Publications by authors named "Gi Beom Kim"

194 Publications

Does the degree of intraoperatively identified cartilage loss affect the outcomes of primary total knee arthroplasty without patella resurfacing? A prospective comparative cohort study.

Knee Surg Relat Res 2022 Jul 18;34(1):36. Epub 2022 Jul 18.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Hyeonchungno 170, Nam-gu, Daegu, 42415, Republic of Korea.

Purpose: The aim of this study was to investigate whether the degree of patellar cartilage loss confirmed during index surgery affects the clinical and radiologic outcomes of total knee arthroplasty (TKA) performed without patellar resurfacing.

Methods: We prospectively divided 2012 patients with a minimum follow-up of 12 months into two groups according to intraoperatively graded cartilage lesions graded using the International Cartilage Repair Society (ICRS) system: group 1, grades 0‒2 (n = 110); group 2, grades 3‒4 (n = 102). Relevant locations, such as medial, lateral, or both facets of the patella, were also assessed. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, Feller's patella score, and Kujala anterior knee pain score. Radiographic outcomes included patellar tilt angle and lateral patellar shift on Merchant's view.

Results: Clinical and radiographic outcomes were not significantly different between the two groups. No patient underwent secondary patellar resurfacing. Although the lateral facet was significantly more involved, there were no significant differences in outcomes.

Conclusions: The degree of intraoperatively identified patellar cartilage loss did not affect the short-term outcomes following primary TKA without patellar resurfacing. Level of evidence II: Prospective comparative study.
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http://dx.doi.org/10.1186/s43019-022-00161-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290225PMC
July 2022

Bone Hook Reduction Technique Combined with Lateral Parapatellar Arthrotomy for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty: A Technical Note.

Orthop Surg 2022 Aug 22;14(8):1902-1906. Epub 2022 Jun 22.

Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea.

Objective: To report a bone hook reduction technique combined with lateral parapatellar arthrotomy for periprosthetic distal femoral fractures following total knee arthroplasty (TKA).

Methods: From April 2012 to June 2018, a total of 31 knees who underwent this technique for the treatment of periprosthetic distal femoral fractures following TKA were retrospectively reviewed. Through a lateral parapatellar arthrotomy, the vastus lateralis fascia was dissected from the muscle belly to allow anteromedial mobilization of the muscles. With direct visualization of the posteriorly angulated distal fragment, a bone hook was placed on the anterior flange of the femoral component. The hook was then elevated to correct the posteriorly angulated and shortened distal fragment. The coronal and sagittal alignments of the distal segment with the femoral shaft were confirmed using fluoroscopic images, and internal fixation was performed using an anatomically pre-contoured lateral locked plate. Once the overall length and sagittal plane alignment were restored, the plate was inserted via the previous articular approach. The plate was centered on the femur using anteroposterior and lateral fluoroscopy and then fixed.

Results: A total of 28 patients underwent internal fixation using the bone hook reduction technique combined with lateral parapatellar arthrotomy for the treatment of periprosthetic distal femoral fractures following TKA. The average age at operation was 70.9 years (range, 62-83 years), and the average follow-up period was 17.5 months (range, 12-48.5 months). Fractures were classified as Su type I (13/28 [46.4%]), type II (11/28 [39.3%]), and type III (4/28 [14.3%]). Bone union was confirmed radiographically in all patients.

Conclusion: The bone hook reduction technique is a simple and effective method to reduce the distal fragment in periprosthetic distal femoral fractures following TKA.
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http://dx.doi.org/10.1111/os.13349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363775PMC
August 2022

A Multivalent Vaccine Based on Ferritin Nanocage Elicits Potent Protective Immune Responses against SARS-CoV-2 Mutations.

Int J Mol Sci 2022 May 30;23(11). Epub 2022 May 30.

Department of Chemical Engineering, Kyungpook National University, Daegu 41566, Korea.

The SARS-CoV-2 pandemic has created a global public crisis and heavily affected personal lives, healthcare systems, and global economies. Virus variants are continuously emerging, and, thus, the pandemic has been ongoing for over two years. Vaccines were rapidly developed based on the original SARS-CoV-2 (Wuhan-Hu-1) to build immunity against the coronavirus disease. However, they had a very low effect on the virus' variants due to their low cross-reactivity. In this study, a multivalent SARS-CoV-2 vaccine was developed using ferritin nanocages, which display the spike protein from the Wuhan-Hu-1, B.1.351, or B.1.429 SARS-CoV-2 on their surfaces. We show that the mixture of three SARS-CoV-2 spike-protein-displaying nanocages elicits CD4 and CD8 T cells and B-cell immunity successfully in vivo. Furthermore, they generate a more consistent antibody response against the B.1.351 and B.1.429 variants than a monovalent vaccine. This leads us to believe that the proposed ferritin-nanocage-based multivalent vaccine platform will provide strong protection against emerging SARS-CoV-2 variants of concern (VOCs).
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http://dx.doi.org/10.3390/ijms23116123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181758PMC
May 2022

Development of convolutional neural network model for diagnosing meniscus tear using magnetic resonance image.

BMC Musculoskelet Disord 2022 May 30;23(1):510. Epub 2022 May 30.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 42415, Republic of Korea.

Background: Deep learning (DL) is an advanced machine learning approach used in diverse areas, such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is advantageous for image recognition and classification. In this study, we aimed to develop a CNN to detect meniscal tears and classify tear types using coronal and sagittal magnetic resonance (MR) images of each patient.

Methods: We retrospectively collected 599 cases (medial meniscus tear = 384, lateral meniscus tear = 167, and medial and lateral meniscus tear = 48) of knee MR images from patients with meniscal tears and 449 cases of knee MR images from patients without meniscal tears. To develop the DL model for evaluating the presence of meniscal tears, all the collected knee MR images of 1048 cases were used. To develop the DL model for evaluating the type of meniscal tear, 538 cases with meniscal tears (horizontal tear = 268, complex tear = 147, radial tear = 48, and longitudinal tear = 75) and 449 cases without meniscal tears were used. Additionally, a CNN algorithm was used. To measure the model's performance, 70% of the included data were randomly assigned to the training set, and the remaining 30% were assigned to the test set.

