Publications by authors named "Kun Park"

151 Publications

Sarcopenia and Back Muscle Degeneration as Risk Factors for Degenerative Adult Spinal Deformity with Sagittal Imbalance and Degenerative Spinal Disease: A Comparative Study.

World Neurosurg 2021 Jan 23. Epub 2021 Jan 23.

Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, South Korea.

Background: Many factors affect spinal alignment in adult spinal deformity with sagittal imbalance. However, although the importance of the paravertebral muscle and ligamentum complex in proper spinal alignment is well recognized, little information is available regarding the role of the paravertebral muscles in maintaining sagittal spinal alignment.

Methods: A total of 108 patients who had visited our institution from January 2016 to June 2018 were included in the present study. The patients were categorized as follows: degenerative adult spinal deformity with sagittal imbalance group and degenerative spinal disease group. The appendicular skeletal muscle mass index and handgrip strength of each patient were measured to evaluate for sarcopenia. Computed tomography was used to measure the cross-sectional area (CSA) and fat infiltration rate to evaluate paravertebral muscle morphology. The paravertebral muscle function was assessed by measuring the lumbar flexor strength and lumbar extensor strength using a lumbar isokinetic dynamometer.

Results: The degenerative adult spinal deformity with sagittal imbalance group had a lower CSA index and lumbar extensor strength index and higher fat infiltration rate than the degenerative spinal disease group. No statistically significant differences in the appendicular skeletal muscle mass index and handgrip strength were found between the 2 groups. Only the CSA showed a correlation with the radiological parameters, such as pelvic tilt and lumbar lordosis.

Conclusions: Degeneration of the paravertebral muscle is a risk factor for degenerative adult spinal deformity with sagittal imbalance but not for sarcopenia. Thus, spinal sagittal imbalance is affected by isolated paravertebral muscle degeneration rather than by systemic muscle degeneration.
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http://dx.doi.org/10.1016/j.wneu.2021.01.053DOI Listing
January 2021

Coronavirus Disease 2019 and Dementia: Recommendation of the Korean Dementia Association.

Dement Neurocogn Disord 2020 Dec;19(4):125-128

Department of Neurology, Anam Hospital, Korea University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.12779/dnd.2020.19.4.125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781738PMC
December 2020

Cell-Laden Gelatin Methacryloyl Bioink for the Fabrication of Z-Stacked Hydrogel Scaffolds for Tissue Engineering.

Polymers (Basel) 2020 Dec 17;12(12). Epub 2020 Dec 17.

Department of Stem Cell and Regenerative Biotechnology, KU Convergence Science and Technology Institute, Konkuk University, Seoul 05029, Korea.

Hydrogel-based scaffolds have been widely used to fabricate artificial tissues capable of replacing tissues and organs. However, several challenges inherent in fabricating tissues of large size and complex morphology using such scaffolds while ensuring cell viability remain. To address this problem, we synthesized gelatin methacryloyl (GelMA) based bioink with cells for fabricating a scaffold with superior characteristics. The bioink was grafted onto a Z-stacking bioprinter that maintained the cells at physiological temperature during the printing process, without exerting any physical pressure on the cells. Various parameters, such as the bioink composition and light exposure time, were optimized. The printing accuracy of the scaffolds was evaluated using photorheological studies. The internal morphology of the scaffolds at different time points was analyzed using electron microscopy. The Z-stacked scaffolds were fabricated using high-speed printing, with the conditions optimized to achieve high model reproducibility. Stable adhesion and high proliferation of cells encapsulated within the scaffold were confirmed. We introduced various strategies to improve the accuracy and reproducibility of Z-stack GelMA bioprinting while ensuring that the scaffolds facilitated cell adhesion, encapsulation, and proliferation. Our results demonstrate the potential of the present method for various applications in tissue engineering.
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http://dx.doi.org/10.3390/polym12123027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767119PMC
December 2020

One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly.

J Clin Med 2020 Nov 20;9(11). Epub 2020 Nov 20.

Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx's original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.
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http://dx.doi.org/10.3390/jcm9113731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699896PMC
November 2020

Late-stage and strain-accelerated oxidation enabled synthesis of haouamine A.

Chem Sci 2020 Aug 24;11(31):8132-8137. Epub 2020 Jun 24.

Department of Chemistry , Seoul National University , Gwanak-1 Gwanak-ro, Gwanak-gu , Seoul 08826 , South Korea . Email:

Herein we report a new synthetic entry to the strained cyclophane alkaloid natural product, haouamine A. The successful strategy featured a rhodium-catalyzed diazo-insertion reaction to install the all-carbon quaternary center and a rhodium-catalyzed intramolecular aziridination reaction to establish the nitrogen-bearing stereocenter, of the target molecule. Most notably, a late-stage, site-selective and strain-accelerated oxidation of a "deoxygenated" macrocyclic intermediate was successfully implemented, and in doing so provided a novel solution to the infamous biphenol cyclophane system of haouamine A.
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http://dx.doi.org/10.1039/d0sc02299cDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499817PMC
August 2020

Validation Study of the Official Korean Version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale.

