Publications by authors named "Jung Kim"

4,716 Publications

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Sex differences in seizure effects on social anxiety in persons with epilepsy.

Epilepsy Behav 2021 Sep 21;124:108318. Epub 2021 Sep 21.

Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.

Purpose: We investigated sex differences in the effect of seizures on social anxiety in persons with epilepsy.

Method: In this cross-sectional multicenter study, social anxiety was measured using the short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12 were considered to indicate social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9, Stigma Scale-Revised, and Family Adaptation-Partnership-Growth-Affection-Resolve scale were also completed. A logistic regression analysis with an interaction term was used to analyze the data.

Results: Out of 285 participants, a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12 were noted in 62 (21.8%) and 36 (12.6%) of participants, respectively. There was no difference in the prevalence of social anxiety between men and women. Intractable seizures and lack of seizure freedom were associated with a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12, but statistical significance was lost in the adjusted models. However, intractable seizures and lack of seizure freedom significantly interacted with sex for a SPS-6 score ≥ 9 (p = 0.018) and a SIAS-6 score ≥ 12 (p = 0.048) in both the separate and adjusted models. Specifically, intractable seizures tended to be positively associated with SPS-6 scores ≥ 9 than non-intractable seizures in men only (odds ratio = 2.602, p = 0.068), whereas lack of seizure freedom tended to be negatively associated with SIAS-6 scores ≥ 12 than seizure freedom in women only (odds ratio = 4.804, p = 0.053).

Conclusion: We found significant sex differences in seizure effects on social anxiety. Intractable seizures were associated with social phobia in men, whereas lack of seizure freedom in the last year was associated with social interaction anxiety in women.
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http://dx.doi.org/10.1016/j.yebeh.2021.108318DOI Listing
September 2021

30-Year Trends in Graft Survival After Heart Transplant: Modeled Analyses of a Transplant Registry.

Ann Thorac Surg 2021 Sep 21. Epub 2021 Sep 21.

Rutgers Robert Wood Johnson Medical School, Department of Medicine, 125 Paterson St, New Brunswick, NJ; Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ; Institute for Health, Health Care Policy and Aging Research, 112 Paterson St, New Brunswick, NJ. Electronic address:

Background: Heart failure is an epidemic in the United States, and transplantation remains the most definitive therapy. We describe multi-decade trends in post-transplant graft survival, adjusted for concurrent changes in the population, over the 30 years antecedent to the most recent heart allocation policy change.

Methods: Scientific Registry of Transplant Recipients data were used to identify all primary adult heart recipients 1989 through 2017. We described temporal changes in population characteristics (recipient/donor demographics and comorbidities, pretransplant interventions, clinical transplant measures, and providers). The primary outcome was graft survival, defined as freedom from all-cause death and graft failure, within 6 months post-transplant. Modified Poisson logistic regression estimated relative changes in risk of outcomes compared to 1989, with and without adjustment for changing population characteristics. We identified risk factors, quantified by associated risk ratios.

Results: Among 56,488 primary adult heart recipients, we observed 5,529 (9.8%) all-cause deaths and 1,933 (3.4%) graft failure events within 6 months post-transplant. Prevalence of known recipient risk factors increased over time. Unadjusted modeling demonstrated a significant 30-year improvement in graft survival, averaging 2.6% (95%CI:2.4-2.9%) per year (p-for-trend<0.001). After adjusting for population changes, the 30-year trend remained significant and graft survival improved on average 3.0% (95%CI:2.6-3.3%) yearly. Regression modeling identified multiple predictors of graft survival. Modeling two additional outcomes of 6-month mortality and 6-month graft failure produced like results.

Conclusions: Short-term graft survival after heart transplantation has improved significantly leading up to the 2018 heart allocation policy change, despite concurrent increase in prevalence of higher risk population characteristics.
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http://dx.doi.org/10.1016/j.athoracsur.2021.08.023DOI Listing
September 2021

Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea.

PLoS One 2021 20;16(9):e0257541. Epub 2021 Sep 20.

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

Background: Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess.

Methods: A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up.

Results: The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes.

Conclusions: Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257541PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451987PMC
September 2021

Perioperative hemodynamic instability in pheochromocytoma and sympathetic paraganglioma patients.

Sci Rep 2021 Sep 17;11(1):18574. Epub 2021 Sep 17.

Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

For pheochromocytoma and sympathetic paraganglioma (PPGL), surgery can be used as a curative treatment; however, the life-threatening risk of perioperative hemodynamic instability (HI) presents challenges. This study aimed to analyze the incidence and predictive factors of perioperative HI. The electronic medical records of 114 consecutive patients who underwent surgery for PPGLs at our institution were retrospectively reviewed. HI was defined as one or more episodes of systolic blood pressure > 200 mmHg or mean blood pressure < 60 mmHg during surgery. The factors predictive of perioperative HI were determined using both univariate and multivariate analyses. Intraoperative HI occurred in 79 (69.3%) patients. In multivariate analysis, α-adrenergic receptor blocker duration (days) (odds ratio, 1.015; 95% confidence interval, 1.001-1.029) was a predictor for intraoperative HI. Postoperative hypotension occurred in 36 (31.6%) patients. Higher urine epinephrine levels, and greater preoperative highest heart rate (HR) were predictive factors for postoperative hypotension in PPGL patients. Caution should be taken in perioperative management for PPGL, especially with long duration of α-adrenergic receptor blocker use, higher urine epinephrine levels, and greater preoperative highest HR.
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http://dx.doi.org/10.1038/s41598-021-97964-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448751PMC
September 2021

Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide-a report by the HSS International Study Group.

