Publications by authors named "Ko-Eun Lee"

52 Publications

The clinical spectrum of periorbital vascular complications after facial injection.

J Cosmet Dermatol 2021 Feb 21. Epub 2021 Feb 21.

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

Background: Serious complications due to periorbital vascular occlusion can occur after facial injections, including skin necrosis, ophthalmoplegia, blepharoptosis, and visual loss. Visual loss after facial filler injection is particularly rare, but it is known to have a poor prognosis despite treatment.

Aims: This study aimed to describe the prognosis and various clinical features of periorbital vascular complications after facial injection of cosmetic filler or local anesthetic.

Patients/methods: This single-center retrospective study included 10 consecutive patients who presented with occluded periorbital vessels after facial injection.

Results: Nine patients were injected with cosmetic facial fillers: seven with hyaluronic acid, one with collagen, and one with poly-Llactic acid. The other patient was injected with lidocaine mixed with epinephrine. Injection sites included the glabella (n = 5), nasal dorsum (n = 4), and temporal fossa (n = 1). Presumed arteries affected included the central (n = 2) or branch (n = 3) retinal artery, ophthalmic artery (n = 4), and angular artery (n = 1). Nine patients (90%) had purpura and blisters, and eight patients (80%) had ophthalmoplegia at presentation, but all of them recovered within 3 months. Six patients (60%) were blind at the last follow-up, and five of them had occlusion of the central retinal artery or ophthalmic artery. There was a patient with sequelae of phthisis bulbi, which was cosmetically managed with retrobulbar filler injections.

Conclusion: Facial injections can cause periorbital arterial occlusion, and the clinical features are diverse according to the site and extent of vascular occlusion and injection materials. Visual prognosis was associated with the site of vascular occlusion and initial visual acuity. Other common complications, such as skin lesions, blepharoptosis, and limited extraocular movement, can fully resolve only with supportive treatments in most cases.
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http://dx.doi.org/10.1111/jocd.14019DOI Listing
February 2021

The Halotolerant Rhizobacterium- MU2 Enhances Inorganic Silicon and Phosphorus Use Efficiency and Augments Salt Stress Tolerance in Soybean ( L.).

Microorganisms 2020 Aug 19;8(9). Epub 2020 Aug 19.

School of Applied Biosciences, Kyungpook National University, Daegu 41566, Korea.

Optimizing nutrient usage in plants is vital for a sustainable yield under biotic and abiotic stresses. Since silicon and phosphorus are considered key elements for plant growth, this study assessed the efficient supplementation strategy of silicon and phosphorus in soybean plants under salt stress through inoculation using the rhizospheric strain- MU2. The screening analysis of MU2 showed its high salt-tolerant potential, which solubilizes both silicate and phosphate. The isolate, MU2 produced gibberellic acid (GA, GA) and organic acids (malic acid, citric acid, acetic acid, and tartaric acid) in pure culture under both normal and salt-stressed conditions. The combined application of MU2, silicon, and phosphorus significantly improved silicon and phosphorus uptake, reduced Na ion influx by 70%, and enhanced K uptake by 46% in the shoots of soybean plants grown under salt-stress conditions. MU2 inoculation upregulated the salt-resistant genes , , and , which significantly reduced the endogenous hormones abscisic acid and jasmonic acid while, it enhanced the salicylic acid content of soybean. In addition, MU2 inoculation strengthened the host's antioxidant system through the reduction of lipid peroxidation and proline while, it enhanced the reduced glutathione content. Moreover, MU2 inoculation promoted root and shoot length, plant biomass, and the chlorophyll content of soybean plants. These findings suggest that MU2 could be a potential biofertilizer catalyst for the amplification of the use efficiency of silicon and phosphorus fertilizers to mitigate salt stress.
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http://dx.doi.org/10.3390/microorganisms8091256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570339PMC
August 2020

Feasibility of 3-Dimensional Visual Guides for Preparing Pediatric Zirconia Crowns: An In Vitro Study.

Int J Environ Res Public Health 2020 08 8;17(16). Epub 2020 Aug 8.

Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul 02447, Korea.

This study evaluated the feasibility of a tooth preparation guide for prefabricated zirconia crowns (PZCs). Three-dimensional surface data for PZCs of the left maxillary primary first molar and left mandibular primary second molar were obtained using a model scanner. The tooth preparation data were digitally designed to harmonize with the adjacent teeth on the mixed dentition model and visualized using a color-coded map, which presents the required amount of tooth reduction. Twenty participants were recruited for preparing teeth with and without using the tooth preparation guide. The following three parameters were evaluated: tooth preparation time, harmony score, and amount of tooth reduction. The preparation time when using the guide was significantly reduced ( < 0.05), and a significant difference was observed in the harmony scores for the maxillary primary first molar preparation. Furthermore, the amount of tooth reduction was significantly different for both maxillary and mandibular primary molars ( < 0.05) in terms of the occlusal distal surface and buccal line angle in the maxillary primary first molars, and the smooth surfaces, proximal surfaces, and mesial line angles in the mandibular primary second molars. Thus, the results suggest that a tooth preparation guide could facilitate better tooth preparation for PZCs.
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http://dx.doi.org/10.3390/ijerph17165732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459926PMC
August 2020

Effect of Ammonia and Indole-3-acetic Acid Producing Endophytic YNA12 as a Bio-Herbicide for Weed Inhibition: Special Reference with Evening Primroses.

Plants (Basel) 2020 Jun 18;9(6). Epub 2020 Jun 18.

School of Applied Biosciences, Kyungpook National University, Daegu 41566, Korea.

Information on the use of endophytic bacteria as a bio-herbicide for the management of weed control in agricultural fields is limited. The current study aimed to isolate endophytic bacteria from evening primroses and to screen them for their bio-herbicidal activity. Two isolated endophytic bacteria ( YNA11 and YNA12) were initially screened for citrate utilization and for indole-3-acetic acid (IAA) and catalase production. The preliminary biochemical assessment showed YNA12 as a positive strain. Ammonia, catalase, and IAA in its culture filtrate were quantified. Gas Chromatography/Mass Spectroscopy- Selective Ion Monitoring (GC/MS-SIM) analysis revealed the production of IAA by YNA12 in a time-dependent manner. YNA12 also exhibited significant ammonia-producing potential and catalase activity against hydrogen peroxide. The YNA12 culture filtrate significantly inhibited the germination rate of evening primrose seeds, resulting in a marked reduction in seedling length and biomass compared with those of the control seeds. Moreover, the culture filtrate of YNA12 significantly accelerated the endogenous abscisic acid (ABA) production and catalase activity of evening primrose seedlings. Macronutrient regulation was adversely affected in the seedlings exposed to the culture filtrate of YNA12, leading to inhibition of seed germination. The current results suggest that endophytic YNA12 may be used as a potent bio-herbicidal agent for controlling weed growth and development.
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http://dx.doi.org/10.3390/plants9060761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355527PMC
June 2020

Inoculation with Indole-3-Acetic Acid-Producing Rhizospheric KE149 Augments Growth of Adzuki Bean Plants Under Water Stress.

