Publications by authors named "Jae Min"

51 Publications

Characterizing COVID-19 and Influenza Illnesses in the Real World via Person-Generated Health Data.

Patterns (N Y) 2021 Jan 13;2(1):100188. Epub 2020 Dec 13.

Evidation Health, Inc., San Mateo, CA 94401, USA.

The fight against COVID-19 is hindered by similarly presenting viral infections that may confound detection and monitoring. We examined person-generated health data (PGHD), consisting of survey and commercial wearable data from individuals' everyday lives, for 230 people who reported a COVID-19 diagnosis between March 30, 2020, and April 27, 2020 (n = 41 with wearable data). Compared with self-reported diagnosed flu cases from the same time frame (n = 426, 85 with wearable data) or pre-pandemic (n = 6,270, 1,265 with wearable data), COVID-19 patients reported a distinct symptom constellation that lasted longer (median of 12 versus 9 and 7 days, respectively) and peaked later after illness onset. Wearable data showed significant changes in daily steps and prevalence of anomalous resting heart rate measurements, of similar magnitudes for both the flu and COVID-19 cohorts. Our findings highlight the need to include flu comparator arms when evaluating PGHD applications aimed to be highly specific for COVID-19.
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http://dx.doi.org/10.1016/j.patter.2020.100188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815963PMC
January 2021

Development and Validation of a Symptom-Focused Quality of Life Questionnaire (KOQUSS-40) for Gastric Cancer Patients after Gastrectomy.

Cancer Res Treat 2020 Dec 29. Epub 2020 Dec 29.

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

Purpose: Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer.

Materials And Methods: Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity.

Results: The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients: 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8.

Conclusion: The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.
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http://dx.doi.org/10.4143/crt.2020.1270DOI Listing
December 2020

Remodelling of femoral head deformity after hip reconstructive surgery in patients with cerebral palsy.

Bone Joint J 2021 Jan;103-B(1):198-203

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.

Aims: Hip displacement, common in patients with cerebral palsy (CP), causes pain and hinders adequate care. Hip reconstructive surgery (HRS) is performed to treat hip displacement; however, only a few studies have quantitatively assessed femoral head sphericity after HRS. The aim of this study was to quantitatively assess improvement in hip sphericity after HRS in patients with CP.

Methods: We retrospectively analyzed hip radiographs of patients who had undergone HRS because of CP-associated hip displacement. The pre- and postoperative migration percentage (MP), femoral neck-shaft angle (NSA), and sphericity, as determined by the Mose hip ratio (MHR), age at surgery, Gross Motor Function Classification System level, surgical history including Dega pelvic osteotomy, and triradiate cartilage status were studied. Regression analyses using linear mixed model were performed to identify factors affecting hip sphericity improvement.

Results: A total of 108 patients were enrolled. The mean preoperative MP was 58.3% (SD 31.7%), which improved to 9.1% (SD 15.6%) at the last follow-up. NSA and MHR improved from 156.5° (SD 11.5°) and 82.3% (SD 8.6%) to 126.0° (SD 18.5°) and 89.1% (SD 9.0%), respectively. Factors affecting the postoperative MHR were preoperative MP (p = 0.005), immediate postoperative MP (p = 0.032), and history of Dega osteotomy (p = 0.046).

Conclusion: We found that hip sphericity improves with HRS. Preoperative MP, reduction quality, and acetabular coverage influence femoral head remodelling. We recommend that surgeons should consider intervention early before hip displacement progresses and that during HRS, definite reduction and coverage of the femoral head should be obtained. Cite this article: 2021;103-B(1):198-203.
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http://dx.doi.org/10.1302/0301-620X.103B1.BJJ-2020-1339.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954150PMC
January 2021

Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity: A Study Using the Oxford Ankle Foot Questionnaire.

J Bone Joint Surg Am 2020 Sep;102(17):1479-1485

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea.

Background: Idiopathic pes planovalgus is one of the most common foot deformities in children and adolescents. However, there is a discrepancy between subjective symptoms and radiographic severity in idiopathic planovalgus deformity, and very few studies have investigated this aspect. Further, the assessment of subjective symptoms in patients with pes planovalgus requires a quantitative scoring system for making meaningful comparisons, such as the Oxford Ankle Foot Questionnaire for Children (OxAFQ-c) and that for parents (OxAFQ-p). Therefore, the purpose of this study was to evaluate the factors affecting the symptoms of idiopathic planovalgus using the OxAFQ.

Methods: All patients who were ≤18 years of age, had visited our clinic for the evaluation of pes planovalgus deformity, and had completed the OxAFQ were included in this study. The anteroposterior talo-first metatarsal, lateral talo-first metatarsal, and hallux valgus angles were measured on weight-bearing radiographs. The data were analyzed using a multiple regression model, with age, sex, and radiographic indices as explanatory variables.

