1
|
Kim TW, Kim WY, Park S, Lee SH, Park O, Kim T, Yeo HJ, Jang JH, Cho WH, Huh JW, Lee SM, Chung CR, Lee J, Kim JS, Lim SY, Baek AR, Yoo JW, Kim HC, Choi EY, Park C, Kim TO, Moon DS, Lee SI, Moon JY, Kwon SJ, Seong GM, Jung WJ, Baek MS. Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study. J Korean Med Sci 2024; 39:e75. [PMID: 38442718 PMCID: PMC10911941 DOI: 10.3346/jkms.2024.39.e75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. METHODS We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan-Meier (KM) method. RESULTS Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010-1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312-7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). CONCLUSION Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.
Collapse
Affiliation(s)
- Tae Wan Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Onyu Park
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taehwa Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Soo Kim
- Division of Critical Care Medicine, Department of Hospital Medicine, Inha Collage of Medicine, Incheon, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Eun Young Choi
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea
| | - Chul Park
- Division of Pulmonology and Critical Care Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Tae-Ok Kim
- Division of Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Do Sik Moon
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea
| | - Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sun Jung Kwon
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Won Jai Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Jayaram L, King PT, Hunt J, Lim M, Park C, Hu E, Dousha L, Ha P, Bartlett JB, Southcott AM, Muruganandan S, Vogrin S, Rees MA, Dean OM, Wong CA. Evaluation of high dose N- Acetylcysteine on airway inflammation and quality of life outcomes in adults with bronchiectasis: A randomised placebo-controlled pilot study. Pulm Pharmacol Ther 2024; 84:102283. [PMID: 38141851 DOI: 10.1016/j.pupt.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND High dose N acetylcysteine (NAC), a mucolytic, anti-inflammatory and antioxidant agent has been shown to significantly reduce exacerbations, and improve quality of life in placebo controlled, double blind randomised (RCT) studies in patients with COPD, and in an open, randomised study in bronchiectasis. In this pilot, randomised, double-blind, placebo-controlled study, we wished to investigate the feasibility of a larger clinical trial, and the anti-inflammatory and clinical benefits of high dose NAC in bronchiectasis. AIMS Primary outcome: to assess the efficacy of NAC 2400 mg/day at 6 weeks on sputum neutrophil elastase (NE), a surrogate marker for exacerbations. Secondary aims included assessing the efficacy of NAC on sputum MUC5B, IL-8, lung function, quality of life, and adverse effects. METHODS Participants were randomised to receive 2400 mg or placebo for 6 weeks. They underwent 3 visits: at baseline, week 3 and week 6 where clinical and sputum measurements were assessed. RESULTS The study was stopped early due to the COVID pandemic. In total 24/30 patients were recruited, of which 17 completed all aspects of the study. Given this, a per protocol analysis was undertaken: NAC (n = 9) vs placebo (n = 8): mean age 72 vs 62 years; male gender: 44% vs 50%; baseline median FEV11.56 L (mean 71.5 % predicted) vs 2.29L (mean 82.2% predicted). At 6 weeks, sputum NE fell by 47% in the NAC group relative to placebo (mean fold difference (95%CI: 0.53 (0.12,2.42); MUC5B increased by 48% with NAC compared with placebo. Lung function, FVC improved significantly with NAC compared with placebo at 6 weeks (mean fold difference (95%CI): 1.10 (1.00, 1.20), p = 0.045. Bronchiectasis Quality of life measures within the respiratory and social functioning domains demonstrated clinically meaningful improvements, with social functioning reaching statistical significance. Adverse effects were similar in both groups. CONCLUSION High dose NAC exhibits anti-inflammatory benefits, and improvements in aspects of quality of life and lung function measures. It is safe and well tolerated. Further larger placebo controlled RCT's are now warranted examining its role in reducing exacerbations.
Collapse
Affiliation(s)
- L Jayaram
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia.
| | - P T King
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - J Hunt
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - M Lim
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - C Park
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - E Hu
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - L Dousha
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - P Ha
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - J B Bartlett
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - A M Southcott
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Muruganandan
- University of Melbourne, Parkville, VIC, 3010, Australia; Northern Health, Epping, VIC, 3076 Australia
| | - S Vogrin
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - M A Rees
- University of Melbourne, Parkville, VIC, 3010, Australia; Royal Melbourne Hospital, Gratten St, VIC, 3050, Australia
| | - O M Dean
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, 3220 Australia; Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, VIC , 3010, Australia
| | - C A Wong
- Middlemore Hospital, Te Whatu Ora, Otahuhu, Auckland, 1025, New Zealand; University of Auckland, Park Road, Auckland, 1010, New Zealand
| |
Collapse
|
3
|
Kim Y, Park J, Kim B, Yu K, Kim HS, Oh Y, Seo K, Ryu M, Park C, Bhang D, Choi U, Youn H. Serum thymidine kinase 1 protein concentrations and presence of its autoantibody as biomarkers for screening dogs with malignant tumors. J Vet Intern Med 2024; 38:300-307. [PMID: 38088206 PMCID: PMC10800180 DOI: 10.1111/jvim.16946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND An accurate and easily accessible method for diagnosing malignancies in local veterinary clinics has not yet been established. OBJECTIVES To investigate the usefulness of serum thymidine kinase 1 (TK1) protein and its autoantibody as tumor biomarkers in dogs. ANIMALS Serum samples from 1702 dogs were collected from local animal hospitals and referral animal medical centers in South Korea. METHODS TK1 protein OD value and TK1 autoantibody ratio (TK1 autoantibody OD/total IgG OD) in serum samples of dogs classified into healthy controls, group with nontumor disease, group with benign and group with malignant tumors were measured using lateral flow immunochromatographic assay methods. RESULTS TK1 autoantibody levels were significantly higher in malignant tumor group (median 0.71) than in healthy controls (median 0.34), group with nontumor disease (median 0.34), and group with benign tumor (median 0.32, Welch t test, P < .0001). They were also significantly different among dogs with carcinomas (median 0.77), hematopoietic tumors (median 0.71), and sarcomas (median 0.56) than in healthy controls (median 0.34, post hoc Games-Howell test, P < .0001). In the receiver operating characteristic curve of TK1 protein, AUC was 0.633 (95% CI: 0.592-0.675, P < .0001). The AUC of TK1 autoantibody ratio was 0.758 (95% CI: 0.723-0.793, P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE TK1 autoantibody is a potentially useful biomarker for differentiating between healthy and tumor-bearing dogs, better than TK1 protein measurement. However, both were inadequate when used as single biomarkers for screening dogs to discover occult malignant tumors.
Collapse
Affiliation(s)
- Yoonhee Kim
- College of Veterinary MedicineJeonbuk National University, 79 Gobong‐roIksan‐siJeollabuk‐doSouth Korea
| | - Jeongjoo Park
- Biattic Inc., #305, 16 Heungan‐daero, Dongan‐guAnyang‐siGyeonggi‐doSouth Korea
| | - Byunggak Kim
- Biattic Inc., #305, 16 Heungan‐daero, Dongan‐guAnyang‐siGyeonggi‐doSouth Korea
| | - Kyung‐Rok Yu
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life SciencesSeoul National University, 1 Gwanak‐ro, Gwanak‐guSeoulSouth Korea
| | - Hong Sook Kim
- Department of Biological SciencesSungkyunkwan University, 2066 Seobu‐ro, Jangan‐guSuwonGyeonggi‐doSouth Korea
| | - Yein Oh
- College of Veterinary MedicineKyungpook National University, 80 Daehak‐ro, Buk‐guDaeguSouth Korea
| | - Kyoungwon Seo
- College of Veterinary MedicineSeoul National University, 1 Gwanak‐ro, Gwanak‐guSeoulSouth Korea
| | - Minok Ryu
- College of Veterinary MedicineSeoul National University, 1 Gwanak‐ro, Gwanak‐guSeoulSouth Korea
| | - Chul Park
- College of Veterinary MedicineJeonbuk National University, 79 Gobong‐roIksan‐siJeollabuk‐doSouth Korea
| | - Dongha Bhang
- Biattic Inc., #305, 16 Heungan‐daero, Dongan‐guAnyang‐siGyeonggi‐doSouth Korea
| | - Ulsoo Choi
- College of Veterinary MedicineJeonbuk National University, 79 Gobong‐roIksan‐siJeollabuk‐doSouth Korea
| | - Hwayoung Youn
- College of Veterinary MedicineSeoul National University, 1 Gwanak‐ro, Gwanak‐guSeoulSouth Korea
| |
Collapse
|
4
|
Park C. Total rebuilding of the ear after unsatisfactory initial microtia reconstruction: 30-year experience using autogenous costal cartilage framework. J Plast Reconstr Aesthet Surg 2023; 86:174-182. [PMID: 37722306 DOI: 10.1016/j.bjps.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND This study describes the author's experience with long-term follow-up analysis of secondary procedures in patients with unsatisfactory initial microtia reconstruction. METHODS A total of 134 patients who underwent secondary operations between 1992 and 2021 were reviewed by examining medical records and photographic data. A total of 110 patients followed between 6 months and 26 years (average 33.2 months) were included for evaluation of aesthetic outcomes. RESULTS Primary reconstruction was performed with costal cartilage in 113 patients, porous polyethylene implant in 7 patients, silicone implant in 6 patients, and others in 8 patients. The major external features at the time of the secondary reconstruction were lump (91 cases), deficient convolution (19 cases), and no framework with scarred mastoid skin (22 cases). All secondary reconstructions were performed with an autogenous costal cartilage framework. The framework was covered using temporoparietal fascia flap techniques in 118 patients, mastoid skin coverage technique in 12 patients, and others in 4 patients. One major complication (exposure of cartilage framework due to partial necrosis of fascial flap) and three minor complications (loss of moderate-sized full-thickness skin, grafted on the fascia) were recorded. The average score given for aesthetic outcomes, rated on a four-point Likert scale (i.e., 1 = poor, 2 = fair, 3 = good, and 4 = excellent) was 3.17 (median 3.00). A total of 42% of the patients were rated excellent and 36% were rated good.
