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Schnittler M, Inoue M, Shchepin ON, Fuchs J, Chang H, Lamkowski P, Knapp R, Horn K, Bennert HW, Bog M. Hybridization and reticulate evolution in Diphasiastrum (flat-branched clubmosses, Lycopodiaceae) - New data from the island of Taiwan and Vietnam. Mol Phylogenet Evol 2024; 196:108067. [PMID: 38561082 DOI: 10.1016/j.ympev.2024.108067] [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] [Received: 12/01/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
In the species groups related to Diphasiastrum multispicatum and D. veitchii, hybridization was investigated in samples from northern and southern Vietnam and the island of Taiwan, including available herbarium specimens from southeast Asia. The accessions were analyzed using flow cytometry (living material only), Sanger sequencing and multiplexed inter-simple sequence repeat genotyping by sequencing. We detected two cases of ancient hybridization involving different combinations of parental species; both led via subsequent duplication to tetraploid taxa. A cross D. multispicatum × D. veitchii from Malaysia represents D. wightianum, a tetraploid taxon according to reported DNA content measurements of dried material (genome formulas MM, VV and MMVV, respectively). The second case involves D. veitchii and an unknown diploid parent (genome formula XX). Three hybridogenous taxa (genome formulas VVX, VVXX, VVVX) were discernable by a combination of flow cytometry and molecular data. Taxon I (VVX, three clones found on Taiwan island) is apparently triploid. Taxon II represents another genetically diverse and sexual tetraploid species (VVXX) and can be assigned to D. yueshanense, described from Taiwan island but occurring as well in mainland China and Vietnam. Taxon III is as well most likely tetraploid (VVVX) and represented by at least one, more likely two, clones from Taiwan island. Taxa I and III are presumably asexual and new to science. Two independently inherited nuclear markers recombine only within, not between these hybrids, pointing towards reproductive isolation. We present an evolutionary scheme which explains the origin of the hybrids and the evolution of new and fully sexual species by hybridization and subsequent allopolyploidization in flat-branched clubmosses.
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Affiliation(s)
- M Schnittler
- Institute of Botany and Landscape Ecology, Ernst Moritz Arndt University of Greifswald, Soldmannstraße 15, D-17487 Greifswald, Germany
| | - M Inoue
- Institute of Botany and Landscape Ecology, Ernst Moritz Arndt University of Greifswald, Soldmannstraße 15, D-17487 Greifswald, Germany
| | - O N Shchepin
- Institute of Botany and Landscape Ecology, Ernst Moritz Arndt University of Greifswald, Soldmannstraße 15, D-17487 Greifswald, Germany
| | - J Fuchs
- Leibniz-Institute of Plant Genetics and Crop Plant Research (IPK), Corrensstraße 3, Stadt Seeland, D-06466 OT Gatersleben, Germany
| | - H Chang
- Division of Botany, Endemic Species Research Institute, 1, Ming Seng E. Road, Jiji, Nantou 552, Taiwan, ROC
| | - P Lamkowski
- Nature Conservation and Land Use Planning, University of Applied Sciences Neubrandenburg, Brodaer Straße 2, D-17033 Neubrandenburg, Germany
| | - R Knapp
- Steigestraße 78, D-69412 Eberbach, Germany
| | - K Horn
- Büro für angewandte Geobotanik und Landschaftsökologie (BaGL), Frankenstraße 2, D-91077 Dormitz, Germany
| | - H W Bennert
- Evolution and Biodiversity of Plants, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - M Bog
- Institute of Botany and Landscape Ecology, Ernst Moritz Arndt University of Greifswald, Soldmannstraße 15, D-17487 Greifswald, Germany.
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Yu JY, Kim D, Yoon S, Kim T, Heo S, Chang H, Han GS, Jeong KW, Park RW, Gwon JM, Xie F, Ong MEH, Ng YY, Joo HJ, Cha WC. Inter hospital external validation of interpretable machine learning based triage score for the emergency department using common data model. Sci Rep 2024; 14:6666. [PMID: 38509133 PMCID: PMC10954621 DOI: 10.1038/s41598-024-54364-7] [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: 10/17/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Emergency departments (ED) are complex, triage is a main task in the ED to prioritize patient with limited medical resources who need them most. Machine learning (ML) based ED triage tool, Score for Emergency Risk Prediction (SERP), was previously developed using an interpretable ML framework with single center. We aimed to develop SERP with 3 Korean multicenter cohorts based on common data model (CDM) without data sharing and compare performance with inter-hospital validation design. This retrospective cohort study included all adult emergency visit patients of 3 hospitals in Korea from 2016 to 2017. We adopted CDM for the standardized multicenter research. The outcome of interest was 2-day mortality after the patients' ED visit. We developed each hospital SERP using interpretable ML framework and validated inter-hospital wisely. We accessed the performance of each hospital's score based on some metrics considering data imbalance strategy. The study population for each hospital included 87,670, 83,363 and 54,423 ED visits from 2016 to 2017. The 2-day mortality rate were 0.51%, 0.56% and 0.65%. Validation results showed accurate for inter hospital validation which has at least AUROC of 0.899 (0.858-0.940). We developed multicenter based Interpretable ML model using CDM for 2-day mortality prediction and executed Inter-hospital external validation which showed enough high accuracy.
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Affiliation(s)
- Jae Yong Yu
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Doyeop Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sunyoung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - SeJin Heo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Gab Soo Han
- Department of Cardiology, Cardiovascular Center, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyung Won Jeong
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jun Myung Gwon
- Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Feng Xie
- Department of Biomedical Data Science, Stanford University, Stanford, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, USA
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Digital and Smart Health Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea.
- Digital Innovation Center, Samsung Medical Center, Seoul, Republic of Korea.
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Eun S, Yoon H, Kang SY, Jo IJ, Heo S, Chang H, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Baek SY. Real-Time Tracheal Ultrasound vs. Capnography for Intubation Confirmation during CPR Wearing a Powered Air-Purifying Respirator in COVID-19 Era. Diagnostics (Basel) 2024; 14:225. [PMID: 38275472 PMCID: PMC10813934 DOI: 10.3390/diagnostics14020225] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to compare the accuracy of real-time trans-tracheal ultrasound (TTUS) with capnography to confirm intubation in cardiopulmonary resuscitation (CPR) while wearing a powered air-purifying respirator (PAPR). This setting reflects increased caution due to contagious diseases. This single-center, prospective, comparative study enrolled patients requiring CPR while wearing a PAPR who visited the emergency department of a tertiary medical center from December 2020 to August 2022. A physician performed the TTUS in real time and recorded the tube placement assessment. Another healthcare provider attached waveform capnography to the tube and recorded end-tidal carbon dioxide (EtCO2) after five ventilations. The accuracy and agreement of both methods compared with direct laryngoscopic visualization of tube placement, and the time taken by both methods was evaluated. Thirty-three patients with cardiac arrest were analyzed. TTUS confirmed tube placement with 100% accuracy, sensitivity, and specificity, whereas capnography demonstrated 97% accuracy, 96.8% sensitivity, and 100% specificity. The Kappa values for TTUS and capnography compared to direct visualization were 1.0 and 0.7843, respectively. EtCO2 was measured in 45 (37-59) seconds (median (interquartile range)), whereas TTUS required only 12 (8-23) seconds, indicating that TTUS was significantly faster (p < 0.001). No significant correlation was found between the physician's TTUS proficiency and image acquisition time. This study demonstrated that TTUS is more accurate and faster than EtCO2 measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.
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Affiliation(s)
- Seungwan Eun
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Soo Yeon Kang
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si 14353, Republic of Korea;
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sun-Young Baek
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
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Han H, Kim DS, Kim M, Heo S, Chang H, Lee GT, Lee SU, Kim T, Yoon H, Hwang SY, Cha WC, Sim MS, Jo IJ, Park JE, Shin TG. A Simple Bacteremia Score for Predicting Bacteremia in Patients with Suspected Infection in the Emergency Department: A Cohort Study. J Pers Med 2023; 14:57. [PMID: 38248758 PMCID: PMC10817606 DOI: 10.3390/jpm14010057] [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] [Received: 11/18/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Bacteremia is a life-threatening condition that has increased in prevalence over the past two decades. Prompt recognition of bacteremia is important; however, identification of bacteremia requires 1 to 2 days. This retrospective cohort study, conducted from 10 November 2014 to November 2019, among patients with suspected infection who visited the emergency department (ED), aimed to develop and validate a simple tool for predicting bacteremia. The study population was randomly divided into derivation and development cohorts. Predictors of bacteremia based on the literature and logistic regression were assessed. A weighted value was assigned to predictors to develop a prediction model for bacteremia using the derivation cohort; discrimination was then assessed using the area under the receiver operating characteristic curve (AUC). Among the 22,519 patients enrolled, 18,015 were assigned to the derivation group and 4504 to the validation group. Sixteen candidate variables were selected, and all sixteen were used as significant predictors of bacteremia (model 1). Among the sixteen variables, the top five with higher odds ratio, including procalcitonin, neutrophil-lymphocyte ratio (NLR), lactate level, platelet count, and body temperature, were used for the simple bacteremia score (model 2). The proportion of bacteremia increased according to the simple bacteremia score in both cohorts. The AUC for model 1 was 0.805 (95% confidence interval [CI] 0.785-0.824) and model 2 was 0.791 (95% CI 0.772-0.810). The simple bacteremia prediction score using only five variables demonstrated a comparable performance with the model including sixteen variables using all laboratory results and vital signs. This simple score is useful for predicting bacteremia-assisted clinical decisions.
