Publications by authors named "Eun Jung Jun"

43 Publications

A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea.

J Korean Med Sci 2021 Apr 19;36(15):e108. Epub 2021 Apr 19.

Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan, Korea.

Background: Early identification of patients with coronavirus disease 2019 (COVID-19) who are at high risk of mortality is of vital importance for appropriate clinical decision making and delivering optimal treatment. We aimed to develop and validate a clinical risk score for predicting mortality at the time of admission of patients hospitalized with COVID-19.

Methods: Collaborating with the Korea Centers for Disease Control and Prevention (KCDC), we established a prospective consecutive cohort of 5,628 patients with confirmed COVID-19 infection who were admitted to 120 hospitals in Korea between January 20, 2020, and April 30, 2020. The cohort was randomly divided using a 7:3 ratio into a development (n = 3,940) and validation (n = 1,688) set. Clinical information and complete blood count (CBC) detected at admission were investigated using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-Mortality Score). The discriminative power of the risk model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curves.

Results: The incidence of mortality was 4.3% in both the development and validation set. A COVID-Mortality Score consisting of age, sex, body mass index, combined comorbidity, clinical symptoms, and CBC was developed. AUCs of the scoring system were 0.96 (95% confidence interval [CI], 0.85-0.91) and 0.97 (95% CI, 0.84-0.93) in the development and validation set, respectively. If the model was optimized for > 90% sensitivity, accuracies were 81.0% and 80.2% with sensitivities of 91.7% and 86.1% in the development and validation set, respectively. The optimized scoring system has been applied to the public online risk calculator (https://www.diseaseriskscore.com).

Conclusion: This clinically developed and validated COVID-Mortality Score, using clinical data available at the time of admission, will aid clinicians in predicting in-hospital mortality.
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http://dx.doi.org/10.3346/jkms.2021.36.e108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055508PMC
April 2021

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry.

Cardiol J 2021 Feb 26. Epub 2021 Feb 26.

Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.

Background: The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

Methods: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097-1140 days), and the primary endpoint was cardiac death at 3 years.

Results: The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and STEMI in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53-0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65-1.44, p = 0.884).

Conclusions: There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.
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http://dx.doi.org/10.5603/CJ.a2021.0008DOI Listing
February 2021

Drug-coated balloon treatment for nonsmall de-novo coronary artery disease: angiographic and clinical outcomes.

Coron Artery Dis 2021 Sep;32(6):534-540

Department of Cardiology, Ulsan Medical Center, Ulsan.

Objectives: Although drug-coated balloons (DCBs) are established for de-novo lesions in small coronary arteries, the impact of DCB treatment according to the reference vessel diameter (RVD) remains poorly defined. This study aimed to evaluate the angiographic and long-term clinical outcomes of DCB treatment for de-novo coronary lesions according to RVD.

Methods And Results: A total of 227 patients were retrospectively enrolled and stratified according to an RVD >2.5 mm [nonsmall vessel disease (NSVD) group, n = 100] and ≤2.5 mm [small vessel disease (SVD) group, n = 127]. The primary endpoint was late lumen loss (LLL) at a 6-month follow-up, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization and target vessel thrombosis). The LLL among the 206 patients (90.8%) returning for scheduled angiography at 6 month was similar (NSVD, 0.03 ± 0.22 mm vs. SVD, 0.06 ± 0.25 mm; P = 0.384). TVF was also comparable in both groups at a median follow-up of 3.4 years (NSVD, 7.0 vs. SVD, 7.9 %; P = 0.596). At baseline, there were numerically more dissections in the SVD group compared to the NSVD group (47.2 vs. 35.0 %; P = 0.064); however, most of these had disappeared in both groups at a 6-month follow-up. In a multivariable analysis, the presence of dissection was not associated with LLL or TVF in either group.

Conclusions: The safety and efficacy of DCB treatment for de-novo coronary lesions, in terms of LLL and TVF, was unrelated to RVD.
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http://dx.doi.org/10.1097/MCA.0000000000001006DOI Listing
September 2021

Impact of Dissection after Drug-Coated Balloon Treatment of De Novo Coronary Lesions: Angiographic and Clinical Outcomes.

Yonsei Med J 2020 Dec;61(12):1004-1012

Department of Cardiology, Peking University Shougang Hospital, Shijingshan District, Beijig, China.

Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions.

Materials And Methods: A total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) following DCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vessel thrombosis).

Results: The cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differences in LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, =0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, =0.799) at a median follow-up of 3.4 years. In a multivariate analysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completely healed, and there was no newly developed dissection at 6-month angiography.

Conclusion: The presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associated with an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).
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http://dx.doi.org/10.3349/ymj.2020.61.12.1004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700881PMC
December 2020

Septal Reduction Using Transvenous Intramyocardial Cerclage Radiofrequency Ablation: Preclinical Feasibility.

JACC Basic Transl Sci 2020 Oct 30;5(10):988-998. Epub 2020 Sep 30.

Cardiovascular Center, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Republic of Korea.