J Clin Neurol 2020 Oct;16(4):633-645

Department of Neurology, Hanyang University College of Medicine, Seoul, Korea.

Background And Purpose: The Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is widely used for estimating the symptoms of Parkinson's disease. Translation and validation of the MDS-UPDRS is necessary for non-English speaking countries and regions. The aim of this study was to validate the Korean version of the MDS-UPDRS.

Methods: Altogether, 362 patients in 19 centers were recruited for this study. We translated the MDS-UPDRS to Korean using the translation-back translation method and cognitive pretesting. We performed both confirmatory and exploratory factor analyses to validate the scale. We calculated the comparative fit index (CFI) for confirmatory factor analysis, and used unweighted least squares for exploratory factor analysis.

Results: The CFI was higher than 0.90 for all parts of the scale. Exploratory factor analysis also showed that the Korean MDS-UPDRS has the same number of factors in each part as the English version.

Conclusions: The Korean MDS-UPDRS has the same overall structure as the English MDS-UPDRS. Our translated scale can be designated as the official Korean MDS-UPDRS.
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http://dx.doi.org/10.3988/jcn.2020.16.4.633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541990PMC
October 2020

Development of a novel reverse transcription PCR and its application to field sample testing for feline calicivirus prevalence in healthy stray cats in Korea.

J Vet Sci 2020 Sep;21(5):e71

Department of Biotechnology, Inje University, Gimhae 50834, Korea.

Background: Feline calicivirus (FCV) is a major and highly infectious pathogen in cats worldwide. However, there have been limited studies about the status of FCV infections in Korea.

Objectives: To investigate the current status of FCV infections in stray cats in Korea.

Methods: A novel reverse transcription polymerase chain reaction (RT-PCR) assay was developed based on the conserved nucleotide sequences of reported FCV strains. Field swab samples were collected from 122 cats (2 hospital admitted cats and 120 stray cats) in 2016 and 2017. All the samples were tested by virus isolation and 2 different RT-PCRs, including the novel RT-PCR, for the detection of FCV.

Results: The novel RT-PCR assay showed no cross-reactivity to the nucleic acids of the other feline pathogens tested, and the limit of detection was calculated as 10⁰ TCID/mL based on an assessment. The novel RT-PCR assay detected 5 positive samples from the 122 field samples, which showed perfect agreement with the results of the virus isolation method. In contrast, another RT-PCR assay used in a previous study in Korea detected no positive samples. The prevalence of FCV infection in stray cats was 2.5% (3/120) based on the results of virus isolation and the novel RT-PCR assays.

Conclusions: The current study is the first report of the detection and prevalence of FCV in stray cats in Korea. The novel RT-PCR assay developed in this study showed high sensitivity and specificity, which indicates a useful diagnostic assay to identify FCV infection in cats.
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http://dx.doi.org/10.4142/jvs.2020.21.e71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533393PMC
September 2020

Distribution and antimicrobial resistance profiles of bacterial species in stray dogs, hospital-admitted dogs, and veterinary staff in South Korea.

Prev Vet Med 2020 Nov 25;184:105151. Epub 2020 Sep 25.

Department of Biotechnology, Inje University, 197 Injero, Gimhae 50834, South Korea. Electronic address:

Transferring antimicrobial-resistant bacteria from companion animals to human hosts has become increasingly common. Data regarding antimicrobial susceptibility could help veterinarians to select the most appropriate antibiotic treatment. However, standardized and ongoing surveys regarding antimicrobial resistance remain limited. In this study, we investigated the antimicrobial-susceptibility patterns and trends of bacteria isolated from stray dogs, hospital-admitted dogs, and veterinary staff in South Korea from 2018 to 2019. The minimum inhibitory concentrations of different antimicrobials for Staphylococcus spp., Enterobacterales, and Enterococcus spp. were determined to establish representatives of different antibiotic classes relevant for treatment or surveillance. For coagulase-positive and -negative Staphylococci, resistance to gentamicin was <27 %, while that to ampicillin and penicillin was high (33-80 %). The mecA-detection rates among staphylococcal isolates were 28.5 %, 42.6 %, and 32 % from stray dogs, hospital-admitted dogs, and veterinary staffs, respectively. For Enterobacterales, resistance to carbapenems was low (0-6%). A total of 31.2 % and 18.9 % of Enterobacterales isolates from stray dogs and hospital-admitted dogs were confirmed to possess at least one of bla, bla, or bla. Additionally, Enterococcus spp. isolates showed no resistance to vancomycin. These results demonstrate that dogs are commonly colonized with antimicrobial-resistant bacteria and highlight the need for further investigation.
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http://dx.doi.org/10.1016/j.prevetmed.2020.105151DOI Listing
November 2020

Artificial Intelligence Approaches to Social Determinants of Cognitive Impairment and Its Associated Conditions.

Dement Neurocogn Disord 2020 Sep;19(3):114-123

Department of Neurology, Korea University College of Medicine, Seoul, Korea.

Background And Purpose: This study uses an artificial-intelligence model (recurrent neural network) for evaluating the following hypothesis: social determinants of disease association in a middle-aged or old population are different across gender and age groups. Here, the disease association indicates an association among cerebrovascular disease, hearing loss and cognitive impairment.

