Publications by authors named "Hyun Joo Lee"

366 Publications

The patellofemoral joint does not deteriorate clinically after open-wedge high tibial osteotomy.

Orthop Traumatol Surg Res 2021 Mar 28:102907. Epub 2021 Mar 28.

Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea. Electronic address:

Background: After high tibial osteotomy (HTO), the loading of the lateral compartment can be increased. Moreover, the change of patellar height may adversely affect the patellofemoral joint and functional outcomes.

Hypothesis: We hypothesized that the cartilage of the lateral compartment and patellofemoral joint would worsen after open-wedge HTO and the overcorrection of HTO could worsen the cartilage state of the patellofemoral joint. We evaluated the cartilage status and clinical results after medial open-wedge HTO and the factors affecting the outcomes.

Materials And Methods: From 2011 to 2018, 49 patients who had a mean age of 54.9 years and who underwent medial open-wedge HTO were selected. Plate removal was performed at a mean of 37.0 (range, 13-89) months after HTO, whereas diagnostic arthroscopy was performed during medial open-wedge HTO and plate removal. The cartilage status of each joint and the clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), and patellar score, were compared. We evaluated the postoperative changes in the cartilage status and clinical scores. Additionally, we evaluated whether the postoperative correction degree could affect the clinical results.

Result: After medial open-wedge HTO, the patellar height decreased. There was no change in the cartilage at the patellar and femoral trochlear groove. The HSS score, KS, and FS improved, but the patellar score remained unchanged. In the overcorrection group, the cartilage status significantly deteriorated at the lateral tibia condyle as compared with that in the undercorrection group. Higher preoperative clinical scores were associated with less postoperative improvement.

Discussion And Conclusion: The outcomes in the patellofemoral joint, including the cartilage condition and clinical scores, did not change after open-wedge HTO, despite patellar infera. Additionally, they were not influenced by the correction degree. Higher preoperative clinical scores were associated with less postoperative improvement.

Level Of Evidence: IV; Retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2021.102907DOI Listing
March 2021

Analysis of clinical outcomes and prognostic factors in patients treated with definitive chemoradiotherapy for oesophageal squamous cell carcinoma.

Cancer Med 2021 Mar 15;10(5):1745-1758. Epub 2021 Feb 15.

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

As patients receiving definitive chemoradiotherapy (dCRT) for oesophageal squamous cell carcinoma (ESCC) are heterogeneous, we aimed to identify prognostic factors and failure patterns after dCRT. From 2006 to 2015, 327 patients who received dCRT for ESCC were reviewed. Treatment response to dCRT was evaluated based on EORTC-PET criteria with endoscopy and CT results. After dCRT, 296 patients (90.5%) achieved disease stabilisation, with 132 cases of complete response (CR) (40.4%), 158 of partial response (PR) (48.3%) and 6 of stable disease (SD) (1.8%); 31 patients (9.5%) had progressive disease (PD). Median overall survival (OS) from response evaluation was 24.0 months in the overall population. Post-treatment clinical response was the most significant prognostic factor for OS in the multivariate analysis (median OS, 65.0 months for CR, 17.3 months for PR, 4.4 months for SD and 4.0 months for PD; p < 0.0001). Median progression-free survival (PFS) in 296 patients who achieved disease stabilisation was 13.1 months, and only clinical response was a significant factor in the multivariate analysis. The median PFS of CR, PR and SD patients were 36.9, 9.2 and 2.8 months, respectively (p < 0.0001). The clinical response was also significantly associated with the predominant failure pattern (locoregional failure [81.6%] in the initial non-PD group vs. distant metastasis [87.1%] in the initial PD group [p < 0.0001]). In conclusion, definitive chemoradiotherapy-treated ESCC patients showed highly different prognoses after treatment especially according to the clinical response to chemoradiotherapy.
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http://dx.doi.org/10.1002/cam4.3783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940212PMC
March 2021

Evaluation and comparison of the indoor air quality in different areas of the hospital.

Medicine (Baltimore) 2020 Dec;99(52):e23942

Institute of New Frontier Research.

Abstract: The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 μm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.
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http://dx.doi.org/10.1097/MD.0000000000023942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769362PMC
December 2020

Concomitant Coracoid Process Fracture with Bony Bankart Lesion Treated with the Latarjet Procedure.

Clin Shoulder Elb 2020 Mar 26;23(1):31-36. Epub 2020 Feb 26.

Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Bony lesions of the glenoid and Hill-Sachs lesions are the most common injuries after a first-time traumatic shoulder dislocation. However, fracture of the coracoid process after traumatic shoulder dislocation is rare. A single, open surgical procedure could be performed by a Latarjet procedure using a fractured fragment of the coracoid process. If a fracture of the coracoid process is associated with a traumatic anterior shoulder dislocation, the Latarjet procedure may be the most appropriate surgical option.
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http://dx.doi.org/10.5397/cise.2019.00423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714321PMC
March 2020

Dietary pattern and risk of endometrioma in Korean women: a case-control study.