Results: Overall, 123 patients were enrolled in this study, and 246 standing foot radiographs were evaluated along with scores in each domain of the OxAFQ. The factors affecting physical domain scores in the OxAFQ-c were female sex (p = 0.047) and the anteroposterior talo-first metatarsal angle (p = 0.033). Age of ≥10 years was a significant factor (p < 0.05) affecting all domains in both the OxAFQ-c and OxAFQ-p other than the physical domain score.

Conclusions: Although pes planovalgus deformity is 3-dimensional, the forefoot abduction component of the deformity should be carefully assessed as it is closely related to subjective symptoms. Further, in female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity.

Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.19.01504DOI Listing
September 2020

Development and Validation of a Mobile Application for Measuring Femoral Anteversion in Patients With Cerebral Palsy.

J Pediatr Orthop 2020 Jul;40(6):e516-e521

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Gyeonggi Province.

Background: Computed tomography (CT) provides benefits for 3-dimensional (3D) visualization of femur deformities. However, the potential adverse effects of radiation exposure have become a concern. Consequently, a biplanar imaging system EOS has been proposed to enable reconstruction of the 3D model of the femur. However, this system requires a calibrated apparatus, the cost of which is high, and the area occupied by it is substantial. The purpose of this study was to develop a mobile application that included a new method of 3D reconstruction of the femur from conventional radiographic images and to evaluate the validity and reliability of mobile the application when measuring femoral anteversion.

Methods: The statistical shape model, graph-cut algorithm, and iterative Perspective-n-Point algorithm were utilized to develop the application. The anteroposterior and lateral images of a femur can be input using the embedded camera or by file transfer, and the touch interface aids accurate contouring of the femur. Regarding validation, the CT scans and conventional radiographic images of 36 patients with cerebral palsy were used. To evaluate concurrent validity, the femoral anteversion measurements on the images reconstructed from the mobile application were compared with those from the 3D CT images. Three clinicians assessed interobserver reliability.

Results: The mobile application, which reconstructs the 3D image from conventional radiographs, was successfully developed. Regarding concurrent validity, the correlation coefficient between femoral anteversion measured using 3D CT and the mobile application was 0.968 (P<0.001). In terms of interobserver reliability, the intraclass correlation coefficient among the 3 clinicians was 0.953.

Conclusions: The measurement of femoral anteversion with the mobile application showed excellent concurrent validity and reliability in patients with cerebral palsy. The proposed mobile application can be used with conventional radiographs and does not require additional apparatus. It can be used as a convenient technique in hospitals that cannot afford a CT machine or an EOS system.

Level Of Evidence: Level III-diagnostic.
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http://dx.doi.org/10.1097/BPO.0000000000001468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274151PMC
July 2020

Factors affecting GDI improvement after single event multilevel surgery in patients with cerebral palsy.

Gait Posture 2020 07 25;80:101-105. Epub 2020 May 25.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi 13620, Republic of Korea. Electronic address:

Background: Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement.

Research Question: In this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes.

Methods: We screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for >1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement.

Results: Overall, 544 patients were included. The average improvement in overall GDI was 8.9 ± 12.3, 9.6 ± 12.0, and 6.4 ± 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III.

Significance: Postoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set.
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http://dx.doi.org/10.1016/j.gaitpost.2020.05.033DOI Listing
July 2020

Predicting in-hospital mortality of patients with febrile neutropenia using machine learning models.

Int J Med Inform 2020 07 15;139:104140. Epub 2020 Apr 15.

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States. Electronic address:

Background: Febrile neutropenia (FN) has been associated with high mortality among adults with cancer. Current systems for early detection of inpatient FN mortality are based on scoring indexes that require intensive physicians' subjective evaluation.

Objective: In this study, we leveraged machine learning techniques to build a FN mortality risk evaluation tool focused on FN admissions without physicians' subjective evaluation.

Methods: We used the National Inpatient Sample and Nationwide Inpatient Sample (NIS) that included mortality data among adult inpatients who were diagnosed with FN during a hospital admission. Machine learning techniques that we compared included linear models (ridge logistic regression and linear support vector machine) and non-linear models (gradient boosting tree and neural network). The primary outcome for this study was death among individuals with a recorded FN admission. Model comparison was evaluated based on areas under the receiver operating characteristic curve (AUROC) and model performance was estimated using 30 % test set created via stratified split.

Results: Our analysis detected 126,013 adult admissions within the NIS data that were diagnosed with FN, among which 5,856 were declared as deceased (4.6 %). Our machine learning results demonstrate linear models and non-linear models achieved areas under the receiver operating characteristic (AUROC) around 92 % in survival prediction.

Conclusions: We developed machine learning models that do not require physicians' subjective evaluation for FN mortality risk prediction.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255942PMC
July 2020

Progression of planovalgus deformity in patients with cerebral palsy.

BMC Musculoskelet Disord 2020 Mar 3;21(1):141. Epub 2020 Mar 3.

Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea.

Background: Analyzing radiographic changes of pes planovalgus(PV) deformity of cerebral palsy(CP) patients according to age and influencing factors.

