Publications by authors named "Seong Ho Choi"

474 Publications

Evaluation of rapid SARS-CoV-2 antigen tests, AFIAS COVID-19 Ag and ichroma COVID-19 Ag, with serial nasopharyngeal specimens from COVID-19 patients.

PLoS One 2021 8;16(4):e0249972. Epub 2021 Apr 8.

Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

We evaluated the diagnostic accuracy of two newly developed, point-of-care, rapid antigen tests (RATs) for detecting SARS-CoV-2, the AFIAS COVID-19 Ag and the ichromaTM COVID-19 Ag, and investigated antigen kinetics. A total of 200 serially collected nasopharyngeal (NP) specimens from 38 COVID-19 patients and 122 specimens from negative controls were analyzed. Diagnostic sensitivity and specificity were assessed in comparison to molecular test results and subdivided according to targeted genes (E, RdRP, and N) and days post-symptom onset (PSO). For the kinetics evaluation, cut-off-indices from serial NP specimens were used according to the number of days PSO. Both RATs showed sensitivity of 91.3‒100% for specimens with cycle threshold (Ct) < 25. The specificity of AFIAS was 98.7‒98.9% and that of ichromaTM was 100.0%. The kappa values of AFIAS and ichromaTM for the molecular testing of specimens with Ct < 25 (RdRP) were 0.97 and 1.00, respectively. The sensitivity of AFIAS and ichromaTM for all genes was lower for specimens collected at 8‒14 PSO than for those collected before 7-days PSO. The kinetics profiles showed that antigen levels gradually decreased from ≤ 7-days PSO to > 22-days PSO. Both RATs showed excellent specificity and acceptable sensitivity for NP specimens with higher viral loads and for specimens collected within 7-days PSO. Hence, they have the potential to become useful tools for the early detection of SARS-CoV-2. However, because of concerns about false negativity, RATs should be used in conjunction with molecular tests.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249972PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8031412PMC
April 2021

Development, Validation, and Comparison of a Nomogram Based on Radiologic Findings for Predicting Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: An International Multicenter Study.

J Hepatobiliary Pancreat Sci 2021 Apr 2. Epub 2021 Apr 2.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.

Background: Although we previously proposed a nomogram to predict malignancy in intraductal papillary mucinous neoplasms (IPMN) and validated it in an external cohort, its application is challenging without data on tumor markers. Moreover, existing nomograms have not been compared. This study aimed to develop a nomogram based on radiologic findings and to compare its performance with previously proposed American and Korean/Japanese nomograms.

Methods: We recruited 3708 patients who underwent surgical resection at 31 tertiary institutions in eight countries, and patients with main pancreatic duct > 10 mm were excluded. To construct the nomogram, 2606 patients were randomly allocated 1:1 into training and internal validation sets, and area under the receiver operating characteristics curve (AUC) was calculated using 10-fold cross validation by exhaustive search. This nomogram was then validated and compared to the American and Korean/Japanese nomograms using 1102 patients.

Results: Among the 2606 patients, 90 had main-duct type, 900 had branch-duct type, and 1616 had mixed-type IPMN. Pathologic results revealed 1628 low-grade dysplasia, 476 high-grade dysplasia, and 502 invasive carcinoma. Location, cyst size, duct dilatation, and mural nodule were selected to construct the nomogram. AUC of this nomogram was higher than the American nomogram (0.691 vs. 0.664, p = 0.014) and comparable with the Korean/Japanese nomogram (0.659 vs 0.653, p = 0.255).

Conclusions: A novel nomogram based on radiologic findings of IPMN is competitive for predicting risk of malignancy. This nomogram would be clinically helpful in circumstances where tumor markers are not available. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.
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http://dx.doi.org/10.1002/jhbp.962DOI Listing
April 2021

Scanning Electron Microscopic Evaluation of the Internal Fit Accuracy of 3D-Printed Biphasic Calcium Phosphate Block: An Ex Vivo Pilot Study.

Materials (Basel) 2021 Mar 22;14(6). Epub 2021 Mar 22.

Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 03722, Korea.

The aim of this study was to assess the internal fit accuracy of a three-dimensional (3D)-printed biphasic calcium phosphate (BCP) block compared with a 3D-milled poly methyl methacrylate (PMMA) block by scanning electron microscope (SEM) analysis. In a total of 20 porcine rib bones, two different types of defects having two adjacent walls and a floor were produced: a defect with a flat floor (flat defect; = 10) and a defect with a concave floor (curved defect; = 10). Each defect was grafted with either the 3D-printed BCP block or the 3D-milled PMMA block fabricated following the computer aided design. The defects were then cut cross-sectionally and evaluated under the SEM. The extents of internal contact and gap were measured and statistically analyzed ( < 0.05). All blocks in both BCP and PMMA groups were successfully fit to the flat and curved defects. The internal contact ratio was significantly higher in the BCP group (flat defect: 0.47 ± 0.10; curved defect: 0.29 ± 0.05) compared with the PMMA group (flat defect: 0.21 ± 0.13; curved defect: 0.17 ± 0.04; < 0.05). The internal gap area was similar between the two groups regardless of the defect types ( > 0.05). The internal fit accuracy of the 3D-printed BCP block was reliable in both the flat and curved defects when compared with the accuracy of the 3D-milled PMMA block.
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http://dx.doi.org/10.3390/ma14061557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004813PMC
March 2021

Quantification of Bacteria in Mouth-Rinsing Solution for the Diagnosis of Periodontal Disease.

J Clin Med 2021 Feb 22;10(4). Epub 2021 Feb 22.

Department of Periodontology, Dental Hospital, Veterans Health Service Medical Center, Seoul 05368, Korea.

This study aimed to evaluate the feasibility of diagnosing periodontitis via the identification of 18 bacterial species in mouth-rinse samples. Patients (n = 110) who underwent dental examinations in the Department of Periodontology at the Veterans Health Service Medical Center between 2018 and 2019 were included. They were divided into healthy and periodontitis groups. The overall number of bacteria, and those of 18 specific bacteria, were determined via real-time polymerase chain reaction in 92 mouth-rinse samples. Differences between groups were evaluated through logistic regression after adjusting for sex, age, and smoking history. There was a significant difference in the prevalence (healthy vs. periodontitis group) of (2.9% vs. 13.5%), (42.9% vs. 69.2%), and (80% vs. 2.7%). Levels of , , and were significantly associated with severe periodontitis. We demonstrated the feasibility of detecting periopathogenic bacteria in mouth-rinse samples obtained from patients with periodontitis. As we did not comprehensively assess all periopathogenic bacteria, further studies are required to assess the potential of oral-rinsing solutions to indicate oral infection risk and the need to improve oral hygiene, and to serve as a complementary method for periodontal disease diagnosis.
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http://dx.doi.org/10.3390/jcm10040891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926621PMC
February 2021

Diverse patterns of bone regeneration in rabbit calvarial defects depending on the type of collagen membrane.