Clin Rheumatol 2021 Sep 17. Epub 2021 Sep 17.

Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil.

Introduction: Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease.

Objectives: The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type.

Methods: The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients.

Results: This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis.

Conclusion: The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis. Key Points • The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality. • All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease. • The HSS International Study Group reference atlas  classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA). • The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome.
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http://dx.doi.org/10.1007/s10067-021-05912-3DOI Listing
September 2021

Porphyrin-Based Tumor-Targeting Theranostic Agent: Gd-TDAP.

ACS Med Chem Lett 2021 Sep 13;12(9):1459-1463. Epub 2021 Aug 13.

Division of Applied RI, Korea Institute of Radiological & Medical Sciences (KIRAMS), Seoul 01812, Korea.

The aim of this work was to evaluate a tumor-targeting porphyrin-based gadolinium complex (Gd-TDAP) for use as an MR/optical imaging agent and potential therapeutic agent. Gd-TDAP had higher longitudinal relaxivity (11.8 mM s) than a commercial MRI contrast agent (Omniscan; 3.7 mM s) in HSA solution (0.67 mM) at 3 T. The tumor-targeting characteristics were confirmed by T-weighted MR imaging and optical imaging using an orthotopic brain tumor mouse model, which showed 1.3-fold higher uptake in tumor compared to normal brain tissues. The cell fraction data using U87MG glioblastoma cells indicated the potential for gadolinium neutron capture therapy (Gd-NCT), which requires gadolinium to be inside the cell nucleus. In addition, porphyrin derivatives can be used for photodynamic therapy (PDT), and the results demonstrated that Gd-TDAP has great potential not only as a bimodal imaging agent but also for treatment.
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http://dx.doi.org/10.1021/acsmedchemlett.1c00283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436409PMC
September 2021

COCH-related autosomal dominant nonsyndromic hearing loss: a phenotype-genotype study.

Hum Genet 2021 Sep 16. Epub 2021 Sep 16.

Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

This phenotype-genotype study aimed to investigate the extent of audioprofile variability related to cochlin major domains and to identify potential ethnic-specific differences associated with COCH-related hearing loss. Eight Korean families (26 cases) were diagnosed with COCH-related hearing loss by exome sequencing. Audiometric test results were combined with those from nine published East Asian families (20 cases) and compared with those from 38 European-descent families (277 cases). Audioprofiles were created by grouping audiometric test results into age ranges by age at testing and then averaging hearing loss thresholds by frequency within age ranges. The functional impact of the identified variants was assessed in vitro by examining the intracellular trafficking, secretion, and cleavage of cochlin. In both East Asian and European-descent families segregating COCH-related hearing loss, deafness-associated variants in non-LCCL domains of cochlin were associated with hearing loss that was more severe earlier in life than hearing loss caused by variants in the LCCL domain. Consistent with this phenotypic difference, functional studies demonstrated distinct pathogenic mechanisms for COCH variants in a domain-dependent manner; specifically, a cytotoxic effect was observed for the p.Phe230Leu variant, which is located in the vWFA1 domain. No ethnic-specific differences in hearing loss progression were observed, except for those attributable to an overrepresentation of presymptomatic cases in the European-descent cohort.
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http://dx.doi.org/10.1007/s00439-021-02368-yDOI Listing
September 2021

A prospectively collected observational study of pelvic floor muscle strength and erectile function using a novel personalized extracorporeal perineometer.

Sci Rep 2021 Sep 15;11(1):18389. Epub 2021 Sep 15.

Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82, Gumi-Ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.

To investigate the association between pelvic floor muscle strength and erectile function in a prospectively collected observational cohort. 270 male volunteers were prospectively collected and grouped by International Index of Erectile Function-5 (IIEF-5) scores. Pelvic floor muscle strength was compared. Patients with obvious neurologic deficits, abnormal pelvic bones, history of pelvic radiation therapy, prostatectomy, or urinary incontinence were excluded. We analyzed 247 patients with mean (± standard deviation, SD) age of 62.8 (± 10.1) years. Mean (± SD) maximal and average strength were 2.0 (± 1.5) and 1.1 (± 0.8) kgf, respectively. Mean (± SD) endurance and IIEF-5 scores were 7.2 (± 2.6) seconds and 13.3 (± 7.9), respectively. Patients with IIEF-5 scores ≤ 12 tended to be older, with a higher occurrence of hypertension and lower body mass index. Age [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.04-1.12, p < 0.001], and maximal strength < 1.9 kgf (OR 2.62, 95% CI 1.38-4.97, p = 0.003) were independent predictors for IIEF-5 scores ≤ 12 in multivariate regression analysis. Patients with erectile dysfunction were older and showed lower pelvic floor muscle maximal strength. Future prospective trials needed for using physiotherapy are required to verify our results.
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http://dx.doi.org/10.1038/s41598-021-97230-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443575PMC
September 2021

Mutations in the adenosine deaminase ADAR1 that prevent endogenous Z-RNA binding induce Aicardi-Goutières-syndrome-like encephalopathy.