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Affiliation(s)
- Hyelin Han
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Da Seul Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sunkyunkwan University, Seoul 06351, Republic of Korea
| | - Minha Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sunkyunkwan University, Seoul 06351, Republic of Korea
- Digital Innovation, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Min Sub Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Kangwon 20341, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (W.C.C.); (M.S.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sunkyunkwan University, Seoul 06351, Republic of Korea
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Chang H, Jung W, Ha J, Yu JY, Heo S, Lee GT, Park JE, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Kim T. Reply to Letter "A Critical Review of Predictive Modeling with 'Latent Shock' Variable". Shock 2023; 60:782-783. [PMID: 37878489 DOI: 10.1097/shk.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
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Chang H, Kim JW, Jung W, Heo S, Lee SU, Kim T, Hwang SY, Do Shin S, Cha WC. Machine learning pre-hospital real-time cardiac arrest outcome prediction (PReCAP) using time-adaptive cohort model based on the Pan-Asian Resuscitation Outcome Study. Sci Rep 2023; 13:20344. [PMID: 37990066 PMCID: PMC10663550 DOI: 10.1038/s41598-023-45767-z] [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: 07/16/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023] Open
Abstract
To save time during transport, where resuscitation quality can degrade in a moving ambulance, it would be prudent to continue the resuscitation on scene if there is a high likelihood of ROSC occurring at the scene. We developed the pre-hospital real-time cardiac arrest outcome prediction (PReCAP) model to predict ROSC at the scene using prehospital input variables with time-adaptive cohort. The patient survival at discharge from the emergency department (ED), the 30-day survival rate, and the final Cerebral Performance Category (CPC) were secondary prediction outcomes in this study. The Pan-Asian Resuscitation Outcome Study (PAROS) database, which includes out-of-hospital cardiac arrest (OHCA) patients transferred by emergency medical service in Asia between 2009 and 2018, was utilized for this study. From the variables available in the PAROS database, we selected relevant variables to predict OHCA outcomes. Light gradient-boosting machine (LightGBM) was used to build the PReCAP model. Between 2009 and 2018, 157,654 patients in the PAROS database were enrolled in our study. In terms of prediction of ROSC on scene, the PReCAP had an AUROC score between 0.85 and 0.87. The PReCAP had an AUROC score between 0.91 and 0.93 for predicting survived to discharge from ED, and an AUROC score between 0.80 and 0.86 for predicting the 30-day survival. The PReCAP predicted CPC with an AUROC score ranging from 0.84 to 0.91. The feature importance differed with time in the PReCAP model prediction of ROSC on scene. Using the PAROS database, PReCAP predicted ROSC on scene, survival to discharge from ED, 30-day survival, and CPC for each minute with an AUROC score ranging from 0.8 to 0.93. As this model used a multi-national database, it might be applicable for a variety of environments and populations.
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Affiliation(s)
- Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Ji Woong Kim
- LG UPLUS, 71, Magokjungang 8-ro, Gangseo-gu, Seoul, 07795, Republic of Korea
| | - Weon Jung
- Smart Health Lab, Research Institute of Future Medicine, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea.
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea.
- Digital Innovation, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Park J, Park G, Kim DS, Kim M, Heo S, Jeong D, Chang H, Lee SU, Choi G, Lee GT, Shin TG, Park JE, Hwang SY. Effect of Blade Size on the First-Pass Success Rate of Endotracheal Intubation Using the C-MAC Video Laryngoscope. J Clin Med 2023; 12:7055. [PMID: 38002668 PMCID: PMC10672131 DOI: 10.3390/jcm12227055] [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] [Received: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
We sought to determine whether blade size influences the first-pass success (FPS) rate when performing endotracheal intubation (ETI) with a C-MAC video laryngoscope (VL) in emergency department (ED) patients. This single-center, retrospective, observational study was conducted between August 2016 and July 2022. A total of 1467 patients was divided into two categories based on the blade size used during the first ETI attempt: blade-3 (n = 365) and blade-4 groups (n = 1102). The primary outcome was the FPS rate. The secondary outcomes included the glottic view, multiple attempt rate, and ETI-related complications. We used propensity score matching to reduce the potential confounders between the two groups. Among these, 363 pairs of matched propensity scores were generated. The FPS rate did not differ between the blade-3 (84.8%) and blade-4 groups (87.3%) in the matched cohort (p = 0.335). The multiple attempt rate did not differ significantly between groups (p = 0.289) and was 3.9% and 2.5% in the blade-3 and blade-4 groups, respectively. The difficult glottic view (11.3 vs. 6.9%, p = 0.039) and complication rates (15.4% vs. 10.5%, p = 0.047) were significantly higher in the blade-3 group than in the blade-4 group. The FPS rates of ETI with the blade-3 and blade-4 groups in adult patients in the ED did not differ significantly.
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Affiliation(s)
- Jeongyong Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Goeun Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Da Seul Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Minha Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Goosang Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Zhi Y, Liu L, Wang H, Chen X, Lv Y, Cui X, Chang H, Wang Y, Cui S. Prenatal exome sequencing analysis in fetuses with central nervous system anomalies. Ultrasound Obstet Gynecol 2023; 62:721-726. [PMID: 37204857 DOI: 10.1002/uog.26254] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the utility of prenatal exome sequencing (pES) in fetuses with central nervous system (CNS) abnormalities. METHODS This was a retrospective cohort study of fetuses identified to have CNS abnormality on prenatal ultrasound and/or magnetic resonance imaging. All fetuses were first analyzed by chromosomal microarray analysis (CMA). Fetuses with a confirmed aneuploidy or causal pathogenic copy-number variant (CNV) on CMA did not undergo pES analysis and were excluded, while those with a negative CMA result were offered pES testing. RESULTS Of the 167 pregnancies included in the study, 42 (25.1%) were identified to have a pathogenic or likely pathogenic (P/LP) variant. The diagnostic rate was significantly higher in fetuses with a non-isolated CNS abnormality than in those with a single CNS abnormality (35.7% (20/56) vs 14.5% (8/55); P = 0.010). Moreover, when a fetus had three or more CNS abnormalities, the positive diagnostic rate increased to 42.9%. A total of 25/42 (59.5%) cases had de-novo mutations, while, in the remaining cases, mutations were inherited and carried a significant risk of recurrence. Families whose fetus carried a P/LP mutation were more likely to choose advanced pregnancy termination than those with a variant of uncertain significance, secondary/incidental finding or negative pES result (83.3% (25/30) vs 41.3% (38/92); P < 0.001). CONCLUSION pES improved the identification of genetic disorders in fetuses with CNS anomalies without a chromosomal abnormality or CNV identified on CMA, regardless of the number of CNS anomalies and presence of extracranial abnormality. We also demonstrated that pES findings can significantly impact parental decision-making. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Y Zhi
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - L Liu
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - H Wang
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - X Chen
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Y Lv
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - X Cui
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - H Chang
- Scientific Research Office, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Y Wang
- Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - S Cui
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Yoo HH, Ro YS, Ko E, Lee JH, Han SH, Kim T, Shin TG, Kim S, Chang H. Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S1-S12. [PMID: 37967858 PMCID: PMC10662522 DOI: 10.15441/ceem.23.151] [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] [Received: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE : This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. METHODS : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. RESULTS : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. CONCLUSION : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.
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Affiliation(s)
- Hyun Ho Yoo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jin-Hee Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - So-hyun Han
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongjung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Kim S, Chang H, Kim T, Cha WC. Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic. J Korean Med Sci 2023; 38:e303. [PMID: 37821083 PMCID: PMC10562183 DOI: 10.3346/jkms.2023.38.e303] [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: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. METHODS A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. RESULTS ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. CONCLUSION ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.
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Affiliation(s)
- Sumin Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Park JB, Jang BS, Chang JH, Kim JH, Hong KY, Jin US, Chang H, Myung Y, Jeong JH, Heo CY, Kim IA, Shin KH. Impact of the New ESTRO-ACROP Target Volume Delineation Guideline on Breast-Related Complications after Implant-Based Reconstruction and Postmastectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e198. [PMID: 37784842 DOI: 10.1016/j.ijrobp.2023.06.1070] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) recently updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed whether this change has impact on breast-related complications. MATERIALS/METHODS We retrospectively reviewed patients who underwent PMRT after mastectomy with tissue expander or permanent implant insertion from 2016 to 2021. In total, 412 patients were included; 277 received RT by the new ESTRO-ACROP target delineation (ESTRO-T), and 135 received RT by conventional target delineation (CONV-T). The primary endpoint was comparison between the target groups of major breast-related complication, including infection, capsular contracture, deformity and necrosis requiring re-operation or re-hospitalization during follow-up after RT or delayed implant replacement. Complications were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0., and capsular contracture was graded by the Baker Classification. RESULTS The median follow-up was 29.5 months (range, 0.3-76.8). The 1-, 2-, and 3-year incidence rates of major breast-related complication were 5.7%, 10.0%, and 11.6% in the ESTRO-T group, and 8.2%, 13.8%, and 14.7% in the CONV-T groups; it did not show a difference between the groups (P = 0.55). In multivariate analyses, target delineation is not significantly associated with the major complications (hazard ratio [HR] = 0.93; P = 0.83, Table 1). There was no significant difference between the ESTRO-T and CONV-T groups in the incidence of any breast-related complications (3-year cumulative incidence, 37.3% vs. 29.4%, respectively; P = 0.28). Symptomatic RT-induced pneumonitis rates were 2.7% in the ESTRO-T group (7 patients) and 2.2% in the CONV-T group (3 patients). Only one local recurrence event occurred in the ESTRO-T group, which was within the ESTRO-target volume. CONCLUSION Target volume delineation according to the new ESTRO-ACROP guideline did not reduce the risk of major or any breast-related complications. As the dosimetric benefits of heart and lung have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.