Debulking of left ventricular septal mass is typically accomplished using surgical myectomy, which is morbid, or using transcoronary alcohol septal ablation, which can result in geographic miss and occasional catastrophic nontarget coronary injury. The authors developed and tested operational parameters in vitro and vivo for a device to accomplish transvenous intraseptal radiofrequency ablation to reduce ventricular septal mass using a technique derived from mitral cerclage, which the authors call . Cerclage ablation appeared feasible in vitro and safe and effective in vivo. Cerclage ablation is an attractive new approach to debulk the interventricular septum in obstructive hypertrophic cardiomyopathy. These data support clinical investigation.
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http://dx.doi.org/10.1016/j.jacbts.2020.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591824PMC
October 2020

Provisional drug-coated balloon treatment guided by physiology on de novo coronary lesion.

Cardiol J 2021 13;28(4):615-622. Epub 2020 Aug 13.

Division of Cardiology, Department of Internal Medicine, Beijing University Shougang Hospital, Beijing, China.

Although drug-eluting stents (DES) have become the mainstay of percutaneous coronary intervention, late and very late stent thrombosis remains a concern. Drug-coated balloons (DCB) have the advantage of preserving the anti-restenotic benefits of DES while minimizing potential long-term safety concerns. Currently the two methods to ensure successful DCB treatment of a stenotic lesion are angiography or physiology-guided DCB application. This review will evaluate these two methods based on previous evidence and make suggestions on how to perform DCB treatment more efficiently and safely.
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http://dx.doi.org/10.5603/CJ.a2020.0105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276995PMC
August 2020

In Vivo Fluorescence Microendoscopic Monitoring of Stent-Induced Fibroblast Cell Proliferation in an Esophageal Mouse Model.

J Vasc Interv Radiol 2018 12 26;29(12):1756-1763. Epub 2018 Sep 26.

Department of Biomedical Engineering Research Center, and Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea. Electronic address:

Purpose: To evaluate the feasibility of self-expanding metal stent (SEMS) placement and fluorescence microendoscopic monitoring for determination of fibroblast cell proliferation after stent placement in an esophageal mouse model.

Materials And Methods: Twenty fibroblast-specific protein (FSP)-1 green fluorescent protein (GFP) transgenic mice were analyzed. Ten mice (Group A) underwent SEMS placement, and fluoroscopic and fluorescence microendoscopic images were obtained biweekly until 8 weeks thereafter. Ten healthy mice (Group B) were used for control esophageal values.

Results: SEMS placement was technically successful in all mice. The relative average number of fibroblast GFP cells and the intensities of GFP signals in Group A were significantly higher than in Group B after stent placement. The proliferative cellular response, including granulation tissue, epithelial layer, submucosal fibrosis, and connective tissue, was increased in Group A. FSP-1-positive cells were more prominent in Group A than in Group B.

Conclusions: SEMS placement was feasible and safe in an esophageal mouse model, and proliferative cellular response caused by fibroblast cell proliferation after stent placement was longitudinally monitored using a noninvasive fluorescence microendoscopic technique. The results have implications for the understanding of proliferative cellular response after stent placement in real-life patients and provide initial insights into new clinical therapeutic strategies for restenosis.
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http://dx.doi.org/10.1016/j.jvir.2018.06.024DOI Listing
December 2018

Analysis of trends and prospects regarding stents for human blood vessels.

Biomater Res 2018 13;22. Epub 2018 Mar 13.

3Korea Institute of Science and Technology Information, 66 Heogi-ro, 570 Dongdeamoon-gu, Seoul, 02456 Korea.

Background: The purpose of this paper is to provide technology trends and information regarding market and prospects in stents used for human blood vessels in Korea and the world.A stent is a medical device in the form of a cylindrical metal net used to normalize flow when blood or other bodily fluids such as biliary fluids are obstructed in blood vessels, gastrointestinal tracts, etc. by inserting the stent into a narrowed or clogged area. Stents are classified into vascular and non-vascular stents. The coronary artery stent is avascular stent that is used for coronary atherosclerosis.The demand is increasing for stents to treat diseases such as those affecting the heart and blood vessels of elderly and middle-aged patients. Due to the current shift in the demographic structure caused by an aging society, the prospect for stents seems to be very bright.The use of a stent designed to prevent acute vascular occlusion and restenosis, which is a side effect of conventional balloon angioplasty, has rapidly become popular because it can prevent acute complications and improve clinical outcomes. Since the initial release of this stent, there have been significant developments in its design, the most notable of which has been the introduction of drug-eluting stents (DES). Bioresorbable scaffolds (BRS) have the potential to introduce a paradigm shift in interventional cardiology, a true anatomical and functional "vascular restoration" instead of an artificial stiff tube encased by a persistent metallic foreign body.

Methods: Data for this research were gathered from primary and secondary sources as well as the databases of the Korea Institute of Science Technology Information (KISTI) located in Seoul, Korea like KISTI Market Report. The sources used for primary research included the databases available from the Korea Institute of Science Technology Information, past industry research services/studies, economic and demographic data, and trade and industry journals. Secondary research was used to supplement and complement the primary research. Interviews were conducted with physicians and surgeons from the key hospitals and senior sale/marketing managers from stent product suppliers in South Korea.

