Publications by authors named "Hye Sun Lee"

406 Publications

Influence of age on gender-related differences in acute kidney injury after minimally invasive radical or partial nephrectomy.

Surg Endosc 2021 Jun 11. Epub 2021 Jun 11.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Background: Female gender is known to be protective against acute kidney injury (AKI) after radical or partial nephrectomy and estrogen is considered a protective factor. If estrogen is a major contributor to the protective effects of female gender against renal injury, these protective effects may be diminished in postmenopausal women. Therefore, this retrospective study investigated the influence of female age on gender-related differences in AKI after minimally invasive radical or partial nephrectomy.

Methods: Patients who underwent minimally invasive radical (n = 765) or partial (n = 1161) nephrectomy were selected. These patients were stratified by gender and divided into three age categories considered to be pre, peri, and postmenopausal periods in women: ≤ 40 years, 41-59 years, and ≥ 60 years, respectively. Adjusted logistic regression analyses were conducted to identify the risk of AKI according to gender and age.

Results: The incidence of AKI after radical or partial nephrectomy was significantly higher in men as compared to women in all age categories. Women aged ≥ 60 years had a significantly increased risk of AKI as compared to women aged < 60 years in radical nephrectomy, but not in partial nephrectomy. When compared with women aged ≥ 60 years, men aged > 40 years accompanied significantly higher risk of AKI following both radical and partial nephrectomy, even after adjusting confounders. However, men aged ≤ 40 years had a similar risk of AKI after radical nephrectomy, but a significantly higher risk after partial nephrectomy as compared to women aged ≥ 60 years.

Conclusion: Male gender was associated with a higher risk of AKI after radical and partial nephrectomy as compared to postmenopausal women. This calls for more thorough preoperative counseling and renal protective strategies in male patients when undergoing radical and partial nephrectomy.
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http://dx.doi.org/10.1007/s00464-021-08590-zDOI Listing
June 2021

Prognostic significance of bone marrow and spleen F-FDG uptake in patients with colorectal cancer.

Sci Rep 2021 Jun 9;11(1):12137. Epub 2021 Jun 9.

Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.

Serum inflammatory markers are used in the prognostication of colorectal cancer (CRC); however, the corresponding role of positron emission tomography (PET)-derived inflammatory markers remains unclear. This study aimed to investigate the prognostic value of F-fluorodeoxyglucose (FDG) uptake in the bone marrow and spleen of patients with CRC and evaluate the relationship between FDG uptake estimates in these organs and serum inflammatory markers. In total, 411 patients who underwent preoperative FDG PET/computed tomography (CT) within 1 month of surgery were enrolled. The mean standardized uptake values of the bone marrow and spleen were normalized to the value of the liver, thereby generating bone marrow-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) estimates. The value of BLR and SLR in predicting overall survival (OS) was assessed using the Cox proportional hazards model. The correlation between BLR or SLR and neutrophil-to-lymphocyte ratio (NLR) was evaluated. The predictive accuracy of BLR alone and in combination with SLR was compared using the integrated area under the receiver operating characteristic curves (iAUC). In the univariate analysis, BLR (> 1.06) and SLR (> 0.93) were significant predictors of OS. In the multivariate analysis, BLR was an independent predictor of OS (hazard ratio = 5.279; p < 0.001). Both BLR and SLR were correlated with NLR (p < 0.001). A combination of BLR and SLR was better than BLR alone at CRC prognostication (iAUC, 0.561 vs. 0.542). FDG uptake estimates in the bone marrow and spleen may be useful imaging-derived biomarkers of systemic inflammation, supporting CRC prognostication.
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http://dx.doi.org/10.1038/s41598-021-91608-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190120PMC
June 2021

The influence of positive end-expiratory pressure (PEEP) in predicting fluid responsiveness in patients undergoing one-lung ventilation.

Int J Med Sci 2021 29;18(12):2589-2598. Epub 2021 Apr 29.

Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, University of Hallym College of Medicine, Seoul, Korea.

Dynamic preload parameters such as pulse pressure variation (PPV) and stroke volume variation (SVV) have widely been used as accurate predictors for fluid responsiveness in patients under mechanical ventilation. To circumvent the limitation of decreased cyclic change of intrathoracic pressure, we performed an intermittent PEEP challenge test to evaluate whether PPV or SVV can predict fluid responsiveness during one-lung ventilation (OLV). Forty patients undergoing OLV were analyzed. Baseline hemodynamic variables including PPV and SVV and respiratory variables were recorded after chest opening in lateral position under OLV (T1). Five minutes after application of PEEP 10 cmHO, the parameters were recorded (T2). Thereafter, PEEP was withdrawn to 0 cmHO for 5 minutes (T3), and fluid loading was performed with balanced crystalloid solution 6 mL/kg of ideal body weight for 5 minutes. Five minutes after completion of fluid loading, all variables were recorded (T4). The patient was classified as fluid responder if SV increased ≥10% after fluid loading and as non-responder if SV increased <10%. Prediction of fluid responsiveness was evaluated with area under the receiver operating characteristic (ROC) curve (AUC). Change in stroke volume variation (ΔSVV) showed AUC of 0.9 (P < 0.001), 95% CI = 0.82-0.99, sensitivity = 88%, specificity = 82% for discrimination of fluid responsiveness. Change in pulse pressure variation (ΔPPV) showed AUC of 0.88 (P < 0.001), 95% CI = 0.78-0.97, sensitivity = 83%, specificity = 72% in predictability of fluid responsiveness. Cardiac index and stroke volume were well maintained after PEEP challenge in non-responders while they increased in responders. ΔPPV and ΔSVV induced by PEEP challenge are reliable parameters to predict fluid responsiveness as well as very good predictors of fluid unresponsiveness during OLV.
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http://dx.doi.org/10.7150/ijms.59653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176162PMC
April 2021

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion.

