Publications by authors named "Yoon Lee"

1,038 Publications

  • Page 1 of 1

The development and validation of a predictive model for recurrence in rectal cancer based on radiological and clinicopathological data.

Eur Radiol 2021 May 4. Epub 2021 May 4.

Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objective: To develop a prediction model for recurrence by incorporating radiological and clinicopathological prognostic factors in rectal cancer patients.

Methods: All radiologic and clinicopathologic data of 489 patients with rectal cancer, retrospectively collected from a single institution between 2009 and 2013, were used to develop a predictive model for recurrence using the Cox regression. The model performance was validated on an independent cohort between 2015 and 2017 (N = 168).

Results: Out of 489 derivative patients, 103 showed recurrence after surgery. The prediction model was constructed with the following four significant predictors: distance from anal verge, MR-based extramural venous invasion, pathologic nodal stage, and perineural invasion (HR: 1.69, 2.09, 2.59, 2.29, respectively). Each factor was assigned a risk score corresponding to HR. The derivation and validation cohort were classified by sum of risk scores into 3 groups: low, intermediate, and high risk. Each of these groups showed significantly different recurrence rates (derivation cohort: 13.4%, 35.3%, 61.5 %; validation cohort: 6.2%, 23.7%, 64.7%). Our new model showed better performance in risk stratification, compared to recurrence rates of tumor node metastasis (TNM) staging in the validation cohort (stage I: 3.6%, II: 12%, III: 30.2%). The area under the receiver operating characteristic curve of the new prediction model was higher than TNM staging at 3-year recurrence in the validation cohort (0.853 vs. 0.731; p = .009).

Conclusions: The new risk prediction model was strongly correlated with a recurrence rate after rectal cancer surgery and excellent for selection of high-risk group, who needs more active surveillance.

Key Points: • Multivariate analysis revealed four significant risk factors to be MR-based extramural venous invasion, perineural invasion, nodal metastasis, and the short distance from anal verge among the radiologic and clinicopathologic data. • Our new recurrence prediction model including radiologic data as well as clinicopathologic data showed high predictive performance of disease recurrence. • This model can be used as a comprehensive approach to evaluate individual prognosis and helpful for the selection of highly recurrent group who needs more active surveillance.
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http://dx.doi.org/10.1007/s00330-021-07920-yDOI Listing
May 2021

Antioxidant Activity in Wall (Himalayan Rhubarb).

Molecules 2021 Apr 27;26(9). Epub 2021 Apr 27.

Department of Agriculture, Forestry and Bioresources, Plant Genomics and Breeding Institute, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.

Using natural products as antioxidant agents has been beneficial to replace synthetic products. Efforts have been made to profile the antioxidant capacities of natural resources, such as medicinal plants. The polyphenol content of Himalayan rhubarb, wall, was measured and the antioxidant activity was determined using DPPH and ABTS assay, and the oxidative stress was assessed using SOD enzymatic assay. Five different solvent fractions, -hexane, -butanol, ethyl acetate, dichloromethane, and water, were used for screening the antioxidant capacity in effort to determine the optimum extraction solvent. The total phenolic contents for fractions ranged from 27.76 to 209.21 mg of gallic acid equivalents (GAE)/g of dry weight. DPPH and ABTS assay results are presented into IC values, ranged from 21.52 to 2448.79 μg/mL and 90.25 to 1718.05 μg/mL, respectively. The ethyl acetate fraction had the highest antioxidant activity among other fractions. Also, -butanol and water fractions showed significantly lower IC values than the positive control in DPPH radical scavenging activity. The IC values of SOD assay of fractions ranged from 2.31 to 64.78 μg/mL. A similar result was observed with ethyl acetate fraction showing the highest SOD radical scavenging activity. The study suggests that the ethyl acetate fraction of possess the strongest antioxidant activity, thus the most efficient in extracting antioxidant contents. Moreover, a highly significant correlation was shown between total polyphenol content and antioxidant activity screening assays. The compounds related to the antioxidant activity of were identified to myricitrin, myricetin 3-galloyl rhamnoside, and myricetin, which have not been reported in studies about before.
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http://dx.doi.org/10.3390/molecules26092555DOI Listing
April 2021

Long-Term Follow-Up of Inpatients with Failed Back Surgery Syndrome Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey Study.

J Clin Med 2021 Apr 15;10(8). Epub 2021 Apr 15.

Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Korea.

Introduction: this study aimed to investigate the long-term clinical efficacy and satisfaction degree of integrative Korean medicine (KM) treatment for patients with failed back surgery syndrome (FBSS).

Methods: we performed a follow-up questionnaire survey and retrospective analysis of medical records for patients with FBSS who underwent inpatient treatment for ≥ 1 week. The primary evaluation indices were numeric rating scale (NRS) scores for low back pain (LBP) and leg pain at admission and discharge. Sub-evaluation indices included the Oswestry Disability Index (ODI) and EuroQol 5-dimension (EQ-5D) score. The follow-up questionnaire survey obtained information regarding previous surgeries; reasons for satisfaction/dissatisfaction with surgical and KM treatment; and current status.

Results: compared with at admission, there was a significant post-treatment decrease in the NRS scores for LBP and leg pain, as well as the ODI score. Further, there was a significant post-treatment increase in the EQ-5D score. Regarding the patients' global impression of change for KM treatment administered during admission and at the follow-up questionnaire survey, 101 (95.3%) patients selected "minimally improved" or better.

Conclusion: integrative KM treatment could effectively reduce pain, as well as improve function and health-related quality of life, in patients with FBSS.
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http://dx.doi.org/10.3390/jcm10081703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071221PMC
April 2021

The effect of alpha-2A adrenergic receptor (ADRA2A) genetic polymorphisms on the depth of sedation of dexmedetomidine: a genetic observational pilot study.

Braz J Anesthesiol 2021 Apr 26. Epub 2021 Apr 26.

Korea University, College of Medicine, Ansan Hospital, Department of Anaesthesiology and Pain Medicine, Ansan, Republic of Korea.

