1
|
Kim TW, Kim WY, Park S, Lee SH, Park O, Kim T, Yeo HJ, Jang JH, Cho WH, Huh JW, Lee SM, Chung CR, Lee J, Kim JS, Lim SY, Baek AR, Yoo JW, Kim HC, Choi EY, Park C, Kim TO, Moon DS, Lee SI, Moon JY, Kwon SJ, Seong GM, Jung WJ, Baek MS. Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study. J Korean Med Sci 2024; 39:e75. [PMID: 38442718 PMCID: PMC10911941 DOI: 10.3346/jkms.2024.39.e75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. METHODS We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan-Meier (KM) method. RESULTS Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010-1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312-7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). CONCLUSION Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.
Collapse
Affiliation(s)
- Tae Wan Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Onyu Park
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taehwa Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Soo Kim
- Division of Critical Care Medicine, Department of Hospital Medicine, Inha Collage of Medicine, Incheon, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Eun Young Choi
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea
| | - Chul Park
- Division of Pulmonology and Critical Care Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Tae-Ok Kim
- Division of Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Do Sik Moon
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea
| | - Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sun Jung Kwon
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Won Jai Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Lee SI, Ju YR, Kang DH, Lee JE. Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study. BMC Palliat Care 2024; 23:42. [PMID: 38355511 PMCID: PMC10868112 DOI: 10.1186/s12904-024-01375-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. METHODS We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. RESULTS A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality. CONCLUSIONS Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.
Collapse
Affiliation(s)
- Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Ye-Rin Ju
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| |
Collapse
|
3
|
Seo YR, Cho AY, Si YJ, Lee SI, Kim DJ, Jeong H, Kwon JH, Song CS, Lee DH. Evolution and Spread of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus in Wild Birds, South Korea, 2022-2023. Emerg Infect Dis 2024; 30:299-309. [PMID: 38215495 PMCID: PMC10826760 DOI: 10.3201/eid3002.231274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
During October 2022-March 2023, highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b virus caused outbreaks in South Korea, including 174 cases in wild birds. To understand the origin and role of wild birds in the evolution and spread of HPAI viruses, we sequenced 113 HPAI isolates from wild birds and performed phylogenetic analysis. We identified 16 different genotypes, indicating extensive genetic reassortment with viruses in wild birds. Phylodynamic analysis showed that the viruses were most likely introduced to the southern Gyeonggi-do/northern Chungcheongnam-do area through whooper swans (Cygnus cygnus) and spread southward. Cross-species transmission occurred between various wild bird species, including waterfowl and raptors, resulting in the persistence of HPAI in wild bird populations and further geographic spread as these birds migrated throughout South Korea. Enhanced genomic surveillance was an integral part of the HPAI outbreak response, aiding in timely understanding of the origin, evolution, and spread of the virus.
Collapse
|
4
|
Park Y, Lee D, Lee JE, Park HS, Jung SS, Park D, Kang DH, Lee SI, Woo SD, Chung C. The Matrix Stiffness Coordinates the Cell Proliferation and PD-L1 Expression via YAP in Lung Adenocarcinoma. Cancers (Basel) 2024; 16:598. [PMID: 38339350 PMCID: PMC10854616 DOI: 10.3390/cancers16030598] [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: 12/07/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
The extracellular matrix (ECM) exerts physiological activity, facilitates cell-to-cell communication, promotes cell proliferation and metastasis, and provides mechanical support for tumor cells. The development of solid tumors is often associated with increased stiffness. A stiff ECM promotes mechanotransduction, and the predominant transcription factors implicated in this phenomenon are YAP/TAZ, β-catenin, and NF-κB. In this study, we aimed to investigate whether YAP is a critical mediator linking matrix stiffness and PD-L1 in lung adenocarcinoma. We confirmed that YAP, PD-L1, and Ki-67, a marker of cell proliferation, increase as the matrix stiffness increases in vitro using the lung adenocarcinoma cell lines PC9 and HCC827 cells. The knockdown of YAP decreased the expression of PD-L1 and Ki-67, and conversely, the overexpression of YAP increased the expression of PD-L1 and K-67 in a stiff-matrix environment (20.0 kPa). Additionally, lung cancer cells were cultured in a 3D environment, which provides a more physiologically relevant setting, and compared to the results obtained from 2D culture. Similar to the findings in 2D culture, it was confirmed that YAP influenced the expression of PD-L1 and K-67 in the 3D culture experiment. Our results suggest that matrix stiffness controls PD-L1 expression via YAP activation, ultimately contributing to cell proliferation.
Collapse
Affiliation(s)
- Yeonhee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea;
| | - Dahye Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Jeong Eun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Hee Sun Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Sung Soo Jung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Dongil Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Da Hyun Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Song-I Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Seong-Dae Woo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; (D.L.); (J.E.L.); (H.S.P.); (S.S.J.); (D.P.); (D.H.K.); (S.-I.L.); (S.-D.W.)
| |
Collapse
|
5
|
Kim N, Yeo MK, Sun P, Lee D, Kim DK, Lee SI, Chung C, Kang DH, Lee JE. Cathepsin C regulates tumor progression via the Yes-associated protein signaling pathway in non-small cell lung cancer. Am J Cancer Res 2024; 14:97-113. [PMID: 38323275 PMCID: PMC10839315] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Cathepsin C (CTSC), also known as dipeptidyl peptidase I, is a cathepsin with lysosomal exocysteine protease activity and a central coordinator for the activation of neutrophil-derived serine proteases in the lysosomes of neutrophils. Although the role of CTSC in various cancers, including liver and breast cancers, has recently been reported, its role in non-small cell lung cancer (NSCLC) is largely unknown. This study aimed to investigate the functional role of CTSC in NSCLC and the molecular mechanisms underlying CTSC involvement in disease progression. CTSC overexpression markedly enhanced the growth, motility, and invasiveness of NSCLC cells in vitro and in vivo. CTSC knockdown using shRNA in NSCLC cells reversed the migratory and invasive behavior of NSCLC cells. CTSC also induced epithelial-mesenchymal transition through the Yes-associated protein signaling pathway. In addition, our analyses of clinical samples confirmed that high CTSC expression was associated with lymph node metastasis and recurrence in lung adenocarcinoma. In conclusion, CTSC plays an important role in the progression of NSCLC. Thus, targeting CTSC may be a promising treatment option for patients with NSCLC.
Collapse
Affiliation(s)
- Nayoung Kim
- Cancer Research Institute, Chungnam National UniversityDaejeon 35015, Republic of Korea
| | - Min-Kyung Yeo
- Department of Pathology, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Pureum Sun
- Research Institute for Medical Sciences, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Dahye Lee
- Infection Control Convergence Research Center, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Duk Ki Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Song-I Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National UniversityDaejeon 34134, Republic of Korea
| |
Collapse
|
6
|
Kang DH, Kim GHJ, Park SB, Lee SI, Koh JS, Brown MS, Abtin F, McNitt-Gray MF, Goldin JG, Lee JS. Quantitative Computed Tomography Lung COVID Scores with Laboratory Markers: Utilization to Predict Rapid Progression and Monitor Longitudinal Changes in Patients with Coronavirus 2019 (COVID-19) Pneumonia. Biomedicines 2024; 12:120. [PMID: 38255225 PMCID: PMC10813449 DOI: 10.3390/biomedicines12010120] [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: 12/01/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19), is an ongoing issue in certain populations, presenting rapidly worsening pneumonia and persistent symptoms. This study aimed to test the predictability of rapid progression using radiographic scores and laboratory markers and present longitudinal changes. This retrospective study included 218 COVID-19 pneumonia patients admitted at the Chungnam National University Hospital. Rapid progression was defined as respiratory failure requiring mechanical ventilation within one week of hospitalization. Quantitative COVID (QCOVID) scores were derived from high-resolution computed tomography (CT) analyses: (1) ground glass opacity (QGGO), (2) mixed diseases (QMD), and (3) consolidation (QCON), and the sum, quantitative total lung diseases (QTLD). Laboratory data, including inflammatory markers, were obtained from electronic medical records. Rapid progression was observed in 9.6% of patients. All QCOVID scores predicted rapid progression, with QMD showing the best predictability (AUC = 0.813). In multivariate analyses, the QMD score and interleukin(IL)-6 level were important predictors for rapid progression (AUC = 0.864). With >2 months follow-up CT, remained lung lesions were observed in 21 subjects, even after several weeks of negative reverse transcription polymerase chain reaction test. AI-driven quantitative CT scores in conjugation with laboratory markers can be useful in predicting the rapid progression and monitoring of COVID-19.
Collapse
Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Grace Hyun J. Kim
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Sa-Beom Park
- Center of Biohealth Convergence and Open Sharing System, Hongik University, Seoul 04401, Republic of Korea;
| | - Song-I Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Jeong Suk Koh
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea; (D.H.K.); (S.-I.L.); (J.S.K.)
| | - Matthew S. Brown
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Fereidoun Abtin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Michael F. McNitt-Gray
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Jonathan G. Goldin
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.S.B.); (F.A.); (M.F.M.-G.)
| | - Jeong Seok Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| |
Collapse
|
7
|
Kim Y, Hyon Y, Woo SD, Lee S, Lee SI, Ha T, Chung C. Evolution of the Stethoscope: Advances with the Adoption of Machine Learning and Development of Wearable Devices. Tuberc Respir Dis (Seoul) 2023; 86:251-263. [PMID: 37592751 PMCID: PMC10555525 DOI: 10.4046/trd.2023.0065] [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: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
The stethoscope has long been used for the examination of patients, but the importance of auscultation has declined due to its several limitations and the development of other diagnostic tools. However, auscultation is still recognized as a primary diagnostic device because it is non-invasive and provides valuable information in real-time. To supplement the limitations of existing stethoscopes, digital stethoscopes with machine learning (ML) algorithms have been developed. Thus, now we can record and share respiratory sounds and artificial intelligence (AI)-assisted auscultation using ML algorithms distinguishes the type of sounds. Recently, the demands for remote care and non-face-to-face treatment diseases requiring isolation such as coronavirus disease 2019 (COVID-19) infection increased. To address these problems, wireless and wearable stethoscopes are being developed with the advances in battery technology and integrated sensors. This review provides the history of the stethoscope and classification of respiratory sounds, describes ML algorithms, and introduces new auscultation methods based on AI-assisted analysis and wireless or wearable stethoscopes.
