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Bayetti C, Bakhshi P, Davar B, Khemka GC, Kothari P, Kumar M, Kwon W, Mathias K, Mills C, Montenegro CR, Trani JF, Jain S. Critical reflections on the concept and impact of "scaling up" in Global Mental Health. Transcult Psychiatry 2023; 60:602-609. [PMID: 37491885 PMCID: PMC7615199 DOI: 10.1177/13634615231183928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the "treatment gap" faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes "scaling up" mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial "evidence-based" approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in "silos," focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs' impact and ability to innovate. This commentary argues that any "scaling up" of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.
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Affiliation(s)
- C Bayetti
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - P Bakhshi
- School of Occupational Therapy, Washington University in St Louis, MO, USA
| | - B Davar
- Executive Director, Transforming Communities for Inclusion (TCI) Managing Trustee, Bapu Trust for Research on Mind & Discourse, Pune, Maharashtra, India
| | - G C Khemka
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - P Kothari
- Iswar Sankalpa (NGO), Kolkata, West Bengal, India
| | - M Kumar
- Founder & Clinical Director, MHAT, India
| | - W Kwon
- University of Edinburgh Business School, Edinburgh, Scotland
| | - K Mathias
- Burans, Herbertpur Christian Hospital, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
| | - C Mills
- School of Health and Psychological Sciences, City, University of London
| | - C R Montenegro
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, UK
- School of Nursing, Pontificia Universidad Católica de Chile, Chile
| | - J F Trani
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - S Jain
- School of Social and Political Science, The University of Edinburgh, UK
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Kwon W, Yang JH, Lee SH, Choi KH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Ko YG, Yu CW, Jang WJ, Kim HJ, Kwon SU. Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1497] [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
In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.
Methods and results
1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.
Conclusions
Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Lee
- Chonnam National University Hospital , Gwangju , Korea (Republic of)
| | - K H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - Y B Song
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J Y Hahn
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - C M Ahn
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - Y G Ko
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital , Seoul , Korea (Republic of)
| | - S U Kwon
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
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Kwon W, Chang SA, Jeon K, Bak M, Park TK, Yang JH, Kim DK. Pulmonary arterial angioplasty in peripheral pulmonary arterial stenosis in RNF213 vasculopathy: effective but high-risk treatment with reperfusion injury. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1975] [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
p.Arg4810Lys variant of the ring finger protein 213 (RNF213) vasculopathy is a nonsyndromatic vasculopathy involving multisystemic organs including pulmonary arteries. Peripheral pulmonary arterial stenosis (PPAS) with diffuse stenosis and beaded appearance is a unique feature of this disease and no treatment option has been tried before.
Methods
We performed BPA for PPAS in RNF213 patients (n=7). Severity of pulmonary hypertension was assessed by echocardiography and right heart catheterization at the baseline. Several clinical and hemodynamic parameters were followed up after each BPA sessions.
Results
All of the patients had dyspnea on exertion. Right ventricular dysfunction was observed in six patients and NT-proBNP was elevated (949.2±1148.1 pg/mL). Baseline echocardiography showed severe pulmonary hypertension (70.1±19.2 mmHg). Pulmonary arterial ballooning was performed to all patients, but stenting (n=6) and cutting balloon (n=1) was necessary due to elastic recoil. Improvement of clinical and hemodynamic parameters was achieved in six patients after 5.3 sessions of BPA in average. Reperfusion edema was seen in four patients, eventually leading to death in one patient.