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Affiliation(s)
- J B Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - B S Jang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J H Chang
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J H Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - K Y Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - U S Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - H Chang
- 2nd Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
| | - Y Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - J H Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South) Korea
| | - C Y Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - I A Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South) Korea
| | - K H Shin
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea, Republic of (South) Korea
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Tian X, Huang XX, Zhang ZT, Wei PJ, Wang QX, Chang H, Xiao W, Gao Y. Long-Term Outcome of Rectal Cancer Patients Treated by High-Dose Radiotherapy and Concurrent Chemotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e345. [PMID: 37785200 DOI: 10.1016/j.ijrobp.2023.06.2411] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To explore the therapeutic efficacy and adverse effects of high-dose radiotherapy concurrently with chemotherapy in treating patients with non-metastatic rectal cancer. MATERIALS/METHODS Patients were enrolled if they were diagnosed with stage I-III rectal adenocarcinoma, refused surgery and received high-dose pelvic radiotherapy and concurrent chemotherapy instead. Their clinical data were retrospectively analyzed for calculating local control and survival rates. Treatment related toxicities was evaluated according to the Common Terminology Criteria for Adverse Events (version 5.0). RESULTS Between April 2006 and February 2021, a total of 93 patients in our medical center were eligible for this study, with a median age of 61 (range, 21-84) years. Of those, 86 (92.5%) patients had tumors located within 5 cm of the anal verge. There were 8 (8.6%), 30 (32.3%) and 55 (59.1%) patients diagnosed with stage I, II and III, respectively. All patients received fluorouracil-based chemotherapy (single-agent fluorouracil or FOLFOX regimen). The irradiation techniques included three-dimensional conformal and intensity-modulated radiation therapy. The median total radiation dose for gross tumor volume (GTV) was 80 (range, 60-90) Gy. The 15 (16.1%) patients refusing surgery before treatment received one course of radiation (60-70 Gy/30-35 Fr). And a 2-course radiation (Course 1, 45-50 Gy/25 Fr; Course 2: 24-40 Gy/12-20 Fr) were given to the 78 (83.9%) patients who failed to achieve clinical complete remission (cCR) after neoadjuvant chemoradiotherapy but still refused surgery, with a median interval of 79 (range, 35-195) days. The median follow-up duration was 66 (range, 10-161) months. The 3- and 5-year overall survival (OS) rates for all patients were 90.5% and 72.7%, respectively. The clinical complete remission rate at the end of chemoradiotherapy was 69.9%. Colostomy was performed in the 14 patients whose rectal tumor did not attain cCR or progressed. There was no grade 4/5 severe acute toxicity. No patient suffered from intestinal perforation. Only one patient developed anal stenosis. Because of rectal bleeding, blood transfusion was performed in 7 patients, and one patient underwent an enterostomy. CONCLUSION High-dose radiotherapy concurrent with chemotherapy brought encouraging survival outcomes, satisfactory organ preservation and acceptable short- and long-term side effects. It might be a safe and non-invasive alternative to abdominoperineal resection in rectal cancer patients refusing or unsuitable for surgery, especially for those with a low-position tumor.
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Affiliation(s)
- X Tian
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - X X Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Z T Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - P J Wei
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Q X Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - H Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - W Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Y Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Chang H, Jung W, Ha J, Yu JY, Heo S, Lee GT, Park JE, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Kim T. EARLY PREDICTION OF UNEXPECTED LATENT SHOCK IN THE EMERGENCY DEPARTMENT USING VITAL SIGNS. Shock 2023; 60:373-378. [PMID: 37523617 PMCID: PMC10510834 DOI: 10.1097/shk.0000000000002181] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2023] [Accepted: 07/02/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACT Objective/Introduction : Sequential vital-sign information and trends in vital signs are useful for predicting changes in patient state. This study aims to predict latent shock by observing sequential changes in patient vital signs. Methods : The dataset for this retrospective study contained a total of 93,194 emergency department (ED) visits from January 1, 2016, and December 31, 2020, and Medical Information Mart for Intensive Care (MIMIC)-IV-ED data. We further divided the data into training and validation datasets by random sampling without replacement at a 7:3 ratio. We carried out external validation with MIMIC-IV-ED. Our prediction model included logistic regression (LR), random forest (RF) classifier, a multilayer perceptron (MLP), and a recurrent neural network (RNN). To analyze the model performance, we used area under the receiver operating characteristic curve (AUROC). Results : Data of 89,250 visits of patients who met prespecified criteria were used to develop a latent-shock prediction model. Data of 142,250 patient visits from MIMIC-IV-ED satisfying the same inclusion criteria were used for external validation of the prediction model. The AUROC values of prediction for latent shock were 0.822, 0.841, 0.852, and 0.830 with RNN, MLP, RF, and LR methods, respectively, at 3 h before latent shock. This is higher than the shock index or adjusted shock index. Conclusion : We developed a latent shock prediction model based on 24 h of vital-sign sequence that changed with time and predicted the results by individual.
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Affiliation(s)
- Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Weon Jung
- Smart Health Lab, Research Institute of Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Juhyung Ha
- Department of Computer Science, Indiana University Bloomington, Bloomington, Indiana
| | - Jae Yong Yu
- Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Smart Health Lab, Research Institute of Future Medicine, Samsung Medical Center, Seoul, South Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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Chang H, Yu JY, Lee GH, Heo S, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Sim MS, Jo IJ, Kim T. Clinical support system for triage based on federated learning for the Korea triage and acuity scale. Heliyon 2023; 9:e19210. [PMID: 37654468 PMCID: PMC10465866 DOI: 10.1016/j.heliyon.2023.e19210] [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] [Received: 05/08/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
Background and aims This study developed a clinical support system based on federated learning to predict the need for a revised Korea Triage Acuity Scale (KTAS) to facilitate triage. Methods This was a retrospective study that used data from 11,952,887 patients in the Korean National Emergency Department Information System (NEDIS) from 2016 to 2018 for model development. Separate cohorts were created based on the emergency medical center level in the NEDIS: regional emergency medical center (REMC), local emergency medical center (LEMC), and local emergency medical institution (LEMI). External and temporal validation used data from emergency department (ED) of the study site from 2019 to 2021. Patient features obtained during the triage process and the initial KTAS scores were used to develop the prediction model. Federated learning was used to rectify the disparity in data quality between EDs. The patient's demographic information, vital signs in triage, mental status, arrival information, and initial KTAS were included in the input feature. Results 3,626,154 patients' visits were included in the regional emergency medical center cohort; 8,278,081 patients' visits were included in the local emergency medical center cohort; and 48,652 patients' visits were included in the local emergency medical institution cohort. The study site cohort, which is used for external and temporal validation, included 135,780 patients visits. Among the patients in the REMC and study site cohorts, KTAS level 3 patients accounted for the highest proportion at 42.4% and 45.1%, respectively, whereas in the LEMC and LEMI cohorts, KTAS level 4 patients accounted for the highest proportion. The area under the receiver operating characteristic curve for the prediction model was 0.786, 0.750, and 0.770 in the external and temporal validation. Patients with revised KTAS scores had a higher admission rate and ED mortality rate than those with unaltered KTAS scores. Conclusions This novel system might accurately predict the likelihood of KTAS acuity revision and support clinician-based triage.
