Publications by authors named "Sunhee Kim"

81 Publications

Comparative Renal Effects of Dipeptidyl Peptidase-4 Inhibitors and Sodium-Glucose Cotransporter 2 Inhibitors on Individual Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.

Endocrinol Metab (Seoul) 2021 Mar 31. Epub 2021 Mar 31.

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

Background: To compare the renal effects of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors on individual outcomes in patients with type 2 diabetes.

Methods: We searched electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) from inception to June 2019 to identity eligible randomized controlled trials of DPP-4 inhibitors or SGLT2 inhibitors that reported at least one kidney outcome in patients with type 2 diabetes. Outcomes of interest were microalbuminuria, macroalbuminuria, worsening nephropathy, and end-stage kidney disease (ESKD). We performed an arm-based network meta-analysis using Bayesian methods and calculated absolute risks and rank probabilities of each treatment for the outcomes.

Results: Seventeen studies with 87,263 patients were included. SGLT2 inhibitors significantly lowered the risks of individual kidney outcomes, including microalbuminuria (odds ratio [OR], 0.64; 95% credible interval [CrI], 0.41 to 0.93), macroalbuminuria (OR, 0.48; 95% CrI, 0.24 to 0.72), worsening nephropathy (OR, 0.65; 95% CrI, 0.44 to 0.91), and ESKD (OR, 0.65; 95% CrI, 0.46 to 0.98) as compared with placebo. However, DPP-4 inhibitors did not lower the risks. SGLT2 inhibitors were considerably associated with higher absolute risk reductions in all kidney outcomes than DPP-4 inhibitors, although the benefits were statistically insignificant. The rank probabilities showed that SGLT2 inhibitors were better treatments for lowering the risk of albuminuria and ESKD than placebo or DPP-4 inhibitors.

Conclusion: SGLT2 inhibitors were superior to DPP-4 inhibitors in reducing the risk of albuminuria and ESKD in patients with type 2 diabetes.
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http://dx.doi.org/10.3803/EnM.2020.912DOI Listing
March 2021

Development and Validation of a Deep Learning Based Diabetes Prediction System Using a Nationwide Population-Based Cohort.

Diabetes Metab J 2021 Feb 25. Epub 2021 Feb 25.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.

Background: Previously developed prediction models for type 2 diabetes mellitus (T2DM) have limited performance. We developed a deep learning (DL) based model using a cohort representative of the Korean population.

Methods: This study was conducted on the basis of the National Health Insurance Service-Health Screening (NHIS-HEALS) cohort of Korea. Overall, 335,302 subjects without T2DM at baseline were included. We developed the model based on 80% of the subjects, and verified the power in the remainder. Predictive models for T2DM were constructed using the recurrent neural network long short-term memory (RNN-LSTM) network and the Cox longitudinal summary model. The performance of both models over a 10-year period was compared using a time dependent area under the curve.

Results: During a mean follow-up of 10.4±1.7 years, the mean frequency of periodic health check-ups was 2.9±1.0 per subject. During the observation period, T2DM was newly observed in 8.7% of the subjects. The annual performance of the model created using the RNN-LSTM network was superior to that of the Cox model, and the risk factors for T2DM, derived using the two models were similar; however, certain results differed.

Conclusion: The DL-based T2DM prediction model, constructed using a cohort representative of the population, performs better than the conventional model. After pilot tests, this model will be provided to all Korean national health screening recipients in the future.
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http://dx.doi.org/10.4093/dmj.2020.0081DOI Listing
February 2021

Searching for General Model of Conspiracy Theories and Its Implication for Public Health Policy: Analysis of the Impacts of Political, Psychological, Structural Factors on Conspiracy Beliefs about the COVID-19 Pandemic.

Int J Environ Res Public Health 2020 12 31;18(1). Epub 2020 Dec 31.

Department of Local Government Administration, Gangneung-Wonju National University, Gangneung-si 25457, Korea.

Along with the spread of the COVID-19 pandemic, beliefs in conspiracy theories are spreading within and across countries. This study aims to analyze predictors of beliefs in conspiracy theories. Because previous studies have emphasized only specific political, psychological, or structural factors or variables, this study constructs an integrated analytical model that includes all three factors. We analyze data from a large-scale survey of Koreans ( = 1525) and find several results. First, political, psychological, and structural factors influence beliefs in conspiracy theories. Second, when we examine the specific influences of the variables, we find that authoritarianism, support for minority parties, religiosity, trust in SNS (social networking services), perceived risk, anxiety, negative emotions, blame attribution, the quantity of information, health status, and health after COVID-19, all positively influence beliefs in conspiracy theories. Conversely, support for President Moon Jae-In's government, Christianity, trust in the government, perceived control, analytic thinking, knowledge, the quality of information, and gender, all negatively impact these beliefs. Among the predictors, the quality of information, health status, support for President Moon Jae-In's government, perceived risk, and anxiety have the most decisive impacts on beliefs in conspiracy theories.
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http://dx.doi.org/10.3390/ijerph18010266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796329PMC
December 2020

Analysis of the Impact of Health Beliefs and Resource Factors on Preventive Behaviors against the COVID-19 Pandemic.