Conclusions
Pulmonary arterial angioplasty, when coupled with stenting, is an effective treatment for PPAS with RNF213 vasculopathy. Although reperfusion injury was common and fatal in a few cases, it is the only modality to improve the patient's symptom and hemodynamics till now. Careful selection of the target population should be preceded to perform the intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S A Chang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - K Jeon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - M Bak
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - D K Kim
- Samsung Medical Center , Seoul , Korea (Republic of)
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Lee C, Kim K, Kim H, Kwon W, Jang J, Lee K, Oh D, Kim H, Lee K, Chie E. Role of Adjuvant Chemoradiotherapy in Perihilar Bile Duct Cancer: A Single Institutional Long-Term Follow Up Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.390] [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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Lee C, Kim K, Kim H, Kwon W, Jang J, Lee K, Oh D, Lee K, Chie E. PD-0916 role of adjuvant chemoradiotherapy in perihilar bile duct cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07195-4] [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: 11/29/2022]
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Kwon W, Kim H, Han Y, Hwang YJ, Kim SG, Kwon HJ, Vinuela E, Járufe N, Roa JC, Han IW, Heo JS, Choi SH, Choi DW, Ahn KS, Kang KJ, Lee W, Jeong CY, Hong SC, Troncoso AT, Losada HM, Han SS, Park SJ, Kim SW, Yanagimoto H, Endo I, Kubota K, Wakai T, Ajiki T, Adsay NV, Jang JY. Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study. Br J Surg 2020; 107:1334-1343. [PMID: 32452559 DOI: 10.1002/bjs.11618] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/29/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection. METHODS Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted. RESULTS Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70·6 per cent, 74·5 per cent for those with T2a and 65·5 per cent among those with T2b tumours (P = 0·028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73·0 versus 61·5 per cent; P = 0·012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76·5 versus 66·1 per cent; P = 0·094) and T2b (68·2 versus 56·2 per cent; P = 0·084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74·1 versus 71·5 per cent; P = 0·720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1·52; P = 0·002), R1 resection (HR 1·96; P = 0·004) and N1/N2 status (N1: HR 3·40, P < 0·001; N2: HR 9·56, P < 0·001). Among recurrences, 70·8 per cent were metastatic. CONCLUSION Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection.
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Affiliation(s)
- W Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - H Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Y Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Y J Hwang
- School of Medicine, Kyungpook National University, Daegu, South Korea.,Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - S G Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea.,Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - H J Kwon
- School of Medicine, Kyungpook National University, Daegu, South Korea.,Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - E Vinuela
- Department of Digestive Surgery, Santiago, Chile
| | - N Járufe
- Department of Digestive Surgery, Santiago, Chile
| | - J C Roa
- Pathology, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - I W Han
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - J S Heo
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - S-H Choi
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - D W Choi
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - K S Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu, South Korea
| | - K J Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu, South Korea
| | - W Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - C-Y Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - S-C Hong
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - A T Troncoso
- Department of Surgery, Universidad de la Frontera, Temuco, Chile
| | - H M Losada
- Department of Surgery, Universidad de la Frontera, Temuco, Chile
| | - S-S Han
- Department of Surgery, Centre for Liver Cancer, National Cancer Centre, Goyang, South Korea
| | - S-J Park
- Department of Surgery, Centre for Liver Cancer, National Cancer Centre, Goyang, South Korea
| | - S-W Kim
- Department of Surgery, Centre for Liver Cancer, National Cancer Centre, Goyang, South Korea
| | - H Yanagimoto
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - I Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - K Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan
| | - T Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Ajiki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - N V Adsay
- Department of Pathology, Koc University, Istanbul, Turkey.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J-Y Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Rashid MF, Kluger MD, Su GH, Chabot JA, Yang CY, Lou W, Valente R, Del Chiaro M, Shyr YM, Wang SE, van Huijgevoort NCM, Besselink MG, Yang Y, Kim H, Kwon W, Kim SW, Jang JY. Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less. Br J Surg 2020; 107:676. [DOI: 10.1002/bjs.11612] [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: 11/08/2022]
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8
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Jung W, Park T, Kim Y, Park H, Han Y, He J, Wolfgang CL, Blair A, Rashid MF, Kluger MD, Su GH, Chabot JA, Yang CY, Lou W, Valente R, Del Chiaro M, Shyr YM, Wang SE, van Huijgevoort NCM, Besselink MG, Yang Y, Kim H, Kwon W, Kim SW, Jang JY. Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less. Br J Surg 2019; 106:1829-1836. [PMID: 31441048 DOI: 10.1002/bjs.11293] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasm (IPMN) is premalignant pancreatic lesion. International guidelines offer limited predictors of individual risk. A nomogram to predict individual IPMN malignancy risk was released, with good diagnostic performance based on a large cohort of Asian patients with IPMN. The present study validated a nomogram to predict malignancy risk and invasiveness of IPMN using both Eastern and Western cohorts. METHODS Clinicopathological and radiological data from patients who underwent pancreatic resection for IPMN at four centres each in Eastern and Western countries were collected. After excluding patients with missing data for at least one malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 levels, and age). RESULTS In total, data from 393 patients who fit the criteria were analysed, of whom 265 were from Eastern and 128 from Western institutions. Although mean age, sex, log value of serum CA19-9 level, tumour location, main duct diameter, cyst size and presence of mural nodule differed between the Korean/Japanese, Eastern and Western cohorts, rates of malignancy and invasive cancer did not differ significantly. Areas under the receiver operating characteristic (ROC) curve values for the nomogram predicting malignancy were 0·745 for Eastern, 0·856 for Western and 0·776 for combined cohorts; respective values for the nomogram predicting invasiveness were 0·736, 0·891 and 0·788. CONCLUSIONS External validation of the nomogram showed good performance in predicting cancer in both Eastern and Western patients with IPMN lesions.