J Periodontal Implant Sci 2021 Feb;51(1):40-52

Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.

Purpose: Various crosslinking methods have been introduced to increase the longevity of collagen membranes. The aim of this study was to compare and evaluate the degradation and bone regeneration patterns of 3 collagen membranes.

Methods: Four 8-mm-diameter circular bone defects were created in the calvaria of 10 rabbits. In each rabbit, each defect was randomly allocated to 1) the sham control group, 2) the non-crosslinked collagen sponge (NS) group, 3) the chemically crosslinked collagen membrane (CCM) group, or 4) the biphasic calcium phosphate (BCP)-supplemented ultraviolet (UV)-crosslinked collagen membrane (UVM) group. Each defect was covered with the allocated membrane without any graft material. Rabbits were sacrificed at either 2 or 8 weeks post-surgery, and radiographic and histologic analyses were done.

Results: New bone formed underneath the membrane in defects in the CCM and UVM groups, with a distinctive new bone formation pattern, while new bone formed from the base of the defect in the NS and control groups. The CCM maintained its shape until 8 weeks, while the UVM and NS were fully degraded at 8 weeks; simultaneously, sustained inflammatory infiltration was found in the margin of the CCM, while it was absent in the UVM. In conclusion, the CCM showed longer longevity than the UVM, but was accompanied by higher levels of inflammation.

Conclusions: Both the CCM and UVM showed distinctive patterns of enhancement in new bone formation in the early phase. UV crosslinking can be a biocompatible alternative to chemical crosslinking.
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http://dx.doi.org/10.5051/jpis.2004180209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920838PMC
February 2021

Etiology, Characteristics, and Outcomes of Community-Onset Pyomyositis in Korea: A Multicenter Study.

Infect Chemother 2021 Jan 7. Epub 2021 Jan 7.

The Korean Skin and Soft Tissue Study Group, Korea.

Background: Pyomyositis (PM) is a serious soft tissue infection and despite its clinical importance, previous studies have not been able to fully determine the clinical characteristics and microbial epidemiology of PM in Korea, which we therefore aimed to investigate.

Materials And Methods: We retrospectively identified 140 adult patients diagnosed with PM from 13 general hospitals between January 2012 and December 2015. We analyzed the clinical and microbial characteristics of community-onset PM and compared them with community-acquired (CA) and healthcare-associated (HCA) PM.

Results: One hundred eleven organisms were isolated from 96 (68.6%) patients with PM. (38 patients) was the most common pathogen, followed by streptococci (24 patients), and enteric Gram-negative organisms (27 patients). Methicillin-resistant (MRSA) was identified in four (2.9%) patients and in-hospital mortality reached 8.6% (12/140). Enterococci isolates were identified in the HCA PM subgroup only The proportion of MRSA isolates was not comparable between CA and HCA PM subgroups. In the 83 patients with PM infected by monomicrobial pathogens, isolates of Gram-negative organisms were more commonly found in HCA PM subgroup than in CA PM subgroup (47.6% [10/21] of patients with HCA PM 20.7% [12/58] of patients with CA PM; = 0.01).

Conclusion: Gram-positive cocci such as and streptococci were dominant etiologies in community-onset PM, whereas MRSA appears to an uncommon causative organism of PM in Korea. Enteric Gram-negative organisms should also be considered as major etiologies, especially in HCA PM patient population in Korea.
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http://dx.doi.org/10.3947/ic.2020.0102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032918PMC
January 2021

Antibiotic selection based on microbiology and resistance profiles of bile from gallbladder of patients with acute cholecystitis.

Sci Rep 2021 Feb 3;11(1):2969. Epub 2021 Feb 3.

Department of Surgery, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 224-1, Heuk Seok-Dong, Dongjak-Ku, Seoul, 156-755, South Korea.

With the progression of acute cholecystitis, antimicrobial therapy becomes important for infection control. Current antibiotic recommendations were mostly based on reports of patients with acute cholangitis whose bile specimens were sampled from the biliary tract. However, as most infections of acute cholecystitis are limited to the gallbladder, direct sampling from the site increases the probability of identifying the causative pathogen. We investigated 321 positive bile cultures from 931 patients with acute cholecystitis who underwent laparoscopic cholecystectomy between January 2003 and December 2017. The frequency of enterococci declined (P = 0.041), whereas that of Enterobacteriales (P = 0.005), particularly Escherichia (P = 0.008), increased over time. The incidence of ciprofloxacin-resistant Enterobacteriales showed a significant increasing trend (P = 0.031). Vancomycin-resistant E.faecium, carbapenem-resistant Enterobacteriales, and extended-spectrum beta-lactamase-producing Enterobacteriales were recently observed. In grade I and II acute cholecystitis, there were no significant differences in perioperative outcomes in patients with and without early appropriate antimicrobial therapy. In conclusion, the changing incidence of frequently isolated microorganisms and their antibiotic resistance over time would be considered before selecting antibiotics for the treatment of acute cholecystitis. Surgery might be a crucial component of infection control in grade I and II acute cholecystitis.
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http://dx.doi.org/10.1038/s41598-021-82603-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859191PMC
February 2021

Ten-Year Prevalence Trends of Phenotypically Identified Community-Associated Methicillin-Resistant Strains in Clinical Specimens.

Ann Lab Med 2021 Jul;41(4):386-393

Chung-Ang University College of Medicine, Seoul, Korea.

Background: Community-associated methicillin-resistant (CA-MRSA) strains were first detected in hospitals in Korea between the late 2000s and early 2010s. However, there is limited information regarding the prevalence of CA-MRSA strains among hospital isolates and their phenotypic changes over the last decade. We investigated the prevalence trend of CA-MRSA strains isolated from different clinical specimens and their phenotypic changes between September 2009 and September 2019.