Results: The area under the curves (AUCs) of our model were 0.889, 0.817, and 0.924 for medial meniscal tears, lateral meniscal tears, and medial and lateral meniscal tears, respectively. The AUCs of the horizontal, complex, radial, and longitudinal tears were 0.761, 0.850, 0.601, and 0.858, respectively.

Conclusion: Our study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears.
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http://dx.doi.org/10.1186/s12891-022-05468-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9150332PMC
May 2022

Intra-articular Calcaneal Fracture Treatment With Staged Medial External Fixation.

Foot Ankle Int 2022 Aug 19;43(8):1084-1091. Epub 2022 May 19.

Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.

Background: To compare the clinical and radiographic outcomes between the conventional delayed and staged approaches for intra-articular calcaneus fractures in which early definite fixation could not be performed because of severe soft tissue injury.

Methods: From January 2015 to May 2019, a total of 32 cases with acute intra-articular calcaneal fractures met criteria and were enrolled in the study. We compared the outcomes of intra-articular calcaneal fractures that underwent delayed internal fixation between groups treated with a conventional delayed approach (non-EF group) vs a temporary medial external fixation (EF group). Clinical outcome measures included a 10-point visual analog scale score, the AOFAS score, and the Foot Function Index. Radiographic outcome measures included Böhler angle, talar declination angle, and calcaneal width. Reduction of the posterior facet was assessed on CT scans.

Results: The first 15 (46.9%) were treated with a conventional delayed approach, and the latter 17 (53.1%) were treated with a staged approach with temporary medial external fixation. Clinical outcomes were not different between the groups at the last follow-up. The time from injury to definite internal fixation was shorter by an average of 3.8 days in the EF group ( = .001). The Böhler angle, talar declination angle, and calcaneal width were not different between the groups before surgery and at the last follow-up. Reduction of the posterior facet on CT scans was significantly better in the EF group than in the non-EF group (good/excellent = 94% vs 60%, respectively, = .033).

Conclusion: The staged approach using medial external fixation for displaced intra-articular calcaneus fractures could be an effective method to decrease the time to definitive internal fixation and obtain optimal reduction of the posterior facet.

Level Of Evidence: Level III, retrospective case-control study.
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http://dx.doi.org/10.1177/10711007221092761DOI Listing
August 2022

The effects of ammonia acclimation on biogas recovery and the microbial population in continuous anaerobic digestion of swine manure.

Environ Res 2022 09 16;212(Pt D):113483. Epub 2022 May 16.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

This study investigated the ammonia toxicity and the acclimation of anaerobic microbiome in continuous anaerobic digestion of swine manure using unacclimated inoculum. When the total ammonia nitrogen concentration (TAN) reached 2.5 g N/L, the methane yield decreased from 254.1 ± 9.6 to 154.6 ± 9.9 mL/g COD. The free ammonia nitrogen concentration of the inhibited condition was 190 mg N/L. The methane yield was eventually recovered as 269.6 ± 3.6 mL/g COD with a further operation. Anaerobic toxicity assay (ATA) showed that mixed liquor from the recovered phase possessed enhanced tolerance to ammonia, not only within the exposed level in continuous operation (<2.5 g NH/L) but also over the range (>2.5 g NH/L). Microbial analysis revealed that continuous operation under ammonia stress resulted in the change of both bacterial and archaeal populations. The ammonia adaptation was concurrent with the archaeal population shift from Methanosaeta to Methanosarcina and Methanobacterium. The dominancy of Clostridia in bacterial population was found in the recovered phase. It is highly recommended to use an inoculum acclimated to a target ammonia level which can be pre-checked by ATA and to secure a start-up period for ammonia adaptation in the field application of anaerobic digestion for swine manure.
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http://dx.doi.org/10.1016/j.envres.2022.113483DOI Listing
September 2022

Long-term Outcome of Fontan-Associated Protein-Losing Enteropathy: Treatment Modality and Predictive Factor of Mortality.

Korean Circ J 2022 Aug 16;52(8):606-620. Epub 2022 Mar 16.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

Background And Objectives: Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE.

Methods: We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea.

Results: PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6 years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (<90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1).

Conclusions: The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.
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http://dx.doi.org/10.4070/kcj.2021.0309DOI Listing
August 2022

Biohydrogen and biomethane production from food waste using a two-stage dynamic membrane bioreactor (DMBR) system.

Bioresour Technol 2022 May 30;352:127094. Epub 2022 Mar 30.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

This study examined a two-stage dynamic membrane bioreactor (DMBR) system for biohydrogen and biomethane production from food waste (FW) in mesophilic condition. The two-stage DMBR system enabled high-rate H and CH production from particulate feedstock by enhanced microorganism retention. Chemical energy in FW was recovered up to 79% as renewable energy. The highest average hydrogen production rate of 7.09 ± 0.42 L/L-d was observed at a hydraulic retention time (HRT) of 8 h in the H-DMBR, while the highest CH average production rate of 0.99 ± 0.02 L/L-d was observed at an HRT of 6 d in the CH-DMBR. The high specific methanogenic activity of 71.7 mL CH/g VSS-d was maintained at the short HRT, which also contributed to the high MPR. The genus Clostridium was dominant in the H-DMBR, while bacterial and archaeal populations in the CH-DMBR were dominated by the class Clostridia and genera Methanobacterium and Methanosaeta, respectively.
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http://dx.doi.org/10.1016/j.biortech.2022.127094DOI Listing
May 2022

The Design of the Patellar Component Does Not Affect the Patient-Reported Outcome Measures in Primary Posterior-Stabilized Total Knee Arthroplasty: A Randomized Prospective Study.

