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Luckett PH, Olufawo MO, Park KY, Lamichhane B, Dierker D, Verastegui GT, Lee JJ, Yang P, Kim A, Butt OH, Chheda MG, Snyder AZ, Shimony JS, Leuthardt EC. Predicting post-surgical functional status in high-grade glioma with resting state fMRI and machine learning. J Neurooncol 2024:10.1007/s11060-024-04715-1. [PMID: 38789843 DOI: 10.1007/s11060-024-04715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE High-grade glioma (HGG) is the most common and deadly malignant glioma of the central nervous system. The current standard of care includes surgical resection of the tumor, which can lead to functional and cognitive deficits. The aim of this study is to develop models capable of predicting functional outcomes in HGG patients before surgery, facilitating improved disease management and informed patient care. METHODS Adult HGG patients (N = 102) from the neurosurgery brain tumor service at Washington University Medical Center were retrospectively recruited. All patients completed structural neuroimaging and resting state functional MRI prior to surgery. Demographics, measures of resting state network connectivity (FC), tumor location, and tumor volume were used to train a random forest classifier to predict functional outcomes based on Karnofsky Performance Status (KPS < 70, KPS ≥ 70). RESULTS The models achieved a nested cross-validation accuracy of 94.1% and an AUC of 0.97 in classifying KPS. The strongest predictors identified by the model included FC between somatomotor, visual, auditory, and reward networks. Based on location, the relation of the tumor to dorsal attention, cingulo-opercular, and basal ganglia networks were strong predictors of KPS. Age was also a strong predictor. However, tumor volume was only a moderate predictor. CONCLUSION The current work demonstrates the ability of machine learning to classify postoperative functional outcomes in HGG patients prior to surgery accurately. Our results suggest that both FC and the tumor's location in relation to specific networks can serve as reliable predictors of functional outcomes, leading to personalized therapeutic approaches tailored to individual patients.
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Affiliation(s)
- Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Michael O Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bidhan Lamichhane
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Omar H Butt
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Milan G Chheda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
- Department of Mechanical Engineering and Materials Science, Washington University in Saint Louis, St. Louis, MO, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA
- Brain Laser Center, Washington University School of Medicine, St. Louis, MO, USA
- National Center for Adaptive Neurotechnologies, Albany, NY, USA
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Park KY, Shimony JS, Chakrabarty S, Tanenbaum AB, Hacker CD, Donovan KM, Luckett PH, Milchenko M, Sotiras A, Marcus DS, Leuthardt EC, Snyder AZ. Optimal approaches to analyzing functional MRI data in glioma patients. J Neurosci Methods 2024; 402:110011. [PMID: 37981126 PMCID: PMC10926951 DOI: 10.1016/j.jneumeth.2023.110011] [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: 08/17/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Resting-state fMRI is increasingly used to study the effects of gliomas on the functional organization of the brain. A variety of preprocessing techniques and functional connectivity analyses are represented in the literature. However, there so far has been no systematic comparison of how alternative methods impact observed results. NEW METHOD We first surveyed current literature and identified alternative analytical approaches commonly used in the field. Following, we systematically compared alternative approaches to atlas registration, parcellation scheme, and choice of graph-theoretical measure as regards differentiating glioma patients (N = 59) from age-matched reference subjects (N = 163). RESULTS Our results suggest that non-linear, as opposed to affine registration, improves structural match to an atlas, as well as measures of functional connectivity. Functionally- as opposed to anatomically-derived parcellation schemes maximized the contrast between glioma patients and reference subjects. We also demonstrate that graph-theoretic measures strongly depend on parcellation granularity, parcellation scheme, and graph density. COMPARISON WITH EXISTING METHODS AND CONCLUSIONS Our current work primarily focuses on technical optimization of rs-fMRI analysis in glioma patients and, therefore, is fundamentally different from the bulk of papers discussing glioma-induced functional network changes. We report that the evaluation of glioma-induced alterations in the functional connectome strongly depends on analytical approaches including atlas registration, choice of parcellation scheme, and graph-theoretical measures.
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Affiliation(s)
- Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Satrajit Chakrabarty
- Department of Electrical and Systems Engineering, Washington University, St. Louis, MO 63130, USA
| | - Aaron B Tanenbaum
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Carl D Hacker
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kara M Donovan
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aristeidis Sotiras
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Institute for Informatics, Data Science & Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Daniel S Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO 63130, USA; Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO 63110, USA; Brain Laser Center, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Luckett PH, Park KY, Lee JJ, Lenze EJ, Wetherell JL, Eyler L, Snyder AZ, Ances BM, Shimony JS, Leuthardt EC. Data-efficient resting-state functional magnetic resonance imaging brain mapping with deep learning. J Neurosurg 2023; 139:1258-1269. [PMID: 37060318 PMCID: PMC10576012 DOI: 10.3171/2023.3.jns2314] [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: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Resting-state functional MRI (RS-fMRI) enables the mapping of function within the brain and is emerging as an efficient tool for the presurgical evaluation of eloquent cortex. Models capable of reliable and precise mapping of resting-state networks (RSNs) with a reduced scanning time would lead to improved patient comfort while reducing the cost per scan. The aims of the present study were to develop a deep 3D convolutional neural network (3DCNN) capable of voxel-wise mapping of language (LAN) and motor (MOT) RSNs with minimal quantities of RS-fMRI data. METHODS Imaging data were gathered from multiple ongoing studies at Washington University School of Medicine and other thoroughly characterized, publicly available data sets. All study participants (n = 2252 healthy adults) were cognitively screened and completed structural neuroimaging and RS-fMRI. Random permutations of RS-fMRI regions of interest were used to train a 3DCNN. After training, model inferences were compared using varying amounts of RS-fMRI data from the control data set as well as 5 patients with glioblastoma multiforme. RESULTS The trained model achieved 96% out-of-sample validation accuracy on data encompassing a large age range collected on multiple scanner types and varying sequence parameters. Testing on out-of-sample control data showed 97.9% similarity between results generated using either 50 or 200 RS-fMRI time points, corresponding to approximately 2.5 and 10 minutes, respectively (96.9% LAN, 96.3% MOT true-positive rate). In evaluating data from patients with brain tumors, the 3DCNN was able to accurately map LAN and MOT networks despite structural and functional alterations. CONCLUSIONS Functional maps produced by the 3DCNN can inform surgical planning in patients with brain tumors in a time-efficient manner. The authors present a highly efficient method for presurgical functional mapping and thus improved functional preservation in patients with brain tumors.
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Affiliation(s)
- Patrick H. Luckett
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ki Yun Park
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
| | - John J. Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julie L Wetherell
- Mental Health Impact Unit 3, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Lisa Eyler
- Department of Psychiatry, University of California, San Diego, California
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C. Leuthardt
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
- Center for Innovation in Neuroscience and Technology, Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO
- Brain Laser Center, Washington University School of Medicine, St. Louis, Missouri
- National Center for Adaptive Neurotechnologies
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Luckett PH, Olufawo M, Lamichhane B, Park KY, Dierker D, Verastegui GT, Yang P, Kim AH, Chheda MG, Snyder AZ, Shimony JS, Leuthardt EC. Predicting survival in glioblastoma with multimodal neuroimaging and machine learning. J Neurooncol 2023; 164:309-320. [PMID: 37668941 PMCID: PMC10522528 DOI: 10.1007/s11060-023-04439-8] [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: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Glioblastoma (GBM) is the most common and aggressive malignant glioma, with an overall median survival of less than two years. The ability to predict survival before treatment in GBM patients would lead to improved disease management, clinical trial enrollment, and patient care. METHODS GBM patients (N = 133, mean age 60.8 years, median survival 14.1 months, 57.9% male) were retrospectively recruited from the neurosurgery brain tumor service at Washington University Medical Center. All patients completed structural neuroimaging and resting state functional MRI (RS-fMRI) before surgery. Demographics, measures of cortical thickness (CT), and resting state functional network connectivity (FC) were used to train a deep neural network to classify patients based on survival (< 1y, 1-2y, >2y). Permutation feature importance identified the strongest predictors of survival based on the trained models. RESULTS The models achieved a combined cross-validation and hold out accuracy of 90.6% in classifying survival (< 1y, 1-2y, >2y). The strongest demographic predictors were age at diagnosis and sex. The strongest CT predictors of survival included the superior temporal sulcus, parahippocampal gyrus, pericalcarine, pars triangularis, and middle temporal regions. The strongest FC features primarily involved dorsal and inferior somatomotor, visual, and cingulo-opercular networks. CONCLUSION We demonstrate that machine learning can accurately classify survival in GBM patients based on multimodal neuroimaging before any surgical or medical intervention. These results were achieved without information regarding presentation symptoms, treatments, postsurgical outcomes, or tumor genomic information. Our results suggest GBMs have a global effect on the brain's structural and functional organization, which is predictive of survival.