Methods: Data came from the Korean Longitudinal Study of Ageing (2014-2016), with 6,060 participants aged 53 years or more, that is, 2,556 men, 3,504 women, 3,640 aged 70 years or less (70-), 2,420 aged 71 years or more (71+). The disease association was divided into 8 categories: 1 category for having no disease, 3 categories for having 1, 3 categories for having 2, and 1 category for having 3. Variable importance, the effect of a variable on model performance, was used for finding important social determinants of the disease association in a particular gender/age group, and evaluating the hypothesis above.

Results: Based on variable importance from the recurrent neural network, important social determinants of the disease association were different across gender and age groups: 1) leisure activity for men; 2) parents alive, income and economic activity for women; 3) children alive, education and family activity for 70-; and 4) brothers/sisters cohabiting, religious activity and leisure activity for 70+.

Conclusions: The findings of this study support the hypothesis, suggesting the development of new guidelines reflecting different social determinants of the disease association across gender and age groups.
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http://dx.doi.org/10.12779/dnd.2020.19.3.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521952PMC
September 2020

Distribution and antimicrobial resistance profiles of bacterial species in stray cats, hospital-admitted cats, and veterinary staff in South Korea.

BMC Vet Res 2020 Apr 9;16(1):109. Epub 2020 Apr 9.

Department of Veterinary Microbiology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, South Korea.

Background: Antimicrobial resistance is becoming increasingly important in both human and veterinary medicine. According to the One Health concept, an important step is to monitor the resistance patterns of pathogenic bacteria. In this study, the antimicrobial susceptibility patterns and trends of bacteria isolated from stray cats, hospital-admitted cats, and veterinary staff in South Korea between 2017 and 2018 were investigated.

Results: The minimum inhibitory concentrations of different antibiotics for Staphylococcus spp., Enterobacteriaceae, and Enterococcus spp. were determined to establish representatives of different antibiotic classes relevant for treatment or surveillance. For Coagulase-positive and Coagulase-negative Staphylococci, resistance to fluoroquinolones was below 13%, but resistance to ampicillin and penicillin was high (20-88%). A total of 9.5, 12.1, and 40.3% of staphylococcal isolates from stray cats, hospital-admitted cats, and veterinary staff, respectively, were confirmed to be mecA positive. For Enterobacteriaceae, resistance to carbapenems, fluoroquinolones, and 3rd generation cephalosporins was low (0-11.1%). The Enterococcus spp. isolates showed no resistance to vancomycin. The antimicrobial resistance rates of the Staphylococcus spp. and Enterobacteriaceae isolates from stray cats were usually lower than those of isolates from hospital-admitted cats and veterinary staff, but the Enterococcus spp. isolates revealed the opposite. Thus, the antimicrobial resistance varied across bacterial species according to the source from which they were isolated.

Conclusions: Resistance to critically important compounds were low. However, the presence of antimicrobial resistance in cat isolates is of both public health and animal health concern.
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http://dx.doi.org/10.1186/s12917-020-02326-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147017PMC
April 2020

The Rise of Cerebellar Ataxia in South Korea: 2002-2016.

J Clin Neurol 2020 Jan;16(1):175-176

Department of Neurology, Korea University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3988/jcn.2020.16.1.175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974818PMC
January 2020

Livestock-associated methicillin-resistant in Korea: antimicrobial resistance and molecular characteristics of LA-MRSA strains isolated from pigs, pig farmers, and farm environment.

J Vet Sci 2020 Jan;21(1):e2

Department of Animal Science and Technology, School of Bioresources and Bioscience, Chung-Ang University, Anseong 17546, Korea.

The emergence of livestock-associated (LA)-methicillin-resistant (MRSA) in livestock animal has become a significant zoonotic concern. In the present study, we investigated nationwide prevalence of LA-MRSA across pork production chain including pig farms, slaughterhouses, and retail markets. A total of 40 MRSA strains were isolated during the investigation and the overall prevalence of MRSA was 3.4% (n = 37), 0.6% (n = 2), and 0.4% (n = 1) in pig farms, slaughterhouses, and retail markets, respectively. Multilocus sequence typing analyses revealed that the 2 most significant clonal lineages in pork production chain in Korea were ST398 (n = 25) and ST541 (n = 6). All of the 40 MRSA isolates were further characterized to investigate key genotypic and phenotypic correlates associated with the emergence and spread of clonal complex 398 (CC398; ST398, and ST541) LA-MRSA. Although the prevalence of swine-associated MRSA was still relatively low and mostly restricted to pig farms, multidrug-resistant CC398 LA-MRSA isolates with new types (t18102 and t18103) were identified as a major clonal lineage. The CC398 LA-MRSA strains tended to exhibit increased levels of multiple drug resistance (MDR) phenotype compared with non-CC398 MRSA strains. Of note, in comparison with non-CC398 MRSA isolates, CC398 LA-MRSA isolates exhibited significantly enhanced tetracycline (TET) and zinc resistance. These findings suggested that co-selection pressure associated with MDR phenotype, especially TET resistance, and zinc resistance may have played a significant role in the emergence and persistence of CC398 LA-MRSA in pig farms in Korea.
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http://dx.doi.org/10.4142/jvs.2020.21.e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000904PMC
January 2020

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study.