J Microbiol Biotechnol 2020 May;30(5):717-725

School of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea.

The use of plant growth-promoting rhizobacteria is economically viable and environmentally safe for mitigating various plant stresses. Abiotic stresses such as flood and drought are a serious threat to present day agriculture. In the present study, the indole-3-acetic acid-producing rhizobacterium KE149 was selected, and its effect on the growth of adzuki bean plants was investigated under flood stress (FS) and drought stress (DS). IAA quantification of bacterial pure culture revealed that KE149 produced significant amount of IAA. KE149 inoculation significantly decreased stress-responsive endogenous abscisic acid and jasmonic acid and increased salicylic acid in plants under DS and FS. KE149 inoculation also increased proline under DS and methionine under FS. Moreover, KE149 inoculation significantly increased the calcium (Ca), magnesium (Mg), and potassium (K) content and lowered the sodium (Na) content in the plant shoot under stress. KE149-treated plants had significantly higher root length, shoot length, stem diameter, biomass, and chlorophyll content under both normal and stressed conditions. These results suggest that KE149 could be an efficient biofertilizer for mitigating water stress.
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http://dx.doi.org/10.4014/jmb.1911.11063DOI Listing
May 2020

The efficacy of conditioned medium released by tonsil-derived mesenchymal stem cells in a chronic murine colitis model.

PLoS One 2019 2;14(12):e0225739. Epub 2019 Dec 2.

Department of Molecular Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.

Tonsil-derived mesenchymal stem cells (TMSC) have characteristics of MSC and have many advantages. In our previous studies, intraperitoneal (IP) injection of TMSC in acute and chronic colitis mouse models improved the disease activity index, colon length, and the expression levels of proinflammatory cytokines. However, TMSC were not observed to migrate to the inflammation site in the intestine. The aim of this study was to verify the therapeutic effect of conditioned medium (CM) released by TMSC (TMSC-CM) in a mouse model of dextran sulfate sodium (DSS)-induced chronic colitis. TMSC-CM was used after seeding 5×105 cells onto a 100 mm dish and culturing for 5-7 days. TMSC-CM was concentrated (TMSC-CM-conc) by three times using a 100 kDa cut-off centrifugal filter. Seven-week-old C57BL/6 mice were randomly assigned to the following 5 groups: 1) normal, 2) colitis, 3) TMSC, 4) TMSC-CM, and 5) TMSC-CM-conc. Chronic colitis was induced by continuous oral administration of 1.5% dextran sulfate sodium (DSS) for 5 days, followed by 5 additional days of tap water feeding. This cycle was repeated two more times (total 30 days). Phosphate buffered saline (in the colitis group), TMSC, TMSC-CM, and TMSC-CM-conc were injected via IP route 4, 4, 12, and 4 times, respectively. Reduction of disease activity index, weight gain, recovery of colon length, and decreased in the expression level of the proinflammatory cytokines, interleukin (IL)-1β, IL-6, and IL-17 were observed at day 30 in the treatment groups, compared to control. However, histological colitis scoring and the expression level of tumor necrosis factor α and IL-10 did not differ significantly between each group. TMSC-CM showed an equivalent effect to TMSC related to the improvement of inflammation in the chronic colitis mouse model. The data obtained support the use of TMSC-CM to treat inflammatory bowel disease without any cell transplantation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225739PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886802PMC
March 2020

Effect of Silicate and Phosphate Solubilizing Rhizobacterium GAK2 on Oryza sativa L. under Cadmium Stress.

J Microbiol Biotechnol 2020 Jan;30(1):118-126

School of Applied Biosciences, Kyungpook National University, Daegu 41566, Republic of Korea.

Silicon and phosphorus are elements that are beneficial for plant growth. Despite the abundant availability of silicate and phosphate in the Earth's crust, crop nutritional requirements for silicon and phosphorus are normally met through the application of fertilizer. However, fertilizers are one of the major causes of heavy metal pollution. In our study, we aimed to assess silicate and phosphate solubilization by the bacteria GAK2, in the presence and absence of phosphate [Ca(PO)] or silicate (MgOSi), to counteract cadmium stress in rice ( L). Our results showed that the GAK2-treated rice plants, grown in soil amended with phosphate [Ca(PO)] or silicate (MgOSi), had significantly reduced cadmium content, and enhanced plant growth promoting characteristics including fresh shoot and root weight, plant height, and chlorophyll content. These plants showed significant downregulation of the cadmium transporter gene, , and upregulation of the silicon carrier gene, . Moreover, jasmonic acid levels were significantly reduced in the GAK2-inoculated plants, and this was further supported by the downregulation of the jasmonic acid related gene, . These results indicate that GAK2 can be used as a silicon and phosphorus bio-fertilizer, which solubilizes insoluble silicate and phosphate, and mitigates heavy metal toxicity in crops.
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http://dx.doi.org/10.4014/jmb.1906.06010DOI Listing
January 2020

Indole-3-acetic-acid and ACC deaminase producing Leclercia adecarboxylata MO1 improves Solanum lycopersicum L. growth and salinity stress tolerance by endogenous secondary metabolites regulation.

BMC Microbiol 2019 04 25;19(1):80. Epub 2019 Apr 25.

School of Applied Biosciences, Kyungpook National University, Daegu, 41566, Republic of Korea.

Background: The utilization of plant growth-promoting microbes is an environment friendly strategy to counteract stressful condition and encourage plants tolerance. In this regards, the current study was designed to isolate ACC deaminase and indole-3-acetic acid (IAA) producing halotolerant bacteria to promote tomato (Solanum lycopersicum L.) growth and tolerance against salinity stress.