J Stroke 2021 May 31;23(2):244-252. Epub 2021 May 31.

Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.

Background And Purpose: We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.

Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.

Results: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).

Conclusions: The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.
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http://dx.doi.org/10.5853/jos.2020.03622DOI Listing
May 2021

Association between longitudinal blood pressure and prognosis after treatment of cerebral aneurysm: A nationwide population-based cohort study.

PLoS One 2021 27;16(5):e0252042. Epub 2021 May 27.

Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.

Background: High blood pressure is a major risk factor for the development and rupture of cerebral aneurysm. Endovascular coil embolization and surgical clipping are established procedures to treat cerebral aneurysm. However, longitudinal data of blood pressure after the treatment of cerebral aneurysm and its impact on long-term prognosis are not well known.

Methods: This retrospective cohort study included 1275 patients who underwent endovascular coil embolization (n = 558) or surgical clipping (n = 717) of cerebral aneurysm in 2002-2015 using the nationwide health screening database of Korea. Systolic and diastolic blood pressure of patients were repeatedly obtained from the nationwide health screening program. We performed a multivariate time-dependent Cox regression analysis of the primary composite outcome of stroke, myocardial infarction, and all-cause death.

Results: During the mean follow-up period of 6.13 ± 3.41 years, 89 patients suffered the primary outcome. Among the total 3546 times of blood pressure measurement, uncontrolled high blood pressure (systolic ≥140 mmHg or diastolic ≥90 mmHg) was 22.9%. There was a significantly increased risk of primary outcome with high systolic (adjusted HR [95% CI] per 10 mmHg, 1.16 [1.01-1.35]) and diastolic (adjusted HR [95% CI] per 10 mmHg, 1.32 [1.06-1.64]) blood pressure.

Conclusions: High blood pressure is prevalent even in patients who received treatment for cerebral aneurysm, which is significantly associated with poor outcome. Strict control of high blood pressure may further improve the prognosis of patients with cerebral aneurysm.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252042PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158927PMC
May 2021

Androgen-deprivation therapy and the risk of newly developed fractures in patients with prostate cancer: a nationwide cohort study in Korea.

Sci Rep 2021 May 12;11(1):10057. Epub 2021 May 12.

Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.

We evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer. From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. After applying the inclusion and exclusion criteria, a total of 144,670 patients were included in the analysis. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT, after controlling for potential confounding factors. In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305-1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI, 1.703-1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased. The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients. Clinicians who administer ADT for patients with prostate cancer should always be mindful of the risk of osteoporosis and fracture, avoid unnecessary ADT, and perform regular bone health check-ups.
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http://dx.doi.org/10.1038/s41598-021-89589-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115250PMC
May 2021

Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea.

Lipids Health Dis 2021 May 11;20(1):49. Epub 2021 May 11.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.

Background: The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets.

Methods: This study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived.

Results: The combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets.

Conclusions: Smoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.
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http://dx.doi.org/10.1186/s12944-021-01472-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111749PMC
May 2021

Comparison of EQ-5D-3L and metabolic components between patients with hyperhidrosis and the general population: a propensity score matching analysis.

Qual Life Res 2021 May 11. Epub 2021 May 11.

Department of Family Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Korea.

Purpose: It is important to understand the characteristics of patients with hyperhidrosis, which are different from the general population, for treating hyperhidrosis. Sympathetic overactivity, which might play an important role in hyperhidrosis, can contribute to metabolic diseases and the decreased quality of life (QoL). We compared the metabolic components and health-related QoL between patients with hyperhidrosis and the general population.

Methods: We conducted a case-control study and compared the characteristics of the patients (N = 196) with hyperhidrosis and propensity score-matched controls (N = 196) selected from the Korean National Health and Nutrition Examination Survey. Metabolic components and EQ-5D-3L (EQ-5D) index were compared using a two-way mixed analysis of covariance after adjusting for confounders.

Results: Patients with hyperhidrosis had significantly higher waist circumference (estimated mean values ± SD for patients and the control group, 85.5  ±  10.8 cm vs 81.3  ±  10.3 cm, p < 0.001), blood pressure (SBP, 121.1  ±  16.9 vs 111.7  ±  10.3, p < 0.001 AND DBP, 77.5  ±  12.8 vs 73.6  ±  8.6, p < 0.001, respectively), fasting glucose (97.1  ±  11.3 vs 91.5  ±  9.2, p < 0.001), and the number of components of metabolic syndrome (1.4  ±  1.3 vs 1.0  ±  1.2, p = 0.002), and significantly lower estimated glomerular filtration rate (144.3  ±  53.2 vs 158.3  ±  55.7, p = 0.002) and EQ-5D values (estimated mean values (standard error) for patients and the control group, 0.92 (0.01) vs 0.97 (0.01), p < 0.001) compared to the control group after adjustment.

