Publications by authors named "Seung Ho Yang"

72 Publications

Associations of General and Abdominal Obesity with the Risk of Glioma Development.

Cancers (Basel) 2021 Jun 8;13(12). Epub 2021 Jun 8.

Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

The association between obesity and the risk of glioma remains unclear. We sought to evaluate the potential association between general and abdominal obesity and the risk of glioma based on a nationwide population-based cohort study of Koreans. Using data from the Korean National Health Insurance System cohort, 6,833,744 people older than 20 years who underwent regular national health examination in both 2009 and 2011 were followed until the end of 2017. We documented 4771 glioma cases based on an ICD-10 code of C71 during the median follow-up period of 7.30 years. Individuals with a body mass index (BMI) ≥ 25.0 kg/m were at significantly higher risk of developing glioma than those with a BMI < 25.0 kg/m (HR 1.08 CI 1.02-1.15). Individuals with a waist circumference (WC) ≥ 90 cm (males)/85 cm (females) also had a significantly higher risk of glioma than those with a WC < 90 cm (males)/85 cm (females) (HR 1.16 CI 1.09-1.24). In the group with a BMI ≥ 25.0 kg/m, individuals with abdominal obesity were at significantly higher risk of developing glioma (HR 1.18 CI 1.09-1.27) than those without abdominal obesity. The role of abdominal obesity in this association was stronger in women than in men. To the best of our knowledge, this is the first demonstration that obese people may be at higher risk of glioma, especially centrally obese people from an Asian population with a BMI ≥ 25.0 kg/m. Loss of visceral fat in people with abdominal obesity may reduce their risk of developing glioma.
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http://dx.doi.org/10.3390/cancers13122859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228893PMC
June 2021

Estimation of the occurrence rates of and mutations in gliomas and the reconsideration of -wildtype anaplastic astrocytomas: an institutional experience.

J Int Med Res 2021 Jun;49(6):3000605211019258

Department of Pathology, St. Vincent?s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objectives: Most diffuse gliomas are reported to harbor isocitrate dehydrogenase () mutations. However, when these mutations are tested in clinical practice, the results are often negative.

Methods: This study examined the frequency of and mutations in gliomas classified according to the revised 2016 World Health Organization classification, and investigated their prognostic relevance. We tested 87 gliomas for and mutations using the peptide nucleic acid clamp method.

Results: mutations were observed in 42% of diffuse astrocytomas, 23% of anaplastic astrocytomas, all oligodendrogliomas and anaplastic oligodendrogliomas, and 17% of glioblastomas. An mutation was identified in one case of diffuse astrocytoma. In the survival analysis of diffuse astrocytic tumors, patients with -wildtype anaplastic astrocytomas tended to have a poor prognosis, similar to that of glioblastomas.

Conclusions: mutations were infrequent in gliomas. In anaplastic astrocytomas, the frequency of -wildtype was relatively high, and the prognosis of patients with this type of tumor was very similar to that of those with glioblastomas. It may therefore be necessary to reconsider the classification and treatment strategies for -wildtype anaplastic astrocytomas.
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http://dx.doi.org/10.1177/03000605211019258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236789PMC
June 2021

Epidemiological Study of Malignant Gliomas in Korea Using Nationwide Dataset from 2007 to 2017.

J Korean Med Sci 2021 Mar 8;36(9):e68. Epub 2021 Mar 8.

Department of Neurosurgery, Cell Death Disease Research Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Background: The purpose of the study was to investigate the incidence, prevalence, and survival of malignant gliomas (MGs) using population-based Korean National Health Insurance Database (NHID) data.

Methods: Using the Korean NHID, we identified patients with MG as C71 codes in KCD 5-7 according to ICD-10 from January 1, 2007 to December 31, 2017. Epidemiological characteristics of MG, including annual incidence, prevalence, mortality rates, and survival rates, were collected and analyzed according to socioeconomic state (SES) and treatments received.

Results: We identified 45,066 newly diagnosed-MG patients from 2007 to 2017, for an age-adjusted incidence of 7.47 per 100,000 people. The mean age at diagnosis was 54 years. The male to female ratio was 1.11. Mortality and survival probability were analyzed among total subjects and in subgroups. The mortality rates were lower in female than that of male patients (hazard ratio, 0.69; 95% confidence interval, 0.67-0.71), and in younger age population and in higher income group. Patients operated had a slightly higher survival rate. The 1-, 3-, 5-, and 10-year survival rates were estimated at 63.4%, 46.2%, 39.4%, and 34.8%, respectively. This is the first population-based study to determine the incidence and prevalence of MG according to epidemiological characteristics in Korea using NHID.

Conclusion: Our study found that female sex and high SES were factors that significantly lowered the mortality rate in MG, and younger groups and operated patients showed significantly higher survival rates.
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http://dx.doi.org/10.3346/jkms.2021.36.e68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940121PMC
March 2021

Functional Restoration of Pituitary after Pituitary Allotransplantation into Hypophysectomized Rats.

Cells 2021 01 29;10(2). Epub 2021 Jan 29.

Cell Death Disease Research Center, Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, Korea.

Long-term hormone replacement therapy due to panhypopituitarism can lead to serious complications and thus, pituitary transplantation is considered a more desirable. We investigated functional restoration after allotransplatation of the pituitary gland. We transplanted extracted pituitary gland into the omentum of an hypophysectomized rat. Two experiments were performed: (1) to confirm the hypophysectomy was successful and (2) to assess functional restoration after pituitary transplantation. Pituitary hormone level and weight change were consecutively assessed. Electron microscopic (EM) examinations were performed to identify morphological changes at 3 days after transplantation. We confirmed that pituitary gland was properly extracted from 6 rats after sacrifice. The findings showed (1) a weight loss of more than 3% or (2) a weight change of less than 2% along with a decreased growth hormone (GH) level by more than 80% at 2 weeks post-hypophysectomy. A further four rats underwent pituitary transplantation after hypophysectomy and were compared with the previously hypophysectomized rats. All showed rapid weight gain during the two weeks after transplantation. The thyroid-stimulating hormone, prolactin, and GH levels were restored at one week post-transplantation and maintained for 10 weeks. Hypophyseal tissue architecture was maintained at 3 days after transplantation, as indicated by EM. These data suggest that a transplanted pituitary gland can survive in the omentum with concomitant partial restoration of anterior pituitary hormones.
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http://dx.doi.org/10.3390/cells10020267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912485PMC
January 2021

Effect of Pioglitazone on Perihematomal Edema in Intracerebral Hemorrhage Mouse Model by Regulating NLRP3 Expression and Energy Metabolism.