Immunity 2021 Sep;54(9):1976-1988.e7

Department of RNA Biology and Neuroscience, Osaka University, Suita, Osaka 565-0871, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka 565-0871, Japan; The Genome Editing Research and Development Center, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan. Electronic address:

Mutations in the adenosine-to-inosine RNA-editing enzyme ADAR1 p150, including point mutations in the Z-RNA recognition domain Zα, are associated with Aicardi-Goutières syndrome (AGS). Here, we examined the in vivo relevance of ADAR1 binding of Z-RNA. Mutation of W197 in Zα, which abolished Z-RNA binding, reduced RNA editing. Adar1 mice displayed severe growth retardation after birth, broad expression of interferon-stimulated genes (ISGs), and abnormal development of multiple organs. Notably, malformation of the brain was accompanied by white matter vacuolation and gliosis, reminiscent of AGS-associated encephalopathy. Concurrent deletion of the double-stranded RNA sensor MDA5 ameliorated these abnormalities. ADAR1 (W197A) expression increased in a feedback manner downstream of type I interferons, resulting in increased RNA editing at a subset of, but not all, ADAR1 target sites. This increased expression did not ameliorate inflammation in Adar1 mice. Thus, editing of select endogenous RNAs by ADAR1 is essential for preventing inappropriate MDA5-mediated inflammation, with relevance to the pathogenesis of AGS.
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http://dx.doi.org/10.1016/j.immuni.2021.08.022DOI Listing
September 2021

Elevated Neutrophil-to-Lymphocyte Ratio in Perioperative Periods is Suggestive of Poor Prognosis in Patients with Colorectal Cancer.

J Inflamm Res 2021 7;14:4457-4466. Epub 2021 Sep 7.

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

Background: Recent data suggest that alterations in the neutrophil-to-lymphocyte ratio (NLR) in the perioperative periods can serve as prognostic factors. However, research on the clinical impact has been limited and even discordant in patients with colorectal cancer (CRC).

Patients And Methods: The optimal cut-off value of preoperative NLR (NLR-pre), postoperative NLR (NLR-post), and its change (NLR-delta) were determined to maximize differences in overall survival (OS) between groups. Patients were categorized into four groups (NLR-trend) as follows: G1, low NLR-pre and NLR-post; G2, low NLR-pre and high NLR-post; G3, high NLR-pre and low NLR-post; and G4, high NLR-pre and NLR-post. Discriminatory performance was compared using integrated AUC (iAUC) between all indicators.

Results: A total of 576 patients diagnosed with stage I-IV CRC were included. The cut-off points were determined as 2.33 for NLR-pre, 2.06 for NLR-post, and -1.08 for NLR-delta. Subgroup dichotomization using NLR-pre, NLR-post, NLR-delta and NLR-trend were all identified as significant prognostic factors by univariate analysis. However, NLR-trend was only remained as an independent prognostic factor in the multivariate analysis. The iAUC of the NLR-trend was superior to that of NLR-pre (bootstrap iAUC mean difference=0.036; 95% CI 0.013-0.073), NLR-post (bootstrap iAUC mean difference=0.045; 95% CI 0.019-0.081) and NLR-delta (bootstrap iAUC mean difference=0.061; 95% CI 0.025-0.104).

Conclusion: Risk stratification and combining of preoperative and postoperative NLR (NLR-trend) can improve prognostic discrimination compared with single measurements or simple changes in NLR in patients with CRC.
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http://dx.doi.org/10.2147/JIR.S327443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434909PMC
September 2021

Anti-Müllerian Hormone Negatively Regulates Osteoclast Differentiation by Suppressing the Receptor Activator of Nuclear Factor-κB Ligand Pathway.

J Bone Metab 2021 Aug 31;28(3):223-230. Epub 2021 Aug 31.

Department of Pharmacology, Chonnam National University Medical School, Gwangju, Korea.

Background: Multiple members of the transforming growth factor-β (TGF-β) superfamily have well-established roles in bone homeostasis. Anti-Müllerian hormone (AMH) is a member of TGF-β superfamily of glycoproteins that is responsible for the regression of fetal Müllerian ducts and the transcription inhibition of gonadal steroidogenic enzymes. However, the involvement of AMH in bone remodeling is unknown. Therefore, we investigated whether AMH has an effect on bone cells as other TGF-β superfamily members do.

Methods: To identify the roles of AMH in bone cells, we administered AMH during osteoblast and osteoclast differentiation, cultured the cells, and then stained the cultured cells with Alizarin red and tartrate-resistant acid phosphatase, respectively. We analyzed the expression of osteoblast- or osteoclast-related genes using real-time polymerase chain reaction and western blot.