Results: The selected bacterial isolate MO1 was identified as Leclercia adecarboxylata and IAA quantification results revealed that MO1 produced significant amount of IAA (9.815 ± 0.6293 μg mL). The MO1 showed the presence of ACC (1-Aminocyclopropane-1-Carboxylate) deaminase responsible acdS gene and tolerance against salinity stress. A plant microbe interaction experiment using tomato (Solanum lycopersicum L.) with glycine betaine (GB) as a positive control was carried out to investigate the positive role MO1 in improving plant growth and stress tolerance. The results indicated that MO1 inoculation and GB application significantly increased growth attributes under normal as well as saline condition (120 mM NaCl). The MO1 inoculation and GB treatment approach conferred good protection against salinity stress by significantly improving glucose by 17.57 and 18.76%, sucrose by 34.2 and 12.49%, fructose by 19.9 and 10.9%, citric acid by 47.48 and 34.57%, malic acid by 52.19 and 28.38%, serine by 43.78 and 69.42%, glycine by 14.48 and 22.76%, methionine by 100 and 124.99%, threonine by 70 and 63.08%, and proline by 36.92 and 48.38%, respectively, while under normal conditions MO1 inoculation and GB treatment also enhanced glucose by 19.83 and 13.19%, sucrose by 23.43 and 15.75%, fructose by 15.79 and 8.18%, citric acid by 43.26 and 33.14%, malic acid by 36.18 and 14.48%, serine by 46.5 and 48.55%, glycine by 19.85 and 29.77%, methionine by 22.22 and 38.89%, threonine by 21.95 and 17.07%, and proline by 29.61 and 34.68% compared to levels in non-treated plants, respectively. In addition, the endogenous abscisic acid (ABA) level was noticeably lower in MO1-inoculated (30.28 and 30.04%) and GB-treated plants (45 and 35.35%) compared to their corresponding control plants under normal condition as well as salinity stress, respectively.

Conclusion: The current findings suggest that the IAA- and ACC-deaminase-producing abilities MO1 can improve plants tolerance to salinity stress.
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http://dx.doi.org/10.1186/s12866-019-1450-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485084PMC
April 2019

Degranulated Eosinophils Contain More Fine Nerve Fibers in the Duodenal Mucosa of Patients With Functional Dyspepsia.

J Neurogastroenterol Motil 2019 Apr;25(2):212-221

Department of Pathology, College of Medicine, Ewha Womans University, Seoul, Korea.

Background/aims: Functional dyspepsia (FD) is characterized as chronic recurrent upper gastrointestinal symptoms in the absence of any organic disorder. We hypothesized that duodenal low-grade inflammation activates superficial afferent nerve sprouting, thereby contributing to hypersensitivity in patients with FD.

Methods: A prospective case-control study was conducted in a tertiary referral center. FD was defined using the Rome III criteria. Standardized endoscopic biopsies were performed in the stomach and duodenum. Hematoxylin and eosin staining and immunohistochemical staining for major basic proteins were performed to detect granulated eosinophil-derived granules, and S-100 staining was performed to detect fine nerve fibers.

Results: A total of 51 patients with FD (82% female; mean age 35.8 ± 13.4 years) and 35 controls were enrolled. Activated eosinophil counts in the duodenum were significantly higher in patients with FD than in controls (41.4% vs 17.1%, = 0.005). Microscopic duodenitis was more frequently detected in patients with FD than in controls. Fine nerve fibers were more abundant in patients with FD than in controls (45.1% vs 11.4%, = 0.029). The abundance of fine nerve fibers highly correlated with the degree of activated eosinophils.

Conclusion: Duodenal low-grade inflammation, such as mucosal eosinophilic accumulation with degranulation, promoted mucosal enteric nerve fiber density and sprouting in patients with FD.
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http://dx.doi.org/10.5056/jnm18176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474707PMC
April 2019

Influence of anti-tumor necrosis factor-alpha therapy to pregnant inflammatory bowel disease women and their children's immunity.

Intest Res 2019 Apr 8;17(2):237-243. Epub 2019 Feb 8.

Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.

Background/aims: The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children.

Methods: Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children's growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked.

Results: All 18 patients had been diagnosed with Crohn's disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects.

Conclusions: This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children.
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http://dx.doi.org/10.5217/ir.2018.00071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505087PMC
April 2019

Prognostic value of diffuse splenic FDG uptake on PET/CT in patients with gastric cancer.

PLoS One 2018 26;13(4):e0196110. Epub 2018 Apr 26.

Clinical Research Institute, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.

Background: This study investigated the prognostic value of diffuse splenic uptake on F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in gastric cancer (GC) patients.

Methods: A total of 134 pathology confirmed GC patients who underwent PET/CT for staging work-ups were enrolled. The maximal standardized uptake value (SUVmax) of primary tumor (Tmax), spleen (Smax), and spleen to liver uptake ratio (SLR) were measured. The prognostic value of PET-measured parameters in GC patients for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed. And the relationships of the parameters with hematological and inflammatory parameters were also investigated.

Results: During follow-up period, 19 patients (14.1%) had disease recurrence and 12 (8.9%) died from GC. In univariate analysis, hematocrit (p<0.001 and p = 0.002), neutrophil to lymphocyte ratio (NLR; p = 0.021 and p = 0.040), AJCC staging (p<0.001 and p<0.001), adjuvant chemotherapy (p<0.001 and p<0.001), Tmax (p = 0.004 and p = 0.005), and SLR (p = 0.005 and p = 0.016) were significant prognostic factors for RFS and OS, whereas platelet to lymphocyte ratio (PLR; p = 0.034) was a significant prognostic factor for RFS. In multivariate analysis, only SLR was an independent prognostic factor for RFS (p = 0.018, adjusted HR = 3.011, 95% CI = 1.207-7.511). SLR were significantly associated with serum hematocrit level (r = -0.256, p = 0.002), PLR (r = 0.362, p = 0.001), and Tmax (r = 0.280, p = 0.001).

Conclusion: Diffuse splenic uptake on FDG PET/CT was correlated with the level of hematological and inflammatory parameters and was an independent predictor for RFS in GC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196110PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919642PMC
July 2018

[Clinical Course of Percutaneous Endoscopic Gastrostomy: A Single-center Observational Study].

Korean J Gastroenterol 2018 01;71(1):24-30

Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea.

Background/aims: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for long-term tube feeding. This study aimed to investigate the clinical characteristics and outcomes of patients who utilized long-term feeding tube via PEG.