Conclusion: The patients with hyperhidrosis had more central obesity and unfavorable metabolic parameters and a lower EQ-5D index compared with the general population, emphasizing clinical importance of hyperhidrosis to be cured in aspect of metabolic components as well as patients' QOL.
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http://dx.doi.org/10.1007/s11136-021-02856-8DOI Listing
May 2021

Postoperative pain assessment of robotic nipple-sparing mastectomy with immediate prepectoral prosthesis breast reconstruction: a comparison with conventional nipple-sparing mastectomy.

Int J Med Sci 2021 17;18(11):2409-2416. Epub 2021 Apr 17.

Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

Nipple-sparing mastectomy (NSM) is a surgical procedure for patients with breast cancer without nipple-areolar complex (NAC) involvement. Robotic NSM (RNSM) with immediate breast reconstruction has been recently introduced; however, reports regarding RNSM are still lacking. Therefore, this study aimed to evaluate the postoperative assessment with a focus on postoperative pain of RNSM with prepectoral immediate prosthesis breast reconstruction (IPBR) compared with conventional NSM (CNSM) in patients with breast cancer without NAC invasion. This retrospective study included 81 patients who underwent RNSM (n = 40) or CNSM (n = 41) with prepectoral IPBR using direct-to-implant or tissue expander between January 2018 and June 2020. The primary endpoint was to compare postoperative pain intensity based on a numerical rating scale (NRS). The secondary endpoint was to evaluate the postoperative recovery profile, including postoperative nausea/vomiting (PONV) and complications. A statistical difference was observed in the resting NRS scores at 0-6 postoperative hours between the RNSM and CNSM groups (3.2 ± 1.5 versus 4.2 ± 1.6, respectively; Bonferroni corrected = 0.005), however, no difference was shown at other time periods. Also, no between-group difference was found in the NRS scores for acting pain within 48 postoperative hours and the number of patients requiring additional analgesics. Despite a statistical difference in the resting NRS scores during the early postoperative phase, the absence of any significant difference in the requirement of additional analgesics between the groups suggested that RNSM does not significantly attenuate postoperative pain intensity.
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http://dx.doi.org/10.7150/ijms.56997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100638PMC
April 2021

Clinical utility of methionyl-tRNA synthetase 1 immunostaining in cytologic brushings of indeterminate biliary strictures: a multicenter prospective study.

Gastrointest Endosc 2021 May 6. Epub 2021 May 6.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine. Electronic address:

Background And Aims: Endobiliary brushings are routinely used in the diagnosis, treatment, and prognostication of biliary strictures. However, standard Papanicolaou (Pap) staining has a low sensitivity in this setting, and the accuracy of brush cytology has not been established for indeterminate strictures. We therefore evaluated the diagnostic merit of methionyl-tRNA synthetase 1 (MARS1) immunofluorescence (IF) staining in such cytologic specimens.

Methods: During endoscopic retrograde cholangiopancreatography, endobiliary brushings were obtained from patients with extrahepatic biliary strictures prospectively enrolled at 6 tertiary hospitals. Using liquid-based cytologic preparations of these samples, we performed Pap and MARS1 IF staining.

Results: In total, 240 patients were eligible; of these, we compared the Pap and MARS1 IF staining results of 218 (malignant, 157; benign, 61). By conventional Pap staining, the diagnoses were distributed as follows: malignant, 55 suspicious of malignancy, 60 atypical, 45; and negative for malignancy, 58. MARS1 IF staining was strongly positive in malignant biliary stricture, but not so in specimens negative for malignancy. The diagnostic parameters (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the MARS1 IF (93.6%, 96.7%, 98.7%, 85.5%, and 94.5%, respectively) and conventional Pap (73.2%, 100%, 100%, 59.2%, and 80.7%, respectively) staining methods differed significantly (p < 0.0001).

Conclusions: The high sensitivity and accuracy of MARS1 IF staining enabled detection of malignancy in patients with biliary strictures. Further prospective studies are needed to validate our findings (NCT03708445 at ClinicalTrials.gov).
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http://dx.doi.org/10.1016/j.gie.2021.04.026DOI Listing
May 2021

Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson's disease.

J Neurol 2021 May 4. Epub 2021 May 4.

Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Objectives: To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson's disease (PD).

Methods: We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED).

Results: Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED.

Conclusions: These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.
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http://dx.doi.org/10.1007/s00415-021-10529-2DOI Listing
May 2021

Relationship between muscle mass index and LDL cholesterol target levels: Analysis of two studies of the Korean population.

Atherosclerosis 2021 05 31;325:1-7. Epub 2021 Jan 31.

Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Gyeonggi-do, Republic of Korea. Electronic address:

Background And Aims: Decreased skeletal muscle mass is an important change in body composition with aging. Maintaining the optimal low-density lipoprotein (LDL) cholesterol level is crucial for the prevention of cardiovascular diseases (CVD). We investigated whether muscle mass was associated with dyslipidemia.

