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Rim G, Hyun K, Cho DG, Lim Z, Lee B, Kim K, Yoo GY. Early thrombus detection in the extracorporeal membrane oxygenation circuit by noninvasive real-time ultrasonic sensors. Sci Rep 2024; 14:10438. [PMID: 38714704 PMCID: PMC11076605 DOI: 10.1038/s41598-024-59873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/16/2024] [Indexed: 05/10/2024] Open
Abstract
Thrombus formation in extracorporeal membrane oxygenation (ECMO) remains a major concern as it can lead to fatal outcomes. To the best of our knowledge, there is no standard non-invasive method for quantitatively measuring thrombi. This study's purpose was to verify thrombus detection in an ECMO circuit using novel, non-invasive ultrasonic sensors in real-time, utilizing the fact that the ultrasonic velocity in a thrombus is known to be higher than that in the blood. Ultrasonic sensors with a customized chamber, an ultrasonic pulse-receiver, and a digital storage oscilloscope (DSO) were used to set up the measuring unit. The customized chamber was connected to an ECMO circuit primed with porcine blood. Thrombi formed from static porcine blood were placed in the circuit and ultrasonic signals were extracted from the oscilloscope at various ECMO flow rates of 1-4 L/min. The ultrasonic signal changes were successfully detected at each flow rate on the DSO. The ultrasonic pulse signal shifted leftward when a thrombus passed between the two ultrasonic sensors and was easily detected on the DSO screen. This novel real-time non-invasive thrombus detection method may enable the early detection of floating thrombi in the ECMO system and early management of ECMO thrombi.
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Affiliation(s)
- Gongmin Rim
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, St. Vincent's Hospital, 93 Jungbu-Daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, St. Vincent's Hospital, 93 Jungbu-Daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea.
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, St. Vincent's Hospital, 93 Jungbu-Daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea.
| | | | - Byungdoo Lee
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Keunho Kim
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Ga Young Yoo
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
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Hyun K, Kim JJ, Choi WK, Kim YH, Han SC. Prediction of postoperative final degree and recurrence of pectus excavatum using machine learning algorithms. J Thorac Dis 2024; 16:311-320. [PMID: 38410566 PMCID: PMC10894412 DOI: 10.21037/jtd-23-1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
Background Chest wall re-depression after bar removal (BR) in pectus excavatum (PE) is insufficiently investigated. However, it is not easy to investigate chest wall re-depression due to its multifactorial characteristics. Herein, we investigated chest wall re-depression after BR using machine learning algorithms. To the best of my knowledge, this is the first study of chest wall re-depression after BR using machine learning algorithms. Methods We retrospectively reviewed 199 consecutive subjects who underwent both minimally invasive repair of pectus excavatum (MIRPE) and BR at a single hospital from March 2012 to June 2020. We investigated attributes of chest wall re-depression and risk factors for recurrence after BR, predicted final degree and recurrence of PE after BR, and suggested the optimal age at the time of MIRPE based on recurrence. Data for the chest wall re-depression were analyzed to discover differences according to age group [<10 years (early repair group; EG) vs. ≥10 years (late repair group; LG)]. Results We observed no significant difference between the Haller index and radiographical pectus index (RPI) (P=0.431) and a significant correlation between Haller index and RPI (P<0.001). RPI significantly increased for the first 6 months after BR in both age groups (both P<0.001) and was maintained at 1 year after BR. RPI value of the LG were significantly higher than those of the EG for the entire period after MIRPE (P=0.041). Recurrence of PE in the LG was significantly more frequent than in the EG (P<0.001). RPI values before and after MIRPE and age group were identified as independent risk factors for recurrence after BR (P<0.001, P=0.007, and P=0.001, respectively). The linear regression model outperformed for final RPI with performance scores of mean squared error 0.198, root mean squared error 0.445, mean absolute error 0.336, and R2 0.415. In addition, the logistic regression model outperformed for predicting recurrence with performance scores of 0.865 the area under the curve, 0.884 accuracy, 0.859 F1, 0.865 precision, and 0.884 recall. Conclusions The present study shows that machine learning algorithms can provide good estimates for postoperative results in PE. An approach integrating machine learning models and readily available clinical data can be used to create other models in the thoracic surgery field.
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Affiliation(s)
- Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Won Kyu Choi
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Yoon Ho Kim
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Sang Chul Han
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
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Na HR, Moon SW, Kim KS, Moon MH, Hyun K, Yoon SK. Pleural Carcinoembryonic Antigen and Maximum Standardized Uptake Value as Predictive Indicators of Visceral Pleural Invasion in Clinical T1N0M0 Lung Adenocarcinoma. J Chest Surg 2024; 57:44-52. [PMID: 38174890 DOI: 10.5090/jcs.23.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Visceral pleural invasion (VPI) is a poor prognostic factor that contributes to the upstaging of early lung cancers. However, the preoperative assessment of VPI presents challenges. This study was conducted to examine intraoperative pleural carcinoembryonic antigen (pCEA) level and maximum standardized uptake value (SUVmax) as predictive markers of VPI in patients with clinical T1N0M0 lung adenocarcinoma. Methods A retrospective review was conducted of the medical records of 613 patients who underwent intraoperative pCEA sampling and lung resection for non-small cell lung cancer. Of these, 390 individuals with clinical stage I adenocarcinoma and tumors ≤30 mm were included. Based on computed tomography findings, these patients were divided into pleural contact (n=186) and non-pleural contact (n=204) groups. A receiver operating characteristic (ROC) curve was constructed to analyze the association between pCEA and SUVmax in relation to VPI. Additionally, logistic regression analysis was performed to evaluate risk factors for VPI in each group. Results ROC curve analysis revealed that pCEA level greater than 2.565 ng/mL (area under the curve [AUC]=0.751) and SUVmax above 4.25 (AUC=0.801) were highly predictive of VPI in patients exhibiting pleural contact. Based on multivariable analysis, pCEA (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.14-7.87; p=0.026) and SUVmax (OR, 5.25; 95% CI, 1.90-14.50; p=0.001) were significant risk factors for VPI in the pleural contact group. Conclusion In patients with clinical stage I lung adenocarcinoma exhibiting pleural contact, pCEA and SUVmax are potential predictive indicators of VPI. These markers may be helpful in planning for lung cancer surgery.
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Affiliation(s)
- Hye Rim Na
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung Keun Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee SY, Cho HJ, Choi J, Ku B, Moon SW, Moon MH, Kim KS, Hyun K, Kim TJ, Sung YE, Hwang Y, Lee E, Ahn DH, Choi JY, Lim JU, Park CK, Kim SW, Kim SJ, Koo IS, Jung WS, Lee SH, Yeo CD, Lee DW. Correction: Cancer organoid-based diagnosis reactivity prediction (CODRP) index-based anticancer drug sensitivity test in ALK-rearrangement positive non-small cell lung cancer (NSCLC). J Exp Clin Cancer Res 2023; 42:332. [PMID: 38057916 DOI: 10.1186/s13046-023-02919-3] [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: 12/08/2023] Open
Affiliation(s)
- Sang-Yun Lee
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Hyeong Jun Cho
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jimin Choi
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Bosung Ku
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Yeoun Eun Sung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Yongki Hwang
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunyoung Lee
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hyuck Ahn
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Uk Lim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Postech-Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of Korea, Songeui Multiplex Hall, Seoul, Republic of Korea
| | - In-Seong Koo
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
| | - Woo Seok Jung
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
| | - Sang-Hyun Lee
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea.
| | - Chang Dong Yeo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dong Woo Lee
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea.