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Affiliation(s)
- Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Bidhan Lamichhane
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, 74136, USA
| | - Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Peter Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Brain Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Milan G Chheda
- Brain Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Brain Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Brain Tumor Center at Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in Saint Louis, St. Louis, MO, 63130, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Brain Laser Center, Washington University School of Medicine, St. Louis, MO, 63110, USA
- National Center for Adaptive Neurotechnologies, Albany, USA
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Park KY, Snyder AZ, Olufawo M, Trevino G, Luckett PH, Lamichhane B, Xie T, Lee JJ, Shimony JS, Leuthardt EC. Glioblastoma induces whole-brain spectral change in resting state fMRI: Associations with clinical comorbidities and overall survival. Neuroimage Clin 2023; 39:103476. [PMID: 37453204 PMCID: PMC10371854 DOI: 10.1016/j.nicl.2023.103476] [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: 04/16/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
Glioblastoma, a highly aggressive form of brain tumor, is a brain-wide disease. We evaluated the impact of tumor burden on whole brain resting-state functional magnetic resonance imaging (rs-fMRI) activity. Specifically, we analyzed rs-fMRI signals in the temporal frequency domain in terms of the power-law exponent and fractional amplitude of low-frequency fluctuations (fALFF). We contrasted 189 patients with newly-diagnosed glioblastoma versus 189 age-matched healthy reference participants from an external dataset. The patient and reference datasets were matched for age and head motion. The principal finding was markedly flatter spectra and reduced grey matter fALFF in the patients as compared to the reference dataset. We posit that the whole-brain spectral change is attributable to global dysregulation of excitatory and inhibitory balance and metabolic demand in the tumor-bearing brain. Additionally, we observed that clinical comorbidities, in particular, seizures, and MGMT promoter methylation, were associated with flatter spectra. Notably, the degree of change in spectra was predictive of overall survival. Our findings suggest that frequency domain analysis of rs-fMRI activity provides prognostic information in glioblastoma patients and offers a means of noninvasively studying the effects of glioblastoma on the whole brain.
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Affiliation(s)
- Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA; Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bidhan Lamichhane
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO, USA; Center for Health Sciences, Oklahoma State University, 1013 E 66th Pl, Tulsa, OK 74136, USA
| | - Tao Xie
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA; Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO, USA
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Luckett PH, Lee JJ, Park KY, Raut RV, Meeker KL, Gordon EM, Snyder AZ, Ances BM, Leuthardt EC, Shimony JS. Resting state network mapping in individuals using deep learning. Front Neurol 2023; 13:1055437. [PMID: 36712434 PMCID: PMC9878609 DOI: 10.3389/fneur.2022.1055437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Resting state functional MRI (RS-fMRI) is currently used in numerous clinical and research settings. The localization of resting state networks (RSNs) has been utilized in applications ranging from group analysis of neurodegenerative diseases to individual network mapping for pre-surgical planning of tumor resections. Reproducibility of these results has been shown to require a substantial amount of high-quality data, which is not often available in clinical or research settings. Methods In this work, we report voxelwise mapping of a standard set of RSNs using a novel deep 3D convolutional neural network (3DCNN). The 3DCNN was trained on publicly available functional MRI data acquired in n = 2010 healthy participants. After training, maps that represent the probability of a voxel belonging to a particular RSN were generated for each participant, and then used to calculate mean and standard deviation (STD) probability maps, which are made publicly available. Further, we compared our results to previously published resting state and task-based functional mappings. Results Our results indicate this method can be applied in individual subjects and is highly resistant to both noisy data and fewer RS-fMRI time points than are typically acquired. Further, our results show core regions within each network that exhibit high average probability and low STD. Discussion The 3DCNN algorithm can generate individual RSN localization maps, which are necessary for clinical applications. The similarity between 3DCNN mapping results and task-based fMRI responses supports the association of specific functional tasks with RSNs.
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Affiliation(s)
- Patrick H. Luckett
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - John J. Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ki Yun Park
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Ryan V. Raut
- Department of Physiology and Biophysics, University of Washington, Seattle, WA, United States
- MindScope Program, Allen Institute, Seattle, WA, United States
| | - Karin L. Meeker
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Evan M. Gordon
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric C. Leuthardt
- Division of Neurotechnology, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States
- Center for Innovation in Neuroscience and Technology, Division of Neurotechnology, Washington University School of Medicine, St. Louis, MO, United States
- Brain Laser Center, Washington University School of Medicine, St. Louis, MO, United States
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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Johnson EA, Lee JJ, Hacker CD, Park KY, Rustamov N, Daniel AGS, Shimony JS, Leuthardt EC. Preoperative functional connectivity by magnetic resonance imaging for refractory neocortical epilepsy. medRxiv 2023:2023.01.10.23284374. [PMID: 36712003 PMCID: PMC9882436 DOI: 10.1101/2023.01.10.23284374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective Patients with refractory epilepsy experience extensive and invasive clinical testing for seizure onset zones treatable by surgical resection. However, surgical resection can fail to provide therapeutic benefit, and patients with neocortical epilepsy have the poorest therapeutic outcomes. This case series studied patients with neocortical epilepsy who were referred for surgical treatment. Prior to surgery, patients volunteered for resting-state functional magnetic resonance imaging (rs-fMRI) in addition to imaging for the clinical standard of care. This work examined the variability of functional connectivity in patients, estimated from rs-fMRI, for associations with surgical outcomes. Methods This work examined pre-operative structural imaging, pre-operative rs-fMRI, and post-operative structural imaging from seven epilepsy patients. Review of the clinical record provided Engel classifications for surgical outcomes. A novel method assessed pre-operative rs-fMRI from patients using comparative rs-fMRI from a large cohort of healthy control subjects and estimated Gibbs distributions for functional connectivity in patients compared to healthy controls. Results Three patients had Engel classification Ia, one patient had Engel classification IIa, and three patients had Engel classification IV. Metrics for variability of functional connectivity, including absolute differences of the functional connectivity of each patient from healthy control averages and probabilistic scores for absolute differences, were higher for patients classified as Engel IV, for whom epilepsy surgery provided no meaningful improvement. Significance This work continues on-going efforts to use rs-fMRI to characterize abnormal functional connectivity in the brain. Preliminary evidence indicates that the topography of variant functional connectivity in epilepsy patients may be clinically relevant for identifying patients unlikely to have favorable outcomes after epilepsy surgery. Widespread topographic variations of functional connectivity also support the hypothesis that epilepsy is a disease of brain resting-state networks.
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Lamichhane B, Luckett PH, Dierker D, Yun Park K, Burton H, Olufawo M, Trevino G, Lee JJ, Daniel AGS, Hacker CD, Marcus DS, Shimony JS, Leuthardt EC. Structural gray matter alterations in glioblastoma and high-grade glioma-A potential biomarker of survival. Neurooncol Adv 2023; 5:vdad034. [PMID: 37152811 PMCID: PMC10162111 DOI: 10.1093/noajnl/vdad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Patients with glioblastoma (GBM) and high-grade glioma (HGG, World Health Organization [WHO] grade IV glioma) have a poor prognosis. Consequently, there is an unmet clinical need for accessible and noninvasively acquired predictive biomarkers of overall survival in patients. This study evaluated morphological changes in the brain separated from the tumor invasion site (ie, contralateral hemisphere). Specifically, we examined the prognostic value of widespread alterations of cortical thickness (CT) in GBM/HGG patients. Methods We used FreeSurfer, applied with high-resolution T1-weighted MRI, to examine CT, evaluated prior to standard treatment with surgery and chemoradiation in patients (GBM/HGG, N = 162, mean age 61.3 years) and 127 healthy controls (HC; 61.9 years mean age). We then compared CT in patients to HC and studied patients' associated changes in CT as a potential biomarker of overall survival. Results Compared to HC cases, patients had thinner gray matter in the contralesional hemisphere at the time of tumor diagnosis. patients had significant cortical thinning in parietal, temporal, and occipital lobes. Fourteen cortical parcels showed reduced CT, whereas in 5, it was thicker in patients' cases. Notably, CT in the contralesional hemisphere, various lobes, and parcels was predictive of overall survival. A machine learning classification algorithm showed that CT could differentiate short- and long-term survival patients with an accuracy of 83.3%. Conclusions These findings identify previously unnoticed structural changes in the cortex located in the hemisphere contralateral to the primary tumor mass. Observed changes in CT may have prognostic value, which could influence care and treatment planning for individual patients.