Methods: CP patients with PV deformity younger than 18 years old who had undergone more than a year of follow-up with at least two standing foot radiographs were included. Anteroposterior and lateral talo-first metatarsal(talo-1stMT), talo-second metatarsal(talo-2ndMT), and hallux valgus(HV) angles were measured on the radiographs. The rate of progression was adjusted by multiple factors using the linear mixed model, with the Gross Motor Function Classification System(GMFCS) level as the fixed effect and age and each subject as random effects.

Results: Overall, 194 patients were enrolled in this study, and 1272 standing foot radiographs were evaluated. The AP talo-2MT angle progressed by 0.59° (p < 0.0001) and 0.64° (p = 0.0007) in GMFCS level II and III patients, respectively; however, there was no significant change in GMFCS level I patients (p = 0.3269). HV was significantly affected by age in all three GMFCS groups; it increased by 0.48° (p < 0.0001), 0.66° (p < 0.0001), and 1.19° (p < 0.0001) for levels I, II, and III, respectively. The lateral talo-1stMT angle showed improvements in GMFCS level I and II patients (0.43°, p < 0.0001, and 0.61°, p < 0.0001, respectively). In GMFCS level III patients, there was no significant improvement in the lateral talo-1MT angle (p = 0.0535).

Conclusions: The GMFCS level was the single most important factor influencing the progression of radiographic indices in PV deformity in CP. The AP talo-1MT and talo-2ndMT angles progressed in patients with GMFCS levels II and III. Physicians should take this result into consideration when planning the timing of the surgery.

Level Of Evidence: Prognostic Level IV.
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http://dx.doi.org/10.1186/s12891-020-3149-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055068PMC
March 2020

Are Preregistration and Registered Reports Vulnerable to Hacking?

Epidemiology 2020 05;31(3):e32

Department of Management, Warrington College of Business, University of Florida, Gainesville, FL.

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http://dx.doi.org/10.1097/EDE.0000000000001162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757516PMC
May 2020

An advanced RFID-based system to localize gastric and colon cancers during laparoscopic surgery.

Surg Endosc 2021 Jan 13;35(1):139-147. Epub 2020 Jan 13.

Department of Research & Development, Medical Device Development Center, Osong Medical Innovation Foundation, 123 Osongsaengmyung-ro, Osong-eub, Heungdeok-gu, Cheongju-si, Chungbuk, 28160, Republic of Korea.

Background: We aimed to improve the tumor localization system using radiofrequency identification (RFID) technology used during laparoscopic surgery for gastric and colorectal cancer. To this end, we developed a detection algorithm and designed improvement for the RFID clip.

Methods: To evaluate the proposed system, a swine-based animal study was conducted, followed by experiments on porcine stomachs and colons using the EASIE-R simulator. The success rates of endoscopic clipping, detection time, and detection accuracy, which is the distance between the detection point and RFID tag, were measured.

Results: Results of the in vivo swine animal study showed success in all three clippings and detections of the RFID clips. Results of the 60 RFID endoclip attempts using the EASIE-R simulator showed a total clipping success rate of 85.0% (n = 51/60; stomach, 83.3%, n = 25/30; colon, 86.7%, n = 26/30). The median detection times were 29.2 s for the stomach and 25.5 s for the colon. The median detection accuracy was 4.0 mm for the stomach and 4.5 mm for the colon.

Conclusions: We confirmed that the proposed RFID-based system showed improvements over the system of a previous study. This RFID-based system is effective at localizing gastric and colorectal tumors.
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http://dx.doi.org/10.1007/s00464-020-07371-4DOI Listing
January 2021

Re: A Call for Deep-learning Healthcare.

Epidemiology 2020 03;31(2):e22

Department of Management, Warrington College of Business, University of Florida, Gainesville, FL.

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http://dx.doi.org/10.1097/EDE.0000000000001155DOI Listing
March 2020

Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: A joinpoint analysis.

PLoS One 2019 22;14(11):e0225223. Epub 2019 Nov 22.

Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America.

Background: Firearm-related death rates and years of potential life lost (YPLL) vary widely between population subgroups and states. However, changes or inflections in temporal trends within subgroups and states are not fully documented. We assessed temporal patterns and inflections in the rates of firearm deaths and %YPLL due to firearms for overall and by sex, age, race/ethnicity, intent, and states in the United States between 1999 and 2016.

Methods: We extracted age-adjusted firearm mortality and YPLL rates per 100,000, and %YPLL from 1999 to 2016 by using the WONDER (Wide-ranging Online Data for Epidemiologic Research) database. We used Joinpoint Regression to assess temporal trends, the inflection points, and annual percentage change (APC) from 1999 to 2016.