Results: AMH does not affect bone morphogenetic protein 2-mediated osteoblast differentiation but inhibits receptor activator of nuclear factor-κB (NF-κB) ligand-induced osteoclast differentiation. The inhibitory effect of AMH on osteoclast differentiation is mediated by IκB-NF-κB signaling.

Conclusions: AMH negatively regulates osteoclast differentiation without affecting osteoblast differentiation.
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http://dx.doi.org/10.11005/jbm.2021.28.3.223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441534PMC
August 2021

Differential genetic diagnoses of adult post-lingual hearing loss according to the audiogram pattern and novel candidate gene evaluation.

Hum Genet 2021 Sep 14. Epub 2021 Sep 14.

Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Ski-slope hearing loss (HL), which refers to increased auditory threshold at high frequencies, is common in adults. However, genetic contributions to this post-lingual HL remain largely unknown. Here, we prospectively investigated deafness-associated and novel candidate genes causing ski-slope HL. We analyzed 192 families with post-lingual HL via gene panel and/or exome sequencing. With an overall molecular diagnostic rate of 35.4% (68/192) in post-lingual HL, ski-slope HL showed a lower diagnostic rate (30.7%) compared with other conditions (40.7%). In patients who showed HL onset before the age of 40, genetic diagnostic probability was significantly lower for ski-slope HL than for other conditions. Further analysis of 51 genetically undiagnosed patients in the ski-slope HL group identified three variants in delta-like ligand 1 (DLL1), a Notch ligand, which presented in vitro gain-of-function effects on Notch downstream signaling. In conclusion, genetic diagnostic rates in post-lingual HL varied according to audiogram patterns with age-of-onset as a confounding factor. DLL1 was identified as a candidate gene causing ski-slope HL.
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http://dx.doi.org/10.1007/s00439-021-02367-zDOI Listing
September 2021

Wetting Property Modification of AlO by Helium Ion Irradiation: Effects of Beam Energy and Fluence on Contact Angle.

Langmuir 2021 Sep 14. Epub 2021 Sep 14.

Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, 29 Geumgu-gil, Jeongeup-si, Jeollabuk-do 56212, Republic of Korea.

In imparting wetting properties, a fabrication process without the addition of new compounds and deposition of coating layers would be the most desirable because it does not introduce additional complexities. Hence, the ion beam irradiation technique is used as it enables the chemistry of materials to be modified through simple adjustments of irradiation parameters such as the type of accelerated particles, beam energy, and fluence. In this study, the hydrophilicity of alumina surfaces was weakened by irradiating He ion beams of different energy levels (200 keV and 20 MeV). These transitions become more pronounced as the total beam fluence increases. In low-energy irradiation, the effect of irradiation is predominant near the surface, and hydrophilicity is weakened by the increase in carbon adsorption and suppression of dissociative adsorption of water molecules owing to the introduction of oxygen vacancies. In contrast, nuclear transmutations are induced by irradiation with high-energy beams. Consequently, fluorine is generated, and hydrophobic functional groups are formed on the surface. By varying the beam conditions, the wetting properties of the target ceramic can be controlled to the desired level, which is required in various industries, via appropriate adjustments of the beam parameters. In addition, the beam irradiation technique may be applicable to all ceramic materials, including lattice oxygen and alumina.
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http://dx.doi.org/10.1021/acs.langmuir.1c01859DOI Listing
September 2021

Gender Difference in the Relationship Between Pulse Pressure and Visceral Adiposity Index in Korean Adults.

Metab Syndr Relat Disord 2021 Sep 13. Epub 2021 Sep 13.

Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea.

This study was conducted to assess the association of pulse pressure (PP) and visceral adiposity index (VAI) by gender in Korean adults. This study used the data of 4960 adults at age ≥20 years, from the 2015 Korean National Health and Nutrition Examination Survey. In the overall population ( = 4960), after adjustment for related variables and with quartile 1 of VAI as a reference, the odds ratios of high PP (PP >60 mmHg) was significantly higher in quartile 3 [1.32 (95% confidence interval [CI], 1.02-1.71)] and quartile 4 of VAI [1.40 (95% CI, 1.07-1.83)]. In women ( = 2784), the OR of high PP, with quartile 1 of VAI as a reference, was significantly higher in quartile 3 [2.36 (95% CI, 1.55-3.61)] and quartile 4 of VAI [2.70 (95% CI, 1.77-4.12)]. In men ( = 2176), high PP was not associated with the quartiles of VAI. In addition, after adjustment for related variables, the PP level was positively associated with the quartiles of VAI in the overall population ( < 0.001) and women ( < 0.001, but not in men ( = 0.316). VAI was positively associated with PP in Korean women, but not in Korean men.
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http://dx.doi.org/10.1089/met.2021.0035DOI Listing
September 2021

Prospective Study of Plant-Based Dietary Patterns and Diabetes in Puerto Rican Adults.

J Nutr 2021 Sep 13. Epub 2021 Sep 13.

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.

Background: Vegetarian-type dietary patterns have been associated with reducing the risk of developing diabetes and may function as an effective strategy for diabetes management.

Objectives: We aimed to examine the associations between adherence to plant-based diet indices and the risk of developing diabetes in the Boston Puerto Rican Health Study.

