lee HG, Lim IT, Moon DH, Pac MY, Seo H, Seo JW, Shin CD, Yang BS, Yoo J, Yoon SG, Yeo IS, Yu I. Search for Sub-eV Sterile Neutrinos at RENO. Phys Rev Lett 2020; 125:191801. [PMID: 33216576 DOI: 10.1103/physrevlett.125.191801] [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] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
We report a search result for a light sterile neutrino oscillation with roughly 2200 live days of data in the RENO experiment. The search is performed by electron antineutrino (ν[over ¯]_{e}) disappearance taking place between six 2.8 GW_{th} reactors and two identical detectors located at 294 m (near) and 1383 m (far) from the center of the reactor array. A spectral comparison between near and far detectors can explore reactor ν[over ¯]_{e} oscillations to a light sterile neutrino. An observed spectral difference is found to be consistent with that of the three-flavor oscillation model. This yields limits on sin^{2}2θ_{14} in the 10^{-4}≲|Δm_{41}^{2}|≲0.5 eV^{2} region, free from reactor ν[over ¯]_{e} flux and spectrum uncertainties. The RENO result provides the most stringent limits on sterile neutrino mixing at |Δm_{41}^{2}|≲0.002 eV^{2} using the ν[over ¯]_{e} disappearance channel.
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Affiliation(s)
- J H Choi
- Institute for High Energy Physics, Dongshin University, Naju 58245, Korea
| | - H I Jang
- Department of Fire Safety, Seoyeong University, Gwangju 61268, Korea
| | - J S Jang
- GIST College, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - S H Jeon
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K K Joo
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - K Ju
- Department of Physics, KAIST, Daejeon 34141, Korea
| | - D E Jung
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J G Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J H Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J Y Kim
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - S B Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - S Y Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - W Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Korea
| | - E Kwon
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - D H Lee
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - H G Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - I T Lim
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - D H Moon
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - M Y Pac
- Institute for High Energy Physics, Dongshin University, Naju 58245, Korea
| | - H Seo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - J W Seo
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - C D Shin
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - B S Yang
- Institute for Basic Science, Daejeon 34047, Korea
| | - J Yoo
- Department of Physics, KAIST, Daejeon 34141, Korea
- Institute for Basic Science, Daejeon 34047, Korea
| | - S G Yoon
- Department of Physics, KAIST, Daejeon 34141, Korea
| | - I S Yeo
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - I Yu
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
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Park JE, Kim JY, Kim HS, Shim WH. Comparison of Dynamic Contrast-Enhancement Parameters between Gadobutrol and Gadoterate Meglumine in Posttreatment Glioma: A Prospective Intraindividual Study. AJNR Am J Neuroradiol 2020; 41:2041-2048. [PMID: 33060100 DOI: 10.3174/ajnr.a6792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Differences in molecular properties between one-molar and half-molar gadolinium-based contrast agents are thought to affect parameters obtained from dynamic contrast-enhanced imaging. The aim of our study was to investigate differences in dynamic contrast-enhanced parameters between one-molar nonionic gadobutrol and half-molar ionic gadoterate meglumine in patients with posttreatment glioma. MATERIALS AND METHODS This prospective study enrolled 32 patients who underwent 2 20-minute dynamic contrast-enhanced examinations, one with gadobutrol and one with gadoterate meglumine. The model-free parameter of area under the signal intensity curve from 30 to 1100 seconds and the Tofts model-based pharmacokinetic parameters were calculated and compared intraindividually using paired t tests. Patients were further divided into progression (n = 12) and stable (n = 20) groups, which were compared using Student t tests. RESULTS Gadobutrol and gadoterate meglumine did not show any significant differences in the area under the signal intensity curve or pharmacokinetic parameters of K trans, Ve, Vp, or Kep (all P > .05). Gadobutrol showed a significantly higher mean wash-in rate (0.83 ± 0.64 versus 0.29 ± 0.63, P = .013) and a significantly lower mean washout rate (0.001 ± 0.0001 versus 0.002 ± 0.002, P = .02) than gadoterate meglumine. Trends toward higher area under the curve, K trans, Ve, Vp, wash-in, and washout rates and lower Kep were observed in the progression group in comparison with the treatment-related-change group, regardless of the contrast agent used. CONCLUSIONS Model-free and pharmacokinetic parameters did not show any significant differences between the 2 gadolinium-based contrast agents, except for a higher wash-in rate with gadobutrol and a higher washout rate with gadoterate meglumine, supporting the interchangeable use of gadolinium-based contrast agents for dynamic contrast-enhanced imaging in patients with posttreatment glioma.