Asian Spine J 2020 Jun 8;14(3):364-372. Epub 2020 Jan 8.

Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.

Study Design: Case-control study.

Purpose: To investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.

Overview Of Literature: The Asian Working Group for Sarcopenia recommends diagnosis using handgrip strength, gait speed, and skeletal muscle mass. However, these criteria do not strongly reflect back muscle degeneration.

Methods: Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.

Results: The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.

Conclusions: We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.
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http://dx.doi.org/10.31616/asj.2019.0125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280920PMC
June 2020

Pain-Relieving Effect of 4.4 MHz of Pulsed Radiofrequency on Acute Knee Arthritis in Rats.

Pain Med 2020 08;21(8):1572-1580

Department of Physiology, Korea University College of Medicine, Seoul, Korea.

Objective: Drug injections and surgery are popular treatments for knee joint osteoarthritis. However, these treatments are invasive, and new noninvasive treatments with similar or better efficacy are needed. Here, we evaluated the application of 4.4 MHz of pulsed radiofrequency (PRF) as a new treatment.

Methods: Acute arthritis was induced by injection of carrageenan into the intra-articular space of the knee in male rats. At 4.5 hours after arthritis induction, PRF with the treatment protocol of three seconds on and off was applied to the affected knee joint for 20 minutes. The changes in pain behavior were evaluated by comparing the peak weight load values of both hind paws at pretreatment and four, six, seven, eight, and 24 hours after treatment. And we also used Western blotting and immunohistochemistry to measure the inflammatory changes in the synovial membrane of the inflamed knee.

Results: We found that the 20-minute application of PRF with the treatment protocol significantly recovered the weight load reduction at six-, seven-, and eight-hour time points after carrageenan injection. COX-2 and IL-1β levels were significantly reduced in the inflamed rats after PRF application at six and eight hours post-carrageenan injection. Immunohistochemistry showed that PRF significantly reduced inflammatory cell infiltration at six hours post-carrageenan injection.

Conclusions: . Our results indicate that noninvasive PRF application inhibited pain-related behavior and decreased inflammatory cytokine expression in the inflamed knee joints of rats. Accordingly, PRF application can serve as a potential therapeutic treatment to relieve pain associated with peripheral joint/tissue damage or inflammation.
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http://dx.doi.org/10.1093/pm/pnz264DOI Listing
August 2020

Treatment of Adult Spinal Deformity with Sagittal Imbalance Using Oblique Lumbar Interbody Fusion: Can We Predict How Much Lordosis Correction Is Possible?

Asian Spine J 2019 Dec 30;13(6):1017-1027. Epub 2019 Jul 30.

Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.

Study Design: Prospective, single-center study.

Purpose: The current trend of operative treatment for adult spinal deformity (ASD) is combined anterior-posterior staged surgery. When anterior surgery was first performed, oblique lumbar interbody fusion (OLIF) was employed; this method became increasing popular. This study aimed to determine the lordosis correction that can be achieved using OLIF and assess whether we can preoperatively predict the lordosis correction angle achieved using OLIF.

Overview Of Literature: Many previous studies on OLIF have shown improved clinical and radiologic outcomes. With the increase in the popularity of OLIF, several surgeons have started using larger cages to attain greater lordosis correction. Moreover, some studies have reported complications of OLIF because of immoderate cage insertion. To our knowledge, this is the first prospective study that attempted to determine whether it is possible to predict the lordosis correction angle achieved with OLIF preoperatively, using fullextension lateral view (FELV).

Methods: Forty-six patients with ASD were enrolled. All the operations were performed by a single surgeon in two stages (first, anterior and second, posterior) with a 1-week interval. Radiological evaluation was performed by comparing the Cobb's angle of the segmental and regional lordosis obtained using preoperative and postoperative simple radiography (including the FELV) and magnetic resonance imaging (MRI).

Results: Regional lordosis (L1-S1) in the whole-spine standing lateral radiograph was -3.03°; however, in the supine lateral MRI, it was 20.92°. The regional lordosis of whole-spine standing lateral and supine lateral (MRI) was significantly different. In the FELV, regional lordosis was 25.72° and that in the postoperative supine lateral (MRI) was 25.02°; these values were not significantly different.

Conclusions: Although OLIF offers many advantages, it alone plays a limited role in ASD treatment. Lordosis correction using OLIF as well as lordosis determined in the FELV was possible. Hence, our results suggest that FELV can help predict the lordosis correction angle preoperatively and thus aid the selection of the appropriate technique in the second staged operation.
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http://dx.doi.org/10.31616/asj.2018.0306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894966PMC
December 2019

Social determinants of the association among cerebrovascular disease, hearing loss and cognitive impairment in a middle-aged or older population: Recurrent neural network analysis of the Korean Longitudinal Study of Aging (2014-2016).

Geriatr Gerontol Int 2019 Aug 30;19(8):711-716. Epub 2019 Jun 30.