Obstet Gynecol Sci 2021 Jan 16;64(1):99-106. Epub 2020 Dec 16.

Department of Obstetrics and Gynecology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Objective: The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts.

Methods: A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher's exact test for categorical variables.

Results: The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold.

Conclusion: The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.
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http://dx.doi.org/10.5468/ogs.20230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834755PMC
January 2021

Trends in Extracorporeal Membrane Oxygenation Application and Outcomes in Korea.

ASAIO J 2021 02;67(2):177-184

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea.

The use of extracorporeal membrane oxygenation (ECMO) is increasing despite the limited evidence in survival benefit. This study aimed to analyze the changes of in-hospital mortality, medical costs, and other outcomes in ECMO therapy. We used 2004-2017 data from a nationwide healthcare administrative claims database in Korea. Overall, 14,775 ECMO procedures were performed in 14,689 patients at 112 hospitals. We found a 170-fold and a 334-fold increase in the number of ECMO procedures and related costs, respectively. For indications, the performance of ECMO for heart or lung transplantation and respiratory failure increased, whereas that for cardiovascular surgery decreased. The duration of ECMO increased from a median of 3 days (IQR, 2-5 days) in 2004 to 4 days (IQR, 2-9 days) in 2017. The overall in-hospital mortality rate was 68.6%, and this improved over time, especially for lung transplantation and respiratory failure patients. Bleeding-related complications and the transfusion amount also decreased. Hospitals with higher case volume showed better survival outcomes. The median cost per procedure and per day was 26,538 USD (IQR, 14,646-47,862 USD) and 1,560 USD (IQR, 903-2,929 USD), respectively, and increased with time. A trend toward greater resource use and better outcomes requires additional cost-effective analysis based on indications.
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http://dx.doi.org/10.1097/MAT.0000000000001331DOI Listing
February 2021

Retained Foreign Body Which Should be Suspected as a Cause of Retractable Chronic Hand Inflammation and Diagnostic Capacity of Ultrasonography.

J Hand Surg Asian Pac Vol 2020 Dec;25(4):423-426

Daegu Park's Hospital, Daegu, Korea.

Foreign bodies in the hand are common but easily and often missed in the initial evaluation of injury. Diagnosing retained foreign bodies is difficult due to radiolucent foreign bodies. Purpose of this study is to emphasize the need of consideration of foreign bodies in patients with chronic synovitis in hand. Twenty-five patients who had retained foreign body in soft tissue of hand with chronic inflammation symptoms were included. Ultrasonography was conducted in all of the patients. Patient age, sex, localization of foreign body, duration of symptom, history of injury, follow up period, complication, and biopsy results were recorded and reviewed. Also, patients' demographics and clinical results were retrospectively reviewed. Nine of the 25 patients diagnosed with a foreign body in the hand did not remember the initial presentation of injury. The average symptom duration (from injury to hospitalization) was 10.5 months (range 1-96 months). The middle finger and the proximal interphalangeal joint were the most common site of a retained foreign body (10 patients). All patients were diagnosed via ultrasonography and underwent surgery. Biopsy results showed mainly chronic inflammation, fibrosis, granuloma, and foreign bodies. Patient with symptoms of cellulitis, osteomyelitis, and palpable mass in hand for over a month without a diagnosis should be suspected of retained FBs.
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http://dx.doi.org/10.1142/S2424835520500459DOI Listing
December 2020

Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis.

Knee Surg Sports Traumatol Arthrosc 2021 Mar 23;29(3):998-1005. Epub 2020 Oct 23.

Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.

Purpose: Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair.

Methods: A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up.

Results: Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA.

Conclusion: The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06307-8DOI Listing
March 2021

Can medial stability be preserved after open wedge high tibial osteotomy?

Knee Surg Relat Res 2020 Oct 1;32(1):51. Epub 2020 Oct 1.

Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

Purpose: This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing.

Methods: Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA).

Results: The JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively).

Conclusions: Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
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http://dx.doi.org/10.1186/s43019-020-00071-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531106PMC
October 2020

Identification of Missense Mutation as a Candidate Genetic Cause of Familial Febrile Seizure 4.

Children (Basel) 2020 Sep 18;7(9). Epub 2020 Sep 18.