Collapse
Affiliation(s)
- Chul Park
- Seoul Center for Developmental Ear Anomalies and the BIO Plastic Surgery Group, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Oh J, Lim H, Jeong CW, Kim MS, Lee J, Kang WS, An UR, Park JU, Ahn Y, Kim YR, Park C. Clinical implication of thoracic skeletal muscle volume as a predictor of ventilation-weaning failure in brain-injured patients: A retrospective observational study. Medicine (Baltimore) 2023; 102:e35847. [PMID: 37904365 PMCID: PMC10615541 DOI: 10.1097/md.0000000000035847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/06/2023] [Indexed: 11/01/2023] Open
Abstract
Sarcopenia, a generalized loss of skeletal muscle mass that is primarily evident in the respiratory musculature, is associated with adverse outcomes in critically ill patients. However, the relationship between sarcopenia and ventilation-weaning outcomes has not yet been fully studied in patients with brain injuries. In this study, we examined the effect of reduced respiratory muscle mass on ventilation weaning in patients with brain injury. This observational study retrospectively reviewed the medical records of 73 patients with brain injury between January 2017 and December 2019. Thoracic skeletal muscle volumes were measured from thoracic CT images using the institute's three-dimensional modeling software program of our institute. The thoracic skeletal muscle volumes index (TSMVI) was normalized by dividing muscle volume by the square of patient height. Sarcopenia was defined as a TSMVI of less than the 50th sex-specific percentile. Among 73 patients with brain injury, 12 (16.5%) failed to wean from mechanical ventilation. The patients in the weaning-failure group had significantly higher sequential organ failure assessment scores [7.8 ± 2.7 vs 6.1 ± 2.2, P = .022] and lower thoracic skeletal muscle volume indexes [652.5 ± 252.4 vs 1000.4 ± 347.3, P = .002] compared with those in the weaning-success group. In multivariate analysis, sarcopenia was significantly associated with an increased risk of weaning failure (odds ratio 12.72, 95% confidence interval 2.87-70.48, P = .001). Our study showed a significant association between the TSMVI and ventilation weaning outcomes in patients with brain injury.
Collapse
Affiliation(s)
- Jimi Oh
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyun Lim
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Chang Won Jeong
- Smart Health IT Center, Wonkwang University Hospital, Iksan-si, South Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University, College of Medicine, Cheonan-si, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin-si, South Korea
| | - Wu Seong Kang
- Department of Trauma Surgery, Cheju Halla General Hospital, Jeju-si, South Korea
| | - Ui Ri An
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Joo Un Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Youngick Ahn
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Chul Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| |
Collapse
|
6
|
Marsden MER, Buckley AM, Park C, Tai N, Rees P. Balloons on the battlefield: REBOA implementation in the UK Defence Medical Services. BMJ Mil Health 2023; 169:448-451. [PMID: 34408063 DOI: 10.1136/bmjmilitary-2021-001925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022]
Abstract
Established in 2018, the Defence Endovascular Resuscitation (DefER) group recognised that resuscitative endovascular balloon occlusion of the aorta (REBOA) offered an option to improve survival in battle casualties dying from haemorrhage, particularly in remote and austere surgical settings. Following a successful jHub opportunity assessment, DefER purchased training and operational kit at pace. By 1 April 2019, the first forward surgical group undertook a bespoke endovascular training and assessment package. Results of the pilot were presented back to a jHub 4* Innovation Board, which initially awarded £500 000 to fund the project to full implementation. Med Op Cap provided a solution to establish REBOA as a core capability on to the 370 modules. REBOA catheters and arterial access kit are now available to deployed Role 2 facilities across defence as an adjunct to damage control resuscitation in specific circumstances. REBOA has, from a standing start, gained pan-Defence Medical Services (DMS) endorsement and has been integrated into deployed damage control resuscitation. To establish a new resuscitation capability across all Role 2 platforms within 15 months of inception represents implementation at pace. This agility was unlocked by empowering clinicians to develop the platform in conjunction with commercial procurement. This article describes how this innovative pathway facilitated the rapid introduction of a lifesaving haemorrhage control technique to equip DMS clinicians.
Collapse
Affiliation(s)
- Max E R Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - A M Buckley
- jHubMed, UKStratCom, London, UK
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - C Park
- Critical Care, King's College Hospital, London, UK
- London's Air Ambulance, Barts Health NHS Trust, London, UK
| | - N Tai
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - P Rees
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| |
Collapse
|
7
|
Marsden MER, Park C, Barratt J, Tai N, Rees P. Defence Medical Services' REBOA training course. BMJ Mil Health 2023; 169:452-455. [PMID: 34607909 DOI: 10.1136/bmjmilitary-2021-001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022]
Abstract
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors' perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.
Collapse
Affiliation(s)
- Max E R Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Science, Blizard Institute, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - C Park
- Critical Care, King's College Hospital NHS Trust, London, London, UK
- London's Air Ambulance, Barts Health NHS Trust, London, UK
| | - J Barratt
- Emergency Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - N Tai
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- UK STRATCOM, jHubMed, London, UK
| | - P Rees
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
- University of St Andrews School of Medicine, St Andrews, UK
| |
Collapse
|
8
|
Gopal K, Desir A, Abdelfattah KR, Park C. A Call for Formalized Training of Surgical Educators. J Surg Educ 2023; 80:1056-1060. [PMID: 37365118 DOI: 10.1016/j.jsurg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Current training curricula for future surgeons do not prioritize teaching residents how to teach. With increased expectations but decreased opportunities to operate, developing efficient and effective educators is a pressing necessity. In this article, we discuss the need to formalize the role of the surgical educator, and future directions to implement better training paradigms for surgical educators.
Collapse
Affiliation(s)
- K Gopal
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas.
| | - A Desir
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
| | - K R Abdelfattah
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
| | - C Park
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas Texas
| |
Collapse
|
9
|
Eom H, Park C. Evaluation of phytoplankton-stimulating potency of effluent nitrogen depending on its chemical forms: A comparison between inorganic and organic nitrogen. J Environ Manage 2023; 336:117601. [PMID: 36870319 DOI: 10.1016/j.jenvman.2023.117601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Wastewater-originated nitrogen (N) is considered a primary N source in urban waters. In order to mitigate eutrophication in such waters, decreasing N discharges from wastewater treatment plants (WWTPs) is necessary. Upgrading WWTPs from conventional activated sludge (CAS) to biological nutrient removal (BNR) is the most common measure to lower levels of effluent N. However, in spite of successful N reduction through such upgrades, eutrophication persists in numerous urban waters. In this study, we investigated why decreased N discharge resulting from upgrading CAS to BNR, particularly predenitrification BNR, cannot necessarily alleviate eutrophication. Our laboratory reactor study demonstrated that compared to CAS effluent N, predenitrification BNR effluent N contains less dissolved inorganic N (DIN) but more dissolved organic N (DON), especially low molecular weight DON (LMW-DON). Bioassay-based experimental and numerical analyses found that effluent N has dissimilar phytoplankton-stimulating potency depending on its chemical forms. In particular, effluent LMW-DON showed significantly greater potency than effluent DIN. This difference in potency makes predenitrification BNR effluent N more productive for causing primary production than CAS effluent N. These results indicate that the impact of effluent N on eutrophication should be evaluated based on not only the total quantity but also the qualitative aspect of N.
Collapse
Affiliation(s)
- Heonseop Eom
- Department of Civil Engineering, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
| | - Chul Park
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| |
Collapse
|
10
|
Ansari AA, Ansari AA, Gikonyo JG, Abouhend AS, Park C. The Coupled Effect of Light and Iron on the Photogranulation Phenomenon. Environ Sci Technol 2023. [PMID: 37273233 DOI: 10.1021/acs.est.3c00432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cyanobacteria occasionally self-immobilize and form spherical aggregates. This photogranulation phenomenon is central for oxygenic photogranules, which present potential for aeration-free and net-autotrophic wastewater treatment. Light and iron are tightly coupled via photochemical cycling of Fe, suggesting that phototrophic systems continually respond to their combined effects. Thus far, photogranulation has not been investigated from this important aspect. Here, we studied the effects of light intensity on the fate of Fe and their combined effects on the photogranulation process. Photogranules were batch-cultivated with the activated sludge inoculum under three photosynthetic photon flux densities: 27, 180, and 450 μmol/m2·s. Photogranules were formed within a week under 450 μmol/m2·s compared to 2-3 and 4-5 weeks under 180 and 27 μmol/m2·s, respectively. Batches under 450 μmol/m2·s showed faster but lower quantity of Fe(II) release into bulk liquids compared to the other two sets. However, when ferrozine was added, this set showed substantially more Fe(II), indicating that Fe(II) released by photoreduction undergoes fast turnover. Fe linked with extracellular polymeric substances (EPS), FeEPS, diminished significantly faster under 450 μmol/m2·s, while the granular shape in all three batches appeared along with the depletion of this FeEPS pool. We conclude that light intensity has a major influence on the availability of Fe, and light and Fe together impact the speed and characteristics of photogranulation.
