Publications by authors named "Ji Hyun Lee"

1,260 Publications

  • Page 1 of 1

Low hemoglobin levels and an increased risk of psoriasis in patients with chronic kidney disease.

Sci Rep 2021 Jul 20;11(1):14741. Epub 2021 Jul 20.

Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.

Chronic diseases, such as chronic kidney disease (CKD), are frequently accompanied by various comorbidities, including anemia, which is considered a surrogate marker of systemic inflammation. Psoriasis is a chronic inflammatory skin disease prevalent in patients with chronic disease. Psoriasis risk in patients with CKD, however, especially in patients with low hemoglobin levels, has never been investigated. In this study, we investigated associations between low hemoglobin levels and psoriasis in patients with CKD using data from the National Health Insurance Service of Korea. During a mean follow-up period of 6.16 ± 1.02 years, psoriasis was recorded in 13,803 patients with CKD (2.39% of CKD patients). The cumulative incidence of psoriasis was significantly higher in CKD patients with anemia (hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) than those without. In multivariate-adjusted Cox proportional hazards regression models, the risk of psoriasis was significantly higher in anemic CKD patients than nonanemic CKD patients (hazard ratio [HR] 1.136, 95% CI 1.089-1.185, p < 0.001). Additionally, we noted that the incidence of psoriasis decreased with increasing hemoglobin levels in CKD patients (HR 0.953, 95% CI 0.942-0.965, p < 0.001). Altogether, our findings indicate that low hemoglobin levels are significantly related to psoriasis risk in patients with CKD. Further study is required to elucidate whether low hemoglobin levels have an impact on the development of psoriasis or are merely a surrogate marker of psoriasis risk in patients with CKD.
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http://dx.doi.org/10.1038/s41598-021-94165-wDOI Listing
July 2021

Correction: A Determinants-of-Fertility Ontology for Detecting Future Signals of Fertility Issues From Social Media Data: Development of an Ontology.

J Med Internet Res 2021 Jul 13;23(7):e31601. Epub 2021 Jul 13.

Department of Health Management, Samyook University, Seoul, Republic of Korea.

[This corrects the article DOI: 10.2196/25028.].
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http://dx.doi.org/10.2196/31601DOI Listing
July 2021

Targeted sequencing of localized acral melanoma in Korean patients identified recurrent CCND1 amplification.

Int J Dermatol 2021 Jul 9. Epub 2021 Jul 9.

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

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http://dx.doi.org/10.1111/ijd.15766DOI Listing
July 2021

Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - A case report.

Anesth Pain Med (Seoul) 2021 Jul 8. Epub 2021 Jul 8.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Background: Pediatric patients with moyamoya disease are vulnerable to ischemic attacks following physical or emotional stress, such as those experienced during blood sampling. A central venous catheter might be beneficial for blood sampling, and a peripherally inserted central catheter (PICC) is a considerable option for central venous access. However, PICC insertion during anesthetic management is relatively rare.

Case: Thirty cases of ultrasound-guided PICC insertion were performed in children undergoing surgery for moyamoya disease after anesthetic induction. Positioning was successful in 22 cases, and 5 were malpositioned. In three cases, the peripheral insertion failed. Adjustment of the insertion depth was performed in nine cases. No complications related to catheterization were observed during the procedure or the catheter indwelling period.

Conclusions: We report the successful use of PICC in children undergoing surgery for moyamoya disease with a considerable success rate and low incidence of malpositioning or complications.
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http://dx.doi.org/10.17085/apm.20099DOI Listing
July 2021

The Risk of Psoriasis in Patients With Allergic Diseases: A Nationwide Population-based Cohort Study.

Allergy Asthma Immunol Res 2021 Jul;13(4):638-645

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

The spectrum of allergic diseases includes atopic dermatitis (AD), allergic rhinitis (AR), and asthma. To date, the association between allergic diseases and psoriasis has not yet been completely evaluated. This study was conducted to determine the risk of psoriasis in patients with allergic diseases. A health screening database, a sub-dataset of the Korean National Health Insurance Service database, was used. All 9,718,722 subjects who underwent health examination in 2009 at age over 20 were included. Subjects with allergic diseases including AD (n = 35,685), AR (n = 1,362,713), asthma (n = 279,451) and control subjects without all three allergic diseases (n = 8,210,042), without AD (n = 9,683,037), without AR (n = 8,356,009) and without asthma group (n = 9,439,271) were analyzed. The subjects were tracked using their medical records during the 8-year period from 2010 to 2017 to identify those who developed psoriasis. Multivariate Cox regression models were used to assess the risk of psoriasis. The incidence probability of psoriasis was analyzed through the Kaplan-Meier method. The incidence of psoriasis per 1,000 person-years was 9.57, 3.78, and 4.28 in the AD, AR, and asthma groups, respectively. The AD group exhibited a significantly increased risk of developing psoriasis compared to subjects without AD (hazard ratio [HR], 3.18; 95% confidence interval [95% CI], 3.05-3.31; < 0.001) after adjustment for confounding factors. The risk of psoriasis was significantly increased in the AR group compared to subjects without AR (HR, 1.32; 95% CI, 1.31-1.34; < 0.001) and asthma group compared to subjects without asthma (HR, 1.30; 95% CI, 1.27-1.33; < 0.001). Allergic diseases, particularly AD, may be a risk factor for psoriasis.
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http://dx.doi.org/10.4168/aair.2021.13.4.638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255348PMC
July 2021

Distinct Characteristics and Clinical Outcomes to Predict the Emergence of Amplification in Patients with Non-Small Cell Lung Cancer Who Developed Resistance after Treatment with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors.

