Publications by authors named "Hae-Young Kim"

276 Publications

Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea.

Emerg Infect Dis 2021 Aug 24;27(11). Epub 2021 Aug 24.

We reviewed the timeline of key policies for control of the coronavirus disease epidemic and determined their impact on the epidemic and hospital burden in South Korea. Using a discrete stochastic transmission model, we estimated that multilevel policies, including extensive testing, contact tracing, and quarantine, reduced contact rates by 90% and rapidly decreased the epidemic in Daegu and nationwide during February‒March 2020. Absence of these prompt responses could have resulted in a >10-fold increase in infections, hospitalizations, and deaths by May 15, 2020, relative to the status quo. The model suggests that reallocation of persons who have mild or asymptomatic cases to community treatment centers helped avoid overwhelming hospital capacity and enabled healthcare workers to provide care for more severely and critically ill patients in hospital beds and negative-pressure intensive care units. As small outbreaks continue to occur, contact tracing and maintenance of hospital capacity are needed.
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http://dx.doi.org/10.3201/eid2711.203779DOI Listing
August 2021

Associated health and social determinants of mobile populations across HIV epidemic gradients in Southern Africa.

J Migr Health 2021 26;3:100038. Epub 2021 Mar 26.

Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.

Background: Growing travel connectivity and economic development have dramatically increased the magnitude of human mobility in Africa. In public health, vulnerable population groups such as mobile individuals are at an elevated risk of sexually transmitted diseases, including HIV.

Methods: The population-based Demographic Health Survey data of five Southern African countries with different HIV epidemic intensities (Angola, Malawi, South Africa, Zambia, and Zimbabwe) were used to investigate the association between HIV serostatus and population mobility adjusting for socio-demographic, sexual behavior and spatial covariates.

Results: Mobility was associated with HIV seropositive status only in Zimbabwe (adjusted odds ratio [AOR] = 1.37 [95% confidence interval [CI]: 1.01-1.67]). These associations were not significant in Angola, Malawi, South Africa, and Zambia. Females had higher odds of mobility than males in Zimbabwe (AOR = 1.37, CI: 1.10-1.69). The odds of mobility decreased with age in all five countries.

Conclusions: Our findings highlight the heterogeneity of the social and health determinants of mobile populations in several countries with different HIV epidemic intensities. Effective interventions using precise geographic focus combined with detailed attribute characterization of mobile populations can enhance their impact especially in areas with high density of mobile individuals and high HIV prevalence.
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http://dx.doi.org/10.1016/j.jmh.2021.100038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352162PMC
March 2021

Dose reduction potential of vendor-agnostic deep learning model in comparison with deep learning-based image reconstruction algorithm on CT: a phantom study.

Eur Radiol 2021 Aug 14. Epub 2021 Aug 14.

Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.

Objectives: To compare the dose reduction potential (DRP) of a vendor-agnostic deep learning model (DLM, ClariCT.AI) with that of a vendor-specific deep learning-based image reconstruction algorithm (DLR, TrueFidelity™).

Methods: Computed tomography (CT) images of a multi-sized image quality phantom (Mercury v4.0) were acquired under six radiation dose levels (0.48/0.97/1.93/3.87/7.74/15.47 mGy) and were reconstructed using filtered back projection (FBP) and three strength levels of the DLR (low/medium/high). The FBP images were denoised using the DLM. For all DLM and DLR images, the detectability index (d') (a task-based detection performance metric) was obtained, under various combinations of three target sizes (10/5/1 mm), five inlets (CT value difference with the background; -895/50/90/335/1000 HU), five phantom diameters (36/31/26/21/16 cm), and six radiation dose levels. Dose reduction potential (DRP) measures the dose reduction made by using DLM or DLR, while yielding d' equivalent to that of FBP at full dose.

Results: The DRPs of the DLM, DLR-low, DLR-medium, and DLR-high were 86% (81-88%), 60% (46-67%), 76% (60-81%), and 87% (78-92%), respectively. For 10-mm targets, the DRP of the DLM (87%) was higher than that of all DLR algorithms (58-86%). However, for smaller targets (5 mm/1 mm), the DRPs of the DLR-high (89/88%) were greater than those of the DLM (87/84%).

Conclusion: The dose reduction potential of the vendor-agnostic DLM was shown to be comparable to that of the vendor-specific DLR at high strength and superior to those of the DLRs at medium and low strengths.

Key Points: • DRP of the vendor-agnostic model was comparable to that of high-strength vendor-specific model and superior to those of medium- and low-strength models. • Under various radiation dose levels, the deep learning model shows higher detectability indexes compared to FBP.
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http://dx.doi.org/10.1007/s00330-021-08199-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364308PMC
August 2021

Classification of true progression after radiotherapy of brain metastasis on MRI using artificial intelligence: a systematic review and meta-analysis.

Neurooncol Adv 2021 Jan-Dec;3(1):vdab080. Epub 2021 Jul 1.

Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea.

Background: Classification of true progression from nonprogression (eg, radiation-necrosis) after stereotactic radiotherapy/radiosurgery of brain metastasis is known to be a challenging diagnostic task on conventional magnetic resonance imaging (MRI). The scope and status of research using artificial intelligence (AI) on classifying true progression are yet unknown.

Methods: We performed a systematic literature search of MEDLINE and EMBASE databases to identify studies that investigated the performance of AI-assisted MRI in classifying true progression after stereotactic radiotherapy/radiosurgery of brain metastasis, published before November 11, 2020. Pooled sensitivity and specificity were calculated using bivariate random-effects modeling. Meta-regression was performed for the identification of factors contributing to the heterogeneity among the studies. We assessed the quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria and a modified version of the radiomics quality score (RQS).

Results: Seven studies were included, with a total of 485 patients and 907 tumors. The pooled sensitivity and specificity were 77% (95% CI, 70-83%) and 74% (64-82%), respectively. All 7 studies used radiomics, and none used deep learning. Several covariates including the proportion of lung cancer as the primary site, MR field strength, and radiomics segmentation slice showed a statistically significant association with the heterogeneity. Study quality was overall favorable in terms of the QUADAS-2 criteria, but not in terms of the RQS.

Conclusion: The diagnostic performance of AI-assisted MRI seems yet inadequate to be used reliably in clinical practice. Future studies with improved methodologies and a larger training set are needed.
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http://dx.doi.org/10.1093/noajnl/vdab080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350153PMC
July 2021

Erratum: Correction of Text in the Article "The Impact of COVID-19 on the Use of Radiology Resources in a Tertiary Hospital".

J Korean Med Sci 2021 Aug 2;36(30):e215. Epub 2021 Aug 2.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

This corrects the article on p. e368 in vol. 35, PMID: 33075859.
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http://dx.doi.org/10.3346/jkms.2021.36.e215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8329390PMC
August 2021

CD4+ T-cell count at antiretroviral therapy initiation in the "treat all" era in rural South Africa: an interrupted time series analysis.