J Clin Med 2022 Mar 2;11(5). Epub 2022 Mar 2.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyonchung-ro, Namgu, Daegu 42415, Korea.

This randomized comparative study was conducted to investigate the outcomes of patellar resurfacing with a medialized dome or an anatomical type in patients receiving primary unilateral posterior-stabilized TKA. Between March 2019 and January 2021, 98 knees were randomly assigned to receive patellar resurfacing by a medialized dome type (group D, 49 knees) or an anatomic type (group A, 49 knees). The primary outcome was the Knee Injury and Osteoarthritis Outcome Score. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index, Feller's patella score, the Kujala anterior knee pain score, knee joint range of motion (ROM), and postoperative complications, including periprosthetic patellar fracture, patellar tilt angle, and lateral patellar shift. Patient-reported outcomes were not significantly different between the two groups. The ROM of the knee joint was significantly better in group A at six months after surgery ( = 0.021). No complications such as patellar fractures were observed. The anatomic type of patellar component showed a significant improvement of the patellar tilt angle after surgery compared with the medialized dome type of component. However, there were no significant differences in patient-reported clinical outcomes between the two groups during the follow-up period of 12 months.
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http://dx.doi.org/10.3390/jcm11051363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910848PMC
March 2022

A novel open synovectomy technique using an arthroscopy shaver blade in revision surgery to treat infected total knee arthroplasty: a technical note.

J Orthop Surg Res 2022 Mar 3;17(1):132. Epub 2022 Mar 3.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro Nam-gu, Daegu, 42415, Republic of Korea.

Background: This article introduces a novel open synovectomy technique using an arthroscopy shaver blade to effectively remove intra-articular synovitis during revision surgery for infected primary total knee arthroplasty.

Methods (techniques): Open synovectomy is performed using a 4.2-mm arthroscopy shaver blade, and the handpiece is connected to suction drainage. Suction is supplied through the central cylinder of the shaver blade to bring the debrided fragments of soft tissue into the window. Grossly inflamed, reddened, diseased synovium is debrided to reveal yellowish, healthy synovium. The inflamed tissues of the knee joint (suprapatellar pouch, medial and lateral gutters, and peripatellar area) are debrided. Then, with maintaining full flexion of the knee joint, a shaver equipped with a longer bar can be used to easily access the medial and lateral posterior compartments, which are generally difficult to access.

Results: During a mean of 13.5-month follow-up, there was no recurrent infection in either group; however, patients who underwent the novel technique improved significantly faster in terms of acute serological markers during the first period.

Conclusions: This technique yielded favorable outcomes compared with the conventional technique. In particular, it may facilitate the approach to the posterior joint space, which is difficult to access.
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http://dx.doi.org/10.1186/s13018-022-03024-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8895592PMC
March 2022

Implication of microRNA as a potential biomarker of myocarditis.

Clin Exp Pediatr 2022 May 2;65(5):230-238. Epub 2022 Mar 2.

Department of Transdisciplinary Research and Collaboration, Genomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.

Myocarditis was previously attributed to an epidemic viral infection. Additional harmful reagents, in addition to viruses, play a role in its etiology. Coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis has recently been described, drawing attention to vaccine-induced myocarditis in children and adolescents. Its pathology is based on a series of complex immune responses, including initial innate immune responses in response to viral entry, adaptive immune responses leading to the development of antigen-specific antibodies, and autoimmune responses to cellular injury caused by cardiomyocyte rupture that releases antigens. Chronic inflammation and fibrosis in the myocardium eventually result in cardiac failure. Recent advancements in molecular biology have remarkably increased our understanding of myocarditis. In particular, microRNAs (miRNAs) are a hot topic in terms of the role of new biomarkers and the pathophysiology of myocarditis. Myocarditis has been linked with microRNA-221/222 (miR-221/222), miR-155, miR-10a*, and miR-590. Despite the lack of clinical trials of miRNA intervention in myocarditis yet, multiple clinical trials of miRNAs in other cardiac diseases have been aggressively conducted to help pave the way for future research, which is bolstered by the success of recently U.S. Food and Drug Administration-approved small-RNA medications. This review presents basic information and recent research that focuses on myocarditis and related miRNAs as a potential novel biomarker and the therapeutics.
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http://dx.doi.org/10.3345/cep.2021.01802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082251PMC
May 2022

New Classification for Periprosthetic Distal Femoral Fractures Based on Locked-Plate Fixation Following Total Knee Arthroplasty: A Multicenter Study.

J Arthroplasty 2022 05 2;37(5):966-973. Epub 2022 Feb 2.

Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.

Background: This study aimed to establish a new classification using locked-plate fixation for periprosthetic distal femoral fracture (PDFF) following total knee arthroplasty (TKA) and to determine when dual locked-plate fixation is necessary through defining this classification.

Methods: One-hundred fifteen consecutive PDFFs that underwent operative treatment were reviewed from 2011 to 2019 with minimum 1-year follow-up. Most PDFFs were fixed with single or dual locked-plate fixations using the minimally invasive plate osteosynthesis technique. Based on preoperative radiographs, PDFFs were classified according to the level of main fracture line relative to the anterior flange of femoral component: type I and II, main fracture line located proximal and distal to the anterior flange; and type III, component instability regardless of fracture line requiring revisional TKA. Furthermore, type II fractures were subclassified based on the direction of fracture beak as follows: type II, lateral-beak; type II, medial-beak. The incidence, treatment methods, and complications were analyzed according to the classification.