Background: The genetic polymorphisms of the alpha-2A adrenergic receptor (ADRA2A), which plays a significant role in sedation, anxiety relief, and antinociception, particularly in dexmedetomidine, may differ in the degree of sedation. This study aimed to investigate the effect of the genetic polymorphisms of ADRA2A (rs11195418, rs1800544, rs2484516, rs1800545, rs553668, rs3750625) on the sedative effects of dexmedetomidine.

Methods: A total of 131 patients aged 50 years or more from May 2018 to August 2019 were included in this study. The ADRA2A gene variants were evaluated using the TaqMan Assay. Dexmedetomidine diluted in normal saline to a concentration of 4 μg.mL was infused at a dose of 2 μg.kg to achieve procedural sedation (modified Ramsay sedation scale 4 [mRSS 4]).

Results: A total of 131 patients were evaluated. The genetic polymorphisms (rs11195418) of the ADRA2A receptor gene demonstrated no variation in our participants. The ADRA2A receptor gene polymorphisms (rs1800544, rs2484516, rs1800545, rs553668, and rs3750625) exhibited no differences in total dexmedetomidine doses (p > 0.217), bispectral index at mRSS 4 (p > 0.620), and time to obtain mRSS 4 (p > 0.349).

Conclusion: This study suggested that the genetic polymorphisms of ADRA2A did not affect the sedative efficacy of dexmedetomidine.
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http://dx.doi.org/10.1016/j.bjane.2021.04.005DOI Listing
April 2021

Ultrasound Echogenicity of Papillary Thyroid Cancer Is Affected by Tumor Growth Patterns and Tumor Fibrosis.

In Vivo 2021 May-Jun;35(3):1633-1640

Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea

Background/aim: The association between preoperative ultrasound (US) echogenicity and histopathological characteristics of papillary thyroid cancer (PTC) has been rarely investigated is not well characterized. This study evaluated a relationship between the clinical characteristics of PTC, histopathological phenomena including tumor growth patterns (TGPs) and tumor fibrosis (TF), and US echogenicity.

Patients And Methods: In total, 170 patients with PTC (<2 cm) underwent total thyroidectomy with central neck dissection. Demographics, US echogenicity, tumor size, extra-thyroidal extension (ETE), lymph node metastasis (LNM) within the central and lateral neck, TGPs, and TF percentage were reviewed.

Results: Patients with TGP II (encapsulated growth with partial pericapsular extension) and III (infiltrative growth) were more frequently burdened by ETE and lateral neck LNM compared to patients with TGP I (encapsulated growth with a well-defined cystic or solid characteristic). Older age was significantly deterministic of TGP III, and male gender and higher TF percentage were independent risk factors for lateral neck LNM. TGP III and TF were independent determining factors for marked hypoechogenicity on US.

Conclusion: PTC with TGP II and III and higher tumor fibrosis exhibited more aggressive clinicopathologic behaviors. TGP III and TF were determinants for marked hypoechogenicity.
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http://dx.doi.org/10.21873/invivo.12421DOI Listing
January 2021

Deep learning-based denoising algorithm in comparison to iterative reconstruction and filtered back projection: a 12-reader phantom study.

Eur Radiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Objectives: (1) To compare low-contrast detectability of a deep learning-based denoising algorithm (DLA) with ADMIRE and FBP, and (2) to compare image quality parameters of DLA with those of reconstruction methods from two different CT vendors (ADMIRE, IMR, and FBP).

Materials And Methods: Using abdominal CT images of 100 patients reconstructed via ADMIRE and FBP, we trained DLA by feeding FBP images as input and ADMIRE images as the ground truth. To measure the low-contrast detectability, the randomized repeat scans of Catphan® phantom were performed under various conditions of radiation exposures. Twelve radiologists evaluated the presence/absence of a target on a five-point confidence scale. The multi-reader multi-case area under the receiver operating characteristic curve (AUC) was calculated, and non-inferiority tests were performed. Using American College of Radiology CT accreditation phantom, contrast-to-noise ratio, target transfer function, noise magnitude, and detectability index (d') of DLA, ADMIRE, IMR, and FBPs were computed.

Results: The AUC of DLA in low-contrast detectability was non-inferior to that of ADMIRE (p < .001) and superior to that of FBP (p < .001). DLA improved the image quality in terms of all physical measurements compared to FBPs from both CT vendors and showed profiles of physical measurements similar to those of ADMIRE.

Conclusions: The low-contrast detectability of the proposed deep learning-based denoising algorithm was non-inferior to that of ADMIRE and superior to that of FBP. The DLA could successfully improve image quality compared with FBP while showing the similar physical profiles of ADMIRE.

Key Points: • Low-contrast detectability in the images denoised using the deep learning algorithm was non-inferior to that in the images reconstructed using standard algorithms. • The proposed deep learning algorithm showed similar profiles of physical measurements to advanced iterative reconstruction algorithm (ADMIRE).
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http://dx.doi.org/10.1007/s00330-021-07810-3DOI Listing
April 2021

Enhancing the landscape of colorectal cancer using targeted deep sequencing.

Sci Rep 2021 Apr 14;11(1):8154. Epub 2021 Apr 14.

Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Targeted next-generation sequencing (NGS) technology detects specific mutations that can provide treatment opportunities for colorectal cancer (CRC) patients. We included 145 CRC patients who underwent surgery. We analyzed the mutation frequencies of common actionable genes and their association with clinicopathological characteristics and oncologic outcomes using targeted NGS. Approximately 97.9% (142) of patients showed somatic mutations. Frequent mutations were observed in TP53 (70%), APC (60%), and KRAS (49%). TP53 mutations were significantly linked to higher overall stage (p = 0.038) and lower disease-free survival (DFS) (p = 0.039). ATM mutation was significantly associated with higher tumor stage (p = 0.012) and shorter overall survival (OS) (p = 0.041). Stage 3 and 4 patients with ATM mutations (p = 0.023) had shorter OS, and FBXW7 mutation was significantly associated with shorter DFS (p = 0.002). However, the OS of patients with or without TP53, RAS, APC, PIK3CA, and SMAD4 mutations did not differ significantly (p = 0.59, 0.72, 0.059, 0.25, and 0.12, respectively). Similarly, the DFS between patients with RAS, APC, PIK3CA, and SMAD4 mutations and those with wild-type were not statistically different (p = 0.3, 0.79, 0.13, and 0.59, respectively). In multivariate Cox regression analysis, ATM mutation was an independent biomarker for poor prognosis of OS (p = 0.043). A comprehensive analysis of the molecular markers for CRC can provide insights into the mechanisms underlying disease progression and help optimize a personalized therapy.
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http://dx.doi.org/10.1038/s41598-021-87486-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046812PMC
April 2021

A uterine cervix supporting device (Con-CapTM) for reducing canal stenosis after Loop Electrosurgical Excisional Procedure.