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

Febrile seizure (FS) is related to a febrile illness (temperature > 38 °C) not caused by an infection of central nervous system, without neurologic deficits in children aged 6-60 months. The family study implied a polygenic model in the families of proband(s) with single FS, however in families with repeated FS, inheritance was matched to autosomal dominance with reduced disease penetrance. A 20 month-old girl showed recurrent FS and afebrile seizures without developmental delay or intellectual disability. The seizures disappeared after 60 months without anti-seizure medication. The 35 year-old proband's mother also experienced five episodes of simple FS and two episodes of unprovoked seizures before 5 years old. Targeted exome sequencing was conducted along with epilepsy/seizure-associated gene-filtering to identify the candidate causative mutation. As a result, a heterozygous c.2039A>G of the gene leading to a codon change of aspartic acid to glycine at the position 680 (rs547076322) was identified. This protein's glycine residue is highly conserved, and its allele frequency is 0.00002827 in the gnomAD population database. mutation may have an influential role in the occurrence of genetic epilepsies, especially those with febrile and afebrile seizures. Further investigation of mutations is needed to prove that it is a significant susceptible gene for febrile and/or afebrile seizures in early childhood.
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http://dx.doi.org/10.3390/children7090144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552766PMC
September 2020

Comparison between lung perfusion scan and single-photon emission computed tomography/computed tomography for predicting postoperative lung function after pulmonary resection in patients with borderline lung function.

Eur J Cardiothorac Surg 2020 12;58(6):1228-1235

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Korea.

Objectives: We compared the usefulness of single-photon emission computed tomography/computed tomography (SPECT/CT) and lung perfusion scintigraphy (LPS) for predicting postoperative lung function by comparing patients with borderline lung function.

Methods: A total of 274 patients who underwent simultaneous LPS and SPECT/CT and had a forced expiratory volume in 1 s (FEV1) or diffusing capacity for carbon monoxide (DLCO) under 80% were included. The % uptake by LPS was calculated by the posterior-oblique method. The concordance and difference of the % uptake, predicted postoperative (ppo) FEV1 and ppoDLCO as determined by 2 methods were evaluated. The association between ppo values and actual postoperative FEV1 and DLCO was examined. Subgroup analysis was conducted in redo-operation cases.

Results: The % uptake of each lobe, except the right middle lobe, showed fair concordance (concordance correlation coefficients for right upper, middle, lower, left upper and lower lobe = 0.61, 0.37, 0.71, 0.66 and 0.69, respectively). ppoFEV1 and ppoDLCO also revealed high concordance between both methods (concordance correlation coefficient = 0.93 for ppoFEV1 and concordance correlation coefficient = 0.92 for ppoDLCO) without a significant difference (P = 0.42 for ppoFEV1; P = 0.31 for ppoDLCO). Both ppoFEV1 and ppoDLCO showed a significantly high correlation with the actual FEV1 (r = 0.77, P < 0.01 for LPS, r = 0.77, P < 0.01 for SPECT/CT) and DLCO (r = 0.62, P < 0.01 for LPS, r = 0.62, P < 0.01 for SPECT/CT). High concordance of % uptake, ppoFEV1 and ppoDLCO was present in redo-operation patients.

Conclusions: Both LPS and SPECT/CT showed high predictability for actual postoperative lung function, and LPS showed good performance to estimate ppoFEV1 and ppoDLCO with reference to SPECT/CT, even in redo-operation cases.
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http://dx.doi.org/10.1093/ejcts/ezaa211DOI Listing
December 2020

Reciprocal change in Glucose metabolism of Cancer and Immune Cells mediated by different Glucose Transporters predicts Immunotherapy response.

Theranostics 2020 25;10(21):9579-9590. Epub 2020 Jul 25.

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

The metabolic properties of tumor microenvironment (TME) are dynamically dysregulated to achieve immune escape and promote cancer cell survival. However, properties of glucose metabolism in cancer and immune cells are poorly understood and their clinical application to development of a biomarker reflecting immune functionality is still lacking. We analyzed RNA-seq and fluorodeoxyglucose (FDG) positron emission tomography profiles of 63 lung squamous cell carcinoma (LUSC) specimens to correlate FDG uptake, expression of glucose transporters (GLUT) by RNA-seq and immune cell enrichment score (ImmuneScore). Single cell RNA-seq analysis in five lung cancer specimens was performed. We tested the GLUT3/GLUT1 ratio, the GLUT-ratio, as a surrogate representing immune metabolic functionality by investigating the association with immunotherapy response in two melanoma cohorts. ImmuneScore showed a negative correlation with GLUT1 ( = -0.70, < 0.01) and a positive correlation with GLUT3 ( = 0.39, < 0.01) in LUSC. Single-cell RNA-seq showed GLUT1 and GLUT3 were mostly expressed in cancer and immune cells, respectively. In immune-poor LUSC, FDG uptake was positively correlated with GLUT1 ( = 0.27, = 0.04) and negatively correlated with ImmuneScore ( = -0.28, = 0.04). In immune-rich LUSC, FDG uptake was positively correlated with both GLUT3 ( = 0.78, = 0.01) and ImmuneScore ( = 0.58, = 0.10). The GLUT-ratio was higher in anti-PD1 responders than nonresponders ( = 0.08 for baseline; = 0.02 for on-treatment) and associated with a progression-free survival in melanoma patients who treated with anti-CTLA4 ( = 0.04). Competitive uptake of glucose by cancer and immune cells in TME could be mediated by differential GLUT expression in these cells.
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http://dx.doi.org/10.7150/thno.48954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449929PMC
July 2020

The Impact of Consumer Competence in Purchasing Foods on Satisfaction with Food-Related Consumer Policies and Satisfaction with Food-Related Life through Perceptions of Food Safety.