Collapse
Affiliation(s)
- Yoonjoo Kim
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - YunKyong Hyon
- Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea
| | - Seong-Dae Woo
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sunju Lee
- Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea
| | - Song-I Lee
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Taeyoung Ha
- Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| |
Collapse
|
8
|
Kim JH, Na YS, Lee SI, Moon YY, Hwang BS, Baek AR, Kim WY, Lee BY, Seong GM, Baek MS. Corticosteroid outcome may be dependent of duration of use in severe COVID-19. Korean J Intern Med 2023; 38:382-392. [PMID: 37038264 PMCID: PMC10175872 DOI: 10.3904/kjim.2022.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/01/2023] [Indexed: 04/12/2023] Open
Abstract
Background/Aims For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of corticosteroids is associated with decreased mortality. Methods Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (≤ 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis. Results There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60- day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90-18.26; p = 0.003). Conclusions For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19.
Collapse
Affiliation(s)
- Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Youn Young Moon
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Beom Seuk Hwang
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Seoul, Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Moon Seong Baek
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Kang DH, Song MK, Ju SH, Lee SI, Kang YE. Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibody-Positive Vasculitis and Agranulocytosis: A Rare Case with Life-Threatening Multiple Systemic Manifestations. Endocrinol Metab (Seoul) 2023; 38:282-284. [PMID: 36914241 PMCID: PMC10164498 DOI: 10.3803/enm.2022.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mi-Kyung Song
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sang-Hyeon Ju
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Song-I Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| |
Collapse
|
10
|
Kim KE, Jung SS, Park HS, Lee JE, Chung C, Kang DH, Lee SI, Koh JS, Park D. The first case report of Paragonimus westermani infection diagnosed by transbronchial lung cryobiopsy. Int J Infect Dis 2023; 128:184-186. [PMID: 36608785 DOI: 10.1016/j.ijid.2022.12.041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/18/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
We report a case of pulmonary paragonimiasis diagnosed by transbronchial lung cryobiopsy (TBLC). TBLC is likely to be a superior method to transbronchial forceps biopsy because TBLC can get larger specimens, resulting in a higher chance of containing the eggs. A male patient aged 57 years presented with hemoptysis and dyspnea on exertion. His initial chest computed tomography scans showed a cavitary nodule with a peripheral ground-glass appearance, leading to a prescription of an oral antibiotic, with an initial assumption of pneumonia. A follow-up chest computed tomography, however, revealed an appearance of a new nodule adjacent to the original nodule. TBLC and transbronchial forceps biopsy were done to rule out lung cancer and eventually, the eggs of Paragonimus westermani were found using TBLC. Praziquantel was prescribed, showing improvements in symptoms and chest X-ray findings. TBLC has more potential to be utilized as a diagnostic method than transbronchial forceps biopsy because it has a better chance to confirm pulmonary paragonimiasis, which can be initially suspected as pulmonary tuberculosis or lung cancer.
Collapse
Affiliation(s)
- Ka Eun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Hee Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Jeong Suk Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea
| | - Dongil Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, Republic of Korea.
| |
Collapse
|
11
|
Na YS, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Seong GM, Lee SI. Clinical outcomes of and risk factors for secondary infection in patients with severe COVID-19: a multicenter cohort study in South Korea. Korean J Intern Med 2023; 38:68-79. [PMID: 36420564 PMCID: PMC9816674 DOI: 10.3904/kjim.2022.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/AIMS Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. METHODS This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. RESULTS Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). CONCLUSION In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.
Collapse
Affiliation(s)
- Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju,
Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Bo young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Seoul,
Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju,
Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| |
Collapse
|
12
|
Kim Y, Koh JS, Woo SD, Lee SI, Kang DH, Park D, Chung C, Kwon IS, Lee JE. The Tri-iodothyronine (T3) Level Is a Prognostic Factor for Patients With Advanced NSCLC: Receiving Immune Checkpoint Inhibitors and Is Associated With Liver Metastasis. Clin Med Insights Oncol 2022; 16:11795549221139522. [PMID: 36532699 PMCID: PMC9751177 DOI: 10.1177/11795549221139522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/01/2022] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Endocrine hormones influence tumor progression and the response to treatment. Despite the importance of immune checkpoint inhibitors (ICIs) as treatments for advanced non-small cell lung cancer (NSCLC), few studies have explored the effects of hormone levels in NSCLC patients on the effectiveness of ICI therapies. We thus investigated the effects of baseline blood markers in patients with advanced NSCLC on ICI treatments. METHODS Patients with advanced NSCLC who received programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors at Chungnam National University Hospital between December 2016 and November 2020 and who lacked any history of thyroid gland-related diseases were analyzed retrospectively. We collected clinical information and baseline laboratory data, including the levels of endocrine hormones, cytokines, complete blood counts (CBCs), and peripheral blood chemistry panels. We explored the relationships of hormone levels with clinical outcomes (overall survival [OS], progression-free survival [PFS], and best response), liver metastasis, and blood markers using the Kaplan-Meier method, Cox's proportional hazards regression, and logistic regression. RESULTS A total of 113 patients were enrolled. A shorter PFS was independently associated with liver metastasis, higher cortisol levels, and lower hemoglobin (Hb) levels; a shorter OS was associated with liver metastasis, lower tri-iodothyronine (T3) levels, higher lactate dehydrogenase (LDH) levels, and lower albumin levels. Patients with low T3 levels exhibited a shorter PFS and OS, and a poorer best response. Patients with low T3 levels tended to have higher disease progression rates, lower levels of adrenocorticotropic hormone (ACTH), C-peptide, albumin, Hb, and neutrophil-to-lymphocyte ratio, and higher levels of interleukin (IL)-6, white blood cells, platelets, compared with those with normal T3 levels. We found a significant association between a low T3 level and liver metastasis. CONCLUSIONS We found the baseline T3 level was associated with both prognosis and the response to ICIs in patients with advanced NSCLC, probably reflecting impaired liver function and systemic inflammation induced by the interaction of T3 with other biomarkers, such as IL-6, ACTH, cortisol, C-peptide, Hb, LDH, and albumin.
Collapse
Affiliation(s)
- Yoonjoo Kim
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong Suk Koh
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Seong-Dae Woo
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Song-I Lee
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dongil Park
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - In-Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| |
Collapse
|
13
|
Hyun DG, Lee SY, Ahn JH, Huh JW, Hong SB, Koh Y, Lim CM, Oh DK, Suh GY, Jeon K, Ko RE, Cho YJ, Lee YJ, Lim SY, Park S, Heo J, Lee JM, Kim KC, Lee YJ, Chang Y, Jeon K, Lee SM, Hong SK, Cho WH, Kwak SH, Lee HB, Ahn JJ, Seong GM, Lee SI, Park S, Park TS, Lee SH, Choi EY, Moon JY. Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study. Crit Care 2022; 26:280. [PMID: 36114545 PMCID: PMC9482246 DOI: 10.1186/s13054-022-04149-z] [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: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hospital-onset sepsis is associated with a higher in-hospital mortality rate than community-onset sepsis. Many hospitals have implemented rapid response teams (RRTs) for early detection and timely management of at-risk hospitalized patients. However, the effectiveness of an all-day RRT over a non-all-day RRT in reducing the risk of in-hospital mortality in patient with hospital-onset sepsis is unclear. We aimed to determine the effect of the RRT’s operating hours on in-hospital mortality in inpatient patients with sepsis. Methods We conducted a nationwide cohort study of adult patients with hospital-onset sepsis prospectively collected from the Korean Sepsis Alliance (KSA) Database from 16 tertiary referral or university-affiliated hospitals in South Korea between September of 2019 and February of 2020. RRT was implemented in 11 hospitals, of which 5 (45.5%) operated 24-h RRT (all-day RRT) and the remaining 6 (54.5%) had part-day RRT (non-all-day RRT). The primary outcome was in-hospital mortality between the two groups. Results Of the 405 patients with hospital-onset sepsis, 206 (50.9%) were admitted to hospitals operating all-day RRT, whereas 199 (49.1%) were hospitalized in hospitals with non-all-day RRT. A total of 73 of the 206 patients in the all-day group (35.4%) and 85 of the 199 patients in the non-all-day group (42.7%) died in the hospital (P = 0.133). After adjustments for co-variables, the implementation of all-day RRT was associated with a significant reduction in in-hospital mortality (adjusted odds ratio 0.57; 95% confidence interval 0.35–0.93; P = 0.024). Conclusions In comparison with non-all-day RRTs, the availability of all-day RRTs was associated with reduced in-hospital mortality among patients with hospital-onset sepsis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04149-z.
Collapse
|
14
|
Lee SI, Koh Y, Lim CM, Hong SB, Huh JW. Comparison of the Outcomes of Patients Starting Mechanical Ventilation in the General Ward Versus the Intensive Care Unit. J Patient Saf 2022; 18:546-552. [PMID: 35771969 PMCID: PMC9422769 DOI: 10.1097/pts.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Mechanical ventilation is sometimes initiated in the general ward (GW) due to the shortage of intensive care unit (ICU) beds. We investigated whether invasive mechanical ventilation (MV) started in the GW affects the patient's prognosis compared with its initiation in the ICU. METHODS From January 2016 to December 2018, medical records of patients who started MV in the GW or ICU were collected. The 28-day mortality, ICU mortality, ventilator-free days, and complications related to the ventilator and the ventilator-free days were analyzed as outcomes. RESULTS A total of 673 patients were enrolled. Among these, 268 patients (39.8%) started MV in the GW and 405 patients (60.2%) started MV within 24 hours after admittance to the ICU. There was no difference in 28-day mortality between the 2 groups (27.2% versus 27.2%, P = 0.997). In addition, there was no difference between ventilator-related complication rates, ventilator-free days, or the length of hospital stay. A high Acute Physiology and Chronic Health Evaluation II score, the presence of solid tumor, the absence of chronic kidney diseases, and low platelet count were associated with higher 28-day mortality. However, the initiation of MV in the GW was not associated with an increase in 28-day mortality compared with the initiation in the ICU. CONCLUSIONS Starting MV in the GW was not a risk factor for 28-day mortality. Therefore, prompt application of a ventilator if medically indicated, regardless of the patient's location, is desirable if a skilled airway team and appropriate monitoring are available.