Results: The global stent market is estimated at US $ 7.98 billion in 2016 and is expected to grow at a Compound Annual Growth Rate (CAGR) of 3.8% over the next 5 years. As of 2016, the global market for vascular stents is estimated at $ 7.22 billion, with coronary artery stents accounting for 67.3% of the vascular stent market. Among the coronary artery stents, BRS is notably expected to grow at an annual average rate of 8.8% by 2020, but the global adoption rate of BRS remains low at present. In the Korean market, stents for blood vessels account for most of the market, and the market size of stents for blood vessels in Korea was estimated to be 145 billion won as of 2016.

Conclusions: In comparison to the sales growth rate of other medical devices, the future stent technology market is judged to be higher in growth potential.
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http://dx.doi.org/10.1186/s40824-018-0114-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851094PMC
March 2018

Radiation-induced esophageal strictures treated with fluoroscopic balloon dilation: clinical outcomes and factors influencing recurrence in 62 patients.

Acta Radiol 2018 Mar 2;59(3):313-321. Epub 2017 Jun 2.

5 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background Balloon dilation is safe and effective for the treatment of radiation-induced esophageal stricture (RIES), with favorable short-term and mid-term outcomes; however, few reports of long-term outcomes exist. Few studies have evaluated factors associated with recurrence after balloon dilation. Purpose To evaluate the long-term outcome of balloon dilation in patients with RIES and to identify factors associated with stricture recurrence. Material and Methods The medical records of 62 consecutive patients who had undergone fluoroscopic balloon dilation for RIES at our institution between December 1998 and June 2016 were reviewed. Results One hundred and twenty balloon dilation sessions were performed in 62 patients (mean = 1.9 sessions per patient). Clinical success was achieved in 53 (86%) patients after single (n = 37) or multiple (n = 16) dilation sessions. Complications occurred in 27% of the dilation sessions. The primary patency rates at one, two, three, and five years were 60%, 56%, 52%, and 52%, respectively. Secondary patency rates at one, two, three, and five years were 87%, 85%, 85%, and 80%, respectively. Multivariate logistic regression analysis identified an interval from radiation therapy (RT) to stricture of ≥6 months (hazard ratio [HR] = 0.205; P < 0.001), strictures located at the cervical esophagus (HR = 5.846; P < 0.001), and stricture length of ≥2 cm (HR = 2.923; P = 0.006) as significant predictors of recurrence. Conclusion Despite the high incidence of ruptures and recurrences, fluoroscopic balloon dilation is valuable as an initial therapeutic option for patients with RIES.
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http://dx.doi.org/10.1177/0284185117713351DOI Listing
March 2018

Evaluation of a New Esophageal Stent for the Treatment of Malignant and Benign Esophageal Strictures.

Cardiovasc Intervent Radiol 2017 Oct 17;40(10):1576-1585. Epub 2017 May 17.

Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.

Purpose: To evaluate the efficacy and safety of the EGIS esophageal stent for treating malignant and benign esophageal strictures.

Materials And Methods: Data of 73 patients (mean age 63.0 ± 11.9 years; 66 males) with malignant esophageal stricture and 16 patients (mean age 63.7 ± 9.5 years; 13 males) with benign esophageal stricture who received the EGIS esophageal stent (S&G Biotech, Seongnam, Korea) between October 2010 and April 2016 were obtained from a prospectively maintained electronic database.

Results: Technical and clinical success rates were 100% (89/89). Stent malfunction (i.e., tumor/tissue overgrowth, stent migration, and food impaction) occurred in 20.5% (15/73) and 37.5% (6/16) of patients with malignant and benign esophageal strictures, respectively. Stent migration occurred in five (6.8%) and four (25%) patients with malignant and benign esophageal strictures, respectively. The median follow-up durations in patients with malignant and benign esophageal strictures were 130 [interquartile range (IQR) 76-322] days and 486 (IQR 315-736) days, respectively. Recurrent dysphagia occurred in 14.1% (10/73) and 87.5% (14/16) of patients with malignant and benign esophageal strictures, respectively. The median recurrence-free durations in patients with malignant and benign esophageal strictures were 126 (IQR 69-259) days and 100 (IQR 40-182) days, respectively.

Conclusion: The EGIS esophageal stent appears to be effective for malignant esophageal strictures, with relatively low rate of stent migration, whereas, for benign esophageal strictures, it seems to be associated with a high rate of recurrent dysphagia, mainly due to stent migration.
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http://dx.doi.org/10.1007/s00270-017-1677-2DOI Listing
October 2017

Fluoroscopic Balloon Dilation for Treating Postoperative Nonanastomotic Strictures in the Proximal Small Bowel: A 15-Year Single-Institution Experience.

J Vasc Interv Radiol 2017 Aug 7;28(8):1141-1146. Epub 2017 Mar 7.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.