Clin Infect Dis 2021 Jul 26. Epub 2021 Jul 26.

Africa Health Research Institute, KwaZulu-Natal, South Africa.

Background: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART).

Methods: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults ≥16 years old attending 17 public sector primary care services in rural South Africa between July 2014 and March 2019.

Results: Among 20,599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval, CI, 308.6 to 325.6)-one to eight months prior to UTT-to 421.0 cells/μL (95% CI 413.0 to 429.0) one to twelve months after UTT, including an immediate increase of 124.2 cells/μL (95% CI 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI 381.8 to 397.1) 13 to 30 months after UTT, but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI -125.5 to -111.0) throughout the study.

Conclusions: Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in HIV infection, particularly among men.
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http://dx.doi.org/10.1093/cid/ciab650DOI Listing
July 2021

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS.

PLoS One 2021 22;16(7):e0253742. Epub 2021 Jul 22.

Department of Public Health, New York Medical College, Valhalla, New York, United States of America.

Background: Antiretroviral therapy (ART) success has led people to live longer with HIV/AIDS (PLWH) and thus be exposed to increasing risk of cardiovascular diseases (CVD). Hypertension (HTN), the biggest contributor to CVD burden, is a growing concern among PLWH. The current report describes the prevalence and predictors of HTN among PLWH in care in Cameroon.

Methods: This cross-sectional study included all PLWH aged 20 years and above who received care between 2016 and 2019 at one of the three Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) sites in Cameroon (Bamenda, Limbe, and Yaoundé). HTN was defined as blood pressure (BP) ≥140/90 mm Hg or self-reported use of antihypertensive medication. Logistic regressions models examined the relationship between HTN and clinical characteristics, and HIV-related factors.

Results: Among 9,839 eligible PLWH, 66.2% were women and 25.0% had prevalent HTN [age-standardized prevalence 23.9% (95% CI: 22.2-25.6)], among whom 28 (1.1%) were on BP lowering treatment, and 6 of those (21.4%) were at target BP levels. Median age (47.4 vs. 40.5 years), self-reported duration of HIV infection (5.1 vs 2.8 years years), duration of ART exposure (4.7 vs 2.3 years), and CD4 count (408 vs 359 cell/mm3) were higher in hypertensives than non-hypertensives (all p<0.001). Age and body mass index (BMI) were independently associated with higher prevalent HTN risk. PLWH starting ART had a 30% lower risk of prevalent HTN, but this advantage disappeared after a cumulative 2-year exposure to ART. There was no significant association between other HIV predictive characteristics and HTN.

Conclusion: About a quarter of these Cameroonian PLWH had HTN, driven among others by age and adiposity. Appropriate integration of HIV and NCDs services is needed to improve early detection, treatment and control of common comorbid NCD risk factors like hypertension and safeguard cardiovascular health in PLWH.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253742PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297808PMC
July 2021

Evaluating the impact of the nationwide public-private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis.

PLoS Med 2021 Jul 14;18(7):e1003717. Epub 2021 Jul 14.

Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea.

Background: Public-private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea's PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program.

Methods And Findings: Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes-treatment success (TS) and loss to follow-up (LTFU)-in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and -8.7% (95% CI -9.7% to -7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program's impact on TB mortality.

Conclusions: We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.
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http://dx.doi.org/10.1371/journal.pmed.1003717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318235PMC
July 2021

Superoxide Dismutase 3-Transduced Mesenchymal Stem Cells Preserve Epithelial Tight Junction Barrier in Murine Colitis and Attenuate Inflammatory Damage in Epithelial Organoids.

Int J Mol Sci 2021 Jun 16;22(12). Epub 2021 Jun 16.

Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Superoxide dismutase 3 (SOD3), also known as extracellular superoxide dismutase, is an enzyme that scavenges reactive oxygen species (ROS). It has been reported that SOD3 exerts anti-inflammatory abilities in several immune disorders. However, the effect of SOD3 and the underlying mechanism in inflammatory bowel disease (IBD) have not been uncovered. Therefore, in the present study, we investigated whether SOD3 can protect intestinal cells or organoids from inflammation-mediated epithelial damage. Cells or mice were treated with SOD3 protein or SOD3-transduced mesenchymal stem cells (MSCs). Caco-2 cells or intestinal organoids stimulated with pro-inflammatory cytokines were used to evaluate the protective effect of SOD3 on epithelial junctional integrity. Dextran sulfate sodium (DSS)-induced colitis mice received SOD3 or SOD3-transduced MSCs (SOD3-MSCs), and were assessed for severity of disease and junctional protein expression. The activation of the mitogen-activated protein kinase (MAPK) pathway and elevated expression of cytokine-encoding genes decreased in TNF-α-treated Caco-2 cells or DSS-induced colitis mice when treated with SOD3 or SOD3-MSCs. Moreover, the SOD3 supply preserved the expression of tight junction (ZO-1, occludin) or adherence junction (E-cadherin) proteins when inflammation was induced. SOD3 also exerted a protective effect against cytokine- or ROS-mediated damage to intestinal organoids. These results indicate that SOD3 can effectively alleviate enteritis symptoms by maintaining the integrity of epithelial junctions and regulating inflammatory- and oxidative stress.
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http://dx.doi.org/10.3390/ijms22126431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233984PMC
June 2021

Trends in demographic and clinical characteristics and initiation of antiretroviral therapy among adult patients enrolling in HIV care in the Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) 2004 to 2018.

J Int AIDS Soc 2021 06;24(6):e25672

Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

Introduction: The Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) is an open observational cohort study investigating impact, progression and long-term outcomes of HIV/AIDS among people living with HIV (PLWH) in Burundi, Cameroon, Democratic Republic of Congo (DRC), Republic of Congo (ROC) and Rwanda. We describe trends in demographic, clinical and immunological characteristics as well as antiretroviral therapy (ART) use of patients aged > 15 years entering into HIV care in the participating CA-IeDEA site.

Methods: Information on sociodemographic characteristics, height, weight, body mass index (BMI), CD4 cell count, WHO staging and ART status at entry into care from 2004 through 2018 were extracted from clinic records of patients aged > 15 years enrolling in HIV care at participating clinics in Burundi, Cameroon, DRC, ROC and Rwanda. We assessed trends in patient characteristics at enrolment in HIV care including ART initiation within the first 30 days after enrolment in care and calculated proportions, means and medians (interquartile ranges) for the main variables of interest.