Methods: CA-MRSA strains were phenotypically identified by confirming their resistance to penicillin (PCN) and oxacillin (OXA) and evaluating their susceptibility to trimethoprim-sulfamethoxazole, rifampin, fusidic acid, tetracycline, and at least one of the following four antimicrobials: clindamycin (CLI), erythromycin (ERY), ciprofloxacin (CIP), and gentamicin (GEN). A CA-MRSA strain that exhibited resistance to ERY, CLI, CIP, or GEN was classified as having resistance pattern I, II, III, or IV, respectively, regardless of its resistance to other antimicrobial agents.

Results: Of the 8,278 MRSA isolates identified in specimens obtained two days after admission, 1,385 (16.73%) were CA-MRSA strains. The prevalence of CA-MRSA strains increased from 12.2% to 26.6% (3.21% per period, =0.05). Resistance type analysis revealed an increasing trend in the prevalence of PCN/OXA-resistant (1.84%; =0.049) and PCN/OXA/ERY/CLI/CIP-resistant (0.98%; =0.04) CA-MRSA strains and in resistance pattern III strains (2.08%; =0.004).

Conclusions: The prevalence of CA-MRSA strains in Korea has increased significantly over the last decade, and CA-MRSA strains have gained phenotypic diversity beyond PCN/OXA-resistance, including antimicrobial resistance to non-β-lactams, especially CIP.
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http://dx.doi.org/10.3343/alm.2021.41.4.386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884191PMC
July 2021

Differences in Bile Microbiology and Antibiotic Resistances between Liver Transplant Recipients and Non-Transplant Patients.

Surg Infect (Larchmt) 2021 Feb 2. Epub 2021 Feb 2.

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

Treatment of biliary infection in liver transplant (LT) recipients is a challenge, especially because of ineffectiveness of the antibiotic agents otherwise recommended for non-transplant populations. We aimed to understand the factors underlying the choice of antibiotic therapy. A total of 373 bile cultures from LT recipients with biliary complications (n = 127; LT group) and from a non-transplant population that underwent cholecystectomy for acute cholecystitis (n = 246; non-transplant group) between January 2009 and December 2018, were investigated. Polymicrobial cultures (13.4% vs. 1.6%; p < 0.001), (26.0% vs. 8.5%; p < 0.001), and (13.4% vs. 4.1%; p = 0.001) in the LT group, and non- enterococci (3.9% vs. 18.3%; p < 0.001) and Enterobacteriales (40.2% vs. 54.9%; p = 0.007), especially (11.0% vs. 29.7%; p < 0.001), in the non-transplant group, showed higher abundance. Most of the antibiotic agents recommended as initial antibiotic therapy for the non-transplant population as per previous guidelines were not effective in LT recipients. The incidences of (14.9% vs. 32.5%; p = 0.029) in the LT recipients with model for end-stage liver disease (MELD) score >12 and non- enterococci (8.5% vs. 1.3%; p = 0.042) in those with MELD score ≤12 were higher than those in the other group. The incidence of Enterobacteriales increased over time after LT (p = 0.048) and was similar to that in the non-transplant group after one year of LT. Bile micro-organisms in LT recipients, resistant to most antibiotic agents, especially soon after LT changed over time and became similar to those in the non-transplant group after one year of LT. Antibiotic therapy for biliary infection in LT recipients should be different from that in non-transplant populations, considering clinical factors such as the time interval after LT and MELD score.
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http://dx.doi.org/10.1089/sur.2020.358DOI Listing
February 2021

Clinical and radiological findings of adult hospitalized patients with community-acquired pneumonia from SARS-CoV-2 and endemic human coronaviruses.

PLoS One 2021 14;16(1):e0245547. Epub 2021 Jan 14.

Department of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

Endemic human coronaviruses (HCoVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are members of the family Coronaviridae. Comparing the findings of the infections caused by these viruses would help reveal the novel characteristics of SARS-CoV-2 and provide insight into the unique pathogenesis of SARS-CoV-2 infection. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). This study was performed at a university-affiliated tertiary hospital in the Republic of Korea, between January 1, 2015, and July 31, 2020. A total of 109 consecutive patients who were over 18 years of age with confirmed SARS-CoV-2 and endemic HCoVs were enrolled. Finally, 19 patients with SARS-CoV-2 CAP were compared to 40 patients with endemic HCoV CAP. Flu-like symptoms such as cough, sore throat, headache, myalgia, and prolonged fever were more common in SARS-CoV-2 CAP, whereas clinical findings suggestive of bacterial pneumonia such as dyspnea, leukocytosis with left shift, and increased C-reactive protein were more common in endemic HCoV CAP. Bilateral peripherally distributed ground-glass opacities (GGOs) were typical radiologic findings in SARS-CoV-2 CAP, whereas mixed patterns of GGOs, consolidations, micronodules, and pleural effusion were observed in endemic HCoV CAP. Coinfection was not observed in patients with SARS-CoV-2 CAP, but was observed in more than half of the patients with endemic HCoV CAP. There were distinctive differences in the clinical and radiologic findings between SARS-CoV-2 and endemic HCoV CAP. Further investigations are required to elucidate the mechanism underlying this difference. Follow-up observations are needed to determine if the presentation of SARS-CoV-2 CAP changes with repeated infection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245547PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808673PMC
February 2021

Evaluation of the Nutrient Composition, In Vitro Fermentation Characteristics, and In Situ Degradability of , , and in Cattle.

Animals (Basel) 2020 Dec 24;11(1). Epub 2020 Dec 24.

Department of Animal Science, Chungbuk National University, Cheongju, Chungbuk 28644, Korea.