Results: National firearm mortality rates were 10.3 and 11.8 per 100,000 in 1999 and 2016, with two distinct segments; a plateau until 2014 followed by an increase of APC = 7.2% (95% CI 3.1, 11.4). YPLL rates were from 304.7 and 338.2 in 1999 and 2016 with a steady APC increase in %YPLL of 0.65% (95% CI 0.43, 0.87) from 1999 to an inflection point in 2014, followed by a larger APC in %YPLL of 5.1% (95% CI 0.1, 10.4). The upward trend in firearm mortality and YPLL rates starting in 2014 was observed in subgroups of male, non-Hispanic blacks, Hispanic whites and for firearm assaults. The inflection points for firearm mortality and YPLL rates also varied across states.

Conclusions: Within the United States, firearm mortality rates and YPLL remained constant between 1999 and 2014 and has been increasing subsequently. There was, however, an increase in firearm mortality rates in several subgroups and individual states earlier than 2014.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225223PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874349PMC
March 2020

Injury Burden in the United States: Accurate, Reliable, and Timely Surveillance Using Electronic Health Care Data.

Am J Public Health 2019 12 17;109(12):1702-1706. Epub 2019 Oct 17.

Jae Min, Kelly K. Gurka, and Mattia Prosperi are with the Department of Epidemiology, University of Florida, Gainesville. Bindu Kalesan is with the Department of Medicine, Boston University, Boston, MA. Jiang Bian is with the Department of Health Outcomes and Biomedical Informatics, University of Florida.

Current injury surveillance systems in the United States, including the National Electronic Injury Surveillance System (NEISS), are unable to draw reliable subnational and subannual incidence estimates.Compared with the (), the clinical ontology system currently used widely in health care, NEISS's coding structure lacks specificity and consistency. In parallel, the quality of codes depends on accurate and complete documentation by health care providers and skillful translation into codes in electronic health care data. Additionally, there is no national mandate to collect external cause of injury data.Electronic health care data, such as health records and claims, with updated codes and uniform adherence to recommendations for coding external cause of injury, have the potential to be used for a more robust and timely surveillance of injury to accurately and reliably reflect the injury burden in the United States.
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http://dx.doi.org/10.2105/AJPH.2019.305306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836806PMC
December 2019

Clinical correlates of workplace injury occurrence and recurrence in adults.

PLoS One 2019 12;14(9):e0222603. Epub 2019 Sep 12.

School of Business Administration, Zhejiang Gongshang University, Hangzhou, China.

Objectives: To examine the morbidities associated with workplace injury and to explore how clinical variables modify the risk of injury recurrence.

Methods: A case-control study was designed using Florida's statewide inpatient, outpatient, and emergency visits data obtained from the Healthcare Cost and Utilization Project. We included adults who were admitted for a workplace injury (WPI) or injury at other places (IOP), and a matched population of random controls without WPI/IOP. The associations between WPI and clinical morbidities were assessed by univariate and multivariable regression, ranking predictors by information gain, area under the receiver operating characteristic (AUROC), and odds ratios. We analyzed WPI recurrence using survival methods (Kaplan-Meier, Cox regression, survival decision trees) and developed prediction models via regularized logistic regression, random forest, and AdTree. Performance was assessed by 10-fold cross-validation comparing AUROC, sensitivity, specificity, and Harrell's c-index.

Results: A total of 80,712 WPI, 161,424 IOP, and 161,424 control patients were included; 485 distinct clinical diagnostic and 160 procedure codes were analyzed after filtering. Acute bronchitis and bronchiolitis, sprains and strains of shoulder and upper arm, ankle and foot, or other and unspecified parts of back, accidents caused by cutting and piercing instruments or objects, and overexertion and strenuous movements were identified as important consequences of WPI. The prediction models of injury recurrence identified several key factors, such as insurance type and prior injury events, although none of the models exhibited high predictive performance (best AUROC = 0.60, best c-index = 0.62).

Conclusions: WPI is associated to diverse serious physical comorbidity burden. There are demographic, social and clinical comorbidity components associated to the risk of WPI recurrence, although their predictive value is moderate, which warrants future investigation in other information source domains, e.g. deepening into the environmental and societal sphere.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222603PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742381PMC
March 2020

Prodromal clinical, demographic, and socio-ecological correlates of asthma in adults: a 10-year statewide big data multi-domain analysis.

J Asthma 2020 11 26;57(11):1155-1167. Epub 2019 Jul 26.

Department of Epidemiology, College of Medicine & College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.