Department of Neurology, Korea University College of Medicine, Seoul, Korea.

Aim: The present study used a deep learning model (recurrent neural network) for testing: (i) whether social determinants are major determinants of the association among cerebrovascular disease, hearing loss and cognitive impairment in a middle-aged or older population (hypothesis 1); and (ii) whether the association among the three diseases is very strong in the middle-aged or older population (hypothesis 2).

Methods: Data came from the Korean Longitudinal Study of Aging (2014-2016), with 6060 participants aged ≥53 years. The association among the three diseases was divided into eight categories: one category for having no disease, three categories for having one disease, three categories for having two diseases and one category for having three diseases. Variable importance, the effect of a variable on model performance, was used for evaluating the two hypotheses. Hypothesis 1 was based on whether family support, socioeconomic status and social activity in the year 2014 were the top 10 determinants of the association in the year 2016. Hypothesis 2 was based on whether cerebrovascular disease, hearing loss and cognitive impairment in the year 2014 were the top five determinants of the association in the year 2016.

Results: Based on variable importance from the recurrent neural network, cerebrovascular disease (0.0386), cognitive impairment (0.0151) and hearing loss (0.0092) in 2014 were the top three determinants of the association in 2016. Children alive (0.0072), education (0.0049), income (0.0075), friendship activity (0.0042) and marriage (0.0036) in 2014 were the top 10 determinants of the association in 2016.

Conclusions: The findings of the present study support the two hypotheses, highlighting the importance of preventive measures, family support, socioeconomic status and friendship activity for managing the three diseases. Geriatr Gerontol Int 2019; 19: 711-716.
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http://dx.doi.org/10.1111/ggi.13716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851663PMC
August 2019

Precautions for Combined Anterior and Posterior Long-Level Fusion for Adult Spinal Deformity: Perioperative Surgical Complications Related to the Anterior Procedure (Oblique Lumbar Interbody Fusion).

Asian Spine J 2019 10 4;13(5):823-831. Epub 2019 Jun 4.

Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.

Study Design: Retrospective, single-center study.

Purpose: We aimed to determine the perioperative complications of oblique lumbar interbody fusion (OLIF) as a first-stage procedure in combined anterior and posterior operation for adult spinal deformity (ASD) along with sagittal imbalance. Specifically, we aimed to identify the radiological and clinical types of perioperative surgical complications and the factors affecting these complications.

Overview Of Literature: OLIF has recently gained popularity, and there are several reports of good outcomes and only a few of complications with OLIF; however, a few studies have focused on the perioperative surgical complications of ASD along with sagittal imbalance.

Methods: The perioperative period was a 1-week interval between the anterior and posterior procedures. All patients underwent simple radiography and magnetic resonance imaging preoperatively and postoperatively. Cage placement was evaluated for displacement (i.e., subsidence and migration) and vertebral body fracture. Clinical patient complaints were evaluated perioperatively. Student t-test was used for data analysis.

Results: A total of 46 patients were included, totaling 138 fusion segments. A week after OLIF, 14 patients/33 segments (30.4%/23.9%) demonstrated endplate injury-associated cage placement change. Subsidence was the most common cage placement-related complication. As compared with patients without endplate injury, those with endplate injuries showed significantly larger correction angles and a higher proportion of them had larger height cages than the disk height in the full-extension lateral view. Although 32.6% of the patients experienced perioperative clinical complications, they were relatively minor and transient. The most common complication was severe postoperative pain (Visual Analog Scale score of >7), and hip flexor weakness spontaneously resolved within 1 week.

Conclusions: OLIF yielded more than expected endplate injuries from treatment modalities for ASD along with sagittal imbalance. Therefore, surgeons should be cautious about endplate injury during OLIF procedures. It is difficult to accomplish lordosis correction via OLIF alone; therefore, surgeons should not attempt this impractical correction goal and insert an immoderate cage.
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http://dx.doi.org/10.31616/asj.2018.0304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773981PMC
October 2019

Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot.

Foot Ankle Int 2019 Sep 27;40(9):1079-1086. Epub 2019 May 27.

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

Background: The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot.

Methods: We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters.

Results: There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap ( <.001), lateral talo-first metatarsal angle ( = .002), and metatarsus adductus angle ( = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo-first metatarsal angle ( = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences.

Conclusion: Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV.

Level Of Evidence: Level III, retrospective comparative series.
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http://dx.doi.org/10.1177/1071100719850148DOI Listing
September 2019

A comparative evaluation of tibial metaphyseal-diaphyseal angle changes between physiologic bowing and Blount disease.