Methods: The medical records of 137 patients who underwent PEG tube insertion at Ewha Womans University Mokdong Hospital between January 2002 and December 2013 were reviewed.

Results: PEG was indicated most frequently for cerebrovascular accidents (66 patients, 48.2%), followed by head and neck cancer (20 patients, 14.6%), and Parkinson's disease (10 patients, 7.3%). The tubes were endoscopically inserted in 133 patients (97.1%); 4 patients (2.9%) underwent radiologic intervention. The tubes of 90 patients (65.7%) were exchanged at least once during the follow- up period. At the first exchange, 71 patients (78.9%) had their tubes exchanged by endoscopy, 24 patients (16.7%) by manually, and 4 patients (4.4%) by radiologic intervention. Of the 61 patients (44.5%) who had their tubes exchanged twice, 44 patients (72.1%) changed their tubes by endoscopic exchange, 13 patients (21.3%) by manually, and 4 patients (4.4%) via radiologic intervention. The mean time interval between the initial insertion and the first exchange was 9.83±6.19 months, and that between the initial insertion and the second exchange was 10.7±6.25 months. Of all the 137 patients, acute complications at initial insertion occurred in only 18 patients (13.1%), with insertion site infection (9 patients, 6.6%) being the most common acute complication.

Conclusions: PEG appears to be a safe procedure for providing long-term tube feeding. Our results may help to develop strategies for further management of subjects receiving feeding tubes via PEG.
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http://dx.doi.org/10.4166/kjg.2018.71.1.24DOI Listing
January 2018

Metabolism-mediated induction of zinc tolerance in Brassica rapa by Burkholderia cepacia CS2-1.

J Microbiol 2017 Dec 7;55(12):955-965. Epub 2017 Dec 7.

School of Applied Biosciences, Kyungpook National University, Daegu, 41566, Republic of Korea.

Brassica rapa (Chinese cabbage) is an essential component of traditional Korean food. However, the crop is often subject to zinc (Zn) toxicity from contaminated irrigation water, which, as a result, compromises plant growth and production, as well as the health of human consumers. The present study investigated the bioaccumulation of Zn by Burkholderia cepacia CS2-1 and its effect on the heavy metal tolerance of Chinese cabbage. Strain CS2-1 was identified and characterized on the basis of 16S rRNA sequences and phylogenetic analysis. The strain actively produced indole-3-acetic acid (3.08 ± 0.21 μg/ml) and was also able to produce siderophore, solubilize minerals, and tolerate various concentrations of Zn. The heavy metal tolerance of B. rapa plants was enhanced by CS2-1 inoculation, as indicated by growth attributes, Zn uptake, amino acid synthesis, antioxidant levels, and endogenous hormone (ABA and SA) synthesis. Without inoculation, the application of Zn negatively affected the growth and physiology of B. rapa plants. However, CS2-1 inoculation improved plant growth, lowered Zn uptake, altered both amino acid regulation and levels of flavonoids and phenolics, and significantly decreased levels of superoxide dismutase, endogenous abscisic acid, and salicylic acid. These findings indicate that B. cepacia CS2-1 is suitable for bioremediation against Zn-induced oxidative stress.
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http://dx.doi.org/10.1007/s12275-017-7305-7DOI Listing
December 2017

Development, validation, and application of a novel tool to measure disease-related knowledge in patients with inflammatory bowel disease.

Korean J Intern Med 2019 Jan 29;34(1):81-89. Epub 2017 Nov 29.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Background/aims: The Crohn's and Colitis Knowledge (CCKNOW) score does not reflect updated knowledge relating to inflammatory bowel disease (IBD). The aim of this study was to develop, validate, and apply a novel tool to measure disease-related knowledge in IBD patients.

Methods: A questionnaire composed of 24 items regarding knowledge of IBD was developed: Inflammatory Bowel Disease Knowledge (IBD-KNOW). Discriminate ability of IBD-KNOW was validated in three occupational groups (14 doctors, 20 nurses, and 19 clerks). The CCKNOW and IBD-KNOW were administered to IBD patients. Factors affecting the level of IBD-related knowledge were analyzed.

Results: The median Inflammatory Bowel Disease Knowledge (IBD-KNOW) score was significantly different among the three groups for validation (22 doctors, 20 nurses, and five clerks; p < 0.001). The IBD-KNOW showed excellent internal consistency (Cronbach α = 0.952) and high correlation with CCKNOW (Spearman ρ = 0.827, p = 0.01). A total of 200 IBD patients (120 Crohn's disease, 80 ulcerative colitis) completed questionnaires. Multivariate analysis showed that a higher IBDKNOW score than the median was associated with hospitalization history (odds ratio [OR], 2.625; p = 0.003), high education level (OR, 2.498; p = 0.012), and information acquired from patient organization (OR, 3.305, p = 0.035).

Conclusion: The IBD-KNOW demonstrated excellent test characteristics. Hospitalization history, education level, and information acquired from patient organization play an important role in correct IBD-related knowledge.
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http://dx.doi.org/10.3904/kjim.2017.104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6325432PMC
January 2019

Emergence of rifampin-resistant staphylococci after rifaximin administration in cirrhotic patients.

PLoS One 2017 5;12(10):e0186120. Epub 2017 Oct 5.

Departments of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

Objectives: Rifaximin, a poorly absorbed antibiotics, has gut-specific therapeutic effects. Although frequently prescribed to manipulate intestinal luminal bacterial population in various diseases, the possible induction of antibacterial cross-resistance to a target pathogen is a major concern in long-term rifaximin administration. We aimed to evaluate whether rifampin-resistant staphylococci could evolve after rifaximin treatment in cirrhotic patients.

Method: A total of 25 cirrhotic patients who were administered rifaximin for the prevention of hepatic encephalopathy were enrolled. Swabs from both hands and the perianal skin were acquired on day 0 (before rifaximin treatment), period 1 (1-7 weeks after treatment), and period 2 (8-16 weeks after treatment) the staphylococcal strain identification and rifampin-resistance testing.

Results: A total of 198 staphylococcal isolates from 15 species were identified. Staphylococcus epidermidis was isolated most frequently, and Staphylococcus haemolyticus was the most common resistant species both from hands and perianal skin. Eleven patients (44.0%) developed rifampin-resistant staphylococcal isolates in period 1. Among these patients, only six (54.5%) were found to have rifampin-resistant isolates in period 2, with no significant infectious events. Rifampin-resistant staphylococcal isolates were more frequently found in perianal skin than from the hands. No patients acquired a newly resistant strain in period 2.