Results: Incidences of type I, II, II, and III were 64.4%, 8.7%, 24.3%, and 2.6%, respectively. Meanwhile, most PDFFs in type I and II were treated with lateral single locked-plate fixations, except for type II, which was treated with either single or dual locked-plate fixations. Overall complications were significantly higher in type II (28.9%) than in type I (10.8%, P = .019). In type II, bone union-related complications were significantly higher in single locked-plate fixation (50.0%) than in dual locked-plate fixation (5.6%; P = .013).

Conclusion: The new classification provides practical and obvious strategies for the treatment of PDFF following TKA using locked-plate fixation. For type II fracture, dual plate fixation is necessary to prevent fixation failure or nonunion.
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http://dx.doi.org/10.1016/j.arth.2022.01.078DOI Listing
May 2022

Identification of rare coding variants associated with Kawasaki disease by whole exome sequencing.

Genomics Inform 2021 Dec 31;19(4):e38. Epub 2021 Dec 31.

Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Kawasaki disease (KD) is an acute pediatric vasculitis that affects genetically susceptible infants and children. To identify coding variants that influence susceptibility to KD, we conducted whole exome sequencing of 159 patients with KD and 902 controls, and performed a replication study in an independent 586 cases and 732 controls. We identified five rare coding variants in five genes (FCRLA, PTGER4, IL17F, CARD11, and SIGLEC10) associated with KD (odds ratio [OR], 1.18 to 4.41; p = 0.0027-0.031). We also performed association analysis in 26 KD patients with coronary artery aneurysms (CAAs; diameter > 5 mm) and 124 patients without CAAs (diameter < 3 mm), and identified another five rare coding variants in five genes (FGFR4, IL31RA, FNDC1, MMP8, and FOXN1), which may be associated with CAA (OR, 3.89 to 37.3; p = 0.0058-0.0261). These results provide insights into new candidate genes and genetic variants potentially involved in the development of KD and CAA.
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http://dx.doi.org/10.5808/gi.21046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752980PMC
December 2021

Sludge disintegration and anaerobic digestion enhancement by alkaline-thermal pretreatment: Economic evaluation and microbial population analysis.

Bioresour Technol 2022 Feb 22;346:126594. Epub 2021 Dec 22.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

Alkaline-thermal pretreatment was examined for waste activated sludge (WAS) disintegration and subsequent anaerobic digestion (AD). Pretreatment at 60 °C was estimated to provide better economic benefits than higher temperature conditions. The maximum methane yield of 215.6 mL/g COD was achieved when WAS was pretreated at 60 °C and pH 10 for 24 h, which was 46.6% higher than untreated WAS. The pretreatment condition also provided the maximum net savings. The degree of sludge disintegration, considering both loosely bound-extracellular polymeric substance and soluble COD, would be a better indicator to predict anaerobic digestibility than the solubilization rate that considers soluble COD alone. Microbial analysis implied that pretreatment facilitated the growth of hydrolytic bacteria, phyla Bacteroidetes and Firmicutes. In addition, sludge pretreatment enhanced the growth of both acetoclastic and hydrogenotrophic methanogens, genera Methanosaeta and Methanobacterium. The mild AT-PT would be useful to enhance the digestion performance and economic benefit of WAS digestion.
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http://dx.doi.org/10.1016/j.biortech.2021.126594DOI Listing
February 2022

Relationship between life-threatening events and electromechanical window in patients with hypertrophic cardiomyopathy: A novel parameter for risk stratification of sudden cardiac death.

Heart Rhythm 2022 04 18;19(4):588-594. Epub 2021 Dec 18.

Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea. Electronic address:

Background: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young individuals, largely due to ventricular arrhythmias, which may be associated with electrical disturbances from pathologic myocardial changes.

Objectives: The purpose of this study was to investigate electromechanical mismatches in patients with HCM and the relationship between electromechanical mismatches and life-threatening events (LTEs).

Methods: We performed a retrospective review of patients (age 1-80 years) diagnosed with HCM. Electromechanical mismatch was evaluated using the electromechanical window (EMW), defined as the interval between the Q wave and aortic valve closure minus the QT interval.

Results: We enrolled 458 patients (mean age 52.4 ± 18.8 years). When the EMW of patients with HCM was compared to that of age-/sex-matched normal controls, EMW was more negative in patients with HCM than in normal controls (-51 ± 35 ms vs 7 ± 19 ms; P <.001). LTEs occurred in 25 patients (5.5%). EMW was more negative in patients with LTEs than in those without (-77 ± 33 ms vs -42 ± 31 ms; P <.001). The cutoff value of EMW to identify patients with LTEs was -54 ms, and the c-index of EMW was 0.726. EMW less than -54 ms, unexplained syncope, pediatric onset, and extreme left ventricular hypertrophy were significant risk factors for LTEs on multivariate analysis.

Conclusion: EMW was more negative in patients with HCM than in healthy individuals, and profound EMW negativity was an independent risk factor for LTEs. EMW can be useful for risk stratification of SCD in patients with HCM.
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http://dx.doi.org/10.1016/j.hrthm.2021.12.016DOI Listing
April 2022

Biofilm formation as a method of improved treatment during anaerobic digestion of organic matter for biogas recovery.

Bioresour Technol 2022 Jan 16;344(Pt B):126309. Epub 2021 Nov 16.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

The efficiency of anaerobic digestion could be increased by promoting microbial retention through biofilm development. The inclusion of certain types of biofilm carriers has differentiated existing AD biofilm reactors through their respective mode of biofilm growth. Bacteria and archaea engaged in methanogenesis during anaerobic processes potentially build biofilms by adhering or attaching to biofilm carriers. Meta-analyzed results depicted varying degrees of biogas enhancement within AD biofilm reactors. Furthermore, different carrier materials highly induced the dynamicity of the dominant microbial population in each system. It is suggested that the promotion of surface contact and improvement of interspecies electron transport have greatly impacted the treatment results. Modern spectroscopy techniques have been and will continue to give essential information regarding biofilm's composition and structural organization which can be useful in elucidating the added function of this special layer of microbial cells.
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http://dx.doi.org/10.1016/j.biortech.2021.126309DOI Listing
January 2022

The Waiting List Mortality of Pediatric Heart Transplantation Candidates in Korea before the Pediatric Ventricular Assist Device Era.