Technol Health Care 2021 Apr 2. Epub 2021 Apr 2.

Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea.

Bacground: Cervical stenoses are one of the main long-term consequences after conization of the uterine cervix.

Objective: The purpose of this study was to evaluate the safety and efficacy of a uterine cervix supporting device (Con-CapTM) in reducing uterine cervical stenosis after Loop Electrosurgical Excisional Procedure (LEEP).

Methods: We enrolled 112 patients who underwent LEEP between March 2017 to May 2019. Con-CapTM was inserted into the uterine endocervical canal for 4 weeks after LEEP. Laboratory values and clinical symptoms were evaluated. The presence of uterine cervical narrowing was determined at 2 weeks after removal of the Con-CapTM. Data were analyzed using the two-sample t test and χ2 test.

Results: A total of 78 women completed the 6-week study period. Thirty-four patients did not complete the study period. The diameter of the uterine cervical canal was significantly greater at postoperative 6 weeks than preoperatively (Hegar dilator No, 2.10 ± 0.56 vs. 3.21 ± 0.71, P< 0.01). The complications were acceptable.

Conclusions: Con-CapTM can be used to reduce uterine cervical stenosis safely and effectively after conization of uterine cervix.
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http://dx.doi.org/10.3233/THC-202639DOI Listing
April 2021

Nationwide "Pediatric Nutrition Day" survey on the nutritional status of hospitalized children in South Korea.

Nutr Res Pract 2021 Apr 22;15(2):213-224. Epub 2020 Sep 22.

Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Background/objectives: To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea.

Subjects/methods: This first cross-sectional nationwide "Pediatric Nutrition Day (pNday)" survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests.

Results: At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively. During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) ( < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization.

Conclusions: Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.
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http://dx.doi.org/10.4162/nrp.2021.15.2.213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007407PMC
April 2021

Seasonal Changes in Vitamin D Levels of Healthy Children in Mid-Latitude, Asian Urban Area.

Pediatr Gastroenterol Hepatol Nutr 2021 Mar 4;24(2):207-217. Epub 2021 Mar 4.

Department of Pediatrics, Korea University Medical Center, Seoul, Korea.

Purpose: This study aimed to investigate the seasonal changes in vitamin D levels in a healthy pediatric population living in mid-latitude East Asian urban areas.

Methods: A pediatric population was selected from single secondary hospital visitors. Clinical data and serum vitamin D levels were collected retrospectively. Statistical analyses were performed based on the month of the blood sampling date, subject age, and vitamin D supplementation history. The data were categorized into three subgroups based on serum vitamin D levels-adequate (≥30 ng/mL), insufficient (20-29 ng/mL), and deficient (<20 ng/mL).

Results: Of the 481 patients, 172 had vitamin D supplementation history. More than 70% of the total study population had inadequate vitamin D levels (<30 ng/mL). The non-supplemented group and the supplemented group showed significantly uneven monthly distribution of the adequate, insufficient, and deficient subgroups. Only the non-supplemented group showed significantly different average vitamin D levels in the summer months compared to the winter months. In the non-supplemented group, vitamin D levels were the lowest in March, the highest in August and September. Significant relevance was noted between vitamin D supplementation status and vitamin D serum level in February and March. There was no significant difference between different age groups in terms of the distribution of vitamin D levels.

Conclusion: Currently-widespread vitamin D replacement methods seem to have some effect on increasing the overall serum vitamin D levels, specifically during late winter when natural serum vitamin D levels plunge. However, they are unable to fully compensate the seasonal fluctuation.
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http://dx.doi.org/10.5223/pghn.2021.24.2.207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007836PMC
March 2021

A National Survey on the Environment and Basic Techniques of Endoscopic Retrograde Cholangiopancreatography in Korea.

Gut Liver 2021 Apr 6. Epub 2021 Apr 6.

Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Background/aims: The work environment in which endoscopic retrograde cholangiopancreatography (ERCP) is conducted has influence on its efficacy and safety. We aimed to assess the current status of ERCP work environments and to investigate the trends associated with the basic techniques of ERCP in Korea.

Methods: The work environment and information on the basic techniques of ERCP were acquired by the Korean Pancreatobiliary Association (KPBA) through a national survey in 2019. The survey was performed at the KPBA conference in 2019. The contents of survey comprised of the current environment of ERCP, preparation before ERCP, and the preferred basic techniques used in ERCP.

Results: Completed questionnaires were returned from 84 KPBA members. The mean ERCP volume per year was approximately 500. About 60% (50/84) reported that they worked with a dedicated ERCP team with experienced nurses. Two-thirds (57/84, 68%) answered that they had a fluoroscopy room used solely for ERCP procedures. All respondents intravenously hydrated the patient to prevent post-ERCP pancreatitis (84/84, 100%). The preferred procedural sedations were balanced propofol sedation (50%) and midazolam-only sedation (47%). Wire-guided cannulation was most commonly used for selective cannulation (81%). Endoscopic retrograde biliary drainage was preferred over endoscopic nasobiliary drainage (60% vs 22%). The initial method of ampullary intervention was endoscopic sphincterotomy in 60%.