Conclusions: About one-half of cirrhotic patients in this study developed rifampin-resistant staphylococcal isolates after rifaximin treatment. Although the resistant strains were no longer detected in about half of the patients in the short-term, the long-term influence of this drug treatment should be determined.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186120PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628927PMC
November 2017

Feedback Facility-Assisted Balance Training in a Patient With Multiple System Atrophy: A Case Presentation.

PM R 2018 05 21;10(5):555-559. Epub 2017 Sep 21.

Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea.

Multiple system atrophy is a rare neurodegenerative disease with a poor prognosis. Furthermore, there are no pharmacological or notable rehabilitation strategies available to prevent the worsening of the disease. This case presentation assessed the outcome of feedback facility-assisted balance training in combination with physical therapy in a 61-year-old man. The patient participated in 30 training sessions over 6 weeks for 30 minutes each that involved balance training. His static and dynamic balance abilities were improved on the Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measure, and Functional Reach. Although this patient's gait speed and muscle strength did not show improvement after training, feedback facility-assisted balance training might be a potential strategy to help reduce the rate of symptom deterioration in patients with multiple system atrophy.

Level Of Evidence: V.
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http://dx.doi.org/10.1016/j.pmrj.2017.09.007DOI Listing
May 2018

Therapeutic potential of tonsil-derived mesenchymal stem cells in dextran sulfate sodium-induced experimental murine colitis.

PLoS One 2017 30;12(8):e0183141. Epub 2017 Aug 30.

Department of Molecular Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.

The therapeutic potential of tonsil-derived mesenchymal stem cells (TMSC) prepared from human tonsillar tissue has been studied in animal models for several diseases such as hepatic injury, hypoparathyroidism, diabetes and muscle dystrophy. In this study, we examined the therapeutic effects of TMSC in a dextran sulfate sodium (DSS)-induced colitis model. TMSC were injected in DSS-induced colitis mice via intraperitoneal injection twice (TMSC[x2]) or four times (TMSC[x4]). Control mice were injected with either phosphate-buffered saline or human embryonic kidney 293 cells. Body weight, stool condition and disease activity index (DAI) were examined daily. Colon length, histologic grading, and mRNA expression of pro-inflammatory cytokines, interleukin 1β (IL-1β), IL-6, IL-17 and tumor necrosis factor α, and anti-inflammatory cytokines, IL-10, IL-11 and IL-13, were also measured. Our results showed a significant improvement in survival rates and body weight gain in colitis mice injected with TMSC[x2] or TMSC[x4]. Injection with TMSC also significantly decreased DAI scores throughout the experimental period; at the end of experiment, almost complete reversal of DAI scores to normal was found in colitis mice treated with TMSC[x4]. Colon length was also significantly recovered in colitis mice treated with TMSC[x4]. However, histopathological alterations induced by DSS treatment were not apparently improved by injection with TMSC. Finally, treatment with TMSC[x4] significantly reversed the mRNA levels of IL-1β and IL-6, although expression of all pro-inflammatory cytokines tested was induced in colitis mice. Under our experimental conditions, however, no apparent alterations in the mRNA levels of all the anti-inflammatory cytokines tested were found. In conclusion, our findings demonstrate that multiple injections with TMSC produced a therapeutic effect in a mouse model of DSS-induced colitis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183141PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576698PMC
October 2017

Multidisciplinary Approach to Refractory Upper Gastrointestinal Bleeding: Case Series of Angiographic Embolization.

J Korean Med Sci 2017 Sep;32(9):1552-1557

Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.

Although medical and endoscopic hemostasis is now considered as the first-line therapy for nonvariceal upper gastrointestinal (UGI) bleeding, refractory bleeding still occurs in 5%-10% of the patients. In these patients, transcatheter arterial embolization (TAE) or surgery is required, but research on embolization for unmanageable UGI bleeding in Korea is scanty. We reviewed the medical records of 518 patients who underwent endoscopic hemostasis during 4 years. Among these subjects, 8 patients who required embolization due to failure of endoscopic hemostasis were enrolled. Mean patient age was 74.00 ± 8.25 years, and rebleeding occurred in 4 patients within 48 hours after TAE. Three patients with duodenal rebleeding underwent surgery, and the other patient with a gastric ulcer underwent endoscopic hemostasis. Nonvariceal UGI bleeding remains a serious clinical challenge, especially in older patients. A multidisciplinary approach including endoscopists, interventional radiologists, and surgeons may be important for the treatment of nonvariceal UGI bleeding.
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http://dx.doi.org/10.3346/jkms.2017.32.9.1552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546978PMC
September 2017

Comparative analysis of complete plastid genomes from wild soybean (Glycine soja) and nine other Glycine species.

PLoS One 2017 1;12(8):e0182281. Epub 2017 Aug 1.

School of Applied Biosciences, Kyungpook National University, Daegu, Republic of Korea.

The plastid genomes of different plant species exhibit significant variation, thereby providing valuable markers for exploring evolutionary relationships and population genetics. Glycine soja (wild soybean) is recognized as the wild ancestor of cultivated soybean (G. max), representing a valuable genetic resource for soybean breeding programmes. In the present study, the complete plastid genome of G. soja was sequenced using Illumina paired-end sequencing and then compared it for the first time with previously reported plastid genome sequences from nine other Glycine species. The G. soja plastid genome was 152,224 bp in length and possessed a typical quadripartite structure, consisting of a pair of inverted repeats (IRa/IRb; 25,574 bp) separated by small (178,963 bp) and large (83,181 bp) single-copy regions, with a 51-kb inversion in the large single-copy region. The genome encoded 134 genes, including 87 protein-coding genes, eight ribosomal RNA genes, and 39 transfer RNA genes, and possessed 204 randomly distributed microsatellites, including 15 forward, 25 tandem, and 34 palindromic repeats. Whole-plastid genome comparisons revealed an overall high degree of sequence similarity between G. max and G. gracilis and some divergence in the intergenic spacers of other species. Greater numbers of indels and SNP substitutions were observed compared with G. cyrtoloba. The sequence of the accD gene from G. soja was highly divergent from those of the other species except for G. max and G. gracilis. Phylogenomic analyses of the complete plastid genomes and 76 shared genes yielded an identical topology and indicated that G. soja is closely related to G. max and G. gracilis. The complete G. soja genome sequenced in the present study is a valuable resource for investigating the population and evolutionary genetics of Glycine species and can be used to identify related species.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182281PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538705PMC
October 2017

Comparison of clinical outcomes after endoscopic submucosal dissection and surgery in the treatment of early gastric cancer: A single-institute study.