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Sung YE, Han DH, Hyun K, Jung JY, Chang S. Imaging features and clinical significance of atypical pleural plaques mimicking bone tumors: a retrospective case series. Quant Imaging Med Surg 2023; 13:8729-8738. [PMID: 38106336 PMCID: PMC10722080 DOI: 10.21037/qims-23-725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
This study aimed to examine the imaging characteristics and clinical implications of atypical pleural lesions that mimic bone tumors and form along the inner margins of consecutive ribs. This retrospective analysis included 45 atypical pleural lesions arising from 13 patients who underwent chest computed tomography (CT) between April 2021 and March 2023. The clinical features, CT findings, and radiologic diagnoses prior to pathologic identification were examined. Pathological findings were reviewed in the surgically resected case. Subgroup analysis was performed based on the presence of concurrent typical pleural plaques. The mean age of the patients was 69.3±8.4 years with a predominance of males (76.9%). The lesions primarily exhibited unilateral involvement (84.6%), being most frequently located in the right mid-level posterior region. Calcification was present in 75.6% of cases, typically seen continuously along the ribs (82.4%). Adjacent rib changes were observed in 28.9% of cases. These lesions were frequently misdiagnosed as osteochondromas or bony spurs (55.6%) by thoracic radiologists. No significant growth was observed during follow-up (n=11, 47±41 months), and the pathological findings were consistent with pleural plaques. Patients with concurrent typical pleural plaques had more atypical pleural lesions without statistical significance (P=0.071) and showed a more even distribution (P=0.039). In conclusion, atypical pleural lesions resembling bone tumors along consecutive ribs represent a distinct subset of pleural plaques. Their unique distribution and morphology should be recognized by radiologists to avoid misinterpretation and unnecessary interventions.
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Affiliation(s)
- Yeoun Eun Sung
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Hee Han
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suyon Chang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee SY, Cho HJ, Choi J, Ku B, Moon SW, Moon MH, Kim KS, Hyun K, Kim TJ, Sung YE, Hwang Y, Lee E, Ahn DH, Choi JY, Lim JU, Park CK, Kim SW, Kim SJ, Koo IS, Jung WS, Lee SH, Yeo CD, Lee DW. Cancer organoid-based diagnosis reactivity prediction (CODRP) index-based anticancer drug sensitivity test in ALK-rearrangement positive non-small cell lung cancer (NSCLC). J Exp Clin Cancer Res 2023; 42:309. [PMID: 37993887 PMCID: PMC10664561 DOI: 10.1186/s13046-023-02899-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Recently, cancer organoid-based drug sensitivity tests have been studied to predict patient responses to anticancer drugs. The area under curve (AUC) or IC50 value of the dose-response curve (DRC) is used to differentiate between sensitive and resistant patient's groups. This study proposes a multi-parameter analysis method (cancer organoid-based diagnosis reactivity prediction, CODRP) that considers the cancer stage and cancer cell growth rate, which represent the severity of cancer patients, in the sensitivity test. METHODS On the CODRP platform, patient-derived organoids (PDOs) that recapitulate patients with lung cancer were implemented by applying a mechanical dissociation method capable of high yields and proliferation rates. A disposable nozzle-type cell spotter with efficient high-throughput screening (HTS) has also been developed to dispense a very small number of cells due to limited patient cells. A drug sensitivity test was performed using PDO from the patient tissue and the primary cancer characteristics of PDOs were confirmed by pathological comparision with tissue slides. RESULTS The conventional index of drug sensitivity is the AUC of the DRC. In this study, the CODRP index for drug sensitivity test was proposed through multi-parameter analyses considering cancer cell proliferation rate, the cancer diagnosis stage, and AUC values. We tested PDOs from eight patients with lung cancer to verify the CODRP index. According to the anaplastic lymphoma kinase (ALK) rearrangement status, the conventional AUC index for the three ALK-targeted drugs (crizotinib, alectinib, and brigatinib) did not classify into sensitive and resistant groups. The proposed CODRP index-based drug sensitivity test classified ALK-targeted drug responses according to ALK rearrangement status and was verified to be consistent with the clinical drug treatment response. CONCLUSIONS Therefore, the PDO-based HTS and CODRP index drug sensitivity tests described in this paper may be useful for predicting and analyzing promising anticancer drug efficacy for patients with lung cancer and can be applied to a precision medicine platform.
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Affiliation(s)
- Sang-Yun Lee
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Hyeong Jun Cho
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jimin Choi
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Bosung Ku
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Yeoun Eun Sung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Yongki Hwang
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunyoung Lee
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hyuck Ahn
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Uk Lim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Postech-Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of Korea, Songeui Multiplex Hall, Seoul, Republic of Korea
| | - In-Seong Koo
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
| | - Woo Seok Jung
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea
| | - Sang-Hyun Lee
- Central R & D Center, Medical & Bio Decision (MBD) Co., Ltd, Suwon, 16229, Republic of Korea.
| | - Chang Dong Yeo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dong Woo Lee
- Department of Biomedical Engineering, Gachon University, Seongnam, 13120, Republic of Korea.
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Beck KS, Chang S, Hyun K, Sung YE, Lee KY, Jung JI. T1 and T2 Mapping for Characterization of Mediastinal Masses: A Feasibility study. Can Assoc Radiol J 2023; 74:723-736. [PMID: 36882380 DOI: 10.1177/08465371231160052] [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] [Indexed: 03/09/2023] Open
Abstract
Purpose: To evaluate the feasibility and usefulness of T1 and T2 mapping in characterization of mediastinal masses. Methods: From August 2019 through December 2021, 47 patients underwent 3.0-T chest MRI with T1 and post-contrast T1 mapping using modified look-locker inversion recovery sequences and T2 mapping using a T2-prepared single-shot shot steady-state free precession technique. Mean native T1, native T2, and post-contrast T1 values were measured by drawing the region of interest in the mediastinal masses, and enhancement index (EI) was calculated using these values. Results: All mapping images were acquired successfully, without significant artifact. There were 25 thymic epithelial tumors (TETs), 3 schwannomas, 6 lymphomas, and 9 thymic cysts, and 4 other cystic tumors. TET, schwannoma, and lymphoma were grouped together as "solid tumor," to be compared with thymic cysts and other tumors ("cystic tumors"). The mean post-contrast T1 mapping (P < .001), native T2 mapping (P < .001), and EI (P < .001) values showed significant difference between these two groups. Among TETs, high risk TETs (thymoma types B2, B3, and thymic carcinoma) showed significantly higher native T2 mapping values (P = .002) than low risk TETs (thymoma types A, B1, and AB). For all measured variables, interrater reliability was good to excellent (intraclass coefficient [ICC]: .869∼.990) and intrarater reliability was excellent (ICC: .911∼.995). Conclusion: The use of T1 and T2 mapping in MRI of mediastinal masses is feasible and may provide additional information in the evaluation of mediastinal masses.