Methods: We analyzed the data of 17,546 adults from the 2008-2011 Korean National Health and Nutrition Examination Survey (KNHANES) and 5126 adults from the Korean Genome and Epidemiology Study (KoGES). Participants were classified into the lower skeletal muscle mass index (LSMI) group and normal group. LSMI was defined as body mass index (BMI)-adjusted appendicular skeletal muscle mass <0.789 (men) and <0.512 (women) in the KNHANES, and as sex-specific lowest quintile of the BMI-adjusted total skeletal muscle mass in the KoGES. Participants were defined as having dyslipidemia when the serum LDL cholesterol levels were higher than their LDL cholesterol management targets based on their CVD risk level.

Results: The odds ratio with 95% confidence interval (CI) for dyslipidemia of the LSMI group was 1.230 (1.016-1.488, p = 0.034) after adjusting for confounding variables compared to the normal group in the 2008-2011 KNHANES. In the KoGES, the hazard ratio with 95% CI for incident dyslipidemia of the LSMI group compared to the normal group was 1.225 (1.101-1.364, p < 0.001). Regardless of abdominal obesity, LSMI was significantly associated with a higher risk of incident dyslipidemia.

Conclusions: LSMI was associated with dyslipidemia regardless of abdominal obesity. Prevention of muscle mass loss may be an important strategy for LDL cholesterol management.
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http://dx.doi.org/10.1016/j.atherosclerosis.2021.01.016DOI Listing
May 2021

Inverse association between serum bilirubin level and testosterone deficiency in middle-aged and older men.

Sci Rep 2021 Apr 13;11(1):8026. Epub 2021 Apr 13.

Department of Family medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Low serum bilirubin levels have been associated with increased risk of cardiovascular disease (CVD) and metabolic syndrome. Testosterone deficiency could also contribute to increased risk of CVD and metabolic syndrome. Therefore, this study aimed to examine the relationship between serum bilirubin level and testosterone deficiency in 1284 Korean men aged 45 to 70 years. Serum bilirubin level was categorized into quartiles: Q1 ≤ 0.7, Q2 0.8-0.9, Q3 1.0-1.1, and Q4 ≥ 1.2 mg/dL. Testosterone deficiency was defined as level less than 8.0 nmol/L, as suggested by the position statement of International Society of Andrology. The overall prevalence of testosterone deficiency was 5.8% and significantly decreased with the quartiles from Q1 to Q4. Compared with the referent fourth quartile (serum bilirubin ≥ 1.2 mg/dL), the ORs (95% CIs) for testosterone deficiency was 2.29 (1.04-4.94) for the first quartile after adjusting for age, fasting glucose, triglyceride, HDL-cholesterol, leukocyte count, hemoglobin, smoking status, and alcohol intake. We found inversely graded associations of serum bilirubin level with testosterone deficiency. These findings suggest that low bilirubin level may be interpreted as a state of testosterone deficiency in middle-aged and older men.
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http://dx.doi.org/10.1038/s41598-021-87220-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044079PMC
April 2021

White Blood Cell Count as a Predictor of Incident Type 2 Diabetes Mellitus Among Non-Obese Adults: A Longitudinal 10-Year Analysis of the Korean Genome and Epidemiology Study.

J Inflamm Res 2021 1;14:1235-1242. Epub 2021 Apr 1.

Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.

Purpose: Limited evidence is available on whether the white blood cell (WBC) count is a predictor of type 2 diabetes mellitus (T2DM) in non-obese individuals. This study aimed to determine whether WBC count could be used as an indicator for the prediction of incident T2DM among non-obese individuals using a large, community-based Korean cohort that was observed over 10 years.

Patients And Methods: A total of 4211 non-obese adults without diabetes aged 40-69 years were selected from the Korean Genome and Epidemiology Study. The participants were divided into four groups according to WBC count quartiles. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM, based on the American Diabetes Association criteria, using multivariate Cox proportional hazards regression models over 10 years after the baseline survey.

Results: During the follow-up period, 592 (14.1%) participants had newly developed T2DM. The higher quartile of WBC count groups showed significantly higher cumulative T2DM incidence over 10 years after the baseline survey (log-rank test, P < 0.001). Compared with the HRs for individuals in the referent lowest quartile, the HR (95% CI) for incident T2DM in individuals in the highest quartile was 1.55 (1.10-2.18) after adjusting for confounding variables.

Conclusion: A higher WBC count predicts future incident T2DM among community-dwelling non-obese Korean adults. This study suggests that WBC count could facilitate the prediction of non-obese individuals susceptible to T2DM.
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http://dx.doi.org/10.2147/JIR.S300026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021258PMC
April 2021

Non-Alcoholic Fatty Liver Disease Is an Independent Risk Factor for LDL Cholesterol Target Level.

Int J Environ Res Public Health 2021 03 26;18(7). Epub 2021 Mar 26.

Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin-si 16995, Korea.

Although patients with non-alcoholic fatty liver disease (NAFLD) face a higher risk of cardiovascular disease (CVD), it is not known whether people with NAFLD are less likely to achieve optimal management of low-density lipoprotein (LDL) cholesterol than those without NAFLD. We aimed to investigate the longitudinal effect of NAFLD on the management of LDL cholesterol in 5610 adults from the Korean Genome and Epidemiology Study. Participants were classified into NAFLD and normal groups. Non-achievement of the target LDL cholesterol level was set according to one's cardiovascular disease (CVD) risk level. The estimated proportion of individuals who did not achieve their LDL cholesterol targets was higher in the NAFLD group than in the normal group during the follow-up period of 12 years in a generalized estimation equation model. Multivariable Cox regression analysis revealed a hazard ratio and 95% confidence interval for incident non-achievement of one's LDL cholesterol target of 1.196 (1.057-1.353) in the NAFLD group ( = 0.005). We found that NAFLD was significantly related to non-achievement of LDL cholesterol targets in this prospective cohort study. Prevention and proper management of NAFLD have important health implications for the prevention of CVD.
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http://dx.doi.org/10.3390/ijerph18073442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037151PMC
March 2021

Prediction of Insulin Resistance by Modified Triglyceride Glucose Indices in Youth.