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Affiliation(s)
- J E Park
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., W.H.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J Y Kim
- Department of Radiology (J.Y.K.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., W.H.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - W H Shim
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., W.H.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kim JY, Choi H, Park JH, Jung HD, Jung YS. Effects of anti-resorptive drugs on implant survival and peri-implantitis in patients with existing osseointegrated dental implants: a retrospective cohort study. Osteoporos Int 2020; 31:1749-1758. [PMID: 32367226 DOI: 10.1007/s00198-019-05257-3] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
UNLABELLED The effect of anti-resorptive drug (ARD) usage among patients with successful dental implant osseointegration is controversial. This study showed an increased risk of implant failure in ARD users. Risk factors included pre-existing marginal bone loss, overdenture, diabetes, and a short interval between implant placement and ARD administration. INTRODUCTION This retrospective study aimed to determine whether anti-resorptive drug (ARD) usage increased risk of implant failure among patients with successful implant osseointegration. Additionally, the study investigated risk factors that affected implant survival rate in ARD users. METHODS Eighty ARD users with 344 implants who had more than 12 months of follow-up from the initiation of ARD treatment during the period between 2008 and 2017 were included, along with 80 non-ARD users from the same period. The primary outcome was dental implant survival. Kaplan-Meier survival curves and Cox proportional hazard models were used for survival analysis. RESULTS Average follow-up was 85.3 months. Implant survival rates were 89.83% in ARD users and 96.03% in non-ARD users. In the univariate Cox proportional hazard model, risk of implant failure was significantly higher in patients with pre-existing marginal bone loss (MBL), diabetes, and concurrent bone augmentation. However, risk of implant failure was significantly lower when the interval between implant placement and ARD administration was < 36 months. Compared with overdenture, single crown and fixed splinted users had lower risk of implant failure. In multivariate analysis, variables including pre-existing MBL, diabetes, < 36-month interval between implant placement and ARD treatment, and usage of fixed splinted prosthesis were significantly associated with increased risk of implant failure. CONCLUSIONS ARD administration after implant osseointegration was correlated with a reduced implant survival rate. Pre-existing MBL, diabetes, type of final prosthesis, and the interval between implant placement and initiation of ARD administration influenced risk of implant failure.
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Affiliation(s)
- J Y Kim
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - H Choi
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - J H Park
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - H D Jung
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Y S Jung
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Sohng C, Han MH, Park D, Park KD, Jang YH, Lee WJ, Lee SJ, Kim JY. Clinical features of subungual melanoma according to the extent of Hutchinson's nail sign: a retrospective single-centre study. J Eur Acad Dermatol Venereol 2020; 35:380-386. [PMID: 32562580 DOI: 10.1111/jdv.16762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hutchinson's nail sign (HS) is among the diagnostic criteria for subungual melanoma (SUM). However, there is minimal evidence supporting the overall clinical significance of HS in SUM. OBJECTIVES To identify clinicopathological features of SUM according to the extent of HS. METHODS Retrospective cohort study was performed with consecutive SUM patients at a single centre from January 2006 to December 2017. The extent of HS was defined by the number of affected nail folds (range 0-4). Comparison groups were organized as follows: patients with HS (affecting ≥1 nail folds) vs. without HS; patients with HS affecting ≥2 nail folds vs. HS affecting <2 nail folds; patients with HS affecting ≥3 nail folds vs. HS affecting <3 nail folds. Clinicopathological characteristics of SUM were compared between the groups. RESULTS Sixty-one SUM patients were included. Forty-six (75.4%) exhibited HS; 22 (47.8%) on a toe and 24 (52.2%) on a finger. In multivariate analysis, nail destruction [hazard ratio (HR), 10.00; 95% confidence interval (CI), 2.61-38.30; P = 0.001] was significantly associated with the presence of HS and amputation was significantly associated with HS affecting ≥2 nail folds (HR, 4.75; 95% CI, 1.36-16.61; P = 0.015). High T stage (HR, 1.85; 95% CI, 1.20-2.85; P = 0.005, Fig. 2) was significantly associated with HS appearing in ≥3 nail folds. CONCLUSION Besides its value of detecting SUM, HS provides useful clinical information. The number of nail folds exhibiting HS could be a useful clinical clue for planning therapeutic strategies for SUM.
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Affiliation(s)
- C Sohng
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - M H Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - D Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - K D Park
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Y H Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - W J Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - S J Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - J Y Kim
- Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Park MG, Kim WJ, Choi JY, Kim JH, Park DH, Kim JY, Wang M, Je YH. Development of a Bacillus thuringiensis based dsRNA production platform to control sacbrood virus in Apis cerana. Pest Manag Sci 2020; 76:1699-1704. [PMID: 31758591 DOI: 10.1002/ps.5692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sacbrood virus (SBV) is a fatal viruses that infects the Asian honey bee, Apis cerana in Korea. Recently, RNA interference (RNAi) has been suggested as a promising strategy for the suppression of honey bee viruses. For the efficient control of SBV infection using RNAi, simple and cost-effective methods to produce double-stranded RNA (dsRNA) are needed. RESULTS To develop a dsRNA production platform using Bacillus thuringiensis (Bt), pBTdsSBV-VP1 vector was constructed in which the SBV vp1 gene was located between two oppositely oriented cyt promoters. Both strands of the vp1 gene were bidirectionally transcribed under the control of the sporulation-dependent cyt promoter in Bt cells transformed with pBTdsSBV-VP1, and the resulting dsRNA was easily extracted from the Bt transformant, Bt 4Q7/pBTdsSBV-VP1, by inducing its autolysis. The replication of SBV was dramatically suppressed in A. cerana workers who ingested the dsRNA produced from the Bt 4Q7/pBTdsSBV-VP1. CONCLUSION In this study, we successfully silenced SBV in its host, A. cerana, by the application of exogenous dsRNA produced from an entomopathogenic bacteria, Bt. These results suggested that Bt could be a useful dsRNA production platform to control viral pathogens in their host insects. © 2019 Society of Chemical Industry.