J Korean Med Sci 2021 Nov 15;36(44):e283. Epub 2021 Nov 15.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Despite advancements in heart transplantation for pediatric patients in Korea, the waiting list mortality has not been reported. Therefore, we investigated the waiting list mortality rate and factors associated with patient mortality.

Methods: We reviewed the medical records of pediatric patients who were registered for heart transplantation at three major hospitals in Korea from January 2000 to January 2020. All patients who died while waiting for heart transplantation were investigated, and we identified the waiting list mortality rate, causes of mortality and median survival periods depending on the variable risk factors.

Results: A total of 145 patients received heart transplantations at the three institutions we surveyed, and the waiting list mortality rate was 26%. The most common underlying diseases were cardiomyopathy (66.7%) and congenital heart disease (30.3%). The leading causes that contributed to death were heart failure (36.3%), multi-organ failure (27.2%), and complications associated with extracorporeal membrane oxygenation (ECMO) (25.7%). The median survival period was 63 days. ECMO was applied in 30 patients. The different waiting list mortality percentages according to age, cardiac diagnosis, use of ECMO, and initial Korean Network of Organ Sharing (KONOS) level were determined using univariate analysis, but age was the only significant factor associated with waiting list mortality based on a multivariate analysis.

Conclusion: The waiting list mortality of pediatric heart transplantation candidates was confirmed to be considerably high, and age, underlying disease, the application of ECMO, and the initial KONOS level were the factors that influenced the survival period.
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http://dx.doi.org/10.3346/jkms.2021.36.e283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593407PMC
November 2021

Association between the Use of Diuretics and Size Reduction in Pediatric Atrial Septal Defect.

Korean Circ J 2021 Dec 31;51(12):1017-1029. Epub 2021 Aug 31.

Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea.

Background And Objectives: While diuretics are sometimes used in atrial septal defect (ASD) treatment, their effect on ASD size reduction remains unclear. We aimed to evaluate the efficacy of diuretics in ASD size reduction in pediatric patients.

Methods: We retrospectively reviewed the medical records of patients with secundum ASD (size ≥10 mm), between 2005 and 2019. Patients were divided into two groups based on the diuretic administration.

Results: Of the 73 enrolled patients, 40 received diuretics. The initial age at ASD diagnosis (2.8±1.7 vs. 2.5±2.0 years, p=0.526) and follow-up duration (22.3±11.4 vs. 18.7±13.2 months, p=0.224) were not significantly different between the groups. The ASD diameter at the initial diagnosis (13.7±2.0 vs. 13.5±3.4 mm, p=0.761) and the indexed ASD diameter (25.5±5.9 vs. 26.9±10.3 mm/m², p=0.493) were also not significantly different between two groups. The ASD diameter significantly increased in the non-diuretic group during follow-up (0.0±2.9 vs. +2.6±2.0 mm, p<0.001). The indexed ASD diameter significantly decreased in the diuretic group during follow-up (-5.7±6.5 vs. +0.2±3.9 mm/m², p<0.001). In the linear mixed model analysis, diuretic use was associated with ASD diameter decrease (p<0.001) and indexed ASD diameter reduction (p<0.001) over time. Device closure was more frequently performed in the diuretic (75.0%) than in the non-diuretic group (39.4%).

Conclusions: Patients receiving diuretics are less likely to undergo surgery. The diuretics administration may be associated with the use of smaller ASD devices for transcatheter treatment through ASD size reduction.
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http://dx.doi.org/10.4070/kcj.2021.0076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8636757PMC
December 2021

Effect of low-thermal pretreatment on the methanogenic performance and microbiome population of continuous high-solid anaerobic digester treating dewatered sludge.

Bioresour Technol 2021 Dec 12;341:125756. Epub 2021 Aug 12.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

Undigested and dewatered sludge at 10% total solids was pretreated at 60 °C for 3 h and fed to a lab-scale horizontal anaerobic bioreactor for 130 days with solids retention time (SRTs) from 25 to 16 d. The low-thermal pretreatment enabled higher net energy production, improved sludge treatment efficiency, and enhanced digestion stability. The highest average biomethane yield and production rate were 138.5 mL/g VS and 0.43 L/L.d, respectively, and the economic benefit was expected to be the maximum at SRT 16 d. Pretreatment did not increase the specific methanogenic activity per unit methanogen, but resulted in higher abundance of methanogenic archaea and hydrolytic bacteria. Methanogenic population shifted from hydrogenotrophic to acetoclastic, consistent with predicted gene expression at SRT equal or below 20 d. Anaerobic digestion along with low-thermal could be a feasible management strategy for undigested dewatered sludge from small WWTPs.
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http://dx.doi.org/10.1016/j.biortech.2021.125756DOI Listing
December 2021

Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study.

J Korean Med Sci 2021 Aug 16;36(32):e232. Epub 2021 Aug 16.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Korean health authority plans to vaccinate adolescents against coronavirus disease 2019 (COVID-19) starting high school seniors during the summer vacation of 2021. However, the myocarditis/pericarditis following COVID-19 vaccine has been reported recently in adolescents and young adults. This study was performed to answer the urgent questions about the basic epidemiology and clinical course of myocarditis/pericarditis in hospitalized patients prior to the introduction of COVID-19 vaccines in pediatric population.

Methods: A retrospective medical record analysis including frequency, clinical characteristics, etiology and outcome of myocarditis/pericarditis was conducted in 17 years and younger patients who were hospitalized in two referral hospitals in Korea between 2010 and 2019.

