Publications by authors named "Ji-Hoon Sim"

23 Publications

  • Page 1 of 1

Association of skeletal muscle index with postoperative acute kidney injury in living donor hepatectomy: A retrospective single-centre cohort study.

Liver Int 2021 Nov 24. Epub 2021 Nov 24.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Although living donor liver transplantation (LDLT) is the standard treatment option for patients with end-stage liver disease, it always entails ethical concerns about the risk of living donors. Recent studies have reported a correlation between sarcopenia and surgical prognosis in recipients. However, there are few studies of donor sarcopenia and the surgical prognosis of donors. This study investigated the association between sarcopenia and postoperative acute kidney injury in liver donors.

Methods: This retrospective study analysed 2892 donors who underwent donor hepatectomy for LDLT between January 2008 and January 2018. Sarcopenia was classified into pre-sarcopenia and severe sarcopenia, which were determined to be -1 standard deviation (SD), and -2 SD from the mean baseline of the skeletal muscle index, respectively. Multivariate regression analysis was performed to evaluate the association between donor sarcopenia and postoperative AKI. Additionally, we assessed the association between donor sarcopenia and delayed recovery of liver function (DRHF).

Results: In the multivariate analysis, donor sarcopenia was significantly associated a higher incidence of postoperative AKI (adjusted odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.15-6.11, P = .022 in pre-sarcopenia, OR: 5.59, 95% CI: 1.11-28.15, P = .037 in severe sarcopenia, respectively). Additionally, hypertension and synthetic colloid use were significantly associated with postoperative AKI. In the multivariate analysis, risk factors of DRHF were male gender, indocyanine green retention rate at 15 minutes, and graft type, however, donor sarcopenia was not a risk factor.

Conclusions: Donor sarcopenia is associated with postoperative AKI following donor hepatectomy.
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http://dx.doi.org/10.1111/liv.15109DOI Listing
November 2021

Effects of Perioperative Inflammatory Response in Cervical Cancer: Laparoscopic versus Open Surgery.

J Clin Med 2021 Sep 16;10(18). Epub 2021 Sep 16.

Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea.

There are few studies between postoperative neutrophil to lymphocyte ratio (NLR) and survival in cervical cancer. We compared postoperative changes in NLR according to surgical methods and analyzed the effect of these changes on 5-year mortality of cervical cancer patients. A total of 929 patients were assigned to either the laparoscopic radical hysterectomy (LRH) ( = 721) or open radical hysterectomy (ORH) ( = 208) group. Propensity score matching analysis compared the postoperative NLR changes between the two groups, and multivariate logistic regression analysis evaluated the association between NLR changes and 5-year mortality. Surgical outcomes between the two groups were also compared. In the LRH group, NLR changes at postoperative day (POD) 0 and POD 1 were significantly lower than in the ORH group after matching (NLR change at POD 0, 10.4 vs. 14.3, < 0.001; NLR change at POD 1, 3.5 vs. 5.4, < 0.001). In multivariate logistic regression analysis, postoperative NLR change was not associated with 5-year mortality (2nd quartile: OR 1.55, 95% CI 0.56-4.29, = 0.401; 3rd quartile: OR 0.90, 95% CI 0.29-2.82, = 0.869; 4th quartile: OR 1.40, 95% CI 0.48-3.61, = 0.598), whereas preoperative NLR was associated with 5-year mortality (OR 1.23, 95% CI 1.06-1.43, = 0.005). After matching, there were no significant differences in surgical outcomes between the two groups. There were significantly fewer postoperative changes of NLR in the LRH group. However, the extent of these NLR changes was not associated with 5-year mortality. By contrast, preoperative NLR was associated with 5-year mortality.
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http://dx.doi.org/10.3390/jcm10184198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467117PMC
September 2021

Association between Neutrophil-Lymphocyte Ratio and Herpes Zoster Infection in 1688 Living Donor Liver Transplantation Recipients at a Large Single Center.