Results: Among 69,176 patients in the CA-IeDEA cohort, 39% were from Rwanda, 24% from ROC, 18% from Cameroon, 14% from Burundi and 5% from DRC. More women (66%) than men enrolled in care and subsequently initiated ART. Women were also younger than men (32 vs. 38 years, P < 0.001) at enrolment and at ART initiation. Trends over time show increases in median CD4 cell count at enrolment from 190 cells/µL in 2004 to 334 cells/µL in 2018 at enrolment. Among those with complete data on CD4 counts (60%), women had a higher median CD4 cell count at care entry than men (229 vs. 249 cells/µL, P < 0.001). Trends in the proportion of patients using ART within 30 days of enrolment at the participating site show an increase from 16% in 2004 to 75% in 2018.

Conclusions: Trends from 2004 to 2018 in the characteristics of patients participating in the CA-IeDEA cohort highlight improvements at entry into care and subsequent ART initiation including after the implementation of Treat All guidelines in the participating sites.
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http://dx.doi.org/10.1002/jia2.25672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216247PMC
June 2021

The epidemiological landscape of anemia in women of reproductive age in sub-Saharan Africa.

Sci Rep 2021 Jun 7;11(1):11955. Epub 2021 Jun 7.

Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, OH, 45221, USA.

The role of geographical disparities of health-related risk factors with anemia are poorly documented for women of reproductive age in sub-Saharan Africa (SSA). We aimed to determine the contribution of potential factors and to identify areas at higher risk of anemia for women in reproductive age in SSA. Our study population comprised 27 nationally representative samples of women of reproductive age (15-49) who were enrolled in the Demographic and Health Surveys and conducted between 2010 and 2019 in SSA. Overall, we found a positive association between being anemic and the ecological exposure to malaria incidence [adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) 1.02-1.02], and HIV prevalence (AOR = 1.01, CI 1.01-1.02). Women currently pregnant or under deworming medication for the last birth had 31% (AOR = 1.31, CI 1.24-1.39) and 5% (AOR = 1.05, CI 1.01-1.10) higher odds of having anemia, respectively. Similarly, women age 25-34 years old with low education, low income and living in urban settings had higher odds of having anemia. In addition, underweight women had 23% higher odds of suffering anemia (AOR = 1.23, CI 1.15-1.31). Females with low levels of education and wealth index were consistently associated with anemia across SSA. Spatial distribution shows increased risk of anemia in Central and Western Africa. Knowledge about the contribution of known major drivers and the spatial distribution of anemia risk can mitigate operational constraints and help to design geographically targeted intervention programs in SSA.
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http://dx.doi.org/10.1038/s41598-021-91198-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184956PMC
June 2021

Can Patient Triaging with Clinical Scoring Systems Reduce CT Use in Adolescents and Young Adults Suspected of Having Appendicitis?

Radiology 2021 08 18;300(2):350-358. Epub 2021 May 18.

From the School of Computer Science and Engineering, Soongsil University, Seoul, Korea (H.S.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L., J.H.P., K.H.L.) and Interdisciplinary Program in Bioengineering (K.H.L.), Seoul National University, Seoul, Korea; Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (J.H.P., H.Y.K., H.D.M., K.H.L.); Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.).

Background There are ongoing efforts to reduce CT radiation exposure for the diagnosis of appendicitis. Recent guidelines recommend using clinical scoring systems to triage patients who need imaging examinations. Purpose To determine whether patient triaging with scoring systems can reduce CT use without a loss of diagnostic accuracy in adolescents and young adults suspected of having appendicitis. Materials and Methods This retrospective study used data from a previous multicenter randomized controlled trial conducted between December 2013 and August 2016. Five scoring systems (adult appendicitis, appendicitis inflammatory response, modified Alvarado, Broek, and Christian scores) were used to categorize patients into low-, intermediate-, or high-probability groups. CT use was simulated for only the intermediate-probability group. The primary outcomes were CT reduction rate, sensitivity, and specificity. The CT reduction rate was defined as the proportion of patients in low- and high-probability groups who would not have to undergo CT among all patients. Sensitivity and specificity were calculated in the overall diagnostic pathway using each scoring system and subsequent CT. As a secondary analysis, to maintain the diagnostic accuracy to a level of when CT was used for all patients with suspected appendicitis, new cutoff values for probability group stratification targeting 97.6% sensitivity and 94.9% specificity were applied for each of the scoring systems. Results A total of 2888 patients (mean age ± standard deviation, 28 years ± 9; 1580 women and 1308 men) with suspected appendicitis were evaluated, of whom 1088 had and 1800 did not have appendicitis. The CT reduction rates of the five scoring systems ranged from 55.6% (1606 of 2888 patients) to 71.1% (2053 of 2888), but at the cost of sensitivity (range, 48.7% [530 of 1088] to 81.2% [883 of 1088]) and specificity (range, 79.0% [1422 of 1800] to 97.8% [1761 of 1800]). Targeting 97.6% sensitivity and 94.9% specificity, the CT reduction rates of all five scoring systems were 0% (0 of 2888). Conclusion Using clinical scoring systems in triaging patients for selective CT use led to a considerable loss of diagnostic accuracy. © RSNA, 2021 See also the editorial by Mellnick in this issue.
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http://dx.doi.org/10.1148/radiol.2021203884DOI Listing
August 2021

Final diagnosis and patient disposition following equivocal results on 2-mSv CT vs. conventional-dose CT in adolescents and young adults with suspected appendicitis: a post hoc analysis of large pragmatic randomized trial data.

Eur Radiol 2021 May 15. Epub 2021 May 15.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.

Objective: To compare 2-mSv CT and conventional-dose CT (CDCT, typically 7-8 mSv) regarding final diagnosis and patient disposition following equivocal CT results in adolescents and young adults with suspected appendicitis.

Methods: In total, 3074 patients of 15-44 years (28 ± 9 years, 1672 women) from 20 hospitals were randomized to undergo contrast-enhanced 2-mSv CT (n = 1535) or CDCT (n = 1539) from December 2013 through August 2016. One hundred sixty-one radiologists prospectively rated the likelihood of appendicitis in a Likert scale (i.e., grades 1-5). The final diagnosis was based on CT image, surgical, pathologic, and clinical findings. Post hoc analysis was performed for final diagnosis, surgical procedure, and delay in patient management following equivocal results (i.e., grade 3).

Results: The 2-mSv CT and CDCT groups were comparable for final diagnosis following equivocal results, including confirmed appendicitis (1.2% [18 patients] vs. 1.2% [19], p > 0.99), negative appendectomy (0.1% [2] vs. 0.3% [4], p = 0.53), and perforated appendicitis (0.1% [1] vs. 0.2% [3], p = 0.53). More patients were confirmed as not having appendicitis following equivocal results in the CDCT group than in the 2-mSv CT group (2.2% [34] vs. 1.0% [16], p = 0.016). The two groups were comparable for the need of appendectomy (1.4% [22] vs. 1.5% [23], p > 0.99), need of additional imaging tests (0.7% [11] vs. 1.1% [17], p = 0.35), and delay in patient management following equivocal results.