To identify prodromal correlates of asthma as compared to chronic obstructive pulmonary disease and allied-conditions (COPDAC) using a multi domain analysis of socio-ecological, clinical, and demographic domains. This is a retrospective case-risk-control study using data from Florida's statewide Healthcare Cost and Utilization Project (HCUP). Patients were grouped into three groups: asthma, COPDAC (without asthma), and neither asthma nor COPDAC. To identify socio-ecological, clinical, demographic, and clinical predictors of asthma and COPDAC, we used univariate analysis, feature ranking by bootstrapped information gain ratio, multivariable logistic regression with LogitBoost selection, decision trees, and random forests. A total of 141,729 patients met inclusion criteria, of whom 56,052 were diagnosed with asthma, 85,677 with COPDAC, and 84,737 with neither asthma nor COPDAC. The multi-domain approach proved superior in distinguishing asthma versus COPDAC and non-asthma/non-COPDAC controls (area under the curve (AUROC) 84%). The best domain to distinguish asthma from COPDAC without controls was prior clinical diagnoses (AUROC 82%). Ranking variables from all the domains found the most important predictors for the asthma versus COPDAC and controls were primarily socio-ecological variables, while for asthma versus COPDAC without controls, demographic and clinical variables such as age, CCI, and prior clinical diagnoses, scored better. In this large statewide study using a machine learning approach, we found that a multi-domain approach with demographics, clinical, and socio-ecological variables best predicted an asthma diagnosis. Future work should focus on integrating machine learning-generated predictive models into clinical practice to improve early detection of those common respiratory diseases.
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http://dx.doi.org/10.1080/02770903.2019.1642352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982549PMC
November 2020

Prospective Multicenter Feasibility Study of Laparoscopic Sentinel Basin Dissection after Endoscopic Submucosal Dissection for Early Gastric Cancer: SENORITA 2 Trial Protocol.

J Gastric Cancer 2019 Jun 15;19(2):157-164. Epub 2019 Apr 15.

Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

Purpose: Although standard radical gastrectomy is recommended after noncurative resection of endoscopic submucosal dissection (ESD) for early gastric cancer in most cases, residual tumor and lymph node metastasis have not been identified after surgery. The aim of this study is to evaluate the feasibility of sentinel node navigation surgery after noncurative ESD.

Materials And Methods: This trial is an investigator-initiated, multicenter prospective phase II trial. Patients who underwent ESD for clinical stage T1N0M0 gastric cancer with noncurative resections were eligible. Qualified investigators who completed the prior phase III trial (SENORITA 1) are exclusively allowed to participate. In this study, 2 detection methods will be used: 1) intraoperative endoscopic submucosal injection of dual tracer, including radioisotope and indocyanine green (ICG) with sentinel basins detected using gamma-probe; 2) endoscopic injection of ICG, with sentinel basins detected using a fluorescence imaging system. Standard laparoscopic gastrectomy with lymphadenectomy will be performed. Sample size is calculated based on the inferior confidence interval of the detection rate of 95%, and the calculated accrual is 237 patients. The primary endpoint is detection rate, and the secondary endpoints are sensitivity and postoperative complications.

Conclusions: This study is expected to clarify the feasibility of laparoscopic sentinel basin dissection after noncurative ESD. If the feasibility is demonstrated, a multicenter phase III trial will be initiated to compare laparoscopic sentinel node navigation surgery versus laparoscopic standard gastrectomy in early gastric cancer after endoscopic resection.

Trial Registration: ClinicalTrials.gov Identifier: NCT03123042.
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http://dx.doi.org/10.5230/jgc.2019.19.e12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589427PMC
June 2019

Psychiatric disorders' paradoxical protective effect on cardiovascular procedures and mortality.

Psychiatry Res 2019 03 12;273:808. Epub 2019 Jan 12.

Department of Epidemiology, University of Florida, Gainesville, Florida, United States.

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http://dx.doi.org/10.1016/j.psychres.2018.06.030DOI Listing
March 2019

Big data hurdles in precision medicine and precision public health.

BMC Med Inform Decis Mak 2018 12 29;18(1):139. Epub 2018 Dec 29.

Center for Health Outcomes and Informatics Research, Loyola University Chicago, Maywood, IL, 60153, USA.

Background: Nowadays, trendy research in biomedical sciences juxtaposes the term 'precision' to medicine and public health with companion words like big data, data science, and deep learning. Technological advancements permit the collection and merging of large heterogeneous datasets from different sources, from genome sequences to social media posts or from electronic health records to wearables. Additionally, complex algorithms supported by high-performance computing allow one to transform these large datasets into knowledge. Despite such progress, many barriers still exist against achieving precision medicine and precision public health interventions for the benefit of the individual and the population.

Main Body: The present work focuses on analyzing both the technical and societal hurdles related to the development of prediction models of health risks, diagnoses and outcomes from integrated biomedical databases. Methodological challenges that need to be addressed include improving semantics of study designs: medical record data are inherently biased, and even the most advanced deep learning's denoising autoencoders cannot overcome the bias if not handled a priori by design. Societal challenges to face include evaluation of ethically actionable risk factors at the individual and population level; for instance, usage of gender, race, or ethnicity as risk modifiers, not as biological variables, could be replaced by modifiable environmental proxies such as lifestyle and dietary habits, household income, or access to educational resources.

Conclusions: Data science for precision medicine and public health warrants an informatics-oriented formalization of the study design and interoperability throughout all levels of the knowledge inference process, from the research semantics, to model development, and ultimately to implementation.
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http://dx.doi.org/10.1186/s12911-018-0719-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311005PMC
December 2018

Comparison of oncological benefits of deep neuromuscular block in obese patients with gastric cancer (DEBLOQS_GC study): A study protocol for a double-blind, randomized controlled trial.