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Affiliation(s)
- Bidhan Lamichhane
- Corresponding Author: Bidhan Lamichhane, PhD, Department of Neurosurgery, Washington University School of Medicine, Box 8057, 660 South Euclid, St. Louis, MO 63110, USA ()
| | - Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Harold Burton
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andy G S Daniel
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Carl D Hacker
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel S Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri, USA
- Brain Laser Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Neurotechnology, Washington University School of Medicine, St. Louis, Missouri, USA
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9
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Luckett PH, Maccotta L, Lee JJ, Park KY, Dosenbach NU, Ances BM, Hogan RE, Shimony JS, Leuthardt EC. Deep learning resting state fMRI lateralization of temporal lobe epilepsy. Epilepsia 2022; 63:1542-1552. [PMID: 35320587 DOI: 10.1111/epi.17233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Localization of focal epilepsy is critical for surgical treatment of refractory seizures. There remains a great need for non-invasive techniques to localize seizures for surgical decision-making. We investigate the use of deep learning using resting state functional MRI (RS-fMRI) to identify the hemisphere of seizure onset in temporal lobe epilepsy (TLE) patients. METHODS 2132 healthy controls and 32 pre-operative TLE patients were studied. All participants underwent structural MRI and RS-fMRI. Healthy control data was used to generate training samples for a 3D convolutional neural network (3DCNN). RS-fMRI was synthetically altered in randomly lateralized regions in the healthy control participants. The model was then trained to classify the hemisphere containing synthetic noise. Finally, the model was tested on TLE patients to assess its performance for detecting biological seizure-onset zones, and gradient-weighted class activation mapping (Grad-CAM) identified the strongest predictive regions. RESULTS The 3DCNN classified healthy control hemispheres known to contain synthetic noise with 96% accuracy, and TLE hemispheres clinically identified to be seizure onset zones with 90.6% accuracy. Grad-CAM identified a range of temporal, frontal, parietal, and subcortical regions that were strong anatomical predictors of the seizure onset zone, while the resting state networks which colocalized with Grad-CAM results included default mode, medial temporal, and dorsal attention networks. Lastly, in an analysis of a subset of patients with post-surgical outcomes, the 3DCNN leveraged a more focal set of regions to achieve classification in patients with Engel class > 1 compared to Engel class 1. SIGNIFICANCE Non-invasive techniques capable of localizing the seizure-onset zone could improve pre-surgical planning in patients with intractable epilepsy. We have demonstrated the ability of deep learning to identify the correct hemisphere of the seizure onset zone in TLE patients using RS-fMRI with high accuracy. This approach represents a novel technique of seizure lateralization that could improve preoperative surgical planning.
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Affiliation(s)
- Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Luigi Maccotta
- Department of Neurology, Washington University School of Medicine, St. Louis
| | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis
| | - Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
| | - Nico Uf Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis
| | - R Edward Hogan
- Department of Neurology, Washington University School of Medicine, St. Louis
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis
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10
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Hong JY, Han HS, Youn JH, Kim HW, Ryu HS, Park KY. Irradiation with 590-nm yellow light-emitting diode light attenuates oxidative stress and modulates UVB induced change of dermal fibroblasts. Exp Dermatol 2022; 31:931-935. [PMID: 35181944 DOI: 10.1111/exd.14542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
Recently, light-emitting diode (LED)-based devices have emerged as effective and safe tools for the treatment of photoaged skin. However, few studies have been conducted to elucidate the underlying mechanism behind the effect on photoaging of LED light. In this study, we induced photoaging of human dermal fibroblasts (HDFs) with Ultraviolet B (UVB) irradiation and evaluated the ability of 590 nm LED radiation to induce recovery from oxidative stress, restore collagen formation, and regulate inflammatory changes. Photoaging was induced in cultured human dermal fibroblasts (HDFs) using UVB irradiaton of 50 mJ/cm2 . Then, the photoaged HDFs were irradiated with LED using a custom-built 590 nm LED device which emits light with an intensity of 38 mW/cm2 (irradiated for 900 s with 34.2 J/cm2 of total energy). LED irradiation significantly attenuated UVB-induced reactive oxygen species generation and UVB-induced phosphorylation of JNK, c-Fos, and c-Jun. In addition, the procollagen levels were recovered significantly, and MMP-9 levels were significantly suppressed after LED irradiation. The UVB-induced phosphorylation levels of NF-κB and pro-inflammatory enzyme COX-2 also significantly decreased. Our results suggest that 590-nm yellow light irradiation may be an effective and safe anti-oxidative and anti-inflammatory treatment modality for photoaged skin.
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Affiliation(s)
- J Y Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - H W Kim
- CG Bio Co. Ltd, Seoul, Korea
| | - H S Ryu
- CG Bio Co. Ltd, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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11
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Kim J, Han HJ, Lee W, Park SK, Chung J, Kim YB, Park KY. Safety and Efficacy of Stent-Assisted Coiling of Unruptured Intracranial Aneurysms Using Low-Profile Stents in Small Parent Arteries. AJNR Am J Neuroradiol 2021; 42:1621-1626. [PMID: 34210666 DOI: 10.3174/ajnr.a7196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coiling of intracranial aneurysms arising from small vessels (≤ 2.0 mm) is a common procedure. However, data regarding its treatment outcomes are scarce. This study evaluated the clinical and radiologic outcomes of stent-assisted coiling using low-profile stents for aneurysms of small parent arteries. MATERIALS AND METHODS From November 2015 to October 2020, sixty-four patients with 66 aneurysms arising from parent arteries of ≤2.0 mm were treated with stent-assisted coiling using a Low-Profile Visualized Intraluminal Support Junior (LVIS Jr) or the Neuroform Atlas stent in a single institution. The clinical and radiologic data were retrospectively reviewed, and the risk factors for procedure-related complications were evaluated. RESULTS The LVIS Jr and Neuroform Atlas stents were used in 22 (33.3%) and 44 (66.7%) cases, respectively. Technical success was achieved in 66 cases (100%). Immediate postprocedural aneurysm occlusion grades assessed by the Raymond-Roy occlusion classification were I (57.6%), II (19.7%), and III (22.7%), respectively. Procedure-related complications occurred in 10 cases (15.2%), with 8 thromboembolic complications (12.1%) and 2 hemorrhagic complications (3.0%). Procedure-related morbidity was 4.5% without mortality. On multivariate analysis, current smoking (odds ratio = 7.1, P = .021) had a statistically significant effect on procedure-related complications. CONCLUSIONS Stent-assisted coiling of intracranial aneurysms with low-profile stents in small vessels (≤ 2.0 mm) had a 100% success rate and a 15.2% overall complication rate with 4.5% morbidity. Current smoking was a significant risk factor associated with procedure-related complications.
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Affiliation(s)
- J Kim
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - H J Han
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - W Lee
- Severance Stroke Center, and Department of Neurosurgery (W.L., S.K.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S K Park
- Severance Stroke Center, and Department of Neurosurgery (W.L., S.K.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Chung
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - Y B Kim
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - K Y Park
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
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12
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Park KY, Ozaki T, Kostynskyy A, Kortman H, Hilario A, Nicholson P, Agid R, Krings T, Pereira VM. Ticagrelor versus Clopidogrel in the Dual Antiplatelet Regimen for Intracranial Stenting or Flow-Diverter Treatment for Unruptured Cerebral Aneurysms: A Single-Center Cohort Study. AJNR Am J Neuroradiol 2021; 42:1638-1644. [PMID: 34244132 DOI: 10.3174/ajnr.a7216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Ticagrelor is a novel P2Y12 antagonist, and little is known about its efficacy and safety in the endovascular treatment of aneurysms. This study evaluated the efficacy and safety of ticagrelor versus clopidogrel for stent-assisted coiling or flow-diversion treatment in patients with unruptured cerebral aneurysms. MATERIALS AND METHODS From November 2003 to February 2019, two hundred one patients (mean age, 57.5 years; 156 women) with 233 unruptured aneurysms underwent stent-assisted coiling or flow-diversion treatment. All patients received antiplatelet therapy of aspirin plus clopidogrel (clopidogrel group, 121 patients with 140 aneurysms) or aspirin plus ticagrelor (ticagrelor group, 80 patients with 93 aneurysms). The clinical and radiologic data in each group were retrospectively reviewed and compared. RESULTS Two hundred thirty-six procedures were performed, including stent-assisted coiling (n = 101) and flow diversion (n = 135). At 90 days, the primary outcome-a composite of any stroke and death-occurred in 9.9% of the clopidogrel group and 8.6% of the ticagrelor group (P = .822). Ischemic stroke occurred in 10 (7.0%) of the clopidogrel group and 7 (7.5%) of the ticagrelor group (P > .999). Disabling stroke occurred in 4 (2.8%) in the clopidogrel group and in 4 (4.3%) in the ticagrelor group (P = .716). Ninety-day death occurred in 3 (2.1%) in the clopidogrel group and 1 (1.1%) in the ticagrelor group (P > .999). Any bleeding at 90 days occurred in 13 (9.2%) in the clopidogrel group and 6 (6.5%) in the ticagrelor group (P = .479). CONCLUSIONS Ticagrelor appears to be as effective and safe as clopidogrel in stent-assisted coiling or flow-diversion treatment for unruptured cerebral aneurysms.