Methods: Puerto Rican adults (n = 646), aged 45-75 y and free of diabetes at baseline, were included. Dietary intake was assessed via a validated FFQ. Three plant-based dietary indices were calculated: an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), glycated hemoglobin ≥ 6.5% (48 mmol/mol), or use of hypoglycemic agents during follow-up. Cox proportional hazards were used to evaluate associations between the dietary patterns and incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depressive symptomatology, and plasma concentrations of lipids.

Results: During a mean of 4.2 y of follow-up, we identified 134 diabetes cases. After adjustment for covariates, higher hPDI was associated with lower risk of developing diabetes (adjusted HR for the highest compared with the lowest tertile: 0.54; 95% CI: 0.31, 0.94; P-trend = 0.03). In contrast, the PDI and uPDI were not significantly associated with the risk of diabetes (P-trend > 0.3 for both).

Conclusions: The healthful plant-based dietary index, but not the total plant-based dietary index, was inversely associated with diabetes risk. These findings suggest that the quality of plant-based diets must be considered when recommending plant-based diets for the prevention of diabetes.This trial was registered at clinicaltrials.gov as NCT01231958.
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http://dx.doi.org/10.1093/jn/nxab301DOI Listing
September 2021

Estimation of core body temperature by near-infrared imaging of vein diameter change in the dorsal hand.

Biomed Opt Express 2021 Aug 6;12(8):4700-4712. Epub 2021 Jul 6.

School of Mechanical Engineering and Department of Integrative Biomedical Science and Engineering, Graduate School, Kookmin University, Seoul 02707, Republic of Korea.

Core body temperature ( ) is a key indicator of personal thermal comfort and serves as a monitor of thermal strain. Multi-parametric sensors are not practical for estimating core temperature because they require long data collection times and a wide variety of settings. This study introduces dorsal hand vein dynamics as a novel indicator along with heart rate (HR) and dorsal hand skin temperature ( ) for predicting during rest following elevation. Twelve healthy males aged 27 ± 9 years old participated in the experiment. The experimental procedure consisted of a 10-min rest followed by 60 min of passive heat stress induced by leg immersion in hot water at 42°C and a 40-min thermal relaxation period after the legs were removed from the water. A near-infrared (NIR) imaging system was configured to monitor the dorsal hand veins during the entire experimental session. The values of , , and were continuously monitored while the ambient temperature and relative humidity (RH) were maintained in a climate chamber at 20°C and 50%, respectively. Our selected predictor parameters demonstrated similar patterns in the such that the value increased as a result of passive heat stress and decreased in the thermal relaxation phase. The experimental data were divided into two phases: thermal stress and relaxation. At the resting condition, inclusion of the hand vein diameter () improved the multiple linear regression value ( ) about 26%. At the relaxation phase, however, training regressions  = 0.68 and  = 0.94 were observed in the regression model with and without considering , respectively. The test regression value of  = 0.88 and the root mean square error (RMSE) of 0.18°C showed good agreement with the predicted values. These findings demonstrate acceptable validity of the non-invasive estimation at the resting condition. In particular, the inclusion of as a predictor in the regression analysis increases the prediction accuracy with a lower RMSE value.
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http://dx.doi.org/10.1364/BOE.431534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407806PMC
August 2021

Role of the Melanocortin System in the Central Regulation of Cardiovascular Functions.

Front Physiol 2021 25;12:725709. Epub 2021 Aug 25.

Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, United States.

Increasing evidence indicates that the melanocortin system is not only a central player in energy homeostasis, food intake and glucose level regulation, but also in the modulation of cardiovascular functions, such as blood pressure and heart rate. The melanocortins, and in particular α- and γ-MSH, have been shown to exert their cardiovascular activity both at the central nervous system level and in the periphery (e.g., in the adrenal gland), binding their receptors MC3R and MC4R and influencing the activity of the sympathetic nervous system. In addition, some studies have shown that the activation of MC3R and MC4R by their endogenous ligands is able to improve the outcome of cardiovascular diseases, such as myocardial and cerebral ischemia. In this brief review, we will discuss the current knowledge of how the melanocortin system influences essential cardiovascular functions, such as blood pressure and heart rate, and its protective role in ischemic events, with a particular focus on the central regulation of such mechanisms.
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http://dx.doi.org/10.3389/fphys.2021.725709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424695PMC
August 2021

Transport and Co-Transport of Carboxylate Ions and Ethanol in Anion Exchange Membranes.

Polymers (Basel) 2021 Aug 27;13(17). Epub 2021 Aug 27.

Department of Chemical Engineering, Auburn University, Auburn, AL 36849, USA.