Medicine (Baltimore) 2019 Apr;98(17):e15349

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

The purpose of this study was to estimate the rate of spontaneous improvement in tibial metaphyseal-diaphyseal angle (TMDA) in physiologic bowing in comparison to that in Blount disease and to provide reference values of TMDA for monitoring patients with highly suspected to have Blount disease.We retrospectively reviewed patients with physiologic bowing meeting the following criteria:(1) TMDA greater than 9° before 36 months of age at initial evaluation;(2) two or more standing long bone radiographs available; and(3) follow-up conducted up to resolution of deformity.Patients with Blount disease had(1) more than 2 standing long bone radiographs obtained before 36 months of age and(2) underwent no treatment during the period in which these images were obtained.TMDA measurements were obtained from 174 patients with physiologic bowing and 32 patients with Blount disease. Rates of TMDA improvement were adjusted by multiple factors using a linear mixed model, with sex and laterality as fixed effects and age and individual patients as the random effects.In the physiologic bowing group, TMDA improved significantly, by 3° per 6 months and by 6° per year. Changes in TMDA were not significant in the Blount disease group.Knowing the rate of TMDA change can be helpful for physicians seeking to monitor infants with suspected as having Blount disease with a high TMDA and to avoid unnecessary repeat radiographic evaluations.
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http://dx.doi.org/10.1097/MD.0000000000015349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831111PMC
April 2019

Prevention of Adjacent Segmental Disease after Fusion in Degenerative Spinal Disorder: Correlation between Segmental Lumbar Lordosis Ratio and Pelvic Incidence-Lumbar Lordosis Mismatch for a Minimum 5-Year Follow-up.

Asian Spine J 2019 08 10;13(4):654-662. Epub 2019 Apr 10.

Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.

Study Design: Retrospective study.

Purpose: Associations among risk factors related to adjacent segmental disease (ASD) remain unclear. We evaluated the risk factors and segmental lordosis ratio to prevent ASD developing after lumbar spinal fusion.

Overview Of Literature: Risk factors related to ASD development are age, sex, obesity, pre-existing degeneration, number of fusion segments, and decreased postoperative lumbar lordosis (LL). However, the associations among these factors are still unclear and should be clearly identified.

Methods: We retrospectively reviewed data on 274 patients who underwent lumbar spinal fusion of three segments or below for lumbar degenerative disease from January 2010 to December 2012, with over 5 years of follow-up. Patients with preoperative sagittal vertical axis (SVA) >5 cm were excluded due to sagittal imbalance. A total of 37 patients with ASD and 40 control patients (CTRL) were randomly selected in a similar distribution of matching variables: age, sex, and preoperative degenerative changes. Sex, age, number of fusion segments, radiologic measurements, L4-5-S1/L1-S1 LL ratio, and spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and SVA) were analyzed. Logistic regression was used to analyze the correlation between PI-LL mismatch and L4-5-S1 segmental lordosis rate.

Results: No significant difference was found between ASDs and CTRL groups regarding age, sex, number of fusion segments, fusion method, and preoperative and postoperative spinopelvic parameters (PI, SS, PT, and LL). However, regarding the L4-5-S1/L1-S1 lordosis ratio, 50% (p=0.045), 60% (p=0.031), 70% (p=0.042), 80% (p=0.023), and 90% (p=0.023) were statistically significant; <20% (p=0.478), 30% (p=0.223), and 40% (p=0.089) were not statistically significant. In the postoperative PI-LL <10 group, ASD occurred less frequently than in the PI-LL >10 group, and the difference was statistically significant (p=0.048).

Conclusions: Patients with a postoperative L4-5-S1/L1-S1 lordosis ratio >50% had less occurrence of ASD. Correcting LL according to PI and physiologic segmental lordosis ratio is important in preventing ASD.
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http://dx.doi.org/10.31616/asj.2018.0279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680035PMC
August 2019

Social Determinants of Association among Diabetes Mellitus, Visual Impairment and Hearing Loss in a Middle-Aged or Old Population: Artificial-Neural-Network Analysis of the Korean Longitudinal Study of Aging (2014⁻2016).

Geriatrics (Basel) 2019 Mar 25;4(1). Epub 2019 Mar 25.

Department of Neurology, Korea University College of Medicine, Seoul 02841, Korea.

Background: This study introduces a new framework based on an artificial neural network (ANN) for testing whether social determinants are major determinants of association among diabetes mellitus, visual impairment and hearing loss in a middle-aged or old population.

Methods: The data came from the Korean Longitudinal Study of Aging (2014⁻2016), with 6120 participants aged 45 years or more. The association was divided into eight categories: one category for having no disease, three categories for having one, three categories for having two and one category for having three. Variable importance, the effect of a variable on model performance, was used to evaluate the hypothesis based on whether family support, socioeconomic status and social activity in Y2014 are among the top 10 determinants of the association in the year 2016 (Y2016).

Results: Based on variable importance from the ANN, brothers/sisters cohabiting (0.0167), voluntary activity (0.0148), income (0.0125), family activity (0.0125), parents alive (0.0121), leisure activity (0.0095) and meeting with friends (0.0092) in Y2014 are the top-10 determinants of comorbidity in Y2016.

Conclusion: The findings of this study support the hypothesis, highlighting the importance of social determinants for the effective management of the comorbidities of the three diseases.
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http://dx.doi.org/10.3390/geriatrics4010030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473411PMC
March 2019

Treatment for gastric 'indefinite for neoplasm/dysplasia' lesions based on predictive factors.

World J Gastroenterol 2019 Jan;25(4):469-484

Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea.