Medicine (Baltimore) 2017 Jul;96(30):e7210

Department of Internal Medicine Surgery Pathology, Ewha Womans University College of Medicine, Seoul, Korea.

The feasibility of expanding the indications for endoscopic submucosal dissection to treat early gastric cancer based on long-term outcomes has shown conflicting results. This study aimed to investigate whether outcomes or adverse events associated with endoscopic submucosal dissection are comparable to those of surgery for early gastric cancer that including the absolute and expanded indications.Data of 159 early gastric cancers from 153 patients treated with endoscopic submucosal dissection or surgery between January 2004 and October 2014 were reviewed retrospectively. Early gastric cancers fulfilled the absolute or expanded indications with differentiated type adenocarcinoma were included.The endoscopic submucosal dissection and surgery group showed no significant difference in the incidence of residual disease (P = .48), local recurrence (P = .46), and metachronous cancer (P = .22). Kaplan-Meier analysis showed no significant difference in 2-year (97.6% versus [vs] 92.4%; P = .45) and 5-year (95.8% vs 95.6%; P = .26) overall survival rate between 2 groups. There was also no significant difference in 2-year (100% vs 94.1%; P = .98) and 5-year (100% vs 98.4%; P = .89) disease-free survival rate. Early and late adverse events also showed no significant differences.For the treatment of early gastric cancer fulfilled absolute and expanded indications, endoscopic submucosal dissection is not inferior modality regarding the clinical outcomes and safety, compared with surgery.
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http://dx.doi.org/10.1097/MD.0000000000007210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627802PMC
July 2017

Glucose metabolism of visceral adipose tissue measured by 18F-FDG PET/CT is related to the presence of colonic adenoma.

Medicine (Baltimore) 2017 Jun;96(25):e7156

Department of Nuclear Medicine Health Promotion Center Department of Internal Medicine Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.

This study investigated the relationships between the area and metabolic activity of adipose tissue and the presence of colorectal adenoma (CRA). Our institutional review board approved the study and waived informed consent. A total of 212 subjects who underwent fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and colonoscopy for routine health check-ups were enrolled. The volumetric parameters of areas of visceral (VATav), subcutaneous (SATav), and total adipose tissue (TATav) and calculated visceral-to-subcutaneous adipose tissue ratio (VSR) and visceral-to-total adipose tissue ratio (VAR) were considered. Metabolic parameters of standardized uptake value (SUV) of visceral (vcSUVmax, vcSUVmean), subcutaneous (scSUVmax, scSUVmean), and calculated visceral-to-subcutaneous adipose tissue ratio (VSRmax, VSRmean) were considered. Anthropometric data of height, weight, body mass index (BMI), waist circumference (WC), body fat mass (BFM), skeletal muscle mass (SMM), and diverse laboratory data were also considered as variables. Sixty-six subjects were placed in the CRA group and 146 subjects in the non-CRA group. The presence of CRA was significantly correlated with older age (P  =  .001), male sex (P  =  .041), higher BMI (P  =  .004), higher WC (P  =  .001), higher BFM (P  =  .024), higher VATav (P < .001), higher TATav (P  =  .004), higher VSR (P < .001), higher VAR (P < .001), lower vcSUVmax (P  =  .002), lower vcSUVmean (P < .001), and lower VSRmean (P  =  .002). On multiple regression analysis, vcSUVmax and vcSUVmean were independently associated with the presence of CRA (P  =  .009 and P  =  .045). Lower glucose metabolism of visceral adipose tissue was related to the presence of CRA. Our findings identify the value of visceral metabolic dysfunction as a potential surrogate marker of elevated risk for CRA.
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http://dx.doi.org/10.1097/MD.0000000000007156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484200PMC
June 2017

Factors associated with pregnancy-related knowledge in women of reproductive age with inflammatory bowel disease.

Scand J Gastroenterol 2017 Aug 7;52(8):833-839. Epub 2017 Apr 7.

c Department of Gastroenterology , University of Ulsan College of Medicine , Seoul , Republic of Korea.

Objective: Inflammatory bowel disease (IBD) usually develops at a young age, and many women experience marriage, pregnancy, and delivery during the disease course. We aimed to evaluate the pregnancy-related knowledge of women with IBD in Korea and investigate the associated factors.

Material And Methods: A total of 270 women with IBD, aged 19-45 years, from four tertiary hospitals in Korea were administered a questionnaire comprising 17 questions from the validated Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow) that were translated into Korean.

Results: The average CCPKnow score of the 270 patients was 7.47 ± 3.07; and most of the patients (51.5%) exhibited a poor knowledge level. Younger age at diagnosis, Crohn's disease rather than ulcerative colitis, longer disease duration, anti-TNF-α medication history, higher household income, and delivery after diagnosis were associated with an appropriate level of pregnancy-related knowledge. Younger age at diagnosis (odds ratio [OR], 1.87; p = .036), anti-TNF-α therapy (OR, 1.87; p = .047), and delivery while suffering from IBD (OR, 3.07; p = .002) were independent factors affecting the pregnancy-related knowledge level. Approximately 69.6% of patients acquired related knowledge from their gastroenterology doctor, whereas 19.4% of patients intended to remain childless.

Conclusions: To our knowledge, this is the first study to assess the pregnancy-related knowledge of women of reproductive-age with IBD and their perceptions by using a questionnaire in Asia. As more than half of the patients showed a poor knowledge level of IBD, a general education program should be conducted by gastroenterology doctors.
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http://dx.doi.org/10.1080/00365521.2017.1310288DOI Listing
August 2017

The Therapeutic Efficacy of Tonsil-derived Mesenchymal Stem Cells in Dextran Sulfate Sodium-induced Acute Murine Colitis Model.

Korean J Gastroenterol 2017 Feb;69(2):119-128

Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.

Background/aims: Mesenchymal stem cells (MSCs) are multipotent progenitor cells currently under investigation for its efficacy as the treatment for inflammatory bowel disease. In this study, we evaluated the efficacy of tonsil-derived mesenchymal stem cells (T-MSCs) as a novel source of mesenchymal stem cells and traced their localization in a murine model of acute colitis induced by dextran sulfate sodium (DSS).