J Korean Neurosurg Soc 2020 Nov 27;63(6):689-697. Epub 2020 Oct 27.

Department of Neurosurgery, Cell Death Disease Research Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objective: Cerebral edema is the predominant mechanism of secondary inflammation after intracerebral hemorrhage (ICH). Pioglitazone, peroxisome proliferator-activated receptor gamma agonist has been shown to play a role in regulation of central nervous system inflammation. Here, we examined the pharmacological effects of pioglitazone in an ICH mouse model and investigated its regulation on NLRP3 inflammasome and glucose metabolism.

Methods: The ICH model was established in C57 BL/6 mice by the stereotactical inoculation of blood (30 µL) into the right frontal lobe. The treatment group was administered i.p. pioglitazone (20 mg/kg) for 1, 3, and 6 days. The control group was administered i.p. phosphate-buffered saline for 1, 3, and 6 days. We investigated brain water contents, NLRP3 expression, and changes in the metabolites in the ICH model using liquid chromatography-tandem mass spectrometry.

Results: On day 3, brain edema in the mice treated with pioglitazone was decreased more than that in the control group. Expression levels of NLRP3 in the ICH model treated with pioglitazone were decreased more than those of the control mice on days 3 and 7. The pioglitazone group showed higher levels of glycolytic metabolites than those in the ICH mice. Lactate production was increased in the ICH mice treated with pioglitazone.

Conclusion: Our results demonstrated less brain swelling following ICH in mice treated with pioglitazone. Pioglitazone decreased NLRP3-related brain edema and increased anaerobic glycolysis, resulting in the production of lactate in the ICH mice model. NLRP3 might be a therapeutic target for ICH recovery.
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http://dx.doi.org/10.3340/jkns.2020.0056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671775PMC
November 2020

High-dose methotrexate monotherapy for newly diagnosed primary central nervous system lymphoma: 15-year multicenter experience.

Asia Pac J Clin Oncol 2021 Feb 25;17(1):123-130. Epub 2020 Sep 25.

Department of Neurosurgery, St. Vincent's Hospital, Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Aim: Primary central nervous system lymphoma (PCNSL) is rare disease and shows poor prognosis although methotrexate-based chemotherapy is used. Here, we present our experiences with high-dose methotrexate (HD-MTX) monotherapy for immunocompetent patients with PCNSL at three institutions and investigate factors related to survival.

Methods: PCNSL patients, who were histologically confirmed with diffuse large B cells and treated with HD-MTX monotherapy from 2001 to 2016, were retrospectively reviewed. Patients underwent induction chemotherapy with 8 g/m of MTX every 10 days (maximum three cycles). Maintenance chemotherapy of 3.5 g/m of MTX (maximum six cycles) was selectively performed depending on the response to induction chemotherapy.

Results: A total of 67 patients were included. Although seven patients discontinued induction chemotherapy because of MTX toxicity, 40 (59.7%) patients showed a complete response (CR) to induction chemotherapy. Twenty-six (38.8%) and three (4.5%) patients showed a CR and partial response, respectively, after maintenance chemotherapy. Forty-one patients with recurrence or progression following HD-MTX underwent second-line treatment. Progression-free survival rates were 43% and 24% at 1 and 2 years, respectively. The median overall survival was 40.3 months. In a multivariate analysis, a radiological CR to induction chemotherapy was a significant factor related to prolonged progression-free survival and overall survival (P < 0.05).

Conclusion: MTX-monotherapy is tolerable in terms of adverse effects and still considered as a treatment option in patients with PCNSL. However, an additional therapeutic option should be prepared for non-CR responders to induction chemotherapy.
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http://dx.doi.org/10.1111/ajco.13427DOI Listing
February 2021

Cigarette Smoking Is Associated with Increased Risk of Malignant Gliomas: A Nationwide Population-Based Cohort Study.

Cancers (Basel) 2020 May 25;12(5). Epub 2020 May 25.

Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea.

The association between cigarette smoking and the risk of developing malignant glioma (MG) remains unclear. We aimed to evaluate this potential association in a large general population, using a well-established and validated longitudinal nationwide database. Using data from the Korean National Health Insurance System cohort, 9,811,768 people over 20 years old without any cancer history in 2009 were followed until the end of 2017. We documented 6100 MG cases (ICD-10 code C71) during the median follow-up period of 7.31 years. Current smokers had a higher risk of developing MG (HR = 1.22, CI: 1.13-1.32) compared with never-smokers, after adjusting for confounders. This association was stronger for those who smoked ≥ 20 cigarettes daily (HR = 1.50, CI: 1.36-1.64). Furthermore, having 30 or more pack-years of smoking over the course of one's lifetime was associated with an increased risk of developing MG in a dose-dependent manner, compared with never-smokers (HR = 1.31, CI: 1.16-1.48 for 30-39 pack-years of smoking; HR = 1.36, CI: 1.17-1.59 for 40-49 pack-years of smoking; HR = 1.68; CI: 1.44-1.95 for ≥ 50 pack-years of smoking). These results suggest that cigarette smoking may be associated with developing MG. Further prospective studies could help elucidate this association.
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http://dx.doi.org/10.3390/cancers12051343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280985PMC
May 2020

The association between total lymphocyte count after concomitant chemoradiation and overall survival in patients with newly diagnosed glioblastoma.

J Clin Neurosci 2020 Jan 13;71:21-25. Epub 2019 Dec 13.

Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Electronic address:

Several studies have been conducted to determine the relationship between post-treatment total lymphocyte count (TLC) and overall survival (OS) in patients with malignant tumors including glioblastomas (GBMs). In this retrospective study, whether patients with newly diagnosed GBM experience significant lymphopenia after concomitant chemoradiation (CCRT) was evaluated, and whether TLC after this treatment is associated with OS in the treated population was examined. Using electronic medical records, all patients newly diagnosed with GBM between 2008 and 2016 at Seoul St. Mary's Hospital were retrospectively examined. The eligible criteria included the following: 1) craniotomy with surgical resection or biopsy, 2) completion of CCRT, 3) accessible baseline and/or follow-up complete blood count (CBC). Median TLC significantly decreased after completion of CCRT, compared to TLC at baseline (1742 versus 1319 cells/mm, P-value < 0.001). Patients with TLC < 1200 cells/mm at 4 weeks after the completion of CCRT showed shorter survival than those with TLC ≥ 1200 cells/mm with median OS of 14.5 versus 21.0 months (P-value = 0.017). Also, in multivariate analysis for OS, TLC < 1200 cells/mm at 4 weeks after the completion of CCRT (HR 1.97, 95% CI 1.61 - 2.25, P-value = 0.004) were significantly associated with shorter survival. The results from the present study indicate that treatment-related total lymphocyte counts after CCRT is associated with worse survival in patients with newly diagnosed GBM.
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http://dx.doi.org/10.1016/j.jocn.2019.11.017DOI Listing
January 2020

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade II Cerebral Gliomas in Adults: Version 2019.01.

Brain Tumor Res Treat 2019 Oct;7(2):74-84

Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.

Background: There was no practical guideline for the management of patients with central nervous system tumor in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has developed the guideline for glioblastoma. Subsequently, the KSNO guideline for World Health Organization (WHO) grade II cerebral glioma in adults is established.

Methods: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords regarding diffuse astrocytoma and oligodendroglioma of brain in adults.

Results: Whenever radiological feature suggests lower grade glioma, the maximal safe resection if feasible is recommended globally. After molecular and histological examinations, patients with diffuse astrocytoma, isocitrate dehydrogenase ()-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. In terms of patients with diffuse astrocytoma, -mutant and oligodendroglioma (-mutant and 1p19q codeletion), standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group while observation with regular follow up should be considered for the low-risk group.

Conclusion: The KSNO's guideline recommends that WHO grade II gliomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors and clinical characteristics of patients.
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http://dx.doi.org/10.14791/btrt.2019.7.e43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829081PMC
October 2019

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade III Cerebral Gliomas in Adults: Version 2019.01.

Brain Tumor Res Treat 2019 Oct;7(2):63-73

Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: There was no practical guideline for the management of patients with central nervous system tumor in Korea in the past. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, developed the guideline for glioblastoma successfully and published it in , the official journal of KSNO, in April 2019. Recently, the KSNO guideline for World Health Organization (WHO) grade III cerebral glioma in adults has been established.

Methods: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searches in PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords. Scope of the disease was confined to cerebral anaplastic astrocytoma and oligodendroglioma in adults.

Results: Whenever radiological feature suggests high grade glioma, maximal safe resection if feasible is globally recommended. After molecular and histological examinations, patients with anaplastic astrocytoma, isocitrate dehydrogenase ()-mutant should be primary treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy whereas those with anaplastic astrocytoma, NOS, and anaplastic astrocytoma, -wildtype should be treated following the protocol for glioblastomas. In terms of anaplastic oligodendroglioma, -mutant and 1p19q-codeletion, and anaplastic oligodendroglioma, NOS should be primary treated by standard brain radiotherapy and neoadjuvant or adjuvant PCV (procarbazine, lomustine, and vincristine) combination chemotherapy.

Conclusion: The KSNO's guideline recommends that WHO grade III cerebral glioma of adults should be treated by maximal safe resection if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors.
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http://dx.doi.org/10.14791/btrt.2019.7.e42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829084PMC
October 2019

The role of NLRP3 in traumatic brain injury and its regulation by pioglitazone.

J Neurosurg 2019 Sep 27:1-9. Epub 2019 Sep 27.

1Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea; and.

Objective: Perilesional edema is a predominant mechanism underlying secondary brain injury after traumatic brain injury (TBI). Perilesional edema is characterized by inflammation, production of proinflammatory cytokines, and migration of peripheral immune cells into the brain. The nucleotide-binding domain and leucine-rich repeat (NLR) family pyrin domain-containing 3 protein (NLRP3) is a key component of secondary injury. Pioglitazone regulates NLRP3 and other inflammatory cytokines. In the present study, the role of NLRP3 and the pharmacological effects of pioglitazone were investigated in animal TBI models.

Methods: Brain contusion was induced in a weight drop model involving 3 groups of mice: C57 BL/6 (sham group), NLRP3 knockout (K/O group), and pioglitazone-treated mice (treatment group). The percentage of brain water content of the 3 groups of mice was compared over a period of time. Western blot, immunohistochemistry, and immunofluorescence analyses were conducted to investigate NLRP3-related inflammasomes and the effects of pioglitazone in the TBI models.

Results: Brain edema was the highest on day 3 after TBI in the sham group. Brain edema in both the K/O and the treatment groups was lower than in the sham group. In Western blot, the expression of inflammasomes was higher after TBI in the sham group, but the expression of interleukin-1β, caspase-1, and NLRP3 was decreased significantly following treatment with pioglitazone. The expression of GFAP (glial fibrillary acidic protein) and Iba1 was decreased in both the K/O and treatment groups. In addition, confocal microscopy revealed a decrease in microglial cell and astrocyte activation following pioglitazone therapy.

Conclusions: The inflammasome NLRP3 plays a pivotal role in regulating cerebral edema and secondary inflammation. Interestingly, pioglitazone reduced cerebral edema and immune response after TBI by downregulating the effects of NLRP3. These results suggest that the clinical application of pioglitazone may be a neuroprotective strategy in TBI.
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http://dx.doi.org/10.3171/2019.6.JNS1954DOI Listing
September 2019

Metabolic profiling of human gliomas assessed with NMR.

J Clin Neurosci 2019 Oct 10;68:275-280. Epub 2019 Aug 10.