Collapse
Affiliation(s)
- Abeera A Ansari
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Massachusetts 01003, United States
- U.S.-Pakistan Center for Advance Studies in Energy (USPCAS-E), National University of Sciences and Technology (NUST), Sector H-12, Islamabad 44000, Pakistan
| | - Arfa A Ansari
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Massachusetts 01003, United States
| | - Joseph G Gikonyo
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Massachusetts 01003, United States
| | - Ahmed S Abouhend
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Massachusetts 01003, United States
| | - Chul Park
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Massachusetts 01003, United States
| |
Collapse
|
11
|
Bishop J, Rogachev GV, Ahn S, Barbui M, Cha SM, Harris E, Hunt C, Kim CH, Kim D, Kim SH, Koshchiy E, Luo Z, Park C, Parker CE, Pollacco EC, Roeder BT, Roosa M, Saastamoinen A, Scriven DP. First Observation of the β3αp Decay of ^{13}O via β-Delayed Charged-Particle Spectroscopy. Phys Rev Lett 2023; 130:222501. [PMID: 37327448 DOI: 10.1103/physrevlett.130.222501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 06/18/2023]
Abstract
The β-delayed proton decay of ^{13}O has previously been studied, but the direct observation of β-delayed 3αp decay has not been reported. Rare 3αp events from the decay of excited states in ^{13}N^{⋆} provide a sensitive probe of cluster configurations in ^{13}N. To measure the low-energy products following β-delayed 3αp decay, the Texas Active Target (TexAT) time projection chamber was employed using the one-at-a-time β-delayed charged-particle spectroscopy technique at the Cyclotron Institute, Texas A&M University. A total of 1.9×10^{5} ^{13}O implantations were made inside the TexAT time projection chamber. A total of 149 3αp events were observed, yielding a β-delayed 3αp branching ratio of 0.078(6)%. Four previously unknown α-decaying excited states were observed in ^{13}N at 11.3, 12.4, 13.1, and 13.7 MeV decaying via the 3α+p channel.
Collapse
Affiliation(s)
- J Bishop
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - G V Rogachev
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
- Nuclear Solutions Institute, Texas A&M University, College Station, Texas 77843, USA
| | - S Ahn
- Center for Exotic Nuclear Studies, Institute for Basic Science, 34126 Daejeon, Republic of Korea
| | - M Barbui
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - S M Cha
- Center for Exotic Nuclear Studies, Institute for Basic Science, 34126 Daejeon, Republic of Korea
| | - E Harris
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - C Hunt
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - C H Kim
- Department of Physics, Sungkyunkwan University (SKKU), Seoul 16419, Republic of Korea
| | - D Kim
- Center for Exotic Nuclear Studies, Institute for Basic Science, 34126 Daejeon, Republic of Korea
| | - S H Kim
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - E Koshchiy
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - Z Luo
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - C Park
- Center for Exotic Nuclear Studies, Institute for Basic Science, 34126 Daejeon, Republic of Korea
| | - C E Parker
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - E C Pollacco
- IRFU, CEA, Université Paris-Saclay, Gif-Sur-Yvette 91190, France
| | - B T Roeder
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - M Roosa
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - A Saastamoinen
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - D P Scriven
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| |
Collapse
|
12
|
Yoo H, Kim SY, Park MS, Jeong SH, Park SW, Lee HL, Lee HK, Yang SH, Jegal Y, Yoo JW, Lee J, Kang HK, Choi SM, Park J, Kim YW, Song JW, Park JH, Choi WI, Choi HS, Park C, Park JW, Chung MP. COVID-19 Vaccine-Associated Pneumonitis in the Republic of Korea: A Nationwide Multicenter Survey. J Korean Med Sci 2023; 38:e106. [PMID: 37038643 PMCID: PMC10086377 DOI: 10.3346/jkms.2023.38.e106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/03/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Recent reports have suggested that pneumonitis is a rare complication following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, its clinical features and outcomes are not well known. The aim of this study was to identify the clinical characteristics and outcomes of patients with vaccine-associated pneumonitis following vaccination against SARS-CoV-2. METHODS In this nationwide multicenter survey study, questionnaires were distributed to pulmonary physicians in referral hospitals. They were asked to report cases of development or exacerbation of interstitial lung disease (ILD) associated with the coronavirus disease 2019 vaccine. Vaccine-associated pneumonitis was defined as new pulmonary infiltrates documented on chest computed tomography within 4 weeks of vaccination and exclusion of other possible etiologies. RESULTS From the survey, 49 cases of vaccine-associated pneumonitis were identified between February 27 and October 30, 2021. After multidisciplinary discussion, 46 cases were analyzed. The median age was 66 years and 28 (61%) were male. The median interval between vaccination and respiratory symptoms was 5 days. There were 20 (43%), 17 (37%), and nine (19%) patients with newly identified pneumonitis, exacerbation of pre-diagnosed ILD, and undetermined pre-existing ILD, respectively. The administered vaccines were BNT162b2 and ChAdOx1 nCov-19/AZD1222 each in 21 patients followed by mRNA-1273 in three, and Ad26.COV2.S in one patient. Except for five patients with mild disease, 41 (89%) patients were treated with corticosteroid. Significant improvement was observed in 26 (57%) patients including four patients who did not receive treatment. However, ILD aggravated in 9 (20%) patients despite treatment. Mortality was observed in eight (17%) patients. CONCLUSION These results suggest pneumonitis as a potentially significant safety concern for vaccines against SARS-CoV-2. Clinical awareness and patient education are necessary for early recognition and prompt management. Additional research is warranted to identify the epidemiology and characterize the pathophysiology of vaccine-associated pneumonitis.
Collapse
Affiliation(s)
- Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hwan Jeong
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung-Woo Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hong Lyeol Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Inha University, Incheon, Korea
| | - Hyun-Kyung Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sei-Hoon Yang
- Division of Pulmonary, Department of Internal Medicine, College of Medicine, Wonkwang University, Iksan, Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Young Whan Kim
- Division of Respiratory-Allergy and Clinical Immunology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Won-Il Choi
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Hye Sook Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyunghee University Hospital, Seoul, Korea
| | - Chul Park
- Division of Pulmonary, Department of Internal Medicine, College of Medicine, Wonkwang University, Iksan, Korea
| | - Jeong-Woong Park
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
13
|
Nozari Y, Park C, Brietzke E, Iacobucci M, Gill H, McIntyre RS. Correlation between improved leptin signaling and cognitive function post bariatric surgery. J Affect Disord 2023; 326:225-231. [PMID: 36736790 DOI: 10.1016/j.jad.2023.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Determining whether changes in leptin signaling plays a role in the improvement of cognitive function post-bariatric surgery may aid in the understanding and development of novel therapeutic approaches targeting cognitive dysfunction through the greater understanding of processes connecting obesity and brain health. Several studies have explored the effects of cognition post bariatric surgery, and others have studied leptin and its changes post surgery. However the amalgamation of the effects of leptin signaling in relation to cognition post bariatric surgery have yet to be considered as key tools in the understanding of cognitive dysfunction in obese subjects with leptin resistance or insensitivity. This review serves to highlight the potential correlations, to further elucidate the effect of improved leptin signaling on cognition post bariatric surgery, and to propose a direct cause for the improvement of cognitive function via the amelioration of the leptin Janus kinase/Signal transducer and activator of transcription (JAK/STAT) signaling pathway as a result of the reversal of inflammatory processes involved in diseased individuals.
Collapse
Affiliation(s)
- Y Nozari
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, Toronto, ON, Canada; University of Toronto HBSc, Toronto, ON, Canada.
| | - C Park
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, Toronto, ON, Canada; University of Toronto MSc, Toronto, ON, Canada
| | - E Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada; Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - M Iacobucci
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, Toronto, ON, Canada; University of Toronto HBSc, Toronto, ON, Canada
| | - H Gill
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - R S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| |
Collapse
|
14
|
Vassallo J, Cowburn P, Park C, Bull D, Harris S, Moran C, Smith J. Ten second triage: A novel and pragmatic approach to major incident triage. Trauma 2023. [DOI: 10.1177/14604086231156219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.
Collapse
Affiliation(s)
- J. Vassallo
- Institute of Naval Medicine, Gosport, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - P. Cowburn
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- South Western Ambulance Service NHS Foundation Trust, North Bristol Operations Centre, Bristol, UK
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - C. Park
- Academic Department of Military Anaesthesia & Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Anaesthesia and Critical Care, Kings College Hospital, London, UK
| | - D. Bull
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - S. Harris
- London Ambulance Service, London, UK
| | - C.G. Moran
- NHS England London, London, UK
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J.E. Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
15
|
Ahn B, Park C, Kim M, Lee J, Choi J, Kim H, Lee G, Yu N, Lee Y, Han JY. OP27 A phase II study of neoadjuvant erlotinib for operable stage II or IIIA non-small cell lung cancer with epidermal growth factor receptor activating mutations. ESMO Open 2022. [DOI: 10.1016/j.esmoop.2022.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
16
|
Kwon J, Ko HJ, Yang MH, Park C, Park SC. Antibiotic Resistance and Species Profile of Enterococcus Species in Dogs with Chronic Otitis Externa. Vet Sci 2022; 9:592. [PMID: 36356069 PMCID: PMC9695832 DOI: 10.3390/vetsci9110592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 01/13/2024] Open
Abstract
Otitis externa, a common disease in dogs, has different etiologies. Enterococcus is a Gram-positive bacterium that frequently causes opportunistic ear infections. Here, we determined the distribution of Enterococcus in canine otitis externa via time-of-flight mass spectrometry and biochemical tests and evaluated their resistance patterns to 10 commonly used antibiotics. Among the 197 Enterococcus isolates, E. faecalis (48.7%; 96/197) was the most common, followed by E. faecium (21.3%; 42/197), E. casseliflavus (11.7%; 23/197), E. hirae (10.7%; 21/197), E. avium (3.6%; 7/197), E. gallinarum (2.5%; 5/197), E. canintestini (1.0%; 2/197), and E. durans (0.5%; 1/197). All isolates were tested for antibiotic resistance using the Kirby-Bauer disc diffusion method. Enterococcus faecalis strains were highly resistant to erythromycin (45.8%) and rifampin (34.3%) but were generally susceptible to penicillin class antibiotics. In contrast, E. faecium isolates were highly resistant to penicillin class antibiotics (ampicillin, 61.9%; penicillin, 71.4%). Most importantly, E. faecium demonstrated high resistance to most of the antibiotics used in this study. Multidrug resistance was found in 28.4% of the isolates (56/197). This study shows prevalence and antibiotics resistance profiles of Enterococcus species in canine chronic otitis externa. The results can contribute to establish therapeutic strategies of Enterococcus infections and be used as a comparable index of antibiotic resistance of Enterococcus in the future.