Int J Environ Res Public Health 2020 11 22;17(22). Epub 2020 Nov 22.

Department of Public Administration, Ajou University, Suwon 16499, Korea.

The global spread of COVID-19 requires not only national-level responses but also active compliance with individual-level prevention measures. Because COVID-19 is an infectious disease that spreads through human contact, it is impossible to end its spread without individuals' active cooperation and preventive behavior. This study analyzes the effects of health beliefs and resource factors on behaviors to prevent COVID-19. In particular, it analyzes how resource factors moderate the impact of health beliefs on preventive behavior. A regression analysis showed that gender (female), age, number of elderly people in one's family, perceived severity, perceived benefit, self-efficacy, poor family health, media exposure, knowledge, personal health status, and social support positively affected preventive actions, whereas perceived susceptibility negatively affected them. In explaining preventive actions, self-efficacy had the greatest explanatory power, followed by gender (female), knowledge, personal health status, perceived severity, and social support. In addition, an analysis of moderating effects shows that resource variables, such as education level, personal health status, and social support, play moderating roles in inducing preventive actions.
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http://dx.doi.org/10.3390/ijerph17228666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700576PMC
November 2020

Searching for New Directions for Energy Policy: Testing Three Causal Models of Risk Perception, Attitude, and Behavior in Nuclear Energy Context.

Int J Environ Res Public Health 2020 10 12;17(20). Epub 2020 Oct 12.

Department of Local Government Administration, Gangneung-Wonju National University, Gangneung-si 25457, Korea.

Although many risk studies investigate perceptions, attitudes, and behaviors, the causal relationships among them have not yet been verified. Thus, further investigations of these relationships are necessary. This study analyzes three causal models consisting of three components: perceptions (i.e., perceived risk in this study), attitudes (i.e., satisfaction), and behavior (i.e., support for policy). This study checks these relationships in the context of nuclear energy policy. Using a hierarchical regression model, this study tests three different models between the three components: (1) Model 1 (a high-involvement model), (2) Model 2 (a low-involvement model), and (3) Model 3 (a hedonic model). First, in the high-involvement model, behavior is affected by perceptions and attitudes. In particular, attitudes mediate the relationship between risk perceptions and satisfaction. Second, in the low-involvement model, attitudes indirectly affect perceptions through behaviors. Third, in the hedonic model, behaviors affect attitudes, and risk perceptions do not mediate that relationship. This causal model does not depend on perceptions of the benefits and drawbacks of nuclear power. Our analysis shows that Model 1 is fully significant, and Model 2 and 3 are only partially significant.
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http://dx.doi.org/10.3390/ijerph17207403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600510PMC
October 2020

Spatial localization of charged molecules by salt ions in oil-confined water microdroplets.

Sci Adv 2020 Oct 7;6(41). Epub 2020 Oct 7.

Center for Plant Aging Research, Institute for Basic Science, Daegu 42988, Republic of Korea.

Cells contain more than 100 mM salt ions that are typically confined to dimensions of 5 to 10 micrometers by a hydrophobic cellular membrane. We found that in aqueous microdroplets having the same size as cells and that are confined in hydrocarbon oil, negatively charged molecules were distributed rather uniformly over the interior of the microdroplet, whereas positively charged molecules were localized at and near the surface. However, the addition of salt (NaCl) to the microdroplet caused all charged molecules to be localized near the oil-water interface. This salt-induced relocalization required less salt concentration in microdroplets compared to bulk water. Moreover, the localization became more prominent as the size of the microdroplet was reduced. The relocatization also critically depended on the type of oil. Our results imply that salt ions and different hydrophobic interfaces together may govern the local distribution of charged biomolecules in confined intracellular environments.
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http://dx.doi.org/10.1126/sciadv.aba0181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541078PMC
October 2020

Laparoscopic pancreatectomy for cancer in high volume centers is associated with an increased use and fewer delays of adjuvant chemotherapy.

HPB (Oxford) 2021 Apr 25;23(4):625-632. Epub 2020 Sep 25.

Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA. Electronic address:

Background: This study aimed to investigate the relationship between hospital case volume, surgical approach and AC-use in patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC).

Methods: Patients were divided into quartiles by institutional pancreatectomy case volume, resection type (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or total pancreatectomy [TP]) and surgical approach (laparoscopic vs. open). The rates and contributing factors of AC administration and delay >90 days were compared among volume quartiles and surgical approaches.