Department of Neurosurgery, St. Vincent's Hospital, Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Republic of Korea. Electronic address:

Little is known about the underlying metabolic alterations of gliomas. The objective of this study was to analyze metabolomic profiles of gliomas diagnosed according to revised WHO classification to demonstrate metabolic signatures beyond isocitrate dehydrogenase (IDH) 1/2 mutation. H NMR spectroscopy of tumor extracts was performed to analyze brain tumor metabolism. We detected 46 metabolites including 2-hydroxyglutarate from human brain tumors. Metabolic profiles obtained were analyzed using multivariate analysis and MetaboAnalyst 3.0, a pathway analysis tool. We found that lactate, glutamate, alanine, glutamine, 2-hydroxglutarate, serine, O-phosphocholine, glycine, glycerol, myo-inositol, aspartate, leucine, threonine, creatine, and valine had top-ranked VIP scores in metabolic pathway analyses of glioma. Major metabolism pathways perturbed in glioma included alanine/aspartate/glutamate metabolism, glycine/serine/threonine metabolism, pyruvate metabolism, taurine/hypotaurine metabolism, and d-glutamine/d-glutamate metabolism. Altered metabolites were defined between low-grade and high-grade gliomas. We identified metabolomics signatures of gliomas associated with 2-hydroxglutarate and glioma grade. Metabolic approach may lead to metabolomic cluster-precision strategy and development of metabolic anti-glioma therapy in the future.
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http://dx.doi.org/10.1016/j.jocn.2019.07.078DOI Listing
October 2019

The Korean Society for Neuro-Oncology (KSNO) Guideline for Glioblastomas: Version 2018.01.

Brain Tumor Res Treat 2019 Apr;7(1):1-9

Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: There has been no practical guidelines for the management of patients with central nervous system (CNS) tumors in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, started to prepare guidelines for CNS tumors from February 2018.

Methods: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords.

Results: First, the maximal safe resection if feasible is recommended. After the diagnosis of a glioblastoma with neurosurgical intervention, patients aged ≤70 years with good performance should be treated by concurrent chemoradiotherapy with temozolomide followed by adjuvant temozolomide chemotherapy (Stupp's protocol) or standard brain radiotherapy alone. However, those with poor performance should be treated by hypofractionated brain radiotherapy (preferred)±concurrent or adjuvant temozolomide, temozolomide alone (Level III), or supportive treatment. Alternatively, patients aged >70 years with good performance should be treated by hypofractionated brain radiotherapy+concurrent and adjuvant temozolomide or Stupp's protocol or hypofractionated brain radiotherapy alone, while those with poor performance should be treated by hypofractionated brain radiotherapy alone or temozolomide chemotherapy if the patient has methylated MGMT gene promoter (Level III), or supportive treatment.

Conclusion: The KSNO's guideline recommends that glioblastomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to the individual comprehensive condition of the patient.
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http://dx.doi.org/10.14791/btrt.2019.7.e25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504754PMC
April 2019

Analysis of Risk Factors for Posterior C1 Screw-Related Complication: A Retrospective Study of 358 Posterior C1 Screws.

Oper Neurosurg (Hagerstown) 2019 11;17(5):509-517

Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.

Background: Although C1 screw fixation is becoming popular, only a few studies have discussed about the risk factors and the patterns of C1 screw complications.

Objective: To investigate the incidence of C1 screw complications and analyze the risk factors of the C1 screw complications.

Methods: A total of 358 C1 screws in 180 consecutive patients were analyzed for C1 screw complications. Screw malposition, occipital neuralgia, major complications, and total C1 screw complications were analyzed.

Results: The distribution of C1 screw entry point is as follows: inferior lateral mass, 317 screws (88.5 %); posterior arch (PA), 38 screws (10.7 %); and superior lateral mass, 3 screws (0.8 %). We sacrificed the C2 root for 127 screws (35.5 %). C1 instrumentation induced 3.1 % screw malposition, 6.4 % occipital neuralgia, 0.6 % vascular injury, and 3.4 % major complications. In multivariate analysis, deformity (odds ratio [OR]: 2.10, P = .003), traumatic pathology (OR: 4.97, P = .001), and PA entry point (OR: 3.38, P = .001) are independent factors of C1 screw malposition. C2 root resection can decrease the incidence of C1 screw malposition (OR: 0.38, P = .012), but it is a risk factor of occipital neuralgia (OR: 2.62, P = .034). Advanced surgical experience (OR: 0.09, P = .020) correlated with less major complication.

Conclusion: The incidence of C1 screw complications might not be uncommon, and deformity or traumatic pathology and PA entry point could be the risk factors to total C1 screw complications. The PA screw induces more malposition, but less occipital neuralgia. C2 root resection can reduce screw malposition, but increases occipital neuralgia.
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http://dx.doi.org/10.1093/ons/opz068DOI Listing
November 2019

Functional survival of rat pituitary gland in hypothermic storage for pituitary transplantation.

Pituitary 2019 Aug;22(4):353-361

Department of Neurosurgery, College of Medicine, Cell Death Disease Research Center, St. Vincent's Hospital, The Catholic University of Korea, 222, Banpodaero, Seochogu, Seoul, South Korea.

Purpose: Deteriorated pituitary function can lead to serious complications that might need lifelong hormone replacement therapy. However, long-term hormone administration can have significant adverse effects. Thus, it would be more desirable to restore pituitary function by pituitary transplantation. In this study, we investigated functional preservation of extracted pituitary gland in special preservation solution under hypothermic condition for pituitary transplantation.

Methods: We obtained nineteen pituitary glands from 250-300 g male Sprague-Dawley rats via parapharyngeal approach. These extracted glands were divided into three pieces and stored in histidine-tryptophan-ketoglutarate (HTK) solution at 4 °C and compared to their corresponding glands stored in phosphate buffer saline (PBS). Light and electron microscopic examinations were performed to identify morphological changes of pituitary gland at 0,3, and 7 days after storage. TUNEL assay to confirm cell viability, and adenosine-triphosphate (ATP) concentration were also serially examined.