Conclusions: Data from the survey involving a large number of Korean ERCP doctors revealed considerable variabilities with regard to the work environment and basic techniques of ERCP in Korea. The study provides information regarding the current trends of ERCP that can be used to establish ERCP standards in Korea.
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http://dx.doi.org/10.5009/gnl20329DOI Listing
April 2021

Prediction model for cervical lymph node metastasis in human papillomavirus-related oropharyngeal squamous cell carcinomas.

Eur Radiol 2021 Mar 29. Epub 2021 Mar 29.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.

Objectives: To develop and validate a risk scoring system based on clinical and imaging findings to predict lymph node metastasis from HPV-related oropharyngeal squamous cell carcinomas.

Methods: This study population who had undergone neck dissections or lymph node biopsies in patients with HPV+ OPSCC was obtained from a historical cohort from two tertiary referral hospitals. The training set from one hospital included 455 lymph nodes from 82 patients, and the test set from the other hospital included 150 lymph nodes from 42 patients. The baseline clinical and imaging findings on pretreatment CT or MR were investigated and the reference standards were the histopathologic results. A risk scoring system was constructed based on logistic regression and validated both internally and externally.

Results: A 7-point risk scoring system was developed based on the following variables: central necrosis, infiltration of adjacent planes, lymph node level, and the maximal axial diameter of the lymph node. This risk scoring system showed good discriminative ability for metastasis in the training set (C-statistic 0.952; 95% CI, 0.931-0.972) and test set (C-statistic 0.968, 95% CI, 0.936-0.999) and good calibration ability in the training set (p = 0.723) and test set (p = 0.253).

Conclusions: We developed and validated a reliable risk scoring system that predicts lymph node metastasis from HPV+ OPSCCs based on the clinical data and pretreatment imaging findings. We expect this risk scoring system to be a useful guide for better decision-making in practice.

Key Points: • It is important to diagnose lymph node metastasis from HPV+ OPSCC for treatment planning; however, there has been little research on that. • We developed and externally validated a new scoring system for stratifying the risk of lymph node metastasis from HPV+ OPSCC based on clinical and imaging data. • A predictive model combining both clinical and imaging data showed high diagnostic accuracy and efficiency for lymph node metastasis from HPV+ OPSCC.
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http://dx.doi.org/10.1007/s00330-021-07766-4DOI Listing
March 2021

Impact of age on the incidence of complications after liver transplantation: A single-center retrospective study.

Braz J Anesthesiol 2021 Mar 21. Epub 2021 Mar 21.

Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Yangsan, Republic of Korea.

Background And Objective: Advances in surgical technique, postoperative management, and immunosuppressive therapy have led to a steady increase in the number of patients undergoing organ transplantation. This study aimed to compare the incidence of postoperative complications between young and elderly patients undergoing liver transplantation (LT) at a single university hospital.

Method: The medical records of 253 patients who underwent LT between January 2010 and July 2017 were retrospectively reviewed. The patients were divided into two groups: those younger than 65 years (group Y, n=231) and those older than 65 years (group O, n=22). Data on patient demographics, perioperative management, and postoperative complications were collected.

Results: The patients' baseline characteristics, including underlying diseases and the Model for End-Stage Liver Disease scores, were not different between groups. Preoperative laboratory findings were not significantly different between the two groups, except for hemoglobin level. The total amounts of infused fluid and packed red blood cells were higher in group O than in group Y. The postoperative plasma creatinine level was higher in group O than in group Y; however, the incidence of postoperative complications was not considerably different between the two groups. In addition, there was no difference in the survival rate after LT depending on age.

Conclusion: With the development of medical technology, LT in elderly patients is not an operation to be avoided, and the prognosis is expected to improve. Therefore, continuous efforts to understand the disease characteristics and physical differences in elderly patients who require LT are essential.
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http://dx.doi.org/10.1016/j.bjane.2021.02.040DOI Listing
March 2021

Can we Predict the Clinical Course of Immune Thrombocytopenia in Children by The Mean Platelet Volume? A Preliminary Study.

Clin Lab 2021 Mar;67(3)

Background: Mean platelet volume (MPV) is considered a marker of platelet function and is known to increase in immune thrombocytopenia (ITP). We aimed to investigate the predictive value of MPV for predicting the clinical course of ITP in children.

Methods: We retrospectively analyzed children aged < 18 years with ITP (n = 36) and healthy controls (n = 36) from June 2010 to November 2018. The subjects were stratified into: (i) Healthy controls [group I, n = 36]; (ii) Newly diagnosed ITP (nITP) and persistent ITP (pITP) [group II, n = 24]; and (iii) Chronic ITP (cITP) [group III, n = 12]. Hematological indices including MPV were measured and compared between the three groups.

Results: The median MPV values at diagnosis in group I, II, and III were 7.20, 8.15, and 8.65 fL, respectively (p = 0.0004). Cutoff value of MPV at diagnosis differentiating group I from group II + III was 7.6 fL, and group II from group III was 8.7 fL. MPV change (ΔMPV after three months minus MPV at diagnosis) in children with nITP and pITP (n = 22) was greater than in those with cITP (n = 6) (-2.18 fL vs. 0.66 fL, p = 0.0059).

Conclusions: This study revealed that group III had a higher MPV than group II at diagnosis. Therefore, an initial MPV value more than 8.7 fL may be used as a predictive factor for chronicity in children with ITP. The change in MPV over time as well as MPV at diagnosis, may be regarded as a prognostic marker to predict the course of ITP in children.
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http://dx.doi.org/10.7754/Clin.Lab.2020.200715DOI Listing
March 2021

Deep learning-based algorithm to detect primary hepatic malignancy in multiphase CT of patients at high risk for HCC.

Eur Radiol 2021 Mar 18. Epub 2021 Mar 18.

Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objectives: To develop and evaluate a deep learning-based model capable of detecting primary hepatic malignancies in multiphase CT images of patients at high risk for hepatocellular carcinoma (HCC).