Authors:
Hyun-Joo Lee

Foods 2020 Aug 12;9(8). Epub 2020 Aug 12.

Department of Consumer Science, Inha University, Incheon 22212, Korea.

Based on the knowledge-deficit model, this study proposes a relationship between consumer competence in purchasing foods and perceptions of the safety of imported and domestic foods. This study also examines how perceptions of the safety of imported and domestic foods affect satisfaction with food-related consumer policy and satisfaction with food-related life. Using data from the "2019 Consumer Behavior Survey for Food," which has been conducted every year since 2013 by the Korea Rural Economic Institute, we analyzed the responses of a final sample of 5869 respondents. The hypothesized conceptual model was assessed through structural equation modeling. All but one of the proposed relationships between consumer competence in purchasing foods and perceptions of food safety were supported. The relationship between perceptions of food safety and satisfaction with food-related consumer policies depends on whether foods are imported or domestic. Food origin also affected the relationship between perceptions of food safety and satisfaction with food-related life. Satisfaction with food-related consumer policies is significantly connected with satisfaction with food-related life. We discuss how the findings of this study can be applied to the development of food-related consumer policies.
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http://dx.doi.org/10.3390/foods9081103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464957PMC
August 2020

The association between expression of p53 and aggressiveness of serous adenocarcinoma of the uterine cervix.

J Res Med Sci 2020 22;25:47. Epub 2020 May 22.

Department of Obstetrics and Gynecology, School of Medicine, Pusan National University, Busan, South Korea.

Background: Serous adenocarcinoma of the uterine cervix is an extremely rare variant of cervical adenocarcinoma. This study aimed to evaluate the clinicopathological and molecular features and outcomes of serous adenocarcinoma of the uterine cervix (SACC).

Materials And Methods: This was a retrospective study conducted based on the clinical and pathological data of seven patients diagnosed with SACC after hysterectomy, who were evaluated at the gynecologic oncologic centers between 2010 and 2019.

Results: Five cases were diagnosed at Stage IB and two at Stage IV. All patients underwent radical hysterectomy with bilateral salpingo-oophorectomy and subsequently received postoperative radiotherapy or chemotherapy. One patient showed persistent disease, and two patients suffered recurrence. Immunohistochemical study showed that three (43%) of the seven patients were positive for p53, and among these three patients, two with diffuse strong p53 expression experienced an aggressive course with recurrences at pelvic lymph nodes, lung, and brain.

Conclusion: High p53 expression and advanced stage may be associated with poorer clinical outcomes in SACC, which suggest that immunohistochemistry may contribute to the prediction of prognosis.
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http://dx.doi.org/10.4103/jrms.JRMS_788_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377125PMC
May 2020

Laxative and antioxidant effects of ramie ( L) leaf extract in experimental constipated rats.

Food Sci Nutr 2020 Jul 7;8(7):3389-3401. Epub 2020 May 7.

Department of Food and Nutrition Chosun University Gwangju Korea.

Ramie leaf ( L.) is rich in cellulose, polyphenol compounds, vitamin C, and minerals. The leaves of this plant, which are used for medicinal purposes, have long been reported to have anti-inflammatory, antioxidant, anticolitis, and antidiabetic effects. We investigated the protective effects of ramie leaf ethanol extract (RLE) against loperamide-induced constipation and oxidative stress in rats. Male Sprague-Dawley rats were administered 200 or 400 mg/kg body weight of RLE (RLEL and RLEH groups) by gavage, while normal (NOR) and control (CON) rats received saline. Loperamide (4.0 mg/kg, twice per day) was injected subcutaneously to induce constipation in RLEL, RLEH, and CON groups. Total fecal number, wet weight, and water content decreased, while the total number of loperamide-induced fecal pellets in the distal colon increased with administration of RLE in a dose-dependent manner. Gastrointestinal transit time was more greatly reduced in RLE-treated groups than in the CON group. Serum total cholesterol (TC) level, as well as alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activity, was significantly lower in both RLEL and RLEH groups compared with the CON group. Intestinal mucosa malondialdehyde (MDA) and hydrogen peroxide (HO) production decreased significantly in a dose-dependent manner in the RLE-treated groups. Loperamide decreased the antioxidant enzyme activity, including that of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), while RLE administration increased the antioxidant activity. These results suggest that RLE exerts potent laxative and antioxidant effects in model rats with loperamide-induced constipation.
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http://dx.doi.org/10.1002/fsn3.1619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382170PMC
July 2020

Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation.