Understanding multi-component transport behavior through hydrated dense membranes is of interest for numerous applications. For the particular case of photoelectrochemical CO reduction cells, it is important to understand the multi-component transport behavior of CO electrochemical reduction products including mobile formate, acetate and ethanol in the ion exchange membranes as one role of the membrane in these devices is to minimize the permeation of these products. Anion exchange membranes (AEM) have been employed in these and other electrochemical devices as they act to facilitate the transport of common electrolytes (i.e., bicarbonates). However, as they act to facilitate the transport of carboxylates as well, thereby reducing the overall performance, the design of new AEMs is necessary to improve device performance through the selective transport of the desired ion(s) or electrolyte(s). Here, we investigate the transport behavior of formate and acetate and their co-transport with ethanol in two types of AEMs: (1) a crosslinked AEM prepared by free-radical copolymerization of a monomer with a quaternary ammonium (QA) group and a crosslinker, and (2) Selemion AMVN. We observe a decrease in diffusivities to carboxylates in co-diffusion. We attribute this behavior to charge screening by the co-diffusing alcohol, which reduces the electrostatic attraction between QAs and carboxylates.
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http://dx.doi.org/10.3390/polym13172885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433790PMC
August 2021

Bioassay-Guided Isolation of Two Eudesmane Sesquiterpenes from Using Centrifugal Partition Chromatography.

Molecules 2021 Aug 30;26(17). Epub 2021 Aug 30.

College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Korea.

In this study, a centrifugal partition chromatography (CPC) separation was applied to identify antioxidant-responsive element (ARE) induction molecules from the crude extract of roots. CPC was operated with a two-phase solvent system composed of -hexane-methanol-water (10:8.5:1.5, //) in dual mode (descending to ascending), which provided a high recovery rate (>95.5%) with high resolution. Then, ARE induction activity of obtained CPC fractions was examined in ARE-transfected HepG2 cells according to the weight ratios of the obtained fractions. The fraction exhibiting ARE-inducing activity was further purified by preparative HPLC that led to isolation of two eudesmane type sesquiterpenes as active compounds. The chemical structures were elucidated as linderolide U () and a new sesquiterpene named as linderolide V () by spectroscopic data. Further bioactivity test demonstrated that compounds and enhanced ARE activity by 22.4-fold and 7.6-fold, respectively, at 100 μM concentration while 5 μM of sulforaphane induced ARE activity 24.8-fold compared to the control.
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http://dx.doi.org/10.3390/molecules26175269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433645PMC
August 2021

Tailored eradication strategy concomitant therapy for eradication treatment in Korean patients.

World J Gastroenterol 2021 Aug;27(31):5247-5258

Division of Internal Medicine, Department of Gastroenterology, Gachon University College of Medicine, Gil Medical Center, Inchoen 21565, South Korea.

Background: Antibiotic resistance to ) infection, which ultimately results in eradication failure, has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for infection has received attention.

Aim: To investigate the efficacy and safety profiles of TT for infection treatment compared to a non-bismuth quadruple therapy, concomitant therapy (CT) regimen.

Methods: We included patients (> 18 years) with an infection and without a history of eradication who visited the Gil Medical Center between March 2016 and October 2020. After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were assessed and compared between the two groups. infection was diagnosed using a rapid urease test, Giemsa stain, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR). Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation. For the TT group, a DPO-PCR test, which detected A2142G and/or A2143G point mutations, and a clarithromycin resistance test were performed. Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen.

Results: Of the 217 patients with a treatment naive infection, 110 patients [mean age: 58.66 ± 13.03, men, = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, = 52 (48.60%)] were treated with CT. The compliance (TT CT, 100% 98.13%, = 0.30), and follow-up loss rates (8.18% 9.35%, = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT CT, 82.73% 82.24%, = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% 50.52%, < 0.001).

Conclusion: The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.
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http://dx.doi.org/10.3748/wjg.v27.i31.5247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384750PMC
August 2021

[Topic Modeling and Keyword Network Analysis of News Articles Related to Nurses before and after "the Thanks to You Challenge" during the COVID-19 Pandemic].

J Korean Acad Nurs 2021 Aug;51(4):442-453

College of Nursing Science, Kyung Hee University, Seoul, Korea.

Purpose: This study was conducted to assess public awareness and policy challenges faced by practicing nurses.

Methods: After collecting nurse-related news articles published before and after 'the Thanks to You Challenge' campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles.

Results: Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics 'infection of medical staff' and 'return of overseas Koreans' disappeared, but 'the Thanks to You Challenge' emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of 'the Thanks to You Challenge' topic.

Conclusion: The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.
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http://dx.doi.org/10.4040/jkan.20287DOI Listing
August 2021

Tumor-induced disruption of the blood-brain barrier promotes host death.

Dev Cell 2021 Sep 1. Epub 2021 Sep 1.

Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720, USA. Electronic address:

Cancer patients often die from symptoms that manifest at a distance from any tumor. Mechanisms underlying these systemic physiological perturbations, called paraneoplastic syndromes, may benefit from investigation in non-mammalian systems. Using a non-metastatic Drosophila adult model, we find that malignant-tumor-produced cytokines drive widespread host activation of JAK-STAT signaling and cause premature lethality. STAT activity is particularly high in cells of the blood-brain barrier (BBB), where it induces aberrant BBB permeability. Remarkably, inhibiting STAT in the BBB not only rescues barrier function but also extends the lifespan of tumor-bearing hosts. We identify BBB damage in other pathological conditions that cause elevated inflammatory signaling, including obesity and infection, where BBB permeability also regulates host survival. IL-6-dependent BBB dysfunction is further seen in a mouse tumor model, and it again promotes host morbidity. Therefore, BBB alterations constitute a conserved lethal tumor-host interaction that also underlies other physiological morbidities.
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http://dx.doi.org/10.1016/j.devcel.2021.08.010DOI Listing
September 2021

Genomic and evolutionary classification of lung cancer in never smokers.