Biomedicines 2021 Aug 5;9(8). Epub 2021 Aug 5.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Liver transplantation (LT) is closely associated with decreased immune function, a contributor to herpes zoster (HZ). However, risk factors for HZ in living donor LT (LDLT) remain unknown. Neutrophil-lymphocyte ratio (NLR) and immune system function are reportedly correlated. This study investigated the association between NLR and HZ in 1688 patients who underwent LDLT between January 2010 and July 2020 and evaluated risk factors for HZ and postherpetic neuralgia (PHN). The predictive power of NLR was assessed through the concordance index and an integrated discrimination improvement (IDI) analysis. Of the total cohort, 138 (8.2%) had HZ. The incidence of HZ after LT was 11.2 per 1000 person-years and 0.1%, 1.3%, 2.9%, and 13.5% at 1, 3, 5, and 10 years, respectively. In the Cox regression analysis, preoperative NLR was significantly associated with HZ (adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02-1.09; = 0.005) and PHN (HR, 1.08; 95% CI, 1.03-1.13; = 0.001). Age, sex, mycophenolate mofetil use, and hepatitis B virus infection were risk factors for HZ versus age and sex for PHN. In the IDI analysis, NLR was discriminative for HZ and PHN ( = 0.020 and = 0.047, respectively). Preoperative NLR might predict HZ and PHN in LDLT recipients.
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http://dx.doi.org/10.3390/biomedicines9080963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391531PMC
August 2021

Low Psoas Lumbar Vertebral Index Is Associated with Mortality after Hip Fracture Surgery in Elderly Patients: A Retrospective Analysis.

J Pers Med 2021 Jul 16;11(7). Epub 2021 Jul 16.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.

The psoas-to-lumbar index (PLVI) has been reported as a simple and easy way to measure central sarcopenia. However, only few studies have evaluated the association between PLVI and survival in surgical patients. This study evaluated the association between preoperative PLVI and mortality in elderly patients who underwent hip fracture surgery. We retrospectively analyzed 615 patients who underwent hip fracture surgery between January 2014 and December 2018. The median value of each PLVI was calculated according to sex, and the patients were categorized into two groups on the basis of the median value (low PLVI group vs. high PLVI group). Cox regression analysis was performed to evaluate the risk factors for 1 year and overall mortalities. The median values of PLVI were 0.62 and 0.50 in men and women, respectively. In the Cox regression analysis, low PLVI was significantly associated with higher 1 year (hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.18-2.96, = 0.008) and overall mortalities (HR: 1.51, 95% CI: 1.12-2.03, = 0.006). Low PLVI was significantly associated with a higher mortality. Therefore, PLVI might be an independent predictor of mortality in elderly patients undergoing hip fracture surgery.
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http://dx.doi.org/10.3390/jpm11070673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305556PMC
July 2021

The Association between Herpes Zoster and Increased Cancer Risk: A Nationwide Population-Based Matched Control Study.

Curr Oncol 2021 07 17;28(4):2720-2730. Epub 2021 Jul 17.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Background: Herpes zoster (HZ) is strongly associated with decreased immune function, a factor of cancer development. Previous studies suggested inconsistent results regarding the association between HZ and increased cancer risk. We aimed to analyze the association between HZ and specific cancer risk.

Methods: Of 134,454 patients diagnosed with HZ between 2002 and 2015, 81,993 HZ patients were matched 1:1 with non-HZ individuals by age, sex, and Charlson comorbidity index. Both groups were examined at 1, 3, and 5 years for cancer diagnosis. A Cox proportional hazard regression model was used to estimate cancer risk in both groups. The postherpetic neuralgia (PHN) and non-HZ groups were compared for specific cancer risk.

Results: The HZ group showed a slightly decreased overall cancer risk compared with the non-HZ group (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.90-0.97, = 0.002). The HRs for specific cancer risk were 0.41 (95% CI, 0.33-0.50, < 0.001); 0.86 (95% CI, 0.81-0.91, < 0.001); 0.87 (95% CI, 0.78-0.97, = 0.014); 0.80 (95% CI 0.73-0.87, < 0.001); 1.20 (95% CI, 1.07-1.34, = 0.001); and 1.66 (95% CI, 1.35-2.03, < 0.001) for cancers of the lips, mouth, and pharynx; digestive system; respiratory system; unknown secondary and unspecified sites; thyroid and endocrine glands; and lymphoid and hematopoietic systems, respectively. The HZ with PHN group showed higher HR for specific cancer risk, such as lymphoid and hematopoietic systems (95% CI, 1.27-2.39, < 0.001).

Conclusion: HZ was associated with increased or decreased incidence of specific cancers. PHN further increased the risk of developing certain cancers in HZ patients.
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http://dx.doi.org/10.3390/curroncol28040237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293079PMC
July 2021

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients Who Underwent Hepatectomy for Hepatocellular Carcinoma.