The amaranth plants showed high potential feed value as forage for ruminants. An in-depth study of this plant, particularly in cattle, will help extend its utilization as an alternative protein and fiber feed source in cattle feeding. In this study, the nutrient compositions of three different species of amaranth, , , and -two varieties for each species, A.ca 74, A.ca 91, A.cu 62, A.cu 66, A. hy 30, and A. hy 48-were evaluated. The in vitro technique was used to evaluate the fermentation characteristics such as total gas production, total volatile fatty acids (VFA) concentration, pH, and ammonia concentration of the rumen fluid. Moreover, the effective degradabilities of dry matter (EDDM) and crude protein (EDCP) of the amaranth forages were determined through in situ bag technique. The amaranth forages: , , and showed better nutritive value than the locally produced forages in Chungcheong province of Korea. The CP of the amaranth ranged from 11.95% to 14.19%, and the neutral detergent fiber (NDF) and acid detergent fiber (ADF) contents ranged from 45.53% to 70.88% and 34.17% to 49.83%, respectively. Among the amaranth varieties, 48 showed the most excellent ruminant feed nutrient quality (CP, 14.19%; NDF, 45.53%; and ADF, 34.17%). The effective degradabilities of dry matter (EDDM; 33-56%) and crude protein EDCP (27-59%) of the amaranth were lower compared to other studies, which could be due to the maturity stage at which the forages were harvested. Nonetheless, showed the highest EDDM (56.73%) and EDCP (59.09%). The different amaranth species did not differ greatly in terms of total VFA concentration or molar proportions, total gas production, or ammonia-N concentration. The high nutrient composition, and highly effective degradability of dry matter and crude protein, coupled with the favorable fermentation characteristics, suggest that the amaranth forages showed good to excellent feed quality for cattle.
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http://dx.doi.org/10.3390/ani11010018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824583PMC
December 2020

Electrocatalytic Oxidation of Methanol by a Polymeric Ni Complex-Modified Electrode Prepared by a One-Step Cold-Plasma Process.

Front Chem 2020 10;8:595616. Epub 2020 Dec 10.

Department of Chemistry, Hannam University, Daejeon, South Korea.

In this work, a polymeric nickel complex-modified indium tin oxide (ITO) electrode was prepared by a one-step cold-plasma process of acrylic-Ni complex precursors. Also, the work provides the electrocatalytic oxidation of methanol by a polymeric Ni complex-modified electrode prepared by a simple one-step cold-plasma process. The acrylic-Ni complex precursors were synthesized by complexation of nickel (II) chloride, and acrylic acid in a small amount of water; subsequently we added N,N'-methylene-bis-acrylamide as a crosslinking agent to the complex solution. We characterized the prepared polymeric Ni complex-modified (Ni-modified) catalytic electrode by X-ray photoelectron spectroscopy, field emission scanning electron microscopy, and electrochemical methods. Electrochemical characterization showed stable redox behavior of Ni(III)/Ni(II) couples. Cyclic voltammetric experiments have shown that electrocatalytic oxidation of methanol can occur on Ni-modified catalytic electrodes, while not observed on bare ITO. As a result, this work provides the simple and easy preparation of electrocatalysts by one-step plasma process for methanol fuel cell.
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http://dx.doi.org/10.3389/fchem.2020.595616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758414PMC
December 2020

Effect of hydroxychloroquine pre-exposure on infection with SARS-CoV-2 in rheumatic disease patients: a population-based cohort study.

Clin Microbiol Infect 2021 Apr 11;27(4):611-617. Epub 2020 Dec 11.

Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: Early in vitro studies have suggested that hydroxychloroquine (HCQ) is a potentially useful drug against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. This study was conducted to determine whether HCQ had a preventive effect on coronavirus disease 2019 (COVID-19) in rheumatic disease patients who were taking HCQ.

Methods: We conducted a population-based retrospective cohort study using the records of the Korean Health Insurance Review and Assessment (HIRA) claim records. The clinical data of patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) who were tested for SARS-CoV-2 were investigated. We compared the attack rate of COVID-19 between those who underwent HCQ therapy within 14 days before the test for SARS-CoV-2 (HCQ users) and HCQ non-users. Data were analysed using logistic regression models, χ, and Student's t-tests.

Results: As of 15th May 2020, 2066 patients with RA or SLE were tested for COVID-19. Among them, 31.4% (649/2066) were treated with HCQ. Most HCQ users (93.7%, 608/649) were taking 200-400 mg/day recommended for the treatment of rheumatic diseases. The attack rate of COVID-19 in the HCQ users (2.3%, 15/649) did not differ from that in the HCQ non-users (2.2%, 31/1417) (p 0.86).

Conclusions: HCQ prophylactic use at a usual dose did not prevent COVID-19 in patients with rheumatic disease.
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http://dx.doi.org/10.1016/j.cmi.2020.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832641PMC
April 2021

Risk prediction for malignant intraductal papillary mucinous neoplasm of the pancreas: logistic regression versus machine learning.

Sci Rep 2020 11 18;10(1):20140. Epub 2020 Nov 18.

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, South Korea.

Most models for predicting malignant pancreatic intraductal papillary mucinous neoplasms were developed based on logistic regression (LR) analysis. Our study aimed to develop risk prediction models using machine learning (ML) and LR techniques and compare their performances. This was a multinational, multi-institutional, retrospective study. Clinical variables including age, sex, main duct diameter, cyst size, mural nodule, and tumour location were factors considered for model development (MD). After the division into a MD set and a test set (2:1), the best ML and LR models were developed by training with the MD set using a tenfold cross validation. The test area under the receiver operating curves (AUCs) of the two models were calculated using an independent test set. A total of 3,708 patients were included. The stacked ensemble algorithm in the ML model and variable combinations containing all variables in the LR model were the most chosen during 200 repetitions. After 200 repetitions, the mean AUCs of the ML and LR models were comparable (0.725 vs. 0.725). The performances of the ML and LR models were comparable. The LR model was more practical than ML counterpart, because of its convenience in clinical use and simple interpretability.
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http://dx.doi.org/10.1038/s41598-020-76974-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676251PMC
November 2020

Extract Reduces Insulin Resistance by Enhancing AMPK Activation in High-Fat Diet-Induced Obese Mice.

Nutrients 2020 Oct 30;12(11). Epub 2020 Oct 30.