Cancers (Basel) 2021 Jun 21;13(12). Epub 2021 Jun 21.

Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.

Objectives: Patients with epidermal growth factor receptor () mutant non-small cell lung cancer (NSCLC) ultimately acquire resistance to tyrosine kinase inhibitors (TKIs) during treatment. In 5-22% of these patients, resistance is mediated by aberrant mesenchymal epithelial transition factor () gene amplification. Here, we evaluated the emergence of amplification after EGFR-TKI treatment failure based on clinical parameters.

Materials And Methods: We retrospectively analyzed 186 patients with advanced -mutant NSCLC for amplification status by in situ hybridization (ISH) assay after EGFR-TKI failure. We collected information including baseline patient characteristics, metastatic locations and generation, line, and progression-free survival (PFS) of EGFR-TKI used before evaluation. Multivariate logistic regression analysis was conducted to evaluate associations between amplification status and clinical variables.

Results: Regarding baseline mutations, exon 19 deletion was predominant (57.5%), followed by L858R mutation (37.1%). The proportions of ISH assays performed after first/second-generation and third-generation TKI failure were 66.7% and 33.1%, respectively. The median PFS for the most recent EGFR-TKI treatment was shorter in amplification-positive patients than in amplification-negative patients (median PFS 7.0 vs. 10.4 months, = 0.004). Multivariate logistic regression demonstrated that a history of smoking, short PFS on the most recent TKI, and less intracranial progression were associated with a high probability of amplification (all < 0.05).

Conclusions: Our results demonstrated the distinct clinical characteristics of patients with amplification-positive NSCLC after EGFR-TKI therapy. Our clinical prediction can aid physicians in selecting patients eligible for amplification screening and therapeutic targeting.
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http://dx.doi.org/10.3390/cancers13123096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234556PMC
June 2021

Efficient Matrix Cleanup of Soft-Gel-Type Dietary Supplements for Rapid Screening of 92 Illegal Adulterants Using EMR-Lipid dSPE and UHPLC-Q/TOF-MS.

Pharmaceuticals (Basel) 2021 Jun 15;14(6). Epub 2021 Jun 15.

College of Pharmacy, Kyung Hee University, Seoul 02447, Korea.

An efficient matrix cleanup method was developed for the rapid screening of 92 illegal adulterants (25 erectile dysfunction drugs, 15 steroids, seven anabolic steroids, 12 antihistamines, 12 nonsteroidal anti-inflammatory drugs (NSAIDs), four diuretics, and 17 weight-loss drugs) in soft-gel-type supplements by ultra-high performance liquid chromatography-quadrupole/time of flight-mass spectrometry (UHPLC-Q/TOF-MS). As representative green chemistry methods, three sample preparation methods (dispersive liquid-liquid microextraction (DLLME), "quick, easy, cheap, effective, rugged, and safe" dispersive solid-phase extraction (QuEChERS-dSPE), and enhanced matrix removal-lipid (EMR-Lipid) dSPE) were evaluated for matrix removal efficiency, recovery rate, and matrix effect. In this study, EMR-Lipid dSPE was shown to effectively remove complicated matrix contents in soft-gels, compared to DLLME and QuEChERS-dSPE. For the rapid screening of a wide range of adulterants, extracted common ion chromatogram (ECIC) and neutral loss scan (NLS) based on specific common MS/MS fragments were applied to randomly collected soft-gel-type dietary supplement samples using UHPLC-Q/TOF-MS. Both ECICs and NLSs enabled rapid and simple screening of multi-class adulterants and could be an alternative to the multiple reaction monitoring (MRM) method. The developed method was validated in terms of limit of detection (LOD), precision, accuracy, recovery, and matrix effects. The range of LODs was 0.1-16 ng/g. The overall precision values were within 0.09-14.65%. The accuracy ranged from 81.6% to 116.6%. The recoveries and matrix effects of 92 illegal adulterants ranged within 16.9-119.4% and 69.8-114.8%, respectively. The established method was successfully applied to screen and identify 92 illegal adulterants in soft-gels. This method can be a promising tool for the high-throughput screening of various adulterants in dietary supplements and could be used as a more environmentally friendly routine analytical method for screening dietary supplements illegally adulterated with multi-class drug substances.
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http://dx.doi.org/10.3390/ph14060570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232078PMC
June 2021

NecroX-5 Can Suppress Melanoma Metastasis by Reducing the Expression of Rho-Family GTPases.

J Clin Med 2021 Jun 25;10(13). Epub 2021 Jun 25.

Department of Biomedicine & Health Sciences, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.

NecroX-5 (NX-5) is a cell-permeable necrosis inhibitor with cytoprotective effects. Although it has been reported to inhibit lung and breast cancer metastasis by modulating migration, its therapeutic effect on melanoma metastasis is still unknown. In this study, we examined the anti-metastatic effect of NX-5 on melanoma cell lines and its related therapeutic mechanism. The anti-metastatic effect of NX-5 on melanoma cell lines was determined using a transwell migration assay. We performed a quantitative real-time polymerase chain reaction and western blot analysis to measure changes in the expression of mRNA and protein, respectively, for major mediators of Rho-family GTPases after NX-5 treatment in melanoma cells. In addition, after constructing the 3D melanoma model, the expression of Rho-family GTPases was measured by immunohistochemistry. NX-5 (10 μM and 20 μM) treatment significantly reduced melanoma cell migration ( < 0.01). Additionally, NX-5 (20 μM) treatment significantly decreased the mRNA and protein expression levels of Cdc42, Rac1, and RhoA in melanoma cells compared with the untreated group ( < 0.001 and < 0.05, respectively). Immunohistochemistry for our 3D melanoma model showed that Cdc42, Rac1, and RhoA were constitutively expressed in the nuclei of melanoma cells of the untreated group, and NX-5 treatment decreased their expression. These results demonstrate that NX-5 can suppress melanoma metastasis by reducing the expression of Rho-family GTPases.
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http://dx.doi.org/10.3390/jcm10132790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267632PMC
June 2021

Anti-Obesity Effect of (L.) Pers. Extract Containing Phenolic Acids.