Nat Genet 2021 Sep 6;53(9):1348-1359. Epub 2021 Sep 6.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.

Lung cancer in never smokers (LCINS) is a common cause of cancer mortality but its genomic landscape is poorly characterized. Here high-coverage whole-genome sequencing of 232 LCINS showed 3 subtypes defined by copy number aberrations. The dominant subtype (piano), which is rare in lung cancer in smokers, features somatic UBA1 mutations, germline AR variants and stem cell-like properties, including low mutational burden, high intratumor heterogeneity, long telomeres, frequent KRAS mutations and slow growth, as suggested by the occurrence of cancer drivers' progenitor cells many years before tumor diagnosis. The other subtypes are characterized by specific amplifications and EGFR mutations (mezzo-forte) and whole-genome doubling (forte). No strong tobacco smoking signatures were detected, even in cases with exposure to secondhand tobacco smoke. Genes within the receptor tyrosine kinase-Ras pathway had distinct impacts on survival; five genomic alterations independently doubled mortality. These findings create avenues for personalized treatment in LCINS.
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http://dx.doi.org/10.1038/s41588-021-00920-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432745PMC
September 2021

IRF2 enhances RANKL-induced osteoclast differentiation via regulating NF-κB/ NFATc1 signaling.

BMB Rep 2021 Sep 7. Epub 2021 Sep 7.

Department of Pharmacology, Chonnam National University Medical School, Gwangju 61469, Republic of Korea; Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea.

Interferon regulatory factors (IRFs) play roles in various biological processes including cytokine signaling, cell growth regulation and hematopoietic development. Although it has been reported that several IRFs are involved in bone metabolism, the role of IRF2 in bone cells has not been elucidated. Here, we investigated the involvement of IRF2 in RANKL-induced osteoclast differentiation. IRF2 overexpression in osteoclast precursor cells enhanced osteoclast differentiation by regulating the expression of NFATc1, a master regulator of osteoclastogenesis. Conversely, IRF2 knockdown inhibited osteoclast differentiation and decreased the NFATc1 expression. Moreover, IRF2 increased the translocation of NF-κB subunit p65 to the nucleus in response to RANKL and subsequently induced the expression of NFATc1. IRF2 plays an important role in RANKL-induced osteoclast differentiation by regulating NF-κB/NFATc1 signaling pathway. Taken together, we demonstrated the molecular mechanism of IRF2 in osteoclast differentiation, and provide a molecular basis for potential therapeutic targets for the treatment of bone diseases characterized by excessive bone resorption.
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September 2021

Bispecific Antibody Designed for Targeted NK Cell Activation and Functional Assessment for Biomedical Applications.

ACS Appl Mater Interfaces 2021 Sep 4;13(36):42370-42381. Epub 2021 Sep 4.

Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.

Natural killer (NK) cells serve as key innate effectors and their activity has been considered a prognostic biomarker in diverse human diseases. Currently, NK cell functional assays have several problems primarily related to adequate preparation, labeling, or treatment of target cells, which are cumbersome and often hamper consistent sensitivity for NK cells. Here, bispecific antibodies (BsAb's) targeting NKG2D and 2B4 receptors, whose combination mounts selective cytotoxicity and IFN-γ production of NK cells, are developed as acellular, consistent, and easy-to-use strategies for assessing NK cell functions. These NK cell activator BsAb's (NKABs) are constructed in symmetric dual bivalent formats with different interdomain spacings [immunoglobulin G (IgG)-single-chain variable fragment (scFv) and dual-variable domain (DVD)-Ig] and kappa constant (Cκ)-scFv format linking two scFv's with a Cκ domain. These NKABs are specific and superior to a combination of monospecific antibodies for NK cell activation. NKAB elicits both direct cytotoxicity and IFN-γ production via integration of NKG2D and 2B4 signals. Moreover, stimulation with NKAB IgG-scFv and Cκ-scFv reveals defective NK cell functions in X-linked lymphoproliferative disease involving 2B4 dysfunction in NK cells and multiple myeloma in peripheral blood mononuclear cells and whole blood, respectively. Hence, this work provides a proof of concept that NKAB facilitates the reliable and comprehensive measurement of NK cell function in clinical settings for diagnostic and prognostic purposes.
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http://dx.doi.org/10.1021/acsami.1c08986DOI Listing
September 2021

IL-6 and IL-10 Levels, Rather Than Viral Load and Neutralizing Antibody Titers, Determine the Fate of Patients With Severe Fever With Thrombocytopenia Syndrome Virus Infection in South Korea.

Front Immunol 2021 17;12:711847. Epub 2021 Aug 17.

Deparment of Microbiology, Hanyang University College of Medicine, Seoul, South Korea.