Department of Biochemistry, School of Biological Sciences, Chungbuk National University, Cheongju 28644, Korea.

is used widely in oriental medicine to treat obesity and metabolic diseases. Bioactive substances extracted from have been shown to ameliorate dyslipidemia, insulin resistance, and type 2 diabetes in mice via multiple 5' AMP-activated protein kinase (AMPK)-mediated mechanisms; however, further studies are required to elucidate the anti-obesity effects of in vivo. In this study, we demonstrated that 3% extract powder (GEP) can be used to prevent obesity and insulin resistance in a mouse model. C57BL/6 mice were provided with a normal diet (ND) or a high-fat diet (HFD) supplemented with 1, 3, or 5% GEP for 12 weeks and the effect of GEP on body weight, liver, adipose tissue, adipokines, insulin and glucose tolerance (ITT and GTT), glucose uptake, glucose-metabolism related proteins, and lipogenesis related genes was examined. GEP administration was found to reduce weight gain in the liver and fat tissues of the mice. In addition, serum parameters were significantly lower in the 3% and 5% GEP mice groups than in those fed a HFD alone, whereas adiponectin levels were significantly higher. We also observed that GEP improved glucose metabolism, reduced lipid accumulation in the liver, and reduced adipocyte size. These effects may have been mediated by enhanced AMPK activation, which attenuated the transcription and translation of lipogenic genes such as fatty acid synthase (FAS), stearoyl-CoA desaturase 1 (SCD1), and sterol regulatory element-binding protein-1c (SREBP1c). Moreover, AMP-activated protein kinase (AMPK) activation increased acetyl-CoA carboxylase (ACC), insulin receptor (IR), IR substrate 1 (IRS1), and Akt protein expression and activation, as well as glucose transporter type 1/4 (GLUT1/4) protein production, thereby improving insulin sensitivity and glucose metabolism. Together, these findings demonstrate that may effectively prevent obesity and suppress obesity-induced insulin resistance via AMPK activation.
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http://dx.doi.org/10.3390/nu12113338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693844PMC
October 2020

Factors of Severity in Patients with COVID-19: Cytokine/Chemokine Concentrations, Viral Load, and Antibody Responses.

Am J Trop Med Hyg 2020 12 27;103(6):2412-2418. Epub 2020 Oct 27.

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

The severity of COVID-19 ranges from mild to critical diseases. However, limited data have been published on the detailed kinetics of viral load and host immune response throughout the disease course depending on disease severity. In this study, we comprehensively analyzed viral load, antibody responses to SARS-CoV-2, and cytokines/chemokines during the disease course, and identified the factors related to severity. Nasopharyngeal (NP) and plasma specimens were obtained from 31 patients with COVID-19 during hospitalization. Viral RNA in NP specimens was quantified by reverse transcription-PCR. Anti-SARS-CoV-2 antibodies and cytokines/chemokines in plasma specimens were analyzed by ELISA and cytometric bead array. The viral load in patients with COVID-19 peaked at the early stage of the disease and continuously decreased. Severe and critical cases showed higher viral load and prolonged viral shedding than asymptomatic and mild cases. Whereas plasma IgG was gradually increased and maintained during hospitalization, plasma IgM peaked at 3 weeks after symptom onset and dissipated. The antibody response in severe and critical cases was slightly delayed but stronger than those in others. High levels of interferon (IFN)-α, IFN-γ-induced protein-10, monokine induced by IFN-γ, and interleukin-6 at 5-10 days from symptom onset were associated with the severity of COVID-19. Our data indicate that high viral load in the respiratory tract and excessive production of cytokines and chemokines between 1 and 2 weeks from the symptom onset were significantly associated with the severity of COVID-19.
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http://dx.doi.org/10.4269/ajtmh.20-1110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695090PMC
December 2020

Transcriptomic profiles and their correlations in saliva and gingival tissue biopsy samples from periodontitis and healthy patients.

J Periodontal Implant Sci 2020 Oct;50(5):313-326

Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.

Purpose: This study was conducted to analyze specific RNA expression profiles in gingival tissue and saliva samples in periodontitis patients and healthy individuals, and to determine their correlations in light of the potential use of microarray-based analyses of saliva samples as a periodontal monitoring tool.

Methods: Gingival tissue biopsies and saliva samples from 22 patients (12 with severe periodontitis and 10 with a healthy periodontium) were analyzed using transcriptomic microarray analysis. Differential gene expression was assessed, and pathway and clustering analyses were conducted for the samples. The correlations between the results for the gingival tissue and saliva samples were analyzed at both the gene and pathway levels.

Results: There were 621 differentially expressed genes (DEGs; 320 upregulated and 301 downregulated) in the gingival tissue samples of the periodontitis group, and 154 DEGs (44 upregulated and 110 downregulated) in the saliva samples. Nine of these genes overlapped between the sample types. The periodontitis patients formed a distinct cluster group based on gene expression profiles for both the tissue and saliva samples. Database for Annotation, Visualization and Integrated Discovery analysis revealed 159 enriched pathways from the tissue samples of the periodontitis patients, as well as 110 enriched pathways In the saliva samples. Thirty-four pathways overlapped between the sample types.

Conclusions: The present results indicate the possibility of using the salivary transcriptome to distinguish periodontitis patients from healthy individuals. Further work is required to enhance the extraction of available RNA from saliva samples.
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http://dx.doi.org/10.5051/jpis.1905460273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606893PMC
October 2020

Antibody kinetics and serologic profiles of SARS-CoV-2 infection using two serologic assays.

PLoS One 2020 22;15(10):e0240395. Epub 2020 Oct 22.

Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

Background: Coronavirus disease 2019 (COVID-19) is an emerging threat worldwide. This study aims to assess the serologic profiles and time kinetics of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with COVID-19 using two immunoassays.

Methods: A total of 97 samples serially collected from 17 patients with COVID-19 and 137 negative control samples were analyzed for IgM and IgG against SARS-CoV-2 using the AFIAS COVID-19 Ab (Boditech Med Inc., Chuncheon, Republic of Korea) and the EDI™ Novel Coronavirus COVID-19 ELISA Kit (Epitope Diagnostics, Inc., San Diego, CA).

Results: With both assays, IgM and IgG rapidly increased after 7 days post symptom onset (PSO). IgM antibody levels reached a peak at 15-35 d PSO and gradually decreased. IgG levels gradually increased and remained at similar levels after 22-35 d. The diagnostic sensitivities of IgM/IgG for ≤14d PSO were 21.4%/35.7~57.1% and increased to 41.2~52.9%/88.2~94.1% at >14 d PSO with specificities of 98.5%/94.2% for AFIAS COVID-19 Ab and 100.0%/96.4% for EDI™ Novel Coronavirus COVID-19 ELISA Kit. Among 137 negative controls, 12 samples (8.8%) showed positive or indeterminate results.