Conclusion: 2-mSv CT is comparable to CDCT regarding final diagnosis and patient disposition following equivocal CT results.

Key Points: • Our results strengthen evidence justifying the use of low-dose CT instead of conventional-dose CT (CDCT) in adolescents and young adults with suspected appendicitis. • The 2-mSv CT and CDCT groups were comparable for final diagnosis following equivocal CT results, including confirmed appendicitis (1.2% vs. 1.2%, p > 0.99), negative appendectomy (0.1% vs. 0.3%, p = 0.53), and perforated appendicitis (0.1% vs. 0.2%, p = 0.53). • The two groups were comparable for the need for appendectomy (1.4% vs. 1.5%, p > 0.99), need for additional imaging tests (0.7% vs. 1.1%, p = 0.35), and delay in patient management, following equivocal CT results.
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http://dx.doi.org/10.1007/s00330-021-08020-7DOI Listing
May 2021

Deep learning-based denoising algorithm in comparison to iterative reconstruction and filtered back projection: a 12-reader phantom study.

Eur Radiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Objectives: (1) To compare low-contrast detectability of a deep learning-based denoising algorithm (DLA) with ADMIRE and FBP, and (2) to compare image quality parameters of DLA with those of reconstruction methods from two different CT vendors (ADMIRE, IMR, and FBP).

Materials And Methods: Using abdominal CT images of 100 patients reconstructed via ADMIRE and FBP, we trained DLA by feeding FBP images as input and ADMIRE images as the ground truth. To measure the low-contrast detectability, the randomized repeat scans of Catphan® phantom were performed under various conditions of radiation exposures. Twelve radiologists evaluated the presence/absence of a target on a five-point confidence scale. The multi-reader multi-case area under the receiver operating characteristic curve (AUC) was calculated, and non-inferiority tests were performed. Using American College of Radiology CT accreditation phantom, contrast-to-noise ratio, target transfer function, noise magnitude, and detectability index (d') of DLA, ADMIRE, IMR, and FBPs were computed.

Results: The AUC of DLA in low-contrast detectability was non-inferior to that of ADMIRE (p < .001) and superior to that of FBP (p < .001). DLA improved the image quality in terms of all physical measurements compared to FBPs from both CT vendors and showed profiles of physical measurements similar to those of ADMIRE.

Conclusions: The low-contrast detectability of the proposed deep learning-based denoising algorithm was non-inferior to that of ADMIRE and superior to that of FBP. The DLA could successfully improve image quality compared with FBP while showing the similar physical profiles of ADMIRE.

Key Points: • Low-contrast detectability in the images denoised using the deep learning algorithm was non-inferior to that in the images reconstructed using standard algorithms. • The proposed deep learning algorithm showed similar profiles of physical measurements to advanced iterative reconstruction algorithm (ADMIRE).
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http://dx.doi.org/10.1007/s00330-021-07810-3DOI Listing
April 2021

Extracellular Superoxide Dismutase Prevents Skin Aging by Promoting Collagen Production through the Activation of AMPK and Nrf2/HO-1 Cascades.

J Invest Dermatol 2021 Oct 6;141(10):2344-2353.e7. Epub 2021 Apr 6.

Laboratory of Dermato-Immunology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

With aging, the skin becomes thin and drastically loses collagen. Extracellular superoxide dismutase (EC-SOD), also known as superoxide dismutase (SOD) 3, is the major SOD in the extracellular matrix of the tissues and is well-known to maintain the reduction‒oxidation homeostasis and matrix components of such tissues. However, the role of EC-SOD in aging-associated reductions of skin thickness and collagen production is not well-studied. In this study, we compared the histological differences in the dorsal skin of EC-SOD‒overexpressing transgenic mice (Sod3) of different age groups with that in wild-type mice and also determined the underlying signaling mechanism. Our data showed that the skin thickness in Sod3 mice significantly increased with aging compared with that in wild-type male mice. Furthermore, Sod3 mice had promoted collagen production through the activation of adenosine monophosphate-activated protein kinase and Nrf2/HO-1 pathways in aged mice. Interestingly, subcutaneous injection of adeno-associated virus‒overexpressing EC-SOD exhibited increased skin thickness and collagen expression. Furthermore, combined recombinant EC-SOD and dihydrotestosterone treatment synergistically elevated collagen production through the activation of TGFβ in human dermal fibroblasts. Altogether, these results showed that EC-SOD prevents skin aging by promoting collagen production in vivo and in vitro. Therefore, we propose that EC-SOD may be a potential therapeutic target for antiaging in the skin.
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http://dx.doi.org/10.1016/j.jid.2021.02.757DOI Listing
October 2021

Conventional-Dose CT Versus 2-mSv CT for Right Colonic Diverticulitis as an Alternate Diagnosis of Appendicitis: Secondary Analysis of Large Pragmatic Randomized Trial Data.

AJR Am J Roentgenol 2021 Sep 9:1-9. Epub 2021 Sep 9.

Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea.

Adoption of low-dose CT for the diagnosis of appendicitis has been slow in children and in adults, partly because of concern about missing alternative diagnoses including right colonic diverticulitis. The purpose of our study was to retrospectively compare the diagnostic performance of IV contrast-enhanced 2-mSv and conventional-dose CT (CDCT) for the diagnosis of right colonic diverticulitis in adolescents and young adults with suspected appendicitis. This posthoc analysis of a prospective randomized controlled trial included 3074 patients (1672 female patients and 1402 male patients) ranging in age from 15 to 44 years old (mean ± SD, 28 ± 9 years) from 20 hospitals. From December 2013 to August 2016, patients were randomized to either the 2-mSv CT group ( = 1535 patients) or the CDCT (median, 7 mSv) group ( = 1539 patients). A total of 161 radiologists prospectively issued CT reports in which they suggested alternative diagnoses for 976 (2-mSV CT) and 924 (CDCT) patients. Seven independent assessors adjudicated final diagnoses on the basis of clinical and CT findings. Endpoints of test-positives, test-negatives, sensitivity, and specificity for right colonic diverticulitis were compared using chi-square and Mann-Whitney tests. Characteristics and disposition of patients with test-positive results were assessed. Four readers retrospectively reviewed CT images of 400 patients selected from the trial (113 and 108 patients with diverticulitis from 2-mSv CT and CDCT groups, respectively) to evaluate interobserver agreement for right colonic diverticulitis in terms of Gwet coefficients. Between-group differences were minute for most endpoints related to right colonic diverticulitis: test-positives (difference, 0.2% [95% CI, -1.8% to 2.1%]; 7.8% [119/1535 patients] vs 7.6% [117/1539 patients]; = .93), test-negatives (0.5% [95% CI, -1.5% to 2.5%]; 91.7% [1407/1535] vs 91.2% [1403/1539]; = .67), sensitivity (0% [95% CI, -6% to 6%]; 95% [110/116] vs 95% [105/111]; .99), and specificity (0.3% [95% CI, -0.5% to 0.9%]; 99.4% [1401/1410] vs 99.1% [1397/1409]; = .66). The characteristics and disposition of test-positive patients were similar between the two groups. Gwet coefficients were high and comparable between the two groups (2-mSv CT vs CDCT, 0.849 vs 0.889; = .20). Two-millisievert CT is comparable to conventional-dose CT for the diagnosis of right colonic diverticulitis. By mitigating concern about a missed diagnosis of right colonic diverticulitis, the results further support the use of low-dose CT in patients with suspected appendicitis. ClinicalTrials.gov NCT01925014.
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http://dx.doi.org/10.2214/AJR.21.25584DOI Listing
September 2021