Medicine (Baltimore) 2018 Dec;97(49):e13424

Department of Surgery.

Purpose: Many studies have demonstrated the advantage of maintaining intraoperative deep neuromuscular block (NMB) with sugammadex. This trial is designed to evaluate the impact of muscle relaxation during laparoscopic subtotal gastrectomy on the oncological benefits, particularly in obese patients with gastric cancer.

Materials And Methods: This is a double-blind, randomized controlled multicenter prospective trial. Patients with clinical stage I-II gastric cancer with a body mass index of 25 and over, who undergo laparoscopic subtotal gastrectomy will be eligible for trial inclusion. The patients will be randomized into a deep NMB group or a moderate NMB group with a 1:1 ratio. A total of 196 patients (98 per group) are required. The primary endpoint is the number of harvested lymph nodes, which is a critical index of the quality of surgery in gastric cancer treatment. The secondary endpoints are surgeon's surgical condition score, patient's sedation score, and surgical outcomes including peak inspiratory pressure, operation time, postoperative pain, and morbidity.

Discussion: This is the first study that compares deep NMB with moderate NMB during laparoscopic gastrectomy in obese patients with gastric cancer. We hope to show the oncologic benefits of deep NMB compared with moderate NMB during subtotal gastrectomy.

Trial Registration Number: ClinicalTrials.gov (NCT03196791), date of registration: October 10, 2017.
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http://dx.doi.org/10.1097/MD.0000000000013424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310580PMC
December 2018

First Conference on Big Data for Pharmacovigilance.

Drug Saf 2018 12;41(12):1281-1284

Drug Safety Research Unit, Southampton, UK.

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http://dx.doi.org/10.1007/s40264-018-0727-2DOI Listing
December 2018

Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts.

Int J Qual Health Care 2019 Jun;31(5):325-330

Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA.

Objective: To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU).

Design: Retrospective analysis of secondary database.

Setting: Ten years of public de-identified ICU electronic medical records from a large hospital in USA.

Participants: Patients (18-65 years old) who had private insurance or no insurance were extracted from the database.

Main Outcome Measures: Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities.

Results: Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse.

Conclusions: Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.
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http://dx.doi.org/10.1093/intqhc/mzy175DOI Listing
June 2019

Safety of Laparoscopic Sentinel Basin Dissection in Patients with Gastric Cancer: an Analysis from the SENORITA Prospective Multicenter Quality Control Trial.

J Gastric Cancer 2018 Mar 26;18(1):30-36. Epub 2018 Mar 26.

Center of Gastric Cancer, National Cancer Center, Goyang, Korea.

Purpose: We investigated complications after laparoscopic sentinel basin dissection (SBD) for patients with gastric cancer who were enrolled in a quality control study, prior to the phase III trial of sentinel lymph node navigation surgery (SNNS).

Materials And Methods: We analyzed prospective data from a Korean multicenter prerequisite quality control trial of laparoscopic SBD for gastric cancer and assessed procedure-related and surgical complications. All complications were classified according to the Clavien-Dindo Classification (CDC) system and were compared with the results of the previously published SNNS trial.

Results: Among the 108 eligible patients who were enrolled in the quality control trial, 8 (7.4%) experienced complications during the early postoperative period. One patient with gastric resection-related duodenal stump leakage recovered after percutaneous drainage (grade IIIa in CDC). The other postoperative complications were mild and patients recovered with supportive care. No complications were directly related to the laparoscopic SBD procedure or tracer usage, and there were no mortalities. The laparoscopic SBD complication rates and patterns that were observed in this study were comparable to those of a previously reported trial.

Conclusions: The results of our prospective, multicenter quality control trial demonstrate that laparoscopic SBD is a safe procedure during SNNS for gastric cancer.
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http://dx.doi.org/10.5230/jgc.2018.18.e6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881008PMC
March 2018

Laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture during laparoscopic gastrectomy for gastric cancer.

Ann Surg Treat Res 2017 Dec 1;93(6):305-309. Epub 2017 Dec 1.

Department of Surgery, Dong-A University College of Medicine, Busan, Korea.

Purpose: Duodenal stump fistula (DSF) is a serious complication after gastrectomy for gastric cancer. Although risk evaluation and management of DSF were presented by some investigators, there was no technical attempt has been made to prevent DSF during laparoscopic gastrectomy until now.

Methods: Consecutive 99 patients were enrolled from April 2014 to February 2016 in 2 institutes. All patients were performed laparoscopic gastrectomy for gastric cancer. After cutting of duodenal stump, laparoscopic reinforcement suture (LARS) commenced with continuous invagination method or interrupted method by barbed suture. Clinicopathologic features and postoperative outcomes were analyzed.