Purpose: To evaluate safety and effectiveness of fluoroscopic balloon dilation (FBD) for treating postoperative nonanastomotic strictures in proximal small bowel.

Materials And Methods: Data of 44 patients (26 men and 18 women; mean age, 53.7 y ± 13.0) treated with FBD for postoperative nonanastomotic strictures in the proximal small bowel between January 2000 and February 2016 were retrospectively reviewed. Site of stricture was located in the first portion of duodenum in 8 (18.2%) patients, second portion of duodenum in 8 (18.2%) patients, third portion of duodenum in 1 (2.3%) patient, fourth portion of duodenum in 1 (2.3%) patient, and proximal jejunum in 26 (59.1%) patients. Mean distance between the most anal-side lesion and the oral cavity was 63.9 cm ± 15.0.

Results: Technical success was achieved in 39 (88.6%) patients. Mean stricture length was 3.0 cm ± 1.8. Technical failure because of inability to negotiate the guide wire through the stricture occurred in 5 (13.6%) patients. Complete resolution of obstructive symptoms and resumption of oral intake of soft or solid food within 3 days occurred in 34 patients after 1 (n = 32) or 2 (n = 2) FBD sessions, rendering a clinical success rate of 87.2%. There were no major complications directly related to FBD. Median follow-up period was 1,406 days (interquartile range, 594-2,236 d). Nine (26.5%) patients had recurrence within a median 47 days (interquartile range, 20-212 d).

Conclusions: FBD may be safe and effective for treating postoperative nonanastomotic strictures in the proximal small bowel.
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http://dx.doi.org/10.1016/j.jvir.2017.01.003DOI Listing
August 2017

EW-7197, an activin-like kinase 5 inhibitor, suppresses granulation tissue after stent placement in rat esophagus.

Gastrointest Endosc 2017 Jul 27;86(1):219-228. Epub 2017 Jan 27.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background And Aims: Self-expanding metallic stent (SEMS) placement is a well-established method for treating malignant esophageal strictures; however, this procedure has not gained widespread acceptance for treating benign esophageal strictures because of granulation tissue formation. The aim of the present study was to investigate whether EW-7197, a novel per-oral transforming growth factor-β type I receptor kinase inhibitor, suppressed granulation tissue formation after SEMS placement in the rat esophagus.

Methods: Sixty rats underwent SEMS placement and were randomly divided into 4 groups. Group A (n = 20) received vehicle-treated control for 4 weeks. Group B (n = 20) received 20 mg/kg/day EW-7197 for 4 weeks. Group C (n = 10) received 20 mg/kg/day EW-7197 for 4 weeks followed by vehicle-treated control for 4 weeks. Group D (n = 10) received 20 mg/kg/day EW-7197 for 8 weeks.

Results: SEMS placement was technically successful in all rats. Eleven rats, however, were excluded because of stent migration (n = 9) and procedure-related death (n = 2). The luminal diameter in group A was significantly smaller than those in groups B, C, and D (all P < .001). The percentage of granulation tissue area, number of epithelial layers, thickness of submucosal fibrosis, percentage of connective tissue area, and degree of collagen deposition were significantly higher in group A than in groups B, C, and D (all P < .001); however, there were no significant differences among groups B, C, and D. EW-7197 decreased the expression levels of phospho-Smad 3, N-cadherin, fibronectin, α-smooth muscle actin, and transforming growth factor-β1 and increased the expression level of E-cadherin (all P < .01).

Conclusions: EW-7197 suppressed granulation tissue formation after SEMS placement in the rat esophagus.
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http://dx.doi.org/10.1016/j.gie.2017.01.013DOI Listing
July 2017

3D-printed phantom study for investigating stent abutment during gastroduodenal stent placement for gastric outlet obstruction.

3D Print Med 2017 25;3(1):10. Epub 2017 Sep 25.

4Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.

Background: Placing a self-expandable metallic stent (SEMS) is safe and effective for the palliative treatment of malignant gastroduodenal (GD) strictures. SEMS abutment in the duodenal wall is associated with increased food impaction, resulting in higher stent malfunction and shorter stent patency. The desire to evaluate the mechanism and significance of stent abutment led us to design an in vitro experiment using a flexible anthropomorphic three-dimensional (3D)-printed GD phantom model.

Results: A GD phantom was fabricated using 3D printer data after performing computed tomography gastrography. A partially covered (PC) or fully covered (FC) stent was placed so that its distal end abutted onto the duodenal wall in groups PC-1 and FC-1 or its distal end was sufficiently directed caudally in groups PC-2 and FC-2. The elapsed times of the inflowing of three diets (liquid, soft, and solid) were measured in the GD phantom under fluoroscopic guidance. There was no significant difference in the mean elapsed times for the liquid diet among the four groups. For the soft diet, the mean elapsed times in groups PC-1 and FC-1 were longer than those in groups PC-2 and FC-2 ( = 0.018 and  < 0.001, respectively). For the solid diet, the mean elapsed time in group PC-1 was longer than that in group PC-2 ( < 0.001). The solid diet could not pass in group FC-1 due to food impaction. The mean elapsed times were significantly longer in groups FC-1 and FC-2 than in groups PC-1 and PC-2 for soft and solid diets (all  < 0.001).