Conclusions: The antibody kinetics against SARS-CoV-2 are similar to common findings of acute viral infectious diseases. Antibody testing is useful for ruling out SARS-CoV-2 infection after 14 d PSO, detecting past infection, and epidemiologic surveys.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240395PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580996PMC
November 2020

Prognostic Impact of Intra-Ampullary Papillary-Tubular Neoplasm versus Flat Dysplasia as Precursor Lesions of Ampullary Adenocarcinoma.

Dig Surg 2020 20;37(6):505-514. Epub 2020 Oct 20.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: The aim of this study is to compare the prognostic impact of 2 precursor lesions of ampullary adenocarcinoma, intra-ampullary papillary-tubular neoplasm (IAPN) and flat dysplasia (FD).

Methods: From December 1994 to December 2012, a total of 359 patients underwent curative surgery for ampullary adenocarcinoma.

Results: The precursor lesions were IAPNs in 134 (37.3%) patients and FD in the other 225 (62.7%) patients. The FD group had more aggressive tumor biology with advanced T stage (p = 0.002), nodal involvement (p < 0.001), poor differentiation (p < 0.001), perineural and lymphovascular invasion (p < 0.001), and pancreatobiliary or mixed subtype (p < 0.001). Five-year overall survival rates were 71.1% in the IAPN group and 51.4% in the FD group (p = 0.002), respectively. Five-year disease-free survival rates were 69.7% in the IAPN group and 49.6% in the FD group (p < 0.001), respectively. The recurrence rate was also higher in the FD group (49.8 vs. 30.6%; p < 0.001). On multivariate analysis, higher levels of tumor markers including CEA and CA19-9, lymph node metastasis, poorly differentiated histology, and perineural invasion were negative predictive factors for survival. Higher levels of CEA and CA19-9, lymphovascular invasion, and FD were independent prognostic factors for recurrence.

Conclusion: FD was significantly associated with worse prognosis and a greater tendency toward advanced disease. Further studies are needed to clarify the impacts of these precursor lesions.
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http://dx.doi.org/10.1159/000510961DOI Listing
October 2020

Long-term outcomes following en bloc resection for pancreatic ductal adenocarcinoma of the head with portomesenteric venous invasion.

Asian J Surg 2021 Jan 21;44(1):313-320. Epub 2020 Sep 21.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Background: The aim of this study is to clarify the prognostic influence of venous resection of the portal vein (PV) or superior mesenteric vein (SMV) on long-term outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) of the head with suspected vascular invasion.

Methods: From May 1995 to December 2014, a total of 557 patients underwent surgery with curative intent for pancreatic cancer of the head.

Results: Among 557 patients, 106 (19%) underwent pancreaticoduodenectomy (PD) with PV-SMV resection and 89 (75.5%) of these patients were confirmed to have true pathological invasion. The 5-year overall survival rate in patients underwent PV-SMV resection was significantly lower compared with those who did not (18.7% versus 24.3%; p = 0.002). Patients with negative resection margins who underwent PV-SMV resection had a better prognosis than those with positive resection margins who did not undergo PV-SMV resection with positive resection margins (17% versus 6.3% in 5-year overall survival rate; p = 0.003). The overall morbidity rate was not significantly different between PV-SMV resection group and no PV-SMV resection group (p = 0.064). On multivariate analysis, margin status, advanced T stage (3 or 4), lymph node metastasis, and adjuvant therapy were independent prognostic factors for survival.

Conclusion: PV-SMV resection was related to lower overall survival. However, on multivariate analysis, margin status was a more important prognostic factor than PV-SMV resection and true pathological invasion for survival. Therefore, en bloc PV-SMV resection should be performed when PV-SMV invasion is suspected to achieve R0 resection.
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http://dx.doi.org/10.1016/j.asjsur.2020.07.021DOI Listing
January 2021

Utility of Magnetic Resonance Imaging for Differentiating Necrotizing Fasciitis from Severe Cellulitis: A Magnetic Resonance Indicator for Necrotizing Fasciitis (MRINEC) Algorithm.

J Clin Med 2020 Sep 21;9(9). Epub 2020 Sep 21.

Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea.

We developed a new magnetic resonance indicator for necrotizing fasciitis (MRINEC) algorithm for differentiating necrotizing fasciitis (NF) from severe cellulitis (SC). All adults with suspected NF between 2010 and 2018 in a tertiary hospital in South Korea were enrolled. Sixty-one patients were diagnosed with NF and 28 with SC. Among them, 34 with NF and 15 with SC underwent magnetic resonance imaging (MRI). The MRINEC algorithm, a two-step decision tree including T2 hyperintensity of intermuscular deep fascia and diffuse T2 hyperintensity of deep peripheral fascia, diagnosed NF with 94% sensitivity (95% confidence interval (CI), 80-99%) and 60% specificity (95% CI, 32-84%). The algorithm accurately diagnosed all 15 NF patients with a high (≥8) laboratory risk indicator for necrotizing fasciitis (LRINEC) score. Among the five patients with an intermediate (6-7) LRINEC score, sensitivity and specificity were 100% (95% CI, 78-100%) and 0% (95% CI, 0-84%), respectively. Finally, among the 29 patients with a low (≤5) LRINEC score, the algorithm had a sensitivity and specificity of 88% (95% CI, 62-98%) and 69% (95% CI, 39-91%), respectively. The MRINEC algorithm may be a useful adjuvant method for diagnosing NF, especially when NF is suspected in patients with a low LRINEC score.
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http://dx.doi.org/10.3390/jcm9093040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564512PMC
September 2020

Sinus floor augmentation using mixture of mineralized cortical bone and cancellous bone allografts: Radiographic and histomorphometric evaluation.

J Dent Sci 2020 Sep 8;15(3):257-264. Epub 2020 Jun 8.

Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea.

Background/purpose: Due to the pneumatization of the maxillary sinus, the sinus floor augmentation is often performed to implant placement in the maxillary posterior region. The aim was to perform radiographic and histomorphometric evaluation after placement of mixed allografts (cortical freeze-dried bone allograft [FDBA] 50%:cancellous FDBA 50%) during sinus floor augmentation.

Materials And Methods: In 37 patients, anorganic bovine bone (ABB, sites = 16), mineralized cancellous bone allograft (MCBA, sites = 15), and mixed allografts (Mixed AG, sites = 20) were placed during sinus floor elevation via the lateral approach (LSFE), at total 51 sites with residual alveolar bone height (RBH) < 5 mm. Cone-beam computed tomography images were obtained before LSFE (T0), after surgery (T1), and 6 months after surgery (T2) for radiographic analysis. After a 6-month healing period, core biopsies were harvested and histomorphometric analysis was performed.