Results: Fifty-six patients had comorbidity including 5 patients with duodenal ulcer. Most patients were performed distal gastrectomy with B-II, and 10 patients total gastrectomy with Roux en Y esophagojejunostomy. Although there were 2 esophagojejunostomy leakage and 1 artificial lesser curvature leakage, DSF did not occurred at all in this study. Mean operation time was 3 hours and mean LARS procedure time was 8 minutes.

Conclusion: LARS of duodenal stump can be considered as one of prevention methods of DSF during laparoscopic gastrectomy for gastric cancer. So this new technique will be necessary to appropriately evaluate by prospective randomized controlled trial in the future.
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http://dx.doi.org/10.4174/astr.2017.93.6.305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729124PMC
December 2017

Phylodynamic applications in 21 century global infectious disease research.

Glob Health Res Policy 2017 8;2:13. Epub 2017 May 8.

Department of Epidemiology, University of Florida, Gainesville, FL USA.

Background: Phylodynamics, the study of the interaction between epidemiological and pathogen evolutionary processes within and among populations, was originally defined in the context of rapidly evolving viruses and used to characterize transmission dynamics. The concept of phylodynamics has evolved since the early 21 century, extending its reach to slower-evolving pathogens, including bacteria and fungi, and to the identification of influential factors in disease spread and pathogen population dynamics.

Results: The phylodynamic approach has now become a fundamental building block for the development of comparative phylogenetic tools capable of incorporating epidemiological surveillance data with molecular sequences into a single statistical framework. These innovative tools have greatly enhanced scientific investigations of the temporal and geographical origins, evolutionary history, and ecological risk factors associated with the growth and spread of viruses such as human immunodeficiency virus (HIV), Zika, and dengue and bacteria such as Methicillin-resistant .

Conclusions: Capitalizing on an extensive review of the literature, we discuss the evolution of the field of infectious disease epidemiology and recent accomplishments, highlighting the advancements in phylodynamics, as well as the challenges and limitations currently facing researchers studying emerging pathogen epidemics across the globe.
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http://dx.doi.org/10.1186/s41256-017-0034-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683535PMC
May 2017

Real-time detection system for tumor localization during minimally invasive surgery for gastric and colon cancer removal: In vivo feasibility study in a swine model.

J Surg Oncol 2018 Mar 28;117(4):699-706. Epub 2017 Nov 28.

Department of Research and Development, Medical Device Development Center in the Osong Medical Innovation Foundation, Cheongju, Republic of Korea.

Background And Objectives: During minimally invasive surgery (MIS), it is impossible to directly detect marked clips around tumors via palpation. Therefore, we developed a novel method and device using Radio Frequency IDentification (RFID) technology to detect the position of clips during minimally invasive gastrectomy or colectomy.

Methods: The feasibility of the RFID-based detection system was evaluated in an animal experiment consisting of seven swine. The primary outcome was to successfully detect the location of RFID clips in the stomach and colon. The secondary outcome measures were to detect time (time during the intracorporeal detection of the RFID clip), and accuracy (distance between the RFID clip and the detected site).

Results: A total of 25 detection attempts (14 in the stomach and 11 in the colon) using the RFID antenna had a 100% success rate. The median detection time was 32.5 s (range, 15-119 s) for the stomach and 28.0 s (range, 8-87 s) for the colon. The median detection distance was 6.5 mm (range, 4-18 mm) for the stomach and 6.0 mm (range, 3-13 mm) for the colon.

Conclusions: We demonstrated favorable results for a RFID system that detects the position of gastric and colon tumors in real-time during MIS.
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http://dx.doi.org/10.1002/jso.24922DOI Listing
March 2018

Reported Adverse Events with Painkillers: Data Mining of the US Food and Drug Administration Adverse Events Reporting System.

Drug Saf 2018 Mar;41(3):313-320

Department of Epidemiology, University of Florida, 2004 Mowry Rd, PO Box 100231, Gainesville, FL, 32610, USA.

Introduction: One-third of adults in the USA experience chronic pain and use a variety of painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. However, some serious adverse events (AEs), such as cardiovascular incidents, overdose, and death, have been found to be related to painkillers.

Methods: We used 2015 and 2016 AE reports from the US FDA's Adverse Events Reporting System (FAERS) to conduct exploratory analysis on the demographics of those who reported painkiller-related AEs, examine the AEs most commonly associated with different types of painkillers, and identify potential safety signals. Summary descriptive statistics and proportional reporting ratios (PRRs) were performed.

Results: Out of over 2 million reports submitted to FAERS in 2015 and 2016, a total of 64,354 AE reports were associated with painkillers. Reports of opioid-associated AEs were more likely to be from males or younger patients (mean age 47.6 years). The highest numbers of AEs were reported for NSAID and opioid use, and the most commonly found AEs were related to drug ineffectiveness, administration issues, abuse, and overdose. Death was reported in 20.0% of the reports, and serious adverse reactions, including death, were reported in 67.0%; both adverse outcomes were highest among patients using opioids or combinations of painkillers and were associated with PRRs of 2.12 and 1.87, respectively.