Results: Total 142 patients with myocarditis (n = 119) and/or pericarditis (n = 23) were identified. Median age was 5.4 years (interquartile range, 0.6-12.9 years; range, 11 days-17.8 years), and male was 61%. In adolescents aged 12-17 years, the male to female ratio was 3.2. Myocarditis/pericarditis occurred 0.70 per 1,000 in-patients during the study period: 0.96 (< 1 year), 0.50 (1-5 years), 0.67 (6-11 years) and 1.22 (12-17 years) per 1,000 in-patients, respectively. There was an increasing tendency for the annual frequency from 0.34 in 2010 to 1.25 per 1,000 in-patients in 2019 ( = 0.021). Among the 56 (40%) proven pathogens at admission, (n = 11, 8%) and enterovirus (n = 10, 7%) were most common. Of the 142 patients, 99 (70%) required pediatric intensive care unit care and 10 (7%) received heart transplantation. In addition, 61 patients (61/131, 47%) without heart medication at admission needed heart medication when they were discharged. Eleven (7.7%) patients died, of which five patients were previously healthy. The median age of deceased patients was lower than the survival group (0.8 vs. 6.3 years, = 0.014).

Conclusion: The frequency of myocarditis/pericarditis was highest among male adolescent in-patients; however, the outcome was favorable in this group without any mortality.
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http://dx.doi.org/10.3346/jkms.2021.36.e232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369310PMC
August 2021

Nanocages displaying SIRP gamma clusters combined with prophagocytic stimulus of phagocytes potentiate anti-tumor immunity.

Cancer Gene Ther 2021 09 4;28(9):960-970. Epub 2021 Aug 4.

KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Republic of Korea.

Antigen-presenting cells (APCs), including macrophages and dendritic cells (DCs), play a crucial role in bridging innate and adaptive immunity; thereby, innate immune checkpoint blockade-based therapy is an attractive approach for the induction of sustainable tumor-specific immunity. The interaction between the cluster of differentiation 47 (CD47) on tumor and signal-regulatory protein alpha (SIRPα) on phagocytic cells inhibits the phagocytic function of APCs, acting as a "don't eat me" signal. Accordingly, CD47 blockade is known to increase tumor cell phagocytosis, eliciting tumor-specific CD8 T-cell immunity. Here, we introduced a nature-derived nanocage to deliver SIRPγ for blocking of antiphagocytic signaling through binding to CD47 and combined it with prophagocytic stimuli using a metabolic reprogramming reagent for APCs (CpG-oligodeoxynucleotides). Upon delivering the clustered SIRPγ variant, the nanocage showed enhanced CD47 binding profiles on tumor cells, thereby promoting active engulfment by phagocytes. Moreover, combination with CpG potentiated the prophagocytic ability, leading to the establishment of antitumorigenic surroundings. This combination treatment could competently inhibit tumor growth by invigorating APCs and CD8 T-cells in TMEs in B16F10 orthotopic tumor models, known to be resistant to CD47-targeting therapeutics. Collectively, enhanced delivery of an innate immune checkpoint antagonist with metabolic modulation stimuli of immune cells could be a promising strategy for arousing immune responses against cancer.
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http://dx.doi.org/10.1038/s41417-021-00372-yDOI Listing
September 2021

Statin-mediated inhibition of RAS prenylation activates ER stress to enhance the immunogenicity of KRAS mutant cancer.

J Immunother Cancer 2021 07;9(7)

Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea

Background: Statins preferentially promote tumor-specific apoptosis by depleting isoprenoid such as farnesyl pyrophosphate and geranylgeranyl pyrophosphate. However, statins have not yet been approved for clinical cancer treatment due, in part, to poor understanding of molecular determinants on statin sensitivity. Here, we investigated the potential of statins to elicit enhanced immunogenicity of -mutant ( ) tumors.

Methods: The immunogenicity of treated cancer cells was determined by western blot, flow cytometry and confocal microscopy. The immunotherapeutic efficacy of mono or combination therapy using statin was assessed in tumor models, including syngeneic colorectal cancer and genetically engineered lung and pancreatic tumors. Using NanoString analysis, we analyzed how statin influenced the gene signatures associated with the antigen presentation of dendritic cells in vivo and evaluated whether statin could induce CD8+ T-cell immunity. Multiplex immunohistochemistry was performed to better understand the complicated tumor-immune microenvironment.

Results: Statin-mediated inhibition of prenylation provoked severe endoplasmic reticulum (ER) stress by attenuating the anti-ER stress effect of mutation, thereby resulting in the immunogenic cell death (ICD) of cancer cells. Moreover, statin-mediated ICD enhanced the cross-priming ability of dendritic cells, thereby provoking CD8+ T-cell immune responses against tumors. Combination therapy using statin and oxaliplatin, an ICD inducer, significantly enhanced the immunogenicity of tumors and promoted tumor-specific immunity in syngeneic and genetically engineered tumor models. Along with immune-checkpoint inhibitors, the abovementioned combination therapy overcame resistance to PD-1 blockade therapies, improving the survival rate of tumor models.

Conclusions: Our findings suggest that mutation could be a molecular target for statins to elicit potent tumor-specific immunity.
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http://dx.doi.org/10.1136/jitc-2021-002474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327837PMC
July 2021

Siblings With Familial Dwarfism Presenting With Acute Myocardial Infarction at Adolescence.

JACC Case Rep 2021 May 19;3(5):795-800. Epub 2021 May 19.

Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

We encountered siblings with familial Majewski osteodysplastic primordial dwarfism type II (MOPD II) with acute myocardial infarction in adolescence and in their early 20s. We successfully performed percutaneous and surgical coronary interventions. From these cases, we were able to better understand coronary artery disease of MOPD II and provide better management. ().
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http://dx.doi.org/10.1016/j.jaccas.2021.03.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311190PMC
May 2021

Mid-term outcomes of the Pulsta transcatheter pulmonary valve for the native right ventricular outflow tract.