Collapse
Affiliation(s)
- Song-I Lee
- From the Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Lee SI, Koh Y, Huh JW, Hong SB, Lim CM. Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit. Acute Crit Care 2022; 37:372-381. [PMID: 35977895 PMCID: PMC9475142 DOI: 10.4266/acc.2022.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade. Methods We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis. Results Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality. Conclusions The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.
Collapse
|
16
|
Na YS, Kim JH, Baek MS, Kim WY, Baek AR, Lee BY, Seong GM, Lee SI. In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19. Acute Crit Care 2022; 37:303-311. [PMID: 35791648 PMCID: PMC9475168 DOI: 10.4266/acc.2022.00017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly. Methods This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis. Results The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis. Conclusions The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.
Collapse
|
17
|
Kang DH, Choi SW, Sun P, Chung C, Park D, Lee SI, Koh JS, Kim Y, Lee JE. The rest period between chemotherapy and immunotherapy influences the efficacy of immune checkpoint inhibitors in lung cancer. Thorac Cancer 2022; 13:2346-2354. [PMID: 35818294 PMCID: PMC9376175 DOI: 10.1111/1759-7714.14568] [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: 04/13/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The use of immune checkpoint inhibitors (ICIs) as first‐line treatment rather than as second‐line treatment makes a big difference in the drug efficacy and progression‐free survival. However, the mechanism for this is still not clear. This study aimed to analyze the effects of the rest period between chemotherapy and immunotherapy on the efficacy of ICIs. Methods This study included 100 patients with advanced NSCLC treated with PD‐1/PD‐L1 inhibitors at Chungnam National University Hospital (CNUH) between May 2016 and August 2019. The rest period was defined from the last dose of cytotoxic chemotherapy to the first dose of ICIs. We retrospectively reviewed patients' clinical data and blood test records and analyzed lymphocyte subsets using flow cytometry. Results The median rest period was 64 days. The long rest period group (≥36 days) showed significantly higher clinical benefits than the short rest period group (<36 days) (69.4% vs. 39.5%, p = 0.003). White blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and neutrophil‐lymphocyte ratio (NLR) just before chemotherapy were not different between the two groups. However, the blood test after chemotherapy immediately before immunotherapy showed significantly higher ANC and NLR in the short rest period group than in the long rest period group. The frequency of the Th1 subset and PD‐1 + CD8+ T cells were significantly higher in the long rest period group than in the short rest period group. Conclusion Time interval from chemotherapy to immunotherapy may affect immune cell status and efficacy of ICIs.
Collapse
Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Seong-Woo Choi
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Pureum Sun
- Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Chaeuk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Dongil Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Song-I Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jeong Suk Koh
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Yoonjoo Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| |
Collapse
|
18
|
Kim JH, Baek AR, Lee SI, Kim WY, Na YS, Lee BY, Seong GM, Baek MS. ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study. PLoS One 2022; 17:e0268431. [PMID: 35551328 PMCID: PMC9098056 DOI: 10.1371/journal.pone.0268431] [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: 11/25/2021] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, can help identify patients with hypoxemic respiratory failure at high risk for intubation following high-flow nasal cannula (HFNC) initiation; however, whether it is effective for predicting intubation in coronavirus disease 2019 (COVID-19) patients receiving HFNC remains unknown. Moreover, the SpO2/FiO2 ratio has been assessed as a prognostic marker for acute hypoxemic respiratory failure. This study aimed to determine the utility of the ROX index and the SpO2/FiO2 ratio as predictors of failure in COVID-19 patients who received HFNC. METHODS This multicenter study was conducted in seven university-affiliated hospitals in Korea. Data of consecutive hospitalized patients diagnosed with COVID-19 between February 10, 2020 and February 28, 2021 were retrospectively reviewed. We calculated the ROX index and the SpO2/FiO2 ratio at 1 h, 4 h, and 12 h after HFNC initiation. The primary outcome was HFNC failure defined as the need for subsequent intubation despite HFNC application. The receiver operating characteristic curve analysis was used to evaluate discrimination of prediction models for HFNC failure. RESULTS Of 1,565 hospitalized COVID-19 patients, 133 who received HFNC were analyzed. Among them, 63 patients (47.4%) were successfully weaned from HFNC, and 70 (52.6%) were intubated. Among patients with HFNC failure, 32 (45.7%) died. The SpO2/FiO2 ratio at 1 h after HFNC initiation was an important predictor of HFNC failure (AUC 0.762 [0.679-0.846]). The AUCs of SpO2/FiO2 ratio at 4 h and ROX indices at 1 h and 4 h were 0.733 (0.640-0.826), 0.697 (0.597-0.798), and 0.682 (0.583-0.781), respectively. Multivariable analysis showed that the patients aged ≥70 years are 3.4 times more likely to experience HFNC failure than those aged <70 years (HR 3.367 [1.358-8.349], p = 0.009). The SpO2/FiO2 ratio (HR 0.983 [0.972-0.994], p = 0.003) at 1 h was significantly associated with HFNC failure. CONCLUSIONS The SpO2/FiO2 ratio following HFNC initiation was an acceptable predictor of HFNC failure. The SpO2/FiO2 ratio may be a good prognostic marker for predicting intubation in COVID-9 patients receiving HFNC.
Collapse
Affiliation(s)
- Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Bo Young Lee
- Division of Allergy and Respiratory Diseases Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
19
|
Lee SI, Koh JS, Kim YJ, Kang DH, Lee JE. Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit. BMC Emerg Med 2022; 22:18. [PMID: 35114944 PMCID: PMC8811968 DOI: 10.1186/s12873-022-00575-y] [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: 06/17/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The utilization of a rapid response team (RRT) has influenced the clinical outcomes of patients in the general ward. However, the characteristics of RRT-screened patients who are transferred to the intensive care unit (ICU) are unknown. Therefore, the present study aimed to evaluate these factors. METHODS We conducted a retrospective study using patient data from a tertiary medical center in Republic of Korea between January 2016 and December 2017. Multivariate logistic regression analyses were performed to assess the factors associated with the risk of in-hospital mortality. RESULTS A total of 1,096 patients were included: 389 patients were transferred to the ICU, and 707 patients stayed in the ward. Patients in the ICU group were more likely to be admitted for medical reasons, hepatobiliary disease, and high heart rate. More interventions were performed, hospital stays were longer, and the 28-day and in-hospital mortality rates were higher in the ICU group than in the ward group. Multivariate logistic regression analyses showed that risk factors affecting ICU admission were higher Sequential Organ Failure Assessment (SOFA) score, National Early Warning Score (NEWS), platelet count, and lactate level. ICU transfer was not associated with in-hospital mortality. CONCLUSIONS Among RRT-screened patients, those with higher SOFA score, NEWS, and lactate level were more likely to be transferred to the ICU. Therefore, these patients should be closely monitored and considered for ICU transfer.
Collapse
Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, 301-721, Daejeon, Republic of Korea
| | - Jeong Suk Koh
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, 301-721, Daejeon, Republic of Korea
| | - Yoon Joo Kim
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, 301-721, Daejeon, Republic of Korea
| | - Da Hyun Kang
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, 301-721, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, 301-721, Daejeon, Republic of Korea.
| |
Collapse
|
20
|
Lee BY, Lee SI, Baek MS, Baek AR, Na YS, Kim JH, Seong GM, Kim WY. Lower Driving Pressure and Neuromuscular Blocker Use Are Associated With Decreased Mortality in Patients With COVID-19 ARDS. Respir Care 2022; 67:216-226. [PMID: 34848546 PMCID: PMC9993948 DOI: 10.4187/respcare.09577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/05/2022]
Abstract
BACKGROUND The impact of mechanical ventilation parameters and management on outcomes of patients with coronavirus disease 2019 (COVID-19) ARDS is unclear. METHODS This multi-center observational study enrolled consecutive mechanically ventilated patients with COVID-19 ARDS admitted to one of 7 Korean ICUs between February 1, 2020-February 28, 2021. Patients who were age < 17 y or had missing ventilation parameters for the first 4 d of mechanical ventilation were excluded. Multivariate logistic regression was used to identify which strategies or ventilation parameters that were independently associated with ICU mortality. RESULTS Overall, 129 subjects (males, 60%) with a median (interquartile range) age of 69 (62-78) y were included. Neuromuscular blocker (NMB) use and prone positioning were applied to 76% and 16% of subjects, respectively. The ICU mortality rate was 37%. In the multivariate analysis, higher dynamic driving pressure (ΔP) values during the first 4 d of mechanical ventilation were associated with increased mortality (adjusted odds ratio 1.16 [95% CI 1.00-1.33], P = .046). NMB use was associated with decreased mortality (adjusted odds ratio 0.27 [95% CI 0.09-0.81], P = .02). The median tidal volume values during the first 4 d of mechanical ventilation and the ICU mortality rate were significantly lower in the NMB group than in the no NMB group. However, subjects who received NMB for ≥ 6 d (vs < 6 d) had higher ICU mortality rate. CONCLUSIONS In subjects with COVID-19 ARDS receiving mechanical ventilation, ΔP during the first 4 d of mechanical ventilation was independently associated with mortality. The short-term use of NMB facilitated lung-protective ventilation and was independently associated with decreased mortality.
Collapse
Affiliation(s)
- Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Lee SI, Kang DH, Ahn HJ, Kim MJ, Shim MS, Lee JE. Age is an important prognostic factor in COVID-19 patients treated with extracorporeal membrane oxygenation. J Thorac Dis 2022; 14:3094-3097. [PMID: 36071774 PMCID: PMC9442505 DOI: 10.21037/jtd-22-493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hong Joon Ahn
- Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Mi Joo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Man-Shik Shim
- Department of Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| |
Collapse
|
22
|
Koh JS, Kim YJ, Kang DH, Lee JE, Lee SI. Severe mediastinitis and pericarditis after endobronchial ultrasound-guided transbronchial needle aspiration: A case report. World J Clin Cases 2021; 9:10723-10727. [PMID: 35005007 PMCID: PMC8686124 DOI: 10.12998/wjcc.v9.i34.10723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/07/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation. However, infectious complications may occur after EBUS-TBNA. Among these, mediastinitis and pericarditis are rare.
CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography (CT). EBUS-TBNA was performed on the lymph node lesions, and prophylactic oral antibiotics were administered. Seven days after EBUS-TBNA, the patient visited the emergency room with a high fever and chest pain. Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level (25.7 mg/dL). Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions. The patient received intravenous antibiotic treatment, cardiac drainage through pericardiocentesis, and surgical management. The patient recovered favorably and was discharged 31 d after the operation.
CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.
Collapse
Affiliation(s)
- Jeong Suk Koh
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Yoon Joo Kim
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Da Hyun Kang
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Jeong Eun Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| |
Collapse
|
23
|
Seong GM, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Na YS, Lee SI. Comparison of Clinical Characteristics and Outcomes of Younger and Elderly Patients with Severe COVID-19 in Korea: A Retrospective Multicenter Study. J Pers Med 2021; 11:jpm11121258. [PMID: 34945730 PMCID: PMC8708855 DOI: 10.3390/jpm11121258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making.
Collapse
Affiliation(s)
- Gil Myeong Seong
- Department of Internal Medicine, Jeju National University, Jeju 63243, Korea;
| | - Ae-Rin Baek
- Department of Internal Medicine, Division of Allergy and Pulmonology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Moon Seong Baek
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Won-Young Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Jin Hyoung Kim
- Department of Internal Medicine, Division of Respiratory and Critical Care Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea;
| | - Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju 61453, Korea;
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-42-280-6816
| |
Collapse
|
24
|
Kang DH, Chung C, Sun P, Lee DH, Lee SI, Park D, Koh JS, Kim Y, Yi HS, Lee JE. Circulating regulatory T cells predict efficacy and atypical responses in lung cancer patients treated with PD-1/PD-L1 inhibitors. Cancer Immunol Immunother 2021; 71:579-588. [PMID: 34278517 PMCID: PMC8854239 DOI: 10.1007/s00262-021-03018-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/11/2021] [Indexed: 11/06/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) have become the standard of care for a variety of cancers, including non-small cell lung cancer (NSCLC). In this study, we investigated the frequency of pseudoprogression and hyperprogression in lung cancer patients treated with ICIs in the real world and aimed to discover a novel candidate marker to distinguish pseudoprogression from hyperprogression soon after ICI treatment. Methods This study included 74 patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitors at Chungnam National University Hospital (CNUH) between January 2018 and August 2020. Chest X-rays were examined on day 7 after the first ICI dose to identify changes in the primary mass, and the response was assessed by computed tomography (CT). We evaluated circulating regulatory T (Treg) cells using flow cytometry and correlated the findings with clinical outcomes. Results The incidence of pseudoprogression was 13.5%, and that of hyperprogression was 8.1%. On day 7 after initiation of treatment, the frequency of CD4+CD25+CD127loFoxP3+ Treg cells was significantly decreased compared with baseline (P = 0.038) in patients who experienced pseudoprogression and significantly increased compared with baseline (P = 0.024) in patients who experienced hyperprogression. In the responder group, the frequencies of CD4+CD25+CD127loFoxP3+ Treg cells and PD-1+CD4+CD25+CD127loFoxP3+ Treg cells were significantly decreased 7 days after commencement of treatment compared with baseline (P = 0.034 and P < 0.001, respectively). Conclusion Circulating Treg cells represent a promising potential dynamic biomarker to predict efficacy and differentiate atypical responses, including pseudoprogression and hyperprogression, after immunotherapy in patients with NSCLC. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-03018-y.
Collapse
Affiliation(s)
- Da Hyun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Chaeuk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Pureum Sun
- College of Medicine, Research Institute for Medical Sciences, Chungnam National University, Daejeon, Korea
| | - Da Hye Lee
- College of Medicine, Research Institute for Medical Sciences, Chungnam National University, Daejeon, Korea
| | - Song-I Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Dongil Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Jeong Suk Koh
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Yoonjoo Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Hyon-Seung Yi
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
| |
Collapse
|
25
|
Koh JS, Kim YJ, Kang DH, Lee JE, Lee SI. Usefulness of presepsin in predicting the prognosis of patients with sepsis or septic shock: a retrospective cohort study. Yeungnam Univ J Med 2021; 38:318-325. [PMID: 34126701 PMCID: PMC8688790 DOI: 10.12701/yujm.2021.01018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background The diagnosis and prediction of prognosis are important in patients with sepsis, and presepsin is helpful. In this study, we aimed to examine the usefulness of presepsin in predicting the prognosis of sepsis in Korea. Methods Patients diagnosed with sepsis according to the sepsis-3 criteria were recruited into the study and classified into surviving and non-surviving groups based on in-hospital mortality. A total of 153 patients (32 and 121 patients with sepsis and septic shock, respectively) were included from July 2019 to August 2020. Results Among the 153 patients with sepsis, 91 and 62 were in the survivor and non-survivor groups, respectively. Presepsin (p=0.004) and lactate (p=0.003) levels and the sequential organ failure assessment (SOFA) score (p<0.001) were higher in the non-survivor group. Receiver operating characteristic curve analysis revealed poor performances of presepsin and lactate in predicting the prognosis of sepsis (presepsin: area under the curve [AUC]=0.656, p=0.001; lactate: AUC=0.646, p=0.003). The SOFA score showed the best performance, with the highest AUC value (AUC=0.751, p<0.001). The prognostic cutoff point for presepsin was 1,176 pg/mL. Presepsin levels higher than 1,176 pg/mL (odds ratio [OR], 3.352; p<0.001), higher lactate levels (OR, 1.203; p=0.003), and higher SOFA score (OR, 1.249; p<0.001) were risk factors for in-hospital mortality. Conclusion Presepsin levels were higher in non-survivors than in survivors. Thus, presepsin may be a valuable biomarker in predicting the prognosis of sepsis.
Collapse
Affiliation(s)
- Jeong Suk Koh
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yoon Joo Kim
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Da Hyun Kang
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong Eun Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
26
|
Lee SI, Koh Y, Huh JW, Hong SB, Lim CM. Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients. Gerontology 2021; 68:280-288. [PMID: 34107481 DOI: 10.1159/000516297] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. METHODS This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. RESULTS Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (>72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, p = 0.005). CONCLUSIONS ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.
Collapse
Affiliation(s)
- Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea, .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea,
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jin Won Huh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| |
Collapse
|
27
|
Lee SI. Effectiveness of polymyxin B hemoperfusion in acute exacerbation of interstitial pneumonia: a retrospective analysis. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021012. [PMID: 33867795 PMCID: PMC8050624 DOI: 10.36141/svdld.v38i1.9734] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute exacerbation (AE) of interstitial pneumonia (IP) occurs commonly and has a poor prognosis. Polymyxin B hemoperfusion (PMX-DHP) has a beneficial effect on AE of some types of IPs, particularly idiopathic pulmonary fibrosis (IPF). However, little is known about the efficacy of PMX-DHP in the Korean population. The aim of this study was to examine the effectiveness of PMX-DHP in AE of IP. METHODS We conducted a retrospective study of 12 patients with AE of IP, including two patients with AE of IPF, who were treated with PMX-DHP at our center. Treatment with PMX-DHP was carried out once or twice. We collected and analyzed data on changes in oxygenation with PMX-DHP and survival after AE. RESULTS In patients with AE of IP, the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, or the P/F ratio, had significantly improved at the end of the treatment with PMX-DHP (87.0 [80.3 - 130.9] to 200.6 [105.0 - 245.5] mmHg, p = 0.019). The white blood cell (WBC) count had significantly reduced at the end of the treatment (12,400 [8,860 - 20,287] to 6,800 [3,950 - 15,775]/mm3, p = 0.050). The 28-day and in-hospital mortality rates of patients after AE of IP were 41.7 % and 75.0 %, respectively. CONCLUSION PMX-DHP improved oxygenation and reduced the WBC count in patients with AE, with either steroids alone or steroids and cyclophosphamide. Further studies are required to verify the potential benefits of PMX-DHP for patients with AE of IP.
Collapse
Affiliation(s)
- Song-I Lee
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| |
Collapse
|
28
|
Abstract
Background Vitamin C is a well-known antioxidant and essential cofactor for numerous biological reactions. Several studies reported that vitamin C can improve the symptoms and prognosis of patients with sepsis and respiratory infection. We aimed to examine the effect of vitamin C when used in viral pneumonia patients with severe respiratory failure. Methods Total 201 patients with viral pneumonia were included, of them 35 patients used vitamin C. We performed a statistical analysis through a propensity score matching of the age and baseline characteristics of these patients. Results There were differences between the vitamin C group and non-vitamin C group in terms of age (60±15 vs. 66±14, P=0.03), extracorporeal membrane oxygenation (28.6% vs. 5.4%, P<0.001), and procalcitonin (3±8 vs. 9±23, P=0.02). The 28-day mortality was not different between the two groups (20.0% vs. 24.7%, P=0.33). In the propensity-matched group, the 28-day mortality was not significantly different between the two groups (20.0% vs. 37.1%, P=0.07). Moreover, no difference was observed in shock reversal within 14 days (45.7% vs. 25.7%, P=0.08) and recovery after acute kidney injury (52.9% vs. 66.7%, P=0.41) between the two groups. Vitamin C was not a prognostic factor for 28-day mortality (P=0.33). Conclusions In this study adjunctive intravenous vitamin C therapy alone was not associated with improvement of the 28-day mortality and prognosis in patients with severe viral pneumonia with respiratory failure.
Collapse
Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
29
|
Lee SI. Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation. KMJ 2020. [DOI: 10.7180/kmj.2020.35.2.156] [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: 11/11/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.