Life (Basel) 2021 Mar 28;11(4). Epub 2021 Mar 28.

Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea.

The triglyceride glucose (TyG) index, derived from a combination of fasting glucose and triglycerides, has been suggested as a useful marker for insulin resistance (IR), in addition to modified TyG indices that combine obesity parameters. This study investigated the association and utility of TyG and modified TyG indices for IR prediction in youth. Based on the Korea National Health and Nutritional Examination Survey, the data of 3728 youth aged 10-19 years were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) of tertiles 2 and 3 for each parameter were calculated and compared with tertile 1 as a reference. To compare the parameters for identifying IR, receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. The ORs and 95% CIs for insulin resistance (IR) progressively increased across tertiles of each parameter. Overall, all modified TyG indices presented higher ORs and AUC than the TyG index. The TyG-body mass index standard deviation score showed the largest AUC for IR detection in all subjects. In conclusion, TyG and modified TyG indices could be used as valuable markers for the prediction of IR in youth. Moreover, modified TyG indices had better diagnostic accuracy than the TyG index.
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http://dx.doi.org/10.3390/life11040286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066260PMC
March 2021

Ten-Year Trends of Metabolic Syndrome Prevalence and Nutrient Intake among Korean Children and Adolescents: A Population-Based Study.

Yonsei Med J 2021 Apr;62(4):344-351

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Metabolic syndrome (MetS) comprises a cluster of risk factors for future cardiovascular and metabolic diseases. Only a few recent studies have reported the trend in the prevalence of MetS in youth. This study aimed to analyze trends in the prevalence of MetS and nutrient intake in the last 10 years and investigate the changes in MetS components among Korean children and adolescents.

Materials And Methods: We analyzed the data of 9513 children and adolescents aged 10-19 years from the 2008-2017 Korean National Health and Nutrition Examination Surveys. Diagnosis of MetS was based on the International Diabetes Federation (IDF) and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria.

Results: Based on the IDF criteria, MetS prevalence increased from 1.53% in 2008 to 3.19% in 2017 (=0.007). Based on the NCEP-ATP III criteria, MetS prevalence increased from 2.18% in 2008 to 3.19% in 2017; however, the increase was not statistically significant. Daily calorie and fat intakes increased significantly during the study period. Among the risk factors that MetS comprises, the prevalence rates of central obesity, low high-density lipoprotein cholesterol levels, and high fasting glucose levels increased significantly.

Conclusion: Over the last 10 years, the prevalence of MetS has grown significantly with increasing calorie and fat intake in Korean children and adolescents. Central obesity and high-density lipoprotein cholesterol and fasting glucose levels have worsened. Therefore, active support and close monitoring are required to control MetS and prevent further increase in the prevalence of cardiovascular diseases.
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http://dx.doi.org/10.3349/ymj.2021.62.4.344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007432PMC
April 2021

Temporalis muscle thickness as an indicator of sarcopenia is associated with long-term motor outcomes in Parkinson's disease.

J Gerontol A Biol Sci Med Sci 2021 Mar 23. Epub 2021 Mar 23.

Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.

Background: To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson's disease (PD).

Methods: We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up > 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia (LID), wearing-off, and freezing of gait (FOG) and a linear mixed model for the longitudinal increases in levodopa-equivalent dose (LED) per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed.

Results: TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p < 0.001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing LID, wearing-off, or FOG during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in LED per body weight in male PD patients, but not in female PD patients.

Conclusions: This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.
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http://dx.doi.org/10.1093/gerona/glab082DOI Listing
March 2021

Incidence rate of congenital scoliosis estimated from a nationwide health insurance database.

Sci Rep 2021 Mar 9;11(1):5507. Epub 2021 Mar 9.

Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.

To investigate the epidemiology of congenital scoliosis (CS) and treatment trends. An age-matched, nationwide, population-based study was conducted using the National Health Insurance and Health Insurance Review and Assessment databases from 2010 to 2015. Data regarding the diagnosis and treatment of scoliosis were extracted using International Classifications of Diseases, 10th revision codes. The age-matched normal population was determined from the Korean Statistical Information Service database. We analyzed the incidence rate of CS according to age and sex, as well as the proportion of surgically treated patients. A total of 1664 patients (aged 0-19 years) were diagnosed with CS. The overall average incidence rate of CS over the 5-year period was 3.08 per 100,000 persons, with the highest and second highest rates at 0 years and 12-16 years of age, respectively. The incidence rate stratified by age ranged from 1.5 to 20.1 per 100,000 persons among the age-matched normal population, with peaks at 0 years of age and the second growth spurt in adolescence (12-16 years for males; 10-14 years for females). Anterior surgery was rarely performed; posterior surgery was performed in 92 patients (5.5% of all patients), with the highest prevalence (56.5%) in patients diagnosed at 10-14 years of age. The overall average incidence rate of CS over a 5-year period was 3.08 per 100,000 persons. Only 5.5% of patients underwent surgery within 5 years after the initial diagnosis.
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http://dx.doi.org/10.1038/s41598-021-85088-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943574PMC
March 2021

Influence of government-driven quality assessment program on patients with chronic obstructive pulmonary disease.