Severe fever with thrombocytopenia syndrome (SFTS) is a new tick-borne viral disease, and most SFTS virus (SFTSV) infections occur bites from the tick ; however, SFTSV transmission can also occur through close contact with an infected patient. SFTS is characterized by acute high fever, thrombocytopenia, leukopenia, elevated serum hepatic enzyme levels, gastrointestinal symptoms, and multiorgan failure and has a 16.2 to 30% mortality rate. In this study, we found that age, dyspnea rates, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, multiorgan dysfunction score (MODS), viral load, IL-6 levels, and IL-10 levels were higher in patients with fatal disease than in patients with nonfatal disease during the initial clinical course of SFTS. In addition, we found that IL-6 and IL-10 levels, rather than viral load and neutralizing antibody titers, in patients with an SFTSV infection strongly correlated with outcomes (for severe disease with an ultimate outcome of recovery or death).
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http://dx.doi.org/10.3389/fimmu.2021.711847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416084PMC
August 2021

OCULAR MANIFESTATIONS OF ASP38ALA AND THR59LYS FAMILIAL TRANSTHYRETIN AMYLOIDOSIS.

Retina 2021 Aug 30. Epub 2021 Aug 30.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Department of Ophthalmology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea.

Purpose: To describe the ophthalmic manifestations of familial transthyretin amyloidosis (FTA) mutations, including Asp38Ala and Thr59Lys, which have not been previously reported to have ocular involvement.

Methods: This is an observational case series of prospectively collected data of 16 FTA patients who were taking tafamidis for mild peripheral neuropathy and underwent a comprehensive ophthalmic examination at a single tertiary center, between January 2013 and March 2020. The ocular involvement of each FTA mutation type and the specific manifestations were the main outcome measures.

Results: Six of 16 FTA patients manifested ocular involvement. Ocular involvement was noted in two of three patients with Glu89Lys mutations having retinal deposits, retinal hemorrhages, and corneal opacity. Three of nine patients with Asp38Ala mutations and one of two patients with Thr59Lys mutations showed ocular involvement that had not been previously described. The ophthalmic findings included glaucoma, anterior lens capsule opacity, vitreous opacity, and retinal deposits. The decrease in vascular flow due to perivascular cuffing of the amyloid deposits was detected by optical coherence tomography angiography.

Conclusion: The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
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http://dx.doi.org/10.1097/IAE.0000000000003296DOI Listing
August 2021

Dispersion profile of a needle-free jet injection depends on the interfacial property of the medium.

Drug Deliv Transl Res 2021 Sep 3. Epub 2021 Sep 3.

School of Mechanical Engineering and Department of Integrative Biomedical Science and Engineering, Graduate School, Kookmin University, Seoul, 02707, Republic of Korea.

Injections into or through the skin are common drug or vaccine administration routes, which can be achieved with conventional needles, microneedles, or needle-free jet injections (NFJI). Understanding the transport mechanism of these injected fluids is critical for the development of effective drug administration devices. NFJI devices are distinct from traditional injection techniques by their route and time scale, which relies on a propelled microjet with sufficient energy to penetrate the skin surface and deliver the drug into the targeted region. The injected fluid interacts with multiple skin tissue layers and interfaces, which implies that the corresponding injection profile is dependent on their mechanical properties. In this study, we address the lack of fundamental knowledge on the impact of these interfaces on the injection profiles of NFJI devices.
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http://dx.doi.org/10.1007/s13346-021-01049-7DOI Listing
September 2021

Safety of endoscopic endonasal biopsy for the pituitary stalk-hypothalamic lesions.

Pituitary 2021 Sep 1. Epub 2021 Sep 1.

Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Purpose: The indications for and the optimal biopsy approach in pituitary stalk-hypothalamic (PsH) lesions are controversial. Biopsies through an endoscopic endonasal approach (EEA) for PsH lesions have often been considered to cause the infundibulo-tuberal syndrome. The purpose of this study was to analyze the surgical and endocrinological safety of EEA biopsies for PsH lesions.

Methods: A total of 39 consecutive patients who underwent an EEA biopsy between June 2011 and August 2020 in a single institute were retrospectively analyzed. The ophthalmological and endocrinological outcomes were assessed before and after surgery.

Results: PsH lesions were confirmed to be diverse pathological diagnoses, ranging from lymphocytic hypophysitis to diffuse midline glioma, and the most common pathologic diagnosis was a germinoma (18 patients, 46.2%). No patients developed visual deterioration after the biopsy. In patients without preoperative panhypopituitarism, 13 out of 28 patients (46.4%) developed new anterior pituitary hormonal deficiencies after the biopsy. When the tissue was collected from the stalk, the endocrinological deterioration rate was 100% (6 of 6 patients), while the rate was 31.8% (7 of 22 patients) when tissue could be harvested from an extra-stalk lesion. The rate of newly developed permanent diabetes insipidus after surgery was 40.9% (9 of 22 patients). The median surgery time was 125 min, and there was no postoperative CSF leakage or infections noted.

Conclusions: An EEA biopsy for PsH lesions is a safe and efficient surgical method unless the tissue is collected from the stalk.
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http://dx.doi.org/10.1007/s11102-021-01181-0DOI Listing
September 2021
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