Foods 2021 Jun 2;10(6). Epub 2021 Jun 2.

Department of Food Science and Nutrition & the Korean Institute of Nutrition, Hallym University, Chuncheon 24252, Korea.

(L.) Pers. water extract (EAW) was investigated for its anti-obesity effects in C57BL/6J mice on a high-fat diet. Mice were divided into groups fed normal and high-fat diets (ND and HFD, respectively), and HFD mice were treated with EAW (50, 100, and 200 mg/kg/day) for 8 weeks. Inhibition of HFD-induced obesity by EAW was evaluated using biochemical parameters, immunohistochemistry, real-time PCR, and immunoblot assay. EAW supplementation significantly diminished the final body weight, adipose tissue size, and epididymal adipose tissue volume compared with mice with obesity induced by HFD ( < 0.05 for all). EAW also decreased serum triglyceride (TG) and LDL-cholesterol (LDL-c) levels in obese mice. EAW attenuated HFD-induced obesity by down-regulating C/EBPα, PPARγ, and SREBP-1c to suppress adipogenesis. Moreover, this study indicated that EAW activates the AMPK pathway and increases ACC phosphorylation and downstream CPT1 expression in HFD-induced obese mice. Furthermore, several phenolic acids with anti-obesity properties have been identified in EAW, including quinic acid, caffeic acid, chlorogenic acid, and 3,4-dicaffeoylquinic acid. Based on these data, EAW has anti-obesity effects in vivo, which indicates that it is an excellent candidate for the development of anti-obesity functional foods.
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http://dx.doi.org/10.3390/foods10061266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228698PMC
June 2021

Changes in the Long-term Prognosis of Crohn's Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study.

Gut Liver 2021 Jun 22. Epub 2021 Jun 22.

Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background/aims: The long-term course of Crohn's disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the longterm prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort.

Methods: Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015.

Results: During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68).

Conclusions: The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades.
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http://dx.doi.org/10.5009/gnl210044DOI Listing
June 2021

A Determinants-of-Fertility Ontology for Detecting Future Signals of Fertility Issues From Social Media Data: Development of an Ontology.

J Med Internet Res 2021 Jun 14;23(6):e25028. Epub 2021 Jun 14.

Department of Health Management, Samyook University, Seoul, Republic of Korea.

Background: South Korea has the lowest fertility rate in the world despite considerable governmental efforts to boost it. Increasing the fertility rate and achieving the desired outcomes of any implemented policies requires reliable data on the ongoing trends in fertility and preparations for the future based on these trends.

Objective: The aims of this study were to (1) develop a determinants-of-fertility ontology with terminology for collecting and analyzing social media data; (2) determine the description logics, content coverage, and structural and representational layers of the ontology; and (3) use the ontology to detect future signals of fertility issues.

Methods: An ontology was developed using the Ontology Development 101 methodology. The domain and scope of the ontology were defined by compiling a list of competency questions. The terms were collected from Korean government reports, Korea's Basic Plan for Low Fertility and Aging Society, a national survey about marriage and childbirth, and social media postings on fertility issues. The classes and their hierarchy were defined using a top-down approach based on an ecological model. The internal structure of classes was defined using the entity-attribute-value model. The description logics of the ontology were evaluated using Protégé (version 5.5.0), and the content coverage was evaluated by comparing concepts extracted from social media posts with the list of ontology classes. The structural and representational layers of the ontology were evaluated by experts. Social media data were collected from 183 online channels between January 1, 2011, and June 30, 2015. To detect future signals of fertility issues, 2 classes of the ontology, the socioeconomic and cultural environment, and public policy, were identified as keywords. A keyword issue map was constructed, and the defined keywords were mapped to identify future signals. R software (version 3.5.2) was used to mine for future signals.

Results: A determinants-of-fertility ontology comprised 236 classes and terminology comprised 1464 synonyms of the 236 classes. Concept classes in the ontology were found to be coherently and consistently defined. The ontology included more than 90% of the concepts that appeared in social media posts on fertility policies. Average scores for all of the criteria for structural and representations layers exceeded 4 on a 5-point scale. Violence and abuse (socioeconomic and cultural factor) and flexible working arrangement (fertility policy) were weak signals, suggesting that they could increase rapidly in the future.

Conclusions: The determinants-of-fertility ontology developed in this study can be used as a framework for collecting and analyzing social media data on fertility issues and detecting future signals of fertility issues. The future signals identified in this study will be useful for policy makers who are developing policy responses to low fertility.
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http://dx.doi.org/10.2196/25028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240803PMC
June 2021

Phase II Study of 5-Fluorouracil, Oxaliplatin plus Dasatinib (FOLFOX-D) in First-Line Metastatic Pancreatic Adenocarcinoma.

Oncologist 2021 Jun 8. Epub 2021 Jun 8.

Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Lessons Learned: Preclinical studies have demonstrated that Src inhibition through dasatinib synergistically enhances the antitumor effects of oxaliplatin. In this phase II, single-arm study, FOLFOX with dasatinib in previously untreated patients with mPC only showed only modest clinical activity, with a progressive-free survival of 4 months and overall survival of 10.6 months. Continued investigation is ongoing to better understand the role of Src inhibition with concurrent 5-fluorouracil and oxaliplatin in a subset of exceptional responders.

Background: Src tyrosine kinase activity is overexpressed in many human cancers, including metastatic pancreatic cancer (mPC). Dasatinib is a potent inhibitor of Src family of tyrosine kinases. This study was designed to investigate whether dasatinib can synergistically enhance antitumor effects of FOLFOX regimen (FOLFOX-D).

Methods: In this single-arm, phase II study, previously untreated patients received dasatinib 150 mg oral daily on days 1-14, oxaliplatin 85 mg/m intravenous (IV) on day 1 every 14 days, leucovorin (LV) 400 mg/m IV on day 1 every 14 days, 5-fluorouracil (5-FU) bolus 400 mg/m on day 1 every 14 days, and 5-FU continuous infusion 2,400 mg/m on day 1 every 14 days. Primary endpoint was progression-free survival (PFS) with preplanned comparison to historical controls.

Results: Forty-four patients enrolled with an estimated median PFS of 4.0 (95% confidence interval [CI], 2.3-8.5) months and overall survival (OS) of 10.6 (95% CI, 6.9-12.7) months. Overall response rate (ORR) was 22.7% (n = 10): one patient (2.3%) with complete response (CR) and nine patients (20.5%) with partial response (PR). Fifteen patients (34.1%) had stable disease (SD). Nausea was the most common adverse event (AE) seen in 35 patients (79.5%).

Conclusion: The addition of dasatinib did not appear to add incremental clinical benefit to FOLFOX in untreated patients with mPC.
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http://dx.doi.org/10.1002/onco.13853DOI Listing
June 2021

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis.

Sci Rep 2021 Jun 7;11(1):11922. Epub 2021 Jun 7.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Many pharmacologic agents were investigated for the effect to prevent delirium. We aimed to comprehensively compare the effect of the pharmacological interventions to prevent postoperative delirium. A Bayesian network meta-analysis of randomized trials was performed using random effects model. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched on 20 January 2021. Randomized trials comparing the effect of a drug to prevent postoperative delirium with another drug or placebo in adult patients undergoing any kind of surgery were included. Primary outcome was the postoperative incidence of delirium. Eighty-six trials with 26,992 participants were included. Dexmedetomidine, haloperidol, and atypical antipsychotics significantly decreased the incidence of delirium than placebo [dexmedetomidine: odds ratio 0.51, 95% credible interval (CrI) 0.40-0.66, moderate quality of evidence (QOE); haloperidol: odds ratio 0.59, 95% CrI 0.37-0.95, moderate QOE; atypical antipsychotics: odds ratio 0.27, 95% CrI 0.14-0.51, moderate QOE]. Dexmedetomidine and atypical antipsychotics had the highest-ranking probabilities to be the best. However, significant heterogeneity regarding diagnostic time window as well as small study effects precludes firm conclusion.
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http://dx.doi.org/10.1038/s41598-021-91314-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184858PMC
June 2021

Production of IL-31 in CD45ROCLAH4R T Cells in Atopic Dermatitis.

J Clin Med 2021 May 4;10(9). Epub 2021 May 4.

Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.

IL-31 is involved in pruritus in atopic dermatitis (AD) and the pathogenesis of AD. However, the mechanism of IL-31 production is not fully understood. We sought to investigate the association between CD45ROCLAH4R T cells and IL-31 production. Immunofluorescence studies were performed retrospectively on punch-biopsy specimens from five people with AD and three healthy controls. In addition, blood samples were collected prospectively from eight patients with AD and eight healthy controls for sorting CD45ROCLAH4R T cells. There was no overlap of patients between the biopsy group and the blood sampling group. Sorted cells were stimulated with 4-methylhistamine (4MH), and the level of IL-31 was measured by an enzyme-linked immunosorbent assay. Immunofluorescence showed co-localization of H4R and IL-31 in lesional AD skin but not in normal skin of healthy controls. The proportion of CLAH4R T cells among CD3CD45RO lymphocytes was 18.3 ± 6.2% in patients with AD and 11.2 ± 7.6% in healthy controls. In the AD group, production of IL-31 by CD45ROCLAH4R T cells increased from 32.4 ± 13.3 pg/mL to 47.5 ± 18.7 pg/mL by 4MH stimulation after 24 h ( < 0.001). However, in the control group, production of IL-31 was 20.1 ± 10.6 pg/mL without and 22.1 ± 9.3 pg/mL with 4MH stimulation ( > 0.05). According to our study, CD45ROCLAH4R T cells are an important source of IL-31 in AD, and may be a target for treatment of IL-31-induced pruritus.
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http://dx.doi.org/10.3390/jcm10091976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124489PMC
May 2021

Prediction of gastric fluid volume by ultrasonography in infants undergoing general anaesthesia.

Br J Anaesth 2021 Aug 25;127(2):275-280. Epub 2021 May 25.

Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Point-of-care ultrasonography can estimate gastric contents and volume to assess the risk of pulmonary aspiration; however, its use in infants has not been well validated. We aimed to develop a predictive model for estimating gastric fluid volume using ultrasonography in infants.