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Affiliation(s)
- W Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - T Park
- Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Y Kim
- Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea
| | - H Park
- Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Y Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C L Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Blair
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M F Rashid
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University, College of Physicians and Surgeon, New York, USA
| | - M D Kluger
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University, College of Physicians and Surgeon, New York, USA
| | - G H Su
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - J A Chabot
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Columbia University, College of Physicians and Surgeon, New York, USA
| | - C-Y Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - W Lou
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - R Valente
- Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Digestive and Liver Disease Unit, Sapienza University of Rome, Rome, Italy
| | - M Del Chiaro
- Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Y-M Shyr
- Departments of Surgery, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - S-E Wang
- Departments of Surgery, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - N C M van Huijgevoort
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Academic Medical Centre, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Y Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - H Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - W Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - S-W Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J-Y Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Kurz E, Chill M, Desai A, Kwon W. Increasing periprocedural efficiency in interventional radiology. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1163] [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] Open
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Osei-Bonsu S, Bergen M, Kesselman A, Seit R, Kwon W. Utility of hepatobiliary MR contrast agents for HCC diagnosis: a review for the interventional radiologist. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.639] [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: 10/22/2022] Open
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Braun R, Gallo V, Leonardo R, Walsh J, Kwon W. When sugar isn’t sweet: a primer on the perioperative management of diabetes for the interventional radiologist. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.572] [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] Open
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12
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Park JW, Jang JY, Kim EJ, Kang MJ, Kwon W, Chang YR, Han IW, Kim SW. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg 2013; 100:1064-70. [DOI: 10.1002/bjs.9146] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/08/2022]
Abstract
Abstract
Background
There are concerns about the extent of impaired endocrine and exocrine pancreatic function and poor quality of life (QoL) after pancreatectomy, but there is little information from large prospective follow-up studies.
Methods
Consecutive patients undergoing pancreaticoduodenectomy or distal pancreatectomy between 2007 and 2011 were included. Relative bodyweight (RBW), triceps skinfold thickness (TSFT), serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose (PP2), glycosylated haemoglobin A1c and stool elastase measurements, and European Organization for Research and Treatment of Cancer QLQ-C30 questionnaires were collected serially for 1 year.
Results
Some 136 patients undergoing pancreatic resection completed the study. RBW and TSFT recovered to over 90 per cent of the preoperative value by 12 months, whereas transferrin, albumin and protein had returned to preoperative levels by 3 months. Diabetes mellitus, impaired fasting glucose or raised PP2 was present in 42 of 76 patients at 6 months and 36 of 76 at 12 months. Although steatorrhoea and diarrhoea had mainly resolved by 3 months, stool elastase level decreased after operation and showed no recovery. Nutritional status, pancreatic endocrine function and QoL returned to preoperative levels in 63 (46·3 per cent), 72 (52·9 per cent) and 77 (56·6 per cent) of 136 patients within 6 months of pancreatectomy. Multivariable analysis revealed that age 60 years or more, operation type, chronic pancreatitis and malignant disease had a significant impact on nutritional index, pancreatic function and QoL.