Results: This study identified 23,494 patients who had undergone pancreatectomy for PDAC between 2010 and 2016 and met inclusion criteria. After correcting for confounders, compared to low volume hospitals patients at high-case-volume hospitals had the highest rates of AC administration after PD and DP. Moreover, compared to open surgery for all resection types, laparoscopic surgery was associated with a higher rate of AC use at high and highest-case-volume hospitals and less delay to chemotherapy at high-volume hospitals. For DP, laparoscopic approach had a positive impact on AC delay >90-day at the highest volume institutions only.

Conclusions: Laparoscopic surgery for pancreatic cancer leads to higher utilization and lower probability of delay of AC in high and highest volume hospitals.
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http://dx.doi.org/10.1016/j.hpb.2020.09.003DOI Listing
April 2021

A consistent approach to the genotype encoding problem in a genome-wide association study of continuous phenotypes.

PLoS One 2020 15;15(7):e0236139. Epub 2020 Jul 15.

The Department of Industrial and Systems Engineering, Kongju National University, Cheonan, South Korea.

In this study, we suggested a hypothesis test method that was robust to different genotype encodings in a genome-wide association analysis of continuous traits. When the population stratification is corrected for using a method based on principal component analysis, ordinally (or categorically) encoded genotypes are adjusted and turn into continuous values. Due to the adjustment of the encoded genotype, the association test result using conventional methods, such as the test of Pearson's correlation coefficient, was shown to be dependent on how genotypes were encoded. To overcome this shortcoming, we proposed a non-parametric test based on Kendall's tau. Because Kendall's tau deals with rank, rather than value, associations between adjusted genotype and phenotype values, Kendall's test can be more robust than Pearson's test under different genotype encodings. We assessed the robustness of Kendall's test and compared with that of Pearson's test in terms of the difference in p-values obtained by using different genotype encodings. With simulated as well as real data set, we demonstrated that Kendall's test was more robust than Pearson's test under different genotype encodings. The proposed method can be applicable to the broad topics of interest in population genetics and comparative genomics, in which novel genetic variants are associated with traits. This study may also bring about a cautious approach to the genotype encoding in the numerical analysis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236139PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363099PMC
September 2020

A cellular surveillance and defense system that delays aging phenotypes in .

Aging (Albany NY) 2020 04 29;12(9):8202-8220. Epub 2020 Apr 29.

Center for Plant Aging Research, Institute for Basic Science, Daegu 42988, Republic of Korea.

Physiological stresses, such as pathogen infection, are detected by "cellular Surveillance Activated Detoxification and Defenses" (cSADD) systems that trigger host defense responses. Aging is associated with physiological stress, including impaired mitochondrial function. Here, we investigated whether an endogenous cSADD pathway is activated during aging in . We provide evidence that the transcription factor ZIP-2, a well-known immune response effector in , is activated in response to age-associated mitochondrial dysfunction. ZIP-2 mitigates multiple aging phenotypes, including mitochondrial disintegration and reduced motility of the pharynx and intestine. Importantly, our data suggest that ZIP-2 is activated during aging independently of bacterial infection and of the transcription factors ATFS-1 and CEBP-2. Thus, ZIP-2 is a key component of an endogenous pathway that delays aging phenotypes in . Our data suggest that aging coopted a compensatory strategy for regulation of aging process as a guarded process rather than a simple passive deterioration process.
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http://dx.doi.org/10.18632/aging.103134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244029PMC
April 2020

Reliability Analysis of an Epileptic Seizure Detector Powered by an Energy Harvester.

Micromachines (Basel) 2019 Dec 30;11(1). Epub 2019 Dec 30.

Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul 03760, Korea.

Due to a limited lifetime of a battery, energy harvesters have been studied as alternative energy sources for implantable biomedical devices such as an implantable stimulator for epileptic seizure suppression. However, energy harvesters have weakness in providing stable power. We designed a neural recording circuit powered solely by a piezoelectric energy harvester, and applied its output to a seizure detector to analyze the reliability of the recorded signal. Performance of the seizure detector was evaluated. We found that the average time differences between with and without voltage variances were about 0.05 s under regular vibrations and about 0.07 s under irregular vibrations, respectively. The ratio of average true positive alarm period varied within about 0.02% under regular vibrations and 0.029% under irregular vibrations, respectively. The ratio of average false positive alarm period varied within about 0.004% under regular vibrations and 0.014% under irregular vibrations, respectively. This paper presents a reliability analysis of an epileptic seizure detector with a neural signal recording circuit powered by a piezoelectric energy harvester. The results showed that a supply voltage variance within ±10% could be acceptable for reliable operation of a seizure detector.
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http://dx.doi.org/10.3390/mi11010045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019978PMC
December 2019

Development and verification of prediction models for preventing cardiovascular diseases.

PLoS One 2019 19;14(9):e0222809. Epub 2019 Sep 19.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objectives: Cardiovascular disease (CVD) is one of the major causes of death worldwide. For improved accuracy of CVD prediction, risk classification was performed using national time-series health examination data. The data offers an opportunity to access deep learning (RNN-LSTM), which is widely known as an outstanding algorithm for analyzing time-series datasets. The objective of this study was to show the improved accuracy of deep learning by comparing the performance of a Cox hazard regression and RNN-LSTM based on survival analysis.