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Affiliation(s)
- Kyongmin S Beck
- Department of Radiology, Catholic University of Korea, Banpo-daero, Seoul, Republic of Korea
| | - Suyon Chang
- Department of Radiology, Catholic University of Korea, Banpo-daero, Seoul, Republic of Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Korea, Banpo-daero, Seoul, Republic of Korea
| | - Yeoun Eun Sung
- Department of Hospital Pathology, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo-Young Lee
- Department of Hospital Pathology, Catholic University of Korea, Seoul, Republic of Korea
- Department of Pathology, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Jung Im Jung
- Department of Radiology, Catholic University of Korea, Banpo-daero, Seoul, Republic of Korea
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Koo JM, Park HJ, Rim GM, Hyun K, Huh J, Choi H, Kim Y, Hwang W. Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management. J Clin Med 2023; 12:5240. [PMID: 37629283 PMCID: PMC10455545 DOI: 10.3390/jcm12165240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Children with pectus excavatum are treated with surgical repair in a procedure known as minimally invasive repair of pectus excavatum (MIRPE). MIRPE causes considerable postoperative pain, resulting in the administration of a substantial dose of opioids. This study aimed to identify perioperative factors that influence the requirement for opioids in children undergoing MIRPE. Retrospective data from children who underwent MIRPE were analyzed. A multimodal analgesic protocol was implemented with a continuous wound infiltration system and administration of non-opioid analgesics. Intravenous opioid analgesics were administered if the pain score was greater than 4. The cumulative opioid use was assessed by calculating the morphine equivalent dose at 6, 24, and 48 h after surgery. Perioperative factors affecting the postoperative opioid use were identified with multiple linear regression analyses. This study included 527 children aged 3-6 years, with a mean age of 3.9 years. Symmetrically depressed chest walls, a lower Haller index, and a lower revised depression index were found to be associated with decreased postoperative opioids. Boys required higher opioid doses than girls. Longer pectus bars (10 inches versus 9 inches) were associated with increased opioid use. Severity indices, gender, and the length of pectus bars influence postoperative opioid requirement in children undergoing MIRPE surgery with multimodal analgesia.
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Affiliation(s)
- Jung Min Koo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea; (H.J.P.); (G.M.R.)
| | - Gong Min Rim
- Department of Thoracic and Cardiovascular Surgery, Nanoori Hospitals, Seoul 06048, Republic of Korea; (H.J.P.); (G.M.R.)
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea;
| | - Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
| | - Yunji Kim
- Department of Anesthesiology and Pain Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si 11765, Republic of Korea;
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02706, Republic of Korea; (J.M.K.); (J.H.); (H.C.)
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9
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Yoon J, Hyun K, Sung SW. Using Continuous Flow Data to Predict the Course of Air Leaks After Lung Lobectomy. J Chest Surg 2023; 56:179-185. [PMID: 36882901 PMCID: PMC10165431 DOI: 10.5090/jcs.22.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
Background Assessments of air leaks are usually performed subjectively, precluding the use of air leaks as an evaluation factor. We aimed to identify objective parameters as predictive factors for prolonged air leak (PAL) and air leak cessation (ALC) from air flow data produced by a digital drainage system. Methods Flow data records of 352 patients who underwent lung lobectomy were reviewed, and flow data at designated intervals (1, 2, and 3 hours postoperatively [POH] and 3 times a day thereafter [06:00, 13:00, 19:00]) were extracted. ALC was defined by flow less than 20 mL/min over 12 hours, and PAL was defined as ALC after 5 days. Cumulative incidence curves were obtained using Kaplan-Meier estimates of time to ALC. Cox regression analysis was performed to determine the effects of variables on the rate of ALC. Results The incidence of PAL was 18.2% (64/352). Receiver operating characteristic curve analysis showed cut-off values of 180 mL/min for the flow at 3 POH and 73.3 mL/min for the flow on postoperative day 1; the sensitivity and specificity of these values were 88.9% and 82.5%, respectively. The rates of ALC by Kaplan-Meier analysis were 56.8% at 48 POH and 65.6% at 72 POH. Multivariate Cox regression analysis revealed that the flow at 3 POH (≤80 mL/min), operation time (≤220 minutes), and right middle lobectomy independently predicted ALC. Conclusion Air flow measured by a digital drainage system is a useful predictor of PAL and ALC and may help optimize the hospital course.
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Affiliation(s)
- Jaeshin Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Seoul, Korea
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Abstract
INTRODUCTION The multiple bar approach was developed to cover broader and heavier teenager/adult chest wall deformities. We designed the cross-bar technique to achieve remodeling of the entire chest wall. This study aimed to demonstrate the role of cross-bar and its benefits over the parallel bar. MATERIALS AND METHODS The cross-bar technique involves placing two bars diagonally and then cross on the target. The primary purposes are to double the lifting forces by making two bars converge on a single target to lift inflexible heavy chest wall depressions or cover lower lateral areas. The results of the cross-bar and parallel bar are compared for the indications, postrepair outcomes, and complications. RESULTS From 2016 to 2019, 247 patients who underwent multiple bar pectus excavatum (PE) repair were enrolled in the study: 157 with cross-bar and 90 with parallel bar. In the cross-bar group, 33% (51/157) received three bars in XI fashion to cover the upper depression. The cross-bar group was older (18.0 ± 6.1 vs. 15.7 ± 5.0), had higher depression index (1.9 ± 0.7 vs. 1.8 ± 0.3), and was less asymmetric (45% vs. 71%) than those in the parallel bar group. The overall complication rates were not different between the two groups (9.6% vs. 10%, p = 1.0), although the cross-bar group was more rigid and complex. There was no bar displacement or reoperation in both groups. CONCLUSION The cross-bar technique is as safe and effective as the parallel-bar technique, even though it was selected to correct more complexities. The cross-bar technique could be a method for complex PE deformities for remodeling of the entire chest wall.
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Affiliation(s)
- Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
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11
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Viljoen C, Al-Naili M, Noubiap JJ, Jackson A, Hyun K, Neves A, Nkoke C, Mondo C, Nabbaale J, Dragus A, Perel P, Banerjee A, Cupido BJ, Sliwa K, Hoevelmann J. Point-of-care NT-proBNP for the screening of PREGnancy-related Heart Failure – the PREG-HF study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2601] [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
Introduction
Cardiovascular disease is an important cause of maternal mortality worldwide. However, diagnosing heart failure (HF) during pregnancy remains challenging. Patients with HF present with symptoms that are often attributed to the physiological changes of pregnancy. Although the measurement of natriuretic peptides (such as NT-proBNP) has been recommended as a cost-effective screening test for HF, its value in predicting underlying structural heart disease on echocardiography during pregnancy is unclear.
Purpose
To evaluate the accuracy of point-of-care (POC) NT-proBNP to predict echocardiographic evidence of structural heart disease in pregnant women.
Methods
All consecutive consenting pregnant women with symptoms of HF (New York Heart Association functional class [NYHA FC] II–IV), who underwent echocardiography at Groote Schuur Hospital (a tertiary hospital in South Africa) between 1 March 2021 and 15 March 2022 were recruited and compared with asymptomatic pregnant women (NYHA FC I). Demographic and obstetric data were collected, as well as clinical and echocardiographic parameters. POC NT-proBNP was measured; a receiver operating characteristic (ROC) curve was used to determine the level of NT-proBNP that would have the best predictive value for detecting structural heart disease on echocardiography.