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Affiliation(s)
- Min G Park
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Woo J Kim
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Jae Y Choi
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Jong H Kim
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Dong H Park
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Jun Y Kim
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Minghui Wang
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
| | - Yeon H Je
- Department of Agricultural Biotechnology, College of Agriculture & Life Science, Seoul National University, Seoul, Republic of Korea
- Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
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Abstract
SETTING: In Korea, the price of a pack of cigarettes increased 80% from US$2.2 to US$4 in 2015. The smoking rate decreased in 2015. However, it rebounded in the following year.OBJECTIVE: To evaluate the characteristics associated with this rebound in smoking rate following the price increase.DESIGN: We analysed the KNHANES (Korean National Health and Nutrition Examination Survey) data of 44 015 participants to evaluate current smoking rate and the proportion of smokers planning to quit within 6 months from 2010 to 2016. We also performed focused analysis of 18 303 participants between 2014 and 2016 KNHANES to determine the current smoking rate according to their demographic and socio-economic characteristics.RESULTS: Individuals who were older, female, unemployed, had a low household income or a shorter total smoking period, or smoked less per day were more likely to stop or reduce smoking after the price increase. The current smoking rate increased to 18.8% in 2016 from 17.7% in 2015; this difference was significant in men, those in the lower-middle quartile of household income, those with a middle-school or college education, and those who were employed.CONCLUSION: The rebound in smoking after the price increase was significantly related to the individual's sex, income, education and employment status.
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Affiliation(s)
- J W Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - J Y Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Jung JW, Yoon SW, Lee GE, Shin HG, Kim H, Shin JW, Park IW, Choi BW, Kim JY. Poor nutritional intake is a dominant factor for weight loss in chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2020; 23:631-637. [PMID: 31097074 DOI: 10.5588/ijtld.18.0456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec id="st1"> <title>SETTING</title> Increase in energy expenditure and/or decrease in nutritional intake leads to low body mass index (BMI). The balance between energy expenditure and nutritional intake has rarely been evaluated in a large population of patients with chronic obstructive pulmonary disease (COPD). </sec> <sec id="st2"> <title>OBJECTIVE</title> To evaluate BMI, nutritional intake and physical activity and the association of these factors with the severity of airflow obstruction in COPD patients. </sec> <sec id="st3"> <title>DESIGN</title> We analysed the Korean National Health and Nutrition Examination Survey (KNHANES) data set from 2012 to 2015. </sec> <sec id="st4"> <title>RESULTS</title> Among the 9682 individuals (1601 with COPD and 8081 without COPD) recruited, BMI was lower in COPD patients than in non-COPD participants (males, 23.86 ± 2.76 vs. 24.28 ± 2.80, P < 0.001; females, 23.63 ± 2.94 vs. 23.98 ± 3.10, P < 0.05). As the stage of COPD advanced, BMI, intake of nutrients (food, water and carbohydrates) and total energy levels declined in COPD patients. Total time spent walking in the preceding week decreased with advancing COPD stage in male patients with COPD. COPD severity was an important risk factor for the limitation of physical activity due to respiratory problems (OR 3.92, 95%CI 2.77∼5.34, P < 0.001). </sec> <sec id="st5"> <title>CONCLUSION</title> Patients with COPD had a low nutritional intake with little physical activity, which worsened with advancing COPD stage. In late-stage COPD, impaired nutritional intake outweighed the decrease in physical activity, resulting in weight loss. </sec>.
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Affiliation(s)
- J-W Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - S W Yoon
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - G-E Lee
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - H-G Shin
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - H Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - J W Shin
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - I W Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - B W Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - J Y Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Heo W, Jin N, Park MS, Kim HY, Yoon SM, Lee J, Kim JY. STIM1 knock-down decreases the affinity of obinutuzumab for CD20 by altering CD20 localization to Triton-soluble membrane. Clin Exp Immunol 2020; 200:260-271. [PMID: 32056202 DOI: 10.1111/cei.13427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 01/16/2023] Open
Abstract
Obinutuzumab is thought to exert its effects through its high antibody-dependent cellular cytotoxicity (ADCC) via glyco-engineering of the Fc region. In addition, obinutuzumab causes direct binding-induced cell death (DCD) only by specifically binding to its target CD20, a Ca2+ channel. However, the specific features of CD20 related to obinutuzumab binding-induction of cell death are not clearly understood. In this study, we evaluated the relationship between the Ca2+ channel features of CD20 as a store-operated Ca2+ channel (SOC) and obinutuzumab binding-induced cell death. Ca2+ channel function and biochemical analysis revealed that CD20 is an Orai1- and stromal interaction molecule (STIM1)-dependent Ca2+ pore. However, binding of obinutuzumab on CD20 did not have any effect on Ca2+ influx activity of CD20; the direct cell death rate mediated by obinutuzumab binding was almost equivalent with or without the extracellular Ca2+ condition. Given the apparent interaction between STIM1 and CD20, we observed Triton-X solubilized obinutuzumab-bound CD20 accompanied by STIM1. Subsequently, obinutuzumab binding and cell death were decreased by STIM1 knock-down in Ramos B cells. Thus, STIM1 directly contributes to cell death by increasing the affinity of cells for obinutuzumab by transferring CD20 to the Triton-soluble membrane region.