Results: Tissue architecture and cellular viability of specimens preserved in HTK solution for 3 days were considerably maintained and similar to those in normal pituitary gland (0 day specimen). In contrast, specimens stored in PBS were markedly destroyed after 3 days of storage. After 7 days of storage, significant degeneration occurred in tissues stored in both HTK and PBS. However, tissue architecture was preserved more in specimens stored in HTK solution than those stored in PBS. ATP concentration decreased more rapidly in specimens stored in PBS solution, but there was no statistical significance (p= 0.055).

Conclusions: Extracted rat pituitary gland supplemented with special preservation solution could be preserved for 3 days under hypothermic condition.
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http://dx.doi.org/10.1007/s11102-019-00959-7DOI Listing
August 2019

Change of Extracellular Glutamate Level in Striatum during Deep Brain Stimulation of the Entopeduncular Nucleus in Rats.

J Korean Neurosurg Soc 2019 Mar 27;62(2):166-174. Epub 2019 Feb 27.

Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objective: Globus pallidus interna (GPi) is acknowledged as an essential treatment for advanced Parkinson's disease (PD). Nonetheless, the neurotransmitter study about its results is undiscovered. The goal of this research was to examine influences of entopeduncular nucleus (EPN) stimulation, identical to human GPi, in no-lesioned (NL) rat and 6-hydroxydopamine (6-HD)-lesioned rat on glutamate change in the striatum.

Methods: Extracellular glutamate level changes in striatum of NL category, NL with deep brain stimulation (DBS) category, 6-HD category, and 6-HD with DBS category were examined using microdialysis and high-pressure liquid chromatography. Tyrosine hydroxylase (TH) immunoreactivities in substantia nigra and striatum of the four categories were also analyzed.

Results: Extracellular glutamate levels in the striatum of NL with DBS category and 6-HD with DBS category were significantly increased by EPN stimulation compared to those in the NL category and 6-HD category. EPN stimulation had no significant effect on the expression of TH in NL or 6-HD category.

Conclusion: Clinical results of GPi DBS are not only limited to direct inhibitory outflow to thalamus. They also include extensive alteration within basal ganglia.
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http://dx.doi.org/10.3340/jkns.2018.0122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411569PMC
March 2019

Validity of a Smartphone Application (Sagittalmeter Pro) for the Measurement of Sagittal Balance Parameters.

World Neurosurg 2019 Jun 14;126:e8-e15. Epub 2018 Dec 14.

Department of Neurosurgery, St. Vincent`s Hospital, Catholic University of Korea, Suwon, South Korea.

Objective: The study was aimed to compare the validity, reproducibility, precision, and efficiency of a picture archiving and communication system (PACS) and a smartphone application, which is an educative app to easily measure sagittal balance parameters (SagittalMeter Pro), for measuring spinopelvic sagittal parameters.

Methods: Three spine surgeons measured lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) on standing posteroanterior radiographs of 30 patients using PACS and SagittalMeter Pro. Measurements were repeated a week after the original measurements. Intraobserver and interobserver variabilities and reliabilities of each parameter (LL, PI, SS, and PT) were calculated for both techniques. Comparisons were performed using the paired t-test. Results are expressed as mean ± standard deviation and P values of < 0.05 were considered significant.

Results: PACS to SagittalMeter Pro differences between the mean absolute values of LL, PI, SS, PT were 0.50°, 0.82°, 0.81°, 0.34°, respectively, and intraobserver and interobserver variabilities were similar. Excellent intraobserver and interobserver reliabilities were obtained for PACS and SagittalMeter Pro as demonstrated by values >0.86 and >0.84, respectively. Measurement times for PACS and SagittalMeter Pro were 36.63 ± 7.55 and 14.57 ± 1.96 seconds, respectively, and this difference was significant (P = 0.001).

Conclusions: The study shows PACS and SagittalMeter Pro are equivalent in terms of their abilities to measure spinopelvic sagittal parameters, and that the time required to obtain measurements was significantly less for SagittalMeter Pro. We believe that SagittalMeter Pro may be helpful when planning spinal surgery.
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http://dx.doi.org/10.1016/j.wneu.2018.11.242DOI Listing
June 2019

Difference of Dynamic Morphometric Changes Between in Patients with Ossification of Posterior Longitudinal Ligament and Patients with Cervical Spondylosis: Assessment by Cervical Dynamic Magnetic Resonance Imaging.

World Neurosurg 2019 Mar 6;123:e566-e573. Epub 2018 Dec 6.

Department of Neurosurgery, Eunpyeong St. Mary's Hospital, Seoul, South Korea. Electronic address:

Purpose: To evaluate differences between thicknesses of the ligamentum flavum (LF) and diameter of the spinal canal in different neck positions in patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical degenerative spondylosis (CDS) using cervical dynamic magnetic resonance imaging (MRI).

Methods: Eighty-eight patients (66 CDS and 22 OPLL) who underwent neutral and dynamic MRI at our institute from February 2014 to July 2017 were the subjects of this retrospective study. Canal diameters and LF thicknesses were measured and Muhle's grades were determined in neutral and dynamic MRI from C2-C3 to C7-T1. Patients with CDS and OPLL were compared with respect to changes in morphometric parameters. Statistical analysis was performed using SPSS software and statistical significance was accepted for P values < 0.05.

Results: Mean ages in the CDS and OPLL groups were 68.2 ± 12.27 and 63.1 ± 9.36 years, respectively. Mean canal diameters were smaller in extension than in neutral at all measured levels, especially between C3-C4 and C6-C7 in patients with CDS. LF thickness in extension was significantly greater than in neutral and flexion positions in the CDS group, but not in the OPLL group. In addition, positional changes in Muhle's grades in the CDS group were significantly greater than in the OPLL group (P = 0.042).

Conclusions: Dynamic morphometric changes were found to be significantly greater in the CDS group than in the OPLL group. The study shows dynamic MRI may provide additional information in CDS patients.
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http://dx.doi.org/10.1016/j.wneu.2018.11.213DOI Listing
March 2019

Influence of the Sintering Temperature of Al-Doped Higher Manganese Silicide for Improved Thermoelectric Properties.

J Nanosci Nanotechnol 2019 Mar;19(3):1699-1703

Department of Materials Science and Engineering, Inha University, Incheon 22212, Republic of Korea.