Collapse
Affiliation(s)
- Jun Kwon
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
| | - Hyoung Joon Ko
- Department of Veterinary Internal Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Myoung Hwan Yang
- Department of Veterinary Internal Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Chul Park
- Department of Veterinary Internal Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Se Chang Park
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea
| |
Collapse
|
17
|
Kang S, Park C, Lee J, Yoon D. Machine Learning Model for the Prediction of Hemorrhage in Intensive Care Units. Healthc Inform Res 2022; 28:364-375. [PMID: 36380433 PMCID: PMC9672494 DOI: 10.4258/hir.2022.28.4.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/16/2022] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Early hemorrhage detection in intensive care units (ICUs) enables timely intervention and reduces the risk of irreversible outcomes. In this study, we aimed to develop a machine learning model to predict hemorrhage by learning the patterns of continuously changing, real-world clinical data. METHODS We used the Medical Information Mart for Intensive Care databases (MIMIC-III and MIMIC-IV). A recurrent neural network was used to predict severe hemorrhage in the ICU. We developed three machine learning models with an increasing number of input features and levels of complexity: model 1 (11 features), model 2 (18 features), and model 3 (27 features). MIMIC-III was used for model training, and MIMIC-IV was split for internal validation. Using the model with the highest performance, external verification was performed using data from a subgroup extracted from the eICU Collaborative Research Database. RESULTS We included 5,670 ICU admissions, with 3,150 in the training set and 2,520 in the internal test set. A positive correlation was found between model complexity and performance. As a measure of performance, three models developed with an increasing number of features showed area under the receiver operating characteristic (AUROC) curve values of 0.61-0.94 according to the range of input data. In the subgroup extracted from the eICU database for external validation, an AUROC value of 0.74 was observed. CONCLUSIONS Machine learning models that rely on real clinical data can be used to predict patients at high risk of bleeding in the ICU.
Collapse
Affiliation(s)
- Sora Kang
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Chul Park
- Division of Pulmonology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin, Korea
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- BUD.on Inc., Jeonju, Korea
| |
Collapse
|
18
|
Budhiraja S, Baisiwala S, Perrault E, Cho S, Dara G, Nandoliya K, Zolp A, Chen L, Dmello C, Park C, Sonabend A, Ahmed A. OS08.6.A Novel role of ARF4-mediated retrograde trafficking as a driver of chemoresistance in GBM. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is the most common type of adult malignant brain tumor, with a median survival of only 21 months. This is partly due to the high rate of resistance to conventional therapy, including temozolomide (TMZ), leading to recurrence rates close to 100%. To identify the unknown genes driving the development of this resistance, we performed a genome-wide CRISPR knockout screen comparing a DMSO-treated population with a TMZ-treated population over 14 days. Results showed substantial enrichment of ~200 novel genes, including a previously unstudied gene ARF4—involved in retrograde trafficking to the nucleus. Here, we set out to characterize the mechanism by which ARF4 may be acting to promote chemoresistance.
Material and Methods
A whole-genome CRISPR-Cas9 sensitivity screen as well as a variety of in vitro and in vivo experiments, such as live-cell imaging, cell viability assays, and western blotting were conducted.
Results
Initial investigation into ARF4 showed significant elevations in expression at RNA and protein levels (p<0.05) in recurrent patient tumors, as well as a significant survival benefit in patient datasets when downregulated (p<0.05). Knocking out ARF4 resulted in significantly heightened sensitivity to TMZ in multiple GBM patient-derived xenograft lines and extended survival compared to the controls (p<0.01) in vivo. Further investigation via live-cell imaging of transferrin receptors, a retrograde transport marker, revealed that ARF4-knockdowns significantly inhibited retrograde trafficking, while ARF4-overexpressions resulted in an untenable increase in retrograde trafficking in vitro. This effect was also seen in TMZ-treated cells, which displayed enhanced trafficking dynamics, suggesting that ARF4-mediated retrograde trafficking is elevated during therapy to drive nuclear localization of key chemoresistance-promoting factors. We then performed an unbiased proteomics screen to identify which genes were being uniquely transported to the nucleus as a product of ARF4-mediated retrograde trafficking, which revealed enrichment of the EGFR signaling pathway in particular. Validation experiments confirmed a decrease in EGFR trafficking and nuclear EGFR expression in ARF4-knockdowns and an increase in EGFR trafficking and nuclear EGFR expression in ARF4-overexpression and TMZ-treated GBM cells. Furthermore, nuclear DNA-PK, a DNA repair protein known to be transcriptionally activated by EGFR, was similarly found to be downregulated in ARF4-knockdown conditions and elevated in ARF4-overexpression and TMZ-treated conditions.
Conclusion: Here, we show that ARF4 may be responsible for promoting chemoresistance through altered retrograde trafficking of EGFR specifically. Thus, our study has yielded a promising and novel therapeutic target for GBM, a disease desperately in need of new therapeutic strategies.
Collapse
Affiliation(s)
- S Budhiraja
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - S Baisiwala
- David Geffen School of Medicine at UCLA , Los Angeles, CA , United States
| | - E Perrault
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - S Cho
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - G Dara
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - K Nandoliya
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - A Zolp
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - L Chen
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - C Dmello
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - C Park
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - A Sonabend
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| | - A Ahmed
- Northwestern University Feinberg School of Medicine , Chicago, IL , United States
| |
Collapse
|
19
|
Kim S, Chowdhury T, Yu H, Choi S, Kim K, Kang H, Lee J, Lee S, Won J, Kim K, Kim K, Kim M, Lee J, Kim J, Kim Y, Kim T, Choi S, Phi J, Shin Y, Ku J, Lee S, Yun H, Lee H, Kim D, Kim K, Hur JK, Park S, Kim S, Park C. P02.01.B The telomere maintenance mechanism spectrum and its dynamics in gliomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The activation of the telomere maintenance mechanism (TMM) is one of the critical drivers of cancer cell immortality. In gliomas, TERT expression and TERT promoter mutation are considered to reliably indicate telomerase activation, while ATRX mutation indicates alternative lengthening of telomeres (ALT). However, these relationships have not been extensively validated in tumor tissues. Here, we show through the direct measurement of telomerase activity and ALT in a large set of glioma samples that the TMM in glioma cannot be defined in the dichotomy of telomerase activity and ALT, regardless of TERT expression, TERT promoter mutation and ATRX mutation. Moreover, we observed that a considerable proportion of gliomas lack both telomerase activity and ALT (Neither group). And this Neither group exhibited evidence of slow growth potential. From a set of longitudinal samples from a separate cohort of glioma patients, we discovered that the TMM is not fixed but changes with glioma progression. Collectively, these results suggest that the TMM is a dynamic entity and that reflects the plasticity of the oncogenic biological status of tumor cells and that the TMM should be defined by the direct measurement of telomerase enzyme activity and evidence of ALT.
Collapse
Affiliation(s)
- S Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - T Chowdhury
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - H Yu
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - S Choi
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - K Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - H Kang
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Lee
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - S Lee
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Won
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - K Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - K Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - M Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Lee
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - Y Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - T Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - S Choi
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Phi
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - Y Shin
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - J Ku
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - S Lee
- Seoul National University Hospital , Seoul , Korea, Republic of
| | - H Yun
- Seoul National University Hospital , Seoul , Korea, Republic of
| | - H Lee
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - D Kim
- Kyung Hee University , Seoul , Korea, Republic of
| | - K Kim
- Korea University , Seoul , Korea, Republic of
| | - J K Hur
- Hanyang University , Seoul , Korea, Republic of
| | - S Park
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - S Kim
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| | - C Park
- Seoul National University College of Medicine , Seoul , Korea, Republic of
| |
Collapse
|
20
|
Kim H, Joo E, Bae J, Park J, Bang Y, Park C, Gulati N, Park W. 096 Deconvolution of adult T-cell leukemia/lymphoma with single-cell RNA-seq using frozen archived skin tissue reveals new subset of cancer-associated fibroblast. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
21
|
Lim Y, Kang S, Kim H, Mun J, Roh M, Gulati N, Yang H, Moon J, Won C, Park C. 631 Determining intra-tumoral heterogeneity and immune escape mechanisms in melanoma using spatial transcriptomics. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
22
|
Gikonyo JG, Ansari A, Park C, Tobiason J. Physical characterization of oxygenic photogranules. Biochem Eng J 2022. [DOI: 10.1016/j.bej.2022.108592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Lee B, Bang Y, Lim S, Kang S, Park C, Kim H, Kim T. 067 Dissecting circulating regulatory T cells in severe Korean psoriasis patients by mass cytometry. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
24
|
Abstract
Exposed dental pulp can maintain its vitality through a pulp-capping procedure with biocompatible materials, followed by reparative dentin formation. Our previous study demonstrated that a vitronectin-derived peptide (VnP-16) promotes osteoblast differentiation and concomitantly restrains osteoclast differentiation and resorptive function. In this study, we aimed to demonstrate that VnP-16 promotes odontoblast differentiation, mineralization, and reparative dentin formation in a pulp exposure model using a rat tooth. VnP-16 showed no cytotoxicity and promoted cellular behavior in human dental pulp cells, enhancing their differentiation into odontoblast-like cells and mineralization, effects that are comparable to those obtained with vitronectin. In a rat pulp exposure model, VnP-16 showed mild inflammatory responses at 2 and 4 wk or none. Mineral trioxide aggregate (MTA) demonstrated a tendency of early formation of reparative dentin at 2 wk when compared with recombinant human bone morphogenetic protein 2 (rhBMP-2) and VnP-16. However, VnP-16 induced reparative dentin formation similar to MTA and rhBMP-2 without inflammation at 4 wk. In addition, VnP-16 showed a thicker and homogeneous reparative dentin formation versus MTA and rhBMP-2. Collectively, these results suggest that VnP-16 can be a useful, direct pulp-capping agent for highly qualified reparative dentin formation by promoting cell behavior and odontoblastic differentiation of human dental pulp cells.