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Affiliation(s)
- K Y Park
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neurosurgery (K.Y.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - T Ozaki
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Kostynskyy
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - H Kortman
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Radiology (H.K.), Elisabeth-TweeSteden Ziekenhuis St. Elisabeth Hospital, Tilburg, the Netherlands
| | - A Hilario
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - P Nicholson
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - R Agid
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - T Krings
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - V M Pereira
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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13
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Park SJ, Han HS, Shin SH, Yoo KH, Li K, Kim BJ, Seo SJ, Park KY. Adverse skin reactions due to use of face masks: a prospective survey during the COVID-19 pandemic in Korea. J Eur Acad Dermatol Venereol 2021; 35:e628-e630. [PMID: 34131961 PMCID: PMC8447351 DOI: 10.1111/jdv.17447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S J Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S H Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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14
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Daniel AGS, Park KY, Roland JL, Dierker D, Gross J, Humphries JB, Hacker CD, Snyder AZ, Shimony JS, Leuthardt EC. Functional connectivity within glioblastoma impacts overall survival. Neuro Oncol 2021; 23:412-421. [PMID: 32789494 PMCID: PMC7992880 DOI: 10.1093/neuonc/noaa189] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Indexed: 12/12/2022] Open
Abstract
Background Glioblastoma (GBM; World Health Organization grade IV) assumes a variable appearance on MRI owing to heterogeneous proliferation and infiltration of its cells. As a result, the neurovascular units responsible for functional connectivity (FC) may exist within gross tumor boundaries, albeit with altered magnitude. Therefore, we hypothesize that the strength of FC within GBMs is predictive of overall survival. Methods We used predefined FC regions of interest (ROIs) in de novo GBM patients to characterize the presence of within-tumor FC observable via resting-state functional MRI and its relationship to survival outcomes. Results Fifty-seven GBM patients (mean age, 57.8 ± 13.9 y) were analyzed. Functionally connected voxels, not identifiable on conventional structural images, can be routinely found within the tumor mass and was not significantly correlated to tumor size. In patients with known survival times (n = 31), higher intranetwork FC strength within GBM tumors was associated with better overall survival even after accounting for clinical and demographic covariates. Conclusions These findings suggest the possibility that functionally intact regions may persist within GBMs and that the extent to which FC is maintained may carry prognostic value and inform treatment planning.
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Affiliation(s)
- Andy G S Daniel
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri
| | - Ki Yun Park
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jarod L Roland
- Washington University School of Medicine, St Louis, Missouri.,Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Joseph B Humphries
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri
| | - Carl D Hacker
- Department of Neurological Surgery, St Louis, Missouri
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri.,Washington University School of Medicine, St Louis, Missouri.,Department of Neurological Surgery, St Louis, Missouri.,Department of Neuroscience, St Louis, Missouri.,Department of Mechanical Engineering and Materials Science, St Louis, Missouri.,Center for Innovation in Neuroscience and Technology, St Louis, Missouri.,Brain Laser Center, St Louis, Missouri
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15
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Park SJ, Park JW, Park KY, Li K, Seo SJ, Kim BJ, Yoo KH. Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food. Clin Exp Dermatol 2020; 46:324-327. [PMID: 32974941 DOI: 10.1111/ced.14458] [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] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
Systemic contact dermatitis (SCD) develops when a person who was previously sensitized to an allergen is exposed to the same allergen via the systemic route. In East Asia, the use of lacquer for polishing furniture is common and a part of the traditional culture. Contact exposure to tableware polished with Rhus lacquer may lead to sensitization. In Korea, SCD is commonly observed after systemic exposure to Rhus, a nutritious food item consumed because of the common belief of it improving the immune system. In this study, we reviewed the medical records of 21 Korean patients with SCD caused by Rhus ingestion. We found that the most significant epidemiological factor for SCD was the season of the year. Furthermore, 66.67% of the patients presented with leucocytosis and 23.81% showed increased liver enzyme levels. It is important to educate people on the risks associated with the systemic ingestion of Rhus.
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Affiliation(s)
- S J Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - J W Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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16
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Luckett P, Lee JJ, Park KY, Dierker D, Daniel AGS, Seitzman BA, Hacker CD, Ances BM, Leuthardt EC, Snyder AZ, Shimony JS. Mapping of the Language Network With Deep Learning. Front Neurol 2020; 11:819. [PMID: 32849247 PMCID: PMC7419701 DOI: 10.3389/fneur.2020.00819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Pre-surgical functional localization of eloquent cortex with task-based functional MRI (T-fMRI) is part of the current standard of care prior to resection of brain tumors. Resting state fMRI (RS-fMRI) is an alternative method currently under investigation. Here, we compare group level language localization using T-fMRI vs. RS-fMRI analyzed with 3D deep convolutional neural networks (3DCNN). Methods: We analyzed data obtained in 35 patients with brain tumors that had both language T-fMRI and RS-MRI scans during pre-surgical evaluation. The T-fMRI data were analyzed using conventional techniques. The language associated resting state network was mapped using a 3DCNN previously trained with data acquired in >2,700 normal subjects. Group level results obtained by both methods were evaluated using receiver operator characteristic analysis of probability maps of language associated regions, taking as ground truth meta-analytic maps of language T-fMRI responses generated on the Neurosynth platform. Results: Both fMRI methods localized major components of the language system (areas of Broca and Wernicke). Word-stem completion T-fMRI strongly activated Broca's area but also several task-general areas not specific to language. RS-fMRI provided a more specific representation of the language system. Conclusion: 3DCNN was able to accurately localize the language network. Additionally, 3DCNN performance was remarkably tolerant of a limited quantity of RS-fMRI data.
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Affiliation(s)
- Patrick Luckett
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ki Yun Park
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Andy G S Daniel
- Department of Biomedical Engineering, Washington University, St. Louis, MO, United States
| | - Benjamin A Seitzman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Carl D Hacker
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric C Leuthardt
- Department of Biomedical Engineering, Washington University, St. Louis, MO, United States.,Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Abraham Z Snyder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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17
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Park KY, Lee JJ, Dierker D, Marple LM, Hacker CD, Roland JL, Marcus DS, Milchenko M, Miller-Thomas MM, Benzinger TL, Shimony JS, Snyder AZ, Leuthardt EC. Mapping language function with task-based vs. resting-state functional MRI. PLoS One 2020; 15:e0236423. [PMID: 32735611 PMCID: PMC7394427 DOI: 10.1371/journal.pone.0236423] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/06/2020] [Indexed: 01/21/2023] Open
Abstract
Background Use of functional MRI (fMRI) in pre-surgical planning is a non-invasive method for pre-operative functional mapping for patients with brain tumors, especially tumors located near eloquent cortex. Currently, this practice predominantly involves task-based fMRI (T-fMRI). Resting state fMRI (RS-fMRI) offers an alternative with several methodological advantages. Here, we compare group-level analyses of RS-fMRI vs. T-fMRI as methods for language localization. Purpose To contrast RS-fMRI vs. T-fMRI as techniques for localization of language function. Methods We analyzed data obtained in 35 patients who had both T-fMRI and RS-fMRI scans during the course of pre-surgical evaluation. The RS-fMRI data were analyzed using a previously trained resting-state network classifier. The T-fMRI data were analyzed using conventional techniques. Group-level results obtained by both methods were evaluated in terms of two outcome measures: (1) inter-subject variability of response magnitude and (2) sensitivity/specificity analysis of response topography, taking as ground truth previously reported maps of the language system based on intraoperative cortical mapping as well as meta-analytic maps of language task fMRI responses. Results Both fMRI methods localized major components of the language system (areas of Broca and Wernicke) although not with equal inter-subject consistency. Word-stem completion T-fMRI strongly activated Broca's area but also several task-general areas not specific to language. RS-fMRI provided a more specific representation of the language system. Conclusion We demonstrate several advantages of classifier-based mapping of language representation in the brain. Language T-fMRI activated task-general (i.e., not language-specific) functional systems in addition to areas of Broca and Wernicke. In contrast, classifier-based analysis of RS-fMRI data generated maps confined to language-specific regions of the brain.
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Affiliation(s)
- Ki Yun Park
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - John J. Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura M. Marple
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Carl D. Hacker
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jarod L. Roland
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel S. Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michelle M. Miller-Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Tammie L. Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric C. Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Park KY, Yeon JY, Kim BM, Jeon P, Kim JH, Jang CK, Kim DJ, Lee JW, Kim YB, Chung J, Song DH, Park HG, Park JS. Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling. AJNR Am J Neuroradiol 2020; 41:663-668. [PMID: 32165365 DOI: 10.3174/ajnr.a6476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling. MATERIALS AND METHODS Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated. RESULTS Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n = 16) or without (n = 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged. CONCLUSIONS Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.
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Affiliation(s)
- K Y Park
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Y Yeon
- Department of Neurosurgery (J.Y.Y.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - B M Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - P Jeon
- Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J-H Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C K Jang
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D J Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J W Lee
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y B Kim
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Chung
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D H Song
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H G Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J S Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Samara A, Rahn R, Neyman O, Park KY, Samara A, Marshall B, Dougherty J, Hershey T. Developmental hypomyelination in Wolfram syndrome: new insights from neuroimaging and gene expression analyses. Orphanet J Rare Dis 2019; 14:279. [PMID: 31796109 PMCID: PMC6889680 DOI: 10.1186/s13023-019-1260-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Wolfram syndrome is a rare multisystem disorder caused by mutations in WFS1 or CISD2 genes leading to brain structural abnormalities and neurological symptoms. These abnormalities appear in early stages of the disease. The pathogenesis of Wolfram syndrome involves abnormalities in the endoplasmic reticulum (ER) and mitochondrial dynamics, which are common features in several other neurodegenerative disorders. Mutations in WFS1 are responsible for the majority of Wolfram syndrome cases. WFS1 encodes for an endoplasmic reticulum (ER) protein, wolframin. It is proposed that wolframin deficiency triggers the unfolded protein response (UPR) pathway resulting in an increased ER stress-mediated neuronal loss. Recent neuroimaging studies showed marked alteration in early brain development, primarily characterized by abnormal white matter myelination. Interestingly, ER stress and the UPR pathway are implicated in the pathogenesis of some inherited myelin disorders like Pelizaeus-Merzbacher disease, and Vanishing White Matter disease. In addition, exploratory gene-expression network-based analyses suggest that WFS1 expression occurs preferentially in oligodendrocytes during early brain development. Therefore, we propose that Wolfram syndrome could belong to a category of neurodevelopmental disorders characterized by ER stress-mediated myelination impairment. Further studies of myelination and oligodendrocyte function in Wolfram syndrome could provide new insights into the underlying mechanisms of the Wolfram syndrome-associated brain changes and identify potential connections between neurodevelopmental disorders and neurodegeneration.