Yonsei Med J 2020 Jul;61(7):606-613

Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data.

Materials And Methods: This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated.

Results: Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, =0.007).

Conclusion: Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.
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http://dx.doi.org/10.3349/ymj.2020.61.7.606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329739PMC
July 2020

Association between nutrients and metabolic syndrome in middle-aged Korean women.

Arch Endocrinol Metab 2020 May-Jun;64(3):298-305

Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, Korea.

Objectives: The aim of this study was to evaluate the association between nutritional intake and metabolic syndrome in otherwise healthy middle-aged Korean women.

Subjects And Methods: Retrospectively, medical records were reviewed for nutritional intake of 2,182 Korean women who had undergone routine medical check-ups from 2010 to 2016 at Pusan National University Hospital. The patients who met diagnostic criteria for metabolic syndrome based on NCEP-ATPIII were included, and each of the patients was assessed through self-report questionnaires and individual interview with a health care provider. The recommended dietary allowance (RDA) for women in Republic of Korea was based on 2015 criteria discussed in Dietary Reference Intake for Koreans, organized by the Ministry of Health and Welfare.

Results: Through univariate analysis, daily calorie, protein, fat, and carbohydrate consumption were significantly higher and exceeded RDA in the patients with metabolic syndrome; other than major nutrients, iron, vitamin B2, and niacin were also consumed in excess of the RDA in these patients. Multivariate analysis showed that carbohydrate consumption, along with protein and vitamin B2, were significantly higher in the patients with metabolic syndrome.

Conclusion: In middle-aged Korean women, high consumption of carbohydrates, along with protein and vitamin B2, was found to have a statistically significant association with the presence of metabolic syndrome. Arch Endocrinol Metab. 2020;64(3):298-305.
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http://dx.doi.org/10.20945/2359-3997000000252DOI Listing
June 2020

The Role of Primary Tumor Resection in Patients with Pleural Metastasis Encountered at the Time of Surgery.

Korean J Thorac Cardiovasc Surg 2020 Jun;53(3):114-120

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Background: Evidence is lacking on whether the resection of lung parenchymal cancer improves the survival of patients with unexpected pleural metastasis encountered during surgery. We conducted a single-center retrospective study to determine the role of lung resection in the long-term survival of these patients.

Methods: Among 4683 patients who underwent lung surgery between 1995 and 2014, 132 (2.8%) had pleural metastasis. After excluding 2 patients who had incomplete medical records, 130 patients' data were collected. Only a diagnostic pleural and/or lung biopsy was performed in 90 patients, while the lung parenchymal mass was resected in 40 patients.

Results: The mean follow-up duration was 29.8 months. The 5-year survival rate of the resection group (34.7%±9.4%) was superior to that of the biopsy group (15.9%±4.3%, p=0.016). Multivariate Cox regression analysis demonstrated that primary tumor resection (p=0.041), systemic treatment (p<0.001), lower clinical N stage (p=0.018), and adenocarcinoma histology (p=0.009) were significant predictors of a favorable outcome. Interestingly, primary tumor resection only played a significant prognostic role in patients who received systemic treatment.

Conclusion: When pleural metastasis is unexpectedly encountered during surgical exploration, resection in conjunction with systemic treatment may improve long-term survival, especially in adenocarcinoma patients without lymph node metastasis.
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http://dx.doi.org/10.5090/kjtcs.2020.53.3.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287219PMC
June 2020

Effectiveness of a daytime rapid response system in hospitalized surgical ward patients.

Acute Crit Care 2020 May 13;35(2):77-86. Epub 2020 May 13.

Rapid Response Team, Seoul National University Hospital, Seoul, Korea.

Background: Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.

Methods: A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of "do not resuscitate" orders, and the survival of discharged CPA patients.

Results: The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).

Conclusions: The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.
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http://dx.doi.org/10.4266/acc.2019.00661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280793PMC
May 2020

A sagittal reference line using the preoperative radiograph in total knee arthroplasty.

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(2):2309499020924143

Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

Background: We evaluated the accuracy of a sagittal alignment of tibial component in total knee arthroplasty (TKA) with the sagittal reference line using the preoperative radiograph.

Methods: We evaluated 151 patients who underwent primary TKA with posterior cruciate substituting type implant. For 75 patients, the sagittal reference line using preoperative radiograph (group A) was used, while for 76 patients the sagittal reference using intraoperative fibular shaft line (group B) was used. The parallel line (line S) to the anatomical axis of the tibia in the lateral plain radiograph was used as the sagittal reference. The distance from line S to proximal tibia cutting area and to skin surface 20 cm distal to the cutting area was measured in preoperative radiographs. Next, the distance to the extramedullary guide rod was applied intraoperatively, reflecting the results. The intraoperative fibular shaft line was determined using the connecting line between the tip of fibular head and the lateral malleolus. The postoperative tibial component slope angle and the difference to the target slope angle were compared.