Collapse
Affiliation(s)
- C Park
- Department of Oral Biochemistry and Program in Cancer and Developmental Biology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.,Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - M Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheon-An, Korea
| | - S Y Kim
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - B M Min
- Department of Oral Biochemistry and Program in Cancer and Developmental Biology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| |
Collapse
|
25
|
Park K, Park J, You E, Kim H, Park C, Kim Y. M051 The variant call format normalization is essential for the accuracy of variant nomenclature. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
26
|
Lee HJ, Park C. Distribution Variations of Chigger Mites Collected in Jinan, Jeollabuk-do. Korean J Clin Lab Sci 2021. [DOI: 10.15324/kjcls.2021.53.4.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyeok Jae Lee
- Department of Biomedical Laboratory Science, Gwangju Health University, Gwangju, Korea
| | - Chul Park
- Department of Biomedical Laboratory Science, Gwangju Health University, Gwangju, Korea
| |
Collapse
|
27
|
Youk S, Le MT, Kang M, Ahn B, Choi M, Kim K, Kim TH, Kim JH, Ho CS, Park C. Development of a high-resolution typing method for SLA-3, swine MHC class I antigen 3. Anim Genet 2021; 53:166-170. [PMID: 34910829 DOI: 10.1111/age.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
We developed a high-resolution and comprehensive typing method for swine leukocyte antigen 3 (SLA-3), an MHC class I gene, employing locus-specific genomic PCR followed by subsequent direct sequencing. A total of 292 individuals from nine pure, one cross-breed and six cell lines were successfully typed. A total of 21 SLA-3 alleles were identified, of which four were found to be novel alleles. However, the allelic diversity of SLA-3 was lower than that of previously reported class I genes, SLA-1 and -2. More SLA-3 alleles were observed in the Landrace and Yorkshire breeds than the other breeds. SLA-3*04:01 was identified in seven out of nine breeds and was the most widely distributed allele across all breeds. Therefore, the typing method reported in this study completes our efforts to develop high-resolution typing methods for major SLA molecules, facilitating the combined analysis of major SLA genes from field samples, which is important to understand the relationship between the adaptive immune responses against pathogens and the immunogenetic makeup of an individual.
Collapse
Affiliation(s)
- S Youk
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - M T Le
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - M Kang
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - B Ahn
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - M Choi
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - K Kim
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea.,Livestock Support Department, National Agricultural Cooperative Federation Agribusiness Group, Seoul, 04516, Korea
| | - T H Kim
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, RDA, Wanju, 55365, Korea
| | - J H Kim
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| | - C S Ho
- Gift of Hope Organ and Tissue Donor Network, 425 Spring Lake Drive, Itasca, IL, 60143, USA
| | - C Park
- Department of Stem Cell and Regenerative Biotechnology, Konkuk University, Gwangjin-gu, Seoul, 05029, Korea
| |
Collapse
|
28
|
Chung H, Park C, Kang WS, Lee J. Gender Bias in Artificial Intelligence: Severity Prediction at an Early Stage of COVID-19. Front Physiol 2021; 12:778720. [PMID: 34912242 PMCID: PMC8667070 DOI: 10.3389/fphys.2021.778720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Artificial intelligence (AI) technologies have been applied in various medical domains to predict patient outcomes with high accuracy. As AI becomes more widely adopted, the problem of model bias is increasingly apparent. In this study, we investigate the model bias that can occur when training a model using datasets for only one particular gender and aim to present new insights into the bias issue. For the investigation, we considered an AI model that predicts severity at an early stage based on the medical records of coronavirus disease (COVID-19) patients. For 5,601 confirmed COVID-19 patients, we used 37 medical records, namely, basic patient information, physical index, initial examination findings, clinical findings, comorbidity diseases, and general blood test results at an early stage. To investigate the gender-based AI model bias, we trained and evaluated two separate models-one that was trained using only the male group, and the other using only the female group. When the model trained by the male-group data was applied to the female testing data, the overall accuracy decreased-sensitivity from 0.93 to 0.86, specificity from 0.92 to 0.86, accuracy from 0.92 to 0.86, balanced accuracy from 0.93 to 0.86, and area under the curve (AUC) from 0.97 to 0.94. Similarly, when the model trained by the female-group data was applied to the male testing data, once again, the overall accuracy decreased-sensitivity from 0.97 to 0.90, specificity from 0.96 to 0.91, accuracy from 0.96 to 0.91, balanced accuracy from 0.96 to 0.90, and AUC from 0.97 to 0.95. Furthermore, when we evaluated each gender-dependent model with the test data from the same gender used for training, the resultant accuracy was also lower than that from the unbiased model.
Collapse
Affiliation(s)
- Heewon Chung
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin-si, South Korea
| | - Chul Park
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, South Korea
| | - Wu Seong Kang
- Department of Trauma Surgery, Cheju Halla General Hospital, Jeju-si, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin-si, South Korea
| |
Collapse
|
29
|
Jung JW, Kim HR, Yoon KH, Park C. Mobile computed tomography for the efficient allocation of medical resources in patients with COVID-19 pneumonia: A case report. Medicine (Baltimore) 2021; 100:e27872. [PMID: 34797328 PMCID: PMC8601319 DOI: 10.1097/md.0000000000027872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The highly contagious Coronavirus 2019 (COVID-19) infection raise social and economic burden. Medical staff and resources are being diverted for the care of patients with COVID-19. There are problems for healthcare systems, including burnout syndrome for the medical staff and exhaustion of medical resources. PATIENT CONCERNS The patient was a 65-year-old woman presenting with fever, cough, and dyspnea due to COVID-19 pneumonia. She received antiviral agents, broad-spectrum antibiotics, and conservative treatment. Although her clinical condition improved, there was no significant improvement in portable chest X-ray results. DIAGNOSES Due to concerns over the propagation of infection when transferring to patients for scanning and the need for excessive medical personnel to move patients, we moved a mobile chest computed tomography (CT) machine to an isolation ward for CT scanning. INTERVENTIONS We report our experience using mobile chest CT to effectively allocate medical resources and assess treatment response in patient with COVID-19 pneumonia. OUTCOMES Follow-up mobile CT scans disclosed progressive resolution of the multifocal ground-glass opacities and mixed consolidations distributed peripheral to subpleural spaces. During the mobile chest CT scan, there were no adverse or unforeseen events. Three medical personnel were required to performed mobile chest CT, including a clinician, a nurse, and a radiologist. LESSONS As a result of using mobile chest CT on COVID-19 patients, the number of medical personnel required for CT scanning decreased by about 83%, rapid, and safe compared with a patient who performed conventional CT.
Collapse
Affiliation(s)
- Jae Wan Jung
- Division of Pulmonology, Department of Internal Medicine, Wonkwang University Hospital, Muwang-ro 895, Iksan-si, Jeollabuk-do, South Korea
| | - Hak Ryul Kim
- Division of Pulmonology, Department of Internal Medicine, Wonkwang University Hospital, Muwang-ro 895, Iksan-si, Jeollabuk-do, South Korea
| | - Kwon Ha Yoon
- Department of Radiology, Wonkwang University Hospital, Muwang-ro 895, Iksan-si, Jeollabuk-do, South Korea
| | - Chul Park
- Division of Pulmonology, Department of Internal Medicine, Wonkwang University Hospital, Muwang-ro 895, Iksan-si, Jeollabuk-do, South Korea
| |
Collapse
|
30
|
Al Saikhan L, Park C, Tillin T, Williams S, Jones S, Manisty C, Mayet J, Chaturvedi N, Hughes A. Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Both left ventricular (LV) ejection fraction (EF) and Global Longitudinal Strain (GLS) by 2D-echocardiography predict mortality and cardiac events, and GLS may be superior to EF. 3D-speckle tracking echocardiography (3D-STE), a recently validated method, allows simultaneous assessment of EF, GLS and principal tangential strain (PTS), but its prognostic utility in the general population is unknown.
Purpose
We hypothesized that 3D-STE derived LV myocardial strains predict a composite of cardiac endpoints, and that GLS would be a better prognostic marker than EF. We also investigated the utility of PTS compared with GLS and EF.