J Pers Med 2021 May 18;11(5). Epub 2021 May 18.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Various biological indicators are reportedly associated with postoperative acute kidney injury (AKI) in the surgical treatment of hepatocellular carcinoma (HCC). However, only a few studies have evaluated the association between the preoperative prognostic nutritional index (PNI) and postoperative AKI. This study evaluated the association of the preoperative PNI and postoperative AKI in HCC patients. We retrospectively analyzed 817 patients who underwent open hepatectomy between December 2007 and December 2015. Multivariate regression analysis was performed to evaluate the association between the PNI and postoperative AKI. Additionally, we evaluated the association between the PNI and outcomes such as postoperative renal replacement therapy (RRT) and mortality. Cox regression analysis was performed to assess the risk factors for one-year and five-year mortality. In the multivariate analysis, high preoperative PNI was significantly associated with a lower incidence of postoperative AKI (odds ratio (OR): 0.92, 95% confidence interval (CI): 0.85 to 0.99, = 0.021). Additionally, diabetes mellitus and the use of synthetic colloids were significantly associated with postoperative AKI. PNI was associated with postoperative RRT (OR: 0.76, 95% CI: 0.60 to 0.98, = 0.032) even after adjusting for other potential confounding variables. In the Cox regression analysis, high PNI was significantly associated with low one-year mortality (Hazard ratio (HR): 0.87, 95% CI: 0.81 to 0.94, < 0.001), and five-year mortality (HR: 0.93, 95% CI: 0.90-0.97, < 0.001). High preoperative PNI was significantly associated with a lower incidence of postoperative AKI and low mortality. These results suggest that the preoperative PNI might be a predictor of postoperative AKI and surgical prognosis in HCC patients undergoing open hepatectomy.
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http://dx.doi.org/10.3390/jpm11050428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157861PMC
May 2021

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients with Colorectal Cancer Surgery.

Nutrients 2021 May 11;13(5). Epub 2021 May 11.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

The prognostic nutritional index (PNI) has been reported to be associated with postoperative complications and prognosis in cancer surgery. However, few studies have evaluated the association between preoperative PNI and postoperative acute kidney injury (AKI) in colorectal cancer patients. This study evaluated association of preoperative PNI and postoperative AKI in patients who underwent colorectal cancer surgery. This study retrospectively analyzed 3543 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into four groups by the quartile of PNI: Q1 (≤43.79), Q2 (43.79-47.79), Q3 (47.79-51.62), and Q4 (≥51.62). Multivariate regression analysis was performed to assess the risk factors for AKI and 1-year mortality. AKI was defined according to Kidney Disease Improving Global Outcomes classification (KDIGO) criteria. Additionally, we assessed surgical outcomes such as hospital stay, ICU admission, and postoperative complications. The incidence of postoperative AKI tended to increase in the Q1 group (13.4%, 9.2%, 9.4%, 8.8%). In the multivariate analysis, high preoperative PNI was significantly associated with low risk of postoperative AKI (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93-0.99, = 0.003) and low 1-year mortality (OR: 0.92, 95% CI: 0.86-0.98, = 0.011). Male sex, body mass index, diabetes mellitus, and hypertension were risk factors for AKI. The Q1 (≤43.79) group had poor surgical outcomes, such as postoperative AKI (OR: 1.52, 95% CI: 1.18-1.95, = 0.001), higher rates of ICU admission (OR: 3.13, 95% CI: 1.82-5.39, < 0.001) and higher overall mortality (OR: 3.81, 95% CI: 1.86-7.79, < 0.001). In conclusion, low preoperative PNI levels, especially in the Q1 (≤43.79), were significantly associated with postoperative AKI and surgical outcomes, such as hospital stay, postoperative ICU admission, and mortality.
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http://dx.doi.org/10.3390/nu13051604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170895PMC
May 2021

The Association between Prognostic Nutritional Index (PNI) and Intraoperative Transfusion in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma: A Retrospective Cohort Study.

Cancers (Basel) 2021 May 21;13(11). Epub 2021 May 21.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Background: PNI is significantly associated with surgical outcomes; however, the association between PNI and intraoperative transfusions is unknown.