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Affiliation(s)
- W Heo
- Department of Pharmacology and Brain, Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - N Jin
- Department of Pharmacology and Brain, Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M S Park
- Department of Pharmacology and Brain, Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - H-Y Kim
- Department of Pharmacology and Brain, Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - S M Yoon
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea
| | - J Lee
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea
| | - J Y Kim
- Department of Pharmacology and Brain, Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Yu HT, Yang PS, Jang E, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip GYH. P4758Label adherence of non-vitamin K antagonist oral anticoagulants and clinical outcomes in patients with atrial fibrillation: A nationwide study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1134] [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
Dose adjustment of non-vitamin K antagonist oral anticoagulants (NOACs) is indicated in some patients with atrial fibrillation (AF), based on selected patient factors or concomitant medications.
Purpose
We assessed the frequency of label adherence of NOAC dosing among AF patients and the associations between off-label NOAC dosing and clinical outcomes in real-world clinical practice.
Methods
We evaluated 53,649 AF patients treated with a NOAC using Korean National Health Insurance Service database during the period from January 2013 to December 2016. NOAC doses were classified as either underdosed or overdosed, consistent with U.S. Food and Drug Administration labeling. Cox proportional hazards regression was performed to investigate the effectiveness and safety outcomes including stroke or systemic embolism, major bleeding, and all-cause mortality.
Results
Overall, 16,757 NOAC-treated patients (31.2%) were underdosed, 4,492 were overdosed (8.4%), and 32,400 (60.4%) were dosed appropriately according to drug labeling. Compared with patients with label adherence, those who were underdosed or overdosed were older (71±8 and 75±7 years of age vs. 70±9 years of age, respectively; p<0.001), more likely female (39% and 53% vs. 38%, respectively; p<0.001), and had higher CHA2DS2-VASc scores (4.6±1.7 and 5.3±1.7 vs. 4.5±1.8, respectively; p<0.001). NOAC overdosing was associated with increased risk for stroke or systemic embolism (5.76 vs. 4.03 events/100 patient-years, p<0.001), major bleeding (4.77 vs. 2.94 events/100 patient-years, p<0.001), and all-cause mortality (5.43 vs. 3.05 events/100 patient-years, p<0.001) compared with label-adherent use.
Figure 1
Conclusion
In routine clinical practice, a significant proportion (almost 2 in 5) of AF patients received NOAC doses inconsistent with drug labeling. NOAC overdosing is associated with increased risk for stroke or systemic embolism, major bleeding, and all-cause mortality in Asian patient with AF.
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Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
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Yoo BS, Ahn MS, Lee SJ, Son JW, Kim JY, Park SW. P783Guideline-directed therapy at discharge is important in patients with heart failure and atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0383] [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
There are limited and conflicting data regarding the prognostic implication of guideline-directed therapy, especially in heart failure (HF) patients with atrial fibrillation (AF). Thus, this study evaluated the relationship between guideline adherence to recommended therapy at discharge and relevant 60-day clinical outcomes in acute HF patients with AF having reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF).
Methods and results
Of 5,625 acute HF patients in the Korean Acute Heart Failure Registry, 2,071 with documented AF (HFrEF, n=986; HFpEF, n=1,085) were separately analysed. A guideline adherence score was calculated for the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, and anticoagulants. In HFrEF patients with AF, there was significant trend of increase in mortality (p for trend <0.001) and composite endpoint (p for trend = 0.002) according to guideline adherence. Poor adherence was associated with a significantly high risk of mortality (hazard ratio [HR], 4.75; 95% confidence interval [95% CI], 1.77–12.74) and composite endpoint (HR, 2.36; 95% CI, 1.33–4.18). In HFpEF patients with AF, there was a significant increasing trend for rehospitalization (p for trend = 0.04) and composite endpoint (p for trend = 0.03). However, the beneficial effect of good guideline adherence was statistically non-significant for all clinical outcomes
Conclusion
Better adherence to guidelines was associated with a better 60-day prognosis in both HFrEF and HFpEF patients with AF. However, the beneficial effect of guideline adherence was more pronounced in HFrEF patients with AF.
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Affiliation(s)
- B S Yoo
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
| | - M S Ahn
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
| | - S J Lee
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
| | - J W Son
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
| | - J Y Kim
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
| | - S W Park
- Wonju College of Medicine, Yonsei University, Division of Cardiology, Department of Internal Medicin, Wonju, Korea (Republic of)
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Kim IS, Lee BK, Yang PS, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Kim JY, Joung B. P5660Clinical impact of polycythemia on cardiovascular outcome from the general population: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0603] [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
Although adverse effect of anemia had been reported, effect of polycythemia on cardiovascular outcome from the general population had not been revealed yet.
Methods
We included 451,107 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort from 2009–2013. Medical records were screened from January 2002 to investigate the subjects' disease-free baseline period. They were followed until December 2013. We divided male and female subjects into four categories each based on hemoglobin level (normal, moderate to severe and mild anemia, polycythemia) to assess each outcome.
Results
During 1,735,964 person·years, 12,107 major adverse cardiovascular and cerebrovascular events (MACCE), 862 incident acute myocardial infarction (MI), 5,850 incident ischemic stroke, and 2,430 incident atrial fibrillation (AF) were observed. Compared to normal hemoglobin range group, polycythemia group showed higher MACCE (HR=1.23 [1.12–1.35] in male, HR=1.79 [1.20–2.67] in female, each p<0.001), incident MI (HR=1.37 [1.05–1.79] in male, HR=3.46 [1.06–14.00] in female, each p<0.001), incident ischemic stroke (HR=1.27 [1.10–1.46] in male, HR=1.72 [1.02–2.91] in female, each p<0.001), and incident AF (HR=1.46 [1.21–1.74] in male, HR=2.13 [1.03–4.77] in female, each p<0.001). Each outcome was linearly increased with the increase of hemoglobin among subjects with polycythemia (p<0.001), and with the decrease of hemoglobin among subjects with anemia (each p<0.001, U-shaped relationship). These relationship was more profound in obese female younger than 60-year-old.