Higher manganese silicide is generally used in thermoelectric devices between 700 K and 900 K. MnSiAl samples were fabricated by two continuous solid-state reactions followed by hot pressing because the electrical conductivity of all the samples is strongly dependent on Al doping, showing superior thermoelectric performance to the as-synthesized higher manganese silicide. The solid-state-reaction was performed at 1173 K for 6 hours. The effects of the sintering temperature were examined by sintering at three different temperatures: 1273 K, 1323 K and 1373 K. For the surface, microstructural, and electrical properties, scanning electron microscopy, X-ray diffraction, and a series of electric conductivity, Seebeck coefficient, and thermal conductivity analyses were conducted, respectively. As a result, the optimal process temperature for Al-doped higher manganese silicide using a hot-press technique was determined.
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http://dx.doi.org/10.1166/jnn.2019.16188DOI Listing
March 2019

Intermetallic Growth Mechanism and Mechanical Properties of Post-Annealed SAC305 Solder Joints on Cu-Based Electrode Interfaces.

J Nanosci Nanotechnol 2019 Mar;19(3):1645-1648

Department of Materials Science and Engineering, Inha University, Incheon 22212, Republic of Korea.

Intrinsic Cu- and Ni-added Cu electrodes were prepared to study Sn-3Ag-0.5Cu lead-free solder joints. Our work focused on three categories: (1) formation and role of intermetallic compounds, (2) structural and compositional change of intermetallic compounds due to thermal aging effects, and (3) mechanical bonding strength of solder joints. A series of SEM, EDX, and bonding test analyses were performed on two electrode types to study joint morphologies, the types of intermetallic compounds formed, and bonding strengths, respectively. As a result, after heat treatments at 150 °C for 10 h, 100 h, and 300 h, CuSn and (Ni, Cu)₃Sn₄ were obtained at the interfaces of the intrinsic Cu electrode and the Ni-added Cu electrode, respectively. In the Ni-added Cu electrode samples, the growth rate of the intermetallic compounds was reduced, but the mechanical bonding strength had a higher value compared to that of the intrinsic Cu electrode. The bonding characteristics under different heat treatment conditions are also discussed.
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http://dx.doi.org/10.1166/jnn.2019.16187DOI Listing
March 2019

Thermoelectric Properties of Cu-Doped Bi₂TeSe Fabricated by Hot Pressing.

J Nanosci Nanotechnol 2019 Mar;19(3):1533-1537

Department of Material Science and Engineering, INHA University, Incheon 22212, Korea.

Owing to the energy and environmental issues, energy recovery technologies attract an increasing interest. Thermoelectric power generation is a recycling technology, which directly converts heat energy into electric energy by reusing waste heat. In this study, -type Bi₂TeSe thermoelectric materials doped with Cu were fabricated by hot pressing. The Bi-Te system has excellent thermoelectric properties in the middle- and low-temperature ranges; when a certain amount of Cu dopant is added, the thermoelectric properties are improved. The thermoelectric properties of the samples doped with Cu were compared with those of the intrinsic Bi-Te-based sample without Cu doping. In addition, the effects of the Cu concentration on the thermoelectric-material structures were investigated.
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http://dx.doi.org/10.1166/jnn.2019.16199DOI Listing
March 2019

The Usefulness of Dual-Volume Visualization (Three-Dimensional Digital Subtraction Angiography and Cross-Sectional Imaging) for Surgical Planning in Treating Intracranial Meningiomas: A Case Series and Technical Report.

World Neurosurg 2019 Feb 18;122:e59-e66. Epub 2018 Sep 18.

Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Objective: In presurgical planning for intracranial meningiomas, the relationship between tumors and adjacent vasculature must be identified. The purpose of this study was to evaluate the usefulness of 3-dimensional digital subtraction angiography (3D-DSA) with dual-volume visualization (DVV).

Methods: Between February 2013 and April 2016, 26 patients with intracranial meningiomas enrolled in this study. Two or 3 days before surgery, 3D-DSA with DVV was performed for presurgical planning. If necessary, the tumor was simultaneously embolized.

Results: Vascular supply and disfiguration observed by preoperative 3D-DSA with DVV closely resembled those actually observed during surgery. All but 2 patients had total tumor resection (Simpson grade 1 or 2). Three of 26 patients had new neurologic deficits.

Conclusions: 3D-DSA with DVV may be useful for preoperative planning by allowing the surgeon to identify the relationship between a tumor and peritumoral vasculature before meningioma surgery. Young neurosurgeons with little experience may benefit most from this technique.
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http://dx.doi.org/10.1016/j.wneu.2018.09.046DOI Listing
February 2019

900MHz 1H-/13C-NMR analysis of 2-hydroxyglutarate and other brain metabolites in human brain tumor tissue extracts.

PLoS One 2018 7;13(9):e0203379. Epub 2018 Sep 7.

Department of Molecular Medicine, Gachon University School of Medicine, Yeonsu-gu, Incheon, Korea.

Purpose: To perform in vitro high-resolution 900 MHz magnetic resonance spectroscopy (NMR) analysis of human brain tumor tissue extracts and analyze for the oncometabolite 2-hydroxyglutarate (2HG) and other brain metabolites, not only for 1H but also for 13C with indirect detection by heteronuclear single quantum correlation (HSQC).

Material And Methods: Four surgically removed human brain tumor tissue samples were used for extraction and preparation of NMR samples. These tissue samples were extracted with 4% perchloric acid and chloroform, freeze-dried, then dissolved into 0.28 mL of deuterium oxide (D2O, 99.9 atom % deuterium) containing 0.025 wt % sodium 3-(trimethylsilyl)propionate-2,2,3,3-d4 (TSP). All samples were adjusted to pH range of 6.9-7.1 before finally transferred to 5 mm Shigemi™ NMR microtube. NMR experiments were performed on Bruker DRX 900 MHz spectrometer with 1H/13C/15N Cryo-probe™ with Z-gradient, without further temperature control for the samples. All chemical shift values were presented relative to TSP at 0.00 ppm for both 1H and 13C. 1H 1D, 1H-13C HSQC, 1H-1H correlation spectroscopy (COSY) and 1H-13C heteronuclear multiple bond correlation (HMBC) spectra were acquired and analyzed.