Collapse
|
30
|
Lee SI, Koh JS, Kim YJ, Kang DH, Park D, Park HS, Jung SS, Kim JO, Lee JE. Secondary infection among hospitalized COVID-19 patients: A retrospective cohort study in a tertiary care setting. Respirology 2020; 26:277-278. [PMID: 33350007 DOI: 10.1111/resp.13992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong Suk Koh
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yoon Joo Kim
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Da Hyun Kang
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dongil Park
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hee Sun Park
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sung Soo Jung
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ju-Ock Kim
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| |
Collapse
|
31
|
Kim SH, Lee SI, Jeong HG, Yoo J, Jeong H, Choi Y, Son K, Jheong WH. Rapid emergence of African swine fever virus variants with different numbers of a tandem repeat sequence in South Korea. Transbound Emerg Dis 2020; 68:1726-1730. [PMID: 33012101 PMCID: PMC8359160 DOI: 10.1111/tbed.13867] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
African swine fever virus variants with different numbers of a 10‐bp tandem repeat were isolated in South Korea soon after being identified in wild boar. The short emergence periods and sympatric distributions within a narrow geographical region suggest that the variants were sporadically generated in the pre‐existing viral population.
Collapse
Affiliation(s)
- Seon-Hee Kim
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Song-I Lee
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Hyun-Gi Jeong
- Nakdong River Environment Research Center, National Institute of Environmental Research, Daegu, South Korea
| | - Jongchan Yoo
- Nakdong River Basin Environment Office, Ministry of Environment, Changwon, South Korea
| | - Hyesung Jeong
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Yongjun Choi
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Kidong Son
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Weon-Hwa Jheong
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| |
Collapse
|
32
|
Lee SI, Sung H, Hong SB, Lim CM, Koh Y, Huh JW. Usefulness of ICU criteria for diagnosis of invasive pulmonary aspergillosis in nonhematologic critically ill patients. Med Mycol 2020; 58:275-281. [PMID: 31204780 DOI: 10.1093/mmy/myz062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/03/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a life-threatening disease in the intensive care unit (ICU). The ICU criteria were proposed to diagnose IPA in critically ill patients. This study aims to evaluate the usefulness of ICU criteria for diagnosis and treatment of IPA in nonhematologic patients in the ICU. We retrospectively reviewed 103 ICU patients with positive galactomannan test in blood and respiratory tract from January 1, 2016, to May 31, 2017. We excluded patients with hematologic malignancy. We divided the treatment and non-treatment groups according to the IPA treatment. We compared the baseline characteristics and outcomes between two groups and the agreement with ICU criteria. There were 49 patients in treatment groups and 54 patients in non-treatment groups. There were more cases of solid organ transplantation (P = .003), immunosuppressive therapy (P < .001) and bacterial viral coinfection (P = .048) in the treatment group compared to nontreatment group. There was no statistically significant difference in mortality, the use of ventilator, and septic shock between the two groups. The agreement rate between the putative group and treatment was low (59.2%). There was no statistically significant difference in outcome between the putative and colonization groups according to the ICU criteria in each group. The treatment of IPA based on the symptom, radiologic finding and galactomannan test did not showed the better outcome. Also, the treatment based on the ICU criteria didn't show the difference of outcome. The new criteria for diagnosis of IPA in critically ill patients are needed.
Collapse
Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.,Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| |
Collapse
|
33
|
Lee SI, Chae EJ, Song JS, Lee JH, Song JW. Pleuroparenchymal fibroelastosis in patients with idiopathic pulmonary fibrosis. Respirology 2020; 25:1046-1052. [PMID: 32147954 DOI: 10.1111/resp.13796] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 08/21/2019] [Revised: 12/01/2019] [Accepted: 02/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE PPFE is characterized by fibrosis in the pleura and subpleural lung parenchyma in the upper lobes, while other types of ILD, mainly UIP, can be observed in about half of the patients in their lower lobes. The aim of this study was to evaluate the clinical significance of the radiologically defined PPFE in patients with IPF. METHODS Clinical data and chest CT images were retrospectively analysed in 445 patients with IPF (biopsy-proven cases, n = 165). The radiological criteria of PPFE were defined as follows: (i) bilateral subpleural dense fibrosis with or without pleural thickening in the upper lobes, (ii) evidence of disease progression and (iii) no clinical evidence of identifiable aetiologies. RESULTS The median follow-up period was 43.0 months. The mean age of the patients was 66.4 years and 76.4% were male. PPFE was identified in 28 patients (6.3%). The PPFE group showed lower BMI and lung function (FVC and TLC) at baseline, more frequent pneumothorax and pneumomediastinum, higher decline rates in lung function and poorer prognosis during follow-up than the no-PPFE group. PPFE was an independent risk factor (HR = 2.953, 95% CI: 1.350-6.460, P = 0.007) for pneumothorax or pneumomediastinum, but not for mortality in patients with IPF. CONCLUSION Among patients with IPF, the PPFE group, when compared to the no-PPFE group, showed lower BMI and lung function and showed more frequent complications and poorer survival during follow-up.
Collapse
Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
34
|
Kang S, Lee SI, Min BW, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH, Kim JS, Ji WB, Um JW, Hong KD. A multicentre comparative study between laparoscopic and open surgery for intussusception in adults. Colorectal Dis 2020; 22:1415-1421. [PMID: 32356391 DOI: 10.1111/codi.15102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
AIM Intussusception in adults is rare and requires surgery in most cases. While abdominal laparoscopic surgery (LS) is becoming more popular, there are few reports on the outcomes of adult intussusception treated with LS. This study compared the feasibility of LS vs open surgery (OS) for adult intussusception. METHOD We reviewed retrospectively the medical records of adult patients with intussusception from three tertiary hospitals between 2000 and 2016. The patients were divided into LS and OS groups, and their surgical outcomes were compared. RESULTS Surgery was indicated in 71 patients with intussusception (41 LS and 30 OS). The median age of the patients was 49.0 and 51.5 years in the LS and OS groups, respectively (P = 0.930). Overall, nine (12.7%) patients had a negative laparotomy or laparoscopy with spontaneous reduction of the intussusception. Conversion to OS from LS was necessary in one patient (2.4%). The operative time and intra-operative and postoperative complication rates were not significantly different. However, there were more serious complications such as bowel perforation and major vessel injury in the LS group. The patients in the LS group had a shorter time to first food intake and hospital stay vs patients in the OS group (4.0 vs 6.0 days, P < 0.001, and 7.0 vs 10.5 days, P < 0.001, respectively). CONCLUSION LS may be feasible for adult intussusception; there may be more severe intra-operative complications than in OS.
Collapse
Affiliation(s)
- S Kang
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - S I Lee
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - B W Min
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - T H Lee
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-J Baek
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J-M Kwak
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-H Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J S Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - W-B Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - J W Um
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| |
Collapse
|
35
|
O'Shea A, Tam AL, Kilcoyne A, Flaherty KT, Lee SI. Image-guided biopsy in the age of personalised medicine: strategies for success and safety. Clin Radiol 2020; 76:154.e1-154.e9. [PMID: 32896425 DOI: 10.1016/j.crad.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Oncology has progressed into an era of personalised medicine, whereby the therapeutic regimen is tailored to the molecular profile of the patient's cancer. Determining personalised therapeutic options is achieved by using tumour genomics and proteomics to identify the specific molecular targets against which candidate drugs can interact. Several dozen targeted drugs, many for multiple cancer types are already widely in clinical use. Molecular profiling of tumours is contingent on high-quality biopsy specimens and the most common method of tissue sampling is image-guided biopsy. Thus, for radiologists performing these biopsies, the paradigm has now shifted away from obtaining specimens simply for histopathological diagnosis to acquiring larger amounts of viable tumour cells for DNA, RNA, or protein analysis. These developments have highlighted the central role now played by radiologists in the delivery of personalised cancer care. This review describes the principles of molecular profiling assays and biopsy techniques for optimising yield, and describes a scoring system to assist in patient selection for percutaneous biopsy.
Collapse
Affiliation(s)
- A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - A L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - A Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K T Flaherty
- Department of Medicine, Division of Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S I Lee
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| |
Collapse
|
36
|
Jang HJ, Yang KE, Oh WK, Lee SI, Hwang IH, Ban KT, Yoo HS, Choi JS, Yeo EJ, Jang IS. Nectandrin B-mediated activation of the AMPK pathway prevents cellular senescence in human diploid fibroblasts by reducing intracellular ROS levels. Aging (Albany NY) 2020; 11:3731-3749. [PMID: 31199782 PMCID: PMC6594796 DOI: 10.18632/aging.102013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/12/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022]
Abstract
Nectandrin B (NecB) is a bioactive lignan compound isolated from Myristica fragrans (nutmeg), which functions as an activator of AMP-activated protein kinase (AMPK). Because we recently found that treatment with NecB increased the cell viability of old human diploid fibroblasts (HDFs), the underlying molecular mechanism was investigated. NecB treatment in old HDFs reduced the activity staining of senescence-associated β-galactosidase and the levels of senescence markers, such as the Ser15 phosphorylated p53, caveolin-1, p21waf1, p16ink4a, p27kip1, and cyclin D1. NecB treatment increased that in S phase, indicating a enhancement of cell cycle entry. Interestingly, NecB treatment ameliorated age-dependent activation of AMPK in old HDFs. Moreover, NecB reversed the age-dependent expression and/or activity changes of certain sirtuins (SIRT1-5), and cell survival/death-related proteins. The transcriptional activity of Yin-Yang 1 and the expression of downstream proteins were elevated in NecB-treated old HDFs. In addition, NecB treatment exerted a radical scavenging effect in vitro, reduced cellular ROS levels, and increased antioxidant enzymes in old HDFs. Moreover, NecB-mediated activation of the AMPK pathway reduced intracellular ROS levels. These results suggest that NecB-induced protection against cellular senescence is mediated by ROS-scavenging through activation of AMPK. NecB might be useful in ameliorating age-related diseases and extending human lifespan.