Patterns of multimorbidity and their association with hospitalisation: a population-based study of older adults in urban Tanzania.

Age Ageing 2021 06;50(4):1349-1360

Africa Health Research Institute, KwaZulu-Natal, South Africa.

Background: while the HIV epidemic remains a considerable challenge in sub-Saharan Africa, a dramatic reduction in the associated mortality has led to a fundamental shift in the public health priorities aimed at tackling multimorbidity. Against the unprecedented level of urbanisation taking place in Tanzania, the burden of multimorbidity and its consequences among ageing adults, in the form of costly inpatient hospitalisation, remain unquantified.

Methods: we used data from one of Africa's largest urban population cohort, the Dar es Salaam Health and the Demographic Surveillance System, to quantity the extent of multimorbidity (occurrence of 2 ≥ health conditions) and discordant multimorbidity (occurrence of conditions in 2 ≥ domains in mental health, non-communicable and communicable health) among 2,299 adults aged ≥40 years in Dar es Salaam, Tanzania. We fitted logistic regression models to investigate the association between multimorbidity and inpatient hospitalisation.

Results: the prevalence of multimorbidity and discordant multimorbidity were 25.3 and 2.5%, respectively. Although the severe forms of multimorbidity (2.0% with ≥4 health conditions) and discordancy were low, hospitalisation was significantly higher based on the regression analyses. Household food insecurity was the only socio-economic variable that was significantly and consistently associated with a greater hospitalisation.

Conclusion: we found an alarmingly high degree of multimorbidity among this ageing urban population where hospitalisation was driven by multimorbidity. As public health resources remain scarce, reducing costly inpatient hospitalisation requires multilevel interventions that address clinical- and structural-level challenges (e.g. food insecurity) to mitigate multimorbidity and promote long-term healthy independent living among older adults in Tanzania.
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http://dx.doi.org/10.1093/ageing/afab046DOI Listing
June 2021

Low-Temperature Argon Plasma Regulates Skin Moisturizing and Melanogenesis-Regulating Markers through Yes-Associated Protein.

Int J Mol Sci 2021 Feb 14;22(4). Epub 2021 Feb 14.

Department of Dermato-Immunology, College of Medicine, Catholic University of Korea, Seoul 06591, Korea.

Extensive water loss and melanin hyperproduction can cause various skin disorders. Low-temperature argon plasma (LTAP) has shown the possibility of being used for the treatment of various skin diseases, such as atopic dermatitis and skin cancer. However, the role of LTAP in regulating skin moisturizing and melanogenesis has not been investigated. In this study, we aimed to determine the effect of LTAP on yes-associated protein (YAP), a major transcriptional coactivator in the Hippo signaling pathway that is involved in skin moisturizing and melanogenesis-regulating markers. In normal human epidermal keratinocytes (NHEKs), the human epidermal keratinocyte line HaCaT, and human dermal fibroblasts (HDFs), we found that LTAP exhibited increased expression levels of YAP protein. In addition, the expression levels of filaggrin (FLG), which is involved in natural moisturizing factors (NMFs), and hyaluronic acid synthase (HAS), transglutaminase (TGM), and involucrin (IVL), which regulate skin barrier and moisturizing, were also increased after exposure to LTAP. Furthermore, collagen type I alpha 1 and type III alpha 1 (COL1A1, COL3A1) were increased after LTAP exposure, but the expression level of matrix metalloproteinase-3 (MMP-3) was reduced. Moreover, LTAP was found to suppress alpha-melanocyte stimulating hormone (α-MSH)-induced melanogenesis in murine melanoma B16F10 cells and normal human melanocytes (NHEMs). LTAP regulates melanogenesis of the melanocytes through decreased YAP pathway activation in a melanocortin 1 receptor (MC1R)-dependent manner. Taken together, our data show that LTAP regulates skin moisturizing and melanogenesis through modulation of the YAP pathway, and the effect of LTAP on the expression level of YAP varies from cell to cell. Thus, LTAP might be developed as a treatment method to improve the skin barrier, moisture content, and wrinkle formation, and to reduce melanin generation.
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http://dx.doi.org/10.3390/ijms22041895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918577PMC
February 2021

Robustness of Deep Learning Algorithm to Varying Imaging Conditions in Detecting Low Contrast Objects In Computed Tomography Phantom Images: in Comparison to 12 Radiologists.

Diagnostics (Basel) 2021 Feb 28;11(3). Epub 2021 Feb 28.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.

The performance of deep learning algorithm (DLA) to that of radiologists was compared in detecting low contrast objects in CT phantom images under various imaging conditions. For training, 10,000 images were created using American College of Radiology CT phantom as the background. In half of the images, objects of 3-20 mm size and 5-30 HU contrast difference were generated in random locations. Binary responses were used as the ground truth. For testing, 640 images of Catphan phantom were used, half of which had objects of either 5 or 9 mm size with 10 HU contrast difference. Twelve radiologists evaluated the presence of objects on a five-point scale. The performances of the DLA and radiologists were compared across different imaging conditions in terms of area under receiver operating characteristics curve (AUC). Multi-reader multi-case AUC and Hanley and McNeil tests were used. We performed post-hoc analysis using bootstrapping and verified that the DLA is less affected by the changing imaging conditions. The AUC of DLA was consistently higher than those of the radiologists across different imaging conditions ( < 0.0001), and it was less affected by varying imaging conditions. The DLA outperformed the radiologists and showed more robust performance under varying imaging conditions.
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http://dx.doi.org/10.3390/diagnostics11030410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997324PMC
February 2021

Treatment with phosphodiester CpG-ODN ameliorates atopic dermatitis by enhancing TGF-β signaling.