Results
We included 121 women with a median age of 31.3 years (IQR 24.9–36.4) and a median gravidity of 3 (2–4), mostly in their third trimester of pregnancy (75.2%). Symptomatic women (66.1%) presented mainly with dyspnoea (92.5%) and fatigue (73.8%). Most common signs of HF were peripheral oedema (46.8%), jugular venous distension (17.7%) and pulmonary crackles (17.7%). Overall, the median POC NT-proBNP was 98pg/ml (60–506) but was not statistically different between symptomatic and asymptomatic participants. However, NT-proBNP levels were significantly elevated in those with left ventricular (LV) dilatation (376 [86–744] vs 65 [60–191], p=0.001), left atrial enlargement (395 [65–744] vs 60 [59–108], p<0.001), LV systolic dysfunction (510 [113–1668] vs 65 [60–210], p<0.001), diastolic dysfunction (300 [77–1450] vs 78 [60–257], p=0.031), mitral regurgitation (167 [60–672] vs 78 [60–243], p=0.038) and pericardial effusion (440 [81–1031] vs 71 [60–243], p=0.011) (Figure 1). An NT-proBNP of <200pg/ml had the highest negative predictive value (83%) to rule out structural heart disease (AUC 0.68 [0.59–0.77]). Patients with NT-proBNP of ≥200pg/ml were at increased risk of having echocardiographic evidence of structural heart disease (diagnostic odds ratio 4.9 [95% confidence interval 2.0–11.7]).
Conclusion
In this cohort of pregnant women with symptoms suggestive of HF, POC NT-proBNP identified those with structural heart disease with acceptable discrimination. POC NT-proBNP testing might be particularly useful as a screening test in settings where pregnant women do not readily have access to echocardiography.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): World Heart Federation Salim Yusuf Emerging Leaders Programme
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Affiliation(s)
- C Viljoen
- University of Cape Town, Division of Cardiology , Cape Town , South Africa
| | - M Al-Naili
- University of Cape Town, Division of Cardiology , Cape Town , South Africa
| | - J J Noubiap
- University of Adelaide, Centre for Heart Rhythm Disorders , Adelaide , Australia
| | - A Jackson
- Cardiovascular Research Centre of Glasgow , Glasgow , United Kingdom
| | - K Hyun
- ANZAC Research Institute, Cardiology Department , Sydney , Australia
| | - A Neves
- Hospital Geral José Macamo, Gynecology and Obstetrics , Maputo , Mozambique
| | - C Nkoke
- Buea Regional Hospital, Department of Internal Medicine , Buea , Cameroon
| | - C Mondo
- St. Francis Hospital Nsambya , Kampala , Uganda
| | - J Nabbaale
- Uganda Heart Institute , Kampala , Uganda
| | - A Dragus
- World Heart Federation , Geneva , Switzerland
| | - P Perel
- World Heart Federation , Geneva , Switzerland
| | - A Banerjee
- World Heart Federation , Geneva , Switzerland
| | - B J Cupido
- University of Cape Town, Division of Cardiology , Cape Town , South Africa
| | - K Sliwa
- University of Cape Town, Cape Heart Institute , Cape Town , South Africa
| | - J Hoevelmann
- University of Cape Town, Cape Heart Institute , Cape Town , South Africa
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12
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Vijayarajan V, Hsu A, Cheng YY, Wei MSS, Sy R, Chow V, Hyun K, Brieger D, Kritharides L, Ng ACC. Rates of implantable cardioverter defibrillator implantation and outcomes in octogenarians or older compared to non-octogenarians in a statewide cohort from 2009 to 2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.719] [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
Octogenarians are underrepresented or excluded in major implantable cardioverter defibrillator (ICD) trials. The deployment of ICDs and their real-world outcomes in octogenarians is unclear.
Purpose
To investigate the prevalence and outcomes of ICD implantation in octogenarian or older vs non-octogenarian.
Methods
We extracted details of all ICD implanted statewide from 2009–2018 including patient's characteristics, in-hospital complications and mortality using the Centre-for-Health-Record-Linkage administrative datasets. Implantation rates were adjusted for the population size by sex, age-groups in decade and calendar-year. Analysis was stratified by age <80 vs ≥80yo.
Results
There were 9304 admissions (12.1% ≥80yo) for de novo ICD implantation (mean±SD implantation: 1163±122 cases per-annum). The mean age for ≥80 vs <80yo groups was 83.5±2.9yo vs 66.2±12.1yo respectively (overall cohort mean age 66.1±13.1yo). Total ICD implantations increased by 8.4±12.4% vs 1.8±8.4% per-annum for ≥80 vs <80yo groups. The mean implantation rates were 52.7±10.8 vs 22.0±2.8 per-100,000-persons in ≥80yo compared to <80yo, respectively, with rates increasing at 7.7±18.3% per-100,000-persons-per-annum in ≥80yo. In contrast, implantation rates declined slightly by 0.2±12.4% per-100,000-persons-per-annum in <80yo groups. There was a non-significant trend towards more in-hospital non-fatal complications in ≥80yo compared to <80yo (10.8% vs 9.0% respectively, p=0.054), with no difference in in-hospital mortality (0.6% vs 0.4% respectively, p=0.32). The 1-year mortality was 10.7% in ≥80yo compared to 4.7% in <80yo (p<0.001), and 2-year mortality was 20.2% vs 8.8% respectively (p<0.001). The 1-yr and 2-yr mortality hazard ratio for ≥80yo was 2.0 (95% confidence interval [CI] 1.6–2.5, p<0.001) and 2.2 (95% CI 1.8–2.5, p<0.001) respectively after adjusting for sex, year of implantation, referral source, indications for ICD, and comorbidities. Overall, the annual rates of total in-hospital non-fatal complications and mortality did not alter significantly during the study period.
Conclusion
Despite limited clinical trials data on efficacy of ICD use in octogenarians or older, implantation rate was more than double that of <80yo age-groups, with the implantation rate observed to be increasing in ≥80yo. There was no significant difference in in-hospital mortality between the two age-groups, however the 1-year and 2-year mortality rates were significantly higher in the ≥80yo.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Vijayarajan
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - A Hsu
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - Y Y Cheng
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - M S S Wei
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - R Sy
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - V Chow
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - K Hyun
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - D Brieger
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - L Kritharides
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
| | - A C C Ng
- Concord General Repatriation Hospital, Cardiology , Sydney , Australia
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Park JK, Hyun K, Moon MH, Lee J. Surgical treatment of facial blushing: Patient selection and operative technique (retrospective observational study). Medicine (Baltimore) 2022; 101:e29808. [PMID: 35801793 PMCID: PMC9259148 DOI: 10.1097/md.0000000000029808] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Surgeons are often reluctant to offer further intervention to patients with medically intractable facial blushing. This is mainly because of the relatively high failure rate of blushing resolution and a high incidence of compensatory hyperhidrosis. In this study, we sought to identify the type of blushing that would benefit from surgery and minimize compensatory hyperhidrosis by applying diffuse sympathicotomy (DS). This study was a retrospective review of 62 patients who underwent R2 endoscopic thoracic sympathicotomy (ETS) and preemptive DS for facial blushing. Facial blushing was classified as autonomic-mediated blushing (thermoregulatory, emotional) and vasodilator-mediated blushing (constant) based on the history and precipitating factors for blushing. DS was performed at lower-thoracic levels in the form of limited DS (right R5/7/9/11, left R5/6/8/10) or extended DS (bilateral R5-11). Resolution of blushing (described as "almost disappeared") was achieved in 48% of patients with a median follow-up of 19.6 months. There was a significant difference in resolution among 3 types of blushing (emotional: 55%, thermoregulatory: 28%, constant: 15%, P = .03). Multivariate analysis confirmed thermoregulatory and constant type blushing as a potential independent predictor of blushing resolution. Even though there was no difference between the DS procedures with respect to compensatory hyperhidrosis, intolerable compensatory hyperhidrosis (Hyperhidrosis Disease Severity Scale = 4) occurred in only 11% of patients. DS redistributed sweating area, being predominantly on the chest and mid-back (89%), also seen on the abdomen-waist-groin-buttocks-thighs (63%). Overall, 77% of patients experienced satisfactory results. Emotional blushing proved to be an established indication of ETS where good long-term results can be expected. Expansion of surgical indication to thermoregulatory or constant type blushing needs to be validated in future studies. Additionally, compensatory hyperhidrosis, another hurdle for ETS, can be minimized by preemptive DS, resulting in redistribution and decrease of sweating.