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Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA
| | - Rachel Rahn
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Genetics, Washington University Medical School, St. Louis, MO, 63110, USA
| | - Olga Neyman
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA
| | - Ki Yun Park
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA
| | - Ahmad Samara
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Bess Marshall
- Department of Pediatrics, Washington University Medical School, St. Louis, MO, 63110, USA
| | - Joseph Dougherty
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA.,Department of Genetics, Washington University Medical School, St. Louis, MO, 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Avenue, St. Louis, MO, 63110, USA. .,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Park KY, Jeong GJ, Seo SJ, Kim MN, Rho NK. Seasonality of acne severity in Korean patients: data from a dermatologic clinic and military hospital. J Eur Acad Dermatol Venereol 2019; 33:e480-e482. [PMID: 31310390 DOI: 10.1111/jdv.15806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K Y Park
- Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - G J Jeong
- Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - M N Kim
- Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - N-K Rho
- Leaders Clinic, Seoul, Korea
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Ko EJ, Heo WI, Park KY, Lee MK, Seo SJ. Genetic polymorphism of thymic stromal lymphopoietin in Korean patients with atopic dermatitis and allergic march. J Eur Acad Dermatol Venereol 2018; 32:e468-e470. [PMID: 29763522 DOI: 10.1111/jdv.15073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- E J Ko
- Department of Dermatology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - W I Heo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - M-K Lee
- Department of Laboratory Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
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22
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Shin WC, Moon NH, Jang JH, Park KY, Suh KT. Anterolateral femoral bowing and loss of thigh muscle are associated with occurrence of atypical femoral fracture: Effect of failed tension band mechanism in mid-thigh. J Orthop Sci 2017; 22:99-104. [PMID: 27720510 DOI: 10.1016/j.jos.2016.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 05/07/2016] [Revised: 08/23/2016] [Accepted: 09/10/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this study was to characterize anterolateral bowing of the femur using X-rays and muscular atrophy in the mid-thigh using computed tomography (CT) in patients with atypical femoral fractures (AFFs). We then compared the results with those of an intertrochanteric fracture to understand whether these measures act as causative factors of AFFs. METHODS From January 2009 to December 2015, 37 patients with complete AFF and 12 patients with incomplete AFF were enrolled in this study. Lateral femoral bowing, anterior femoral bowing, cross-sectional area (CSA), and attenuation coefficient of thigh muscles in the AFF group are measured and compare with those in the intertrochanteric fracture group. RESULTS Lateral and anterior femoral bowing in the AFF group were significantly higher than those in the intertrochanteric fracture group. The level of fracture was found to be significantly associated with lateral and anterior femoral bowing (r = 0.569, r2 = 0.324, p < 0.001; r = -0.530, r2 = 0.281, p < 0.001, respectively). Total CSA and CSA of anterior and medial compartments were significantly lower in the AFF group (p < 0.05). The attenuation coefficient of the total thigh muscle and all three compartments in the AFF group were significantly lower than those in the intertrochanteric fracture group (p < 0.05). CONCLUSIONS This study demonstrated that anterolateral femoral bowing and loss of thigh muscle were highly associated with the occurrence of AFFs.
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Affiliation(s)
- W C Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - N H Moon
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, South Korea.
| | - J H Jang
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, South Korea
| | - K Y Park
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, South Korea
| | - K T Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
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No YA, Kwon HJ, Park KY, Hong SA, Seo SJ, Hong CK. Unilateral, erythematous, swollen, sclerosing patch with nodular progression on the right side of the face. Clin Exp Dermatol 2016; 41:945-947. [PMID: 27766675 DOI: 10.1111/ced.12919] [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] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Y A No
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H J Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S A Hong
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Seok J, Yeo IK, Park KY, Kim BJ, Seo SJ, Hong CK. Permanent leucoderma after hair transplantation surgery. Clin Exp Dermatol 2016; 41:440-2. [PMID: 26805507 DOI: 10.1111/ced.12799] [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] [Accepted: 07/24/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J Seok
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - I K Yeo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.
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25
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Jeon HJ, Kim BM, Kim DJ, Park KY, Kim JW, Kim DI. Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms. AJNR Am J Neuroradiol 2015; 37:311-6. [PMID: 26381558 DOI: 10.3174/ajnr.a4526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/10/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coiling of complex aneurysms is still difficult even with current adjuvant techniques. This study sought to evaluate the safety and effectiveness of a combination of multicatheter plus stent or balloon for the treatment of complex aneurysms. MATERIALS AND METHODS All complex aneurysms that underwent coiling with the combination technique were identified from prospectively maintained neurointerventional data bases. "Complex aneurysm" was defined as a wide-neck aneurysm with branch incorporation into or a deep lobulation of the sac. The clinical and angiographic outcomes were retrospectively analyzed. RESULTS Sixty-two complex aneurysms (12 ruptured, 50 unruptured) in 62 patients (mean age, 57 years; male/female ratio, 12:50) were treated with a combination technique by using a multicatheter plus stent (n = 42, 3 ruptured) or balloon (n = 20, 9 ruptured). Treatment-related morbidity (grade 3 hemiparesis) occurred in 1 patient (1.6%). Except for 1 patient who had treatment-related morbidity, none of the other patients with unruptured aneurysms developed new neurologic symptoms at discharge. Nine of the 12 patients with ruptured aneurysms had good outcomes (Glasgow Outcome Score, 4 or 5) at the latest follow-up (mean, 32 months; range, 6-72 months), and 1 patient died from an initial SAH. Posttreatment control angiograms revealed complete occlusion in 27, neck remnant in 34, and incomplete occlusion in 1 aneurysm. At least 1 follow-up catheter or MR angiogram was available in 80.6% (n = 50) (mean, 21 months; range, 6-65 months). There were 4 minor and 3 major recurrences (14.0%). CONCLUSIONS In this case series, the combination technique by using multicatheter plus stent or balloon seemed safe and effective for the treatment of complex aneurysms.
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Affiliation(s)
- H J Jeon
- From the Department of Neurosurgery (H.J.J.), Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - B M Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.) bmoon21@hanmail
| | - D J Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
| | - K Y Park
- Neurosurgery (K.Y.P.), Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J W Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
| | - D I Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
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Kim JM, Park KY, Lee WJ, Byun JS, Kim JK, Park MS, Ahn SW, Shin HW. The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage. Eur J Neurol 2015; 22:1453-8. [PMID: 26130213 DOI: 10.1111/ene.12764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of contrast accumulation from non-contrast brain computed tomography taken immediately after endovascular reperfusion treatment in acute ischaemic stroke patients to predict symptomatic hemorrhage was studied. METHODS Between July 2007 and August 2014, acute anterior circulation ischaemic stroke patients who were treated by intra-arterial thrombolysis or thrombectomy were included. Contrast accumulation was defined as a high attenuation area from non-contrast brain computed tomography immediately taken after endovascular reperfusion treatment, and patients were categorized into three groups according to the presence and location of contrast: (i) negative, (ii) cortical involvement and (iii) non-cortical involvement. The rates of symptomatic hemorrhage after 24 h and functional outcome at discharge were compared between patients with and without cortical involvement. RESULTS Of 64 patients who were treated by endovascular intervention, contrast accumulation was detected in 56, including 33 patients with cortical involvement and 23 patients without cortical involvement. The cortical involvement pattern was more frequently associated with symptomatic hemorrhage (13 vs. 1 patient, P = 0.003) and with grave outcome at discharge with modified Rankin Scale 5 or 6 (14 vs. 4, P = 0.048) than the non-cortical involvement group. Multivariate logistic regression analysis including initial collateral status and occlusion site disclosed that cortical involvement pattern independently predicted symptomatic hemorrhage after endovascular treatment (odds ratio 19.0, confidence interval 1.6-227.6, P = 0.020). CONCLUSION Our study provides evidence that the cortical involvement of contrast accumulation is associated with symptomatic hemorrhage after endovascular reperfusion treatment.