BMB Rep 2021 Feb;54(2):142-147

Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Synthetic oligodeoxynucleotides (ODNs) containing unmethylated CpG phosphorothioate (PS CpG-ODN) are known to decrease IgE synthesis in Th2 allergy responses. Nonetheless, the therapeutic role of PS CpG-ODN is limited due to cytotoxicity. Therefore, we developed a phosphodiester (PO) form of CpG-ODN (46O) with reduced toxicity but effective against allergies. In this study, we first compared the toxicity of 46O with CpG-ODNs containing a PS backbone (1826S). We also investigated the therapeutic efficacy and mechanism of 46O injected intravenously in a mouse model of ovalbumin (OVA)-induced atopic dermatitis (AD). To elucidate the mechanism of 46O underlying the inhibition of IgE production, IgE- and TGF-􀁅-associated molecules were evaluated in CD40/IL-4- or LPS/IL-4-stimulated B cells. Our data showed that the treatment with 46O was associated with a lower hematological toxicity compared with 1826S. In addition, injection with 46O reduced erythema, epidermal thickness, and suppressed IgE and IL-4 synthesis in mice with OVA-induced AD. Additionally, 46O induced TGF-β production in LPS/IL-4-stimulated B cells via inhibition of Smad7, which suppressed IgE synthesis via interaction between Id2 and E2A. These findings suggest that enhanced TGF-β signaling is an effective treatment for IgE-mediated allergic conditions, and 46O may be safe and effective for treating allergic diseases such as AD and asthma. [BMB Reports 2021; 54(2): 142-147].
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907740PMC
February 2021

Home-Based Intervention to Test and Start (HITS): a community-randomized controlled trial to increase HIV testing uptake among men in rural South Africa.

J Int AIDS Soc 2021 02;24(2):e25665

Africa Health Research Institute, Durban, South Africa.

Introduction: The uptake of HIV testing and linkage to care remains low among men, contributing to high HIV incidence in women in South Africa. We conducted the "Home-Based Intervention to Test and Start" (HITS) in a 2x2 factorial cluster randomized controlled trial in one of the World's largest ongoing HIV cohorts in rural South Africa aimed at enhancing both intrinsic and extrinsic motivations for HIV testing.

Methods: Between February and December 2018, in the uMkhanyakude district of KwaZulu-Natal, we randomly assigned 45 communities (clusters) (n = 13,838 residents) to one of the four arms: (i) financial incentives for home-based HIV testing and linkage to care (R50 [$3] food voucher each); (ii) male-targeted HIV-specific decision support application, called EPIC-HIV; (iii) both financial incentives and male-targeted HIV-specific decision support application and (iv) standard of care (SoC). EPIC-HIV was developed to encourage and serve as an intrinsic motivator for HIV testing and linkage to care, and individually offered to men via a tablet device. Financial incentives were offered to both men and women. Here we report the effect of the interventions on uptake of home-based HIV testing among men. Intention-to-treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster levels.

Results: Among all 13,838 men ≥ 15 years living in the 45 communities, the overall population coverage during a single round of home-based HIV testing was 20.7%. The uptake of HIV testing was 27.5% (683/2481) in the financial incentives arm, 17.1% (433/2534) in the EPIC-HIV arm, 26.8% (568/2120) in the arm receiving both interventions and 17.8% in the SoC arm. The probability of HIV testing increased substantially by 55% in the financial incentives arm (risk ratio (RR)=1.55, 95% CI: 1.31 to 1.82, p < 0.001) and 51% in the arm receiving both interventions (RR = 1.51, 95% CI: 1.21 to 1.87 p < 0.001), compared to men in the SoC arm. The probability of HIV testing did not significantly differ in the EPIC-HIV arm (RR = 0.96, 95% CI: 0.76 to 1.20, p = 0.70).

Conclusions: The provision of a small financial incentive acted as a powerful extrinsic motivator substantially increasing the uptake of home-based HIV testing among men in rural South Africa. In contrast, the counselling and testing application which was designed to encourage and serve as an intrinsic motivator to test for HIV did not increase the uptake of home-based testing.
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http://dx.doi.org/10.1002/jia2.25665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883477PMC
February 2021

Effects of hyaluronic acid and deproteinized bovine bone mineral with 10% collagen for ridge preservation in compromised extraction sockets.

J Periodontol 2021 Jan 23. Epub 2021 Jan 23.

Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.

Background: The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets.

Methods: Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry.

Results: At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments.

Conclusions: Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.
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http://dx.doi.org/10.1002/JPER.20-0832DOI Listing
January 2021

Risk of Hematologic Malignant Neoplasms From Abdominopelvic Computed Tomographic Radiation in Patients Who Underwent Appendectomy.

JAMA Surg 2021 Apr;156(4):343-351

Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.

Importance: Whether computed tomography (CT) radiation is truly carcinogenic remains controversial. Large epidemiological studies that purportedly showed an association between CT radiation and carcinogenesis were limited by confounding by indication and reverse causation, because the reasons for CT examination were unknown.

Objective: To measure the risk of hematologic malignant neoplasms associated with perioperative abdominopelvic CT radiation among patients who underwent appendectomy for acute appendicitis.

Design, Setting, And Participants: This nationwide population-based cohort study used the National Health Insurance Service claims database in South Korea to assess 825 820 patients who underwent appendectomy for appendicitis from January 1, 2005, to December 31, 2015, and had no underlying risk factors for cancer. Patients were divided into CT-exposed (n = 306 727) or CT-unexposed (n = 519 093) groups. The study was terminated on December 31, 2017, and data were analyzed from October 30, 2018, to September 27, 2020.

Exposures: Perioperative abdominopelvic CT examination from 7 days before to 7 days after appendectomy.

Main Outcomes And Measures: The primary outcome was the incidence rate ratio (IRR) of hematologic malignant neoplasms for both groups. The secondary outcomes were IRR of abdominopelvic organ cancers and IRR of all cancers. The lag period was 2 years for the primary outcome and 5 years for secondary outcomes. The IRRs were calculated using Poisson regression models with adjustment for age and sex.

Results: Among the study population of 825 820 patients (52.9% male; median age, 28 [interquartile range, 15-41] years), hematologic malignant neoplasms developed in 323 patients in the CT-exposed group during 1 486 518 person-years and 500 patients in the CT-unexposed group during 3 422 059 person-years. For all hematologic malignant neoplasms, the IRR for the CT-exposed vs CT-unexposed group was 1.26 (95% CI, 1.09-1.45; P = .002). In terms of individual categories of hematologic malignant neoplasms, the CT-exposed group had an elevated risk only for leukemia (IRR, 1.40 [98.75% CI, 1.04-1.87, adjusted by Bonferroni correction]; P = .005). There was no between-group difference in incidence rate of abdominopelvic organ cancers (IRR, 1.07 [95% CI, 1.00-1.15]; P = .06) and that of all cancers (IRR, 1.04 [95% CI, 0.99-1.09]; P = .14).