Results: The difference to the target angle was 1.8 ± 1.3° in group A, whereas the difference was 2.5 ± 1.4° in group B ( = 0.04). The patients with difference within 3° to the target angle were 78.7% in group A and 61.8% in group B ( = 0.024).

Conclusion: The sagittal reference line using the preoperative lateral radiograph was helpful as a reference guide for the tibial slope in TKA.
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http://dx.doi.org/10.1177/2309499020924143DOI Listing
February 2021

A 13-week repeated oral dose toxicity evaluation and a 4-week recovery evaluation of the Sam So Eum (SSE) in male and female rats.

J Ethnopharmacol 2020 Oct 22;260:112988. Epub 2020 May 22.

Department of Traditional Korean Medicine Resource Development, National Development Institute of Korean Medicine, Jangheung-gun, 59338, South Korea; College of Veterinary Medicine, Chonnam National University, Gwangju, 61186, South Korea. Electronic address:

Ethnophamacological Relevance: Sam So Eum (SSE), used in traditional Korean medicine, has been prescribed for the treatment of various ailments including emesis, and fever for centuries. SSE is known by several different names (Shen Su Yin in traditional Chinese medicine; Jin So In traditional Japanese Kampo medicine). It is a mixture of medicinal plants including Panax ginseng C. A. Mey., Perilla frutescens (L.) Britton, and Peucedanum praeruptorum Dunn. Studies have revealed that SSE has many pharmacological effects including anti-inflammatory, anti-cancer, and anti-allergic properties, but its toxic effects have not been evaluated in vivo. Recently, the use of traditional medicinal herbs to treat various diseases has increased, owing to increased number of studies supporting their efficacy. However, safety evaluations for toxicity and other adverse effects have not been extensive. It is commonly considered that natural products extracted from traditional medicinal herbs are safer than synthetic drugs, but this lacks a scientific basis. Thus, in this study, we evaluated the toxicity of SSE in male and female rats.

Aim Of The Study: To evaluated the safety of SSE in male and female rats.

Materials And Methods: SSE was administered orally for 13 weeks at 1000, 2000, and 4000 mg kg·day, and then the rats were maintained for 4 weeks without SSE administration (recovery evaluation).

Results: We observed the animals for changes in clinical signs, including hematological parameters, and food consumption; serum chemistry profiling and urinalysis were also carried out. Creatinine levels in the serum were significantly increased following oral administration of SSE at 2000 and 4000 mg kg·day in male and female rats, but returned to the normal levels during the recovery period. In addition, SSE administration does not cause kidney and liver toxicity. Thus, we determined that the no-observed-adverse-effect level of SSE is 4000 mg kg·day. The no-observed-effect level of SSE was determined to be 1000 mg kg·day, because serum creatinine was increased by oral administration of SSE at 2000 and 4000 mg kg·day in male and female rats.

Conclusions: SSE administration does not cause toxicity at 4000 mg kg·day in male and female rats.
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http://dx.doi.org/10.1016/j.jep.2020.112988DOI Listing
October 2020

When is the optimal timing of frozen embryo transfer after controlled ovarian stimulation?

Ann Transl Med 2020 Apr;8(7):425

Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, Korea.

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http://dx.doi.org/10.21037/atm.2020.03.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210185PMC
April 2020

Prevalence and risk factors of reflux after esophagectomy for esophageal cancer.

J Thorac Dis 2020 Mar;12(3):558-567

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Background: Reflux symptoms including various extra-esophageal manifestations are commonly reported after esophagectomy. However, the intensity and presentation of reflux are both diverse and variable by patients. In this study we assessed reflux symptoms using the reflux symptom index (RSI) questionnaire in patients who underwent esophagectomy for esophageal cancer to order to identify the prevalence of significant reflux and its risk factors.

Methods: From April 2017 to July 2017, we investigated patients who underwent esophagectomy for esophageal cancer. The severity of reflux was evaluated with a self-administered nine-item outcomes instrument (score: 0 to 5). An RSI score ≥13 was considered significant reflux. Multivariable analysis was conducted to identify risk factors.

Results: A total of 151 patients was included (mean age, 64.1±8.8 years; male, n=136, 90.1%). The median time after esophagectomy was 22.6 months. The question regarding heartburn, chest pain, indigestion, or acid coming up was most frequently responded (n=104, 68.9%) with 41 (27.2%) patients presenting significant reflux (mean RSI score, 19.9±6.3). Time after esophagectomy <2 years, vocal cord palsy, retrosternal route of reconstruction, and postoperative weight loss were identified as significant risk factors for RSI ≥13 in the multi-variable analysis.