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Affiliation(s)
- Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Jae Yong Yu
- Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Geun Hyeong Lee
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon 16419, South Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, Korea. 81 Irwon-ro Gangnam-gu, Seoul 06351, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, South Korea
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Chung HW, Chang H, Hong D, Yun HJ, Chung HS. Optimal ropivacaine concentration for ultrasound-guided erector spinae plane block in patients who underwent video-assisted thoracoscopic lobectomy surgery. Niger J Clin Pract 2023; 26:1139-1146. [PMID: 37635608 DOI: 10.4103/njcp.njcp_63_23] [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] [Indexed: 08/29/2023]
Abstract
Background An ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective way to control postoperative pain and may be a good alternative way to an epidural block. However, relevant research on the appropriate concentration of local anesthetics for an ESPB remains scarce. Aims This study aimed to investigate the optimal concentration of ropivacaine for an ESPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods A total of 68 patients who underwent a VATS lobectomy were enrolled. An ipsilateral ultrasound-guided ESPB was performed with three different ropivacaine concentrations as a local anesthetic: 0.189% (G1), 0.375% (G2), and 0.556% (G3). The total amount of perioperative remifentanil administered, patient-controlled analgesia (PCA) applied, and rescue drugs for postoperative analgesia during the 24 h after surgery were acquired, and numeric rating scale (NRS) scores were obtained. Results The total amount of intraoperative remifentanil administered was 7.20 ± 3.04 mcg/kg, 5.32 ± 2.70 mcg/kg, and 4.60 ± 1.75 in the G1, G2, and G3 groups, respectively. G2 and G3 had significantly lower amounts of remifentanil administered than the G1 group (P = 0.02 vs. G2; P = 0.003 vs. G3). The G3 group needed more inotropes than the G1 and G2 groups in the perioperative period (P = 0.045). The NRS scores, PCA, and rescue drug were not significantly different in the three groups. Conclusion The optimal concentration of ropivacaine recommended for an ESPB was 0.375%, which was effective in controlling pain and reducing the intraoperative opioid requirements with minimal adverse reactions such as hypotension.
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Affiliation(s)
- H W Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H Chang
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D Hong
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H J Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Park CH, Yoon H, Jo IJ, Woo S, Heo S, Chang H, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG. A Pilot Study Evaluating LV Diastolic Function with M-Mode Measurement of Mitral Valve Movement in the Parasternal Long Axis View. Diagnostics (Basel) 2023; 13:2412. [PMID: 37510155 PMCID: PMC10378499 DOI: 10.3390/diagnostics13142412] [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] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This pilot study aimed to develop a new, reliable, and easy-to-use method for the evaluation of diastolic function through the M-mode measurement of mitral valve (MV) movement in the parasternal long axis (PSLA), similar to E-point septal separation (EPSS) used for systolic function estimation. Thirty healthy volunteers from a tertiary emergency department (ED) underwent M-mode measurements of the MV anterior leaflet in the PSLA view. EPSS, A-point septal separation (APSS), A-point opening length (APOL), and E-point opening length (EPOL) were measured in the PSLA view, along with the E and A velocities and e' velocity in the apical four-chamber view. Correlation analyses were performed to assess the relationship between M-mode and Doppler measurements, and the measurement time was evaluated. No significant correlations were found between M-mode and Doppler measurements in the study. However, M-mode measurements exhibited high reproducibility and faster acquisition, and the EPOL value consistently exceeded the APOL value, resembling the E and A pattern. These findings suggest that visually assessing the M-mode pattern on the MV anterior leaflet in the PSLA view may be a practical approach to estimating diastolic function in the ED. Further investigations with a larger and more diverse patient population are needed to validate these findings.
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Affiliation(s)
- Chan-Ho Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Ik-Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sookyoung Woo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center; Seoul 06351, Republic of Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Jong-Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Se-Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sung-Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Won-Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Tae-Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Du XM, Gao Y, Su YD, Zhao HY, Chang H, Li Y. [Primary peritoneal epithelioid mesothelioma with a STK11 gene mutation: report of a case]. Zhonghua Bing Li Xue Za Zhi 2023; 52:745-747. [PMID: 37408413 DOI: 10.3760/cma.j.cn112151-20230110-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- X M Du
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Y Gao
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Y D Su
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - H Y Zhao
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - H Chang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Y Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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18
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Bai Q, Chen Y, Xiao X, Chang H, Xin B, Jia L, Li J, Wang Z, Yu C, Xiong H, Zhou X. 203P MET gene copy number heterogeneity in non-small cell lung cancer patients resistant to EGFR-TKIs. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00456-2] [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: 04/03/2023]
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19
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Yoon S, Kim T, Kang E, Heo S, Chang H, Seo Y, Cha WC. Feasibility of patch-type wireless 12-lead electrocardiogram in laypersons. Sci Rep 2023; 13:4044. [PMID: 36899040 PMCID: PMC10004446 DOI: 10.1038/s41598-023-31309-0] [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] [Received: 06/28/2022] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Various efforts have been made to diagnose acute cardiovascular diseases (CVDs) early in patients. However, the sole option currently is symptom education. It may be possible for the patient to obtain an early 12-lead electrocardiogram (ECG) before the first medical contact (FMC), which could decrease the physical contact between patients and medical staff. Thus, we aimed to verify whether laypersons can obtain a 12-lead ECG in an off-site setting for clinical treatment and diagnosis using a patch-type wireless 12-lead ECG (PWECG). Participants who were ≥ 19 years old and under outpatient cardiology treatment were enrolled in this simulation-based one-arm interventional study. We confirmed that participants, regardless of age and education level, can use the PWECG on their own. The median age of the participants was 59 years (interquartile range [IQR] = 56-62 years), and the median duration to obtain a 12-lead ECG result was 179 s (IQR = 148-221 s). With appropriate education and guidance, it is possible for a layperson to obtain a 12-lead ECG, minimizing the contact with a healthcare provider. These results can be used subsequently for treatment.
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Affiliation(s)
- Sunyoung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea.,Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Eunjin Kang
- Department of Emergency Medicine Cheju Halla General Hospital, 65, Doryeong-ro63127, Jeju-si, Jeju-do, Republic of Korea
| | - Sejin Heo
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea.,Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea
| | - Yeoni Seo
- Department of International Health and Health Policy, Clinical & Public Health Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea. .,Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul, 06355, Republic of Korea. .,Digital Innovation, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea.
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20
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Haddad P, Kutlar Joss M, Weuve J, Vienneau D, Atkinson R, Brook J, Chang H, Forastiere F, Hoek G, Kappeler R, Lurmann F, Sagiv S, Samoli E, Smargiassi A, Szpiro A, Patton AP, Boogaard H, Hoffmann B. Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis. Int J Hyg Environ Health 2023; 247:114079. [PMID: 36446272 DOI: 10.1016/j.ijheh.2022.114079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke. METHODS PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies. RESULTS Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98-1.09) per 1 μg/m3 EC, 1.09 (0.96-1.23) per 10 μg/m3 PM10, 1.08 (0.89-1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively. CONCLUSION The available literature provides low to moderate evidence for an association of TRAP with stroke.
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Affiliation(s)
- P Haddad
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - M Kutlar Joss
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - D Vienneau
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - R Atkinson
- Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - J Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - F Forastiere
- School of Public Health, Faculty of Medicine, Imperial College, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UK
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, the Netherlands
| | - R Kappeler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - F Lurmann
- Sonoma Technology, Inc, 1450 N McDowell Blvd #200, Petaluma, CA, 94954, USA
| | - S Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - E Samoli
- Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athina, 115 27, Greece
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Quebec, H3N 1X9, Canada
| | - A Szpiro
- Department of Biostatistics, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351617, Seattle, WA, 98195-1617, USA
| | - A P Patton
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - H Boogaard
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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21
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Sun JB, Huang YH, Chang H, Yao W, Li ZL. [Pancreatic pseudocyst after pegaspargase treatment in six children]. Zhonghua Er Ke Za Zhi 2022; 60:1322-1326. [PMID: 36444438 DOI: 10.3760/cma.j.cn112140-20220904-00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children. Methods: The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively. Results: There were 4 males and 2 females, and their age of onset was 9.5 (5.8, 13.0) years. The total number of pegaspargase applications was 2.5 (2.0, 3.5) times. The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0 (9.0, 17.2) days, and 42.5 (35.0, 129.5) days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst. Abdominal pain was the most prominent manifestation of pancreatitis (6/6). All of the 6 children were asymptomatic when pancreatic pseudocyst was noted, and were treated conservatively at first, but one case later developed intermittent abdominal distension or nausea after eating. All the cases had pancreatic pseudocyst enlargement during the conservative treatment. Three children were treated with endoscopic ultrasound-guided transgastric drainage, and the cyst disappeared from 10 days to 4 months after the operation. The other 3 children received endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage, but one of them turned to surgery due to pancreatic duct stricture, and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively. Regarding safety issues, 1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis, which were improved after treatment, and the other 5 had no complications. Conclusions: Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage, and should be diagnosed with a history of pegaspargase treatment and timely imaging examination. Conservative treatment is the first choice for asymptomatic pseudocyst. When the pseudocyst enlarges, different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.
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Affiliation(s)
- J B Sun
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Y H Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - H Chang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - W Yao
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Z L Li
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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22
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Kim M, Yu J, Chang H, Heo S, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Kim T. National Surveillance of Pediatric Out-of-Hospital Cardiac Arrest in Korea: The 10-Year Trend From 2009 to 2018. J Korean Med Sci 2022; 37:e317. [PMID: 36377293 PMCID: PMC9667012 DOI: 10.3346/jkms.2022.37.e317] [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: 04/08/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This study reports trends in pediatric out-of-hospital cardiac arrest (OHCA) and factors affecting clinical outcomes by age group. METHODS We identified 4,561 OHCA patients younger than 18 years between January 2009 and December 2018 in the Korean OHCA Registry. The patients were divided into four groups: group 1 (1 year or younger), group 2 (1 to 5 years), group 3 (6 to 12 years), and group 4 (13 to 17 years). The primary outcome was survival to hospital discharge, and the secondary outcomes were return of spontaneous circulation (ROSC) at the emergency department (ED) and good neurological status at discharge. Multivariate logistic analyses were performed. RESULTS The incidence rate of pediatric OHCA in group 1 increased from 45.57 to 60.89 per 100,000 person-years, while that of the overall population decreased over the 10 years. The rates of ROSC at the ED, survival to hospital discharge, and good neurologic outcome were highest in group 4 (37.9%, 9.7%, 4.9%, respectively) and lowest in group 1 (28.3%, 7.1%, 3.2%). The positive factors for survival to discharge were event location of a public/commercial building or place of recreation, type of first responder, prehospital delivery of automated external defibrillator shock, initial shockable rhythm at the ED. The factors affecting survival outcomes differed by age group. CONCLUSION This study reports comprehensive trends in pediatric OHCA in the Republic of Korea. Our findings imply that preventive methods for the targeted population should be customized by age group.