Conclusions: This flexible anthropomorphic 3D-printed GD phantom study revealed that stent abutment can cause prolonged passage of soft and solid diets through the stent as well as impaction of solid diets into the stent.
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http://dx.doi.org/10.1186/s41205-017-0017-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954787PMC
September 2017

Overlapping self-expandable metallic stent for palliation of a long (>10 cm) malignant gastroduodenal obstruction.

Acta Radiol 2017 May 30;58(5):565-572. Epub 2016 Sep 30.

3 Biomedical Engineering Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background Self-expandable metallic stent (SEMS) placement is a well-established palliative treatment approach for malignant gastroduodenal obstruction. In patients with a long (>10 cm) stricture, multiple stents placed in an overlapping fashion are often required. Purpose To investigate the outcomes of overlapping SEMS placement for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture. Material and Methods The medical records of 40 patients who underwent fluoroscopic overlapping SEMS placement for malignant gastroduodenal obstruction due to a long (>10 cm) stricture were reviewed. Results The technical and clinical success rates were 100% and 65.0%, respectively. The mean length of the stricture was 17.0 ± 4.7 cm and the mean number of stents placed in each patient was 2.2 ± 0.5. Metastatic cancer (odds ratio [OR], 0.315; P = 0.018), Eastern Cooperative Oncology Group (ECOG) score ≥3 (OR, 0.018; P = 0.006), and carcinomatosis with ascites (OR, 0.025; P = 0.017) were independent predictors of poor clinical success. The rates of minor and major complications were 27.5% and 2.5%, respectively. The median stent patency and survival were 33 days (interquartile range [IQR], 19-60 days) and 35 days (IQR, 19-73 days), respectively. An ECOG score ≥3 was an independent predictor of a poor survival outcome (hazard ratio, 4.681; P < 0.001). Conclusion Overlapping SEMS placement may be safe and effective for the palliative treatment of malignant gastroduodenal obstruction in patients with a long (>10 cm) stricture.
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http://dx.doi.org/10.1177/0284185116664228DOI Listing
May 2017

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system.

Eur Radiol 2017 Mar 21;27(3):1257-1266. Epub 2016 Jun 21.

Medical Imaging & Robotics Lab, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.

Objectives: To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success).

Methods: A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success.

Results: Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002).

Conclusions: Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique.

Key Points: • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.
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http://dx.doi.org/10.1007/s00330-016-4431-2DOI Listing
March 2017

Full-thickness esophageal perforation after fluoroscopic balloon dilation: incidence and management in 820 adult patients.

AJR Am J Roentgenol 2015 May;204(5):1115-9

1 Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.

Objective: The purpose of this study is to investigate the incidence, management, and outcomes of esophageal perforation after fluoroscopic balloon dilation in 820 adult patients with esophageal diseases.

Materials And Methods: Between December 1990 and April 2014, a total of 820 adult patients (age range, 21-93 years) underwent 1869 fluoroscopic balloon dilation sessions (mean, 2.3 sessions/patient; range, 1-29 sessions/patient) for esophageal diseases. We retrospectively reviewed the prospectively collected medical records and images of these patients and collected the data of patients who developed esophageal perforations after fluoroscopic balloon dilation.

Results: During this period, 12 patients (six men and six women; mean age, 51 years; age range, 28-69 years) developed perforations. The perforation rate was 1.5% per patient and 0.6% per dilation. Among the first eight patients, four who were treated with surgery had perforations 2 cm or larger, and the other four who underwent fasting, parenteral alimentation, and treatment with antibiotics had perforations smaller than 2 cm. The last four patients underwent stent placement immediately after the diagnosis, regardless of the perforation's size. The median hospital stay was 11.5 days.

Conclusion: Fluoroscopic balloon dilation of esophageal diseases is a safe procedure with a low perforation rate. A perforation size greater than 2 cm is considered large and requires aggressive treatment. Although the number of patients with esophageal perforation we treated is relatively small and further clinical trials are needed, temporary stent placement seems to be an initial choice in the management of esophageal perforations after fluoroscopic balloon dilation.
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http://dx.doi.org/10.2214/AJR.14.13614DOI Listing
May 2015

Concomitant therapy achieved the best eradication rate for Helicobacter pylori among various treatment strategies.

World J Gastroenterol 2015 Jan;21(1):351-9

Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.

Aim: To compare the Helicobacter pylori (H. pylori) eradication rate of clarithromycin-based triple therapy, metronidazole-based triple therapy, sequential therapy and concomitant therapy.

Methods: A total of 680 patients infected with H. pylori were divided into 4 groups and each group was treated with a different eradication therapy. Clarithromycin-based triple therapy was applied to the first group [rabeprazole, amoxicillin and clarithromycin (PAC) group: proton pump inhibitor (PPI), amoxicillin, clarithromycin], whereas the second group was treated with metronidazole-based triple therapy [rabeprazole, amoxicillin and metronidazole (PAM) group: PPI, amoxicillin, metronidazole]. The third group was treated with rabeprazole and amoxicillin, followed by rabeprazole, clarithromycin and metronidazole (sequential group). The final group was simultaneously treated with rabeprazole, amoxicillin clarithromycin and metronidazole (concomitant therapy group). In the case of a failure to eradicate H. pylori, second-line quadruple and third-line eradication therapies were administered.