Results: The mean augmented bone height (ABH) of ABB, MCBA, and mixed AG groups after surgery was similar (13.86 ± 4.19 mm, 13.99 ± 4.07 mm, and 14.20 ± 3.12 mm, respectively;  > 0.05). The mean ABH of ABB, MCBA, and mixed AG groups after 6 months was similar (13.72 ± 4.55 mm, 11.83 ± 3.31 mm, and 12.53 ± 2.97 mm, respectively;  > 0.05). In the ABB, MCBA, and mixed AG groups, the proportion of newly formed bone (NB) was similar (36.13 ± 10.01%, 39.26 ± 10.72%, and 31.27 ± 18.31%, respectively;  > 0.05).

Conclusion: This result demonstrated that mixed AG led to sufficient bone augmentation and histologically comparable NB formation as compared to ABB and MCBA for sinus floor augmentation.
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http://dx.doi.org/10.1016/j.jds.2020.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486514PMC
September 2020

Efficacy and Safety of Cystatin C-Guided Renal Dose Adjustment of Cefepime Treatment in Hospitalized Patients with Pneumonia.

J Clin Med 2020 Aug 30;9(9). Epub 2020 Aug 30.

Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea.

Cystatin C (CysC) may estimate renal function more accurately than serum creatinine (SCr). The clinical impact of renal dose adjustment of cefepime according to CysC rather than SCr has remained uncertain. We investigated the efficacy and safety of CysC-guided cefepime dosing compared with SCr-guided dosing in hospitalized patients with pneumonia. All adults hospitalized with pneumonia between July 2016 and December 2018 who used cefepime for at least 3 days were enrolled. Mortality, acute kidney injury (AKI), cefepime-induced encephalopathy (CIE), and infection were compared between the CysC-guided and SCr-guided groups. One hundred and ninety patients were divided into two groups: 129 and 61 received cefepime based on CysC and SCr, respectively. In-hospital mortality did not significantly differ between the groups (12% versus 31%; hazard ratio (HR) 0.74; 95% confidence interval (CI), 0.31-1.77; = 0.50). CysC-guided cefepime dosing decreased the risk of AKI (13% versus 61%; HR 0.18; 95% CI, 0.07-0.44; < 0.001) and CIE (2% versus 11%; HR 0.11; 95% CI, 0.03-0.47; = 0.003) compared with SCr-guided dosing. There was no significant difference in the risk of infection. CysC-guided dosing of cefepime was associated with decreased risk of the cefepime-associated morbidities including AKI and CIE without increasing mortality among the hospitalized patients with pneumonia.
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http://dx.doi.org/10.3390/jcm9092803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564664PMC
August 2020

Gemcitabine-Based Neoadjuvant Treatment in Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Meta-Analysis of Individual Patient Data.

Front Oncol 2020 11;10:1112. Epub 2020 Aug 11.

Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, United Kingdom.

Non-randomized studies have investigated multi-agent gemcitabine-based neo-adjuvant therapies (GEM-NAT) in borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC). Treatment sequencing and specific elements of neoadjuvant treatment are still under investigation. The present meta-analysis aims to assess the effectiveness of GEM-NAT on overall survival (OS) in BR-PDAC. A meta-analysis of individual participant data (IPD) on GEM-NAT for BR-PDAC were performed. The primary outcome was OS after treatment with GEM-based chemotherapy. In the Individual Patient Data analysis data were reappraised and confirmed as BR-PDAC on provided radiological data. Six studies investigating GEM-NAT were included in the IPD metanalysis. The IPD metanalysis was conducted on 271 patients who received GEM-NAT. Pooled median patient-level OS was 22.2 months (95%CI 19.1-25.2). R0 rates ranged between 81 and 95% ( = 0%, = 0.64), respectively. Median OS was 27.8 months (95%CI 23.9-31.6) in the patients who received NAT-GEM followed by resection compared to 15.4 months (95%CI 12.3-18.4) for NAT-GEM without resection and 13.0 months (95%CI 7.4-18.5) in the group of patients who received upfront surgery ( < 0.0001). R0 rates ranged between 81 and 95% ( = 0%, = 0.64), respectively. Overall survival in the R0 group was 29.3 months (95% CI 24.3-34.2) vs. 16.2 months (95% CI 7·9-24.5) in the R1 group ( = 0·001). The present study is the first meta-analysis combining IPD from a number of international centers with BR-PDAC in a cohort that underwent multi-agent gemcitabine neoadjuvant therapy (GEM-NAT) before surgery. GEM-NAT followed by surgical resection improve survival and R0 resection in BR-PDAC. Also, GEM-NAT may result in a good palliative option in non-resected patients because of progressive disease after neoadjuvant treatment. Results from randomized controlled trials (RCTs) are awaited to validate these findings.
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http://dx.doi.org/10.3389/fonc.2020.01112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431761PMC
August 2020

High dietary oleic acid in olive oil-supplemented diet enhanced omega-3 fatty acid in blood plasma of rats.

Food Sci Nutr 2020 Jul 19;8(7):3617-3625. Epub 2020 May 19.

Department of Animal Science Chungbuk National University Cheongju City South Korea.

This study was conducted to investigate the effect of dietary oleic acid in olive oil-supplemented diets on the blood lipid profile and fatty acid composition in blood plasma and adipose tissue of rats. A total of 60 Sprague Dawley rats with mean body weight of 249 g ± 3.04 g were equally divided into three diet groups: control (CON) contained 10% coconut oil, olive50 contained 5% coconut oil and 5% olive oil, and olive100 contained 10% olive oil. Oleic acid (OA) level was highest in olive100 followed by the olive50 and control. The final body weight (BW) of the rats was significantly affected by the intake of OA, in which rats fed olive100 had the lowest final BW, which signified that OA could be associated with weight loss. Olive oil intake significantly increased levels of the high-density lipoprotein cholesterol (HDL-C) and exhibited a potential attenuation effect on the glutamic-oxaloacetic transaminase and the glutamic-pyruvic transaminase, and a potential role in the reduction of triglycerides in the bloodstream of the animals. In terms of fatty acid composition, significantly high OA was observed in the blood plasma and adipose tissues of rats fed olive100. Omega-3 polyunsaturated fatty acids (PUFAs), such as linolenic (C18:3 -3), eicosapentaenoic (C20:5 -3), and docosahexaenoic (C22:6 -3), and -6 PUFA arachidonic (C20:4 -6) were also significantly increased in the blood plasma of rats fed olive100. These findings suggest that the intake of dietary high OA may enhance the omega-3 fatty acid levels in the blood plasma of rats and may have a positive effect in reducing risks to cardiovascular disease, as evidenced by weight loss, increased HDL-C levels, and decreased TG levels in the blood plasma of experimental animals.
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http://dx.doi.org/10.1002/fsn3.1644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382191PMC
July 2020

Propensity score-matched analysis of internal stent vs external stent for pancreatojejunostomy during pancreaticoduodenectomy: Japanese-Korean cooperative project.