Conclusions: This study examined the AEs most commonly associated with varying classes of painkillers by mining the FAERS database. Our results and methods are relevant for future secondary analyses of big data and for understanding adverse outcomes related to painkillers.
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http://dx.doi.org/10.1007/s40264-017-0611-5DOI Listing
March 2018

Which Factors Are Important for Successful Sentinel Node Navigation Surgery in Gastric Cancer Patients? Analysis from the SENORITA Prospective Multicenter Feasibility Quality Control Trial.

Gastroenterol Res Pract 2017 15;2017:1732571. Epub 2017 Jun 15.

Gastric Cancer Branch, National Cancer Center, Goyang, Republic of Korea.

Background: We investigated the results of quality control study prior to phase III trial of sentinel lymph node navigation surgery (SNNS).

Methods: Data were reviewed from 108 patients enrolled in the feasibility study of laparoscopic sentinel basin dissection (SBD) in gastric cancer. Seven steps contain tracer injection at submucosa (step 1) and at four sites (step 2) by intraoperative esophagogastroduodenoscopy (EGD), leakage of tracer (step 3), injection within 3 minutes (step 4), identification of at least one sentinel basin (SB) (step 5), evaluation of sentinel basin nodes (SBNs) by frozen biopsy (step 6), and identification of at least five SBNs at back table and frozen sections (step 7).

Results: Failure in step 7 ( = 23) was the most common followed by step 3 ( = 15) and step 6 ( = 13). We did not find any differences of clinicopathological factors between success and failure group in steps 1~6. In step 7, body mass index (BMI) was only the significant factor. The success rate was 97.1% in patients with BMI  <  23 kg/m and 80.3% in those with BMI ≥ 23 kg/m ( = 0.028).

Conclusions: Lower BMI group showed higher success rate in step 7. Surgeons doing SNNS should be cautious when evaluating sufficient number of SBN in obese patients.
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http://dx.doi.org/10.1155/2017/1732571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494563PMC
June 2017

Identification of genes dysregulated by elevation of microRNA-210 levels in human trophoblasts cell line, Swan 71.

Am J Reprod Immunol 2017 Nov 27;78(5). Epub 2017 Jun 27.

Department of Biomedical Technology, Kangwon National University, Chuncheon, Korea.

Problem: Preeclampsia is a serious pregnancy disorder characterized by gestational hypertension and proteinuria. miR-210 is significantly overexpressed in the placentas of preeclampsia patients.

Method Of Study: Swan 71 cells, first-trimester human trophoblastic cell line, were transfected with hsa-miR-210-3p oligonucleotides by electroporation. Altered transcriptome was analyzed using microarray technique. Differentially expressed genes (DEGs) were clustered into Gene Ontology annotation biological processes. The extent of physical interaction between miR-210 and IGFBP3 mRNA was assessed via ribonucleoprotein immunoprecipitation.

Results: Microarray analysis showed 408 DEGs by elevated levels of miR-210 in Swan 71 cells. These genes were enriched in several biological processes involved in the pathogenesis of preeclampsia. IGFBP3, a gene associated with preeclampsia pathophysiology, was validated as a target gene of miR-210.

Conclusion: We have demonstrated that elevated miR-210 levels in human trophoblast alter the expression profile of known preeclampsia-associated genes, and of gene targets involved in various biological processes essential to preeclampsia progression.
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http://dx.doi.org/10.1111/aji.12722DOI Listing
November 2017

Identification of Maturity-Onset Diabetes of the Young Caused by Glucokinase Mutations Detected Using Whole-Exome Sequencing.

Endocrinol Metab (Seoul) 2017 Jun 29;32(2):296-301. Epub 2017 May 29.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

Glucokinase maturity-onset diabetes of the young (GCK-MODY) represents a distinct subgroup of MODY that does not require hyperglycemia-lowering treatment and has very few diabetes-related complications. Three patients from two families who presented with clinical signs of GCK-MODY were evaluated. Whole-exome sequencing was performed and the effects of the identified mutations were assessed using bioinformatics tools, such as PolyPhen-2, SIFT, and in silico modeling. We identified two mutations: p.Leu30Pro and p.Ser383Leu. In silico analyses predicted that these mutations result in structural conformational changes, protein destabilization, and thermal instability. Our findings may inform future GCK-MODY diagnosis; furthermore, the two mutations detected in two Korean families with GCK-MODY improve our understanding of the genetic basis of the disease.
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http://dx.doi.org/10.3803/EnM.2017.32.2.296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503876PMC
June 2017

RE: "AGE AND SEX DIFFERENCES IN BODY MASS INDEX AS A PREDICTOR OF HIP FRACTURE: A NOREPOS STUDY".

Authors:
Jae Min

Am J Epidemiol 2017 03;185(6):511

Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL.

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http://dx.doi.org/10.1093/aje/kwx026DOI Listing
March 2017