Results: The per protocol (PP) analysis was performed on 143, 139, 141 and 143 patients in the PAC, PAM, sequential and concomitant groups, respectively. We excluded patients who did not receive a C(13)-urea breath test (22, 20, 23 and 22 patients, respectively) and patients with less than an 80% compliance level (5, 11, 6 and 5 patients, respectively). The eradication rates were 76.2% (109/143) in the PAC group, 84.2% (117/139) in the PAM group, 84.4% (119/141) in the sequential group and 94.4% (135/143) in the concomitant group (P = 0.0002). All 14 patients who failed second-line therapy were treated with third-line eradication therapy. Among these 14 patients, 6 infections were successfully eradicated with the third-line therapy. Both PP and intention-to-treat analysis showed an eradication rate of 42.9% (6/14). In the PAC group, 3 of 4 patients were successfully cured (3/4, 75%); 2 of 2 patients in the PAM group (2/2, 100%) and 1 of 5 patients in the sequential group (1/5, 20%) were also cured. In the concomitant group, all 3 patients failed (0/3, 0%).

Conclusion: The eradication rate for the concomitant therapy was much higher than those of the standard triple therapy or sequential therapy (ClinicalTrials.gov number NCT01922765).
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http://dx.doi.org/10.3748/wjg.v21.i1.351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284355PMC
January 2015

The Usefulness of a Novel Screening Kit for Colorectal Cancer Using the Immunochromatographic Fecal Tumor M2 Pyruvate Kinase Test.

Gut Liver 2015 Sep;9(5):641-8

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Background/aims: M2 pyruvate kinase (M2-PK) is an enzyme that is produced in undifferentiated and proliferating tissues. This study aims to evaluate the usefulness of the immunochromatographic M2 pyruvate kinase (iM2-PK) for the screening of colorectal cancer (CRC) and premalignant lesions.

Methods: Healthy volunteers and patients with colorectal neoplasia were enrolled in six academic hospitals in the capital province of Korea. The iM2-PK value was compared with the immunochromatographic fecal occult blood test (iFOBT) and fecal tumor M2-PK enzyme-linked immunosorbent assay (ELISA).

Results: A total of 323 subjects were enrolled. The sensitivity of iM2-PK for CRC was 92.8%, which was superior to iFOBT (47.5%, p<0.0001). For adenomatous lesions, the sensitivity of iM2-PK was 69.4%, which was also superior to iFOBT (12.1%, p<0.001). Compared with M2-PK ELISA, iM2-PK exhibited significantly enhanced sensitivity for CRC (97.5% vs 80.0%, p=0.0289). The sensitivity of iM2-PK was higher in advanced stages of CRC compared with cancers confined to the mucosa and submucosa (p<0.05). However, lymph node metastasis had no influence on the sensitivity of iM2-PK.

Conclusions: The iM2-PK exhibited increased sensitivity for identifying CRC and adenomatous lesions compared with iFOBT. Given its rapid results and convenience, CRC screening using iM2-PK is promising.
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http://dx.doi.org/10.5009/gnl13457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562782PMC
September 2015

Polydioxanone biodegradable stent placement in a canine urethral model: analysis of inflammatory reaction and biodegradation.

J Vasc Interv Radiol 2014 Aug 7;25(8):1257-1264.e1. Epub 2014 Jun 7.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.

Purpose: To investigate the inflammatory reaction and perform quantitative analysis of biodegradation after placement of a polydioxanone (PDO) biodegradable stent in a canine urethral model.

Materials And Methods: PDO biodegradable stents were placed in the proximal and distal urethra of nine male mongrel dogs. The dogs were euthanized 4 weeks (group A; n = 3), 8 weeks (group B; n = 3), or 12 weeks (group C; n = 3) after stent placement. The luminal diameter of the stent-implanted urethra was assessed by follow-up retrograde urethrography, and histologic findings were obtained after the dogs were killed. Stents were removed after euthanasia, and their surface morphology and molecular weight were evaluated. Hematologic examination was performed to evaluate inflammatory reaction.

Results: Stent placement was technically successful in all dogs. The average luminal diameter gradually decreased. The average number of epithelial layers (2.93 vs 4.42; P < .001), the average thickness of papillary projection (0.80 mm vs 1.28 mm; P < .001), and the average thickness of submucosal fibrosis (0.34 mm vs 0.49 mm ; P < .001) were significantly increased in group B versus group A. There were no significant differences between group B and group C. The average inflammatory cell infiltration did not differ significantly in the three groups. Molecular weight losses were 54% in group A and 84% in group B. In group C, PDO stents were completely decomposed.