Methods
A total of 529 individuals (69±6y; 76.6% male) from SABRE study, a UK-based tri-ethnic community cohort, underwent health examinations. The association between 3D-STE EF or multidirectional myocardial strains and a composite cardiac endpoints comprising coronary heart disease (fatal/non-fatal), heart failure hospitalization, new-onset arrhythmia was determined using Cox proportional hazards models with and without adjustment for potential confounders and Harrell's C statistics were calculated. Associations with cardiovascular (CV) mortality was examined as a secondary objective. The incremental value of 3D-STE EF, GLS and PTS in improving CV risk stratification by the established Framingham risk score (FRS) was investigated using a likelihood ratio test on a series of nested Cox proportional hazards models.
Results
During follow-up (median, 8y), there were 56 composite cardiac endpoints and 24 CV deaths. EF and radial strain were negatively associated, while GLS, global circumferential strain and PTS were positively associated with the composite cardiac endpoints in unadjusted models (Table 1). Associations were only marginally affected by adjustment for potential confounders although confidence intervals of the estimate increased slightly (Table 1). There was little difference in the C-statistics for EF, GLS or PTS for the composite cardiac endpoints (Table 1). Associations with CV mortality were generally weaker and only GLS showed some evidence of a positive association with CV mortality in unadjusted and adjusted models (Table 1). Compared to EF and GLS, PTS most improved the predictive value (model fit) of FRS for composite cardiac endpoints (Table 2). None of the measures convincingly improved calibration for CV mortality.
Conclusions
3D-STE-derived LV myocardial strains predicted adverse cardiac events and CV mortality in a multi-ethnic sample of the UK general population. PTS/3D-strain was an independent predictor of cardiac events with some evidence of it being a slightly better predictor than conventional indices of LV function (GLS and EF). Future prospective studies are needed to confirm and extend these findings.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The main SABRE study is supported by the Wellcome Trust and BHF.
Collapse
Affiliation(s)
- L Al Saikhan
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Park
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - T Tillin
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Williams
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Jones
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Manisty
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - J Mayet
- Imperial College London, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | | |
Collapse
|
31
|
Morris J, Jenny H, Park C, Scarborough A, Antoniou V, Heylen J, Anakwe R. 55 Are Virtual Journal Clubs A Viable Alternative in The Covid-19 Era? Br J Surg 2021. [PMCID: PMC8524593 DOI: 10.1093/bjs/znab259.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction During the COVID-19 pandemic, face to face journal clubs have been curtailed due to Governmental guidance for social distancing. We present an example of a virtual journal club set up for Orthopaedic senior house officers (SHOs) & trainees in the North West Thames (NWT) Deanery from April to August 2020. Method Our aims were to establish a regular online journal club for orthopaedic trainees in NWT that successfully met the objectives of the more established face to face meetings. Assessment of each session was evaluated using a post attendance survey created using an established online generator. Results 64.4% (16/25 participants) had not attended a virtual journal club before, with 100% (33/33) reporting that they would attend another virtual journal club. 39.4% (13/33) of attendees agreed or strongly agreed that they could participate in sessions over more conventional meetings. 24.2% (8/33) of participants reported experiencing technical issues during the sessions. 90.9% (30/33) of respondents reporting the virtual model to be more convenient than standard journal clubs. Conclusions The potential benefits of significantly increased accessibility increased visiting expert contribution whilst still adhering to government guidelines; weighed against marginally less effective teaching nonetheless results in an overall benefit.
Collapse
Affiliation(s)
- J Morris
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - H Jenny
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - C Park
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - A Scarborough
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - V Antoniou
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - J Heylen
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| | - R Anakwe
- Trauma and Orthopaedics Department at Imperial College Health Care Trust, London, United Kingdom
| |
Collapse
|
32
|
Park C, Takeuchi N. Unmasking photogranulation in decreasing glacial albedo and net autotrophic wastewater treatment. Environ Microbiol 2021; 23:6391-6404. [PMID: 34545673 PMCID: PMC9292683 DOI: 10.1111/1462-2920.15780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
In both natural and built environments, microbes on occasions manifest in spherical aggregates instead of substratum‐affixed biofilms. These microbial aggregates are conventionally referred to as granules. Cryoconites are mineral rich granules that appear on glacier surfaces and are linked with expanding surface darkening, thus decreasing albedo, and enhanced melt. The oxygenic photogranules (OPGs) are organic rich granules that grow in wastewater, which enables wastewater treatment with photosynthetically produced oxygen and which presents potential for net autotrophic wastewater treatment in a compact system. Despite obvious differences inherent in the two, cryoconite and OPG pose striking resemblance. In both, the order Oscillatoriales in Cyanobacteria envelope inner materials and develop dense spheroidal aggregates. We explore the mechanism of photogranulation on account of high similarity between cryoconites and OPGs. We contend that there is no universal external cause for photogranulation. However, cryoconites and OPGs, as well as their intravariations, which are all under different stress fields, are the outcome of universal physiological processes of the Oscillatoriales interfacing with goldilocks interactions of stresses. Finding the rules of photogranulation may enhance engineering of glacier and wastewater systems to manipulate their ecosystem impacts.
Collapse
Affiliation(s)
- Chul Park
- Department of Civil and Environmental Engineering, University of Massachusetts Amherst, Amherst, Massachusetts, 01003, USA
| | - Nozomu Takeuchi
- Department of Earth Sciences, Graduate School of Science, Chiba University, Chiba, 263-8522, Japan
| |
Collapse
|
33
|
|
34
|
Park C, Georlette D, Korn W, Xiu J, Babiker H, Coelho Barata P, Sohal D. 1139P Carcinoma of unknown primary (CUP): The role of tumor genomic profiling. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
35
|
Trotier D, Grover P, Park C, McGrath J, Wise-Draper T. 974P Genetic and molecular analysis of solid tumors with hyperprogressive disease after treatment with immunotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
36
|
Cui F, Kim M, Lee W, Park C, Kim M. Pseudo-analytical solutions for multi-species biofilm model of aerobic granular sludge. Environ Technol 2021; 42:3421-3431. [PMID: 32085686 DOI: 10.1080/09593330.2020.1733673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
This paper demonstrates modelling of the aerobic granular sludge (AGS) process with the pseudo-analytical solutions (PAS) of a biofilm model. A MATLAB programmed graphical user interface platform was developed to facilitate the model calculation and access. Model calibration and validation were carried out through using experimental data collected from a granular sludge sequencing batch reactor operation. The experimental and modelling results identified the distribution of heterotrophs and nitrifiers on the AGS and its contribution to the performance of wastewater treatment. The model could describe multi-species biofilms according to the distinguishing features among the three levels of PAS models. The models demonstrated increasing degrees of interaction (no interaction, competition for nitrogen and layering and protection) between heterotrophs and nitrifiers. Modelling the AGS process using PAS increases the accessibility of the simulation of multiple species in both biofilm and suspended biomass.
Collapse
Affiliation(s)
- Fenghao Cui
- Department of Civil & Environmental Engineering, Hanyang University, Ansan City, Republic of Korea
| | - Minkyung Kim
- Department of Civil & Environmental Engineering, Hanyang University, Ansan City, Republic of Korea
| | - Wonbae Lee
- Department of Civil & Environmental Engineering, Hanyang University, Ansan City, Republic of Korea
| | - Chul Park
- Department of Civil & Environmental Engineering, Hanyang University, Ansan City, Republic of Korea
| | - Moonil Kim
- Department of Civil & Environmental Engineering, Hanyang University, Ansan City, Republic of Korea
| |
Collapse
|
37
|
Ansari AA, Ansari AA, Abouhend AS, Gikonyo JG, Park C. Photogranulation in a Hydrostatic Environment Occurs with Limitation of Iron. Environ Sci Technol 2021; 55:10672-10683. [PMID: 34255495 DOI: 10.1021/acs.est.0c07374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Filamentous cyanobacteria are an essential element of oxygenic photogranules for granule-based wastewater treatment with photosynthetic aeration. Currently, mechanisms for the selection of this microbial group and their development in the granular structure are not well understood. Here, we studied the characteristics and fate of iron in photogranulation that proceeds in a hydrostatic environment with an activated sludge (AS) inoculum. We found that the level of Fe in bulk liquids (FeBL) sharply increased due to the decay of the inoculum but quickly diminished along with the bloom of microalgae and the advent of the oxic environment. Iron linked with extracellular polymeric substances (FeEPS) continued to decline but reached steady low values, which occurred along with the appearance of granular structure. Strong negative correlations were found between FeEPS and the pigments specific for cyanobacteria. Spectroscopies revealed the presence of amorphous ferric oxides in pellet biomass, which seemed to remain unaltered during the photogranulation process. These results suggest that the availability of FeEPS in AS inoculums-after algal bloom-selects cyanobacteria, and the limitation of this Fe pool becomes an important driver for cyanobacteria to granulate in a hydrostatic environment. We therefore propose that the availability of iron has a strong influence on the photogranulation process.
Collapse
Affiliation(s)
- Abeera A Ansari
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Amherst, Massachusetts 01003, United States
- U.S.-Pakistan Center for Advanced Studies in Energy (USPCAS-E), National University of Sciences and Technology (NUST), H-12 Sector, 44000 Islamabad , Pakistan
| | - Arfa A Ansari
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Amherst, Massachusetts 01003, United States
| | - Ahmed S Abouhend
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Amherst, Massachusetts 01003, United States
| | - Joseph G Gikonyo
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Amherst, Massachusetts 01003, United States
| | - Chul Park
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, Amherst, Massachusetts 01003, United States
| |
Collapse
|
38
|
Climie RE, Park C, Avolio A, Mynard JP, Kruger R, Bruno RM. Vascular Ageing in Youth: A Call to Action. Heart Lung Circ 2021; 30:1613-1626. [PMID: 34275753 DOI: 10.1016/j.hlc.2021.06.516] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/18/2022]
Abstract
Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.