Methods: This prospective observational study enrolled 200 infants (≤12 months) undergoing general anaesthesia. After anaesthetic induction, while preserving spontaneous respiration, we measured gastric antral cross-sectional area using ultrasonography in both the supine and right lateral decubitus positions. We then suctioned the gastric content and measured its volume. The primary outcome was development of a gastric fluid volume prediction model with multiple regression analysis. Agreement between the predicted volume and the suctioned volume was evaluated using a Bland-Altman plot.

Results: Overall, 192 infants were included in the final analysis. Pearson correlation analysis showed that the gastric antral cross-sectional area in the supine (P<0.001; correlation coefficient: 0.667) and right lateral decubitus (P<0.001; correlation coefficient: 0.845) positions and qualitative antral grade (P<0.001; correlation coefficient: 0.581) correlated with suctioned volume. We developed a predictive model: predicted volume (ml)=-3.7+6.5 × (right lateral decubitus cross-sectional area [cm])-3.9 (supine cross-sectional area [cm])+1.7 × grade (P<0.01). When comparing the predicted volume and suctioned volume, the mean bias was 0.01 ml kg and the limit of agreement was -0.58 to 0.62 ml kg.

Conclusions: Gastric fluid volume can be estimated using a predictive model based on ultrasonography data in infants.

Clinical Trial Registration: NCT03155776.
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http://dx.doi.org/10.1016/j.bja.2021.03.039DOI Listing
August 2021

Chemotherapy education: current practices of oncology nurses counseling patients.

Support Care Cancer 2021 May 27. Epub 2021 May 27.

Department of Medicine, Division of Hematology/Oncology, University of Florida, 1600 SW Archer Rd, P.O. Box 100278, Gainesville, FL, 32610, USA.

Purpose: Chemotherapy education provided by nurses to patients is a fundamental component of high-quality cancer care. The Quality Oncology Practice Initiative (QOPI ®) provides guidance on treatment-related aspects of chemotherapy education (diagnosis, goals, regimen, schedule, adverse events, follow-up), but recommendations on practical lifestyle issues lack evidence and standardization.

Methods: An anonymous, voluntary, uncompensated survey was distributed in October 2019 to 12,995 oncology certified nurses who report working in adult outpatient clinic/infusion room settings. An electronic survey was designed to determine current practice in nurse-patient counseling related to lifestyle and behavior during chemotherapy treatment.

Results: Survey responses were obtained from 1243 oncology certified nurses (9.6%). Nurses reported that their education practice was influenced by their institution and coworkers (other nurses or oncologists). Most nurses (> 50%) reported counseling on all topics asked. Most frequently counseled topics included water intake, infection monitoring, alcohol consumption, exercise, and mucositis. Less frequently counseled topics included hair dye, laundry practices, and mask wearing (pre-pandemic).

Conclusion: This study highlighted that chemotherapy nurses routinely counsel patients on important topics that lack evidence-based recommendations. In the absence of evidence, nurses rely on learned education practices, most commonly institutional guides or recommendations adopted from other nurses or oncologists. On important topics that lack evidence, expert panel review and development of consensus guidelines could standardize and improve the education process for both oncology nurses and patients.
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http://dx.doi.org/10.1007/s00520-021-06308-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154105PMC
May 2021

Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study.

J Aging Health 2021 May 22:8982643211019500. Epub 2021 May 22.

Department of Behavioral Sciences and Social Medicine, 12236Florida State University College of Medicine, Tallahassee, FL, USA.

To examine whether the trajectory of facets of loneliness-emotional and social-varied by cognitive impairment status in older adulthood. Data came from the Health and Retirement Study 2008-2018 waves ( = 15,352). Cognitive impairment was assessed using standard cutoffs for cognitive impairment no dementia (CIND) and dementia. The 11-item UCLA loneliness scale was used to measure emotional and social loneliness. Using multilevel modeling, we found that CIND and dementia status were associated with higher overall, emotional, and social loneliness, controlling for physical health, social contact, and depressive symptoms. The trajectory of loneliness did not vary by cognitive status. There were modest variations by sociodemographic factors. Persons with CIND and dementia experience heightened emotional and social loneliness, but cognitive impairment does not contribute to the worsening of loneliness. Older adults' social integration may be maintained early in cognitive impairment.
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http://dx.doi.org/10.1177/08982643211019500DOI Listing
May 2021

Preventive Behaviors During the COVID-19 Pandemic: Associations With Perceived Behavioral Control, Attitudes, and Subjective Norm.

Front Public Health 2021 7;9:662835. Epub 2021 May 7.

Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States.

The coronavirus disease 2019 (COVID-19) is a highly contagious and potentially fatal infectious disease that has swept the globe. To reduce the spread, it is important to engage in preventive behaviors recommended by health authorities, such as washing your hands, wearing a face mask, and social distancing. In the present study, we draw from the Theory of Planned Behavior (TPB) to examine the associations between perceived behavioral control, attitudes, and subjective norm and whether people engage in eight different preventive behaviors. For each of the preventive behaviors (washing hands; using hand sanitizer; not touching your face; social distancing; wearing a face mask; disinfecting surfaces; coughing in your elbow; staying home if sick), we conducted separate logistic regressions predicting whether the participants ( = 2,256; age range = 1898 years) reported engaging in the behavior from their perceived behavioral control, attitudes, and subjective norm. We found that perceived behavioral control, attitudes, and subjective norm had independent significant associations with each preventive behavior. Moderation analyses revealed that for most behaviors the associations with perceived behavioral control were stronger for older adults than for younger adults. The present study was cross-sectional; future longitudinal studies and interventions are needed to disentangle directionality. Our findings suggest several ways to increase adherence to health behaviors that reduce the spread of coronavirus and other infectious diseases.
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http://dx.doi.org/10.3389/fpubh.2021.662835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139398PMC
May 2021

Predicting hypotension during anesthesia: Variation in pulse oximetry plethysmography predicts propofol-induced hypotension in children.