Conclusion
Not only anemia but also polycythemia were significantly associated with higher rate of MACCE including death, incident MI, ischemic stroke, and AF among the general population.
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Affiliation(s)
- I.-S Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - B K Lee
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - P S Yang
- Bundang CHA General Hospital, Cardiology Division, Seongnam, Korea (Republic of)
| | - H T Yu
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J Y Kim
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
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Uhm JS, Jin MN, Kim IS, Bae HJ, Yu HT, Kim TH, Kim JY, Joung B, Pak HN, Lee MH. P1875Nonspecific intraventricular conduction delay is associated with future occurrence of atrial fibrillation in patients with structurally normal heart and sinus rhythm. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0624] [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
This study aimed to elucidate long-term prognosis of nonspecific intraventricular conduction delay (NIVCD) in patients with structurally normal heart.
Methods
We included 107,838 patients (age, 52.1±15.5 years; men, 46.8%) who underwent electrocardiography in outpatient clinics or medical checkup (model 1). NIVCD was defined as QRS duration ≥110 ms and incompatibility with bundle branch block. The patients with structurally normal heart and sinus rhythm were assigned to the NIVCD group and normal QRS group according to propensity score with matching variables of age, sex, hypertension, and diabetes (model 2), and additional PR interval (model 3). Baseline characteristics, electrocardiographic parameters, and clinical outcomes were compared in model 1, 2, and 3, respectively.
Results
In model 1, the frequencies of male and preexisting atrial fibrillation (AF) were significantly higher in the NIVCD group than in the normal QRS group. In model 2, sinus rate and PR interval were significantly slower and longer in the NIVCD group than in the normal QRS group. In model 3, cumulative incidence of AF was significantly higher in the NIVCD group than in the normal QRS group during follow-up of 8.8±2.9 years (Figure). NIVCD significantly increased risk of AF (hazard ratio, 2.571; 95% confidence interval, 1.074–6.156; p=0.034). NIVCD did not significantly increase risk of sick sinus syndrome, complete atrioventricular block, and heart failure.
Atrial fibrillation-free survival
Conclusions
NIVCD is associated with slow sinus rate and prolonged PR interval. NIVCD is an independent risk factor of AF in patients with structurally normal heart.
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Affiliation(s)
- J S Uhm
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M N Jin
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - I S Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H J Bae
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. 208Effect of hypertension duration and systolic blood pressure on dementia in patients with atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0055] [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
Atrial fibrillation (AF) is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. There are a paucity of data on the associations of hypertension duration and blood pressure (BP) level with risk of dementia in patients with AF.
Purpose
We examined associations of duration of hypertension and secondly, systolic blood pressure (SBP) levels with incidence of dementia among patients with AF.
Methods
We enrolled a total 196,388 patients aged ≥50 years who were newly diagnosed as AF and undergoing hypertension treatment from the Korean National Health Insurance Service database (2005–2016). Starting from AF diagnosis, participants were followed up until the date of dementia, death, or December 31, 2016. To incorporate the effect of BP level and hypertension duration changes over time on dementia incidence, we constructed time-updated multivariable Cox models in which BP levels and hypertension duration were updated at each participants' regular national health examination visits (at 0–7 years of follow-up). Similarly, age, BP medications, and health-related behaviors were included as time-varying covariates in these models.
Results
During 1,016,744 person-years of follow-up, there were 32,692 dementia events. A cubic spline curve using continuous hypertension duration measures suggested a linear association between increase of hypertension duration and dementia risk. One-year increase of hypertension duration increased the adjusted risk of dementia with a hazard ratio (HR) of 1.17 [95% confidence interval (CI) 1.13–1.22]. In patients with hypertension duration <6 years, SBP of ≥140 mmHg was significantly associated with higher dementia risk, compared to SBP of <130 mmHg (in patients with hypertension duration <3 years: adjusted HR 1.08, 95% CI 1.01–1.16; and in those with 3 ≤ hypertension duration <6 years: adjusted HR 1.13, 95% CI 1.07–1.20), whereas no significant association between SBP and dementia risk in those with hypertension duration ≥6 years.
SBP and dementia in different duration
Conclusion
In patients with AF, the increase of hypertension duration was strongly associated with increased risk of dementia. Uncontrolled SBP was also associated with higher dementia risk. But, this effect of SBP might be attenuated in patients with longer hypertension duration. These findings suggest more emphasis needed on BP control in AF patients with earlier phase of hypertension (duration <6 years).
Acknowledgement/Funding
The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Kim IS, Yang PS, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Kim JY, Joung B. P5710Clinical applications of machine learning for prediction of incident atrial fibrillation from the general population: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0651] [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: 11/15/2022] Open
Abstract
Abstract
Background
To evaluate the ability of machine learning algorithms to predict incident atrial fibrillation (AF) from the general population using health examination items.
Methods
We included 483,343 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort (NHIS-NSC). We trained deep neural network model (DNN) of a deep learning system and decision tree model (DT) of a machine learning system using clinical variables and health examination items (including age, sex, body mass index, history of heart failure, hypertension or diabetes, baseline creatinine, and smoking and alcohol intake habits) to predict incident AF using a training dataset of 341,771 subjects constructed from the NHIS-NSC database. The DNN and DT were validated using an independent test dataset of 141,572 remaining subjects. C-indices of DNN and DT for prediction of incident AF were compared with that of conventional logistic regression model.