Conclusions: Reflux related symptoms including extra-esophageal manifestations were common. Our study revealed that short duration after esophagectomy, vocal cord palsy, retrosternal route of reconstruction, and postoperative weight loss were significant associated factors for reflux symptom after esophagectomy.
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http://dx.doi.org/10.21037/jtd.2019.12.134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139076PMC
March 2020

Curved skin incision for Ulnar nerve transposition in Cubital Tunnel Syndrome: Cadaveric and clinical study to avoid injury of medial cutaneous nerve.

Orthop Traumatol Surg Res 2020 06 2;106(4):757-763. Epub 2020 Apr 2.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea. Electronic address:

Introduction: Medial skin incision is obligatory for ulnar nerve transposition in cubital tunnel syndrome. However, inadvertent surgical damage to the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) has been a concern in the current surgical approach.

Hypothesis: We hypothesized a modified curved skin incision to avoid the damage to the medial cutaneous nerve.

Materials And Methods: The numbers and locations of MACN and MBCN terminal branches were investigated; also, the location of the posterior branch of MACN in ten fresh frozen cadaveric upper extremities. Using modified incision which is more anterior than classic approach and includes antegrade dissection of the cutaneous branches, same measurement was performed in clinical cases. We described the techniques.

Results: The average number of MACN posterior terminal branches was 2.6±1.6 and 4.4±2.4 branches in the cadaveric specimens and clinical cases, respectively. The average number of MBCN terminal branches was 2.1±0.87 branches. The MACN posterior terminal branches were located at an average of 19mm proximal and 45mm distal from the medial epicondyle. In clinical cases, we could preserve all MBCN terminal branches and posterior terminal branches of MACN using the indexed skin incision.

Discussion: Our modified medial skin incision technique with antegrade subcutaneous dissection exposed all the terminal branches of MACN and thus, could reduce the risk of inadvertent injury. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN.

Level Of Proof: IV, Cadaveric and Therapeutic study.
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http://dx.doi.org/10.1016/j.otsr.2020.03.003DOI Listing
June 2020

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial.

Ann Coloproctol 2020 Oct 16;36(5):344-348. Epub 2020 Mar 16.

Department of Surgery, Seoul Song Do Hospital, Seoul, Korea.

Purpose: This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.

Methods: One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).

Results: Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).

Conclusion: Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.
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http://dx.doi.org/10.3393/ac.2020.02.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714374PMC
October 2020

Evaluation of glycoprotein E subunit and live attenuated varicella-zoster virus vaccines formulated with a single-strand RNA-based adjuvant.

Immun Inflamm Dis 2020 06 13;8(2):216-227. Epub 2020 Mar 13.

Department of Biotechnology, The Catholic University of Korea, Bucheon, Republic of Korea.

Introduction: Varicella-zoster virus (VZV), a human alphaherpesvirus 3, elicits both chickenpox and shingles and/or postherpetic neuralgia. A live attenuated vaccine (LAV) and glycoprotein E (gE) subunit vaccine were developed to prevent VZV-induced diseases. We recently reported that single-strand RNA (ssRNA) based on the intergenic region of the internal ribosome entry site of cricket paralysis virus (CrPV) is an effective adjuvant for protein-based and virus-like particle-based vaccines. Here, Chinese hamster ovary expression system and an LAV from Oka/SK strains.

Methods: We appraised the adjuvant effect of the same CrPV ssRNA encoding the gE gene formulated in the two vaccines using VZV-primed C57BL/6 mice and guinea pigs. Humoral immunity and cell-mediated immunity were assessed by enzyme-linked immunosorbent assay (ELISA) and ELISPOT in gE subunit vaccine and by ELISA and fluorescent antibody to membrane antigen in LAV.

Results: The gE subunit vaccine-induced gE-specific antibodies and CD4 T-cell responses (indicated by interferon-γ [IFN-γ] and interleukin-2 secretion) in the ssRNA-based adjuvant containing the VZV gE gene. Therefore, an ssRNA adjuvant combined with gE antigen can trigger the innate immune response and induce an adaptive immune response to ultimately activate humoral and cell-mediated responses. VZV LAV could also induce VZV-specific antibodies and IFN-γ stimulated by LAV, whereas the effect of ssRNA as a vaccine adjuvant could not be confirmed. However, the ssRNA adjuvant increased VZV-specific neutralizing antibody response.

Conclusions: Taken together, these results highlight that the gE subunit vaccine and LAV developed in this study can be functional VZV vaccines, and ssRNAs appear to function better as adjuvants in a subunit vaccine than in an LAV.
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http://dx.doi.org/10.1002/iid3.297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212201PMC
June 2020

Relationship Between Metabolic Syndrome and Bone Fracture Risk in Mid-Aged Korean Women Using FRAX Scoring System.

Metab Syndr Relat Disord 2020 05 20;18(4):219-224. Epub 2020 Feb 20.

Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, Korea.