Conclusion
About half of all patients can expect recovery from pancreatectomy after 6 months, but those with risk factors need more careful follow-up and supportive management.
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Affiliation(s)
- J W Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - J-Y Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - E-J Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - M J Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - W Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Y R Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - I W Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - S-W Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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13
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Kwon W, Jang JY, Kim EC, Park JW, Han IW, Kang MJ, Kim SW. Changing trend in bile microbiology and antibiotic susceptibilities: over 12 years of experience. Infection 2012. [PMID: 23180506 DOI: 10.1007/s15010-012-0358-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Rapidly changing medical environments may have changed the microbiology of infected bile. The aim of our study was to identify the changing trends in microorganisms in biliary infections and examine their susceptibilities against currently recommended antibiotics. METHODS Bile cultures taken between 1998 and 2010 at Seoul National University Hospital, a tertiary medical center, were retrospectively reviewed. From 1,403 patients, 3,425 microorganisms were isolated from 2,217 cultures. The cultures were then tested to determine the types of microorganisms and their antibiotic susceptibility. RESULTS The five most frequently isolated microorganisms were Enterococcus (22.7 %) followed by Escherichia (13.2 %), Pseudomonas (10.9 %), Klebsiella (10.3 %), and Enterobacter (7.2 %). The trend in annual incidence indicated a growing emergence of Enterococcus (P < 0.001). Among Enterococcus, E. faecium acquired a dominant position (50.6 %), showing an increasing trend over the study period (P = 0.026). The incidence of vancomycin-resistant Enterococcus also showed an increasing trend (P < 0.001). Many of the commonly used antibiotics provided inadequate coverage for the more frequently encountered microorganisms. Multiple regression revealed that benign causes of obstruction and non-operative treatment harbor an increased risk for enterococcal growth (P = 0.001 and P = 0.027, respectively). CONCLUSIONS In contrast to earlier reports, we found that Enterococcus has emerged as the most frequently isolated microorganism from bile. The importance of enterococcal infection should be recognized, and currently recommended antibiotics need to be re-evaluated since in our bile cultures most provided inadequate coverage for the more frequently encountered microorganisms. The changes in the trends of microorganisms isolated from bile should be considered in cases where patients present with biliary obstruction.
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Affiliation(s)
- W Kwon
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
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Park H, Kim H, Park H, Kwon W, Lee J, Lee M, Kim H, Shin S, Ahn J, Rha S. 968 Pharmacogenetic Predictors for Treatment Outcome of Sunitinib in Metastatic Renal Cell Carcinoma Patients. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71586-1] [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: 10/28/2022]
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15
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Jung M, Zhang X, Kwon W, Jung J, Jeung H, Roh JK, Chung HC, Rha SY. Prediction of response in patients (pts) with advanced gastric cancer (AGC) who received paclitaxel-based chemotherapy: Expression of class III beta tubulin (bTubIII) and ABCB1 gene polymorphisms. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cho H, Zhang X, Jung M, Kwon W, Jung J, Jeung H, Roh JK, Chung HC, Rha SY. C-met as a therapeutic target for metastatic potential of gastric cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim SH, Nawa Y, Kim HY, Kwon W, Yong SJ, Jung SH. A 63-year-old male with marked eosinophilia and dyspnoea on exertion. Thorax 2009; 64:756, 777. [PMID: 19717710 DOI: 10.1136/thx.2008.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S-H Kim
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Kim J, Kwon W, Jo Y, Jung S, Suh G. 206: Outcome Prediction of Postresuscitation Patients During Therapeutic Hypothermia. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.224] [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: 11/28/2022]
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19