Results
During 1,874,789 person·years (mean±standard-deviation age 47.7±14.4 years, 49.6% male), 3,282 subjects with incident AF were observed. In the validation dataset, 1,139 subjects with incident AF were observed. The c-indices of the DNN and DT for incident AF prediction were 0.828 [0.819–0.836] and 0.835 [0.825–0.844], and were significantly higher (p<0.01) than conventional logistic regression model (c-index=0.789 [0.784–0.794]).
Conclusions
Application of machine learning using simple clinical variables and health examination items was helpful to predict incident AF in the general population. Prospective study is warranted to construct an individualized precision medicine.
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Affiliation(s)
- I.-S Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - P S Yang
- Bundang CHA General Hospital, Cardiology Division, Seongnam, Korea (Republic of)
| | - H T Yu
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J Y Kim
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. 64Risk of dementia in patients treated with non-vitamin k antagonist oral anticoagulant or warfarin for nonvalvular atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0010] [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
Evidence is accumulating that use of oral anticoagulants (OACs) decreases the risk of dementia in patients with atrial fibrillation (AF), but it is unclear if there is a difference between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in protecting against dementia.
Purpose
To compare the risk of dementia between patients taking either NOAC or warfarin using a nationwide cohort data covering the entire Korean population.
Methods
Using the Korean national health insurance service database, 68,984 new OAC users with non-valvular AF aged ≥50 years and no prior diagnosis of dementia were identified during the period of 2013–2016 (39,687 NOAC users and 29,297 warfarin users). Starting from OAC initiation, participants were followed up until the date of dementia, death, or December 31, 2016. We compared the rates of dementia in 1:1 propensity score-matched cohorts of NOAC (n=18,925) and warfarin users (n=18,925).
Results
During the 52,259 person-years of follow-up, there were 2,750 dementia events. Use of NOAC was associated with significant lower risk of dementia [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.69–0.81], compared with warfarin. The risk reduction was prominent for vascular dementia (HR 0.60, 95% CI 0.52–0.71), whereas there was no significant difference in the risk of Alzheimer dementia (HR 0.92, 95% CI 0.83–1.02). Restricting the analyses to patients with no stroke diagnosis prior to OAC initiation (primary prevention) showed no significant difference between NOAC and warfarin in any types of dementia, but in the subgroup with prior stroke (secondary prevention), NOAC significantly reduced the risk of overall (HR 0.70, 95% CI 0.63–0.78) and vascular dementia (HR 0.59, 95% CI 0.49–0.69).
Subgroup analysis according to stroke Hx Patient N Overall dementia Alzheimer dementia Vascular dementia HR (95% CI) P for interaction HR (95% CI) P for interaction HR (95% CI) P for interaction Total 37,850 0.75 (0.69–0.81) 0.92 (0.83–1.02) 0.60 (0.52–0.71) Without prior stroke 24,773 0.90 (0.78–1.05) 0.948 0.98 (0.83–1.15) 0.235 0.85 (0.56–1.28) 0.863 With prior stroke 13,077 0.70 (0.63–0.78) 0.90 (0.79–1.03) 0.59 (0.49–0.69) CI, confidence interval; HR, hazard ratio.
KM curves of dementia incidence
Conclusion
In this propensity-weighted nationwide cohort of non-valvular AF patients, NOAC was associated with reduced risk of dementia, compared with warfarin. This association was the most pronounced for vascular dementia in patients with prior stroke.
Acknowledgement/Funding
The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Yang PS, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B. P1027The risk of dementia and catheter ablation for atrial fibrillation: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0618] [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
Atrial fibrillation (AF) is associated with all forms of dementia, including Alzheimer's disease. Catheter ablation of AF reduces the number of AF episodes, prolongs the time in sinus rhythm, and improves quality of life. However, it is still unclear if catheter ablation for AF improve cognitive function and prevent dementia. Our objective was to compare long-term outcome regarding dementia and type of dementia in AF patients with and without ablation, and about long-term exposure to anticoagulants.
Methods
We identified all 801,701 patients with a diagnosis of AF from 2006 to 2015 in the Korean national health insurance service database. During ten years, 10,979 AF ablations were performed among 9,768 individuals. Propensity scores for the likelihood of AF ablation were obtained by logistic regression. Propensity score (PS) matching was used to construct two cohorts of equal size (n=9,768) with similar characteristics in 16 dimensions.
Results
Patients who had undergone catheter ablation were younger (57.2 vs. 65.6 years, P<0.001) and healthier (mean CHA2DS2-VASc scores 2.5±1.7 vs. 3.6±2.1, p<0.001) than other patients with AF. Mean follow-up was 5.5±3.1 years. After propensity score matching, in the ablated group, 184 patients suffered dementia compared with 650 in the matched non-ablated (annual rates 0.42 vs. 1.08%, P<0.001). While a total of 134 ablated and 379 non-ablated patients had Alzheimer disease (annual rates 0.31 vs. 0.62%, p<0.001), 40 ablated and 191 non-ablated patients had vascular disease (annual rates 0.09 vs. 0.31%, p<0.001). After multivariable adjustments, catheter ablation was associated with lower risk of dementia (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.37–0.58), lower risk of Alzheimer disease (HR 0.61, 95% CI 0.46–0.79) and lower risk of vascular dementia (HR 0.27, 95% CI 0.19–0.38). Although the reduction of dementia and Alzheimer disease was observed after AF ablation regardless of thromboembolic risk, vascular dementia was reduced only among patients with CHA2DS2-VASc score ≥2 (HR 0.29, 95% CI 0.20–0.42).