Conclusions: An experimental study in a canine urethral model has demonstrated acceptable inflammatory reaction with gradually increasing granulation tissue but no luminal obstruction within 12 weeks.
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http://dx.doi.org/10.1016/j.jvir.2014.03.023DOI Listing
August 2014

Cataracts among adults aged 30 to 49 years: a 10-year study from 1995 to 2004 in Korea.

Korean J Ophthalmol 2013 Oct 10;27(5):345-50. Epub 2013 Sep 10.

Department of Ophthalmology and Visual Science, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Purpose: To investigate the long-term characteristics of cataracts among adults aged 30 to 49 years in Korean over a span of 10 years.

Methods: Subjects between the ages of 30 to 49 years who underwent cataract surgery at St. Mary's Hospital from 1995 to 2004 (n = 976) were included. Patients with a history of ocular trauma, uveitis, other ocular or systemic diseases, and congenital cataracts were excluded. Additional information including type of lens opacity, urban/rural region, and pre- and postoperative visual acuities were analyzed. Lens opacity grading was conducted using Lens Opacity Classification System III. The Cochran-Armitage proportion trend test was used to analyze vision changes with the passage of time.

Results: Among the patients who had undergone cataract surgeries, 8.8% (976 / 11,111) met the inclusion criteria. The mean age was 41.7 ± 5.45 years. Gender breakdown of the patient population included 79.0% male and 21.0% female. In terms of home environment, 60.9% were from an urban region and 39.1% from a rural region. Opacity type included anterior polar (AP), posterior subcapsular (PSC), AP and PSC, cortical, and nuclear in 35.7%, 35.1%, 7.0%, 6.0%, and 5.4% of patients, respectively. At a 2-month postoperative follow-up appointment, 92.7% of patients showed a best-corrected visual acuity of more than 20 / 40.

Conclusions: Predominance of AP and PSC opacities as well as male patients was observed in this study population.
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http://dx.doi.org/10.3341/kjo.2013.27.5.345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782580PMC
October 2013

Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance.

J Infect Dis 2013 Oct 24;208(7):1123-30. Epub 2013 Jun 24.

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul.

Background: Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.

Methods: A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.

Results: The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.

Conclusion: The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.

Clinical Trials Registration: NCT0145303.
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http://dx.doi.org/10.1093/infdis/jit287DOI Listing
October 2013

Antiviral protection against enterovirus 71 mediated by autophagy induction following FLICE-inhibitory protein inactivation.

Virus Res 2012 Oct 31;169(1):316-20. Epub 2012 Aug 31.

Department of Microbiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Even with the recent awareness of enterovirus 71 (EV71) as a major public health issue, there are no preventive or therapeutic agents that are effective against EV71 infection. Although FLICE-like inhibitory protein (FLIP) has been identified as a factor that modulates virus pathogenesis, there are no reports regarding its effects on EV71 infection. The aim of the present study was to identify whether FLIP influences EV71 pathogenesis and to understand the underlying mechanisms. Virus replication was markedly reduced in MRC5 cells preincubated with anti-FLIP peptides, and infected cells were rescued from the cytopathic effects of the virus. The anti-FLIP peptides induced autophagy by disrupting intrinsic FLIP functions. The antiviral activity of these peptides was reduced when autophagy was inhibited by treatment with siRNA targeted to beclin-1. Thus, the present study provides evidence that anti-FLIP peptides induce autophagy by inactivating cFLIP, and that this is associated with antiviral effects against EV71.
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http://dx.doi.org/10.1016/j.virusres.2012.08.016DOI Listing
October 2012

Corneal thickness measurement using Orbscan, Pentacam, Galilei, and ultrasound in normal and post-femtosecond laser in situ keratomileusis eyes.

Cornea 2012 Sep;31(9):978-82

Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Kyunggi-do, South Korea.

Purpose: To compare corneal pachymetry assessment using slit scanning imaging (Orbscan), rotating Scheimpflug imaging (Pentacam), dual Scheimpflug system (Galilei), and ultrasound pachymetry in normal and post-femtosecond (FS) laser in situ keratomileusis (LASIK) eyes.

Methods: Sixty eyes of 60 patients were enrolled for this study, which consisted of 30 unoperated eyes (normal corneas) and 30 eyes after FS-LASIK (post-LASIK corneas). Central corneal thickness was measured sequentially using Orbscan II, Pentacam, Galilei, and ultrasound pachymetry, and the average value of measurements obtained by the 4 different methods were compared in each group.

Results: In normal corneas, corneal thickness measurements were not different by all 4 methods [P = 0.202, 1-way analysis of variance (ANOVA)]. In post-LASIK corneas, the measurement was significantly different among those achieved by 4 methods (P < 0.001, 1-way ANOVA). Orbscan measurement was thinner than those yielded by Galilei, Pentacam, or ultrasound pachymetry with average of 47.7, 38.5, and 34.4 μm, respectively (all P values < 0.001, 1-way ANOVA and the Tukey multiple comparisons test) in post-LASIK corneas. Orbscan, Pentacam, and Galilei measurements showed good agreement with ultrasound pachymetry data in both groups, except Orbscan data in post-LASIK corneas showed a statistically significant difference from ultrasound pachymetry measurements (P value = 0.001, 1-way ANOVA and the Tukey multiple comparisons test).