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Affiliation(s)
- Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
- *Correspondence: Kwanyong Hyun, Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, South Korea (e-mail: )
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Jungsun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
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14
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Tu Q, Hyun K, Lin S, Hafiz N, Redfern J. Effectiveness of Person-Centred Integrated Care on Cardiovascular Risk Factors for People With Diabetes in High-Income Countries: A Systematic Review and Meta-analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.047] [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: 10/16/2022]
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15
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Rubenis I, Hyun K, Lowe H, Kritharides L, Yong A, Brieger D, Roy P. Efficacy and Safety of Contemporary PCI in the Elderly – A Prospective Two-Year Cohort Study From the Concord Hospital PCI Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.582] [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: 11/26/2022]
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16
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Harvey G, Hyun K, Brieger D, Kritharides L, Chow V, Ng A. Morbidities and Mortality Outcomes Following 537 Patients Who Underwent Isolated Tricuspid Valve Surgery: A Statewide Population-Linkage Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.413] [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: 10/16/2022]
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17
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Yan A, Sindone A, Ng A, Hyun K, Atherton J, Brieger D. Impacts of Angiotensin Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Adherence Within 12 Months After Myocardial Infarction: An Observational Analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.096] [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: 10/16/2022]
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18
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Shu M, Cheng Y, Vijayarajan V, Hsu A, Hyun K, Brieger D, Kritharides L, Chow V, Ng A. Comparing Case-Volumes and Outcomes of Patients Who Underwent Isolated Mitral Valve Surgery Stratified By Age: A Statewide Population-Linkage Study From 2001-2017. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.409] [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: 10/16/2022]
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19
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Hsu A, Vijayarajan V, Cheng Y, Shu M, Hyun K, Chow V, Kritharide L, Brieger D, Ng A. Trends in Sex- and Age-Adjusted Hospitalisation Rates Following Transient Ischaemic Attacks in New South Wales, Australia From 2002 to 2017. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.397] [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: 10/16/2022]
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20
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Hafiz N, Hyun K, Hespe C, Usherwood T, Redfern J. Scope of Quality Improvement-Practice Incentive Program (QI-PIP): How Primary Care Practices Can Utilise QI-PIPs by Participating in a Quality Improvement Program (QUEL Study) Focussed on Improving Cardiovascular Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.512] [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: 11/30/2022]
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21
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Stiles S, Stacey I, Sanfilippo F, Peeters A, Hyun K, Katzenellenbogen J, Briffa T, Chew D, Brieger D, Nedkoff L. Adverse Trends in Myocardial Infarction Incidence and Hospitalisation in Women Aged <55 years in Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Hsu A, Vijayarajan V, Cheng Y, Shu M, Hyun K, Chow V, Kritharide L, Brieger D, Ng A. Sex and Age-Adjusted Temporal Trends in Hospitalisation Rates Following Ischaemic Strokes in New South Wales, Australia From 2002 to 2017. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.379] [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: 11/30/2022]
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23
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Hsu A, Vijayarajan V, Cheng Y, Shu M, Hyun K, Chow V, Kritharide L, Brieger D, Ng A. Mortality Outcomes in 99,145 Patients Admitted for Ischaemic Strokes: A Statewide Population-Linkage Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.353] [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: 10/16/2022]
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24
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Vijayarajan V, Hsu A, Cheng Y, Wei M, Hyun K, Brieger D, Kritharides L, Ng A. Temporal Trends in Acute Haemorrhagic Stroke Hospitalisation Rates Between Males and Females From 2002 to 2017 in New South Wales, Australia: A Statewide-Population Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.384] [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: 11/26/2022]
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25
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Manandi D, Hafiz N, Tu Q, Hyun K, Redfern J. The Development of Assessment Tools for the Plan-Do-Study-Act Cycle. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.386] [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: 11/24/2022]
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26
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Ratwatte S, Ng A, Hyun K, Weber C, Boroumand F, Kritharides L, Brieger D. Comparison between pre-hospital and in-hospital ST-Elevation Myocardial Infarction (STEMI) from 2003 to 2016 in New South Wales, Australia: a population-linkage data analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1473] [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
Outcomes among patients presenting to hospital with STEMI (PH-STEMI) are favourably impacted by access to reperfusion, which has improved in Australia in recent years. Reperfusion rates and outcomes among patients with in-hospital STEMI (IH-STEMI) in Australia are not well described.
Purpose
We compared frequency of percutaneous coronary intervention (PCI) and all-cause mortality trends between patients with PH-STEMI and IH-STEMI over 13-years in a statewide cohort.
Methods
Patients diagnosed with STEMI (both PH and IH) were identified from the NSW Admitted-Patient-Data-Collection registry from 2003 to 2016 and linked to the death registry until 31-December-2018. We calculated the proportion with PCI over time, and rate of long-term mortality was determined with adjustment for age, sex, year of presentation and PCI.
Results
66,794 STEMI patients were identified; 57,721 (86%) had PH-STEMI. Patients with IH-STEMI were older (mean±SD: 75±13 vs 66±14 years), and more likely to be female (46.2% vs 29.8%) than PH-STEMIs. Patients with IH-STEMI were less likely to undergo PCI (17.1% vs 55.8%). From 2003-4 to 2015-6, overall rate of PCI increased for STEMI, but remained lower for IH-STEMI compared to PH-STEMI (9.5% to 23.9% vs 40.4% to 65.5% respectively).
All-cause mortality from STEMI fell over time in both groups. Predictors of mortality improvement in the PH and IH-STEMI populations respectively included PCI: (adjusted hazard ratio [aHR]=0.48, 95% confidence interval [CI]: 0.46–0.49 and (aHR=0.48 [95% CI: 0.44–0.53) and year of event: (aHR=0.74 [95% CI: 0.69–0.8] and aHR=0.79 [95% CI: 0.70–0.88]). Adding the interaction term PCI by year group to the mortality models showed that this progressive reduction in mortality by year grouping was accounted for by the performance of PCI in the PH-STEMI group (p<0.0001) but not in the IH-STEMI group (p=0.65).