Conclusions And Relevance: This study controlled for reverse causation bias by defining the reasons for CT scan, and findings suggest that abdominopelvic CT radiation is associated with a higher incidence of hematologic malignant neoplasms. Efforts should be continued for judicious use of CT examinations.
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http://dx.doi.org/10.1001/jamasurg.2020.6357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047726PMC
April 2021

Predicting survival time of Korean hepatocellular carcinoma patients using the Cox proportional hazards model: a retrospective study based on big data analysis.

Eur J Gastroenterol Hepatol 2021 07;33(7):1001-1008

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Pusan National University College of Medicine, Busan, Korea.

Aim: To predict survival time of Korean hepatocellular carcinoma (HCC) patients by analyzing big data using Cox proportional hazards model.

Methods: Big data of the patients who underwent treatment for HCC from 2008 to 2015, provided by Korea Central Cancer Registry, National Cancer Center, and Ministry of Health and Welfare, were analyzed. A total of 10 742 patients with HCC were divided into two groups, with Group I (3021 patients) confirmed on biopsy and Group II (5563 patients) diagnosed as HCC according to HCC diagnostic criteria as outlined in Korean Liver Cancer Association guidelines. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of recurrence after treatment and survival status.

Results: A total of 3021 patients in Group I and 5563 patients in Group II were included in the study and the difference in survival time between the two groups was statistically significant (P < 0.05). Recurrence was only included in intrahepatic cases, and the rates were 21.2 and 19.8% while the periods from the first treatment to recurrence were 15.57 and 14.19 months, respectively. Age, diabetes, BMI, platelet, alpha-fetoprotein, histologic tumor maximum size, imaging T stage, presence of recurrence, and duration of recurrence were included in multivariate analysis.

Conclusion: By using nationwide, multicenter big data, it is possible to predict recurrence rate and survival time which can provide the basis for treatment response to develop a predictive program.
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http://dx.doi.org/10.1097/MEG.0000000000002058DOI Listing
July 2021

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

J Assoc Nurses AIDS Care 2021 Jan 13. Epub 2021 Jan 13.

Athanase Munyaneza, RN, MPH, is a Research Operations and Nurse Coordinator, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Adebola Adedimeji, PhD, MPH, is an Associate Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. Hae-Young Kim, DrPH, is an Associate Professor and Director of Biostatistics Division, Department of Public Health, New York Medical College, Valhalla, New York, USA. Qiuhu Shi, PhD, is a Biostatistician, Department of Public Health, New York Medical College, Valhalla, New York, USA. Donald R. Hoover, PhD, is a Biostatistician, Department of Statistics and Institute for Health, Health-Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA. Jonathan Ross, MD, MSc, is an Assistant Professor, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA. Lynn Murchison, MPH, is a Grant Manager, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA. Gad Murenzi, MD, MPH, is a Program Director, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Jules Kabahizi, MD, is a Chief Consultant Physician, Division of General Internal Medicine, Rwanda Military Hospital (RMH), Kigali, Rwanda. Josephine Gasana, BSc, is a Social Worker, Rwanda Military Hospital (RMH), Kigali, Rwanda. Boniface Nsengiyumva, MSc, is a Biostatistician, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Gallican Kubwimana, MBA, is a Grant Manager, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Faustin Kanyabwisha, MPH, is a Senior Laboratory Technician, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Benjamin Muhoza, MSc, is a Database Manager, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Charles Ingabire, MPH, is a Qualitative Research Coordinator, Division of Clinical Education and Research, Rwanda Military Hospital (RMH), Kigali, Rwanda. Leon Mutesa, MD, PhD, is a Professor, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. Philip E. Castle, PhD, MPH, is a Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. Joel M. Palefsky, MD, is a Professor of Medicine, Department of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA. Kathryn Anastos, MD, is a Professor of Medicine and Population Health, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA. Viraj V. Patel, MD, MPH, is an Assistant Professor, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.

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http://dx.doi.org/10.1097/JNC.0000000000000228DOI Listing
January 2021

Prevalence and Characteristics of Neuropathic Pain in Patients With Spinal Cord Injury Referred to a Rehabilitation Center.

Ann Rehabil Med 2020 Dec 31;44(6):438-449. Epub 2020 Dec 31.

Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea.

Objective: To identify the prevalence and characteristics of neuropathic pain (NP) in patients with spinal cord injury (SCI) and to investigate associations between NP and demographic or disease-related variables.

Methods: We retrospectively reviewed medical records of patients with SCI whose pain was classified according to the International Spinal Cord Injury Pain classifications at a single hospital. Multiple statistical analyses were employed. Patients aged <19 years, and patients with other neurological disorders and congenital conditions were excluded.

Results: Of 366 patients, 253 patients (69.1%) with SCI had NP. Patients who were married or had traumatic injury or depressive mood had a higher prevalence rate. When other variables were controlled, marital status and depressive mood were found to be predictors of NP. There was no association between the prevalence of NP and other demographic or clinical variables. The mean Numeric Rating Scale (NRS) of NP was 4.52, and patients mainly described pain as tingling, squeezing, and painful cold. Females and those with below-level NP reported more intense pain. An NRS cut-off value of 4.5 was determined as the most appropriate value to discriminate between patients taking pain medication and those who did not.

Conclusion: In total, 69.1% of patients with SCI complained of NP, indicating that NP was a major complication. Treatment planning for patients with SCI and NP should consider that marital status, mood, sex, and pain subtype may affect NP, which should be actively managed in patients with an NRS ≥4.5.
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http://dx.doi.org/10.5535/arm.20081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808793PMC
December 2020

Low-Dose Triple Antihypertensive Combination Therapy in Patients with Hypertension: A Randomized, Double-Blind, Phase II Study.

Drug Des Devel Ther 2020 31;14:5735-5746. Epub 2020 Dec 31.

Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi, Republic of Korea.

Purpose: We evaluated the dose-responsiveness, efficacy, and safety of low-dose triple antihypertensive combination therapies in patients with mild-to-moderate hypertension.

Patients And Methods: After a 1 to 2-week placebo run-in period, 248 patients were randomized to the half-dose triple combination (amlodipine 2.5 mg + losartan 25 mg + chlorthalidone 6.25 mg), third-dose triple combination (amlodipine 1.67 mg + losartan 16.67 mg + chlorthalidone 4.17 mg), quarter-dose triple combination (amlodipine 1.25 mg + losartan 12.5 mg + chlorthalidone 3.13mg), amlodipine 10mg, amlodipine 5mg, losartan 100mg, and placebo groups for 8 weeks. The primary outcome was the mean change in systolic blood pressure (SBP) from baseline to week 8.