Paediatr Anaesth 2021 Aug 11;31(8):894-901. Epub 2021 Jun 11.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.

Background: The development of hypotension on administration of intravenous propofol is common and independently associated with adverse outcomes. Identifying patients with a high risk for anesthesia-induced hypotension may help anesthesiologists prepare for such an event.

Aim: The authors hypothesized that propofol-induced hypotension is predictable by variables related to fluid responsiveness and investigated such variables to determine the factors which can predict hypotensive events.

Methods: Patients 3-6 years of age who underwent general were included. Intravenous midazolam 0.1 mg kg was administered as premedication, and preoperative noninvasive blood pressure, heart rate, perfusion index, pleth variability index, and respiratory variation of pulse oximetry plethysmographic waveform were measured. Intravenous propofol 2.5 mg kg was given, and blood pressure was measured 5 times at 1-min intervals. Subjects with significant hypotension (mean blood pressure decrease ≥20%) were allocated to the hypotensive group; those without significant hypotension were allocated to the relatively normotensive group.

Results: Of 77 patients, 50 (64.9%) developed significant hypotension. Patients in the hypotensive group exhibited significantly higher respiratory variation of pulse oximetry plethysmographic waveform (mean difference 11 [3.3] [95% confidence interval 4.9-18.1]; p = .001) and higher pleth variability index (mean difference 7.1 [2.8] [95% confidence interval 1.6-12.6]; p = .013) than the normotensive group. The areas under the receiver operating characteristic curve for respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were 0.722 and 0.649, respectively.

Conclusion: High preoperative respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were both independently associated with propofol-induced hypotension in children.
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http://dx.doi.org/10.1111/pan.14223DOI Listing
August 2021

A Deeper Look at Autonomous Vehicle Ethics: An Integrative Ethical Decision-Making Framework to Explain Moral Pluralism.

Front Robot AI 2021 4;8:632394. Epub 2021 May 4.

Robots with Social Intelligence and Empathy (ROSIE) Lab, School of Computing Science, Simon Fraser University, Burnaby, BC, Canada.

The autonomous vehicle (AV) is one of the first commercialized AI-embedded robots to make autonomous decisions. Despite technological advancements, unavoidable AV accidents that result in life-and-death consequences cannot be completely eliminated. The emerging social concern of how an AV should make ethical decisions during unavoidable accidents is referred to as the moral dilemma of AV, which has promoted heated discussions among various stakeholders. However, there are research gaps in explainable AV ethical decision-making processes that predict how AVs' moral behaviors are made that are acceptable from the AV users' perspectives. This study addresses the key question: What factors affect ethical behavioral intentions in the AV moral dilemma? To answer this question, this study draws theories from multidisciplinary research fields to propose the "Integrative ethical decision-making framework for the AV moral dilemma." The framework includes four interdependent ethical decision-making stages: AV moral dilemma issue framing, intuitive moral reasoning, rational moral reasoning, and ethical behavioral intention making. Further, the framework includes variables (e.g., perceived moral intensity, individual factors, and personal moral philosophies) that influence the ethical decision-making process. For instance, the framework explains that AV users from Eastern cultures will tend to endorse a situationist ethics position (high idealism and high relativism), which views that ethical decisions are relative to context, compared to AV users from Western cultures. This proposition is derived from the link between individual factors and personal moral philosophy. Moreover, the framework proposes a dual-process theory, which explains that both intuitive and rational moral reasoning are integral processes of ethical decision-making during the AV moral dilemma. Further, this framework describes that ethical behavioral intentions that lead to decisions in the AV moral dilemma are not fixed, but are based on how an individual perceives the seriousness of the situation, which is shaped by their personal moral philosophy. This framework provides a step-by-step explanation of how pluralistic ethical decision-making occurs, reducing the abstractness of AV moral reasoning processes.
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http://dx.doi.org/10.3389/frobt.2021.632394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129167PMC
May 2021

Accurate Detection of Rare Mutant Alleles by Target Base-Specific Cleavage with the CRISPR/Cas9 System.

ACS Synth Biol 2021 06 19;10(6):1451-1464. Epub 2021 May 19.

Department of Chemistry, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

The detection of low-frequency somatic mutations enables early diagnosis of disease; however, base-substitution errors that arise during genomic library preparation and high-throughput sequencing can lead to false diagnostic information. To discriminate true genomic alterations from technical errors, we developed spCas9-assisted true variant labeling sequencing (CARVE-seq), which detects low-frequency mutant alleles with high accuracy. CARVE-seq utilizes single-base discrimination during spCas9 cleavage reactions to exclude technical errors. Ten single nucleotide variants that recurrently occur in tumors were assayed by CARVE-seq using 20 ng reference samples, and 100% positive predictive value and specificity was observed, which proved the highly accurate performance of CARVE-seq.
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http://dx.doi.org/10.1021/acssynbio.1c00056DOI Listing
June 2021

Diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging after radiation therapy for bone metastases in patients with hepatocellular carcinoma.

Sci Rep 2021 May 17;11(1):10459. Epub 2021 May 17.