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Affiliation(s)
- Minha Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyong Yu
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Digital and Smart Health Office, Tan Tock Seng Hospital (TTSH), Singapore
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Zhang Z, Wu J, Wang Q, Huang X, Tian X, Chang H, Zeng Z, Xiao W, Li R, Gao Y. Neoadjuvant Chemoradiotherapy Significantly Improved R0 Resection Rate in Unresectable Locally Advanced Colon Cancer: The Initial Analysis from the Randomized Controlled Phase 3 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1823] [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: 10/31/2022]
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24
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Kim DS, Jeong D, Park JE, Lee GT, Shin TG, Chang H, Kim T, Lee SU, Yoon H, Cha WC, Sim YJ, Park SY, Hwang SY. Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment. J Pers Med 2022; 12:jpm12101720. [PMID: 36294859 PMCID: PMC9605128 DOI: 10.3390/jpm12101720] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
This study sought to determine whether the C-MAC video laryngoscope (VL) performed better than a direct laryngoscope (DL) when attempting endotracheal intubation (ETI) in the emergency department (ED) while wearing personal protective equipment (PPE). This was a retrospective single-center observational study conducted in an academic ED between February 2020 and March 2022. All emergency medical personnel who participated in any ETI procedure were required to wear PPE. The patients were divided into the C-MAC VL group and the DL group based on the device used during the first ETI attempt. The primary outcome measure was the first-pass success (FPS) rate. A multiple logistic regression was used to determine the factors associated with FPS. Of the 756 eligible patients, 650 were assigned to the C-MAC group and 106 to the DL group. The overall FPS rate was 83.5% (n = 631/756). The C-MAC group had a significantly higher FPS rate than the DL group (85.7% vs. 69.8%, p < 0.001). In the multivariable logistic regression analysis, C-MAC use was significantly associated with an increased FPS rate (adjusted odds ratio, 2.86; 95% confidence interval, 1.69−4.08; p < 0.001). In this study, we found that the FPS rate of ETI was significantly higher when the C-MAC VL was used than when a DL was used by emergency physicians constrained by cumbersome PPE.
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Affiliation(s)
- Da Saem Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 20341, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul 06351, Korea
| | - Yong Jin Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-2053
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Chang H, Cha WC. Artificial intelligence decision points in an emergency department. Clin Exp Emerg Med 2022; 9:165-168. [PMID: 36221962 PMCID: PMC9561198 DOI: 10.15441/ceem.22.366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
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Dong B, Simonson L, Vold S, Oldham E, Barten L, Ahmad N, Chang H. 644 Planar cell polarity gene frizzled 6 promotes melanoma metastasis by regulating canonical Wnt signaling and EMT pathways. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.655] [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]
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Kim Y, Choi A, Telluri A, Lipkin I, Bradley A, Jonas R, Crabtree T, Earls J, Min J, Chang H. 412 AI-QCT: Gatekeeper For Invasive Angiography? CONSERVE Sub-Study. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Park H, Chae MK, Jeong W, Yu J, Jung W, Chang H, Cha WC. Appropriateness of Alerts and Physicians’ Responses with a Medication-related Clinical Decision Support System (Preprint). JMIR Med Inform 2022; 10:e40511. [PMID: 36194461 PMCID: PMC9579928 DOI: 10.2196/40511] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Alert fatigue is unavoidable when many irrelevant alerts are generated in response to a small number of useful alerts. It is necessary to increase the effectiveness of the clinical decision support system (CDSS) by understanding physicians’ responses. Objective This study aimed to understand the CDSS and physicians’ behavior by evaluating the clinical appropriateness of alerts and the corresponding physicians’ responses in a medication-related passive alert system. Methods Data on medication-related orders, alerts, and patients’ electronic medical records were analyzed. The analyzed data were generated between August 2019 and June 2020 while the patient was in the emergency department. We evaluated the appropriateness of alerts and physicians’ responses for a subset of 382 alert cases and classified them. Results Of the 382 alert cases, only 7.3% (n=28) of the alerts were clinically appropriate. Regarding the appropriateness of the physicians’ responses about the alerts, 92.4% (n=353) were deemed appropriate. In the classification of alerts, only 3.4% (n=13) of alerts were successfully triggered, and 2.1% (n=8) were inappropriate in both alert clinical relevance and physician’s response. In this study, the override rate was 92.9% (n=355). Conclusions We evaluated the appropriateness of alerts and physicians’ responses through a detailed medical record review of the medication-related passive alert system. An excessive number of unnecessary alerts are generated, because the algorithm operates as a rule base without reflecting the individual condition of the patient. It is important to maximize the value of the CDSS by comprehending physicians’ responses.
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Affiliation(s)
- Hyunjung Park
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Minjung Kathy Chae
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Woohyeon Jeong
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaeyong Yu
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Weon Jung
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute of Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, Republic of Korea
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Yoo S, Chang H, Kim T, Yoon H, Hwang S, Sin T, Sim M, Jo I, Choi J, Cha WC. Timeliness of Single-Patch 12-Lead Electrocardiography for Patients with Chest Pain at the Emergency Department. Stud Health Technol Inform 2022; 294:930-934. [PMID: 35612245 DOI: 10.3233/shti220627] [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] [Indexed: 06/15/2023]
Abstract
A 12-lead ECG is used in emergency departments to diagnose and treat patients with chest discomfort. Performing ECGs at the proper time has been found to increase treatment outcomes. A timer on a wearable ECG ensures proper recording. We compared the timing accuracy of single-patch 12-lead ECG to conventional ECG, expecting the former to be more accurate. Adult patients with chest pain but not in shock were randomized into two groups: SP-ECG and C-ECG. The final analysis included 33 of the 36 recruited patients. The key result was the time taken to record the ECG in both groups. The two groups' average ages were 63.7 and 58.1 years. The SP-ECG group was 87.5 percent timely, while the C-ECG group was 47.0 percent (P.74). At the second follow-up, it was 75.0 percent and 35.2%. Continuous ECG without interfering with other exams is feasible in complex ER circumstances. But the accuracy of single-patch ECG has not been verified. The device also had some minor difficulties. The use of SP-ECG may help alleviate overcrowding or staffing issues in EDs, although more research is required.
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Affiliation(s)
- Suyoung Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sungyeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Taegun Sin
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Minsub Sim
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ikjoon Jo
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jinho Choi
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul, Republic of Korea
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Choi HZ, Chang H, Ko SH, Kim MC. Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry. PLoS One 2022; 17:e0258673. [PMID: 35544548 PMCID: PMC9094503 DOI: 10.1371/journal.pone.0258673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups. Methods This retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge. Results Of the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [–0.526–0.588], P<0.001). In the reproductive age group (age 18–44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765–1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524–0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938–1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079–1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828–0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979–1.566], P = 0.074). Conclusions Females of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.
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Affiliation(s)
- Han Zo Choi
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seok Hoon Ko
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Myung Chun Kim
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- * E-mail:
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Shaw AR, Perales-Puchalt J, Johnson E, Espinoza-Kissell P, Acosta-Rullan M, Frederick S, Lewis A, Chang H, Mahnken J, Vidoni ED. Representation of Racial and Ethnic Minority Populations in Dementia Prevention Trials: A Systematic Review. J Prev Alzheimers Dis 2022; 9:113-118. [PMID: 35098981 DOI: 10.14283/jpad.2021.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite older racial and ethnic minorities (REMs) being more likely to develop dementia they are underrepresented in clinical trials focused on neurological disorders. Inclusion of REMs in dementia prevention studies is vital to reducing the impact of disparities in dementia risk. We conducted a systematic review to characterize the number of REM enrolled in brain health and prevention randomized controlled trials (RCTs). RTCs published from January 1, 2004 to April 21, 2020 were included. Participants were normal cognitive adults aged 45 years and older who participated in a Phase II or Phase III U.S. based preventative trial. Analyses were performed to examine differences in trial characteristics between RCTs that did and those that did not report race/ethnicity and to calculate the pooled proportion of each racial/ethnic group in randomized brain healthy prevention trials. A total of 42 studies consisting of 100,748 participants were included in the final analyses. A total of 26 (62%) reported some racial/ethnic identity data. The pooled proportion of REM participants was 0.256 (95% CI, 0.191, 0.326). There is a lack of racial/ethnic reporting of participants and REMs remain underrepresented in brain health prevention RCTs.