Collapse
Affiliation(s)
- Hyun-Jin Jang
- Drug & Disease Target Group, Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea.,Department of Biological Sciences, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Kyeong Eun Yang
- Drug & Disease Target Group, Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
| | - Won Keun Oh
- Korea Bioactive Natural Material Bank, College of Pharmacy, Seoul National University, Seoul 08826, Republic of Korea
| | - Song-I Lee
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Republic of Korea
| | - In-Hu Hwang
- Neuroscience Research Institute, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Kyung-Tae Ban
- East-West Cancer Center, Daejeon University, Daejeon, 302-120, Republic of Korea
| | - Hwa-Seung Yoo
- East-West Cancer Center, Daejeon University, Daejeon, 302-120, Republic of Korea
| | - Jong-Soon Choi
- Drug & Disease Target Group, Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea
| | - Eui-Ju Yeo
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Republic of Korea.,Department of Biochemistry, College of Medicine, Gachon University, Incheon 21999, Republic of Korea
| | - Ik-Soon Jang
- Drug & Disease Target Group, Division of Bioconvergence Analysis, Korea Basic Science Institute, Daejeon 305-333, Republic of Korea.,Division of Analytical Science, University of Science and Technology, Daejeon 34113, Republic of Korea
| |
Collapse
|
37
|
Lim BH, Lee SI. <italic>Klebsiella pneumoniae</italic>-induced Liver Abscess Complicated with Septic Pulmonary Embolism in a Non-diabetic Adult. KMJ 2020. [DOI: 10.7180/kmj.2020.35.1.69] [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: 11/11/2022] Open
Abstract
<p>A 72-year-old non-diabetic man was admitted to the intensive care unit because of liver abscess, cholecystitis, and septic shock. He underwent percutaneous catheter drainage and received intravenous antibiotics. Shock was improved, and the patient’s fever subsided. Klebsiella pneumoniae was isolated in blood and bile cultures. However, he suddenly developed dyspnea and oxygen desaturation. Chest computed tomography scan revealed multifocal ground-glass opacities with consolidation with peripheral preponderance. Appropriate antibiotic therapy was provided for 2 weeks. The patient recovered fully, and cholecystectomy was then performed. Herein, we report a case of K. pneumoniae-induced liver abscess complicated with septic pulmonary embolism in a non-diabetic patient.
Collapse
|
38
|
Kim SH, Kim J, Son K, Choi Y, Jeong HS, Kim YK, Park JE, Hong YJ, Lee SI, Wang SJ, Lee HS, Kim WM, Jheong WH. Wild boar harbouring African swine fever virus in the demilitarized zone in South Korea, 2019. Emerg Microbes Infect 2020; 9:628-630. [PMID: 32183615 PMCID: PMC7144197 DOI: 10.1080/22221751.2020.1738904] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 12/03/2022]
Abstract
The African swine fever virus (ASFV) was first detected in wild boar in the Demilitarized Zone, a bordered area between South and North Korea, on 2 October 2019. Phylogenetic analyses of ASFV genes encoding p72 and CD2v indicated that the causative strain belongs to genotype II and serogroup 8, respectively, and contained additional tandem repeat sequences between the I73R and the I329L protein genes.
Collapse
Affiliation(s)
- Seon-Hee Kim
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Jisoo Kim
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Kidong Son
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Yongjun Choi
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Hye-Sung Jeong
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Yong-Kwan Kim
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Jung-Eun Park
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Yoon-Jee Hong
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Song-I Lee
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Seung-Jun Wang
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Hyun-Seo Lee
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Won-Meong Kim
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| | - Weon-Hwa Jheong
- Biosafety Research Team, Environmental Health Research Department, National Institute of Environmental Research, Incheon, South Korea
| |
Collapse
|
39
|
Patel M, Lee SI, Akyea RK, Grindlay D, Francis N, Levell NJ, Smart P, Kai J, Thomas KS. A systematic review showing the lack of diagnostic criteria and tools developed for lower-limb cellulitis. Br J Dermatol 2019; 181:1156-1165. [PMID: 30844076 PMCID: PMC6916392 DOI: 10.1111/bjd.17857] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2019] [Indexed: 01/07/2023]
Abstract
Background Cellulitis can be a difficult diagnosis to make. Furthermore, 31% of patients admitted from the emergency department with suspected lower‐limb cellulitis have been misdiagnosed, with incorrect treatment potentially resulting in avoidable hospital admission and the prescription of unnecessary antibiotics. Objectives We sought to identify diagnostic criteria or tools that have been developed for lower‐limb cellulitis. Methods We conducted a systematic review using Ovid MEDLINE and Embase databases in May 2018, with the aim of describing diagnostic criteria and tools developed for lower‐limb cellulitis, and we assessed the quality of the studies identified using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. We included all types of study that described diagnostic criteria or tools. Results Eight observational studies were included. Five studies examined biochemical markers, two studies assessed imaging and one study developed a diagnostic decision model. All eight studies were considered to have a high risk for bias in at least one domain. The quantity and quality of available data was low and results could not be pooled owing to the heterogeneity of the findings. Conclusions There is a lack of high‐quality publications describing criteria or tools for diagnosing lower‐limb cellulitis. Future studies using prospective designs, validated in both primary and secondary care settings, are needed. What's already known about this topic? Diagnosing lower‐limb cellulitis on first presentation is challenging. Approximately one in three patients admitted from the emergency department with suspected lower‐limb cellulitis do not have cellulitis and are given another diagnosis on discharge. Consequently, this results in potentially avoidable hospital admissions and the prescription of unnecessary antibiotics. There are no diagnostic criteria available for lower‐limb cellulitis in the U.K.
What does this study add? This systematic review has identified a key research gap in the diagnosis of lower‐limb cellulitis. There is a current lack of robustly developed and validated diagnostic criteria or tools for use in clinical practice.
Linked Comment: https://doi.org/10.1111/bjd.18317. https://doi.org/10.1111/bjd.18569 available online
Collapse
Affiliation(s)
- M Patel
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, U.K
| | - S I Lee
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, U.K
| | - R K Akyea
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, U.K
| | - D Grindlay
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - N Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, U.K
| | - P Smart
- Patient representative, University of Nottingham, Nottingham, U.K
| | - J Kai
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| |
Collapse
|
40
|
Park JH, Lee SI, Kim IH. Effect of dietary Spirulina (Arthrospira) platensis on the growth performance, antioxidant enzyme activity, nutrient digestibility, cecal microflora, excreta noxious gas emission, and breast meat quality of broiler chickens. Poult Sci 2018; 97:2451-2459. [PMID: 29672750 DOI: 10.3382/ps/pey093] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/07/2018] [Indexed: 02/04/2023] Open
Abstract
This study examined the effects of dietary Spirulina (Arthrospira) platensis supplementation on growth performance, antioxidant enzyme activity, nutrient digestibility, cecal microflora, excreta noxious gas emission, organ weight and breast meat quality in broiler chickens. In total, 800 Ross 308 male broiler chickens (1-d-old) were randomly divided into 5 dietary treatments with 10 replicate cages (16 birds/replicate) per treatment for 5 wk. The dietary treatments were a control basal diet without Spirulina or with 0.25, 0.5, 0.75, or 1.0% Spirulina. Body weight gain, feed conversion, and/or European production efficiency index improved linearly with supplementation of Spirulina during d 8 to 21, 22 to 35, and overall d 1 to 35 (P < 0.05). Dietary Spirulina supplementation caused a significant increase in the serum enzyme activity of superoxide dismutase and glutathione peroxidase (linear, P < 0.05). Apparent total tract digestibility of dry matter and nitrogen showed a linear increase in Spirulina supplementation (P < 0.05). Cecal Lactobacillus count linearly increased and excreta ammonia gas emission linearly decreased, as dietary Spirulina supplementation increased (P < 0.05). There were no significant effects on relative organ weight and breast meat quality of broilers fed with Spirulina diets; however, 7 d drip loss linearly decreased in treatment groups fed with Spirulina (P < 0.05). These results indicate that adding Spirulina to the diet of broilers can improve antioxidant enzyme activity, dry matter and nitrogen digestibility, cecal Lactobacillus population, excreta ammonia gas emission, and 7 d drip loss of breast meat. In addition, dietary inclusion of 1.0% Spirulina powder might provide a good alternative to improve broiler chicken production.
Collapse
Affiliation(s)
- J H Park
- Department of Animal Resource and Science, Dankook University, Cheonan 31116, Republic of Korea
| | - S I Lee
- Department of Animal Resource and Science, Dankook University, Cheonan 31116, Republic of Korea
| | - I H Kim
- Department of Animal Resource and Science, Dankook University, Cheonan 31116, Republic of Korea
| |
Collapse
|
41
|
Lee SI, Lim CM. Change in age distribution of critically ill patients in an aging society. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa4498] [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: 11/05/2022]
|
42
|
Roto SM, Park SH, Lee SI, Kaldhone P, Pavlidis HO, Frankenbach SB, McIntyre DR, Striplin K, Brammer L, Ricke SC. Effects of feeding Original XPC™ to broilers with a live coccidiosis-vaccine under industry conditions: Part 1. Growth performance and Salmonella inhibition. Poult Sci 2018; 96:1831-1837. [PMID: 28340000 DOI: 10.3382/ps/pew445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/27/2016] [Accepted: 11/16/2016] [Indexed: 12/31/2022] Open
Abstract
Supplementation of poultry diets with Diamond V Original XPC™ (XPC) has been proposed as a means to ameliorate the commonly observed loss of appetite and depression of growth in birds given a live coccidiosis vaccine. A study was conducted to compare the effects on bird performance of a live coccidiosis vaccine in broilers, with and without the dietary inclusion of XPC (1.25 g/kg). Ross 708 male broilers (n = 1,280) were allocated to one of 4 feed treatments: cocci-vaccine (T1), cocci-vaccine + XPC (T2), cocci-vaccine + salinomycin in the grower diet only, (T3), and cocci-vaccine + salinomycin in the grower diet + XPC (T4). Birds consuming diets containing XPC (T2 and T4) and salinomycin (T3) exhibited increased (P < 0.05) feed intake and significantly heavier body weights at 28 d (1.70, 1.74, and 1.67 kg, respectively) and 42 d (3.29, 3.31, and 3.26 kg, respectively). Feed conversion ratio at 28 d was improved (P < 0.05) by adding XPC to diets (T2: 1.47 and T4: 1.44) compared to control diets (T1: 1.50 and T3: 1.47). Salmonella prevalence determined via selective media indicated the inclusion of XPC in the diet resulted in a significant reduction of Salmonella when compared to treatments lacking XPC. Molecular confirmation of Salmonella species indicated S. Kentucky to be present in 38 of the 39 positive samples. Results revealed the ability of XPC in reducing the prevalence of Salmonella. Results from this study also suggest that XPC could be used in conjunction with a live coccidiosis-vaccine to increase growth rate and improve feed conversion of broilers. However, further work is needed to delineate more specific effects directly attributable to XPC.