Methods: This study retrospectively analyzed 1065 patients who underwent hepatectomy. We divided patients into two groups according to the PNI (<44 and >44) and compared their transfusion rates and surgical outcomes. We performed multivariate logistic and Cox regression analysis to determine risk factors for transfusion and the 5-year survival. Additionally, we found the net reclassification index (NRI) to validate the discriminatory power of PNI.

Results: The PNI <44 group had higher transfusion rates (adjusted odds ratio [OR]: 2.20, 95%CI: 1.06-4.60, = 0.035) and poor surgical outcomes, such as post hepatectomy liver failure (adjusted [OR]: 3.02, 95%CI: 1.87-4.87, < 0.001), and low 5-year survival (adjusted OR: 1.68, 95%CI: 1.17-2.24, < 0.001). On multivariate analysis, PNI <44, age, hemoglobin, operation time, synthetic colloid use, and laparoscopic surgery were risk factors for intraoperative transfusion. On Cox regression analysis, PNI <44, MELD score, TNM staging, synthetic colloid use, and transfusion were associated with poorer 5-year survival. NRI analysis showed significant improvement in the predictive power of PNI for transfusion ( = 0.002) and 5-year survival ( = 0.004).

Conclusions: Preoperative PNI <44 was significantly associated with higher transfusion rates and surgical outcomes.
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http://dx.doi.org/10.3390/cancers13112508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196581PMC
May 2021

Comparison of the Effects of Laparoscopic and Open Surgery on Postoperative Acute Kidney Injury in Patients with Colorectal Cancer: Propensity Score Analysis.

J Clin Med 2021 Apr 1;10(7). Epub 2021 Apr 1.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Postoperative acute kidney injury (AKI) is a serious complication that increases patient morbidity and mortality. However, few studies have evaluated the effect of laparoscopic surgery on postoperative AKI. This study compared the incidence of postoperative AKI between laparoscopic and open surgery in patients with colorectal cancer. This study retrospectively analyzed 3637 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into laparoscopic ( = 987) and open ( = 2650) surgery groups. We performed multivariable regression analysis to assess the risk factors for AKI and propensity score matching analysis to compare the incidence of AKI between the two groups. We also assessed postoperative intensive care unit (ICU) admission, complications, hospital stay, and 1-year mortality. We observed no significant differences in the incidence of postoperative AKI between the two groups before (8.8% vs. 9.1%, = 0.406) and after (8.8% vs. 7.7%, = 0.406) matching. Laparoscopic surgery was not associated with AKI even after adjusting for intraoperative variables (adjusted odds ratio (OR): 1.17, 95% confidence interval (CI): 0.84-1.62, = 0.355). Body mass index, diabetes mellitus, hypertension, and albumin were risk factors for AKI. ICU admission (0.6% vs. 2.5%, = 0.001), complications (0.2% vs. 1.5%, = 0.002), hospital stay (6.89 days vs. 8.61 days, < 0.001), and 1-year mortality (0.1% vs. 0.9%, = 0.021) were significantly better in the laparoscopic than in the open group. The incidence of postoperative AKI did not differ significantly between laparoscopic and open surgery. However, considering its better surgical outcomes, laparoscopic surgery may be recommended for patients with colorectal cancer.
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http://dx.doi.org/10.3390/jcm10071438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036786PMC
April 2021

Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation.

Reg Anesth Pain Med 2021 06 23;46(6):512-517. Epub 2021 Apr 23.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of).

Background And Objective: Thoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement.

Methods: 38 patients in the prone position were prospectively studied. After the target interlaminar space between T9 and T12 was identified, the needle was advanced under real-time US guidance and was stopped just short of the posterior complex. Further advancement of the needle was accomplished without US guidance using loss-of-resistance techniques to normal saline until the epidural space was accessed. Procedure-related variables such as time to mark space, needling time, number of needle passes, number of skin punctures, and the first-pass success rate were measured. The primary outcome was the success rate of real-time US-guided thoracic epidural catheter placement, which was evaluated using fluoroscopy. In addition, the position of the catheter, contrast dispersion, and complications were evaluated.

Results: This study included 38 patients. The T10-T11 interlaminar space was the most location for epidural access. During the procedure, the mean time for marking the overlying skin for the procedure was 49.5±13.8 s and the median needling time was 49 s. The median number of needle passes was 1.0 (1.0-1.0). All patients underwent one skin puncture for the procedure. The first-pass and second-pass success rates were 76.3% and 18.4%, respectively. Fluoroscopic evaluation revealed that the catheter tips were all positioned in the epidural space and were usually located between T9 and T10 (84.2%). The cranial and caudal contrast dispersion were observed up to 5.4±1.6 and 2.6±1.0 vertebral body levels, respectively. No procedure-related complications occurred.