Catheter Cardiovasc Interv 2021 11 6;98(5):E724-E732. Epub 2021 Jul 6.

Department of Pediatrics, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.

Objectives: The aim of this study is to present the mid-term outcomes of Pulsta valve.

Background: The Pulsta valve is a Self-expandable knitted nitinol-wire stent mounted with a treated tri-leaflet α-Gal-free porcine pericardial valve for percutaneous pulmonary valve implantation (PPVI) in patients with native right ventricular outflow tract (RVOT) lesions.

Methods: A multi-center clinical trial using Pulsta valve® was designed for patients with severe pulmonary regurgitation (PR) in the native RVOT in multiple centers in South Korea and 25 patients were enrolled. Before PPVI, severe PR (mean PR fraction: 45.5 ± 6.9%) and enlarged RV volume (mean indexed RV end-diastolic volume; 169.7 ± 13.0 ml/m ) was present. The mean age was 21.6 ± 6.6 years old.

Results: All patients were successfully implanted with 26, 28, or 32 mm diameter of Pulsta valve loaded on the 18 or 20 French delivery catheters. At 6 months follow up, indexed RV end-diastolic volume was decreased to 126.9 ± 16.9 ml/m . At mean 33.1 ± 14.3 months follow-up, the mean value of mean pressure gradient in Pulsta valve was 6.5 ± 3.0 mmhg without significant PR. There was no serious device-related adverse event.

Conclusions: A multi-center clinical trial was completed successfully with planned Pulsta valve implantation and demonstrated good mid-term effectiveness without device-related serious adverse events.
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http://dx.doi.org/10.1002/ccd.29865DOI Listing
November 2021

Highly Efficient Transfection of Human Primary T Lymphocytes Using Droplet-Enabled Mechanoporation.

ACS Nano 2021 Jun 18. Epub 2021 Jun 18.

School of Biomedical Engineering, Korea University, 02841 Seoul, Republic of Korea.

Whole-cell-based therapy has been extensively used as an effective disease treatment approach, and it has rapidly changed the therapeutic paradigm. To fully accommodate this shift, advances in genome modification and cell reprogramming methodologies are critical. Traditionally, molecular tools such as viral and polymer nanocarriers and electroporation have been the norm for internalizing external biomolecules into cells for cellular engineering. However, these approaches are not fully satisfactory considering their cytotoxicity, high cost, low scalability, and/or inconsistent and ineffective delivery and transfection. To address these challenges, we present an approach that leverages droplet microfluidics with cell mechanoporation, bringing intracellular delivery to the next level. In our approach, cells and external cargos such as mRNAs and plasmid DNAs are coencapsulated into droplets, and as they pass through a series of narrow constrictions, the cell membrane is mechanically permeabilized where the cargos in the vicinity are internalized convective solution exchange enhanced by recirculation flows developed in the droplets. Using this principle, we demonstrated a high level of functional macromolecule delivery into various immune cells, including human primary T cells. By utilizing droplets, the cargo consumption was drastically reduced, and near-zero clogging was realized. Furthermore, high scalability without sacrificing cell viability and superior delivery over state-of-the-art methods and benchtop techniques were demonstrated. Notably, the droplet-based intracellular delivery strategy presented here can be further applied to other mechanoporation microfluidic techniques, highlighting its potential for cellular engineering and cell-based therapies.
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http://dx.doi.org/10.1021/acsnano.0c10473DOI Listing
June 2021

The occurrence of coronary artery lesions in Kawasaki disease based on C-reactive protein levels: a retrospective cohort study.

Pediatr Rheumatol Online J 2021 Jun 2;19(1):78. Epub 2021 Jun 2.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.

Background: This study aimed to assess the occurrence of coronary artery lesions (CAL) in patients with Kawasaki disease (KD) according to serum C-reactive protein (CRP) levels.

Methods: This retrospective analysis was based on the nationwide survey of KD conducted in the Republic of Korea between 2015 and 2017. We enrolled 9131 patients and defined low (< 3 mg/dL) and high (≥3 mg/dL) CRP groups. Demographic data, clinical characteristics, z-scores, and scores based on the Japanese criteria for CAL were compared between the two groups. Logistic regression analysis was used to identify CAL risk factors.

Results: The low CRP group accounted for 23% of patients. The mean age at diagnosis was higher in high CRP group compared to the low CRP group (34.4 ± 24.9 vs 31.7 ± 24.8 months, p < 0.001). Fever duration before treatment was not significantly different between the two groups (5.1 ± 1.7 days vs. 5.2 ± 2.1 days; p = 0.206). A non-response to intravenous immunoglobulin treatment was found in 1377 patients (20.1%) and 225 patients (11.7%) in the high and low CRP groups, respectively (p < 0.001). CAL were found in 12.9 and 18.3% of the high and low CRP patients, respectively (p < 0.001), based on z-scores; and in 9.9 and 12.5%, respectively (p = 0.001), based on the Japanese criteria in the acute phase. The giant coronary artery aneurysm occurrence ratio was similar between groups (p = 1.0).

Conclusions: CAL occurred in patients with both high and low CRP. Therefore, patients with KD should be carefully monitored regardless of their CRP levels.
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http://dx.doi.org/10.1186/s12969-021-00566-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173749PMC
June 2021

Mesenchymal Stem Cell-Derived Exosomes and Their Therapeutic Potential for Osteoarthritis.

Biology (Basel) 2021 Apr 1;10(4). Epub 2021 Apr 1.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University, Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Korea.