Collapse
Affiliation(s)
- S M Roto
- Center for Food Safety and Department of Food Science, University of Arkansas, Fayetteville 72704
| | - S H Park
- Center for Food Safety and Department of Food Science, University of Arkansas, Fayetteville 72704
| | - S I Lee
- Center for Food Safety and Department of Food Science, University of Arkansas, Fayetteville 72704
| | - P Kaldhone
- Center for Food Safety and Department of Food Science, University of Arkansas, Fayetteville 72704
| | | | | | | | | | - L Brammer
- OK Foods, Inc., Fort Smith, AR 72916
| | - S C Ricke
- Center for Food Safety and Department of Food Science, University of Arkansas, Fayetteville 72704
| |
Collapse
|
43
|
Lan RX, Lee SI, Kim IH. Effects of Enterococcus faecium SLB 120 on growth performance, blood parameters, relative organ weight, breast muscle meat quality, excreta microbiota shedding, and noxious gas emission in broilers. Poult Sci 2018; 96:3246-3253. [PMID: 28549196 DOI: 10.3382/ps/pex101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/22/2016] [Accepted: 04/01/2017] [Indexed: 11/20/2022] Open
Abstract
This 5-week study was conducted to determine the effects of Enterococcus faecium (SLB 120) on growth performance, blood parameters, relative organ weight, breast muscle meat quality, excreta microbiota shedding, and noxious gas emission in broilers. A total of 816 one-day-old male broilers were allocated to 4 groups with 12 replications (17 broilers/pen) according to body weight (43.2 ± 0.32 g). Dietary treatment groups were: (1) CON, basal diet, (2) T1, CON + 0.05% E. faecium, (3) T2, CON + 0.10% E. faecium, (4) T3, CON + 0.20% E. faecium. From day 1 to 21, dietary E. faecium supplementation showed linear increase (P < 0.05) in gain:feed ratio. From day 21 to 35 and the overall period, dietary E. faecium supplementation showed a linear increase (P < 0.05) in body weight gain and gain:feed ratio. On day 35, dietary E. faecium supplementation showed a linear increase (P < 0.05) in the apparent total tract digestibility of dry matter and nitrogen, and the relative weight of bursa of Fabricius; no differences were observed in white blood cells, red blood cells or lymphocyte counts. Dietary E. faecium supplementation showed a linear decrease (P < 0.05) in excreta E.coli counts on day 7 and 35, while excreta Lactobacillus counts were linearly increased (P < 0.05) on day 35. On day 35, dietary E. faecium supplementation linearly decreased (P < 0.05) excreta NH3, H2S, and total mercaptans emission, but only H2S emission was linearly decreased (P < 0.05) on day 7. In conclusion, the supplementation of E. faecium improved growth performance, the digestibility of dry matter and nitrogen, the relative weight of bursa of Fabricius, and shifted excreta microbiota by increasing Lactobacillus and decreasing E.coli counts, as well as decreased excreta NH3, H2S, and total mercaptans gas emission.
Collapse
Affiliation(s)
- R X Lan
- Department of Animal Resource & Science, Dankook University, Cheonan, Choongnam 330-714, South Korea
| | - S I Lee
- Department of Animal Resource & Science, Dankook University, Cheonan, Choongnam 330-714, South Korea
| | - I H Kim
- Department of Animal Resource & Science, Dankook University, Cheonan, Choongnam 330-714, South Korea.
| |
Collapse
|
44
|
Varela-Stokes AS, Park SH, Stokes JV, Gavron NA, Lee SI, Moraru GM, Ricke SC. Tick microbial communities within enriched extracts of Amblyomma maculatum. Ticks Tick Borne Dis 2018. [PMID: 29530467 DOI: 10.1016/j.ttbdis.2018.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Our objective of this study was to explore the bacterial microbiome in fresh or fresh-frozen adult Amblyomma maculatum (Gulf Coast ticks) using extracts enriched for microbial DNA. We collected 100 questing adult A. maculatum, surface disinfected them, and extracted DNA from individual ticks collected the same day or after storage at -80 °C. Because only extracts with microbial DNA concentrations above 2 ng/μL were considered suitable for individual analysis, we expected fewer samples to meet these requirements. Of individual ticks extracted, 48 extracts met this minimum concentration. We pooled 20 additional extracts that had lower concentrations to obtain seven additional pools that met the minimum DNA concentration. Libraries created from these 55 samples were sequenced using an Illumina MiSeq platform, and data sets were analyzed using QIIME to identify relative abundance of microorganisms by phylum down to genus levels. Proteobacteria were in greatest abundance, followed by Actinobacteria, Firmicutes, and Bacteroidetes, at levels between 1.9% and 6.4% average relative abundance. Consistent with the Francisella-like endosymbiont known to be present in A. maculatum, the genus Francisella was detected at highest relative abundance (72.9%; SE 0.02%) for all samples. Among the top ten genera identified (relative abundance ≥ 0.5%) were potential extraction kit contaminants, Sphingomonas and Methylobacterium, the soil bacterium Actinomycetospora, and the known A. maculatum-associated genus, Rickettsia. Four samples had Rickettsia at greater than 1% relative abundance, while nine additional samples had Rickettsia at low (0.01-0.04%) relative abundance. In this study, we used the entire microbe-enriched DNA extract for whole ticks for microbiome analysis. A direct comparison of the microbiome in microbe-enriched DNA and total genomic DNA extracts from halves of the same tick would be useful to determine the utility of this extraction method in this system. We anticipate that future tick microbiome studies will be valuable to explore the influence of microbial diversity on pathogen maintenance and transmission, and to evaluate niche-specific microbiomes within individual tick tissues.
Collapse
Affiliation(s)
- A S Varela-Stokes
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, United States.
| | - S H Park
- Center for Food Safety, Department of Food Science, University of Arkansas, Fayetteville, AR, 72704, United States
| | - J V Stokes
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, United States
| | - N A Gavron
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, United States
| | - S I Lee
- Center for Food Safety, Department of Food Science, University of Arkansas, Fayetteville, AR, 72704, United States; Cellular and Molecular Biology Graduate Program, University of Arkansas, Fayetteville, AR, 72701, United States
| | - G M Moraru
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, United States
| | - S C Ricke
- Center for Food Safety, Department of Food Science, University of Arkansas, Fayetteville, AR, 72704, United States; Cellular and Molecular Biology Graduate Program, University of Arkansas, Fayetteville, AR, 72701, United States
| |
Collapse
|
45
|
Kim KW, Kim JH, Choe WJ, Kim JY, Lee SI, Kim KT, Park JS, Kim JW, Lee Y, Lee JH, Park J. Effectiveness of 100 Beats per Minute Music on Cardiopulmonary Resuscitation Compression Rate Education: A Manikin Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Recent cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compression. The aim of this study is to determine the effect of education using music on the chest compression rate. Methods This randomised, open-labeled study enrolled 81 medical students. They were randomly divided into three groups. After they were educated in CPR according to the American Heart Association 2010 guidelines, they performed 100 chest compressions using a mannequin capable of collecting each compression depth and speed. After that, the control group received a verbal feedback about their own results. The metronome group was also notified of their own results, and listened to the metronome sound at 100 beats per minute (bpm). The music group listened to the music (about 100 bpm). Twenty-four hours after their CPR education, chest compressions were performed again with the method identical to the first evaluation. The results were compared using multivariate analysis of variances. Result Compression rate (bpm): There was a significant difference between the control (mean, 110.4; 95% CI: 104.4, 116.5) and metronome group (mean, 98.5; 95% CI: 91.6, 105.4) after education (p=0.01). There was a significant difference between control and music group (mean, 98.2; 95% CI: 94.6, 101.8) after education (p<0.001) There were no differences between the music and metronome group before or after education (p=0.50, p=0.94). However, the variance of music group was significantly less than the metronome group (p=0.01). Compression depth (inches): there was no difference between the groups according to the CPR education method. (Control: 1.8±0.3; Metronome group: 1.6±0.2; Music group: 1.7±0.3 p=0.09) Conclusion Both education method of using music and metronome are more effective than conventional method. However the effect of using music may be better than using metronome.
Collapse
Affiliation(s)
- KW Kim
- Inje University Seoul Paik Hospital, Department of Anesthesiology and Pain Medicine, 9 Marunnai-ro, Jung-gu, Seoul, Korea
| | - JH Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - WJ Choe
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JY Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - SI Lee
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - KT Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JS Park
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JW Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - Y Lee
- Dongguk University Medical Center Ilsan Hospital, Department of Anesthesiology/Statistic Institute, 27 Dongguk-ro IlsanDong-gu, Goyang-si, Gyeonggi-do, Korea
| | - JH Lee
- Dongguk University Medical Center Ilsan Hospital, Department of Anesthesiology/Statistic Institute, 27 Dongguk-ro IlsanDong-gu, Goyang-si, Gyeonggi-do, Korea
| | - J Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| |
Collapse
|
46
|
Narendran P, Jackson N, Daley A, Thompson D, Stokes K, Greenfield S, Charlton M, Curran M, Solomon TPJ, Nouwen A, Lee SI, Cooper AR, Mostazir M, Taylor RS, Kennedy A, Andrews RC. Exercise to preserve β-cell function in recent-onset Type 1 diabetes mellitus (EXTOD) - a randomized controlled pilot trial. Diabet Med 2017; 34:1521-1531. [PMID: 28905421 DOI: 10.1111/dme.13439] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 01/07/2023]
Abstract
AIM Residual β-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this β-cell function reduces complications. We hypothesized that exercise preserves β-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis. METHODS A randomized controlled pilot trial in adults aged 16-60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of β-cell function between intervention and control at 6 and 12 months. RESULTS Of 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 ± 3.8 kg/m2 , HbA1c 75 ± 25 mmol/mol (9 ± 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of β-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this. CONCLUSION We show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of β-cell function. (Clinical Trials Registry No; ISRCTN91388505).