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Affiliation(s)
- A R Shaw
- Eric Vidoni, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, USA, ; Phone: 913-588-5312; Fax: 913-945-5035
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Chang H, Chung T, Chang I, Chiang I, Liu S. Low intensity extracorporeal shockwave therapy improved the resistance index of cavernosal artery in venous occlusive erectile dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.437] [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: 10/18/2022]
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Chang H, Jeong D, Park JE, Kim T, Lee GT, Yoon H, Hwang SY, Cha WC, Shin TG, Sim MS, Jo IJ, Lee S, Shin SD, Choi J. Prehospital airway management for out-of-hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry. Acad Emerg Med 2022; 29:581-588. [PMID: 35064725 DOI: 10.1111/acem.14443] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
AIM This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask (BVM) ventilation. METHODS We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30-day survival with neurologically favorable status defined by cerebral performance category 1 or 2. RESULTS Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30-day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.16 to 1.27; all p < 0.001). In propensity score matching-adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p > 0.05). Inverse probability of treatment weighting- and LASSO-adjusted analyses replicated these results. CONCLUSIONS In this nationwide real-world data analysis of OHCA, the 30-day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.
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Affiliation(s)
- Hansol Chang
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
| | - Daun Jeong
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung‐Hwa Lee
- Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine College of Medicine, Seoul National University Seoul Republic of Korea
| | - Jin‐Ho Choi
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
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Kim D, Jung W, Yu JY, Chang H, Lee SU, Kim T, Hwang SY, Yoon H, Shin TG, Sim MS, Jo IJ, Cha WC. Effect of fever or respiratory symptoms on leaving without being seen during the COVID-19 pandemic in South Korea. Clin Exp Emerg Med 2022; 9:1-9. [PMID: 35354228 PMCID: PMC8995518 DOI: 10.15441/ceem.21.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic.Methods We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP] × post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period.Results A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P < 0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P < 0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P < 0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P < 0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P < 0.001).Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.
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Yoo S, Chang H, Kim T, Yoon H, Hwang SY, Shin TG, Sim MS, Jo IJ, Choi JH, Cha WC. Intervention in the timeliness of two ECG types for emergency department patients with chest pain: randomized controlled trial (Preprint). Interact J Med Res 2022; 11:e36335. [PMID: 36099010 PMCID: PMC9516380 DOI: 10.2196/36335] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the emergency department (ED), the result obtained using the 12-lead electrocardiography (ECG) is the basis for diagnosing and treating patients with chest pain. It was found that performing ECG at the appropriate time could improve treatment outcomes. Hence, a wearable ECG device with a timer can ensure that the findings are continuously recorded. Objective We aimed to compare the time accuracy of a single-patch 12-lead ECG (SP-ECG) with that of conventional ECG (C-ECG). We hypothesized that SP-ECG would result in better time accuracy. Methods Adult patients who visited the emergency room with chest pain but were not in shock were randomly assigned to one of the following 2 groups: the SP-ECG group or the C-ECG group. The final analysis included 33 (92%) of the 36 patients recruited. The primary outcome was the comparison of the time taken by the 2 groups to record the ECG. The average ages of the participants in the SP-ECG and C-ECG groups were 63.7 (SD 18.4) and 58.1 (SD 12.4) years, respectively. Results With a power of 0.95 and effect sizes of 0.05 and 1.36, the minimum number of samples was calculated. The minimum sample size for each SP-ECG and C-ECG group is 15.36 participants, assuming a 20% dropout rate. As a result, 36 patients with chest pain participated, and 33 of them were analyzed. The timeliness of SP-ECG and C-ECG for the first follow-up ECG was 87.5% and 47.0%, respectively (P=.74). It was 75.0% and 35.2% at the second follow-up, respectively (P=.71). Conclusions Continuous ECG monitoring with minimal interference from other examinations is feasible and essential in complex ED situations. However, the precision of SP-ECG has not yet been proved. Nevertheless, the application of SP-ECG is expected to improve overcrowding and human resource shortages in EDs, though more research is needed. Trial Registration ClinicalTrials.gov NCT04114760; https://clinicaltrials.gov/ct2/show/NCT04114760
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Affiliation(s)
- Suyoung Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Health Information and Strategy Center, Samsung Medical Center, Seoul, Republic of Korea
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Mao AW, Barck H, Young J, Paley A, Mao JH, Chang H. Identification of a novel cancer microbiome signature for predicting prognosis of human breast cancer patients. Clin Transl Oncol 2021; 24:597-604. [PMID: 34741726 DOI: 10.1007/s12094-021-02725-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/27/2021] [Accepted: 10/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prognosis of breast cancer (BC) patients differs considerably and identifying reliable prognostic biomarker(s) is imperative. With evidence that the microbiome plays a critical role in the response to cancer therapies, we aimed to identify a cancer microbiome signature for predicting the prognosis of BC patients. METHODS The TCGA BC microbiome data (TCGA-BRCA-microbiome) was downloaded from cBioPortal. Univariate and multivariate Cox regression analyses were used to examine association of microbial abundance with overall survival (OS) and to identify a microbial signature for creating a prognostic scoring model. The performance of the scoring model was assessed by the area under the ROC curve (AUC). Nomograms using the microbial signature, clinical factors, and molecular subtypes were established to predict OS and progression-free survival (PFS). RESULTS Among 1406 genera, the abundances of 94 genera were significantly associated with BC patient OS in TCGA-BRCA-microbiome dataset. From that set we identified a 15-microbe prognostic signature and developed a 15-microbial abundance prognostic scoring (MAPS) model. Patients in low-risk group significantly prolong OS and PFS as compared to those in high-risk group. The time-dependent ROC curves with MAPS showed good predictive efficacy both in OS and PFS. Moreover, MAPS is an independent prognostic factor for OS and PFS over clinical factors and PAM50-based molecular subtypes and superior to the previously published 12-gene signature. The integration of MAPS into nomograms significantly improved prognosis prediction. CONCLUSION MAPS was successfully established to have independent prognostic value, and our study provides a new avenue for developing prognostic biomarkers by microbiome profiling.
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Affiliation(s)
- A W Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - H Barck
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J Young
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - A Paley
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - J -H Mao
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| | - H Chang
- Berkeley Biomedical Data Science Center, Lawrence Berkeley National Laboratory, Berkeley, CA, USA. .,Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
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Syed A, Chang H, Hodge W, Reiner S, Schwartzberg B. Ethnic and Racial (E/R) Differences in Early-Stage Breast Cancer Patients (Pts) Successfully Treated With Intra-Operative Radiation Therapy (IORT) Using Electronic Brachytherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.723] [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]
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Wang H, Yang XX, Huo YX, Hao RZ, Chang H, Liu W, Wang B. [Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb]. Zhonghua Shao Shang Za Zhi 2021; 37:758-763. [PMID: 34404163 DOI: 10.3760/cma.j.cn501120-20200607-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb. Methods: A retrospective observational study was conducted. From February 2016 to April 2019, a total of 21 patients (21 fingers) with finger tip or finger pulp wounds of the thumbs met the inclusion criteria and were admitted to the Second Hospital of Tangshan, including 13 males and 8 females, aged 21 to 65 years, with the defects located at the finger tips of 14 patients and the finger pulps of 7 patients, and all having exposed bones and/or tendons. The wound sizes of patients in this group after debridement ranged from 2.0 cm×1.5 cm to 4.0 cm×2.7 cm. All the wounds were repaired with the neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve, with the flap sizes ranging from 2.3 cm×1.8 cm to 4.3 cm×3.0 cm. In surgery, the terminal branch of lateral antebrachial cutaneous nerve carried by the flaps was anastomosed with the end of the proper digital nerve of the wounds. The donor sites of flaps were sutured directly. The survival of flaps and healing of wounds in donor sites after operation were observed. The appearance of flaps and donor sites were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the degree of satisfaction of patients for the appearances of injured hands were evaluated based on Michigan Hand Function Questionnaire. The total action motion (TAM) of the injured and contralateral thumbs and the angle of thumb web of the injured and contralateral hands were measured. Data were statistically analyzed with paired sample t test. Results: All the flaps of the 21 patients survived with good blood supply and no infection. The wounds at the donor sites were all healed. All the patients were followed up, with the time ranging from 8 to 22 months. The appearances of flaps were good with their color and texture similar to the surrounding tissue. There was no pain in the finger tip or finger pulp, nor any ectopic sensation in flaps. There was only some linear scar left at the radial side of thumb. At the final follow-up, the static two-point discrimination distances of the flaps of the patients were 6 to 11 mm; 18 patients were very satisfied and 3 patients were satisfied with the overall appearance of the injured hand. The TAM of injured thumbs and the angle of thumb web of the injured hands of the patients were respectively (140±5)º and (94±9)°, which were similar to (141±5)º of the thumbs and (95±9)° of hands in the contralateral side, respectively (t=-2.024, -1.142, P>0.05). Conclusions: The neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve has constant anatomy and is easy to perform. It can repair the finger tip or finger pulp wounds of the thumb achieving good appearance and function recovery. It provides a good option for repair of finger tip or finger pulp wounds of the thumb and is especially suitable for emergency application.