Methods: A total of 1350 multiphase CT scans of 1280 hepatic malignancies (1202 HCCs and 78 non-HCCs) in 1320 patients at high risk for HCC were retrospectively analyzed. Following the delineation of the focal hepatic lesions according to reference standards, the CT scans were categorized randomly into the training (568 scans), tuning (193 scans), and test (589 scans) sets. Multiphase CT information was subjected to multichannel integration, and livers were automatically segmented before model development. A deep learning-based model capable of detecting malignancies was developed using a mask region-based convolutional neural network. The thresholds of the prediction score and the intersection over union were determined on the tuning set corresponding to the highest sensitivity with < 5 false-positive cases per CT scan. The sensitivity and the number of false-positives of the proposed model on the test set were calculated. Potential causes of false-negatives and false-positives on the test set were analyzed.

Results: This model exhibited a sensitivity of 84.8% with 4.80 false-positives per CT scan on the test set. The most frequent potential causes of false-negatives and false-positives were determined to be atypical enhancement patterns for HCC (71.7%) and registration/segmentation errors (42.7%), respectively.

Conclusions: The proposed deep learning-based model developed to automatically detect primary hepatic malignancies exhibited an 84.8% of sensitivity with 4.80 false-positives per CT scan in the test set.

Key Points: • Image processing, including multichannel integration of multiphase CT and automatic liver segmentation, enabled the application of a deep learning-based model to detect primary hepatic malignancy. • Our model exhibited a sensitivity of 84.8% with a false-positive rate of 4.80 per CT scan.
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http://dx.doi.org/10.1007/s00330-021-07803-2DOI Listing
March 2021

Original Articles Preoperative Hematological Parameters for Predicting Ovarian Torsion in Patients with Mature Cystic Teratoma.

Int J Womens Health 2021 10;13:317-326. Epub 2021 Mar 10.

Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.

Objective: The objective of this study is to evaluate the preoperative hematological parameters to predict ovarian torsion in patients with ovarian mature cystic teratoma. We also analyzed the diagnostic value of these makers to predict ovarian necrosis in cases of torsion as well as the effect of torsion on ovarian reserve.

Patients And Methods: This is a retrospective study of 132 patients who received either laparoscopic or laparotomy surgery for OMCT at a single university hospital. Clinical characteristics and preoperative hematological parameters were compared between patients with or without torsion. Patients with torsion were further classified as infarction and non-infarction group. Preoperative parameters were compared between the two groups as well.

Results: White blood cell (WBC) count, neutrophil percent, neutrophil count, and neutrophil to lymphocyte ratio (NLR) were higher in the torsion group (n=37) than the non-torsion group (n=95) (<0.05 for all). Although statistically insignificant, the preoperative anti-Mullerian hormone (AMH) was lower in the torsion group than the non-torsion group (4.07 ± 3.38 vs 6.1 ± 3.6, =0.122). In cases of torsion, the infarction group showed higher WBC count and lymphocyte count but lower hemoglobin level and platelet to lymphocyte ratio (PLR) than the non-infarction group (<0.05 for all).

Conclusion: The WBC count, neutrophil percent, neutrophil count, and NLR were higher in the cases of OMCT with torsion, and these parameters may be useful to diagnose OMCT with torsion. Also, adnexal torsion may deteriorate ovarian reserved as indicated by decreased AMH in torsion group.
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http://dx.doi.org/10.2147/IJWH.S285335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956860PMC
March 2021

Major QTLs, and , Additively Regulate Adaxial Leaf Rolling in Rice.

Front Plant Sci 2021 19;12:626523. Epub 2021 Feb 19.

Department of Plant Science, Plant Genomics and Breeding Institute, Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, South Korea.

Moderate leaf rolling is considered optimal for the ideal plant type in rice ( L.), as it improves photosynthetic efficiency and, consequently, grain yield. Determining the genetic basis of leaf rolling the identification of quantitative trait loci (QTLs) could facilitate the development of high-yielding varieties. In this study, we identified three stable rice QTLs, , , and , which control adaxial leaf rolling in a recombinant inbred line (RIL) population derived from a cross between Tong 88-7 (T887) and Milyang 23 (M23), using high-density SNP markers. These QTLs controlled the rolling phenotype of both the flag leaf (FL) and secondary leaf (SL), and different allelic combinations of these QTLs led to a wide variation in the degree of leaf rolling. Additive gene actions of and on leaf rolling were observed in a backcross population. In addition, (markers: 01id4854718 and 01asp4916781) and (markers: 09id19650402 and 09id19740436) were successfully fine-mapped to approximately 60- and 90-kb intervals on chromosomes 1 and 9, respectively. Histological analysis of near-isogenic lines (NILs) revealed that influences leaf thickness across the small vein, and affects leaf thickness in the entire leaf and bulliform cell area, thus leading to adaxial leaf rolling. The results of this study advance our understanding of the genetic and molecular bases of adaxial leaf rolling, and this information can be used for the development of rice varieties with the ideal plant type.
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http://dx.doi.org/10.3389/fpls.2021.626523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940999PMC
February 2021

Development of a photochemical thrombosis investigation system to obtain a rabbit ischemic stroke model.

Sci Rep 2021 Mar 11;11(1):5787. Epub 2021 Mar 11.

Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu, 41061, Republic of Korea.

Photochemical thrombosis is a method for the induction of ischemic stroke in the cerebral cortex. It can generate localized ischemic infarcts in the desired region; therefore, it has been actively employed in establishing an ischemic stroke animal model and in vivo assays of diagnostic and therapeutic techniques for stroke. To establish a rabbit ischemic stroke model and overcome the shortcoming of previous studies that were difficult to build a standardized photothrombotic rabbit model, we developed a photochemical thrombosis induction system that can produce consistent brain damage on a specific area. To verify the generation of photothrombotic brain damage using the system, longitudinal magnetic resonance imaging, 2,3,5-triphenyltetrazolium chloride staining, and histological staining were applied. These analytical methods have a high correlation for ischemic infarction and are appropriate for analyzing photothrombotic brain damage in the rabbit brain. The results indicated that the photothrombosis induction system has a main advantage of being accurately controlled a targeted region of photothrombosis and can produce cerebral hemisphere lesions on the target region of the rabbit brain. In conjugation with brain atlas, it can induce photochemical ischemic stroke locally in the part of the brain that is responsible for a particular brain function and the system can be used to develop animal models with degraded specific functions. Also, the photochemical thrombosis induction system and a standardized rabbit ischemic stroke model that uses this system have the potential to be used for verifications of biomedical techniques for ischemic stroke at a preclinical stage in parallel with further performance improvements.
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http://dx.doi.org/10.1038/s41598-021-85348-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970995PMC
March 2021

Robustness of Deep Learning Algorithm to Varying Imaging Conditions in Detecting Low Contrast Objects In Computed Tomography Phantom Images: in Comparison to 12 Radiologists.