Respir Res 2021 Mar 21;22(1):87. Epub 2021 Mar 21.

Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: The Korean Health Insurance Review and Assessment Service (HIRA) has launched the Chronic Obstructive Pulmonary Disease (COPD) Quality Assessment Program (CQAP) since 2014. We aimed to reveal the influence of this national program on clinical outcomes and the burden of COPD in Korea.

Methods: The CQAP is conducted annually. We used healthcare claims data linked with the results of the program provided by HIRA between May 2014 and April 2017. Patients were considered to have COPD if they visited a hospital for COPD management during the assessment term. Those who visited a medical institution for COPD and were prescribed COPD medications at least twice were assessed by the CQAP (assessed subjects, AS; not-assessed subjects, NAS). CQAP evaluated the pulmonary function test conduction rate, regular visitation rate, and prescription rates of COPD medications.

Results: Among the 560,000 patients with COPD, about 140,000 were assessed by the CQAP annually. In both groups, the pulmonary function test conduction rate and inhaled bronchodilator prescription rate improved since 2014. Compared to the NAS group, the risk of admission and all-cause mortality rate in the AS group were significantly reduced by 21.2% and 40.7%, respectively. In patients who were assessed for 3 consecutive years, all of the above variables were high at baseline and were not improved much from implementation of CQAP. In matching analysis, we observed this improvement to be limited in the COPD quality assessment year.

Conclusions: The CQAP by the health insurance bureau has improved the management protocol and prognosis of COPD.
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http://dx.doi.org/10.1186/s12931-021-01684-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981961PMC
March 2021

Comorbidity index for predicting mortality at 6 months after reperfusion therapy.

Sci Rep 2021 Mar 16;11(1):5963. Epub 2021 Mar 16.

Department of Neurology, Pusan National University School of Medicine, Busan, Korea.

The eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704-0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709-0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.
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http://dx.doi.org/10.1038/s41598-021-85390-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966783PMC
March 2021

Effects of Orlistat/Phentermine versus Phentermine on Vascular Endothelial Cell Function in Obese and Overweight Adults: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Diabetes Metab Syndr Obes 2021 2;14:941-950. Epub 2021 Mar 2.

Department of Family Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.

Background: In clinical practice, concomitant treatment of orlistat with phentermine is commonly used off-label. However, clinical trials have not been performed to evaluate whether their combination improves metabolic parameters and cardiovascular risk factors other than weight loss. Therefore, we aimed to compare the efficacy of concomitant administration of orlistat and phentermine versus phentermine alone on the endothelial cell function in overweight and obese adults with back pain.

Methods: We conducted a 12-week, double-blinded, placebo-controlled clinical trial involving 114 patients with a body mass index of ≥30 (obese) or ≥27 (overweight) with weight-related comorbidities. We randomly assigned patients in a 1:1 ratio to receive orlistat (120mg) three times daily and phentermine (37.5mg) once daily, or a placebo three times daily and phentermine (37.5mg) once daily. Primary endpoint was changes in endothelium-dependent vasodilatation measured using ultrasound assessment of flow-mediated dilatation (FMD). Differences within groups after intervention were compared using the paired -test or Wilcoxon signed-rank test. Differences in changes between the groups were calculated using an analysis of covariance after adjusting for each baseline value.

Results: Mean weight loss during the 12-week study period was 6.1kg in the orlistat/phentermine group and in the placebo/phentermine group. Adjusted mean changes in total and non-high-density lipoprotein cholesterol were significantly greater in the orlistat/phentermine group than in the placebo/phentermine group. Adjusted mean changes in endothelium-dependent FMD were significantly greater in the orlistat/phentermine group than in the placebo/phentermine group (4.97±0.98% vs 2.05±0.99%, respectively; p=0.038). Changes in endothelium-independent nitroglycerin-mediated dilatation were not significantly different between the groups.

Conclusion: Orlistat/phentermine significantly improved the vascular endothelial cell function compared with phentermine alone. Orlistat might have beneficial effects on the decrease of the risk of cardiovascular disease, especially in overweight and obese patients with comorbidities.

Trial Registration: ClinicalTrails.gov number, NCT03675191.
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http://dx.doi.org/10.2147/DMSO.S300342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936679PMC
March 2021

Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease.

Neurology 2021 04 2;96(16):e2121-e2131. Epub 2021 Mar 2.

From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Objective: To investigate the association between enlarged perivascular spaces (PVS) in the basal ganglia (BG-PVS) and long-term motor outcomes in Parkinson disease (PD).

Methods: We reviewed the medical records of 248 patients with drug-naive early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 female) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVS was counted on axial T2-weighted images. Then, patients were divided into 2 groups: a PD group with a low number (0-10) of enlarged PVS (PD-EPVS-; n = 156) and a PD group with a high number (>10) of enlarged PVS (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)-, wearing-off-, and freezing of gait (FOG)-free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model.

Results: Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS- group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal subregions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS- group.