Results: 2-hydroxyglutarate, an oncometabolite associated with gliomas with IDH mutations, was successfully detected and assigned by both 1H-13C HSQC and 1H-1H COSY experiments as well as 1H 1D experiments in two of the tissue samples. In particular, to our knowledge this work shows the first example of detecting 900 MHz 13C-NMR spectral lines of 2-hydroxyglutarate in human brain tumor tissue samples. In addition to the oncometabolite 2-hydroxyglutarate, at least 42 more metabolites were identified from our series of NMR experiment.

Conclusion: The detection of 2-hydroxyglutarate and other metabolites can be facilitated by homonuclear and heteronuclear two-dimensional 900 MHz NMR spectroscopy even in case of real tumor tissue sample extracts without physical separation of metabolites.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203379PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128478PMC
February 2019

Procarbazine and CCNU Chemotherapy for Recurrent Glioblastoma with MGMT Promoter Methylation.

J Korean Med Sci 2018 Jun 10;33(24):e167. Epub 2018 May 10.

Department of Neurosurgery, The Catholic University of Korea, St. Vincent's Hospital, Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Background: While procarbazine, CCNU (lomustine), and vincristine (PCV) has been an alternative chemotherapy option for malignant gliomas, it is worth investigating whether the combination of only procarbazine and CCNU is comparable because vincristine adds toxicity with uncertain benefit. The purpose of this study was to evaluate the feasibility of procarbazine and CCNU chemotherapy for recurrent glioblastoma multiforme (GBM) with O-methylguanine-DNA-methyltransferase (MGMT) promoter methylation.

Methods: Eight patients with recurrent GBM following concurrent chemoradiotherapy and temozolomide (TMZ) adjuvant therapy were enrolled in this trial; they received no other chemotherapeutic agents or target therapy. They received CCNU (75 mg/m) on day 1 and procarbazine (60 mg/m) through days 11 and 24 every 4 weeks. The median cycle of CCNU and procarbazine was 3.5 (range: 2-6).

Results: One patient achieved stable disease. The median progression-free survival (PFS) with procarbazine and CCNU chemotherapy was eight weeks (range: 5-73), and the PFS rates were 25% and 12.5% at 16 and 30 weeks, respectively. The median overall survival (OS) from the initial diagnosis to death was 40 months, and the median OS from the administration of procarbazine and CCNU chemotherapy to death was 9.7 months (95% confidence interval: 6.7-12.7). Serious adverse events were found at six visits, and two cases were considered to be grade 3 toxicities.

Conclusion: The efficacy of procarbazine and CCNU chemotherapy is not satisfactory. This study suggests the need to develop other treatment strategies for recurrent and TMZ-refractory GBM. Trial registry at ClinicalTrials.gov, NCT017337346.
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http://dx.doi.org/10.3346/jkms.2018.33.e167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990446PMC
June 2018

A useful diagnostic method to reduce the in-hospital time delay for mechanical thrombectomy: volume perfusion computed tomography with added vessel reconstruction.

J Neurosurg 2018 Apr 1:1-8. Epub 2018 Apr 1.

OBJECTIVEVolume perfusion CT (VPCT) with added CT angiography (CTA)-like reconstruction from VPCT source data (VPCTA) can reveal multiple intracranial parameters. The authors examined the usefulness of VPCTA in terms of reducing the in-hospital time delay for mechanical thrombectomy.METHODSA total of 180 patients who underwent mechanical thrombectomy at the authors' institution between January 2014 and March 2017 were divided into 2 groups: a CTA-based thrombectomy decision group (group 1: CTA) and a VPCTA-based decision group (group 2: VPCTA). Multiple time interval categories (from symptom onset to groin puncture, from hospital arrival to groin puncture, procedure time, from symptom onset to reperfusion, and from hospital arrival to reperfusion) were reviewed. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale score and the modified Rankin Scale, and radiological results were evaluated by the Thrombolysis in Cerebral Infarction score.RESULTSIn all of the time interval categories except for procedure time, the VPCTA group showed a significantly shorter in-hospital time delay during the prethrombectomy period than did the CTA group. The 3-month modified Rankin Scale score was significantly lower in the VPCTA group (2.8) compared with the CTA group (3.5) (p = 0.003). However, there were no statistically significant differences between the 2 groups in the other clinical and radiological outcomes.CONCLUSIONSCompared with CTA, VPCTA significantly reduced the in-hospital time delay during the prethrombectomy period.
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http://dx.doi.org/10.3171/2017.10.JNS171971DOI Listing
April 2018

Effects of Heat Treatment on Interfacial Behavior and Bonding Strength of Surface Activated Bonding Ti-Al Laminate.

J Nanosci Nanotechnol 2018 Mar;18(3):1847-1850

Department of Materials Engineering, Inha University, Incheon 22212, Republic of Korea.

The surface activated bonding (SAB) method generally has the advantage of high bonding strength, low contact resistance, and high microstructural stability at room temperature. In this study, Ti-Al laminates were produced by surface activated bonding with aluminum and titanium foils. Heat treatment was conducted at the temperature range from 200 to 550 °C in vacuum. The bonding strength Ti-Al laminates was measured by a peel test, and the interfacial characteristics were investigated microstructural observation. The results showed that the bonding strength was the highest with heat treatment at 400 °C, microstructure observation revealed that the bonding strength of the Ti-Al laminate was influenced by the interfacial characteristics.
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http://dx.doi.org/10.1166/jnn.2018.14992DOI Listing
March 2018

High-Dose Metformin Plus Temozolomide Shows Increased Anti-tumor Effects in Glioblastoma In Vitro and In Vivo Compared with Monotherapy.

Cancer Res Treat 2018 Oct 10;50(4):1331-1342. Epub 2018 Jan 10.

Department of Neurosurgery, St. Vincent's Hospital, Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Purpose: The purpose of the study is to investigate the efficacy of combined treatment with temozolomide (TMZ) and metformin for glioblastoma (GBM) in vitro and in vivo.