Diagnostics (Basel) 2021 Feb 28;11(3). Epub 2021 Feb 28.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.

The performance of deep learning algorithm (DLA) to that of radiologists was compared in detecting low contrast objects in CT phantom images under various imaging conditions. For training, 10,000 images were created using American College of Radiology CT phantom as the background. In half of the images, objects of 3-20 mm size and 5-30 HU contrast difference were generated in random locations. Binary responses were used as the ground truth. For testing, 640 images of Catphan phantom were used, half of which had objects of either 5 or 9 mm size with 10 HU contrast difference. Twelve radiologists evaluated the presence of objects on a five-point scale. The performances of the DLA and radiologists were compared across different imaging conditions in terms of area under receiver operating characteristics curve (AUC). Multi-reader multi-case AUC and Hanley and McNeil tests were used. We performed post-hoc analysis using bootstrapping and verified that the DLA is less affected by the changing imaging conditions. The AUC of DLA was consistently higher than those of the radiologists across different imaging conditions ( < 0.0001), and it was less affected by varying imaging conditions. The DLA outperformed the radiologists and showed more robust performance under varying imaging conditions.
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http://dx.doi.org/10.3390/diagnostics11030410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997324PMC
February 2021

Different effects of p53 protein overexpression on the survival of gastric cancer patients according to Lauren histologic classification: a retrospective study.

Gastric Cancer 2021 Feb 18. Epub 2021 Feb 18.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.

Background: Inactivation of TP53, a tumor suppressor gene, is associated with the development of several malignancies, including gastric cancer (GC). The present study aimed to evaluate the correlation between the overexpression of p53 and survival in different Lauren-type GCs.

Methods: From May 2003 to December 2019, 3608 GC patients treated endoscopically or surgically at the Seoul National University Bundang Hospital were enrolled for the study. Immunohistochemical staining for p53 was performed on all endoscopic and surgical gastric specimens. Clinicopathologic characteristics with Lauren classification, survival rate, and cancer recurrence were analyzed according to p53 overexpression.

Results: Among 3608 GC patients, p53 overexpression was seen in 1334 patients (37%). p53 overexpression was associated with lower depth of invasion (P = 0.026) and Early gastric cancer (P = 0.044) in intestinal-type GC, and with advanced TNM stage (P < 0.001) and Advanced gastric cancer (P < 0.001) in diffuse-type GC. The overall survival (OS) and GC-specific survival (GCSS) were significantly lower in p53 overexpression positive patients. This significance was more pronounced and enhanced in the diffuse-type GC and was absent in the intestinal-type GC. In multivariate analyses, p53 overexpression was associated with poor OS in both subtypes of GC and cancer recurrence in diffuse-type GC. (OS in intestinal-type: adjusted hazard ratio [aHR] = 1.423, P = 0.022; OS in diffuse-type: aHR = 1.401 P = 0.035; cancer recurrence in diffuse-type: aHR = 1.502, P = 0.039).

Conclusion: p53 overexpression was associated with poor prognosis in GC, especially in diffuse-type. In addition, p53 overexpression was associated with early stage disease in intestinal-type GC and with advanced stage disease in diffuse-type GC.
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http://dx.doi.org/10.1007/s10120-021-01163-yDOI Listing
February 2021

Clinicopathological characteristics of young never smoker females with oral cavity squamous cell carcinoma: A STROBE compliant retrospective observational study.

Medicine (Baltimore) 2021 Feb;100(5):e23871

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

Abstract: Although the incidence of oral cavity cancer (OCC) in young never smoker females is increasing worldwide, there has been little research on the etiologies and characteristics of these patients to date. In this study, we sought to evaluate the annual increase in OCC incidence in young never smoker females (YNSF) in our hospital as well as to investigate their clinicopathological characteristics and different disease courses compared with those of other OCC patients. We retrospectively reviewed the medical records of patients who were diagnosed and treated at our tertiary referral hospital from 2006 to 2016. The annual incidence of OCC and proportion of YNSF (never smoker females aged 45 years or younger at the time of diagnosis) among the enrolled OCC patients were evaluated. The characteristics and prognosis of the YNSF group were analyzed using their clinicopathological and survival data. Among the OCC patients primarily enrolled in this study, the proportion of YNSF did not show significant annual increase. There were 32 YNSF among 354 OCC patients (9%), who were ultimately included for the analyses of clinicopathological characteristics and survival. However, YNSF showed no significant differences compared with other OCC patients, even in subgroup analyses for overall survival. Our study did not demonstrate significant changes in the annual proportion of YNSF among OCC patients. In addition, differences in neither clinicopathological characteristics nor survival were noted between YNSF and other OCC patients.
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http://dx.doi.org/10.1097/MD.0000000000023871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870205PMC
February 2021

The Effectiveness and safety of T-MSAT on inpatients with acute low back pain caused by traffic accidents: A protocol for randomized controlled trial.

Medicine (Baltimore) 2021 Feb;100(5):e23851

Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea.

Background: Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA.

Methods: This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12).

Discussion: This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.
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http://dx.doi.org/10.1097/MD.0000000000023851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870160PMC
February 2021

The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma.

Ann Surg Treat Res 2021 Feb 1;100(2):100-108. Epub 2021 Feb 1.

Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.

Purpose: Diverting stoma (DS) and transanal tube (TAT) are the 2 main procedures for reducing anastomotic leak (AL) in rectal cancer surgery. However, few studies have compared the protective effect of the 2 modalities against AL.