Conclusion: This study suggests that baseline enlarged BG-PVS can be an indicator of the progression of motor disability in PD.
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http://dx.doi.org/10.1212/WNL.0000000000011797DOI Listing
April 2021

Different patterns of β-amyloid deposition in patients with Alzheimer's disease according to the presence of mild parkinsonism.

Neurobiol Aging 2021 May 3;101:199-206. Epub 2021 Feb 3.

Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address:

This study aimed to compare the patterns of β-amyloid deposition between patients with early-stage Alzheimer's disease (AD) with mild parkinsonism and those without parkinsonism. Sixty-one patients with early-stage AD (Clinical Dementia Rating [CDR], 0.5 or 1) who underwent F-florbetaben (F-FBB) PET scans were enrolled. We performed comparative analyses of regional FBB uptake in the frontal, parietal, lateral temporal, medial temporal, occipital, anterior cingulate, and posterior cingulate cortices and in the precuneus, striatum, and thalamus between AD patients with mild parkinsonism (AD-p+; n = 23) and those without parkinsonism (AD-p-; n = 38). There was no significant difference in age, sex, years of education, Mini-Mental State Examination score, and white matter hyperintensity severity between groups. The AD-p+ group had lower composite scores in frontal/executive function domain than the AD-p- group. The AD-p+ group had a higher FBB uptake in the occipital cortex, but not in other cortical regions, than the AD-p- group. Our findings suggest that additional β-amyloid deposition in the occipital region is associated with mild parkinsonism in early-stage AD.
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http://dx.doi.org/10.1016/j.neurobiolaging.2021.01.022DOI Listing
May 2021

Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial.

Adv Ther 2021 03 21;38(3):1701-1712. Epub 2021 Feb 21.

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea.

Introduction: Robotic radical prostatectomy requires prolonged pneumoperitoneum and a steep Trendelenburg position. Magnesium can attenuate the stress response and hemodynamic perturbations. This study aimed to evaluate the effects of intravenous magnesium administration on hemodynamics and the stress response in patients undergoing robotic radical prostatectomy.

Methods: In this prospective, double-blind, randomized controlled study, 52 patients undergoing robotic radical prostatectomy were randomized into two groups: 26 in the magnesium group and 26 in the control group. The patients in the magnesium group received magnesium sulfate 50 mg/kg intravenously, followed by infusion at a rate of 10 mg/kg/h during surgery. The patients in the control group received an equal volume of 0.9% saline. The primary outcomes were the changes in heart rate and mean arterial pressure (MAP) during surgery. The serum stress hormones (adrenocorticotropic hormone, cortisol, epinephrine, and norepinephrine) were also measured.

Results: MAP showed a significant intergroup difference over time (P = 0.017); it increased significantly at 5 min after Trendelenburg position in the control group and decreased significantly at 30 min after Trendelenburg position in the magnesium group. The intergroup difference in the change in cortisol concentrations was significant over time (P = 0.006). The cortisol concentration decreased significantly from baseline to 24 h after surgery in the magnesium group but did not change significantly in the control group. The requirement for intraoperative remifentanil was 35% lower in the magnesium group (P = 0.011), and the severity of postoperative pain at 30 min and 6 h after surgery was also lower in the magnesium group (P = 0.024 and P = 0.015).

Conclusion: There is a possibility that intravenous magnesium administration during robotic radical prostatectomy reduces the increases in arterial pressure, cortisol concentrations, opioid requirements, and postoperative pain.

Trial Registration: ClinicalTrials.gov identifier, NCT02833038.
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http://dx.doi.org/10.1007/s12325-021-01643-8DOI Listing
March 2021

Relationship between Muscle Mass and Non-Alcoholic Fatty Liver Disease.

Biology (Basel) 2021 Feb 5;10(2). Epub 2021 Feb 5.

Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Korea.

Although sarcopenia is known to be a risk factor for non-alcoholic fatty liver disease (NAFLD), whether NAFLD is a risk factor for the development of sarcopenia is not clear. We investigated relationships between NAFLD and low skeletal muscle mass index (LSMI) using three different datasets. Participants were classified into LSMI and normal groups. LSMI was defined as a body mass index (BMI)-adjusted appendicular skeletal muscle mass <0.789 in men and <0.512 in women or as the sex-specific lowest quintile of BMI-adjusted total skeletal muscle mass. NAFLD was determined according to NAFLD liver fat score or abdominal ultrasonography. The NAFLD groups showed a higher hazard ratios (HRs) with 95% confidence intervals (CIs) for LSMI than the normal groups (HRs = 1.21, 95% CIs = 1.05-1.40). The LSMI groups also showed a higher HRs with 95% CIs for NAFLD than normal groups (HRs = 1.56, 95% CIs = 1.38-1.78). Participants with NAFLD had consistently less skeletal muscle mass over 12 years of follow-up. In conclusion, LSMI and NAFLD showed a relationship. Maintaining muscle mass should be emphasized in the management of NAFLD.
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http://dx.doi.org/10.3390/biology10020122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915258PMC
February 2021

Evaluating enzyme stabilizations in calcium carbonate: Comparing in situ and crosslinking mediated immobilization.

Int J Biol Macromol 2021 Apr 5;175:341-350. Epub 2021 Feb 5.