Conclusion
A fall in mortality in patients with PH-STEMI in NSW was observed from 2003 to 2016 and was accounted for by increasing use of PCI. A more modest fall in mortality was seen in patients with IH-STEMI and this was independent of PCI which was under utilised in this population. Efforts to further improve outcomes in STEMI should include a greater focus on patients with in-hospital events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Ratwatte
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
| | - A Ng
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
| | - K Hyun
- University of Sydney, Sydney, Australia
| | - C Weber
- ANZAC Research Institute, Sydney, Australia
| | | | - L Kritharides
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
| | - D Brieger
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
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Jeon J, Sung S, Moon Y, Koo J, Hyun K, Han K, Hwang W. Comparison of early postoperative cytokine changes in patients undergoing intubated and non-intubated thoracic surgery: a randomized controlled trial. Interact Cardiovasc Thorac Surg 2021; 32:343-350. [PMID: 33831216 DOI: 10.1093/icvts/ivaa265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The inflammatory response after surgery is associated with patient prognosis. Patients who undergo thoracic surgery exhibit a profound systemic inflammatory response due to the surgical procedures used and application of one-lung ventilation. The aim of this study was to compare perioperative inflammatory changes in patients after intubated and non-intubated thoracic surgery for primary lung cancer resection. METHODS This prospective randomized controlled study included forty patients who underwent surgical resection for stage I non-small-cell lung cancer. Blood samples for cytokine analysis were collected just before induction, at 1 and 24 h after surgery. Levels of the pro-inflammatory cytokine and anti-inflammatory cytokines were measured using quantitative sandwich enzyme immunoassay kits. RESULTS The basal values of cytokines were comparable between 2 groups. Within each group, the postoperative levels of interleukin (IL)-1, IL-6 and tumour necrosis factor-α increased, while those of IL-4 and IL-10 did not change significantly. The levels of IL-6 and tumour necrosis factor-α were significantly lower in group NI at 1 and 24 h postoperatively. Other cytokines did not differ in both groups during postoperative period. The IL-6/IL-10 ratio at 1 h after surgery was lower in non-intubated patients than in intubated patients, but there was no difference at 24 h after surgery. CONCLUSIONS Non-intubated thoracic surgery may attenuate the early inflammatory cytokine changes following major resection for primary lung cancer compared with intubated conventional surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov registry number NCT04007354.
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Affiliation(s)
- Joonpyo Jeon
- Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sookwhan Sung
- Department of Thoracic and Cardiovascular Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jungmin Koo
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Wonjung Hwang
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Dhillon M, Frick C, Usherwood T, Redfern J. Do Quality Improvement Workshops Improve Health Professionals’ Knowledge on Implementing Change for Patients With Coronary Heart Disease in Primary Care? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.408] [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: 11/30/2022]
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Rajaratnam D, Hyun K, Wong C, Garcia M, Lau J, Lowe H, Yong A, Kritharides L, Brieger D, Roy P. Longer-Term Safety and Efficacy of Contemporary Percutaneous Coronary Intervention – Insights from 2-Year Follow-Up of a Single Australian Centre Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.487] [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: 10/20/2022]
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Redfern J, Hyun K, Brieger D, Chew D, French J, Astley C, Gallagher R, Ellis C, Carr B, Lefkovits J, Nallaiah K, Lintern K, Neubeck L, Briffa T. Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3108] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.
Purpose
To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.
Methods
SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.
Results
In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees.
Conclusions
Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation
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Affiliation(s)
- J Redfern
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - K Hyun
- University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Sydney, Australia
| | - D Brieger
- ANZAC Research Institute, Sydney, Australia
| | - D Chew
- Flinders University, Adelaide, Australia
| | - J French
- University of New South Wales, Sydney, Australia
| | - C Astley
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - C Ellis
- Auckland City Hospital, Auckland, New Zealand
| | - B Carr
- NSW Agency for Clinical Innovation, Sydney, Australia
| | | | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - K Lintern
- South Western Sydney Local Health District, Sydney, Australia
| | - L Neubeck
- Napier University, Edinburgh, United Kingdom
| | - T Briffa
- University of Western Australia, Perth, Australia
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Hyun K, Brieger D, Briffa T, Chew D, Horsfall M, French J, Ellis C, Hammett C, Nallaiah K, Redfern J. The impact of socioeconomic status on secondary prevention of the acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2970] [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 socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover.
Purpose
The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia.
Methods
Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked.
Results
Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups.
Conclusion
This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - D Brieger
- Concord General Repatriation Hospital, Department of Cardiology, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | | | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - C Ellis
- Auckland Heart Group, Auckland, New Zealand
| | - C Hammett
- Royal Brisbane and Women's Hospital, Department of Cardiology, Brisbane, Australia
| | - K Nallaiah
- The George Institute for Global Health, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
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Abstract
Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.
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Lee J, Moon SW, Choi JS, Hyun K, Moon YK, Moon MH. Impact of Sarcopenia on Early Postoperative Complications in Early-Stage Non-Small-Cell Lung Cancer. Korean J Thorac Cardiovasc Surg 2020; 53:93-103. [PMID: 32551289 PMCID: PMC7287218 DOI: 10.5090/kjtcs.2020.53.3.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
Background Risk assessment for pulmonary resection in patients with early-stage non–small-cell lung cancer (NSCLC) is important for minimizing postoperative morbidity. Depletion of skeletal muscle mass is closely associated with impaired nutritional status and limited physical ability. We evaluated the relationship between skeletal muscle depletion and early postoperative complications in patients with early-stage NSCLC. Methods Patients who underwent curative lung resection between 2016 and 2018 and who were diagnosed with pathological stage I/II NSCLC were included, and their records were retrospectively analyzed. The psoas volume index (PVI, cm3/m3) was calculated based on computed tomography images from routine preoperative positron emission tomography-computed tomography. Early postoperative complications, defined as those occurring within 90 days of surgery, were compared between the lowest sex-specific quartile for PVI and the remaining quartiles. Results A strong correlation was found between the volume and the cross-sectional area of the psoas muscle (R2=0.816). The overall rate of complications was 57.6% among patients with a low PVI and 32.8% among those with a normal-to-high PVI. The most common complication was prolonged air leak (low PVI, 16.9%; normal-to-high PVI, 9.6%), followed by pneumonia (low PVI, 13.6%; normal-to-high PVI, 7.9%) and recurrent pleural effusion (low PVI, 11.9%; normal-to-high PVI, 6.8%). The predictors of overall complications were low PVI (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.07–4.09; p=0.03), low hemoglobin level (OR, 0.686; 95% CI, 0.54–0.87; p=0.002), and smoking history (OR, 3.93; 95% CI, 2.03–7.58; p<0.001). Conclusion Low PVI was associated with a higher rate of early postoperative complications in patients with early-stage NSCLC.
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Affiliation(s)
- Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Na KJ, Hyun K, Kang CH, Park S, Lee HJ, Park IK, Kim YT, Lee GD, Kim HR, Choi SH, Kim YH, Kim DK, Park SI, Shin S, Cho JH, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Lee CY, Lee JG, Kim DJ, Paik HC, Chung KY. Predictors of post-thymectomy long-term neurological remission in thymomatous myasthenia gravis: an analysis from a multi-institutional database. Eur J Cardiothorac Surg 2020; 57:867-873. [DOI: 10.1093/ejcts/ezz334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/30/2023] Open
Abstract
Abstract
OBJECTIVES
Thymectomy is the treatment of choice for thymomatous myasthenia gravis (MG) for both oncological and neurological aspects. However, only a few studies comprising small numbers of patients have investigated post-thymectomy neurological outcomes. We examined post-thymectomy long-term neurological outcomes and predictors of thymomatous MG using a multi-institutional database.