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Affiliation(s)
- J M Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - W J Lee
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - J S Byun
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - J K Kim
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - M S Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - S W Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - H W Shin
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Ko EJ, No YA, Park KY, Li K, Seo SJ, Hong CK. The clinical significance of infrared thermography for the prediction of postherpetic neuralgia in acute herpes zoster patients. Skin Res Technol 2015; 22:108-14. [PMID: 26081167 DOI: 10.1111/srt.12237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infrared thermography is a non-invasive diagnostic tool that provides information for damage to the nerve, there was some reports that thermal asymmetry of acute Herpes zoster (HZ) patients was significantly related to development of PHN. OBJECTIVE To identify whether infrared thermography is useful as a predictor for the development of postherpetic neuralgia (PHN) and as an objective assessment tool of subjective pain in acute HZ patients. METHODS Infrared thermography was performed on the affected body regions of 112 patients who had been diagnosed with an acute stage of HZ. Demographic and clinical data were recorded. Differences >0.5°C for the mean temperature across the face and trunk were considered abnormal. According to whether PHN developed or not, we analyzed the correlation of risk factors. RESULTS The study consisted of a total of 112 subjects (46 males and 66 females) with an age range of 9-93 years. The following summarizes the analysis results. (1) As pain severity increased, the occurrence of PHN increased significantly. (2) In older patients, the occurrence of PHN was significantly higher. (3) As the temperature difference between the affected and contralateral dermatome (ΔT) increased, the occurrence of PHN increased significantly. (4) There is a statically significant association between diabetes mellitus and the occurrence of PHN. (5) There is no correlation between pain intensity and ΔT. CONCLUSION In this study, we showed that infrared thermography is useful as a predictor of PHN development in acute HZ patients but is not useful as an objective assessment tool for indicating subjective pain.
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Affiliation(s)
- E J Ko
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Y A No
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Choi SY, Hyun MY, No YA, Park KY, Li K, Kim BJ, Seo SJ, Kim MN, Hong CK. Scar sarcoidosis on a hypertrophic scar. Clin Exp Dermatol 2014; 39:945-7. [PMID: 25196551 DOI: 10.1111/ced.12417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S Y Choi
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea.
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Hyun MY, Son IP, Lee Y, Choi HG, Park KY, Li K, Kim BJ, Seo SJ, Kim MN, Hong CK. Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study. J Eur Acad Dermatol Venereol 2014; 29:278-282. [PMID: 24909188 DOI: 10.1111/jdv.12518] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although facial hyperhidrosis has been frequently associated with a diminished quality of life, various conservative modalities for its management are still far from satisfactory. OBJECTIVE To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals. METHODS Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one-half of the forehead, whereas the other half of the forehead was treated with a placebo. All patients applied topical glycopyrrolate or placebo once a day for nine successive days. Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale (HDSS) score and any adverse effects. RESULTS Compared with the placebo-treated sides, topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 ± 10.30% (mean ± SD) at 90 min after the first application (day 1), 29.63 ± 7.74% at 24 h after the first application (day 2) and 36.68 ± 11.41% at 24 h after eight additional successive daily applications (day 10) (all P < 0.025). There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead, but the difference was not statistically significant (P > 0.025). No serious adverse events were reported during the course of this study. Only one patient developed a transient headache after treatment. CONCLUSION Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration.
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Affiliation(s)
- M Y Hyun
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - I P Son
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Y Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H G Choi
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - M N Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Son KH, Jeong HW, Jung WW, Kim HS, Lee SK, Kim KT, Ahn CB, Park KY, Kim BM, Lee SH. The use of collagen content as determined by spectral domain polarization-sensitive optical coherence tomography to assess colon anastomosis healing in a rat model. Eur Surg Res 2014; 52:32-40. [PMID: 24480934 DOI: 10.1159/000358057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Many studies have been undertaken to prevent anastomosis leakage of the colon, and several methods have been used to assess anastomosis healing, such as measurement of bursting pressure or hydroxyproline (a marker of collagen) content at the anastomosis site. However, these methods are inappropriate for comparing anastomosis healing at two time points in the same animals. In the present study, we measured the collagen level by spectral domain polarization-sensitive optical coherence tomography (SD-PS-OCT) to assess anastomosis healing. METHODS Sprague-Dawley rats were divided into groups C (saline-administered controls; study group) and M [a 5-fluorouracil (5-FU)-administered experimental group]. Immediately after end-to-end anastomosis of the colon, SD-PS-OCT images of anastomoses were taken (baseline). Animals were administered saline or 5-FU for 7 days. On the 7th postoperative day, SD-PS-OCT images were acquired, a histopathologic exam was performed, and hydroxyproline levels as well as mRNA expressions of collagen-1 and collagen-3 were measured at the anastomosis site. RESULTS Fibroblast proliferation and inflammatory cell infiltration were greater in group C than in group M. The mRNA expressions of collagen-1 and collagen-3 were substantially higher in group C. Hydroxyproline levels were higher in group M than in group C. Though collagen levels measured by SD-PS-OCT at 7 days were elevated compared with baseline in group C, no such changes were observed for group M. CONCLUSION Collagen levels at the colon anastomosis site, measured with SD-PS-OCT, were not increased at 7 days postoperatively versus baseline when 5-FU was injected, but were increased in saline-treated controls. The measurement of collagen content by SD-PS-OCT was found to provide a good means of assessing anastomosis healing, because it allows in situ assessment of collagen contents at baseline and during the postoperative period.
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Affiliation(s)
- K H Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon, South Korea
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Jeon YB, Park KY, Moon JK, Park CH, Choi CH, Lee JI. Dobutamine induced cardiogenic shock due to systolic anterior motion after mitral valve repair. Anaesth Intensive Care 2013; 41:551-552. [PMID: 23808519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Heo SN, Sung CH, Seo YJ, Park KY, Ahmed F, Anwar MS, Koo BH. Morphological studies of SnO2 thin films fabricated by using e-beam method. J Nanosci Nanotechnol 2013; 13:3446-3450. [PMID: 23858876 DOI: 10.1166/jnn.2013.7266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper studies the variations in morphology of SnO2 nanostructures thin films deposited by using e-beam technique with the substrate temperature, oxygen partial pressure and the film thickness. The e-beam conditions were optimized to get crystalline nanosheets of SnO2. The films of 100-700 nm thickness were deposited on quartz substrates at temperatures ranging from room temperature (RT) to 300 degrees C and oxygen partial pressure ranging from 0 to 200 sccm. The nanostructured films have been characterized by means of X-ray diffraction (XRD), field emission scanning electron microscope (FE-SEM) and Energy dispersive spectroscopy (EDS) measurements. XRD results show that the films deposited at RT and 100 degrees C were amorphous, however, for 200 degrees C and 300 degrees C, the films showed crystalline nature with rutile structure. Also, the crystallinity increased with the increase of oxygen partial pressure. FE-SEM images revealed that at RT and 100 degrees C of substrate temperature, the film consist of spherical particles, whereas, the films deposited at 200 degrees C and 300 degrees C consist of sheet like morphology having thickness -40 nm and lateral dimension of 1 microm, respectively. The size of the nanosheets increased with the increase of substrate temperature and oxygen partial pressure due to the enhancement in the crystallinity of the films. A possible growth mechanism of the formation of SnO2 nanosheets is discussed.
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Affiliation(s)
- S N Heo
- School of Nano and Advanced Materials Engineering, Changwon National University, 641-773 Changwon, Korea
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Park KY, Kim HK, Kim BJ. Comparative study of hyaluronic acid fillers by in vitro and in vivo testing. J Eur Acad Dermatol Venereol 2013; 28:565-8. [PMID: 23495913 DOI: 10.1111/jdv.12135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous hyaluronic acid (HA) fillers seem to have similar characteristics, although manufacturers insist that monophasic and biphasic HA fillers are different in many ways. Little information regarding this is available in the literature. OBJECTIVES To determine characteristics of monophasic fillers vs. biphasic fillers. MATERIAL AND METHODS We tested three different (two biphasic and one monophasic) HA fillers both in vitro and in vivo. In the in vitro assay, cell toxicity, resistance to enzyme degradation, syringeability and morphology of particles were tested. In vivo, the efficacy and safety were investigated in the dorsal skin of hairless mice. RESULTS There was no cell toxicity in any of the three HA fillers. Resistance to enzymatic degradation and syringeability were better in the two biphasic HA fillers than in the monophasic filler. In particle morphology test, gel type monophasic HA filler was also found as a particle type, although there was a slight difference. Volume assessment in animal skin was superior with the monophasic than with the two biphasic HA fillers. CONCLUSION Biphasic HA fillers have some advantages in hyaluronidase resistance, syringeability and lower risk for overcorrection, while monophasic HA fillers may be more suitable for volume augmentation due to swelling capacity.
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Affiliation(s)
- K Y Park
- Departments of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Lee KH, Park KY, Khanal SK, Lee JW. Effects of household detergent on anaerobic fermentation of kitchen wastewater from food waste disposer. J Hazard Mater 2013; 244-245:39-45. [PMID: 23246938 DOI: 10.1016/j.jhazmat.2012.10.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 06/01/2023]
Abstract
This study examines the effects of household detergent on anaerobic methane fermentation of wastewater from food waste disposers (FWDs). Anaerobic toxicity assay (ATA) demonstrated that methane production substantially decreased at a higher detergent concentration. The Gompertz three-parameter model fitted well with the ATA results, and both the extent of methane production (M) and methane production rate (R(m)) obtained from the model were strongly affected by the concentration of the detergent. The 50% inhibitory concentration (IC(50)) of the detergent was 603 mg/L based on R(m). Results from fatty acid methyl esters (FAMEs) analysis of microbial culture revealed that deterioration of methane fermentation was attributed to impaired structure of anaerobic microbial membrane due to detergent. This study suggests that wastewater from FWD could be used for methane production, but it is necessary to reduce the concentration of detergent prior to anaerobic fermentation.