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

The objectives of this study were to assess changes in apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters after radiation therapy (RT) for bone metastases from hepatocellular carcinoma (HCC) and to evaluate their prognostic value. This prospective study was approved by the Institutional Review Board. Fourteen patients with HCC underwent RT (30 Gy in 10 fractions once daily) for bone metastases. The ADC and DCE-MRI parameters and the volume of the target lesions were measured before (baseline) and one month after RT (post-RT). The Wilcoxon signed-rank test was used to compare the parameters between the baseline and post-RT MRI. The parameters were compared between patients with or without disease progression in RT fields using the Mann-Whitney test. Intraclass correlation coefficients were used to evaluate the interobserver agreement. The medians of the ADC, rate constant [k], and volume fraction of the extravascular extracellular matrix [v] in the baseline and post-RT MRI were 0.67 (range 0.61-0.72) and 0.75 (range 0.63-1.43) (× 10 mm/s) (P = 0.027), 836.33 (range 301.41-1082.32) and 335.80 (range 21.86-741.87) (× 10/min) (P = 0.002), and 161.54 (range 128.38-410.13) and 273.99 (range 181.39-1216.95) (× 10) (P = 0.027), respectively. The medians of the percent change in the ADC of post-RT MRI in patients with progressive disease and patients without progressive disease were - 1.35 (range - 6.16 to 6.79) and + 46.71 (range 7.71-112.81) (%) (P = 0.011), respectively. The interobserver agreements for all MRI parameters were excellent (intraclass correlation coefficients > 0.8). In conclusion, the ADC, k, and v of bone metastases changed significantly after RT. The percentage change in the ADC was closely related to local tumor progression.
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http://dx.doi.org/10.1038/s41598-021-90065-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128906PMC
May 2021

Longitudinal in vivo imaging of acute neuropathology in a monkey model of Ebola virus infection.

Nat Commun 2021 05 17;12(1):2855. Epub 2021 May 17.

Hammoud Laboratory, Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA.

Ebola virus (EBOV) causes neurological symptoms yet its effects on the central nervous system (CNS) are not well-described. Here, we longitudinally assess the acute effects of EBOV on the brain, using quantitative MR-relaxometry, 18F-Fluorodeoxyglucose PET and immunohistochemistry in a monkey model. We report blood-brain barrier disruption, likely related to high cytokine levels and endothelial viral infection, with extravasation of fluid, Gadolinium-based contrast material and albumin into the extracellular space. Increased glucose metabolism is also present compared to the baseline, especially in the deep gray matter and brainstem. This regional hypermetabolism corresponds with mild neuroinflammation, sporadic neuronal infection and apoptosis, as well as increased GLUT3 expression, consistent with increased neuronal metabolic demands. Neuroimaging changes are associated with markers of disease progression including viral load and cytokine/chemokine levels. Our results provide insight into the pathophysiology of CNS involvement with EBOV and may help assess vaccine/treatment efficacy in real time.
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http://dx.doi.org/10.1038/s41467-021-23088-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129091PMC
May 2021

Effects of tip-manipulated stylet angle on intubation using the GlideScope videolaryngoscope in children: A prospective randomized controlled trial.

Paediatr Anaesth 2021 Jul 9;31(7):802-808. Epub 2021 Jun 9.

Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

Background: An optimal endotracheal tube curve can be a key factor in successful intubation using the GlideScope videolaryngoscope.

Aims: This study aimed to evaluate the effects of tube tip-modified stylet curve on the intubation time in children.

Methods: Children aged 1-5 years were randomly assigned to either the standard curve (group S, n = 60) or tip-modified curve (group T, n = 60) groups. In group S, the endotracheal tube curve was similar to that in the GlideScope. In group T, a point approximately 1.5 cm from the tube tip was additionally angled to the left by 15°-20°. The primary outcome was the total intubation time, and the secondary outcomes were incidence of successful intubation in the first attempt, number of additional manipulations of the stylet curve, and visual analog scale (VAS) score for the easiness of intubation.

Results: The mean total intubation time was significantly longer in group S than that in group T (13.9 [10.8] vs. 9.0 [3.4] sec, mean difference, 4.9 s; 95% confidence interval [CI], 2.0-7.8; p = .001). All patients in group T were successfully intubated in the first attempt, whereas those in group S were not (100% vs. 93.3%, relative risk [RR], 0.11; 95% CI, 0.01-2.02; p = .1376). Three patients in group S could be intubated after modifying the ETT curve similar to that in group T. Operators reported that tracheal intubation was easier in group T than in group S (median [interquartile range] for VAS; 1 [1-2] vs. 2 [1-3]; p < .001).

Conclusions: Having additional angle of the endotracheal tube tip to the left could be a useful technique to facilitate directing and advancing endotracheal tube into the vocal cords.
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http://dx.doi.org/10.1111/pan.14206DOI Listing
July 2021

Concordance Between Electronic Health Record and Tumor Registry Documentation of Smoking Status Among Patients With Cancer.

JCO Clin Cancer Inform 2021 05;5:518-526

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL.

Purpose: Patients with cancer who use tobacco experience reduced treatment effectiveness, increased risk of recurrence and mortality, and diminished quality of life. Accurate tobacco use documentation for patients with cancer is necessary for appropriate clinical decision making and cancer outcomes research. Our aim was to assess agreement between electronic health record (EHR) smoking status data and cancer registry data.

Materials And Methods: We identified all patients with cancer seen at University of Florida Health from 2015 to 2018. Structured EHR smoking status was compared with the tumor registry smoking status for each patient. Sensitivity, specificity, positive predictive values, negative predictive values, and Kappa statistics were calculated. We used logistic regression to determine if patient characteristics were associated with odds of agreement in smoking status between EHR and registry data.