Results: The placebo-corrected SBP reductions of the half-dose, third-dose, quarter-dose combination, amlodipine 10 mg, amlodipine 5 mg and losartan 100 mg treatments were -17.2, -19.5, -14.9, -18.5, -11.3 and -9.9 mmHg, respectively. The BP control and response rates were significantly higher in the half-dose, third-dose, and quarter-dose combination groups than in the placebo group (all p < 0.01). Despite no intergroup differences in study drug-related adverse events, ankle circumference increased significantly in the amlodipine group compared to those in the combination treatment groups. The quarter-dose combination, amlodipine 5 mg, and losartan 100 mg groups showed similar SBP reduction and BP response rates. The SBP reduction and BP response rate in the third-dose and half-dose combination groups were not significantly different from those in the amlodipine 10 mg group but superior to those in the losartan 100 mg group.

Conclusion: Low-dose triple combination therapies could be effective as antihypertensive therapies.

Trial Registration: ClinicalTrials.gov identifier NCT03897868.
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http://dx.doi.org/10.2147/DDDT.S286586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781016PMC
September 2021

Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial.

J Clin Periodontol 2021 03 19;48(3):464-477. Epub 2021 Jan 19.

Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea.

Objective: To verify whether ridge preservation is effective in the reduction of dimensional loss and in bone formation compared to spontaneous healing in extraction sockets of periodontally compromised teeth.

Methods: Twenty-six subjects requiring tooth extraction for stage III/IV periodontitis were randomly assigned to one of two interventions: alveolar ridge preservation using collagenated bovine bone mineral and a resorbable collagen membrane (test, RP) or spontaneous healing (control, SH). Six months later, postoperative cone-beam computed tomography (CBCT) was performed to measure the linear and volumetric changes of the sockets compared to baseline scans. Biopsies were retrieved at the implant site for histomorphometric calculations. Nonparametric tests were applied for statistical analysis.

Results: Significantly less shrinkage occurred in RP compared to SH, mainly in the crestal zone. The width loss difference between groups was 3.3 mm and 2.2 mm at 1 mm and 3 mm below the crest, respectively (p < .05). RP yielded a gain in socket height of 0.25 mm, whereas a loss of -0.39 mm was observed in SH (p < .05). The percentage of volume loss recorded in RP was also less than that recorded in SH (-26.53% vs -50.34, p < .05). Significantly less bone proportion was detected in biopsies from RP (30.1%) compared with SH (53.9%). A positive association between baseline bone loss and ridge shrinkage was found in SH but not in RP.

Conclusion: Ridge preservation in extraction sockets of periodontally compromised teeth was effective in reducing the amount of ridge resorption.
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http://dx.doi.org/10.1111/jcpe.13412DOI Listing
March 2021

Influence of Connections and Surfaces of Dental Implants on Marginal Bone Loss: A Retrospective Study Over 7 to 19 Years.

Int J Oral Maxillofac Implants 2020 Nov/Dec;35(6):1195-1202

Purpose: This retrospective study compared the long-term outcomes of dental implants according to type of connection and surface.

Materials And Methods: Multiunit restorations were classified as follows: an external connection with a turned surface, an external connection with an anodized surface, or an internal connection with a fluoride-modified surface. Patients who were followed up for longer than 7 years after implant loading were included in the study. Cumulative implant survival rates and the amounts of marginal bone loss were calculated by reviewing dental records and radiographs. Only implants that survived until the last follow-up visit were included in the analysis of marginal bone loss. Statistical analyses were performed to detect between-group differences at the significance level of .05.

Results: Sixty-nine patients with 261 bone-level implants were included. The average follow-up duration was 15.2 years in the external turned group, 10.6 years in the external anodized group, and 9.9 years in the internal fluoride-modified group. There was no significant between-group difference in the cumulative survival rate (P = .439) despite eight implant failures (six in the external turned group and two in the internal fluoride-modified group). The mean (SD) marginal bone loss values at the last follow-up were 0.47 mm (0.67), 0.87 mm (1.07), and 0.23 mm (0.58) in the external turned, external anodized, and internal fluoride-modified groups, respectively. After adjusting for follow-up duration, there was significantly less marginal bone loss in the external turned group than in the external anodized group (P < .001) and in the internal fluoride-modified group than in the external anodized group (P < .001). No significant difference in marginal bone loss was found between the external turned and internal fluoride-modified groups (P = .44).

Conclusion: The implant-abutment connection structure is an important contributor to the maintenance of the level of marginal bone surrounding the implant. Implant surface characteristics are another contributor to marginal bone resorption.
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http://dx.doi.org/10.11607/jomi.8450DOI Listing
December 2020

Efficacy and Safety of Nebivolol and Rosuvastatin Combination Treatment in Patients with Concomitant Hypertension and Hyperlipidemia.

Drug Des Devel Ther 2020 17;14:5005-5017. Epub 2020 Nov 17.

Department of Health Policy and Management, College of Health Science & Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea.

Purpose: We evaluated the efficacy and safety of nebivolol and rosuvastatin combination treatment in patients with hypertension and hyperlipidemia.

Patients And Methods: Eligible patients, after more than 4 weeks of therapeutic lifestyle change, were randomly assigned to three groups: 5 mg nebivolol plus 20 mg rosuvastatin (NEBI/RSV), 20 mg rosuvastatin (RSV), or 5 mg nebivolol (NEBI). Treatments lasted 8 weeks.

Results: Efficacy was analyzed using data from 276 patients. Sitting systolic and diastolic blood pressures differed between the NEBI/RSV and RSV groups (LSmean difference = -5.89 and -5.99 mmHg; 95% confidence interval [CI] = -9.88 to -1.90 mmHg and -8.13 to -3.84 mmHg, respectively). Reductions in the two pressures did not differ between the NEB/RSV and NEB groups. The percent reduction in low-density lipoprotein (LDL) cholesterol differed between the NEBI/RSV and NEBI groups (LSmean difference = -47.76%, 95% CI = -52.69 to -42.84%) but not between the NEBI/RSV and RSV groups. The blood pressure (BP) control rate was higher in the NEBI/RSV group than in the RVS group (51.09% vs 29.67%, = 0.003). The LDL cholesterol goal achievement rate was higher in the NEBI/RSV group than in the NEBI group (85.87% vs 11.83%, < 0.001). The incidence of adverse drug reactions in the NEBI/RSV, RSV, and NEBI groups was 8.51%, 7.45%, and 8.60%, respectively ( = 0.950).

Conclusion: Nebivolol plus rosuvastatin treatment is effective in reducing BP and LDL cholesterol levels and is safe in patients with hypertension and hypercholesterolemia without the loss of BP or the LDL cholesterol-lowering effect of each drug.

Trial Registration: CRIS registration number KCT0002148.
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http://dx.doi.org/10.2147/DDDT.S280055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680129PMC
August 2021
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