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Affiliation(s)
- K H Lee
- Department of Environmental Engineering, College of Science and Technology, Korea University, 2511 Sejong-ro, Sejong city 339-700, South Korea
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Choi KS, Kye SJ, Kim JY, Jeon WJ, Lee EK, Park KY, Sung HW. Epidemiological investigation of outbreaks of fowl adenovirus infection in commercial chickens in Korea. Poult Sci 2012; 91:2502-6. [PMID: 22991534 DOI: 10.3382/ps.2012-02296] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [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
In total, 39 clinical cases of fowl adenoviruses (FAdV) infection in chickens (28 broiler, 7 native, and 4 layer chickens) between 2007 and 2010 in Korea were investigated. The FAdV types 4, 8b, and 11 comprised 18, 9, and 12 clinical cases, respectively. All FAdV type 4 cases showed clinical hydropericardium (HPS) lesions as well as inclusion body hepatitis (IBH), whereas all FAdV types 8b and 11 cases exhibited IBH lesions without HPS. All 3 types were detected in broiler (9-30 d old) and layer chickens (23-112 d old), whereas most native chickens (14-65 d old) were affected only by FAdV type 4. Infectious bursal disease virus and chicken infectious anemia virus were complications in 51.3% of FAdV cases, with mortalities of 55% to <0.1%. Chicken infectious anemia virus was detected in all native chicken cases. These results indicate that preventive measures against FAdV infection and immunosuppressive diseases on poultry farms should be implemented.
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Affiliation(s)
- K S Choi
- OIE Newcastle Disease Reference Laboratory, Anyang, Republic of Korea
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Abstract
Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease affecting > 10% of children and 1-3% of adults, and can cause significant morbidity. The incidence of AD seems to be increasing. Omalizumab, a monoclonal antibody, has recently been suggested as a potential new systemic treatment for patients with recalcitrant AD with elevated IgE levels, based on its efficacy in treating asthma and allergic rhinitis. We report a study of 10 patients with AD (aged 19-35 years) who received anti-IgE treatment for persistent asthma. All patients, regardless of IgE value, were treated with a fixed schedule of eight cycles of omalizumab 300 mg administered subcutaneously at intervals of 2 weeks. Eczema symptoms were scored at baseline and after 2, 4 and 6 months of treatment. There was a steady improvement in the objective SCORAD (SCORing Atopic Dermatitis), with significantly lower scores observed at the 6-month evaluation. At 2 months after the end of treatment, two patients had a very good result (SCORAD reduction of > 50%), five patients had a satisfactory result (reduction of 25-50%), and three patients had no clinically relevant result (reduction of 25-50%). No patient had worsening of the AD (increase of > 25% in SCORAD), and once a clinical improvement occurred, none of the patients experienced worsening of their eczema symptoms while on omalizumab. With the caveats of the financial expense and unknown long-term risks of malignancy associated with omalizumab, this drug should be considered for treatment-resistant patients with AD, particularly patients with high IgE level whose symptoms are not controlled by routine therapies. Omalizumab has proven useful in treating asthma, but it may also prove valuable for other conditions, such as allergic rhinitis, food allergies, chronic urticaria, and AD, as shown by the present study.
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Affiliation(s)
- D H Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Park KY, Jang WS, Yang GW, Rho YH, Kim BJ, Mun SK, Kim CW, Kim MN. A pilot study of silver-loaded cellulose fabric with incorporated seaweed for the treatment of atopic dermatitis. Clin Exp Dermatol 2012; 37:512-5. [PMID: 22439868 DOI: 10.1111/j.1365-2230.2011.04273.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because clothing has the longest and most direct contact with human skin, it is important to carefully choose suitable fabrics for atopic patients who have disrupted skin. To evaluate the clinical effectiveness and biophysical properties of a newly developed silver-loaded cellulose fabric with incorporated seaweed, we enrolled 12 subjects with mild to moderate atopic dermatitis into a clinical control study. The subjects wore a two-piece garment (top and leggings), each piece of which was divided into two parts: one side was made of SkinDoctor(®) fabric, and the other of 100% cotton. Treatment efficacy was measured with the modified SCORing Atopic Dermatitis (mSCORAD) index, transepidermal water loss (TEWL) and the patients' subjective impressions. All three of these measures had significantly better scores on the side covered with SkinDoctor. These results suggest that SkinDoctor is a beneficial fabric that can improve the comfort of patients with AD.
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Affiliation(s)
- K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Park KY, Kim HK, Li K, Kim BJ, Seo SJ, Kim MN, Hong CK. Photodynamic therapy: new treatment for refractory lymphocytic infiltration of the skin. Clin Exp Dermatol 2012; 37:235-7. [PMID: 22299667 DOI: 10.1111/j.1365-2230.2011.04189.x] [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: 11/28/2022]
Abstract
Lymphocytic infiltration of the skin (LIS) is a relatively uncommon skin condition, first described by Jessner and Kanof in 1953. LIS presents mainly on the face, in particular on the cheeks and earlobe, but also on the neck, upper trunk or proximal limbs of middle-aged adults. LIS is often resistant to treatment. Photodynamic therapy (PDT) refers to the process of applying a topical prodrug, such as 5-aminolaevulinic acid (ALA) or methyl 5-aminolaevulinic acid (MAL), followed by irradiation with visible or ultraviolet light. The prodrug is converted by target tissue to photoactive porphyrins, which lead to local tissue destruction when activated by light. We describe a 48-year-old woman with refractory LIS, who was treated with MAL-PDT.
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Affiliation(s)
- K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Lee JW, Kim DH, Park KY, Han TY, Li K, Seo SJ, Hong CK, Cho KH. An erythematous plaque on the neck. Folliculotropic mycosis fungoides (MF), stage IVA(T1N3M0). Clin Exp Dermatol 2011; 36:685-7. [PMID: 21771016 DOI: 10.1111/j.1365-2230.2011.04017.x] [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: 11/29/2022]
Affiliation(s)
- J W Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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Park KY, Lee JW, Song KG, Ahn KH. Ozonolysate of excess sludge as a carbon source in an enhanced biological phosphorus removal for low strength wastewater. Bioresour Technol 2011; 102:2462-2467. [PMID: 21109429 DOI: 10.1016/j.biortech.2010.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/28/2010] [Accepted: 11/01/2010] [Indexed: 05/30/2023]
Abstract
Potential use of the municipal sludge ozonolysate as a carbon source was examined for phosphorus removal from low strength wastewater in a modified intermittently decanted extended aeration (IDEA) process. At ozone dosage of 0.2 g O(3)/g solids, readily biodegradable COD accounted for about 36% of COD from sludge ozonolysate. The denitrification potential of ozonolysate as a carbon source was comparable to that of acetate. Although, the first order constant for phosphorus release with the ozonolysate was half that of acetate, it was much higher than that of wastewater. Continuous operation of the modified IDEA process showed that the removals of nitrogen and phosphorus were simultaneously enhanced by addition of the ozonolysate. Phosphorus release was significantly induced after complete denitrification indicating that phosphorus release was strongly depended on nitrate concentration. Effectiveness of the ozonolysate as a carbon source for EBPR was also confirmed in a track study of the modified IDEA.
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Affiliation(s)
- K Y Park
- Department of Civil and Environmental System Engineering, Konkuk University, Seoul, South Korea
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Lee JW, Lee KH, Park KY, Maeng SK. Hydrogenotrophic denitrification in a packed bed reactor: effects of hydrogen-to-water flow rate ratio. Bioresour Technol 2010; 101:3940-3946. [PMID: 20144861 DOI: 10.1016/j.biortech.2010.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 01/04/2010] [Accepted: 01/09/2010] [Indexed: 05/28/2023]
Abstract
Hydrogen dissolution and hydrogenotrophic denitrification performance were investigated in a lab-scale packed bed reactor (PBR) by varying the hydrogen flow rate and hydraulic retention time (HRT). The denitrification performance was enhanced by increasing the hydrogen flow rate and HRT as a result of high dissolved hydrogen concentration (0.39mg/L) and utilization efficiencies (79%). In this study, the hydrogen-to-water flow rate ratio (Q(g)/Q(w)) was found to be a new operating factor representing the two parameters of hydrogen flow rate and HRT. Hydrogen dissolution and denitrification efficiency were nonlinearly and linearly correlated with the Q(g)/Q(w), respectively. Based on its excellent linear correlation with denitrification efficiency, Q(g)/Q(w) should be greater than 2.3 to meet the WHO's guideline of nitrate nitrogen for drinking water. This study demonstrates that Q(g)/Q(w) is a simple and robust factor to optimize hydrogen-sparged bioreactors for hydrogenotrophic denitrification.