Methods: Total of 165 patients with mid rectal cancer, who underwent curative resection from 2012 to 2017, were included. Clinical characteristics and outcomes were compared. Risk factors for AL were identified using multivariate analysis.

Results: The DS group had lower tumor location, higher rates of neoadjuvant concurrent chemoradiotherapy, and longer operative time than the TAT group. However, the level of the anastomosis did not show statistically significant differences (DS: 4.6 cm TAT: 4.9 cm, P = 0.061). AL occurred in 14 of the 165 patients (8.5%), with 10 (10.2%) in the DS group and 4 (6.0%) in the TAT group (P = 0.405). On multivariate analysis, only low body mass index (BMI) and smoking were significantly related to AL. Neither the protection method nor neoadjuvant chemoradiotherapy demonstrated statistical differences in AL. Seven of 10 patients in the DS group who experienced AL were treated conservatively, while all 4 in the TAT group underwent reoperation.

Conclusion: TAT seems to have comparable protective effect against AL to DS. However, in AL, DS appeared to be more effective in preventing reoperation. Therefore, DS is recommended in patients with low BMI or smoking, and with an expected higher probability of morbidity or mortality in case of reoperation. In other cases, TAT may be considered as an alternative to DS.
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http://dx.doi.org/10.4174/astr.2021.100.2.100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870432PMC
February 2021

Comparing the short-term outcomes and cost between solo single-incision distal gastrectomy and conventional multiport totally laparoscopic distal gastrectomy for early gastric cancer: a propensity score-matched analysis.

Ann Surg Treat Res 2021 Feb 1;100(2):67-75. Epub 2021 Feb 1.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: Single-incision laparoscopic distal gastrectomy (SIDG) requires experienced camera operators for a stable image. Since it is difficult for skilled camera operators to participate in all SIDG, we began performing solo surgery using mechanical camera holders. We aimed to compare the short-term outcomes and cost between solo SIDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for early gastric cancer (EGC).

Methods: From January 2014 to December 2016, a total of 938 consecutive patients underwent laparoscopic gastrectomy for EGC. Solo SIDG (n = 99) and MLDG patients (n = 198) were selected and 1:2 propensity score matching was done to compare the quality of operation and cost-effectiveness. All solo SIDG was performed by a surgeon using a camera holder, without any assistant.

Results: Mean operation time (120 ± 35.3 178 ± 53.4 minutes, P = 0.001) and estimated blood loss (24.6 ± 47.4 46.7 ± 66.5 mL, P = 0.001) were significantly lower in the solo SIDG group. Hospital stay, use of analgesics, and postoperative inflammatory markers (WBC, CRP) were similar between the 2 groups. The early (<30 days) complication rate in solo SIDG and MLDG groups was 21.2% and 23.7%, respectively (P = 0.240); the late (≥30 days) complication rate was 7.1% and 11.1%, respectively (P = 0.672). The manpower cost of solo SIDG was significantly lower than that of MLDG (P = 0.001).

Conclusion: This study demonstrated that solo SIDG performed by experienced laparoscopic surgeons is safe and feasible for EGC. Solo SIDG is expected to be a promising potential treatment for EGC.
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http://dx.doi.org/10.4174/astr.2021.100.2.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870426PMC
February 2021

Potential Association between Vaginal Microbiota and Cervical Carcinogenesis in Korean Women: A Cohort Study.

Microorganisms 2021 Jan 31;9(2). Epub 2021 Jan 31.

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

Convincing studies demonstrated that vaginal flora is one of the most impactful key components for the well-being of the genital tract in women. Nevertheless, the potential capability of vaginal-derived bacterial communities as biomarkers to monitor cervical carcinogenesis (CC) has yet to be studied actively compared to those of bacterial vaginosis (BV). We hypothesized that vaginal microbiota might be associated with the progression of CC. In this study, we enrolled 23 participants, including healthy controls (HC group; n = 7), patients with cervical intraepithelial neoplasia (CIN) 2 and 3 (CIN group, n = 8), and patients with invasive cervical cancer (CAN group; n = 8). Amplicon sequencing was performed using the Ion Torrent PGM to characterize the vaginal microbiota. Patients with CIN and CAN presented vaginal microbiota dysbiosis compared with HC. The alpha diversity analysis revealed that CC has a trend to be increased in terms of diversity indexes. Moreover, CC was associated with the abundance of specific microbes, of which and were the most significantly different between HC and CIN, whereas was differentially abundant in CAN compared with CIN. We then evaluated their diagnostic abilities. Testing in terms of diagnostic ability using the three genera revealed considerably high performance with an area under the receiver-operating characteristic curve of 0.982, 0.953, and 0.922. The current study suggests that the presence of and may be involved in the advancment of CC.
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http://dx.doi.org/10.3390/microorganisms9020294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912413PMC
January 2021

Advantages and limitations of using national survey datasets in child and adolescent research.

Authors:
Yoon Lee

Clin Exp Pediatr 2021 Jan 26. Epub 2021 Jan 26.

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

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http://dx.doi.org/10.3345/cep.2020.02110DOI Listing
January 2021

Reappraisal of the prognostic value of Epstein-Barr virus status in monomorphic post-transplantation lymphoproliferative disorders-diffuse large B-cell lymphoma.

Sci Rep 2021 Feb 3;11(1):2880. Epub 2021 Feb 3.

Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

The role of the Epstein-Barr virus (EBV) status in the blood for predicting survival in post-transplantation lymphoproliferative disorders-diffuse large B-cell lymphoma (PTLD-DLBCL) is unknown. We evaluated the prognostic values of pre-treatment EBV-encoded small RNA (EBER) detected with in situ hybridization in tissues and EBV DNA in the whole blood (WB) and plasma in 58 patients with monomorphic PTLD-DLBCL after solid organ transplantation. There were no significant differences in the rates of overall response, complete response, and survival according to EBER EBV and WB EBV status. In contrast, patients with positive plasma EBV DNA had significantly lower rates of overall response (60.0% vs. 94.4%, P = 0.043) and complete response (40.0% vs. 88.9%, P = 0.019) as well as worse progression-free survival (PFS) (P = 0.035) and overall survival (OS) (P = 0.039) compared with patients with negative plasma EBV DNA. In multivariate analysis, plasma EBV DNA positivity was a significantly unfavorable prognostic factor for PFS [hazard ratio (HR) 4.92, 95% confidence interval (CI) 1.22-19.86, P = 0.025] and OS (HR 4.48, 95% CI 1.14-17.63, P = 0.032). Despite small number of 6 patients with plasma EBV positivity, plasma EBV DNA positivity might be more prognostic for survival than EBER or WB EBV DNA positivity in patients with monomorphic PTLD-DLBCL.
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http://dx.doi.org/10.1038/s41598-021-82534-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859229PMC
February 2021

Association between blood cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women.