METHODS
In total, 193 patients (47.3 ± 12.0 years; male:female = 90:103) with surgically resected thymomatous MG between 2000 and 2013 were included. Complete stable remission (CSR) and composite neurological remission (CNR), defined as the achievement of CSR and pharmacological remission after thymectomy, were evaluated. Predictors for CSR and CNR were examined by Cox regression analysis.
RESULTS
The median duration between MG and thymectomy was 3.1 months. In addition, 161 patients (83.4%) had symptoms less than Myasthenia Gravis Foundation of America clinical classification III. All patients underwent an extended thymectomy; there were no perioperative deaths. The 10-year cumulative probability of CSR and CNR was 36.9% and 69.1%, respectively. Mild preoperative symptoms were a significant predictor for CSR (P = 0.040), and a large tumour was a predictor for CNR (P < 0.001). Patients with a large tumour were associated with early MG onset and no steroid treatment. Surgical methods, thymoma stage and histological subtypes were not associated with long-term neurological remission.
CONCLUSIONS
Large tumour size and preoperative mild symptoms were predictors for long-term neurological outcome in thymomatous MG. Considering that patients with early onset of MG and no immunosuppressive treatment tend to have large tumours, early surgical intervention for patients with thymomatous MG having mild symptoms might be beneficial for controlling neurological outcomes.
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Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hafiz N, Hyun K, Chow C, Briffa T, Gallagher R, Reid C, Hare D, Zwar N, Woodward M, Jan S, Atkins E, Laba T, Halcomb E, Billot L, Usherwood T, Redfern J. 732 Gender Comparison in the use of General Practice Management Plans (GPMPs) for Patients With Cardiovascular Disease (CVD). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.739] [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: 10/23/2022]
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Darshni A, Farshid A, MacIsaac A, Hsu B, Pearson S, Falster M, Hyun K, D'Silva M, Brieger D. 730 Exploration of Single Antiplatelet Drug use in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention and Cardiac Stenting. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.737] [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: 11/25/2022]
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Partridge S, Raeside R, Singleton A, Mandoh M, Todd A, Latham Z, Hyun K, Gibson A, Redfern J. 726 Discretionary Food on Demand: Is the Emerging Trend of Online Food Delivery Contributing to Overconsumption of Discretionary Foods? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.733] [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: 10/23/2022]
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Baalbaki A, Ng A, D'Souza M, Hyun K, Chow V, Kritharides L, Yong A, Brieger D. 616 Outcomes Following Cardiac Bypass Surgery (CABG) in Public vs Private Hospitals in NSW. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.623] [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: 11/17/2022]
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Ratwatte S, Barraclough J, Chew D, Shetty P, Patel S, Amos D, Hyun K, D'Souza M, Brieger D. 560 The Association of BMI With Outcomes in an Australian Acute Coronary Syndrome Population. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.567] [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: 10/23/2022]
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Redwood E, Hyun K, French J, Kritharides L, Ryan M, D'Sousa M, Brieger D. 559 The Association Between Mode of Transport, Management and Outcomes of Patients Presenting With STEMI. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.566] [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: 10/23/2022]
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Hou M, Brieger D, Hyun K, Kritharides L, Chew D, Amos D. 464 Comparison of Potent Anti-Platelet Agents in Acute Coronary Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.471] [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: 10/23/2022]
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Anugrah DSB, Patil MP, Li X, Le CMQ, Ramesh K, Kim GD, Hyun K, Lim KT. Click-cross-linked, doxorubicin-loaded hydrogels based on poly(styrene-alt-maleic anhydride). EXPRESS POLYM LETT 2020. [DOI: 10.3144/expresspolymlett.2020.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nedkoff L, Greenland M, Hyun K, Sanfilippo F, Briffa T, Redfern J, Peeters A, Chew D, Brieger D. 552 Sex Specific Risk Profiles and Outcomes in Adults <55 Years With Acute Coronary Syndromes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.559] [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: 10/23/2022]
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Singleton A, Raeside R, Partridge S, Hyun K, Sherman K, Elder E, Redfern J. 715 Are Women Managing Cardiovascular Risk Factors 12-Months After Active Breast Cancer Treatment? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.722] [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: 10/23/2022]
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Hyun K, Hafiz N, Hare D, Reid C, Laba T, Usherwood T, Briffa T, Chow C, Gallagher R, Woodward M, Zwar N, Jan S, Atkins E, Billot L, Brieger D, Redfern J. 007 Characteristics of People With Cardiovascular Disease who did not Receive Influenza Vaccination: A Sub-Analysis Within QUEL Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.014] [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: 10/23/2022]
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Ayad M, Gullick J, Redfern J, Ryan M, Hyun K, D'Souza M, Brieger D. 490 Factors Influencing Catheterisation Rates following Acute Coronary Syndromes in Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.497] [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: 11/24/2022]
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47
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Lee J, Hyun K, Moon MH, Moon SW, Park JK, Choi SY, Sa YJ, Kim KS. Atypical Thymic Carcinoid in a Patient with Zollinger-Ellison Syndrome. Korean J Thorac Cardiovasc Surg 2019; 52:420-424. [PMID: 31832379 PMCID: PMC6901190 DOI: 10.5090/kjtcs.2019.52.6.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/03/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Abstract
Atypical thymic carcinoid is an extremely rare tumor with a poor prognosis. In addition to its known association with multiple endocrine neoplasia type 1, its hallmark characteristics include local invasion and early distant metastasis. In this report, we share our experience treating atypical thymic carcinoid in a patient with Zollinger-Ellison syndrome.
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Affiliation(s)
- Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jo Sa
- Department of Thoracic and Cardiovascular Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Redfern J, Enright G, Hyun K, Raadsma S, Allman-Farinell M, Innes-Hughes C, Khanal S, Lukeis S, Rissel C, Chai HC, Gyani A. 4225Effectiveness of a behavioural incentive scheme linked to goal achievement in overweight children: a multicenter cluster randomized controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0132] [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: 11/12/2022] Open
Abstract
Abstract
Background
The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide and management is vital for primary prevention of cardiovascular disease. Studies in adults have shown that provision of incentives may facilitate behaviour change but there are no similar studies targeting weight management in children.
Purpose
To determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes (with a focus on cardiovascular risk factors) in overweight children at 6 and 18 months.
Methods
Single-blind, multicenter, cluster randomized controlled trial with 10 weeks, 6 and 18 month follow-up. Eligible sites had to be delivering the standard children's weight management program and enrol at least 10 children per term. Eligible children had to be 7–13 years and have a body mass index (BMI) >85th percentile. Recruited sites were randomized to (i) standard weight management program plus incentive scheme (intervention) or (ii) standard program alone (control). The intervention group participated in the standard program plus received milestone based incentives for achievement of goals. Incentives were practical, and healthy in nature such as fun vegetable slicers, sports store vouchers, sport equipment and family zoo passes. Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric (body weight, waist circumference), behavioural (physical activity, nutrition) and self-esteem (Physical Activity Enjoyment Scale, Rosenberg Self Esteem Scale) measures.