Methods And Findings: We selected 361,239 subjects (age 40 to 79 years) with more than two health examination records from 2002-2006 using the National Health Insurance System-National Health Screening Cohort (NHIS-HEALS). The average number of health screenings (from 2002-2013) used in the analysis was 2.9 ± 1.0. Two CVD prediction models were developed from the NHIS-HEALS data: a Cox hazard regression model and a deep learning model. In an internal validation of the NHIS-HEALS dataset, the Cox regression model showed a highest time-dependent area under the curve (AUC) of 0.79 (95% CI 0.70 to 0.87) for in females and 0.75 (95% CI 0.70 to 0.80) in males at 2 years. The deep learning model showed a highest time-dependent AUC of 0.94 (95% CI 0.91 to 0.97) for in females and 0.96 (95% CI 0.95 to 0.97) in males at 2 years. Layer-wise Relevance Propagation (LRP) revealed that age was the variable that had the greatest effect on CVD, followed by systolic blood pressure (SBP) and diastolic blood pressure (DBP), in that order.

Conclusion: The performance of the deep learning model for predicting CVD occurrences was better than that of the Cox regression model. In addition, it was confirmed that the known risk factors shown to be important by previous clinical studies were extracted from the study results using LRP.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222809PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752799PMC
March 2020

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Renal Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Sci Rep 2019 09 10;9(1):13009. Epub 2019 Sep 10.

Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

This study was conducted to investigate the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on individual renal outcomes in patients with type 2 diabetes. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception to September 2017 to identify randomized controlled trials comparing SGLT2 inhibitors with placebo or antidiabetic drugs and reporting any renal outcomes in patients with type 2 diabetes. Additionally, we identified 4 articles which were published after the predefined period to include relevant data. A meta-analysis was performed to calculate weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) for each renal outcome. We included 48 studies involving 58,165 patients in the analysis. SGLT2 inhibitors significantly lowered urine albumin-to-creatinine ratio (UACR) (WMD, -14.64 mg/g; 95% CI, -25.15 to -4.12; P = 0.006) compared with controls. The UACR-lowering effects of SGLT2 inhibitors were greater with a higher baseline UACR. Overall changes in estimated glomerular filtration rate (eGFR) were comparable between two groups (WMD, 0.19 mL/min/1.73 m; 95% CI, -0.44 to 0.82; P = 0.552). However, SGLT2 inhibitors significantly slowed eGFR decline in patients with a higher baseline eGFR and a longer duration of treatment. Compared with controls, SGLT2 inhibitors significantly reduced the risk of microalbuminuria (RR, 0.69; 95% CI, 0.49 to 0.97; P = 0.032), macroalbuminuria (RR, 0.49; 95% CI, 0.33 to 0.73; P < 0.001), and worsening nephropathy (RR, 0.73; 95% CI, 0.58 to 0.93; P = 0.012). In addition, the risk of end-stage renal disease was significantly lower in SGLT2 inhibitors than in controls (RR, 0.70; 95% CI, 0.57 to 0.87; P = 0.001). In conclusion, SGLT2 inhibitors had beneficial renal effects by lowering the risk of albuminuria development or progression and reducing the risk of end-stage renal disease compared with placebo or other antidiabetic drugs.
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http://dx.doi.org/10.1038/s41598-019-49525-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736944PMC
September 2019

Evaluation of the safety of using propofol for paediatric procedural sedation: A systematic review and meta-analysis.

Sci Rep 2019 08 22;9(1):12245. Epub 2019 Aug 22.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, 03080, Korea.

Propofol is one of the most widely used drugs for paediatric procedural sedation owing to its known advantages, but some concerns remain regarding respiratory and/or cardiac complications in patients receiving propofol. Although a considerable number of randomised controlled clinical trials (RCTs) have been conducted to compare it with other sedative agents or opioids for children undergoing various procedures, propofol is still being used off-label for this indication in many countries. We performed a systematic review and meta-analysis of those RCTs to provide an overall summation of evidence that can potentially be considered for further regulatory decisions, including reimbursement policies. We searched for RCTs in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from their inception to January 31, 2018. Our meta-analysis of 30 RCTs confirmed that propofol sedation had advantages in recovery time when compared with other drugs, without excessive concerns for cardiovascular or respiratory adverse events. Its safety profile regarding coughing, nausea or vomiting, and emergence delirium was also similar to that of other drugs. The overall evidence suggests that propofol sedation for paediatric procedures should be considered more positively in the context of regulatory decisions.
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http://dx.doi.org/10.1038/s41598-019-48724-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706375PMC
August 2019

Memristor Neural Network Training with Clock Synchronous Neuromorphic System.

Micromachines (Basel) 2019 Jun 8;10(6). Epub 2019 Jun 8.

Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul 03760, Korea.