The aim of this study is to investigate the relationship between metabolic syndrome (MetS) and bone fracture risk assessed by the Fracture Risk Algoritham (FRAX) tool in mid-aged Korean women. Retrospectively, the study reviewed medical records of 1,975 female patients with or without MetS, who underwent routine medical checkups from 2010 to 2016 at Pusan National University Hospital. The MetS group included the patients who met diagnostic criteria for MetS based on the revised National Cholesterol Education Program reported in Adult Treatment Panel III (NCEP-ATPIII), and the control group was composed of those patients without MetS. Each of the patients was assessed through self-report questionnaires and individual interview with a health care provider. The FRAX tool was used for bone fracture risk. Univariate logistic regression analysis of various parameters for MetS showed increase in both FRAX1 and FRAX2 with odds ratio of 1.387 and 1.474 with  < 0.0001 each, respectively. Through Pearson's correlation coefficient study, correlation of patient's high-risk status of bone fracture with age was found. Multivariate analysis of such variables confirmed that only the age of patients was statistically significant in relationship to high-risk of fracture by FRAX tool. MetS was not significantly associated with the patient's high-risk status of bone fracture analyzed by using FRAX; however, the absolute values of FRAX scores were increased in MetS patients (FRAX1 = 4.10 and FRAX2 = 0.40%) compared to their control group (FRAX1 = 3.20% and FRAX2 = 0.20%).
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http://dx.doi.org/10.1089/met.2019.0060DOI Listing
May 2020

Coexistence of adenoid cystic carcinoma and squamous cell carcinoma of the uterine cervix with HPV 16 infection: clinical course of delayed adjuvant treatment.

Int J Clin Exp Pathol 2019 1;12(4):1418-1423. Epub 2019 Apr 1.

Biomedical Research Institute, Pusan National University Hospital Busan, Republic of Korea.

Adenoid cystic carcinoma (ACC) is a rare variant of cervical carcinoma and has an aggressive clinical behavior, and there have been few reports of co-existing ACC and squamous cell carcinoma (SCC) of the uterine cervix. A 76-year-old postmenopausal woman presented with vaginal bleeding. The cervical cytology and polypectomy results were SCC, and magnetic resonance imaging (MRI) of pelvis revealed a 2.3 × 1.8 cm sized lobulated mass at the cervix. Microscopically, the tumor showed infiltrative nests of squamoid cells and a cribriform pattern of basaloid cells. Immunohistochemical studies showed that squamous cells were positive for p63 and that basaloid cells were mainly positive for CD117 and S-100 protein. Both components were strongly positive for p16 immunostaining. The tumor was diagnosed as invasive SCC with concurrent ACC. The disease relapsed after a follow-up of 14 months with no adjuvant therapy. Subsequently, she received concurrent chemoradiotherapy (CCRT) and then combined chemotherapy with paclitaxel, cisplatin, and bevacizumab; finally, imaging revealed no evidence of residual cancer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947050PMC
April 2019

Spinal Stenosis Grading in Magnetic Resonance Imaging Using Deep Convolutional Neural Networks.

Spine (Phila Pa 1976) 2020 Jun;45(12):804-812

Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.

Study Design: Retrospective magnetic resonance imaging grading with comparison between experts and deep convolutional neural networks (CNNs).

Objective: This study aims to verify the feasibility of a computer-assisted spine stenosis grading system by comparing the diagnostic agreement between two experts and the agreement between the experts and trained artificial CNN classifiers.

Summary Of Background Data: Spinal stenosis grading is important; however, it is tedious job to check the MR images slide by slide to classify patient grades often having different opinions regarding the final diagnosis.

Methods: For 542 L4-5 axial MR images, two experts independently localized the center position of the spine canal and graded the status. Two CNN classifiers each trained with the grading label made by the two experts were validated using 10-fold cross-validation. Each classifier consisted of a CNN detection model responsible for the localization of patches near the canal and a classification CNN model to predict the spinal stenosis status in the localized patches. Faster R-CNN was used for the detection model whereas VGG network was used for the classification model. A comparison in grading agreement was carried out between the two experts as well as that of the experts and the prediction results generated by the CNN models.

Results: Grading agreement between the experts was 77.5% and 75% in terms of accuracy and F1 scores. The agreement between the first expert and the model trained with the labels of the first expert was 83% and 75.4%, respectively. The agreement between the second expert and the model trained with the labels of the second expert was 77.9% and 74.9%. The differences between the two experts were significant, whereas the differences between each expert and the trained models were not significant.

Conclusion: We indeed confirmed that automatic diagnosis using deep learning may be feasible for spinal stenosis grading.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000003377DOI Listing
June 2020

Molluscum contagiosum mimicking condyloma acuminata in a renal transplant patient: A unique presentation.

Transpl Infect Dis 2020 Feb 1;22(1):e13235. Epub 2020 Jan 1.

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

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http://dx.doi.org/10.1111/tid.13235DOI Listing
February 2020