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Chang H, Rha S, Jeung H, Im C, Ahn J, Kwon W, Yoo N, Roh J, Chung H. Association of MDR-1 gene polymorphism 2677G/T(A) and 3435C/T with clinical outcomes of paclitaxel monotherapy in metastatic breast cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Jin SS, Min Y, Kim H, Ahn J, Jegal Y, Seo K, Park C, Shin J, Cha H, Kwon W, Park J. Prospective phase II trial of a combination of gemcitabine, cisplatin and UFT as first-line treatment in patients with advanced, unresectable, non-small cell lung carcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18109 Background: Most patients with advanced non-small cell lung cancer (NSCLC) receive either single agents or doublet chemotherapy. For non-elderly patients in good performance status, platinum-based double combinations represent the standard treatment. And oral UFT had the survival advantage in adjuvant setting. Therefore we performed a phase II study using the combination of gemcitabine, cisplatin and UFT as a first line therapy in patients with advanced NSCLC. Methods: Eligible patients had histologically or cytologically confirmed stage IIIB or IV NSCLC with good performance status and were chemotherapy-naive. This study was two-stage design and planned number of patients was forty-seven. Gemcitabine (1,250 mg/m2, 10 mg/kg/min on days 1 and 8) and cisplatin (75 mg/m2 on day 1) were injected intravenously and UFT (400 mg/day) was administered orally on day 1–14. Treatment repeated every 3 weeks. Primary end point was overall response rate and secondary end points were overall survival, time to progression and toxicity. Results: Thirty seven patients with advanced NSCLC were enrolled. The median age of the patients was 60 years (range: 44 to 72). The performance status (WHO) was 0 in 4, 1 in 30 and 2 in 3 patients. Twenty three patients completed six cycles. Complete response was achieved in 1 (3%) patient, partial response in 22 (59%) patients, stable disease in 9 (24%) patients. Overall response rate was 62% on intent to treat basis. Among patients who response evaluation was possible (33 patients), response rate was 70%. The median survival time was 14.5 months (95% CI 6.9, 22.3) and the 1 year survival was 35% and then median time to progression was 3.4 months(95% CI 3, 3.9). Toxicities were moderate and mostly hematological adverse events. Grade 3/4 neutropenia occurred in 37%, 5 patients with febrile neutropenia. Grade 3/4 anemia and thrombocypenia was occurred in 37% and 5%. Nonhematologic toxicities were mild. Conclusion: The combination therapy consisted of gemcitabine, cisplatin and UFT is active and well tolerable first line regimen for NSCLC patients. No significant financial relationships to disclose.
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Affiliation(s)
- S. S. Jin
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - Y. Min
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - H. Kim
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - J. Ahn
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - Y. Jegal
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - K. Seo
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - C. Park
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - J. Shin
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - H. Cha
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - W. Kwon
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - J. Park
- Ulsan University Hospital, Ulsan, Republic of Korea
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Kwon W, Gang H, Shin S, Jung S, Kwak Y, Suh G. Out-of-Hospital Management of Human Exposures to Toxic Substances. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.135] [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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Chang KJ, Kwon W. Immunohistochemical localization of insulin in pancreatic beta-cells of taurine-supplemented or taurine-depleted diabetic rats. Adv Exp Med Biol 2002; 483:579-87. [PMID: 11787644 DOI: 10.1007/0-306-46838-7_62] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The purpose of this study was to observe the effects of taurine supplementation or depletion on the immunohistochemical localization of insulin in pancreas of streptozotocin-induced diabetic rats. Male Sprague-Dawley rats were fed for 7 weeks with a purified diet that was supplemented with 0, 1, 2 or 3% taurine in their drinking water. To induce taurine depletion, rats were treated with 5% beta-alanine in their drinking water. After 3 weeks, diabetes was induced by streptozotocin injection (50 mg/kg body-weight). The pancreatic tissue was stained immunocytochemically, using an antibody to insulin, and examined by light microscopy. The insulin levels in pancreatic beta-cells of the diabetic group that received no taurine-supplement were significantly decreased, compared to the non-diabetic group. The levels of insulin in beta-cell of 1% and 2% taurine-supplemented diabetic groups were significantly higher than those of the diabetic group, whereas the levels in the group receiving 3% taurine were not significantly different from that of non-diabetic rats. Therefore, it may be suggested that taurine protect pancreatic beta-cells against destruction by ptozotocin injection in a dose-dependent way.
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Affiliation(s)
- K J Chang
- Department of Food and Nutrition, Inha University, Inchon, Korea
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