Conclusion: Real-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.

Trial Registration Number: NCT03890640.
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http://dx.doi.org/10.1136/rapm-2021-102578DOI Listing
June 2021

Comparative Effectiveness of Parasagittal Interlaminar and Transforaminal Cervical Epidural Steroid Injection in Patients with Cervical Radicular Pain: A Randomized Clinical Trial.

Pain Physician 2021 03;24(2):117-125

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy.

Objectives: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain.

Study Design: A prospective randomized assessor-blind study.

Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea.

Methods: This prospective randomized, assessor-blind trial included 80 patients with cervical radicular pain. We randomly assigned patients to the TF or parasagittal IL approach for cervical ESI. The effectiveness of the 2 groups was compared based on pain intensity using the Numeric Rating Scale (NRS-11) at 1 and 3 months. The Neck Disability Index (NDI), Medication Quantification Scale (MQS), and responders at 1 and 3 months between the 2 groups were compared.

Results: The pain intensity of both groups significantly reduced after 1 and 3 months after each procedure (P < 0.001). Two-way repeated measures of analysis of variance showed no significant interaction between group and time for cervical radicular pain (P = 0.266), although NRS-11 pain score was lower in the TF group than the parasagittal IL group after 1 month (P = 0.010). NDI, MQS, and successful responders were not different between the 2 groups at 1 and 3 months after the procedure. We observed 7 cases (18.4%) of vascular visualization in the TF group, although no serious complications were found in either group.

Limitations: This study had no placebo control group and limited follow-up time.

Conclusions: Parasagittal IL ESI may be recommended over the TF ESI in reducing cervical radicular pain, considering both clinical effectiveness and safety.
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March 2021

Association between Postoperative Opioid Requirements and the Duration of Smoking Cessation in Male Smokers after Laparoscopic Distal Gastrectomy with Gastroduodenostomy.

Pain Res Manag 2021 28;2021:1541748. Epub 2021 Jan 28.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.

Smoking is clinically associated with high postoperative pain scores and increased perioperative analgesic requirements. However, the association between the duration of smoking cessation and postoperative opioid requirements remains unclear. Therefore, this study aimed to evaluate the association between the duration of smoking cessation and postoperative opioid requirements. We retrospectively analyzed the data of 144 male patients who received intravenous patient-controlled analgesia (IV PCA) after laparoscopic distal gastrectomy with gastroduodenostomy. All patients were divided into three groups: G0, nonsmoker; G1, smoker who quit smoking within 1 month preoperatively; G2, smoker who quit smoking over 1 month preoperatively. Analgesic use, pain intensity, and IV PCA side effects were assessed up to postoperative day 2. As the duration of smoking cessation increased, the amount of postoperative opioid consumption decreased ( = -0.08; 95% confidence interval (CI), -0.11 to -0.04; < 0.001). The total postoperative opioid requirements in G1 were significantly higher than those in G0 and G2 (G0, 75.5 ± 15.9 mg; G1, 94.6 ± 20.5 mg; and G2, 79.9 ± 19.4 mg ( < 0.001)). A multivariate regression analysis revealed that G1 was independently associated with increased postoperative opioid requirements ( = 12.80; 95% CI, 5.81-19.80; < 0.001). Consequently, male patients who had ceased smoking within 1 month of undergoing a laparoscopic distal gastrectomy with gastroduodenostomy had higher postoperative opioid use than patients who had ceased smoking for more than 1 month and nonsmokers.
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http://dx.doi.org/10.1155/2021/1541748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861925PMC
June 2021

Effects of Curcumin Treatment in a Diabetic Neuropathic Pain Model of Rats: Involvement of c-Jun N-Terminal Kinase Located in the Astrocytes and Neurons of the Dorsal Root Ganglion.

Pain Res Manag 2021 18;2021:8787231. Epub 2021 Jan 18.

Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Curcumin (diferuloylmethane) is a major component of turmeric, which is isolated from the rhizomes of L. from the family Zingiberaceae. It is used as a dietary pigment for curry and in traditional Indian medicine for its anti-inflammatory and attenuating pain effects. This study aimed to evaluate the beneficial effects of curcumin in a rat model of diabetic neuropathic pain. Additionally, we investigated the involvement of the phosphorylated form of c-Jun N-terminal kinase (pJNK) located in the neurons and astrocytes of the dorsal root ganglion (DRG). To induce diabetic neuropathic pain in rats, 50 mg/kg of streptozotocin (STZ) was intraperitoneally injected. After 4 weeks, rats were administered the vehicle, 10 mg/kg/day curcumin, or 50 mg/kg/day curcumin orally for 4 consecutive weeks. One day after the final drug administration, we performed behavioral tests to measure responses of rats to mechanical, heat, cold, and acetone-induced cold stimuli. After behavioral tests, pJNK expression in the DRG was evaluated using western blot assay and immunohistochemistry. Curcumin treatment for 4 consecutive weeks in STZ-induced diabetic neuropathic pain rats improved behavioral responses to mechanical, cold, and thermal stimuli. Increased pJNK expression in the astrocytes and neurons of the DRG in STZ-induced diabetic neuropathic pain rats was reduced by curcumin treatment for 4 consecutive weeks. We suggest that curcumin can be an option for the treatment of diabetes-related neuropathic pain, and one of the mechanisms that underlie the action of curcumin may involve pJNK expression in the astrocytes and neurons of the DRG.
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http://dx.doi.org/10.1155/2021/8787231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837777PMC
June 2021

Evaluation of Contralateral Oblique and Lateral Views for Mid-Thoracic Epidural Access: A Prospective Observational Study.

Pain Physician 2021 01;24(1):E51-E59

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: The mid-thoracic region has been known to be the most difficult area when accessing epidural space despite using fluoroscopy. Contralateral oblique (CLO) view has been considered for use; however, it has not been evaluated in the mid-thoracic region.

Objective: To evaluate the CLO view for mid-thoracic epidural access (TEA).

Study Design: A prospective observational study.

Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea.

Methods: A total of 30 patients participated in this study. After securing the mid-thoracic (T4-8) epidural space, fluoroscopic images were obtained. The needle tip location relative to the ventral interlaminar line (VILL), and the needle tip and laminar visualization were measured and analyzed on the CLO views at 40, 50, 60 degrees, and measured angle, and the lateral view.

Results: The needle tip was clearly visualized in all CLO views, compared with the lateral view (100% vs. 36.7%, P < 0.001). The visualization of the laminar margin and the needle tip location on (or just anterior to) VILL using the CLO measured angle were significantly clearer compared with those in the CLO view at 40 and 50 degrees and the lateral view (laminar margin: 40°, 56.7% vs. 3.3%, P < 0.001; 50°, 56.7% vs. 26.7%, P = 0.012; 90°, 56.7% vs. 26.7%, P = 0.035; needle tip location: 40°, 96.7% vs. 26.7%, P < 0.001; 50°, 96.7% vs. 63.3%, P = 0.002; 90°, 96.7% vs. 66.7%, P = 0.012). There was no difference in these values between the CLO view at 60 degrees and CLO measured angle.

Limitations: Subjective and ambiguous criteria of evaluation may induce bias despite final measured values based on the consensus of an independent investigator.

Conclusion: A CLO view at 60 degrees and CLO measured angle view can provide clearer visualization and more consistent needle tip location than the lateral and other CLO angle views for mid-TEA. A CLO view at 60 degrees and CLO measured angle views could be used to identify the needle location and achieve success in mid-TEA.
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January 2021

Differential Postoperative Effects of Volatile Anesthesia and Intraoperative Remifentanil Infusion in 7511 Thyroidectomy Patients: A Propensity Score Matching Analysis.