The risk of dementia, RFCA vs. no-RFCA Type Propensity score matched ablation group vs. no ablation group adjusted HR (95% CI) P-value Overall dementia 0.46 (0.37–0.58) <0.001 Alzheimer dementia 0.61 (0.46–0.79) <0.001 Vascular dementia 0.27 (0.19–0.38) <0.001
Conclusion
Ablation may be associated with a lower incidence of dementia and both type of dementia in patients with AF. This finding appears more pronounced in patients with high thromboembolic risk factors.
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Affiliation(s)
- P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
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Bak G, Choi JH, Jang HI, Jang JS, Jeon SH, Joo KK, Ju K, Jung DE, Kim JG, Kim JH, Kim JY, Kim SB, Kim SY, Kim W, Kwon E, Lee DH, Lee HG, Lee YC, Lim IT, Moon DH, Pac MY, Park YS, Rott C, Seo H, Seo JW, Seo SH, Shin CD, Yang JY, Yoo J, Yu I. Fuel-Composition Dependent Reactor Antineutrino Yield at RENO. Phys Rev Lett 2019; 122:232501. [PMID: 31298906 DOI: 10.1103/physrevlett.122.232501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 05/16/2019] [Indexed: 06/10/2023]
Abstract
We report a fuel-dependent reactor electron antineutrino (ν[over ¯]_{e}) yield using six 2.8 GW_{th} reactors in the Hanbit nuclear power plant complex, Yonggwang, Korea. The analysis uses 850 666 ν[over ¯]_{e} candidate events with a background fraction of 2.0% acquired through inverse beta decay (IBD) interactions in the near detector for 1807.9 live days from August 2011 to February 2018. Based on multiple fuel cycles, we observe a fuel ^{235}U dependent variation of measured IBD yields with a slope of (1.51±0.23)×10^{-43} cm^{2}/fission and measure a total average IBD yield of (5.84±0.13)×10^{-43} cm^{2}/fission. The hypothesis of no fuel-dependent IBD yield is ruled out at 6.6σ. The observed IBD yield variation over ^{235}U isotope fraction does not show significant deviation from the Huber-Mueller (HM) prediction at 1.3 σ. The measured fuel-dependent variation determines IBD yields of (6.15±0.19)×10^{-43} and (4.18±0.26)×10^{-43} cm^{2}/fission for two dominant fuel isotopes ^{235}U and ^{239}Pu, respectively. The measured IBD yield per ^{235}U fission shows the largest deficit relative to the HM prediction. Reevaluation of the ^{235}U IBD yield per fission may mostly solve the reactor antineutrino anomaly (RAA) while ^{239}Pu is not completely ruled out as a possible contributor to the anomaly. We also report a 2.9 σ correlation between the fractional change of the 5 MeV excess and the reactor fuel isotope fraction of ^{235}U.
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Affiliation(s)
- G Bak
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - J H Choi
- Institute for High Energy Physics, Dongshin University, Naju 58245, Korea
| | - H I Jang
- Department of Fire Safety, Seoyeong University, Gwangju 61268, Korea
| | - J S Jang
- GIST College, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - S H Jeon
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K K Joo
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - K Ju
- Department of Physics, KAIST, Daejeon 34141, Korea
| | - D E Jung
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J G Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J H Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - J Y Kim
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - S B Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - S Y Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - W Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Korea
| | - E Kwon
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - D H Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - H G Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - Y C Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - I T Lim
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - D H Moon
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - M Y Pac
- Institute for High Energy Physics, Dongshin University, Naju 58245, Korea
| | - Y S Park
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - C Rott
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - H Seo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - J W Seo
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - S H Seo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - C D Shin
- Institute for Universe and Elementary Particles, Chonnam National University, Gwangju 61186, Korea
| | - J Y Yang
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - J Yoo
- Institute for Basic Science, Daejeon 34047, Korea
- Department of Physics, KAIST, Daejeon 34141, Korea
| | - I Yu
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
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47
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Jin ES, Kim JY, Min JK, Jeon SR, Choi KH, Lee MS, Jeong JH. Bilateral ovario-hysterectomy induced osteoporotic rabbit model. J BIOL REG HOMEOS AG 2019; 33:391-396. [PMID: 30915825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- E S Jin
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
| | - J Y Kim
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
| | - J K Min
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
| | - S R Jeon
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
- Department of Neurological surgery, Asan Medical Center, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - K H Choi
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - M S Lee
- OSTEONIC, Co., Ltd., Seoul, Republic of Korea
| | - J H Jeong
- Laboratory of Stem Cell Therapy, College of Medicine, Asan Medical Center, University of Ulsan, Ulsan, Republic of Korea
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Gyunggi-do, Republic of Korea
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Yoon KH, Lee KB, Lee H, Lee J, Kim JY, Park HS, Park S, Kim SI, Cho YU, Park BW. Abstract P3-03-31: Is sentinel lymph node biopsy necessary in all patients with early breast cancer? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and objectives : Since the results of the American College of Surgeons Oncology Group Z0011 published, the criteria for applying axillary lymph node (ALN) dissection was relaxed among early breast cancer patients who were scheduled for breast conserving surgery, adjuvant chemotherapy therapy, and adjuvant radiation therapy. SLNB criteria may be established if pathologic nodal status can be predicted. The aim of this study was to develop a nomogram for preoperative prediction of axillary node metastasis.