Background: Gastric 'indefinite for neoplasm/dysplasia' (IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management.

Aim: To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions.

Methods: In total, 461 gastric lesions diagnosed biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection ( = 134), surgery ( = 22), and follow-up endoscopic biopsy ( = 305) were performed to confirm the diagnosis. The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia (60%) or atypical epithelia (40%) at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases.

Results: Four clinical factors [age ≥ 60 years (2.445, 95%CI: 1.305-4.580, = 0.005), endoscopic size ≥ 10 mm (3.519, 95%CI: 1.891-6.548, < 0.001), single lesion (5.702, 95%CI: 2.212-14.696, < 0.001), and spontaneous bleeding (4.056, 95%CI: 1.792-9.180, = 0.001)], and two pathologic factors [atypical epithelium (25.575, 95%CI: 11.537-56.695, < 0.001], and repeated IFND diagnosis [6.022, 95%CI: 1.822-19.909, = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were 91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change (5.594, 95%CI: 1.458-21.462, = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review.

Conclusion: More than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered.
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http://dx.doi.org/10.3748/wjg.v25.i4.469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350171PMC
January 2019

A desymmetrization-based approach to morphinans: application in the total synthesis of oxycodone.

Chem Commun (Camb) 2018 Nov;54(92):13018-13021

Department of Chemistry, Seoul National University, Gwanak-1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea.

Here we report a total synthesis of the pharmacologically significant morphinan alkaloid, oxycodone. The centerpiece of the developed strategy features the first application of the Rovis desymmetrization of peroxyquinol in target-oriented total synthesis to access an optically active phenanthrene framework shared by the morphinans. A Stork-Ueno radical cyclization under photoredox conditions installed the all-carbon quaternary stereocenter, and a late-stage reductive detosylation with concomitant piperidine formation secured the core structure of the target molecule.
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http://dx.doi.org/10.1039/c8cc07667gDOI Listing
November 2018

Surgical excision and mucosal advancement flap: Treatment for refractory lichen planus of the lip.

Dermatol Ther 2018 09 28;31(5):e12695. Epub 2018 Aug 28.

Department of Dermatology, Wonkwang University School of Medicine, Iksan, South Korea.

Lichen planus of the lip (LPL) is not common, and only a few cases have been reported. Medical treatment modalities for LPL are not always effective. Therefore, treatment of this presentation is difficult and challenging. A 41-year-old man was referred to the dermatology clinic with a chronic, painful erosion on the lower lip and buccal mucosa. Treatment with topical steroids, systemic cyclosporine, dapsone, and systemic steroids failed. We performed surgical excision and mucosal advancement flap treatment, with complete response noted after 6 months. Surgical excision with mucosal advancement flap treatment may be effective for the treatment of refractory LPL.
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http://dx.doi.org/10.1111/dth.12695DOI Listing
September 2018

The Incidence of Pruritus and Biochemical Marker Associated with Pruritus in Hemodialysis Patients.

Ann Dermatol 2018 Aug 27;30(4):473-475. Epub 2018 Jun 27.

Department of Dermatology, Wonkwang University School of Medicine, Iksan, Korea.

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http://dx.doi.org/10.5021/ad.2018.30.4.473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029977PMC
August 2018

A Mycobacterium avium subsp. paratuberculosis relA deletion mutant and a 35 kDa major membrane protein elicit development of cytotoxic T lymphocytes with ability to kill intracellular bacteria.

Vet Res 2018 06 26;49(1):53. Epub 2018 Jun 26.

Department of Veterinary Microbiology and Pathology, Washington State University, Pullman, WA, USA.

Efforts to develop live attenuated vaccines against Mycobacterium avium subspecies paratuberculosis (Map), using indirect methods to screen Map deletion mutants for potential efficacy, have not been successful. A reduction in the capacity to survive in macrophages has not predicted the ability of mutants to survive in vivo. Previous studies for screening of three deletion mutants in cattle and goats revealed one mutant, with a deletion in relA (ΔMap/relA), could not establish a persistent infection. Further studies, using antigen presenting cells (APC), blood dendritic cells and monocyte derived DC, pulsed with ΔMap/relA or a 35 kDa Map membrane protein (MMP) revealed a component of the response to ΔMap/relA was directed towards MMP. As reported herein, we developed a bacterium viability assay and cell culture assays for analysis and evaluation of cytotoxic T cells generated against ΔMap/relA or MMP. Analysis of the effector activity of responding cells revealed the reason ΔMap/relA could not establish a persistent infection was that vaccination elicited development of cytotoxic CD8 T cells (CTL) with the capacity to kill intracellular bacteria. We demonstrated the same CTL response could be elicited with two rounds of antigenic stimulation of APC pulsed with ΔMap/relA or MMP ex vivo. Cytotoxicity was mediated through the perforin granzyme B pathway. Finally, cognate recognition of peptides presented in context of MHC I and II molecules to CD4 and CD8 T cells is required for development of CTL.
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http://dx.doi.org/10.1186/s13567-018-0549-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019527PMC
June 2018

Activity of Daily Living After Long Level Fusion in Adult Spinal Deformity: Compared With Over 60-Year-Old Degenerative Spine Patients Without Adult Spinal Deformity.