Medicine (Baltimore) 2016 Feb;95(7):e2764

From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Although remifentanil is used widely by many clinicians during general anesthesia, there are recent evidences of opioid-induced hyperalgesia as an adverse effect. This study aimed to determine if intraoperative remifentanil infusion caused increased pain during the postoperative period in patients who underwent a thyroidectomy. A total of 7511 patients aged ≥ 20 years, who underwent thyroidectomy between January 2009 and December 2013 at the Asan Medical Center were retrospectively analyzed. Enrolled patients were divided into 2 groups: group N (no intraoperative remifentanil and only volatile maintenance anesthesia) and group R (intraoperative remifentanil infusion including total intravenous anesthesia and balanced anesthesia). Following propensity score matching analysis, 2582 patients were included in each group. Pain scores based on numeric rating scales (NRS) were compared between the 2 groups at the postoperative anesthetic care unit and at the ward until 3 days postoperation. Incidences of postoperative complications, such as nausea, itching, and shivering were also compared. The estimated NRS pain score on the day of surgery was 5.08 (95% confidence interval [CI] 4.97-5.19) in group N patients and 6.73 (95% CI 6.65-6.80) in group R patients (P < 0.001). There were no statistically significant differences in NRS scores on postoperative days 1, 2, and 3 between the 2 groups. Postoperative nausea was less frequent in group R (31.4%) than in group N (53.5%) (P < 0.001). However, the incidence of itching was higher in group R (4.3%) than in group N (0.7%) (P < 0.001). Continuous infusion of remifentanil during general anesthesia can cause higher intensity of postoperative pain and more frequent itching than general anesthesia without remifentanil infusion immediately after thyroidectomy. Considering the advantages and disadvantages of continuous remifentanil infusion, volatile anesthesia without opioid may be a good choice for minor surgeries, such as thyroidectomy.
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http://dx.doi.org/10.1097/MD.0000000000002764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998620PMC
February 2016

Application of Ventilating-Bronchoscopy-Adaptor by Fusing a Laparoscopic Trocar during Bronchial Thermoplasty under General Anesthesia.

Yonsei Med J 2016 Mar;57(2):534-5

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3349/ymj.2016.57.2.534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740553PMC
March 2016

Postoperative Anemia Is Associated with Acute Kidney Injury in Patients Undergoing Total Hip Replacement Arthroplasty: A Retrospective Study.

Anesth Analg 2016 06;122(6):1923-8

From the *Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea; and Departments of †Clinical Epidemiology and Biostatistics and ‡Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Chronic and acute anemia are both correlated with an increased risk of injury to major organs, such as the brain, heart, and kidney. We evaluated the association between postoperative anemia (hemoglobin [Hb] < 10 g/dL) and acute kidney injury (AKI) in patients undergoing total hip replacement arthroplasty (THRA).

Methods: Patients who underwent THRA between January 2005 and February 2013 were retrospectively reviewed. We divided patients into 2 groups: Hb < 10 (n = 938) and Hb ≥ 10 (n = 1529). They were then categorized according to changes in plasma creatinine concentration within 48 hours of THRA using Acute Kidney Injury Network criteria. To evaluate the association between postoperative anemia and postoperative AKI, an inverse-probability-of-treatment weighted method was used and both univariate and multivariable analyses were performed.

Results: Postoperative anemia was significantly associated with postoperative AKI (multivariate odds ratio, 2.036; 95% confidence interval, 1.369-3.028; P < 0.001; inverse probability-of-treatment weighted odds ratio, 1.817; 95% confidence interval, 1.169-2.826; P = 0.011). In patients with a normal glomerular filtration rate, postoperative AKI was also related to postoperative anemia (P = 0.010).

Conclusions: Postoperative anemia was associated with postoperative AKI after THRA. Although our study was limited by its retrospective design, our observation suggests that postoperative anemia may play a role in postoperative AKI.
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http://dx.doi.org/10.1213/ANE.0000000000001003DOI Listing
June 2016

Development of tactile allodynia immediately after spinal anesthesia.

Pain Med 2015 Jun 3;16(6):1242-4. Epub 2015 Feb 3.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

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http://dx.doi.org/10.1111/pme.12691DOI Listing
June 2015

Effects of nefopam on streptozotocin-induced diabetic neuropathic pain in rats.

Korean J Pain 2014 Oct 1;27(4):326-33. Epub 2014 Oct 1.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats.

Methods: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated.

Results: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG.

Conclusions: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.
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http://dx.doi.org/10.3344/kjp.2014.27.4.326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196497PMC
October 2014

Green nail syndrome treated with the application of tobramycin eye drop.

Ann Dermatol 2014 Aug 31;26(4):514-6. Epub 2014 Jul 31.

Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.

Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area. Despite the various treatment options available, removal of the nail is still necessary in many cases. A 35-year-old man presented with dark-greenish discoloration of the nail plate and onycholysis on the left thumbnail. He had been treated with oral antifungal and antibiotic agents for several months; however, the lesion showed no improvement. The diagnosis of green nail syndrome was established after a positive bacterial culture, and on the basis of the antibiotic sensitivity test result, tobramycin eye drop (Tobrex®) was then prescribed. Three weeks later, the nail discoloration almost vanished but the onycholysis remained. Herein, we recommend the application of tobramycin eye drop as an easy and safe treatment option for green nail syndrome.
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http://dx.doi.org/10.5021/ad.2014.26.4.514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135110PMC
August 2014

Treatment of melasma by low-fluence 1064 nm Q-switched Nd:YAG laser.

J Dermatolog Treat 2014 Jun 24;25(3):212-7. Epub 2013 Feb 24.

Department of Dermatology, College of Medicine, Soonchunhyang University , Seoul , Korea.

Background: Low-fluence 1064 nm Q-switched Nd:YAG laser has recently been shown to be effective for the melasma treatment.

Objective: The purpose of this study is to evaluate the clinical efficacy and safety of low-fluence 1064 nm Q-switched Nd:YAG laser treatment of melasma in Asian patients.

Methods: Fifty patients with melasma underwent 15 weeks of weekly treatments, using a Q-switched Nd:YAG laser (RevLite®; HOYA ConBio®, Freemont, CA, USA) at 1064 nm with an 8-mm spot size, and a fluence of 2.8 J/cm(2). Patients and investigators subjectively evaluated the intensity of pigmentation after completion of 15 weekly treatments. The objective assessment was also performed with digital photographs and a pigment imaging tool (Janus®, PSI Co., Ltd., KOREA).

Results: Both patients and investigators rated the treatment outcome as "good improvement" on average with improvement rate of 50-74%. The pigment imaging technology system also confirmed the improvement of the pigmentation level on all three locations of the face. None of the 50 patients showed any signs of severe side effects during the course of the treatment.

Conclusion: Low-fluence 1064 nm Q-switched Nd:YAG laser is an effective method to treat melasma without serious side effects in Asian patients.
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http://dx.doi.org/10.3109/09546634.2012.735639DOI Listing
June 2014

Application of the QuantiFERON®-TB Gold test in erythema induratum.

J Dermatolog Treat 2014 Jun 19;25(3):260-3. Epub 2012 Sep 19.

Department of Dermatology, College of Medicine, Soonchunhyang University , Seoul , South Korea.

Erythema induratum (EI) was originally described by Ernest Bazin in 1861 as nodular lesions on the legs in association with tuberculosis (TB). A 33-year-old woman was referred to our hospital with tender ulcerative nodules on her legs. Skin biopsies revealed lobular inflammation of the subcutaneous fat with vasculitis. Although conservative treatment was given, the lesions did not improve. Several months later as the lesions persisted, we suspected a TB infection and additional tests were performed. The chest roentgenogram results were normal. The skin biopsies were negative for acid-fast bacilli (AFB). Mycobacterial cultures of the blood and skin were negative. However, the QuantiFERON®-TB Gold test was positive, which led to a diagnosis of latent TB infection being made. The patient was treated with multidrug antituberculosis therapy, which successfully resolved her skin lesions. Therefore, reported herein is the application of the QuantiFERON®-TB Gold test for the confirmation of latent TB infection in EI patients.
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http://dx.doi.org/10.3109/09546634.2012.699178DOI Listing
June 2014

Vulvar skin metastasis of lung squamous cell carcinoma.

Ann Dermatol 2011 Oct 31;23(Suppl 2):S179-81. Epub 2011 Oct 31.

Department of Dermatology, Soonchunhyang University Hospital, Cheonan, Korea.

In this study, we examined a case where lung cancer metastasized to the vulvar area. A 79-year-old woman that was a heavy smoker was referred to our department with a short (two-week) history of dyspnea, and with a painful nodule on her right labium majora, which she had noticed almost three years earlier. Histopathologically, the specimen appeared as a poorly differentiated squamous cell carcinoma. The chest X-ray, chest computerized tomography scan, and percutaneous transthoracic needle biopsy via bronchoscopy revealed squamous cell carcinoma in the right upper lobe of the lung. Based on these clinical and histopathological findings, we concluded that her condition was skin metastasis at the right labium majora from the lung cancer, which occurs very rarely.
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http://dx.doi.org/10.5021/ad.2011.23.S2.S179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229059PMC
October 2011
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