Results: We analyzed 11,110 patient records. EHR smoking status was documented for nearly all (98%) patients. Overall kappa (0.78; 95% CI, 0.77 to 0.79) indicated moderate agreement between the registry and EHR. The sensitivity was 0.82 (95% CI, 0.81 to 0.84), and the specificity was 0.97 (95% CI, 0.96 to 0.97). The logistic regression results indicated that agreement was more likely among patients who were older and female and if the EHR documentation occurred closer to the date of cancer diagnosis.

Conclusion: Although documentation of smoking status for patients with cancer is standard practice, we only found moderate agreement between EHR and tumor registry data. Interventions and research using EHR data should prioritize ensuring the validity of smoking status data. Multilevel strategies are needed to achieve consistent and accurate documentation of smoking status in cancer care.
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http://dx.doi.org/10.1200/CCI.20.00187DOI Listing
May 2021

The complete mitochondrial genome of the blue runner, (Mitchill, 1815) (Teleostei: Carangidae).

Mitochondrial DNA B Resour 2021 Apr 26;6(4):1519-1520. Epub 2021 Apr 26.

Department of Marine Biology, Pukyong National University, Busan, Republic of Korea.

was collected from offshore of Sierra Leone and its complete mitochondrial genome was determined using next-generation sequencing (NGS). The circular mitogenome encoded a typical 37 genes, including 13 protein-coding genes (PCGs), 2 ribosomal RNA genes (12S rRNA and 16S rRNA), and 22 tRNA genes. An unusual start codon (GTG) was identified for the gene, and incomplete stop codons (T-/TA-) were found in seven genes, including , , , , , , and . All tRNAs were predicted to fold into the typical clover-leaf structures, except for tRNA, which lacks the D-arm. formed a monoclade with the tree other species belonging to the genus , apart from the others. Among them, was most closely related to and . The mitogenome sequence of provides information for a better understanding of evolutionary relationships, systemic, and mitogenomic study within the family Carangidae.
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http://dx.doi.org/10.1080/23802359.2021.1917319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079034PMC
April 2021

Control of temperature dependence of microbial time-temperature integrator (TTI) by microencapsulation of lactic acid bacteria into microbeads with different proportions of alginate.

Food Sci Biotechnol 2021 Apr 31;30(4):571-582. Epub 2021 Mar 31.

Department of Food Science and Biotechnology, Dongguk University, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-820 Korea.

This study has been conducted to investigate the temperature dependence and mass transfer kinetics of a microbial time-temperature integrator (TTI) developed by using emulsification/internal ionotropic gelation method. We report the effect of the Na-alginate concentrations (0.5%, 2.0%, 4.0% and 6.0% w/v) and temperature (8, 15, 20, 25 and 30 °C) on the TTI responses (changes in pH and titratable acidity [TA]). Results revealed that Ca-alginate microbeads (Ca-AMs) prepared from 2.0% Na-alginate were more uniform and smaller, with a narrow size distribution, in comparison with the other Ca-AMs. For microbeads with above 2.0% Na-alginate, the TTI response rates decreased because of the lower diffusion efficiency. Linearity in the TA was greatest for the 2.0% Ca-AMs. Therefore, the mass transfer and TTI response kinetics data demonstrated that 2.0% Na-alginate was optimal for producing Ca-AMs from which an ideal microbial TTI could be developed to monitor food spoilage processes with accuracy and precision.
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http://dx.doi.org/10.1007/s10068-021-00884-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050177PMC
April 2021

Development and validation of liquid chromatography-tandem mass spectrometry method for screening six selective androgen receptor modulators in dietary supplements.

Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021 Jul 1;38(7):1075-1086. Epub 2021 May 1.

Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju-si, Republic of Korea.

Selective androgen receptor modulators (SARMs) are compounds with specific androgenic properties that have been investigated for the treatment of conditions such as muscle wasting disease. The reported androgenic properties have resulted in their use by athletes, and consequently they have been on the World Anti-Doping Agency prohibited list for more than a decade. To minimise the chance of an unattended positive doping test and to avoid potential serious health problems, adequate screening methods for the detection of a wide range of SARMs in these supplements is necessary. In this study, a rapid and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated simultaneously to screen and quantify six SARMs in dietary supplements, with confirmation by liquid chromatography-quadrupole-time of flight mass spectrometry (LC-Q-TOF/MS). The validated method was applied to 60 dietary supplements obtained by on-line and direct purchase from international vendors in 2020. Various SARMs were detected at high concentrations in 20 products which were advertised as having androgenic properties. For example, andarine was present at 7.2% in one product, and GW501516 was found at 3.49% in the another product. Furthermore, MK-677 and YK-11, not disclosed on the label, were detected in some products. YK-11 is easily hydrolysed in just a few hours. Although YK-11 is particularly unstable, such that the protonated ion [M + H] at m/z 431 for YK-11 was not detected, mass fragmentation, and a [M+ Na] ion at m/z 453.3 confirmed the presence of YK-11. Additionally, hydrolysed YK-11 under acidic conditions was confirmed by NMR spectral data, and H NMR and C NMR spectral data for YK-11 were in good agreement with literature data. This rapid and accurate LC-MS/MS method can therefore be successfully applied to screen and identify SARMs for the continuous control and supervision of dietary supplements.
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http://dx.doi.org/10.1080/19440049.2021.1906954DOI Listing
July 2021

Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle.

Toxins (Basel) 2021 04 9;13(4). Epub 2021 Apr 9.

Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler's method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5-15%, 25-35%, 45-55%, and 70-80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15-20%, 35-40%, 55-60%, and 90-100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections.
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http://dx.doi.org/10.3390/toxins13040269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070362PMC
April 2021