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Affiliation(s)
- J W Lee
- Department of Environmental Engineering, College of Science and Technology, Korea University, Jochiwon-eup, Yeongi-gun, Chungnam 339-700, Republic of Korea.
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Park KY, Maeng SK, Song KG, Ahn KH. Ozone treatment of wastewater sludge for reduction and stabilization. J Environ Sci Health A Tox Hazard Subst Environ Eng 2008; 43:1546-1550. [PMID: 18821242 DOI: 10.1080/10934520802293719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ozonation was applied to wastewater sludge for reduction and stabilization. Ozone was found to be very effective at reducing sludge and producing a useful carbon source. An ozone dose of 0.3 g/gDS fulfilled the criteria for the disinfection of class A type biosolids. The sludge treated with 0.5 gO(3)/gDS produced no hydrogen sulfide for a month at 29 degrees C. Ozonation resulted in low pH conditions, which might facilitate the mobilization of heavy metals from sludge. The results of a geotechnical investigation proved that the residuals of ozone-treated sludge did not meet the required properties required for landfill cover without the addition of quick lime.
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Affiliation(s)
- K Y Park
- Department of Civil and Environmental System Engineering, Konkuk University, Seoul, Korea.
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Lee SH, Lee BC, Lee KW, Lee SH, Choi YS, Park KY, Iwamoto M. Phosphorus recovery by mesoporous structure material from wastewater. Water Sci Technol 2007; 55:169-76. [PMID: 17305137 DOI: 10.2166/wst.2007.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study was designed to investigate the fundamental aspects of a possible removal of phosphorous from wastewater by using the mesoporous structure materials for wastewater reuse. The zirconium sulphate with mesoporous structure as a new type of ion exchangers was synthesised by hydrothermal reaction. From the results of X-ray diffraction and transmission electron microscope, it was discovered that the synthesised material had hexagonal mesoporous structure with a pore size of approximately 40-50A. Experimental results showed that the zirconium sulphate with mesoporous structure had very high sorption capacity for the phosphorus. The novel ion exchange occurred between PO4(3-) and SO4(2-), OH-. The amount of phosphate ions exchanged into the solid was as great as 3.4 mmol/g-ZS. Furthermore, it is possible to obtain a higher removal efficiency than other ion exchange media and adsorbents.
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Affiliation(s)
- S H Lee
- Water Environment & Remediation Center, Korea Institute of Science & Technology, Cheongryang, Seoul 130-650, Korea.
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Park KY, Maeng SK, Kim K, Kweon JH, Ahn KH. A high filtration system with synthetic permeable media for wastewater reclamation. Water Sci Technol 2006; 53:185-90. [PMID: 16752780 DOI: 10.2166/wst.2006.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A novel filtration process with synthetic permeable media was investigated for secondary effluent reclamation. Polyurethane was chosen as the filter medium among three tested media. Compressibility and up-flow velocity were changed to determine the optimum operation for the system. An equation was introduced to express the relationship between the removal efficiency and up-flow velocity. In a pilot study, the synthetic medium filtration with compression showed very stable effluent quality without clogging trouble, though the system operated with three times higher filtration rate and much longer backwashing interval than conventional systems.
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Affiliation(s)
- K Y Park
- Dept of Civil and Environmental System Engineering, and Innovative Environmental Technology Center, Konkuk University, Seoul, Korea.
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Lee JW, Cha HY, Park KY, Song KG, Ahn KH. Operational strategies for an activated sludge process in conjunction with ozone oxidation for zero excess sludge production during winter season. Water Res 2005; 39:1199-1204. [PMID: 15862320 DOI: 10.1016/j.watres.2004.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 08/25/2004] [Accepted: 10/04/2004] [Indexed: 05/24/2023]
Abstract
A pilot-scale activated sludge system coupled with sludge ozonation process was operated for 112 days of a winter season without excess sludge wasting. The concept of this process is that the excess sludge produced is first disintegrated by ozone oxidation and then recirculated to a bioreactor in order to mineralize the particulate and soluble organic compounds. The basis of operation was to determine either the optimal amount of sludge in kg SS ozonated each day (SO) or the optimal ozonation frequency under the variable influent chemical oxygen demand (COD) loading and temperature conditions, since the ozone supply consumes costly energy. The optimal SO was obtained using the theoretically estimated sludge production rate (SP) and experimentally obtained ozonation frequency (n). While the SP was mainly subject to the COD loadings, sludge concentration was affected by the temperature changes in winter season. The optimal n was observed between 2.5 and 2.7 at around 15 degrees C, but it was doubled at 10 degrees C. Mixed liquor suspended solids (MLSS) concentration was leveled off at around 5000 mg/L in bioreactor at 15 degrees C, but the volatile fraction of MLSS was fixed around 0.7 indicating that there was no significant inorganic accumulation. Suspended solids (SS) and soluble COD in effluents kept always a satisfactory level of 10 and 15 mg/L with sufficient biodegradation. It was recommended to apply a dynamic SO under variable influent COD loadings and temperature conditions to the activated sludge system without excess sludge production for saving energy as well as system stabilization.
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Affiliation(s)
- J W Lee
- Department of Civil and Environmental Engineering, University of Delaware, Newark, DE 19716, USA.
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Park KY, Kim DY, Chung TH. Granulation in an upflow anaerobic sequencing batch reactor treating disintegrated waste activated sludge. Water Sci Technol 2005; 52:105-11. [PMID: 16477977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
An upflow anaerobic reactor operated with a sequencing batch mode to enhance high rate digestion of raw and thermally disintegrated waste activated sludge with formation of granules. The gas production rate doubled when disintegrated waste activated sludge was introduced. Gradual granulation took place and the dispersed particles become coarse granulation as the operation continued. The granular sludge showed relatively higher specific methanogenic activity than the dispersed sludge. Bacterial morphology by a scanning electron microscope showed diversity of bacteria such as filamentous, rod and spherical shape in the section of granules. Filamentous bacteria, which might support the frame of a granule, were observed as long chains at the outer surface. Meanwhile, rod and spherical bacteria, which might play a role in the initial stage of granule formation, were observed from the inner surface of the granule. High rate digestion of sludge along with efficient liquid-solids separation was achieved due mainly to development of sludge granules within the upflow reactor.
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Affiliation(s)
- K Y Park
- Environment and Process Technology Division, Korea Institute of Science and Technology, P.O. 131, Cheongryang, Seoul 130-650, Korea.
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Hong SW, Choi YS, Kwon G, Park KY. Performance evaluation of physicochemical processes for biologically pre-treated livestock wastewater. Water Sci Technol 2005; 52:107-15. [PMID: 16459782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The use of a combination of biological and physicochemical methods is a promising technique to reduce highly concentrated pollutants in livestock wastewater: firstly, biodegradable organic matters, nitrogen and a part of phosphorus should be removed in a biological treatment process and then residual non-biodegradable organic matters, color and phosphorus be eliminated by physicochemical methods. In this study, therefore, the integrations of chemical coagulation, activated carbon adsorption, Fenton oxidation and ozonation were evaluated to provide an appropriate post-treatment process for biologically pre-treated livestock wastewater. With applying a single method such as coagulation and Fenton oxidation, a yellowish brown color and COD still remained. According to the experimental result, the quality of treated wastewater including color was enough to be discharged after chemical coagulation followed by ozonation or Fenton oxidation process. Among these, ozonation was the most effective technology for decolorization. Neither simple biological nor physicochemical process provides an adequate treatability for the sufficient depletion of organics and decolorization when treating livestock wastewater. Considering only the removal efficiency, the integration of Fenton oxidation and ozonation would be an efficient alternative as a post-treatment.
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Affiliation(s)
- S W Hong
- Water Environment & Remediation Centre, Korea Institute of Science & Technology, P.O. Box 131, Cheongryang, Seoul 130-650, Korea.
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Abstract
The effect of Coptidis Rhizoma extract on ischemia-reperfusion in rats was examined. The blood levels of urea nitrogen and creatinine increased significantly more in rats subjected to 24-h reperfusion than those subjected to 6-h reperfusion following 1-h ischemia, indicating functional kidney damage was more severe after the longer reperfusion time. These parameters were reduced by oral administration of Coptidis Rhizoma extract. Greater activity was found in rats given the extract for 30 days than in rats given the extract for 10 days prior to ischemia-reperfusion. In addition, the serum malondialdehyde level was lower, while the glutathione/glutathione disulfide ratio and the activities of the antioxidation enzymes, superoxide dismutase and catalase, were higher in rats given Coptidis Rhizoma extract orally for 30 consecutive days prior to 1-h ischemia and 24-h reperfusion in comparison with control rats given water. These results indicate that Coptidis Rhizoma has a protective action against the renal dysfunction caused by the ischemia and reperfusion process. Furthermore, renal DNA of rats given Coptidis Rhizoma extract orally showed a significantly lower DNA fragmentation rate, which was dose-dependent, implying that the extract afforded the kidneys protection against oxidative stress-mediated apoptosis during the process and ameliorated renal function impairment.
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Affiliation(s)
- E J Cho
- Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, Toyama 930-0194, Japan
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