Methods: C57BL/6 mice were randomly assigned to the following three groups: the normal control group, DSS colitis group (DSS+phosphate buffered saline), and T-MSC group (DSS+T-MSCs, 1×10). The severity of colitis was assessed by determining the severity of symptoms of colitis, colon length, histopathologic grade, and levels of inflammatory cytokines. T-MSCs labeled with PKH26 were traced .

Results: The T-MSC group, compared with the DSS colitis group, showed a significantly lower disease activity index (11.3±1.5 vs. 8.3±1.9, p=0.015) at sacrifice and less reduction of body weight (-17.1±5.0% vs. -8.1±6.9%, p=0.049). In the T-MSC group, the histologic colitis score was significantly decreased compared with the DSS colitis group (22.6±3.8 vs. 17.0±3.4, p=0.039). IL-6 and IL-1β, the pro-inflammatory cytokines, were also significantly reduced after a treatment with T-MSCs. tracking revealed no PKH26-labelled T-MSCs in the colonic tissue of mice with acute colitis.

Conclusions: In the acute colitis model, we demonstrated that the administration of T-MSCs ameliorates inflammatory symptoms and histology. Moreover, the anti-inflammatory activities of T-MSCs were independent of gut homing.
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http://dx.doi.org/10.4166/kjg.2017.69.2.119DOI Listing
February 2017

Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication.

BMC Gastroenterol 2017 Jan 21;17(1):16. Epub 2017 Jan 21.

Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Institute, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, South Korea.

Background: The eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70-85%. The aim of this study is to compare 7-day triple therapy versus 10-day sequential therapy as the first line treatment.

Methods: Data of 1240 H. pylori positive patients treated with triple therapy or sequential therapy from January 2013 to December 2015 were analyzed retrospectively. The patients who had undertaken previous H. pylori eradication therapy or gastric surgery were excluded.

Results: There were 872 (74.3%) patients in the triple therapy group, and 302 (25.7%) patients in the sequential therapy group. There was no significant difference between the two groups regarding age, residence, comorbidities or drug compliance, but several differences were noted in endoscopic characteristics and indication for the treatment. The eradication rate of H. pylori by intention to treat analysis was 64.3% in the triple therapy group, and 81.9% in the sequential therapy group (P = 0.001). In per protocol analysis, H. pylori eradication rate in the triple therapy and sequential therapy group was 81.9 and 90.3%, respectively (P = 0.002). There was no significant difference in overall adverse events between the two groups (P = 0.706). For the rescue therapy, bismuth-containing quadruple therapy showed comparable treatment efficacy after sequential therapy, as following triple therapy.

Conclusions: The eradication rate of triple therapy was below the recommended threshold. Sequential therapy could be effective and tolerable candidate for the first-line H. pylori eradication therapy.
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http://dx.doi.org/10.1186/s12876-017-0579-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5251227PMC
January 2017

Dilemmas of Korean Athletes With a Spinal Cord Injury to Participate in Sports: A Survey Based on the ICF Core Set for Spinal Cord Injury.

Ann Rehabil Med 2016 Oct 31;40(5):893-901. Epub 2016 Oct 31.

Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea.

Objective: To explore the experiences of athletes with spinal cord injury (SCI) in Korea with respect to dilemmas of participating in sports with regards to the facilitators and barriers, using the International Classification of Functioning, Disability and Health (ICF).

Methods: The facilitators and barriers to sports participation of individuals with SCI were examined using 112 ICF categories. A questionnaire in dichotomous scale was answered, which covered the subjects 'Body functions', 'Body structures', 'Activity and participation' and 'Environmental factors'. Data analysis included the use of descriptive statistics to examine the frequency and magnitude of reported issues.

Results: Sixty-two community-dwelling participants were recruited. Frequently addressed barriers in 'Body functions' were mobility related problems such as muscle and joint problems, bladder and bowel functions, pressure ulcers, and pain. In 'Activity and participation', most frequently reported were mobility and self-care problems. Highly addressed barriers in 'Environmental factors' were sports facilities, financial cost, transportation problems and lack of information. Relationships such as peer, family and friends were the most important facilitators.

Conclusion: Numerous barriers still exist for SCI survivors to participate in sports, especially in the area of health care needs and environmental factors. Our results support the need for a multidisciplinary approach to promote sports participation.
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http://dx.doi.org/10.5535/arm.2016.40.5.893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108717PMC
October 2016

Background Colonic 18F-Fluoro-2-Deoxy-D-Glucose Uptake on Positron Emission Tomography Is Associated with the Presence of Colorectal Adenoma.

PLoS One 2016 10;11(8):e0160886. Epub 2016 Aug 10.

Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.

18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) scan is used to evaluate various kinds of tumors. While most studies on PET findings of the colon focus on the colonic uptake pattern, studies regarding background colonic uptake on PET scan are rare. The purpose of this study was to identify the association between the background colonic uptake and the presence of colorectal adenoma (CRA), which is a frequent precancerous lesion. We retrospectively reviewed the medical records of 241 patients with gynecologic malignancy who had received PET or PET/computed tomography (CT) scan and colonoscopy at the same period as a baseline evaluation. Background colonic 18F-FDG uptake was visually graded and the maximal standardized uptake values (SUVmax) of 7 different bowel segments were averaged. In univariate analysis, older age at diagnosis (≥ 50 years, p = 0.034), overweight (BMI ≥ 23 kg/m², p = 0.010), hypercholesterolemia (≥ 200 mg/dL, p = 0.027), and high grade background colonic uptake (p = 0.009) were positively associated with the prevalence of CRA. By multiple logistic regression, high grade background colonic uptake was independently predictive of CRA (odds ratio = 2.25, p = 0.021). The proportion of CRA patients significantly increased as background colonic uptake grade increased from 1 to 4 (trend p = 0.015). Out of the 138 patients who underwent PET/CT, the proportion of CRA patients in the group with high SUVmax (> 2.25) was significantly higher than in the low SUVmax group (27.5% vs. 11.6%, p = 0.031). In conclusion, high grade of background colonic 18F-FDG uptake is significantly associated with the prevalence of CRA.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979890PMC
August 2017

Usefulness of Submental Ultrasonographic Evaluation for Dysphagia Patients.

Ann Rehabil Med 2016 Apr 25;40(2):197-205. Epub 2016 Apr 25.

Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea.

Objective: To investigate the usefulness of ultrasonographic measurement of hyoid bone movement during swallowing.

Methods: Fifty-two patients who had swallowing dysfunction were enrolled in this study. When a patient swallowed 5 mL of water while maintaining an upright sitting position, hyoid bone movement during swallowing was measured with ultrasonography. Recorded images were analyzed to measure the maximum change in hyoid bone displacement. Mandible was used as reference point to calculate hyoid bone displacement. The farthest distance from resting position and the nearest distance during swallowing were measured and their differences were recorded. Participants also underwent videofluoroscopic swallowing study (VFSS). Based on penetration-aspiration scale (PAS), they were grouped to non-aspirators (PAS 1), penetrators (PAS 2-5), or aspirators (PAS 6-8). Measured hyoid bone displacements by submental ultrasonography were compared among groups.

Results: The mean hyoid bone displacement in non-aspirators group (n=21, 15.9±2.7 mm) was significantly (p<0.05) greater than that in penetrators group (n=20, 11.5±2.8 mm) or aspirators group (n=11, 8.0±1.0 mm). Hyoid bone displacement below 13.5 mm as a cutoff point for detecting penetration or aspiration had a sensitivity and specificity of 83.9% and 81.0%, respectively.

Conclusion: Submental ultrasonographic evaluation was well correlated with PAS measured by VFSS. Therefore, submental ultrasonographic evaluation could be a useful screening tool for dysphagic patients.
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http://dx.doi.org/10.5535/arm.2016.40.2.197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855112PMC
April 2016

Complications of Cardiac Catheterization in Structural Heart Disease.

Korean Circ J 2016 Mar 21;46(2):246-55. Epub 2016 Mar 21.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

Background And Objectives: Cardiac catheterization is used to diagnose structural heart disease (SHD) and perform transcatheter treatment. This study aimed to evaluate complications of cardiac catheterization and the associated risk factors in a tertiary center over 10 years.

Subjects And Methods: Total 2071 cardiac catheterizations performed at the Seoul National University Children's Hospital from January 2004 to December 2013 were included in this retrospective study.

Results: The overall complication, severe complication, and mortality rates were 16.2%, 1.15%, and 0.19%, respectively. The factors that significantly increased the risk of overall and severe complications were anticoagulant use before procedure (odds ratio [OR] 1.83, p=0.012 and OR 6.45, p<0.001, respectively), prothrombin time (OR 2.30, p<0.001 and OR 5.99, p<0.001, respectively), general anesthesia use during procedure (OR 1.84, p=0.014 and OR 5.31, p=0.015, respectively), and total procedure time (OR 1.01, p<0.001 and OR 1.02, p<0.001, respectively). Low body weight (OR 0.99, p=0.003), severe SHD (OR 1.37, p=0.012), repetitive procedures (OR 1.7, p=0.009), and total fluoroscopy time (OR 1.01, p=0.005) significantly increased the overall complication risk. High activated partial thromboplastin time (OR 1.04, p=0.001), intensive care unit admission state (OR 14.03, p<0.001), and concomitant electrophysiological study during procedure (OR 3.41, p=0.016) significantly increased severe complication risk.

Conclusion: Currently, the use of cardiac catheterization in SHD is increasing and becoming more complex; this could cause complications despite the preventive efforts. Careful patient selection for therapeutic catheterization and improved technique and management during the peri-procedural period are required to reduce complications.
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http://dx.doi.org/10.4070/kcj.2016.46.2.246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805570PMC
March 2016

Infantile Marfan syndrome in a Korean tertiary referral center.

Korean J Pediatr 2016 Feb 29;59(2):59-64. Epub 2016 Feb 29.

Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

Purpose: Infantile Marfan syndrome (MFS) is a rare congenital inheritable connective tissue disorder with poor prognosis. This study aimed to evaluate the cardiovascular manifestations and overall prognosis of infantile MFS diagnosed in a tertiary referral center in Korea.

Methods: Eight patients diagnosed with infantile MFS between 2004 and 2014 were retrospectively evaluated.

Results: Their median age at the time of diagnosis was 2.5 months (range, 0-20 months). The median follow-up period was 25.5 months (range, 0-94 months). The median length at birth was 50.0 cm (range, 48-53 cm); however, height became more prominent over time, and the patients were taller than the 97th percentile at the time of the study. None of the patients had any relevant family history. Four of the 5 patients who underwent DNA sequencing had a fibrillin 1 gene mutation. All the patients with echocardiographic data of the aortic root had a z score of >2. All had mitral and tricuspid valve prolapse, and various degrees of mitral and tricuspid regurgitation. Five patients underwent open-heart surgery, including mitral valve replacement, of whom two required multiple operations. The median age at mitral valve replacement was 28.5 months (range, 5-69 months). Seven patients showed congestive heart failure before surgery or during follow-up, and required multiple anti-heart failure medications. Four patients died of heart failure at a median age of 12 months.

Conclusion: The prognosis of infantile MFS is poor; thus, early diagnosis and timely cautious treatment are essential to prevent further morbidity and mortality.
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http://dx.doi.org/10.3345/kjp.2016.59.2.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781733PMC
February 2016

Asterixis in the leg induced by anterior cerebral artery infarction.

Neurol Sci 2016 Jun 23;37(6):979-81. Epub 2016 Jan 23.

Department of Rehabilitation, Bundang Jesaeng General Hospital, 20, Seohyun-ro 180, Bundang gu, Seongnam, Kyunggo-do, 463-774, South Korea.

Asterixis commonly occurs in a patient with metabolic encephalopathy, whereas focal brain lesions such as thalamus, cerebellum, or frontal area also cause focal or unilateral asterixis in the arms. We report a novel case of asterixis in the leg after unilateral anterior cerebral artery territory infarction. A 76-year-old man was admitted with sudden-onset mild right leg weakness and postural instability due to knee buckling. He was diagnosed with ischemic stroke in the left prefrontal area and cingulated gyrus by brain magnetic imaging. Needle electromyography of the right vastus lateralis muscle while standing showed intermittent periods of EMG silence, consistent with asterixis. There were no abnormal involuntary movements in the upper extremities. This case suggests that gait disturbance or postural instability after structural lesions in the prefrontal area may be directly related to asterixis in the leg, not in the arm associated with postural failure.
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http://dx.doi.org/10.1007/s10072-016-2486-0DOI Listing
June 2016