Department of Food Biotechnology, Dong-A University, Busan 49315, Republic of Korea. Electronic address:

Enzyme immobilization using inorganic materials has been shown to preserve enzyme activity improving and improve their practical applications in biocatalytic process designs. Proper immobilization methods have been used to obtain high recycling and storage stability. In this study, we compared the activity and stability of in situ or crosslink-immobilized enzymes in a CaCO biomineral carrier. More than 30% of the initial enzyme activity was preserved for both the systems after 180 days upon 15 activity measurements at room temperature, confirming the improved stability of these enzyme systems (100 mM phosphate buffer, pH 8.0); however, differences in enzyme loading, activity, and characteristics were observed for each of these methods. Each system exhibited efficacy of 80% and 20%, respectively. Based on the same amount of immobilized enzyme (0.2 mg), the specific activities of hydrolysis of p-nitrophenyl butyrate substrate at room temperature of in situ immobilized carboxyl esterase (CE) and crosslinked CE were 11.37 and 7.63 mM min mg, respectively (100 mM phosphate buffer, pH 8.0). Moreover, based on the kinetic behavior, in situ immobilized CE exhibited improved catalytic efficiency (Vmax Km) of the enzyme, exhibiting 4-fold higher activity and efficiency values than those of the CE immobilized in CaCO. This is the first study to describe the stabilization of enzymes in CaCO and compare the enzyme kinetics and efficiencies between in situ immobilization and crosslinking in CaCO carriers.
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http://dx.doi.org/10.1016/j.ijbiomac.2021.02.028DOI Listing
April 2021

Usefulness of chloride levels for fluid resuscitation in patients undergoing targeted temperature management after out-of-hospital cardiac arrest.

Am J Emerg Med 2021 05 16;43:69-76. Epub 2021 Jan 16.

Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, 06273, Republic of Korea.

Objective: Chloride is an important electrolyte in the body. In this study, we aimed to evaluate the associations between chloride levels on emergency department (ED) admission and neurologic outcomes by stratifying patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) into three groups (hyper/normo/hypochloremia); we also assessed the effect of changes in chloride levels from baseline over time on outcomes.

Methods: This retrospective, observational cohort study of 346 patients was conducted between 2011 and 2019. The chloride levels were categorized as hypochloremia, normochloremia, and hyperchloremia by predetermined definitions. The primary endpoint was poor neurologic outcomes after hospital discharge. We evaluated the associations between chloride levels on ED admission and neurologic outcomes and assess the effect of changes in chloride levels over time on clinical outcomes.

Results: On ED admission, compared with normochloremia, hypochloremia was significantly associated with unfavorable neurologic outcomes (OR, 2.668; 95% CI, 1.217-5.850, P = 0.014). Over time, unfavorable neurologic outcomes were significantly associated with increases in chloride levels in the hyperchloremia and normochloremia groups after ED admission. The rates of poor neurologic outcomes in the hyperchloremia and normochloremia groups were increased by 14.2% at Time-12, 20.1% at Time-24, and 9.3% at Time-48 with a 1-mEq/L increase in chloride levels.

Conclusion: In clinical practice, chloride levels can be routinely and serially measured cost-effectively. Thus, baseline chloride levels may be a promising tool for rapid risk stratification of patients after OHCA. For fluid resuscitation after cardiac arrest, a chloride-restricted solution may be an early therapeutic strategy.
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http://dx.doi.org/10.1016/j.ajem.2021.01.027DOI Listing
May 2021

White Matter Hyperintensities, Dopamine Loss, and Motor Deficits in De Novo Parkinson's Disease.

Mov Disord 2021 Jan 29. Epub 2021 Jan 29.

Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.

Background: White matter hyperintensities, prevalent in patients with Parkinson's disease (PD), significantly affect parkinsonian motor symptoms. The objective of this study was to investigate the relationship between white matter hyperintensities and nigrostriatal dopamine depletion and their interaction or mediating effects on motor symptoms in patients with drug-naive early-stage PD.

Methods: This cross-sectional study enrolled 501 patients with de novo PD who initially underwent [ F] N-(3-fluoropropyl)-2β-carbonethoxy-3β-(4-iodophenyl) nortropane positron emission tomography and brain magnetic resonance imaging scans between April 2009 and September 2015 in a tertiary-care university hospital. We quantified dopamine transporter availability in each striatal subregion and assessed the severity of periventricular and lobar white matter hyperintensities using the Scheltens scale. The relationship between white matter hyperintensities, dopamine transporter availability in the posterior putamen, and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores was assessed using multivariate linear regression and mediation analyses.

Results: Periventricular and frontal white matter hyperintensities were generally associated with dopamine transporter availability in striatal subregions after adjusting for age at symptom onset, sex, disease duration, and vascular risk factors. There was an interaction effect between periventricular white matter hyperintensities and dopamine transporter availability in the posterior putamen for the axial motor score. The effect of white matter hyperintensities on UPDRS total score and bradykinesia subscore was indirectly mediated by dopamine transporter availability in the posterior putamen, whereas the axial sub-score was directly affected by white matter hyperintensities.

Conclusions: This study suggests that the detrimental effect of white matter hyperintensities on parkinsonian motor symptoms is more relevant and independent for axial motor impairments in the status of mildly decreased striatal dopamine transporter availability. © 2021 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28510DOI Listing
January 2021