Materials And Methods: We investigated the efficacy of combined treatment with TMZ and metformin using cell viability and apoptosis assays. A GBM orthotopic mice model was established by inoculation of 5×105 U87 cells and treatedwith metformin, TMZ, and the combination for 4weeks. Western blotting and immunofluorescence of tumor specimens were analyzed to investigate AMP-activated protein kinase (AMPK) and AKT pathway.

Results: The combination of TMZ and metformin showed higher cytotoxicity than single agents in U87, U251, and A172 cell lines. A combination of high-dose metformin and TMZ showed the highest apoptotic activity. The combination of TMZ and metformin enhanced AMPK phosphorylation and inhibited mammalian target of rapamycin phosphorylation, AKT phosphorylation, and p53 expression. The median survival of each group was 43.6, 55.2, 53.2, 65.2, and 71.3 days for control, metformin treatment (2 mg/25 g/day or 10 mg/25 g/day), TMZ treatment (15 mg/kg/day), combination treatment with low-dose metformin and TMZ, and combination treatment with high-dose metformin and TMZ, respectively. Expression of fatty acid synthase (FASN) was significantly decreased in tumor specimens treated with metformin and TMZ.

Conclusion: The combination of metformin and TMZ was superior to monotherapy using metformin or TMZ in terms of cell viability in vitro and survival in vivo. The combination of high-dose metformin and TMZ inhibited FASN expression in an orthotopic model. Inhibition of FASN might be a potential therapeutic target of GBM.
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http://dx.doi.org/10.4143/crt.2017.466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192919PMC
October 2018

A Novel Technique for Cervical Laminoplasty Fusion: Simultaneously Enhancing Stabilization and Decompression in Various Cervical Myelopathies: A Technical Note and Outcomes.

World Neurosurg 2018 Mar 8;111:361-366. Epub 2018 Jan 8.

Department of Neurosurgery, Catholic University of Korea, St. Vincent's Hospital, Suwon, Gyeonggi-do, South Korea.

Background: Cervical laminectomy has 2 major disadvantages: postlaminectomy adhesion of dural membrane and lack of a fusion bed. The objective of this study was to determine whether simultaneous cervical laminoplasty with fusion (CLPF) might overcome these unwanted outcomes.

Methods: Patients who underwent CLPF for treating cervical myelopathy with instability who were followed up for at least 12 months were enrolled. Preoperative and postoperative Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores before and after surgery, recovery rates (RRs), C2-C7 lordosis, and fusion success rates were evaluated.

Results: The study cohort comprised 50 patients (35 males and 15 females; mean age, 60.5 ± 14.0 years) who underwent CLPF. The average duration of clinical follow-up was 24.6 ± 16.1 months. Mean preoperative and postoperative NDI scores were 27.0 ± 10.6 and 17.6 ± 7.2, respectively (P = 0.004). Mean preoperative and postoperative JOA scores were 10.4 ± 4.2 and 13.6 ± 3.0, respectively (P = 0.001). The mean JOA RR was 49.8 ± 42.2%. No significant changes in C2-7 lordosis were noted after surgery (preoperative, 7.0 ± 8.0°; postoperative, 7.3 ± 6.3°; P = 0.789). The fusion success rate was 96% (48 of 50 patients). Fusion mass areas at C5 level were significantly different between the opening side and the hinge side (opening side, 15.8 ± 13.1 mm; hinge side, 50.8 ± 27.2 mm; P < 0.001). There was no postoperative restenosis or epidural fibrosis.

Conclusions: CLPF might be useful for canal decompression and a good fusion bed while avoiding postoperative epidural fibrosis.
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http://dx.doi.org/10.1016/j.wneu.2018.01.018DOI Listing
March 2018

Predictive Factors for Recurrence after Burr-Hole Craniostomy of Chronic Subdural Hematoma.

J Korean Neurosurg Soc 2017 Nov 25;60(6):701-709. Epub 2017 Oct 25.

Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Objective: Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma.

Methods: We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study.

Results: Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (=0.0279), headache (=0.0323), and preoperative midline shifting (=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899-6.2898; =0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287-40.2369; =0.0364), headache (OR, 2.951; 95% CI, 1.1464-7.5964; =0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040-1.1699; =0.0391) were independent predictive factors for recurrence of chronic subdural hematoma.

Conclusion: We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.
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http://dx.doi.org/10.3340/jkns.2016.1010.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678055PMC
November 2017

Similarity Analysis of Korean Medical Literature and Its Association with Efforts to Improve Research and Publication Ethics.

J Korean Med Sci 2017 Jun;32(6):887-892

Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea.

In the present study, the frequency of research misconduct in Korean medical papers was analyzed using the similarity check software iThenticate®. All Korean papers written in English that were published in 2009 and 2014 in KoreaMed Synapse were identified. In total, 23,848 papers were extracted. 4,050 Journal Articles of them were randomly selected for similarity analysis. The average Similarity Index of the 4,050 papers decreased over time, particularly in 2013: in 2009 and 2014, it was 10.15% and 5.62%, respectively. And 357 (8.8%) had a Similarity Index of ≥ 20%. Authors considered a Similarity Index of ≥ 20% as suspected research misconduct. It was found that iThenticate® cannot functionally process citations without double quotation marks. Papers with a Similarity Index of ≥ 20% were thus individually checked for detecting such text-matching errors to accurately identify papers with suspected research misconduct. After correcting text-matching errors, 142 (3.5% of the 4,050 papers) were suspected of research misconduct. The annual frequency of these papers decreased over time, particularly in 2013: in 2009 and 2014, it was 5.2% and 1.7%, respectively. The decrease was associated with the introduction of CrossCheck by KoreaMed and the frequent use of similarity check software. The majority (81%) had Similarity Indices between 20% and 40%. The fact suggested that low Similarity index does not necessarily mean low possibility of research misconduct. It should be noted that, although iThenticate® provides a fundamental basis for detecting research misconduct, the final judgment should be made by experts.
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http://dx.doi.org/10.3346/jkms.2017.32.6.887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426249PMC
June 2017
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