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Affiliation(s)
- H Wang
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
| | - X X Yang
- College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China
| | - Y X Huo
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
| | - R Z Hao
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
| | - H Chang
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
| | - W Liu
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
| | - B Wang
- Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
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Schwartzberg B, Chang H, Syed A, Hodge W, Reiner S. PH-0221 Invasive ductal carcinoma tumor grade in patients treated with intra-operative radiation therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07273-x] [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]
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Han D, Achenbach S, Al-Mallah M, Budoff M, Cademartiri F, Maffei E, Callister T, Chinnaiyan K, Chow B, DeLago A, Hadamitzky M, Hausleiter J, Kaufmann P, Villines T, Kim Y, Leipsic J, Feuchtner G, Cury R, Pontone G, Andreini D, Marques H, Rubinshtein R, Rubinshtein R, Chang H, Lin F, Shaw L, Min J, Berman D. Prognostic Significance Of Plaque Location In Non-obstructive Coronary Artery Disease: From The Confirm Registry. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.201] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Takagi H, Leipsic J, Lin F, Shaw L, Lee S, Andreini D, Al-Mallah M, Budoff M, Cademartiri F, Chinnaiyan K, Choi J, Conte E, Marques H, Gonçalves P, Gottlieb I, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim Y, Lee B, Chun E, Sung J, Virmani R, Samady H, Stone P, Berman D, Min J, Narula J, Bax J, Chang H. Association Of Tube Voltage With Plaque Composition On Coronary Ct Angiography: Results From Paradigm Registry. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.297] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Han D, Lin A, Kuronuma K, Tzolos E, Kwan A, Klein E, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow B, Cury R, Feuchtner G, Hadamitzky M, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines T, Al-Mallah M, de Araújo Gonçalves P, danad I, Gransar H, Lu Y, lee J, Baskaran L, Al'Aref S, Budoff M, Samady H, Virmani R, Narula J, Chang H, Min J, Lin F, Shaw L, Slomka P, Dey D, Berman D. Plaque Location And Vessel Geometry On Coronary Computed Tomography Angiography Predict Future Culprit Lesions Associated With Acute Coronary Syndrome: Results From The ICONIC Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Curtis J, Fiore S, Ford K, Janak J, Chang H, Pappas DA, Blachley T, Emeanuru K, Bykerk V. POS0594 MEANINGFUL IMPROVEMENT AND WORSENING IN PATIENTS WHO DO NOT ACHIEVE LDA AND SWITCH THERAPY TO A NEW BIOLOGIC OR TARGETED THERAPY: RESULTS FROM THE CORRONA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Guidelines recommend adjusting therapy in patients with rheumatoid arthritis (RA) who fail to reach and sustain low disease activity (LDA) or remission (disease control). Many factors can affect the decision to change therapy, including the potential for improvement as well as the fear of potential worsening or loss of improvement already achieved. Although data exist on response to treatment in patients who switch therapy, data addressing the likelihood of worsening are limited.Objectives:The aim of this analysis was to describe the demographic, clinical characteristics, and change in clinical outcomes in patients on biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) who had some improvement in clinical disease activity index (CDAI) but did not achieve LDA after ~ 6-12 months of treatment and then switched to a different b/tsDMARD.Methods:This study included adult inadequately responding RA patients from the CORRONA registry who: (1) started a biologic or Janus kinase inhibitor (JAKi) between January 2010 to November 2020 (V1), (2) had any CDAI improvement (i.e., decrease ≥1 unit) but were not in LDA or remission at a subsequent visit (baseline [BL]) occurring 3 to 15 months after V1; (3) had a third visit (follow-up [F/U]) 6 (±3) months after BL with a valid CDAI measure; (4) switched therapy at the BL or between BL and F/U, with the switch occurring at least 3 months prior to the F/U. CDAI >10 and ≤22 was defined as moderate disease activity (MDA) and CDAI >22 was defined as high disease activity (HDA). Two thresholds of change in CDAI (≥6 and ≥12 units) were used to define meaningful improvement and meaningful worsening after the switch. If there was no meaningful improvement or meaningful worsening, this was considered as no meaningful change (-5 to +5 for 6 units change and -11 to +11 for 12 units change). These thresholds for meaningful change were set for all switchers regardless of their pre-switch CDAI value. Descriptive statistics were generated for demographic and clinical characteristics for the switchers at BL, and the change of clinical outcomes was evaluated from BL to F/U.Results:Of the 1,224 patients fulfilling the inclusion criteria, 93 (7.6%) switched therapy and 1,131 (92.4%) did not switch therampy after not achieving an adequate response on the initial b/tsDMARD. At BL, 42.5% and 70.0% of patients had no meaningful improvement to their prior therapy based on ≥6 and ≥12-unit change, respectively; mean (SD) age was 53.1 (14.0) years; duration of RA 10.7 (10.4) years; CDAI 22.2 (10.8); 81.7% were female; 64.5% had MDA, 35.5% had HDA; 21.5 % reported being disabled, 24.7% were current smokers, and 50% were obese. In terms of prior biologic use 57.0%, 22.6%, and 20.4% had been on 1, 2, and 3+, respectively. From BL to F/U, meaningful worsening occurred in 30.1% and 12.9% using a threshold of 6 and 12, respectively, with the remaining patients experiencing meaningful improvement or no meaningful change (Figure 1).Figure 1.Meaningful Worsening, Meaningful Improvement, and No Meaningful Change Based on CDAI Change Thresholds of ≥6 and ≥12 From BL to F/U (N=93)Conclusion:In our analysis, a large proportion of patients who initiated a biologic/JAKi and experienced some improvement but failed to attain LDA or remission, did not switch therapy within approximately a year. This analysis consisted of many patients who did not have a meaningful response to their prior biologic/JAKi, patients who had received multiple prior biologics, and a large portion of patients with poor prognostic factors. Despite this, the proportion of patients with meaningful worsening was low compared with most patients who had either meaningful improvement or no meaningful change. Additional research is warranted to understand the reasons for not switching and whether the likelihood of a meaningful change correlates with prior response, poor prognosis, or other factors.Acknowledgements:Amy Praestgaard (Sanofi) contributed to the statistical analysis for this abstract. Medical writing support for this abstract was provided by Krishna Kammari (Sanofi).Disclosure of Interests:Jeffrey Curtis Grant/research support from: and personal fees from AbbVie, Amgen, BMS, CORRONA, Eli Lily, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, outside the submitted work, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, he has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Judson Janak: None declared, Hong Chang: None declared, Dimitrios A Pappas Employee of: CORRONA LLC. He has previously acted as a consultant for Sanofi, Abbvie, Gtech Roche Hellas, and Novartis. He has an equity interest in CORRONA LLC. and is on the Board of directors of the CORRONA research foundation, Taylor Blachley: None declared, Kelechi Emeanuru: None declared, Vivian Bykerk Grant/research support from: reports grants from Amgen, BMS, UCB, and Novartis were given to institution, that grants from the NIH, PCORI, and CIHR were given to institutions which whom she is affiliated, and that she has received personal fees from Amgen, Gilead, BMS, Pfizer, Sanofi Aventis, Roche, UCB and Regeneron, outside the submitted work.
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Chang H, Li ZB, Wu JY, Zhang L. Circ-100338 induces angiogenesis after myocardial ischemia-reperfusion injury by sponging miR-200a-3p. Eur Rev Med Pharmacol Sci 2021; 24:6323-6332. [PMID: 32572929 DOI: 10.26355/eurrev_202006_21530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the effect of circular RNA circ-100338 on angiogenesis of human umbilical vein endothelial cells (HUVEC) cells after hypoxia/reoxygenation (H/R) and its molecular mechanism. MATERIALS AND METHODS We evaluated the role of circ-100338 in coronary artery endothelial cells using human coronary endothelial cells (HCAEC). Then, we verified the function of circ-100338 in HUVEC cells through cell counting kit-8 (CCK8), scratch test, Tube forming experiment, 5-Ethynyl-2'-deoxyuridine (EdU) staining. Dual-Luciferase reporter gene experiment and RNA Pull-Down experiments were used to detect the binding effect of circ-100338 and miR-200a-3p, miR-200a-3p and FUS. RESULTS QRT-PCR results showed that the expression of circ-100338 decreased in HCAEC after H/R treatment. Overexpression of circ-100338 promotes angiogenesis. The Dual-Luciferase reporter gene assay and RNA pull-down assay consistently indicated the specific binding effect between circ-100338 and miR-200a-3p, miR-200a-3p and FUS, and circ-100338 promoted the angiogenesis phenotype in HUVEC cells. CONCLUSIONS CircRNA-100338 may inhibit the function of miRNA-200a-3p by combining with miRNA-200a-3p, and then miRNA-200a-3p plays a role in regulating FUS, thereby regulating the state of angiogenesis.
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Affiliation(s)
- H Chang
- Department of Cardiovascular Medicine, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China.