Memristor devices are considered to have the potential to implement unsupervised learning, especially spike timing-dependent plasticity (STDP), in the field of neuromorphic hardware research. In this study, a neuromorphic hardware system for multilayer unsupervised learning was designed, and unsupervised learning was performed with a memristor neural network. We showed that the nonlinear characteristic memristor neural network can be trained by unsupervised learning only with the correlation between inputs and outputs. Moreover, a method to train nonlinear memristor devices in a supervised manner, named guide training, was devised. Memristor devices have a nonlinear characteristic, which makes implementing machine learning algorithms, such as backpropagation, difficult. The guide-training algorithm devised in this paper updates the synaptic weights by only using the correlations between inputs and outputs, and therefore, neither complex mathematical formulas nor computations are required during the training. Thus, it is considered appropriate to train a nonlinear memristor neural network. All training and inference simulations were performed using the designed neuromorphic hardware system. With the system and memristor neural network, the image classification was successfully done using both the Hebbian unsupervised training and guide supervised training methods.
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http://dx.doi.org/10.3390/mi10060384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632029PMC
June 2019

Neoadjuvant FOLFIRINOX in Patients With Borderline Resectable Pancreatic Cancer: A Systematic Review and Patient-Level Meta-Analysis.

J Natl Cancer Inst 2019 08;111(8):782-794

See the Notes section for the full list of authors' affiliations.

Background: FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated.

Methods: We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival, resection rate, R0 resection rate, and grade III-IV adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method.

Results: We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n = 20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% confidence interval [CI] = 60.1% to 74.6%), and the R0-resection rate was 83.9% (95% CI = 76.8% to 89.1%). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data were obtained for 20 studies representing 283 BRPC patients. The patient-level median OS was 22.2 months (95% CI = 18.8 to 25.6 months), and patient-level median progression-free survival was 18.0 months (95% CI = 14.5 to 21.5 months). Pooled event rates for grade III-IV adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI = 10.3% to 28.3%), diarrhea (11.1 per 100 patients, 95% CI = 8.6 to 14.3), and fatigue (10.8 per 100 patients, 95% CI = 8.1 to 14.2). No deaths were attributed to FOLFIRINOX.

Conclusions: This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.
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http://dx.doi.org/10.1093/jnci/djz073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695305PMC
August 2019

Evaluation of Propofol in Comparison with Other General Anesthetics for Surgery in Children Younger than 3 Years: a Systematic Review and Meta-Analysis.

J Korean Med Sci 2019 Apr 22;34(15):e124. Epub 2019 Apr 22.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Background: Despite well-known advantages, propofol remains off-label in many countries for general anesthesia in children under 3 years of age due to insufficient evidence regarding its use in this population. This study aimed to evaluate the efficacy and safety of propofol compared with other general anesthetics in children under 3 years of age undergoing surgery through a systematic review and meta-analysis of existing randomized clinical trials.

Methods: A comprehensive literature search was conducted of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to find all randomized clinical trials comparing propofol with another general anesthetic that included children under 3 years of age. The relative risk or arcsine-transformed risk difference for dichotomous outcomes and the weighted or standardized mean difference for continuous outcomes were estimated using a random-effects model.

Results: A total of 249 young children from 6 publications were included. The children who received propofol had statistically significantly lower systolic and diastolic blood pressures, but hypotension was not observed in the propofol groups. The heart rate, stroke volume index, and cardiac index were not significantly different between the propofol and control groups. The propofol groups showed slightly shorter recovery times and a lower incidence of emergence agitation than the control groups, while no difference was observed for the incidence of hypotension, desaturation, and apnea.

Conclusion: This systematic review and meta-analysis indicates that propofol use for general anesthesia in young healthy children undergoing surgery does not increase complications and that propofol could be at least comparable to other anesthetic agents.
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http://dx.doi.org/10.3346/jkms.2019.34.e124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473090PMC
April 2019

Effects of Dipeptidyl Peptidase-4 Inhibitors on Renal Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Endocrinol Metab (Seoul) 2019 03;34(1):80-92

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

Background: To investigate the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on renal outcomes in patients with type 2 diabetes.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) of DPP-4 inhibitors from inception to September 2017. We selected eligible RCTs comparing DPP-4 inhibitors with placebo or other antidiabetic agents and reporting at least one renal outcome. A meta-analysis was conducted to calculate standardized mean differences, weighted mean differences (WMDs), relative risks (RRs), and 95% confidence intervals (CIs) for each renal outcome.