Spine (Phila Pa 1976) 2018 12;43(23):1638-1647

Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.

Study Design: Prospective single center study.

Objective: The aim of this study was to evaluate 1) the activity of daily living (ADL) of three categorized patients group; over 60-year-old degenerative spine patients without adult spinal deformity (ASD), nonoperative ASD patients, and operative ASD patients, 2) what kinds of activities would be impaired, and 3) how the ADL changes over time after long level fusion.

Summary Of Background Data: There is still debate how surgeons could decide treatment methods for old-aged adult spinal deformity, operatively or not. There was lack of information how long level fusion impacts daily activities, especially sedentary Asian lifestyle. In Asia, impaired ADL is much more important issue because of different lifestyle.

Methods: Patients were categorized into three groups; Group 1 was over 60-year old aged degenerative spine disease without deformity, Group 2 was ASD patients who did not have surgery, and Group 3 was ASD patients who had surgery for deformity correction. Patients were evaluated using answer Oswestry Low Back Pain Disability Questionnaire, and Assessment activities of daily living for sedentary Asian culture (ADL-SA) questionnaire.

Results: Group 1 showed nearly full functions in every activity (ADL-SA: 41.4). ADL-SA scores of Group 2 were similar to Group 1 (P = 0.452). However, get up from bottom (P < 0.001), and pick up object (P < 0.001) were impaired. After long level fusion, ADL was impaired but gradually improved by time. From postoperative 1 year, total ADL score recovered to acceptable range. However, among ADL, activities associated sedentary lifestyle (get up from bottom, wipe floor, pick up object, and sit cross-legged) were still impaired after 2 years postoperatively.

Conclusion: ADL was impaired after long level fusion; however it would improve as time goes by. However, among ADL, activities associated sedentary lifestyle was still impaired. Hence give enough information to patients about limited activities before deciding operation.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000002676DOI Listing
December 2018

Mixture risk assessment of selected mainstream cigarette smoke constituents generated from low-yield cigarettes in South Korean smokers.

Regul Toxicol Pharmacol 2018 Apr 31;94:152-162. Epub 2018 Jan 31.

Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea. Electronic address:

A total of 38 hazardous constituents in mainstream cigarette smoke of low-yield cigarettes sold in Korea were selected and analyzed using established methods. Risk calculations were performed using risk algorithms employed in previous studies and Korean population-based exposure parameters. The median cumulative incremental lifetime cancer risk of male smokers could vary from 828 × 10 to 2510 × 10, and that of female smokers could range from 440 × 10 to 1300 × 10, depending on the smoking regimens. The median hazard index as the sum of hazard quotients of male smokers varied from 367 to 1,225, and that of female smokers varied from 289 to 970, depending on the smoking regimens. The sensitivity analysis for this risk assessment indicated that the constituent yields in mainstream cigarette smoke, average number of cigarettes smoked per day or year, and mouth-spill rate are the main risk factors. Statistical positive correlations between the average daily dose calculated by the exposure algorithm used in this study for individual smokers and biomarkers verified the reliability of this assessment. It could be concluded that inhalation of the constituents present in the mainstream of low-yield cigarettes has significant cancer and non-cancer health risks, although its effect on risk reduction is still unknown under the fixed machine-smoking conditions.
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http://dx.doi.org/10.1016/j.yrtph.2018.01.025DOI Listing
April 2018

Effectiveness of Cognitive Behavioral Therapy for Caregivers of People with Dementia: A Systematic Review and Meta-Analysis.

J Clin Neurol 2017 Oct;13(4):394-404

Department of Neurology, Korea University College of Medicine, Seoul, Korea.

Background And Purpose: Caregivers endure tremendous physical, emotional, and financial burdens while caring for people with dementia. The current study aimed to estimate the effectiveness of cognitive behavioral therapy (CBT) for caregivers of people with dementia (CGPWD).

Methods: Studies in the MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS databases were screened. Studies with a randomized controlled design and which produced CBT outcomes for CGPWD were included in this study, and we investigated these outcomes.

Results: The screening of abstracts of 263 studies resulted in 12 randomized controlled trials being included in this study. The mean age of the CGPWD ranged from 51.5 to 66.2 years. The caregiver role was most frequently adopted by a female spouse or daughter. CBT for the CGPWD resulted in positive effects on various conditions, including depression, anxiety, stress, and dysfunctional thoughts. Depression was the most commonly evaluated condition, and the Center for Epidemiologic Studies Depression Scale (CES-D) was most frequently used as an inventory for depressive symptoms. The mean differences between the baseline and postintervention CES-D scores were compared between the CBT-intervention and control groups. The CES-D score decreased significantly more in the CBT-intervention group than in the control group. The difference in pooled mean differences between the two groups was -4.98.

Conclusions: CBT is an efficient intervention tool for reducing the various emotional burdens experienced by CGPWD. This meta-analysis found that CBT significantly improved the depressive symptoms of CGPWD.
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http://dx.doi.org/10.3988/jcn.2017.13.4.394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653628PMC
October 2017