Results
A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. There were no significant differences between the control and intervention groups at any follow-up time-points. There were significantly more participants in the intervention than control group who completed 10 sessions of the weight management program (23% v 13%, p=0.015). Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food meals per week (1.0 v 0.7, p<0.001) and significant increases in physical activity (6.0 v 10.0 hours/week, p<0.001) and self-esteem score (20.7 v 22.0, p<0.002).
Conclusions
The incentive scheme, delivered in addition to a standard community weight management program, did not have a significant impact on health outcomes in overweight children. However, the intervention increased program attendance and overall cohort achieved sustained improvements in clinical and lifestyle outcomes. The results of this study suggest that extrinsic rewards may not provide added value to current community weight management programs however, participation in such programs is likely to support primary prevention of cardiovascular disease.
Acknowledgement/Funding
This work was supported by National Heart Foundation (Australia) pilot funding as part of JR's Future Leader Fellowship, in-kind contributions from th
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Affiliation(s)
- J Redfern
- University of Sydney, Sydney, Australia
| | - G Enright
- University of Sydney, Sydney, Australia
| | - K Hyun
- University of Sydney, Sydney, Australia
| | | | | | | | - S Khanal
- NSW Government, Sydney, Australia
| | - S Lukeis
- Better Health Company, Sydney, Australia
| | - C Rissel
- NSW Government, Sydney, Australia
| | - H C Chai
- NSW Government, Sydney, Australia
| | - A Gyani
- NSW Government, Sydney, Australia
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Hyun K, Redfern J, Briffa T, Chew D, French J, Brieger D. P4343Reconciling acute coronary syndrome diagnoses between linked administrative data and hospital medical records in medical research. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0751] [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/Introduction
Administrative data incorporating the International Classification of Diseases 10th Revision (ICD-10) is commonly used in cardiac research. Using patient records, diagnoses are systematically coded by trained coders who have limited/no clinical experience. Therefore, it is important to understand how systematically coded cardiac diagnoses compare with clinically assessed diagnoses to better analyse and interpret studies that have used linked administrative data to adjudicate patient's diagnosis.
Purpose
To assess the agreement between the acute coronary syndrome (ACS) diagnoses according to linked data compared to those extracted from hospital medical records by clinicians participating in a national registry and determine the factors associated with diagnoses disagreement.
Methods
The rate of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) obtained from the medical records, from admission to discharge, for the nationwide SNAPSHOT ACS audit in 2012 were compared to the corresponding ICD-10 Australian Modification (ICD-10-AM) codes using linked data from 6 jurisdictions covering all Australian states (6) and territories (2). The proportions of the overall agreement (OA), the positive agreement (PA) and the Cohen's weighted kappa and the 95% confidence interval (CI) were derived using both data sources for STEMI, NSTEMI and UA individually, where kappa≥0.8 confers strong agreement and 0.6≤kappa<0.8 moderate agreement. The factors associated with the diagnostic disagreement were explored using multilevel multivariable logistic regression model (backward selection method), accounting for the hospital clustering effect.
Results
Overall, 3130 patients had both medical records and linked data available for comparison. The degree of agreement was greatest for STEMI and lowest for UA (STEMI: OA=97%, PA=85%, kappa (95% CI)=0.84 (0.81, 0.87); NSTEMI: OA=91%, PA=81%, kappa (95% CI)=0.76 (0.73,0.79); UA: OA = 81%, PA=53%, kappa (95% CI)=0.41 (0.38, 0.45)). Further, the independent factors associated with the disagreement between the medical records and the linked data were the diagnosis of UA (UA vs. STEMI (odds ratio (95% CI)): 6.85 (4.12, 11.40)), not receiving revascularisation (2.27 (1.69, 3.03)), and the state where the ICD-10-AM was coded (p=0.007) (see Figure).
Figure 1
Conclusion
This study suggests that the agreement between the systematically coded diagnoses from linked administrative data and the diagnosis from the clinical assessment is greater in patients who received revascularisation and worse in those with UA. Also, the degree of agreement varies between states. As the linked data and the ICD codes are being used more often in research to support the evidence-based policies and practice, more attention is needed in testing and improving the accuracy of the ICD-10 codes as well as the ICD-11 codes that are soon to be introduced.
Acknowledgement/Funding
KH is funded by Heart Foundation Postdoctoral Fellowship. SNAPSHOT data linkage project was funded by the NSW Heart Foundation CVRN Project Grant
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Affiliation(s)
- K Hyun
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - J Redfern
- University of Sydney, Sydney Medical School, Westmead Applied Research Centre, Sydney, Australia
| | - T Briffa
- The University of Western Australia, School of Population Health, Perth, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Department of Cardiovascular Medicine, Adelaide, Australia
| | - J French
- Liverpool Hospital, Department of Cardiology, Sydney, Australia
| | - D Brieger
- Concord Repatriation General Hospital, Department of Cardiology, Sydney, Australia
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Haider R, Hyun K, Cheung NW, Redfern J, Thiagalingam A, Chow CK. Effect of lifestyle focused text messaging on risk factor modification in patients with diabetes and coronary heart disease: A sub-analysis of the TEXT ME study. Diabetes Res Clin Pract 2019; 153:184-190. [PMID: 31063856 DOI: 10.1016/j.diabres.2019.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/03/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022]
Abstract
AIMS There is potential to provide public health interventions through text messaging for patients with Type 2 diabetes mellitus (T2DM). Our objective was to ascertain if lifestyle focused text messaging addressing cardiovascular risk factors in patients with coronary heart disease (CHD) and T2DM, was more effective than usual care. METHODS This is a secondary analysis of the TEXT ME study, a randomised clinical trial of a 6-month text messaging intervention in patients with coronary heart disease. The measured outcomes include cholesterol, blood pressure (BP), body mass index (BMI), HbA1c, waist/hip circumference and smoking status. Our objective was to ascertain if lifestyle focused text messaging in patients with T2DM was more effective than usual care, and to determine if the intervention was more effective in patients with T2DM compared to those without. RESULTS 229 participants in the TEXT ME study had T2DM (32%), 111 participants in the intervention group and 118 in the control group. At 6 months, the mean difference in systolic BP was -7.6 mmHg (95%CI -11.8, -3.37, p = 0.0003) and diastolic BP -3.7 mmHg (95%CI -6.12, -1.24, p = 0.0032). The mean difference in low density lipoprotein in the intervention arm, compared to the control arm, was -0.05 mmol/L (95%CI -0.27, 0.18, p = 0.813), and in triglycerides was -0.29 mmol/L (95%CI -0.59, 0.01, p = 0.035) respectively. The mean difference in BMI was -0.89 kg/m2 (95%CI -2.74, 0.95, p < 0.0001) in the intervention group, waist circumference -3.98 cm (95%CI -8.57, 0.61, p < 0.0001) and hip circumference -3.26 cm (95%CI -7.67, 1.16, p = 0.0006). Intervention subjects with diabetes were less likely to be smokers at 6 months. The mean difference in HbA1c between the control and intervention group was not significant (p = 0.126). The intervention was as effective in patients with diabetes, compared to those without. CONCLUSION Among patients with coronary heart disease with T2DM, lifestyle-focused text messaging resulted in significant risk factor reduction.
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Affiliation(s)
- R Haider
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - K Hyun
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - N W Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - J Redfern
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A Thiagalingam
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C K Chow
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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