Results: We included 23 RCTs with 19 publications involving 41,359 patients. Overall changes in urine albumin-to-creatinine ratio were comparable between DPP-4 inhibitors and controls (=0.150). However, DPP-4 inhibitors were associated with significantly lower risk of incident microalbuminuria (RR, 0.89; 95% CI, 0.80 to 0.98; =0.022) and macroalbuminuria (RR, 0.77; 95% CI, 0.61 to 0.97; =0.027), as well as higher rates of regression of albuminuria (RR, 1.22; 95% CI, 1.10 to 1.35; <0.001) compared with controls. Although DPP-4 inhibitors were associated with small but significantly lower estimated glomerular filtration rate (WMD, -1.11 mL/min/1.73 m²; 95% CI, -1.78 to -0.44; =0.001), there was no difference in the risk of end-stage renal disease between two groups (RR, 0.93; 95% CI, 0.76 to 1.14; =0.475).

Conclusion: DPP-4 inhibitors had beneficial renal effects mainly by reducing the risk of development or progression of albuminuria compared with placebo or other antidiabetic agents.
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http://dx.doi.org/10.3803/EnM.2019.34.1.80DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435854PMC
March 2019

The Role of Job Demands⁻Resources (JDR) between Service Workers' Emotional Labor and Burnout: New Directions for Labor Policy at Local Government.

Int J Environ Res Public Health 2018 12 17;15(12). Epub 2018 Dec 17.

Department of Public Administration, Honam University, 417, Eodeung-daero, Gwangsan-gu, Gwangju 62399, Korea.

Recently, research on service workers' emotional labor has received considerable attention, both in theory and practice. Emotional labor has been reported to cause both stress and burnout in service workers, eventually leading to a decrease in organizational productivity. In this context, there is also a growing interest in identifying ways to reduce such burnout. This study aimed to examine the influence of emotional labor and job demands⁻resources (JD⁻R) on service workers' burnout. Specifically, we analyzed the direct, indirect, and moderating effects of JD⁻R on burnout. Data were collected from service workers ( = 1517) in public sectors. Results revealed that three dimensions-emotional labor, intensity/variety, and surface acting-increase burnout, whereas deep acting decreases it. Additionally, job demands were found to increase burnout, while job resources decreased it. Among the job demands, customer contact had the greatest positive impact on burnout, followed by role ambiguity and workload, respectively. Among the job resources, self-efficacy and social support had the greatest negative impact on burnout. Finally, customer contact, role ambiguity, job autonomy, and social support were identified as moderators that worsened or buffered the impact of emotional labor on burnout.
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http://dx.doi.org/10.3390/ijerph15122894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313555PMC
December 2018

Parp3 promotes long-range end joining in murine cells.

Proc Natl Acad Sci U S A 2018 10 13;115(40):10076-10081. Epub 2018 Sep 13.

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215;

Chromosomal rearrangements, including translocations, are early and essential events in the formation of many tumors. Previous studies that defined the genetic requirements for rearrangement formation have identified differences between murine and human cells, most notably in the role of classic and alternative nonhomologous end-joining (NHEJ) factors. We reported that poly(ADP)ribose polymerase 3 (PARP3) promotes chromosomal rearrangements induced by endonucleases in multiple human cell types. We show here that in contrast to classic (c-NHEJ) factors, Parp3 also promotes rearrangements in murine cells, including translocations in murine embryonic stem cells (mESCs), class-switch recombination in primary B cells, and inversions in tail fibroblasts that generate - fusions. In mESCs, Parp3-deficient cells had shorter deletion lengths at translocation junctions. This was corroborated using next-generation sequencing of - junctions in tail fibroblasts and is consistent with a role for Parp3 in promoting the processing of DNA double-strand breaks. We confirmed a previous report that Parp1 also promotes rearrangement formation. In contrast with Parp3, rearrangement junctions in the absence of Parp1 had longer deletion lengths, suggesting that Parp1 may suppress double-strand break processing. Together, these data indicate that Parp3 and Parp1 promote rearrangements with distinct phenotypes.
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http://dx.doi.org/10.1073/pnas.1801591115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176633PMC
October 2018

Comparison of Tumor Regression Grading of Residual Pancreatic Ductal Adenocarcinoma Following Neoadjuvant Chemotherapy Without Radiation: Would Fewer Tier-Stratification Be Favorable Toward Standardization?

Am J Surg Pathol 2019 03;43(3):334-340

Departments of Pathology.

To assess whether the College of American Pathologists (CAP) and the Evans grading systems for neoadjuvant chemotherapy without radiation-treated pancreatectomy specimens are prognostic, and if a 3-tier stratification scheme preserves data granularity. Conducted retrospective review of 32 patients with ordinary pancreatic ductal adenocarcinoma treated with neoadjuvant therapy without radiation followed by surgical resection. Final pathologic tumor category (AJCC eighth edition) was 46.9% ypT1, 34.4% ypT2, and 18.7% ypT3. Median follow-up time was 29.8 months, median disease-free survival (DFS) was 19.6 months, and median overall survival (OS) was 34.2 months. CAP score 1, 2, 3 were present in 5 (15.6%), 18 (56.3%), and 9 (28.1%) patients, respectively. Evans grade III, IIb, IIa, and I were present in 10 (31.2%), 8 (25.0%), 7 (21.9%), and 7 (21.9%) patients, respectively. OS (CAP: P=0.005; Evans: P=0.001) and DFS (CAP: P=0.003; Evans: P=0.04) were statistically significant for both CAP and Evans. Stratified CAP scores 1 and 2 versus CAP score 3 was statistically significant for both OS (P=0.002) and DFS (P=0.002). Stratified Evans grades I, IIa, and IIb versus Evans grade III was statistically significant for both OS (P=0.04) and DFS (P=0.02). CAP, Evans, and 3-tier stratification are prognostic of OS and DFS.
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http://dx.doi.org/10.1097/PAS.0000000000001152DOI Listing
March 2019

Exploring the Determinants of Perceived Risk of Middle East Respiratory Syndrome (MERS) in Korea.