Exosomes are nano-sized vesicles (50-150 nm in diameter) that contain nucleic acids (e.g., microRNA and messenger RNA), functional proteins, and bioactive lipids. They are secreted by various types of cells, including B cells, T cells, reticulocytes, dendritic cells, mast cells, epithelial cells, and mesenchymal stem cells (MSCs). They perform a wide variety of functions, including the repair of damaged tissues, regulation of immune responses, and reduction in inflammation. When considering the limitations of MSCs, including issues in standardization and immunogenicity, MSC-derived exosomes have advantages such as small dimensions, low immunogenicity, and lack of requirement for additional procedures for culture expansion or delivery. MSC-derived exosomes have shown outstanding therapeutic effects through chondro-protective and anti-inflammatory properties. MSC-derived exosomes may enable a new therapeutic paradigm for the treatment of osteoarthritis. However, further research is needed to prove their clinical effectiveness and feasibility.
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http://dx.doi.org/10.3390/biology10040285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066608PMC
April 2021

Surgical outcomes of infective endocarditis in children: should we delay surgery for infective endocarditis?

Eur J Cardiothorac Surg 2021 10;60(4):920-927

Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea.

Objectives: We compared the surgical outcomes of infective endocarditis (IE) between early surgery and non-early surgery groups in children.

Methods: From January 2000 to April 2020, we retrospectively reviewed 50 patients <18years of age who underwent first surgery for IE. Early surgery was defined as that performed within 2 days for left-sided IE and 7 days for right-sided IE after diagnosis.

Results: The median age and body weight at operation were 7.7 years [interquartile range (IQR), 2.3-13.2] and 23.7 kg (IQR, 10.3-40.7), respectively. The median follow-up duration was 9.5 years (IQR, 4.0-14.5). In 28 patients with native valve endocarditis, the native valve was preserved in 23 (82.1%). The most common causative microorganism was Streptococcus viridans (32.0%). The operative mortality was 2.0%, and 13 (26.0%) patients required reoperation most commonly for prosthesis failure (n = 7). There were no significant differences in patient characteristics and perioperative data between early surgery (n = 9) and non-early surgery (n = 36) groups, except for the interval between diagnosis and surgery (early surgery < non-early surgery, P < 0.001) and preoperative negative blood culture conversion (early surgery < non-early surgery, P = 0.025). There were no significant differences in overall survival, recurrent IE, and reoperation rate between the groups. Early surgery and preoperative negative blood culture conversion were not found as significant factors for surgical adverse outcomes.

Conclusions: Surgical outcomes for IE in children were acceptable irrespective of the time of surgery. Our results suggest that it may not be required to delay surgery for IE and the potential benefit of early surgery could be expected in children.
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http://dx.doi.org/10.1093/ejcts/ezab149DOI Listing
October 2021

Enhanced anaerobic digestion of waste-activated sludge via bioaugmentation strategy-Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt2) analysis through hydrolytic enzymes and possible linkage to system performance.

Bioresour Technol 2021 Jul 31;332:125014. Epub 2021 Mar 31.

School of Civil and Environmental Engineering, Yonsei University, Seoul 03722, Republic of Korea. Electronic address:

In this study, anaerobic digestion of waste-activated sludge was bioaugmented with hydrolytic bacteria, Bacteroidetes uniformis (Bacteroidetes, B) and Clostridium sp. (Firmicutes, F) at various dosages. Bioaugmentation resulted in enhanced methane conversion of waste-activated sludge. The highest methane yield of 298.1 mL CH/g-COD, 85.2% COD conversion efficiency was obtained when Bacteroidetes uniformis and Clostridium sp. were augmented at 100 and 900 CFU/mL, respectively. The microbial community analysis demonstrated that bioaugmentation increased the proportion of Bacteroidetes, Firmicutes, and Proteobacteria. Furthermore, at the highest methane yield, the principal methanogenic pathway was altered from acetoclastic to a mixture of hydrogenotrophic and acetoclastic; the major species shifted from Methanosaeta concilii to Methanobacterium subterraneum. Predicted gene analysis revealed that increased expression of hydrolases resulted in enhanced methane conversion through bioaugmentation.
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http://dx.doi.org/10.1016/j.biortech.2021.125014DOI Listing
July 2021

Effect of Pulmonary Valve Replacement in the Repaired Tetralogy of Fallot Patients with Trans-annular Incision: More than 20 Years of Follow-up.

Korean Circ J 2021 Apr;51(4):360-372

Division of Cardiology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

Background And Objectives: We reviewed the long-term outcomes after tetralogy of Fallot (TOF) repair with trans-annular incision; and evaluated the effectiveness of pulmonary valve replacement (PVR) on outcomes.

Methods: This was a retrospective review of clinical outcomes of 180 of 196 TOF patients who underwent total correction with trans-annular incision from 1991 to 1997 (PVR group: 81; non-PVR group: 99).

Results: The median age of the patients was 14.0 months (interquartile range [IQR], 10.7-19.8 months) at TOF repair. Ten in-hospital deaths (5.1%) occurred. During the follow-up, 81 patients underwent PVR at the median age of 13.5 years (IQR, 11.2-17.1 years). The patients in PVR group showed better outcomes than non-PVR group in overall survival rate (100% in PVR vs. 88.7% in non-PVR, p=0.007), in all adverse events (arrhythmia, neurologic complications, 95.5% in PVR vs. 74.6% in non-PVR, p=0.024) at 20 years. Age at TOF repair younger than 1 year (hazard ratio [HR], 2.265; p=0.01) and previous shunt history (HR, 2.195; p=0.008) were predictive for requiring PVR. During follow-up, 10 late deaths (5 sudden deaths) occurred in the non-PVR group, mainly due to ventricular arrhythmia and right ventricular failure; there was 1 late death (not a sudden death) in the PVR group.

Conclusions: Long-term survival after repair of TOF with trans-annular incision were acceptable. However, arrhythmias were frequently observed during 20 years of follow-up. The patient age <1 year at the time of TOF repair and shunt implantation prior to TOF repair were predictive factors for requiring PVR.
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http://dx.doi.org/10.4070/kcj.2020.0331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022019PMC
April 2021
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