Collapse
Affiliation(s)
- P Narendran
- The Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes and Metabolism, The Medical School, University of Birmingham, Birmingham, UK
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
| | - N Jackson
- Division of Medicine, University of Bristol, Bristol, UK
| | - A Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Thompson
- School for Health, University of Bath, Bath, UK
| | - K Stokes
- School for Health, University of Bath, Bath, UK
| | - S Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Charlton
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
| | - M Curran
- The Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes and Metabolism, The Medical School, University of Birmingham, Birmingham, UK
| | - T P J Solomon
- The Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes and Metabolism, The Medical School, University of Birmingham, Birmingham, UK
| | - A Nouwen
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - S I Lee
- The Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes and Metabolism, The Medical School, University of Birmingham, Birmingham, UK
| | - A R Cooper
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education and Research Centre, Bristol, UK
| | - M Mostazir
- College of Life and Environmental Sciences (CLES), University of Exeter, Exeter, UK
| | - R S Taylor
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Kennedy
- The Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes and Metabolism, The Medical School, University of Birmingham, Birmingham, UK
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
| | - R C Andrews
- University of Exeter, Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
47
|
Kim SA, Park SH, Lee SI, Ricke SC. Rapid and simple method by combining FTA™ card DNA extraction with two set multiplex PCR for simultaneous detection of non-O157 Shiga toxin-producing Escherichia coli strains and virulence genes in food samples. Lett Appl Microbiol 2017; 65:482-488. [PMID: 28960364 DOI: 10.1111/lam.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/06/2017] [Accepted: 08/08/2017] [Indexed: 01/09/2023]
Abstract
The aim of this research was to optimize two multiplex polymerase chain reaction (PCR) assays that could simultaneously detect six non-O157 Shiga toxin-producing Escherichia coli (STEC) as well as the three virulence genes. We also investigated the potential of combining the FTA™ card-based DNA extraction with the multiplex PCR assays. Two multiplex PCR assays were optimized using six primer pairs for each non-O157 STEC serogroup and three primer pairs for virulence genes respectively. Each STEC strain specific primer pair only amplified 155, 238, 321, 438, 587 and 750 bp product for O26, O45, O103, O111, O121 and O145 respectively. Three virulence genes were successfully multiplexed: 375 bp for eae, 655 bp for stx1 and 477 bp for stx2. When two multiplex PCR assays were validated with ground beef samples, distinctive bands were also successfully produced. Since the two multiplex PCR examined here can be conducted under the same PCR conditions, the six non-O157 STEC and their virulence genes could be concurrently detected with one run on the thermocycler. In addition, all bands clearly appeared to be amplified by FTA card DNA extraction in the multiplex PCR assay from the ground beef sample, suggesting that an FTA card could be a viable sampling approach for rapid and simple DNA extraction to reduce time and labour and therefore may have practical use for the food industry. SIGNIFICANCE AND IMPACT OF THE STUDY Two multiplex polymerase chain reaction (PCR) assays were optimized for discrimination of six non-O157 Shiga toxin-producing Escherichia coli (STEC) and identification of their major virulence genes within a single reaction, simultaneously. This study also determined the successful ability of the FTA™ card as an alternative to commercial DNA extraction method for conducting multiplex STEC PCR assays. The FTA™ card combined with multiplex PCR holds promise for the food industry by offering a simple and rapid DNA sample method for reducing time, cost and labour for detection of STEC in food and environmental samples.
Collapse
Affiliation(s)
- S A Kim
- Center for Food Safety - Department of Food Science, University of Arkansas, Fayetteville, AR, USA
| | - S H Park
- Center for Food Safety - Department of Food Science, University of Arkansas, Fayetteville, AR, USA
| | - S I Lee
- Center for Food Safety - Department of Food Science, University of Arkansas, Fayetteville, AR, USA
| | - S C Ricke
- Center for Food Safety - Department of Food Science, University of Arkansas, Fayetteville, AR, USA
| |
Collapse
|
48
|
Abstract
This study was designed to evaluate the effects of two different complex probiotic supplementations on the growth performance, meat quality, excreta microflora, nutrient retention, blood metabolic profile and noxious gas emissions in broilers. A total of 612 conventional healthy 1-d-old Ross 308 broilers with body weight of 41 ± 0.3 g were randomly divided into 3 treatments with 12 replicate cages, with 17 broilers in each cage and fed with the following diets: CON-Basal diet, T1-CON + Probiotic A, T2-CON + Probiotic B. Significant results were observed on body weight gain, but not on feed conversation ratio and feed intake, in the whole experimental period. Increased faecal lactobacillus counts were found with probiotics supplementation. However, no significant effects were found for meat quality, nutrient retention, blood metabolic profile or noxious gas emissions. In conclusion, both multi-strain probiotics had beneficial effects on growth performance, drip loss percentage and faecal Lactobacillus counts in broilers.
Collapse
Affiliation(s)
- B Balamuralikrishnan
- a Department of Animal Resource and Science , Dankook University , Cheonan , Choongnam , South Korea
| | - S I Lee
- a Department of Animal Resource and Science , Dankook University , Cheonan , Choongnam , South Korea
| | - I H Kim
- a Department of Animal Resource and Science , Dankook University , Cheonan , Choongnam , South Korea
| |
Collapse
|
49
|
Park KH, Lee S, Park JH, Kang SY, Kim HY, Park IH, Park YH, Im YH, Lee HJ, Park S, Lee SI, Jung KH, Kim YS, Seo JH. A randomized, multi-center, open-label, phase III study of once-per-cycle DA-3031, a pegylated G-CSF, in comparison with daily filgrastim in patients receiving TAC chemotherapy for breast cancer. Support Care Cancer 2016; 25:505-511. [PMID: 27709313 DOI: 10.1007/s00520-016-3429-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 04/06/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This multi-center, randomized, phase III study was conducted to demonstrate the non-inferiority of DA-3031 compared with daily filgrastim in patients during the first cycle of chemotherapy for breast cancer in terms of the duration of severe neutropenia (DSN). METHODS Seventy-four patients with breast cancer who were receiving combination chemotherapy with docetaxel, doxorubicin, and cyclophosphamide (TAC) were enrolled. All participants were randomized to receive either daily subcutaneous injections of filgrastim 100 μg/m2/day for up to 10 days or a single subcutaneous injection of DA-3031 at fixed doses of 6 mg on day 2 of each chemotherapy cycle. RESULTS The mean duration of grade 4 (G4) neutropenia in cycle 1 was 2.08 ± 0.85 days for the filgrastim group and 2.28 ± 1.14 days for the DA-3031 group. The difference between groups was 0.2 ± 1.10 days (95 % confidence interval (CI) = -0.26, 0.66), which supported non-inferiority. No statistically significant differences were observed in nadir absolute neutrophil count (ANC) (154.34/mm3 and 161.75/mm3 for the filgrastim and DA-3031 groups, respectively; P = 0.8414) or in time to ANC recovery (10.03 ± 0.75 and 9.83 ± 1.56 days in the filgrastim and DA-3031 groups, respectively; P = 0.0611) during cycle 1. Serious AEs occurred in six (15.8 %) patients receiving filgrastim and in ten (27.8 %) patients receiving DA-3031; however, none was determined to be related to the study drug. CONCLUSIONS DA-3031 and daily filgrastim are similar in regard to DSN and safety in breast cancer patients receiving TAC chemotherapy.
Collapse
Affiliation(s)
- K H Park
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, 73 Inchonro, Sungbuk-Gu, Seoul, 02481, South Korea
| | - S Lee
- Division of Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Park
- Division of Oncology/Hematology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, South Korea
| | - S Y Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - H Y Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Pyeongchon, Anyang-si, Gyeonggi-do, South Korea
| | - I H Park
- Center for Breast Cancer and Center for Clinical Trials, National Cancer Center, Goyang-si, South Korea
| | - Y H Park
- Division of Hematology/Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Y H Im
- Division of Hematology/Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - H J Lee
- Product Development HQ, Dong-A ST, Seoul, South Korea
| | - S Park
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University College of Medicine, Seoul, South Korea
| | - S I Lee
- Division of Oncology/Hematology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - K H Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Y S Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Jae Hong Seo
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, 73 Inchonro, Sungbuk-Gu, Seoul, 02481, South Korea.
| |
Collapse
|
50
|
Park JW, Jeong JS, Lee SI, Kim IH. Effect of dietary supplementation with a probiotic (Enterococcus faecium) on production performance, excreta microflora, ammonia emission, and nutrient utilization in ISA brown laying hens. Poult Sci 2016; 95:2829-2835. [PMID: 27422665 DOI: 10.3382/ps/pew241] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/02/2015] [Accepted: 06/10/2016] [Indexed: 11/20/2022] Open
Abstract
The ban on the use of antibiotics as growth promoters due to resistance issues has urged scientists to find alternatives to antibiotics. Entercoccus faecium is one of the probiotics which have been used as an alternative to antibiotics in the livestock industry. This study was conducted to evaluate the effect of probiotic (Enterococcus faecium DSM 7134) supplementation on production performance, feed intake, egg quality, excreta microflora, ammonia emission, and nutrient utilization in laying hens. A total of 288 ISA brown laying hens were used in a 27 wk feeding experiment and randomly assigned to 3 dietary treatments with 8 replicates of 12 birds each. The treatments were CON (basal diet), PB1 (basal diet + 0.005% E. faecium), and PB2 (basal diet + 0.01% E. faecium). Overall, our results demonstrated that E. faecium supplementation resulted in a significant increase in egg production, egg shell thickness, and nutrient digestibility (dry matter, nitrogen, and energy) in laying hens, and a significant reduction in fecal coliform counts as compared with CON. The shift of excreta fecal microbial composition by E. faecium supplementation was accompanied by increased nutrient retention and reduction in nutrient excretion, leading to improved nutrient digestibility and reduced excreta ammonia emission. Overall, E. faecium supplementation appears to have a beneficial effect in ISA brown laying hens and should be considered as a positive diet supplement to use in the industry.
Collapse
Affiliation(s)
- J W Park
- Department of Animal Resource and Science, Dankook University, Cheonan, Choongnam, 330-714, Republic of Korea
| | - J S Jeong
- Department of Animal Resource and Science, Dankook University, Cheonan, Choongnam, 330-714, Republic of Korea
| | - S I Lee
- Department of Animal Resource and Science, Dankook University, Cheonan, Choongnam, 330-714, Republic of Korea
| | - I H Kim
- Department of Animal Resource and Science, Dankook University, Cheonan, Choongnam, 330-714, Republic of Korea
| |
Collapse
|