Int J Environ Res Public Health 2018 06 4;15(6). Epub 2018 Jun 4.

Department of Public Administration, Ajou University, Worldcup-ro, Suwon 16499, Korea.

The world is turning into a risky society. Although modernization based on the developments in science and technology has increased individuals' well-being and wealth, the perceived risk toward the complex technological system has increased. In a risky society, social accidents amplify the existing fear among individuals. It is generally assumed that each value, perception, and resource influences the fear of risk. However, very few studies have tested these three factors together within an integrated causal model. Therefore, the present study aimed to examine the determinants that influence the perceived risk in cases of Middle East Respiratory Syndrome (MERS), a deadly epidemic disease, in Korea. Based on the theoretical model, we analyzed the survey data collected from respondents ( = 814) in Korea. After controlling for variables such as sociodemographic characteristics, we examined how three competing factors, i.e., value, perception, and resource, influence the perceived risk of MERS. The analysis showed that trust and vulnerability variables in the perception factor, health state, and perceived knowledge in the resource factor had a significant impact on the perceived risk of MERS.
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http://dx.doi.org/10.3390/ijerph15061168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025578PMC
June 2018

Undifferentiated pleomorphic sarcoma: Factors predictive of adverse outcomes.

J Am Acad Dermatol 2018 Nov 19;79(5):853-859. Epub 2018 May 19.

Department of Dermatology, University of California San Francisco, San Francisco, California. Electronic address:

Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited.

Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases.

Methods: We evaluated all available cases of UPS (including those termed atypical fibroxanthoma, malignant fibrous histiocytoma, pleomorphic dermal sarcoma, and subfascial UPS) across 3 tertiary care centers.

Results: Among the 319 patients, 45 experienced recurrence, 33 experienced metastasis, and 96 died of any cause. Risk factors for recurrence were clinical tumor size larger than 5 cm and invasion beyond subcutaneous fat. Risk factors for distant metastases were tumor site, tumor size larger than 2 cm, invasion beyond subcutaneous fat, and lymphovascular invasion. Risk factors for overall mortality were age, immunosuppression, tumor size larger than 2 cm, and lymphovascular invasion. History of skin cancer was associated with a lower risk of recurrence and metastasis.

Limitations: This was a retrospective study.

Conclusions: Using the unbiased approach of pooling all UPS cases regardless of terminology, we identified clinical and histologic factors predicting poor outcomes. We propose subcategorization of UPS (into superficial versus deep UPS), which is consistent with the American Joint Committee on Cancer staging of soft-tissue sarcoma.
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http://dx.doi.org/10.1016/j.jaad.2018.05.022DOI Listing
November 2018

A conserved neuronal DAF-16/FoxO plays an important role in conveying pheromone signals to elicit repulsion behavior in Caenorhabditis elegans.

Sci Rep 2017 08 3;7(1):7260. Epub 2017 Aug 3.

Department of Biochemistry, Yonsei University, Seoul, Korea.

Animals use pheromones as a conspecific chemical language to respond appropriately to environmental changes. The soil nematode Caenorhabditis elegans secretes ascaroside pheromones throughout the lifecycle, which influences entry into dauer phase in early larvae, in addition to sexual attraction and aggregation. In adult hermaphrodites, pheromone sensory signals perceived by worms usually elicit repulsion as an initial behavioral signature. However, the molecular mechanisms underlying neuronal pheromone sensory process from perception to repulsion in adult hermaphrodites remain poorly understood. Here, we show that pheromone signals perceived by GPA-3 is conveyed through glutamatergic neurotransmission in which neuronal DAF-16/FoxO plays an important modulatory role by controlling glutaminase gene expression. We further provide evidence that this modulatory role for DAF-16/FoxO seems to be conserved evolutionarily by electro-physiological study in mouse primary hippocampal neurons that are responsible for glutamatergic neurotransmission. These findings provide the basis for understanding the nematode pheromone signaling, which seems crucial for adaptation of adult hermaphrodites to changes in environmental condition for survival.
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http://dx.doi.org/10.1038/s41598-017-07313-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543152PMC
August 2017

HOKF: High Order Kalman Filter for Epilepsy Forecasting Modeling.