Conclusions: Any of central corneal thicknesses obtained by all 4 measurement modalities might be acceptable before refractive surgery. However, in post-FS-LASIK eyes, measurements using Orbscan were thinner than those obtained with other modalities; in contrast, those with Pentacam or Galilei were comparable with ultrasound pachymetry.
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http://dx.doi.org/10.1097/ICO.0b013e31823d03fcDOI Listing
September 2012

Antiviral effects of small interfering RNA simultaneously inducing RNA interference and type 1 interferon in coxsackievirus myocarditis.

Antimicrob Agents Chemother 2012 Jul 16;56(7):3516-23. Epub 2012 Apr 16.

Department of Microbiology, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Antiviral therapeutics are currently unavailable for treatment of coxsackievirus B3, which can cause life-threatening myocarditis. A modified small interfering RNA (siRNA) containing 5'-triphosphate, 3p-siRNA, was shown to induce RNA interference and interferon activation. We aimed to develop a potent antiviral treatment using CVB3-specific 3p-siRNA and to understand its underlying mechanisms. Virus-specific 3p-siRNA was superior to both conventional virus-specific siRNA with an empty hydroxyl group at the 5' end (OH-siRNA) and nonspecific 3p-siRNA in decreasing viral replication and subsequent cytotoxicity. A single administration of 3p-siRNA dramatically attenuated virus-associated pathological symptoms in mice with no signs of toxicity, and their body weights eventually reached the normal range. Myocardial inflammation and fibrosis were rare, and virus production was greatly reduced. A nonspecific 3p-siRNA showed relatively less protective effect under identical conditions, and a virus-specific OH-siRNA showed no protective effects. We confirmed that virus-specific 3p-siRNA simultaneously activated target-specific gene silencing and type I interferon signaling. We provide a clear proof of concept that coxsackievirus B3-specific 3p-siRNA has 2 distinct modes of action, which significantly enhance antiviral activities with minimal organ damage. This is the first direct demonstration of improved antiviral effects with an immunostimulatory virus-specific siRNA in coxsackievirus myocarditis, and this method could be applied to many virus-related diseases.
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http://dx.doi.org/10.1128/AAC.06050-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393429PMC
July 2012

Melanosis ilei induced by prolonged charcoal ingestion.

J Korean Surg Soc 2011 Jul 11;81(1):66-9. Epub 2011 Jul 11.

Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.

Gastrointestinal melanosis is observed most frequently in the colon it also can develop in the ileum, duodenum and esophagus very rarely. Melanosis ilei was thought that causative materials such as aluminum, magnesium, silicate, titanium and other compounds entered the body through the ingestion of agents. We experienced a case of melanosis in the terminal ileum that a 65-year-old female patient ingested 10 g edible charcoal everyday for 3 years to address symptoms of chronic abdominal pain. In Korea, edible charcoal has been considered to be an effective folk remedy for patients with diarrhea or chronic abdominal pain. In our case, a follow up colonoscopy was performed 3.5 years after the termination of the ingestion of edible charcoal, at which point pigmentation was faded color intensity. In conclusion, it is thought that melanosis ilei is a rare disease by ingestion of causative materials and is discontinuous, local and reversible disease.
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http://dx.doi.org/10.4174/jkss.2011.81.1.66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204554PMC
July 2011

Characterization of infections of human leukocytes by non-polio enteroviruses.

Intervirology 2012 3;55(5):333-41. Epub 2011 Nov 3.

Department of Internal Medicine, Asan Medical Center, Seoul, Korea.

To elucidate the detailed susceptibilities of leukocytes to clinically important non-polio enteroviruses (EVs), primary monocytes and various human leukocyte cell lines were infected with coxsackievirus A24 (CVA24), coxsackievirus B3 (CVB3), and enterovirus 70 (EV70). The permissiveness was then assessed by determining virus replication and resultant cytopathic effects. Different EVs varied markedly in their ability to infect leukocyte cell lines. CVB3 replicated effectively in leukocytes of B-cell, T-cell, and monocyte origin, CVA24 in leukocytes of B-cell and monocyte origin, and EV70 in leukocytes of monocyte origin. Primary monocytes, as well as monocyte-derived U-937 cells, were permissive to all three EVs. We observed a positive correlation between cytotoxicity and active virus replication, except in CVB3-infected monocytes. U-937 cells efficiently generated CVB3 progeny virus without severe cellular damage, including cell death. Moreover, infectivity on leukocytes was not absolutely associated with the availability of viral receptors. These findings suggest that the susceptibility of human leukocytes to non-polio EVs may be responsible for virus transport during the viremic phase, particularly to secondary target organs, and that active replication of CVB3 in all human leukocyte lineages leads to greater dissemination, in agreement with the ability of CVB to cause systemic diseases.
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http://dx.doi.org/10.1159/000329987DOI Listing
September 2012
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