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Yoon S, Kim T, Roh T, Chang H, Hwang SY, Yoon H, Shin TG, Sim MS, Jo IJ, Cha WC. Twelve-Lead Electrocardiogram Acquisition With a Patchy-Type Wireless Device in Ambulance Transport: Simulation-Based Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24142. [PMID: 33792550 PMCID: PMC8050747 DOI: 10.2196/24142] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/22/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of death worldwide. Early recognition, diagnosis, and reperfusion are the key elements of treatment for ST-segment elevation myocardial infarction. The absence of a prehospital 12-lead electrocardiogram (P12ECG) can cause definitive treatment delay and repeated transfer. Although guidelines highly recommend the measurement and transmission of P12ECG data, P12ECG use has not been widely established. Objective The aim of this study was to verify the time-efficiency and feasibility of the use of a patchy-type 12-lead ECG measuring and transmitting device (P-ECG) by an emergency medical technician (EMT) in an ambulance during patient transport. Methods This was a simulation-based prospective randomized crossover-controlled study that included EMTs. The participants were randomly assigned to one of two groups. Group A began the experiment with a conventional 12-lead ECG (C-ECG) device and then switched to the intervention device (P-ECG), whereas group B began the experiment with the P-ECG and then switched to the C-ECG. All simulations were performed inside an ambulance driving at 30 km/h. The time interval was measured from the beginning of ECG application to completion of sending the results. After the simulation, participants were administered the System Usability Scale questionnaire about usability of the P-ECG. Results A total of 18 EMTs were recruited for this study with a median age of 35 years. The overall interval time for the C-ECG was 254 seconds (IQR 247-270), whereas the overall interval time for the P-ECG was 130 seconds (IQR 112-150), with a significant difference (P<.001). Significant differences between the C-ECG and P-ECG were identified at all time intervals, in which the P-ECG device was significantly faster in all intervals, except for the preparation interval in which the C-ECG was faster (P=.03). Conclusions Performance of 12-lead ECG examination and transmission of the results using P-ECG are faster than those of C-ECG during ambulance transport. With the additional time afforded, EMTs can provide more care to patients and transport patients more rapidly, which may help reduce the symptoms-to-balloon time for patients with acute coronary syndrome. Trial Registration ClinicalTrials.gov NCT04114760; https://www.clinicaltrials.gov/ct2/show/NCT04114760
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Affiliation(s)
- Sunyoung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taehwan Roh
- Healthrian Co, Ltd, Dajeon, Republic of Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Health Information and Strategy Center, Samsung Medical Center, Seoul, Republic of Korea
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Spigel DR, Vicente D, Ciuleanu TE, Gettinger S, Peters S, Horn L, Audigier-Valette C, Pardo Aranda N, Juan-Vidal O, Cheng Y, Zhang H, Shi M, Luft A, Wolf J, Antonia S, Nakagawa K, Fairchild J, Baudelet C, Pandya D, Doshi P, Chang H, Reck M. Second-line nivolumab in relapsed small-cell lung cancer: CheckMate 331 ☆. Ann Oncol 2021; 32:631-641. [PMID: 33539946 DOI: 10.1016/j.annonc.2021.01.071] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [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: 07/31/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with relapsed small-cell lung cancer (SCLC) have few treatment options and dismal survival. Phase I/II data show activity of nivolumab in previously treated SCLC. PATIENTS AND METHODS CheckMate 331 is a randomized, open-label, phase III trial of nivolumab versus standard chemotherapy in relapsed SCLC. Patients with relapse after first-line, platinum-based chemotherapy were randomized 1 : 1 to nivolumab 240 mg every 2 weeks or chemotherapy (topotecan or amrubicin) until progression or unacceptable toxicity. Primary endpoint was overall survival (OS). RESULTS Overall, 284 patients were randomized to nivolumab and 285 to chemotherapy. Minimum follow-up was 15.8 months. No significant improvement in OS was seen with nivolumab versus chemotherapy [median OS, 7.5 versus 8.4 months; hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.72-1.04; P = 0.11]. A survival benefit with nivolumab was suggested in patients with baseline lactate dehydrogenase ≤ upper limit of normal and in those without baseline liver metastases. OS (nivolumab versus chemotherapy) was similar in patients with programmed death-ligand 1 combined positive score ≥1% versus <1%. Median progression-free survival was 1.4 versus 3.8 months (HR, 1.41; 95% CI, 1.18-1.69). Objective response rate was 13.7% versus 16.5% (odds ratio, 0.80; 95% CI, 0.50-1.27); median duration of response was 8.3 versus 4.5 months. Rates of grade 3 or 4 treatment-related adverse events were 13.8% versus 73.2%. CONCLUSION Nivolumab did not improve survival versus chemotherapy in relapsed SCLC. No new safety signals were seen. In exploratory analyses, select baseline characteristics were associated with improved OS for nivolumab.
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Affiliation(s)
- D R Spigel
- Oncology Department, Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, USA.
| | - D Vicente
- Department of Medical Oncology, Hosp Univ Virgen Macarena, Seville, Spain
| | - T E Ciuleanu
- Medical Oncology, Prof. Dr. Ion Chiricuta Institute of Oncology and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - S Gettinger
- Medical Oncology, Yale Cancer Center, New Haven, USA
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Horn
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | | | - N Pardo Aranda
- Thoracic Unit, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Y Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
| | - H Zhang
- Department of Oncology, Tangdu Hospital, Xi'an, Shaanxi, China
| | - M Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - A Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - J Wolf
- Clinic I for Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - K Nakagawa
- Department of Medical Oncology, Kindai University Hospital, Osaka, Japan
| | - J Fairchild
- Clinical Development, Bristol Myers Squibb, Princeton, USA
| | - C Baudelet
- Global Drug Development, Biometrics & Data Sciences, Bristol Myers Squibb, Princeton, USA
| | - D Pandya
- Translational Pathology, Bristol Myers Squibb, Princeton, USA
| | - P Doshi
- Translational Medicine, Bristol Myers Squibb, Princeton, USA
| | - H Chang
- Translational Bioinformatics, Bristol Myers Squibb, Princeton, USA
| | - M Reck
- Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
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Chang H, Min JY, Yoo D, Lee SU, Hwang SY, Yoon H, Cha WC, Shin TG, Jo IJ, Kim T. National Surveillance of Injury in the Republic of Korea: Increased Injury Vulnerability in the Late Middle Age. Int J Environ Res Public Health 2021; 18:ijerph18031210. [PMID: 33572916 PMCID: PMC7908217 DOI: 10.3390/ijerph18031210] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
Surveillance of injury patterns and comparisons among different age groups help develop a better understanding of recent injury trends and early prevention. This study conducted a national surveillance of injury by age group. Data were collected retrospectively from Emergency Department-Based Injury In-Depth Surveillance (EDIIS) in South Korea, between January 2011 and December 2017. Patients were divided into the following four groups by age: Group 1–18 to 34 years, Group 2–35 to 49 years, Group 3–50 to 64 years, and Group 4—≥65 years. A total of 1,221,746 patients were included in the study. Findings revealed that, each year, the injury rate increased in the population aged ≥65 years. The place and mechanism of injury in Group 3 were similar to those in younger age groups, while injury outcomes and injured body parts were similar to those in Group 4. Further, hospital admission rate, ICU admission rate, hospital death, traumatic brain injury, and injury severity increased with an increase in age. In our study, each age group showed diverse characteristics pertaining to the mechanism, place, time, and outcomes of injuries. Interestingly, Group 3, which represented the late middle age, exhibited increased vulnerability to injury, and emerged as a gray zone between the young and old age groups. Therefore, different injury prevention methods are needed for each age group. Specifically, early prevention methods need to be implemented from the late middle age to improve the old age group’s injury outcomes.
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Affiliation(s)
- Hansol Chang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
| | - Ji Young Min
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
| | - Dajeong Yoo
- Samsung Medical Center, Research Institute of Future Medicine, Seoul 06351, Korea;
| | - Se Uk Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Sung Yeon Hwang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Hee Yoon
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Won Chul Cha
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea;
- Health Information and Strategy Center, Samsung Medical Center, Seoul 06351, Korea
| | - Tae Gun Shin
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Ik Joon Jo
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
| | - Taerim Kim
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.C.); (S.U.L.); (S.Y.H.); (H.Y.); (W.C.C.); (T.G.S.); (I.J.J.)
- Correspondence: ; Tel.: +82-2-3410-2053; Fax: +82-2-3410-0049
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Chang E, Joel M, Chang H, Du J, Yu J, An Y, Hansen J, Omuro A, Chiang V, Aneja S. Deep Learning Survival Analysis for Brain Metastases Treated with Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.932] [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]
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49
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Chang H, Tran A, Al Naber J, Tambor E, Moloney R. P226 AMPLIFYING PATIENT VOICES IN RESEARCH: PATIENT ENGAGEMENT IN CORE OUTCOME SET DEVELOPMENT FOR ASTHMA TRIALS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.123] [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: 10/23/2022]
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50
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Wang Q, Zhang R, Xiao W, Zhang S, Wei M, Li Y, Chang H, Xie W, Li L, Ding P, Wu X, Lu Z, Cheng G, Zeng Z, Pan Z, Wang W, Wan X, Gao Y, Xu R. Watch-and-wait Strategy against Surgical Resection for Rectal Cancer Patients with Complete Clinical Response after Neoadjuvant Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1821] [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: 10/23/2022]
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