Biosystems 2017 Aug 30;158:57-67. Epub 2017 May 30.

Department of Brain and Cognitive Engineering, Korea University, Seoul 136-713, South Korea. Electronic address:

Epilepsy forecasting has been extensively studied using high-order time series obtained from scalp-recorded electroencephalography (EEG). An accurate seizure prediction system would not only help significantly improve patients' quality of life, but would also facilitate new therapeutic strategies to manage epilepsy. This paper thus proposes an improved Kalman Filter (KF) algorithm to mine seizure forecasts from neural activity by modeling three properties in the high-order EEG time series: noise, temporal smoothness, and tensor structure. The proposed High-Order Kalman Filter (HOKF) is an extension of the standard Kalman filter, for which higher-order modeling is limited. The efficient dynamic of HOKF system preserves the tensor structure of the observations and latent states. As such, the proposed method offers two main advantages: (i) effectiveness with HOKF results in hidden variables that capture major evolving trends suitable to predict neural activity, even in the presence of missing values; and (ii) scalability in that the wall clock time of the HOKF is linear with respect to the number of time-slices of the sequence. The HOKF algorithm is examined in terms of its effectiveness and scalability by conducting forecasting and scalability experiments with a real epilepsy EEG dataset. The results of the simulation demonstrate the superiority of the proposed method over the original Kalman Filter and other existing methods.
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http://dx.doi.org/10.1016/j.biosystems.2017.02.004DOI Listing
August 2017

PARP3 is a promoter of chromosomal rearrangements and limits G4 DNA.

Nat Commun 2017 04 27;8:15110. Epub 2017 Apr 27.

Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA.

Chromosomal rearrangements are essential events in the pathogenesis of both malignant and nonmalignant disorders, yet the factors affecting their formation are incompletely understood. Here we develop a zinc-finger nuclease translocation reporter and screen for factors that modulate rearrangements in human cells. We identify UBC9 and RAD50 as suppressors and 53BP1, DDB1 and poly(ADP)ribose polymerase 3 (PARP3) as promoters of chromosomal rearrangements across human cell types. We focus on PARP3 as it is dispensable for murine viability and has druggable catalytic activity. We find that PARP3 regulates G quadruplex (G4) DNA in response to DNA damage, which suppresses repair by nonhomologous end-joining and homologous recombination. Chemical stabilization of G4 DNA in PARP3 cells leads to widespread DNA double-strand breaks and synthetic lethality. We propose a model in which PARP3 suppresses G4 DNA and facilitates DNA repair by multiple pathways.
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http://dx.doi.org/10.1038/ncomms15110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414184PMC
April 2017

Automatic segmentation and user-friendly software techniques for virtual surgical planning of mandibular reconstruction.

Annu Int Conf IEEE Eng Med Biol Soc 2016 Aug;2016:2512-2515

Compared to conventional mandibular reconstruction surgery, a recent approach of virtual planning can reduce surgical time providing reliable surgical outcomes. We present our virtual surgical planning software using automatic segmentation and user-friendly techniques. Evaluation experiments compared with a commercial software prove that the proposed software can achieve successful surgical planning in reduced time with reliable accuracy.
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http://dx.doi.org/10.1109/EMBC.2016.7591241DOI Listing
August 2016

Automatic segmentation of supraspinatus from MRI by internal shape fitting and autocorrection.

Comput Methods Programs Biomed 2017 Mar 21;140:165-174. Epub 2016 Dec 21.

Center for Bionics, Korea Institute of Science and Technology, Seoul, Korea. Electronic address:

Background And Objectives: With significant increase in the number of people suffering from shoulder problems, the automatic image segmentation of the supraspinatus (one of the shoulder muscles) has become necessary for efficient and deliberate diagnosis and surgery. In this study, we developed an automatic segmentation method to extract the three-dimensional (3D) configuration of the supraspinatus, and we compared our segmentation results with reference segmentations obtained by experts.

Methods: We developed a two-stage active contour segmentation method using the level sets approach to automatically extract the supraspinatus configuration. In the first stage, a trial segmentation based on intensity and an internal shape fitting technique were performed. In the second stage, the undesired image portions of the trial segmentation were automatically identified by comparing the trial segmentation with the fitted shape, and then corrected by forcing the contour to stop evolution in the over-segmented region and pass through undesired edges in the under-segmented region.

Results: The proposed method was found to provide highly accurate results when compared with the reference segmentations. This comparison was made on the basis of four measurements: accuracy (0.995 ± 0.001), Dice similarity coefficients (0.951 ± 0.011), average distance (0.440 ± 0.086mm), and maximal distance (3.045 ± 0.433mm). The proposed method could generate regular surfaces of the 3D supraspinatus.

Conclusions: The proposed automatic segmentation method provides a patient-specific tool to accurately extract the 3D configuration of the supraspinatus.
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http://dx.doi.org/10.1016/j.cmpb.2016.12.008DOI Listing
March 2017