Collapse
Affiliation(s)
- R E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France.
| | - C Park
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, UCL, London, UK
| | - A Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - J P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - R Kruger
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - R-M Bruno
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France. https://twitter.com/rosam_bruno
| |
Collapse
|
39
|
Everett D, Ke W, Paquet JF, Vujanovic G, Bass SA, Du L, Gale C, Heffernan M, Heinz U, Liyanage D, Luzum M, Majumder A, McNelis M, Shen C, Xu Y, Angerami A, Cao S, Chen Y, Coleman J, Cunqueiro L, Dai T, Ehlers R, Elfner H, Fan W, Fries RJ, Garza F, He Y, Jacak BV, Jacobs PM, Jeon S, Kim B, Kordell M, Kumar A, Mak S, Mulligan J, Nattrass C, Oliinychenko D, Park C, Putschke JH, Roland G, Schenke B, Schwiebert L, Silva A, Sirimanna C, Soltz RA, Tachibana Y, Wang XN, Wolpert RL. Phenomenological Constraints on the Transport Properties of QCD Matter with Data-Driven Model Averaging. Phys Rev Lett 2021; 126:242301. [PMID: 34213947 DOI: 10.1103/physrevlett.126.242301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/05/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
Using combined data from the Relativistic Heavy Ion and Large Hadron Colliders, we constrain the shear and bulk viscosities of quark-gluon plasma (QGP) at temperatures of ∼150-350 MeV. We use Bayesian inference to translate experimental and theoretical uncertainties into probabilistic constraints for the viscosities. With Bayesian model averaging we propagate an estimate of the model uncertainty generated by the transition from hydrodynamics to hadron transport in the plasma's final evolution stage, providing the most reliable phenomenological constraints to date on the QGP viscosities.
Collapse
Affiliation(s)
- D Everett
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - W Ke
- Department of Physics, University of California, Berkeley, California 94270, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
| | - J-F Paquet
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - G Vujanovic
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - S A Bass
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - L Du
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - C Gale
- Department of Physics, McGill University, Montréal, Quebec City H3A 2T8, Canada
| | - M Heffernan
- Department of Physics, McGill University, Montréal, Quebec City H3A 2T8, Canada
| | - U Heinz
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - D Liyanage
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - M Luzum
- Instituto de Fìsica, Universidade de São Paulo, C.P. 66318, 05315-970 São Paulo, SP, Brazil
| | - A Majumder
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - M McNelis
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - C Shen
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
- RIKEN BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y Xu
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - A Angerami
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Cao
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - Y Chen
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Coleman
- Department of Statistical Science, Duke University, Durham, North Carolina 27708, USA
| | - L Cunqueiro
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - T Dai
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - R Ehlers
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H Elfner
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
- Institute for Theoretical Physics, Goethe University, 60438 Frankfurt am Main, Germany
- Frankfurt Institute for Advanced Studies, 60438 Frankfurt am Main, Germany
| | - W Fan
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - R J Fries
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - F Garza
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - Y He
- Key Laboratory of Quark and Lepton Physics (MOE) and Institute of Particle Physics, Central China Normal University, Wuhan 430079, China
| | - B V Jacak
- Department of Physics, University of California, Berkeley, California 94270, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
| | - P M Jacobs
- Department of Physics, University of California, Berkeley, California 94270, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
| | - S Jeon
- Department of Physics, McGill University, Montréal, Quebec City H3A 2T8, Canada
| | - B Kim
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - M Kordell
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - A Kumar
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - S Mak
- Department of Statistical Science, Duke University, Durham, North Carolina 27708, USA
| | - J Mulligan
- Department of Physics, University of California, Berkeley, California 94270, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
| | - C Nattrass
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D Oliinychenko
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
| | - C Park
- Department of Physics, McGill University, Montréal, Quebec City H3A 2T8, Canada
| | - J H Putschke
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - G Roland
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Schenke
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - L Schwiebert
- Department of Computer Science, Wayne State University, Detroit, Michigan 48202, USA
| | - A Silva
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Sirimanna
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - R A Soltz
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - Y Tachibana
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201, USA
| | - X-N Wang
- Department of Physics, University of California, Berkeley, California 94270, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94270, USA
- Key Laboratory of Quark and Lepton Physics (MOE) and Institute of Particle Physics, Central China Normal University, Wuhan 430079, China
| | - R L Wolpert
- Department of Statistical Science, Duke University, Durham, North Carolina 27708, USA
| |
Collapse
|
40
|
Cui F, Kim M, Park C, Kim D, Mo K, Kim M. Application of principal component analysis (PCA) to the assessment of parameter correlations in the partial-nitrification process using aerobic granular sludge. J Environ Manage 2021; 288:112408. [PMID: 33780822 DOI: 10.1016/j.jenvman.2021.112408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
For the first time, principal component analysis (PCA) was used to extract relevant information hidden in the partial-nitrification process using aerobic granular sludge. The objectives of this research are (a) to determine total ammonia nitrogen (TAN), total nitrite nitrogen (NO2-N), nitrate nitrogen (NO3-N), and other water quality parameters; (b) to identify the diversity of nitrification and denitrification bacterial community of wastewater samples during the partial-nitrification process using aerobic granular sludge and; (c) to analyze the correlation of available parameters using PCA. The nitrite accumulation ratio was determined from TAN, NO2-N, and NO3-N. Other water quality parameters were mixed liquor volatile suspended solids (MLVSS), alkalinity, total nitrogen (TN) and sludge volume index (SVI), pH, and dissolved oxygen (DO). The identification of bacterial community was conducted using 16S rRNA gene-based pyrosequencing by GS Junior Sequencing system. The water quality parameters were computed for PCA using software MATLAB. A nitrite accumulation ratio (NAR) between 0.55 and 0.85 was determined while maintaining the aerobic granular sludge's compact and dense structure. The PCA was used to reduce the data dimensionality from the original 8 variables to 2 principal components explaining 75% of the total data variance. Applying PCA to the data analysis in biological wastewater treatment can support detecting data anomalies and separating useful information from unwanted interferences.
Collapse
Affiliation(s)
- Fenghao Cui
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| | - Minkyung Kim
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| | - Chul Park
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| | - Dokyun Kim
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| | - Kyung Mo
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| | - Moonil Kim
- Department of Civil & Environmental Engineering, Hanyang University, 55 Hanyangdaehak-ro, Ansan City, Kyeonggido, 426-791, Republic of Korea.
| |
Collapse
|
41
|
Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
Collapse
Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
| |
Collapse
|
42
|
Jung JW, Park C. Delayed solitary mediastinal lymph node metastasis from a benign meningothelial meningioma six years after surgical resection of an intracranial tumor. Thorac Cancer 2021; 12:1931-1934. [PMID: 33961737 PMCID: PMC8201534 DOI: 10.1111/1759-7714.13996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022] Open
Abstract
Meningiomas are common intracranial neoplasms with benign features, and extracranial metastases are very rare. There have been no previous reports of solitary mediastinal lymph node metastasis from benign meningiomas without pulmonary lesions. Here, we present a case of an 82‐year‐old female who visited our department for mediastinal lymphadenopathy with a history of meningioma treated with total surgical resection six years prior. Endobronchial ultrasound‐guided transbronchial needle aspiration of the left lower paratracheal lymph node revealed a benign meningothelial meningioma. In patients with a history of meningioma, extracranial metastasis should be considered in the differential diagnosis of mediastinal lymphadenopathy.
Collapse
Affiliation(s)
- Jae Wan Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea
| | - Chul Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea
| |
Collapse
|
43
|
Kwon SH, Park HS, Na YJ, Park C, Shin JY, Kim HL. Price Reduction of Anticancer Drugs from 2007 to 2019 in South Korea: The Impact of Pharmaceutical Cost-Containment Policies. Appl Health Econ Health Policy 2021; 19:439-450. [PMID: 32789657 DOI: 10.1007/s40258-020-00604-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To assess price reductions of anticancer drugs in South Korea over 12 years and analyze the association between price reduction, drug characteristics, and repricing mechanisms. METHODS We constructed a dataset based on the Health Insurance Review and Assessment Service (HIRA) price log of anticancer drugs from January 2007 to June 2019. We investigated each mechanism that resulted in a price reduction, including actual transaction price (ATP), voluntary reduction by a manufacturer, price-volume agreement, expansion of indication or reimbursement scope, price cut at generic entry, lump price cut in April 2012, and re-evaluation. The price reduction rate per year was estimated by dividing the total number of price reduction events by the total period for which the products were on the market. A Poisson regression model was used to estimate the characteristics-adjusted incidence rate ratio of the price reduction. Price reduction per event was also determined across originator and generic products. Data analysis was performed using R (version 3.5.1). RESULTS Five hundred price reductions occurred in 439 new anticancer drugs, with a reduction rate per 100 product-years of 23. ATP was the most frequent cause (39.2%) but had minimal impact (average reduction per event of 3%), followed by lump price cut (19.2%) and voluntary reduction (10.2%). Generic entries and lump price cut had the greatest impact (16-29% reduction per event). ATP was the most frequently occurring mechanism, followed by generic entry, voluntary reduction, and the lump price-cut in April 2012. CONCLUSIONS The incidence of price reduction of anticancer drugs increased gradually due to various repricing mechanisms. Although these mechanisms are effective, improvements can be made. Well-designed mechanisms that actively regulate price adjustment are needed to establish repricing policies that adequately reflect changes in the value of drugs over their entire life cycle.