Pancreatology 2020 Jul 3;20(5):984-991. Epub 2020 Jul 3.

Department of Surgery, Seoul National University, Republic of Korea. Electronic address:

Background: Several studies comparing internal and external stents have been conducted with the aim of reducing pancreatic fistula after PD. There is still no consensus, however, on the appropriate use of pancreatic stents for prevention of pancreatic fistula. This multicenter large cohort study aims to evaluate whether internal or external pancreatic stents are more effective in reduction of clinically relevant pancreatic fistula after pancreaticoduodenectomy (PD).

Methods: We reviewed 3149 patients (internal stent n = 1,311, external stent n = 1838) who underwent PD at 20 institutions in Japan and Korea between 2007 and 2013. Propensity score matched analysis was used to minimize bias from nonrandomized treatment assignment. The primary endpoint was the incidence of clinically relevant pancreatic fistula. This study was registered on the UMIN Clinical Trials Registry (UMIN000032402).

Results: After propensity score matched analysis, clinically relevant pancreatic fistula occurred in more patients in the external stents group (280 patients, 28.7%) than in patients in the internal stents group (126 patients, 12.9%) (OR 2.713 [95% CI, 2.139-3.455]; P < 0.001). In subset analysis of a high-risk group with soft pancreas and no dilatation of the pancreatic duct, clinically relevant pancreatic fistula occurred in 90 patients (18.8%) in internal stents group and 183 patients (35.4%) in external stents group. External stents were significantly associated with increased risk for clinically relevant pancreatic fistula (OR 2.366 [95% CI, 1.753-3.209]; P < 0.001).

Conclusion: Propensity score matched analysis showed that, regarding clinically relevant pancreatic fistula after PD, internal stents are safer than external stents for pancreaticojejunostomy.
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http://dx.doi.org/10.1016/j.pan.2020.06.014DOI Listing
July 2020

Risk Factors for Recurrent Staphylococcus aureus Bacteremia.

Clin Infect Dis 2020 Jun 21. Epub 2020 Jun 21.

Department of Medicine, Duke University Medical Center, Durham, North Carolina.

Background: To understand the clinical, bacterial, and host characteristics associated with recurrent Staphylococcus aureus bacteremia (R-SAB), patients with R-SAB were compared to contemporaneous patients with a single episode of SAB (S-SAB).

Methods: All SAB isolates underwent spa genotyping. All isolates from R-SAB patients underwent Pulsed-Field Gel Electrophoresis (PFGE). PFGE-indistinguishable pairs from 40 patients underwent whole genome sequencing (WGS). Acute phase plasma from R-SAB and S-SAB patients was matched 1:1 for age, race, gender, and bacterial genotype and underwent cytokine quantification using 25-analyte multiplex bead array.

Results: R-SAB occurred in 69 (9.1%) of the 756 study patients. Of the 69 patients, 30 experienced relapse (43.5%) and 39 reinfection (56.5%). Age, race, hemodialysis dependence, presence of foreign body, MRSA, and persistent bacteremia were individually associated with likelihood of recurrence. Multivariate risk modeling revealed that African American (AA) hemodialysis patients were nearly two times more likely (OR = 9.652 [5.402 - 17.418]) than White hemodialysis patients (OR = 4.53 [1.696 - 10.879]) to experience R-SAB. WGS confirmed PFGE interpretations in all cases. Median RANTES levels in acute phase plasma from the initial episode of SAB were higher in R-SAB than in matched S-SAB controls (P = 0.0053, False Discovery Rate < 0.10).

Conclusion: This study identified several risk factors for R-SAB. The largest risk for R-SAB is among AA hemodialysis patients. Higher RANTES levels in R-SAB compared to matched controls warrants further study.
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http://dx.doi.org/10.1093/cid/ciaa801DOI Listing
June 2020

Oral Fluid Biomarkers for Diagnosing Gingivitis in Human: A Cross-Sectional Study.

J Clin Med 2020 Jun 3;9(6). Epub 2020 Jun 3.

Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul 120-749, Korea.

Diagnoses based on oral fluid biomarkers have been introduced to overcome limitations of periodontal probe-based diagnoses. Diagnostic ability of certain biomarkers for periodontitis have been identified and widely studied, however, such studies targeting gingivitis is scarce. The aims of this study were to determine and compare the efficacies and accuracies of eight biomarkers in diagnosing gingivitis with the aid of receiver operating characteristic (ROC) curves. The probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were examined in 100 participants. Gingival crevicular fluid was collected using paper points, and whole-saliva samples were collected using cotton roll. Samples were analyzed using enzyme-linked immunosorbent assay kits for the different biomarkers. The levels of matrix metalloproteinase (MMP)-8, MMP-9, lactoferrin, cystatin C, myeloperoxidase (MPO), platelet-activating factor, cathepsin B, and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen were analyzed. MPO and MMP-8 levels in saliva were strongly correlated with gingivitis, with Pearson's correlation coefficients of 0.399 and 0.217, respectively. The area under the curve (AUC) was largest for MMP-8, at 0.814, followed by values of 0.793 and 0.777 for MPO and MMP-9, respectively. The clinical parameters of GI and PI showed strong correlations and large AUC values, whereas PD and CAL did not. MMP-8 and MPO were found to be effective for diagnosing gingivitis. Further investigations based on the results of this study may identify clinically useful biomarkers for the accurate and early detection of gingivitis.
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http://dx.doi.org/10.3390/jcm9061720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356847PMC
June 2020