Methods: The records of 1650 patients with T1, T2 primary invasive breast cancer who were treated between January 2013 and September 2016 were selected from the medical database of Yonsei University (Seoul, South Korea). Those whom a preoperative diagnosis of axillary node metastases were excluded. Two nomogram that predicted three or more axillary metastasis and one or more axillary metastasis were developed using a binary logistic regression model with a training cohort. Internal validation was carried out adopting bootstrap method by validation cohort 500 times resampling.
Result: A total of 82 (4.8%) patients had three or more ALNs metastasis. Three hundred seventy five (17.4%) patients had one or more ALNs metastasis. Axillary metastasis was associated with Preoperative ALN suspicious image findings, clinical tumor size, Number of neoplastic foci, estrogen receptor status, Ki-67 expression, tumor marker. The nomogram was developed based on the clinical and statistically significant predictors. It had good discrimination performance (AUC 0.79, 95% CI, 0.73–0.85), (AUC 0.71, 95% CI, 0.67–0.74) and calibration fit.
Conclusion:Our nomogram might help predict the ALN metastasis in breast cancer patients. Patients with a low probability of ALN metastasis could be spared SLNB.
Citation Format: Yoon KH, Lee KB, Lee H, Lee J, Kim JY, Park HS, Park S, Kim SI, Cho YU, Park B-W. Is sentinel lymph node biopsy necessary in all patients with early breast cancer? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-31.
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Affiliation(s)
- KH Yoon
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - KB Lee
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H Lee
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Lee
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - JY Kim
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - HS Park
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S Park
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - SI Kim
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YU Cho
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B-W Park
- Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee J, Park HS, Kim JH, Lee DW, Song SY, Lew DH, Kim JY, Kim SI, Cho YU, Lee H, Lee KB, Yoon KH. Abstract OT2-01-03: A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Endoscopic breast surgery was expected to be an adequate technique to complete cancer clearance and preservation of the patient's body image. However, this technique has limitations including incomplete internal movements and unstable vision of a two dimensional camera due to inflexible endoscopic instruments especially during the skin flap formation. High resolution, ten-fold image magnification, and three-dimensional optics of robotic surgery help overcome the limitations of endoscopic surgery, and thus robotic surgery has been adopted in a wide range of intracorporeal procedures including breast surgery. However, few studies have evaluated feasibility and safety of robotic assisted nipple sparing mastectomy (RANSM) and immediate breast reconstruction (IBR) for the treatment of breast cancer. There were not any investigation to assess patients' satisfaction of cosmetic effect after performing RANSM and IBR. This study is aim to verify the feasibility and the safety of RANSM and IBR and to analyze cosmetic effect of the procedure and satisfaction of patients. The target number of enrollments is 15 patients. Patients who are diagnosed with early breast cancer or BRCA 1/2 mutation carriers are enrolled. Female patients over 20 years old who are candidates to preserve nipple areolar complex and considered to perform reconstruction with implants are prospectively collected. Written informed consents are mandatory. Patients who are considered the high possibility of postoperative radiation therapy according to preoperative stage are not included in this study. We exclude patients who want to undergo other methods of breast reconstruction than breast reconstruction with implants. Patients will undergo RANSM and IBR through a single axillary skin incision simultaneously. Regular follow-up at 1 month and 6 months after RANSM and IBR is scheduled to record recovery of a patient, amount of a drain, date of drain removal, and postoperative complications. Patient satisfaction questionnaire will be completed on the last follow-up day. To evaluate the safety of robotic assisted surgery, the oncologic safety (margin status of nipple areolar complex), postoperative recovery of a patient, and postoperative complications are investigated. We compare preoperative and postoperative 6 month photographs of patients and estimate the surgical outcome by objective indicators to evaluate the cosmetic grading by plastic surgeons. Patients' satisfaction are assessed by questionnaire (BREAST-Q) at the 6-month visit.
Citation Format: Lee J, Park HS, Kim JH, Lee DW, Song SY, Lew DH, Kim JY, Kim SI, Cho YU, Lee H, Lee KB, Yoon KH. A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-01-03.
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Affiliation(s)
- J Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - HS Park
- Yonsei University College of Medicine, Seoul, Korea
| | - JH Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - DW Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - SY Song
- Yonsei University College of Medicine, Seoul, Korea
| | - DH Lew
- Yonsei University College of Medicine, Seoul, Korea
| | - JY Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - SI Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - YU Cho
- Yonsei University College of Medicine, Seoul, Korea
| | - H Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - KB Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - KH Yoon
- Yonsei University College of Medicine, Seoul, Korea
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50
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Lee SY, Kang DY, Kim JY, Yoon SH, Choi YH, Lee W, Cho SH, Kang HR. Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System. J Investig Allergol Clin Immunol 2019; 29:444-450. [PMID: 30676320 DOI: 10.18176/jiaci.0374] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM. METHODS This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS). RESULTS The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not. CONCLUSION The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.
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Affiliation(s)
- S Y Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - D Y Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - J Y Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - S H Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - W Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - S H Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - H R Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
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