Collapse
Affiliation(s)
- Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Korea
| | - Hea-Sun Park
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Korea
| | - Young-Jin Na
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Korea
| | - Chul Park
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, 01795, Korea.
| |
Collapse
|
44
|
Lee J, Kim B, Zhang K, Kim S, Kupper T, Lee K, Park C. 012 FABP5-induced Th17 polarization in atopic march. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
45
|
Eom H, Park C. Investigation of characteristics of effluent DON derived from conventional activated sludge (CAS) and predenitrification biological removal (BNR): In terms of proteins and humic substances. Environ Res 2021; 196:110912. [PMID: 33639143 DOI: 10.1016/j.envres.2021.110912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/04/2020] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Upgrading wastewater treatment plants (WWTPs) from conventional activated sludge (CAS) to predenitrification biological nutrient removal (BNR) results in improved removal of dissolved inorganic nitrogen (DIN) from wastewater. However, changes in dissolved organic nitrogen (DON) with these WWTP upgrades and their potential impacts on receiving waters have been little researched. In this study, we investigated characteristics of effluent DON derived from CAS and predenitrification BNR, paying special attention to proteins and humic substances. Through a lab-scale reactor study and analysis of full-scale WWTP effluents, we found that in predenitrification BNR effluent, proteins are much more dominant than humic substances, whereas in CAS effluent, proteins and humic substances are similarly abundant. In terms of molecular weight, the majority of proteins were present in the effluent's low molecular weight (LMW) fraction (<1 kDa), while humic substances were found mostly in the effluent's high molecular weight (HMW) fraction (0.45 μm-1 kDa). Determination of dissolved organic carbon (DOC)/DON ratios in effluents supports that proteins (and LMW-DON) were most likely microbial-derived organic N produced during treatment processing, whereas humic substances (and HMW-DON) more likely originated outside of treatment systems. Bioassay tests demonstrated that effluent DON derived from predenitrification BNR was more bioavailable than that derived from CAS. We also found that LMW-DON and proteins were highly bioavailable DON compared to HMW-DON and humic substances. The results of this study suggest that upgrading CAS to predenitrification BNR makes effluent DON to become more conducive to phytoplankton blooms in receiving waters.
Collapse
Affiliation(s)
- Heonseop Eom
- Department of Biological Environment, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea.
| | - Chul Park
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, 01003, USA
| |
Collapse
|
46
|
Park C, Ko RE, Jung J, Na SJ, Jeon K. Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units. Respir Res 2021; 22:131. [PMID: 33910566 PMCID: PMC8080087 DOI: 10.1186/s12931-021-01732-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background Limited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies. We evaluated factors associated with failed de-cannulations to develop a prediction model that could be easily be used at the time of weaning from MV. Methods In a retrospective cohort of 346 tracheostomised patients managed by a standardized de-cannulation program, multivariable logistic regression analysis identified variables that were independently associated with failed de-cannulation. Based on the logistic regression analysis, the new predictive scoring system for successful de-cannulation, referred to as the DECAN score, was developed and then internally validated. Results The model included age > 67 years, body mass index < 22 kg/m2, underlying malignancy, non-respiratory causes of mechanical ventilation (MV), presence of neurologic disease, vasopressor requirement, and presence of post-tracheostomy pneumonia, presence of delirium. The DECAN score was associated with good calibration (goodness-of-fit, 0.6477) and discrimination outcomes (area under the receiver operating characteristic curve 0.890, 95% CI 0.853–0.921). The optimal cut-off point for the DECAN score for the prediction of the successful de-cannulation was ≤ 5 points, and was associated with the specificities of 84.6% (95% CI 77.7–90.0) and sensitivities of 80.2% (95% CI 73.9–85.5). Conclusions The DECAN score for tracheostomised patients who are successfully weaned from prolonged MV can be computed at the time of weaning to assess the probability of de-cannulation based on readily available variables.
Collapse
Affiliation(s)
- Chul Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Pulmonary Medicine, Wonkwang Medical Center, Iksan, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jinhee Jung
- Intensive Care Unit Nursing Department, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
47
|
Chung H, Ko H, Kang WS, Kim KW, Lee H, Park C, Song HO, Choi TY, Seo JH, Lee J. Prediction and Feature Importance Analysis for Severity of COVID-19 in South Korea Using Artificial Intelligence: Model Development and Validation. J Med Internet Res 2021; 23:e27060. [PMID: 33764883 PMCID: PMC8057199 DOI: 10.2196/27060] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background The number of deaths from COVID-19 continues to surge worldwide. In particular, if a patient’s condition is sufficiently severe to require invasive ventilation, it is more likely to lead to death than to recovery. Objective The goal of our study was to analyze the factors related to COVID-19 severity in patients and to develop an artificial intelligence (AI) model to predict the severity of COVID-19 at an early stage. Methods We developed an AI model that predicts severity based on data from 5601 COVID-19 patients from all national and regional hospitals across South Korea as of April 2020. The clinical severity of COVID-19 was divided into two categories: low and high severity. The condition of patients in the low-severity group corresponded to no limit of activity, oxygen support with nasal prong or facial mask, and noninvasive ventilation. The condition of patients in the high-severity group corresponded to invasive ventilation, multi-organ failure with extracorporeal membrane oxygenation required, and death. For the AI model input, we used 37 variables from the medical records, including basic patient information, a physical index, initial examination findings, clinical findings, comorbid diseases, and general blood test results at an early stage. Feature importance analysis was performed with AdaBoost, random forest, and eXtreme Gradient Boosting (XGBoost); the AI model for predicting COVID-19 severity among patients was developed with a 5-layer deep neural network (DNN) with the 20 most important features, which were selected based on ranked feature importance analysis of 37 features from the comprehensive data set. The selection procedure was performed using sensitivity, specificity, accuracy, balanced accuracy, and area under the curve (AUC). Results We found that age was the most important factor for predicting disease severity, followed by lymphocyte level, platelet count, and shortness of breath or dyspnea. Our proposed 5-layer DNN with the 20 most important features provided high sensitivity (90.2%), specificity (90.4%), accuracy (90.4%), balanced accuracy (90.3%), and AUC (0.96). Conclusions Our proposed AI model with the selected features was able to predict the severity of COVID-19 accurately. We also made a web application so that anyone can access the model. We believe that sharing the AI model with the public will be helpful in validating and improving its performance.
Collapse
Affiliation(s)
- Heewon Chung
- Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Hoon Ko
- Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Wu Seong Kang
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, Republic of Korea
| | - Kyung Won Kim
- Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hooseok Lee
- Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Chul Park
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Hyun-Ok Song
- Department of Infection Biology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Tae-Young Choi
- Department of Pathology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jae Ho Seo
- Department of Biochemistry, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jinseok Lee
- Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea
| |
Collapse
|
48
|
Park C, Ko UW, Ko RE, Na SJ, Yang JH, Jeon K, Suh GY, Sung K, Cho YH. Outcomes of extracorporeal membrane oxygenation in adults with active hematologic and nonhematologic malignancy. Artif Organs 2021; 45:E236-E246. [PMID: 33507563 DOI: 10.1111/aor.13922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
Although the number of cancer patients admitted to the intensive care unit is increasing, the data on the use of extracorporeal membrane oxygenation in patients with malignancy are limited. We applied extracorporeal membrane oxygenation to carefully selected patients with active hematologic malignancy or nonhematologic malignancy who experienced respiratory or cardiac failure despite maximal conventional therapy. Patients with active malignancy who underwent extracorporeal membrane oxygenation in our institution between January 2012 and December 2016 were included in this study. The primary outcome of this study was defined as survival to hospital discharge. We also investigated the factors associated with survival to hospital discharge. There were 30 (30.6%) and 68 (69.4%) patients in the hematologic malignancy group and the nonhematologic malignancy group, respectively. Patients in the hematologic malignancy group were younger, more neutropenic, more hypotensive, had a lower Charlson Comorbidity Index, higher sequential organ failure assessment score, and lower platelet count than those in the nonhematologic malignancy group. Forty-six (46.9%) patients were successfully weaned off extracorporeal membrane oxygenation, and 30 (30.6%) patients survived until hospital discharge. Hospital survival rate and survival status 6 months after hospital discharge were significantly lower in patients with hematologic malignancy than in those with nonhematologic malignancy (13.3% vs. 38.2%, P = .026 and 3.3% vs. 26.5%, P = .017, respectively). Multivariate analysis identified an active hematologic malignancy, older age, acidosis, thrombocytopenia, high vasoactive-inotrope score, and respiratory failure as the risk factors for in-hospital death. Patients with hematologic malignancy requiring extracorporeal membrane oxygenation support had significantly lower rates of hospital survival and 6-month survival after discharge than patients with nonhematologic malignancy. Therefore, extracorporeal membrane oxygenation for treating cardiac or respiratory failure should only be considered in highly selected patients with hematologic malignancy.
Collapse
Affiliation(s)
- Chul Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonology, Department of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Ui Won Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonology, Department of Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
49
|
Park C, Oh H, Kim M, Kim B, Cho H, Oh I, Kim Y. P34.08 Circulating Tumor Cell as a Predictive Marker for Immunotherapy in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Lim S, Yang S, Lim S, Heo S, Daniel S, Markovets A, Rafati M, Park C, Yun J, Pyo K, Yun M, Ahn B, Hong M, Kim H, Cho B. P76.18 Tissue- and Plasma-Based Landscape of Resistance to Osimertinib. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|