Arch Osteoporos 2021 02 2;16(1):22. Epub 2021 Feb 2.

Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.

We aimed to investigate the association between cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. There was a significant positive association between cadmium levels and the risk of osteopenia and osteoporosis, but further studies for dose response are required.

Purpose: Cadmium exposure can exert detrimental effects on bone health, particularly in post-menopausal women. However, previous studies have failed to report an association in Korean post-menopausal women. We aimed to investigate the association between cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women.

Methods: In total, 5432 participants from the 4th and 5th Korean National Health and Nutrition Examination Survey (KNHANES) were randomly sampled for measurements of heavy metal concentrations in the blood, bone mass density (BMD), and nutrient intake. We analyzed data for 1031 post-menopausal women ≥50 years of age. Blood cadmium levels were categorized into quartiles, and a multinomial logistic regression model was used for analysis.

Results: There was a significant positive association between cadmium levels and the risk of osteopenia and osteoporosis, but the odds ratio (OR) at the 4th level was lower than that at the 3rd level (OR and 95% confidence interval (CI) for osteopenia: 2nd quartile: 1.24, 0.88-1.74; 3rd quartile: 3.22, 2.24-4.64; 4th quartile: 1.27, 0.87-1.85; P for trend <0.001; OR and 95% CI for osteoporosis: 2nd quartile: 1.54, 1.05-2.25; 3rd quartile: 3.63, 2.31-5.69; 4th quartile: 1.70, 1.03-2.81; P for trend <0.001). This trend was consistent in the sensitivity analysis.

Conclusion: Our findings suggest that there is an association between blood cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. However, further prospective studies are required to determine whether there is a dose-response relationship and address potential selection bias, especially in patients with femoral neck osteoporosis.
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http://dx.doi.org/10.1007/s11657-021-00887-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850996PMC
February 2021

Nitric Oxide Produced by the Antioxidant Activity of Verapamil Improves the Acute Wound Healing Process.

Tissue Eng Regen Med 2021 02 29;18(1):179-186. Epub 2021 Jan 29.

Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, 06591, Republic of Korea.

Background: Verapamil is used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, hypertrophic scars, and keloids to block transmembrane calcium ion flux. Verapamil has antioxidant activity, which enhances the production of nitric oxide (NO). NO promotes the proliferation of fibroblasts, keratinocytes, endothelial cells, and epithelial cells during wound healing. In this study, we investigated the effect of verapamil and its antioxidant properties on the enhancement of acute wound healing via NO.

Methods: A full-thickness wound healing model was created on the rat dorsal with a silicone ring. The wound closure rate was estimated every 2 days for 14 days. A histological study was performed to evaluate wound healing. Immunofluorescence staining was analyzed for angiogenesis. The expressions of collagen type I (COL I), collagen type III (COL III), and vascular endothelial growth factor (VEGF) were assessed by Western blot. Real-time polymerase chain reaction (qRT-PCR) was performed to examine the expression of endothelial NO synthase and inducible NO synthase, which are related to antioxidant activity in the process of wound healing.

Results: The wound closure rate was faster in the verapamil group compared to the control and silicone groups. Histologic analysis revealed capillaries and stratum basale in the verapamil group. Immunofluorescence staining was shown vessel formation in the verapamil group. Western blot and qRT-PCR analysis revealed high expression levels of COL I, VEGF, eNOS, and FGF in the verapamil.

Conclusion: Verapamil's antioxidant activity enhances NO production in acute wound healing. We suggest that verapamil can be used to promote acute wound healing.
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http://dx.doi.org/10.1007/s13770-020-00308-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862477PMC
February 2021

Predictive value of KRAS mutation and excision repair cross-complementing 1 (ERCC1) protein overexpression in patients with colorectal cancer administered FOLFOX regimen.

Asian J Surg 2021 May 16;44(5):715-722. Epub 2021 Jan 16.

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

Background: Recent studies have reported that KRAS mutational status is correlated with ERCC1 expression level. The purpose of this study was to determine the clinical significance of the KRAS mutation and ERCC1 overexpression status as predictive factors for resistance against oxaliplatin-based treatment.

Methods: We retrospectively analyzed clinicopathologic features, KRAS mutation status, and ERCC1 overexpression status in 386 patients with colorectal cancer (CRC) who underwent curative-intent surgery. Of these patients, 84 were administered the FOLFOX regimen as a first-line or adjuvant treatment. Disease-free survival and overall survival in groups separated by KRAS and ERCC1 statuses were analyzed.

Results: Wild-type KRAS and ERCC1 overexpression were observed in 25.5% of all patients. Among the 84 patients who were treated with the FOLFOX regimen, 73 patients were evaluated for KRAS and ERCC1 status. There were no significant differences in disease-free survival or overall survival in groups separated by KRAS mutation and ERCC1 expression status. Subgroup analysis of patients with wild-type KRAS showed that overall survival in the ERCC1 overexpression group was lower than that of patients in the ERCC1 underexpression group (p = 0.029); however, no significant difference was found in the mutant KRAS patient group (p = 0.671).

Conclusions: Our results suggest that CRC with wild-type KRAS and ERCC1 overexpression might be associated with oxaliplatin resistance. When considering oxaliplatin-based chemotherapy, the status of both KRAS mutation and ERCC1 overexpression should be evaluated.
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http://dx.doi.org/10.1016/j.asjsur.2020.12.028DOI Listing
May 2021