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Yun SY, Suh CH, Byun JH, Jo SY, Chung SJ, Lim JS, Lee JH, Kim MJ, Kim HS, Kim SJ. Efficacy and safety of shunt surgery in patients with idiopathic normal-pressure hydrocephalus: can we predict shunt response by preoperative magnetic resonance imaging (MRI)? Clin Radiol 2024:S0009-9260(24)00142-9. [PMID: 38622045 DOI: 10.1016/j.crad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study was to identify preoperative magnetic resonance imaging (MRI) findings that can predict the shunt responsiveness in idiopathic normal-pressure hydrocephalus (iNPH) patients and to investigate postoperative outcome and complications. MATERIALS AND METHODS A total of 192 patients with iNPH who underwent shunt at our hospital between 2000 and 2021 were included to investigate complications. Of these, after exclusion, 127 (1-month postoperative follow-up) and 77 (1-year postoperative follow-up) patients were evaluated. The preoperative MRI features (the presence of tightness of the high-convexity subarachnoid space, Sylvian fissure enlargement, Evans' index, and callosal angle) of the shunt-response and nonresponse groups were compared, and a systematic review was conducted to evaluate whether preoperative MRI findings could predict shunt response. RESULTS Postoperative complications within one month after surgery were observed in 6.8% (13/192), and the most common complication was hemorrhage. Changes in corpus callosum were observed in 4.2% (8/192). The shunt-response rates were 83.5% (106/127) in the 1-month follow-up group and 70.1% (54/77) in 1-year follow-up group. In the logistic regression analysis, only Evans' index measuring >0.4 had a significant negative relationship with shunt response at 1-month follow-up; however, no significant relationship was observed at 1-year follow-up. According to our systematic review, it is still controversial whether preoperative MRI findings could predict shunt response. CONCLUSION Evans' index measure of >0.4 had a significant relationship with the shunt response in the 1-month follow-up group. In systematic reviews, there is ongoing debate about whether preoperative MRI findings can accurately predict responses to shunt surgery. Postoperative corpus callosal change was observed in 4.2% of iNPH patients.
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Affiliation(s)
- S Y Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - J H Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Y Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-S Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Shin JW, Lee BJ, Chung S, Lee KS, Kim KL, Hwang JI. Correction: Understanding experiences of cancer-related fatigue in patients with lung cancer after their cancer treatment: a qualitative content analysis. Qual Life Res 2024:10.1007/s11136-024-03624-0. [PMID: 38441717 DOI: 10.1007/s11136-024-03624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Jeong-Won Shin
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Beom-Joon Lee
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Soojin Chung
- Department of Nursing, Suwon Science College, Hwaseong, Republic of Korea
| | - Ki Seon Lee
- Accreditation & Evaluation Team 2, Korean Accreditation Board of Nursing Education, Seoul, Republic of Korea
| | - Kwan-Ll Kim
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jee-In Hwang
- Department of Nursing, Kyung Hee University College of Nursing Science, Seoul, Republic of Korea.
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Lee DH, Heo H, Suh CH, Shim WH, Kim E, Jo S, Chung SJ, Lee CS, Kim HS, Kim SJ. Improved diagnostic performance of susceptibility-weighted imaging with compressed sensing-sensitivity encoding and neuromelanin-sensitive MRI for Parkinson's disease and atypical Parkinsonism. Clin Radiol 2024; 79:e102-e111. [PMID: 37863747 DOI: 10.1016/j.crad.2023.09.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
AIM To verify the diagnostic performance of the loss of nigrosome-1 on susceptibility-weighted imaging (SWI) with compressed sensing-sensitivity encoding (CS-SENSE) and neuromelanin on neuromelanin-sensitive (NM) magnetic resonance imaging (MRI) for the diagnosis of Parkinson's disease (PD) and atypical Parkinsonism. MATERIALS AND METHODS A total of 195 patients who underwent MRI between October 2019 and February 2020, including SWI, with or without CS-SENSE, and NM-MRI, were reviewed retrospectively. Two neuroradiologists assessed the loss of nigrosome-1 on SWI and neuromelanin on the NM-MRI. The result of N-3-fluoropropyl-2-beta-carbomethoxy-3-beta-(4-iodophenyl) nortropane positron-emission tomography (PET) was set as the reference standard. RESULTS When CS-SENSE was applied for nigrosome-1 imaging on SWI, the non-diagnostic scan rate was lowered significantly from 19.3% (17/88) to 5.6% (6/107; p=0.004). Diagnosis of PD and atypical Parkinsonism based on the loss of nigrosome-1 on SWI and based on NM-MRI showed good diagnostic value (area under the curve [AUC] 0.821, 95% confidence interval [CI] = 0.755-0.875: AUC 0.832, 95% CI = 0.771-0.882, respectively) with a substantial inter-reader agreement (κ = 0.791 and 0.681, respectively). Combined SWI and neuromelanin had a similar discriminatory ability (AUC 0.830, 95% CI = 0.770-0.880). Similarly, the diagnosis of PD was excellent. CONCLUSIONS CS-SENSE may add value to the diagnostic capability of nigrosome-1 on SWI to reduce the nondiagnostic scan rates. Furthermore, loss of nigrosome-1 on SWI or volume loss of neuromelanin on NM-MRI may be helpful for diagnosing PD.
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Affiliation(s)
- D H Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - E Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C S Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Shin JW, Lee BJ, Chung S, Lee KS, Kim KL, Hwang JI. Understanding experiences of cancer-related fatigue in patients with lung cancer after their cancer treatment: a qualitative content analysis. Qual Life Res 2023:10.1007/s11136-023-03578-9. [PMID: 38085453 DOI: 10.1007/s11136-023-03578-9] [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] [Accepted: 12/01/2023] [Indexed: 03/06/2024]
Abstract
PURPOSE Cancer-related fatigue (CRF) is an important symptom affecting the quality of life of patients with lung cancer. However, research on the characteristics of CRF in lung cancer and their relationship to cancer treatment is limited. We aimed to explore the unique features of CRF in patients with lung cancer, and investigate the influencing factors. METHODS Semi-structured interviews were conducted with 21 adult patients with lung cancer until data saturation was reached. The collected data were analyzed using qualitative content analysis. An inductive coding process and deductive content analysis incorporating the established CRF domains were employed. Patient data from electronic medical records were used for data triangulation. RESULTS The analysis revealed five themes of CRF: (1) energy depletion, the double burden of illness and treatment, and daily life impediments; (2) feeling down and anxious; (3) neurovascular disturbances and changes in sensory perception; (4) cognitive impairment; and (5) personal and social isolation. CRF tended to improve over time, except for persistent emotional fatigue beyond 6 months. Patients who underwent surgery followed by adjuvant cancer treatment exhibited the most diverse CRF symptoms. The concurrent chemoradiation therapy group experienced significant physical fatigue, whereas the radiosurgery group reported distinct emotional fatigue. Certain factors, such as exercise, can serve as both alleviating and aggravating factors for CRF. CONCLUSION Tailored interventions that take into account the multidimensional symptoms of CRF and patient characteristics are crucial. These findings will guide healthcare professionals when implementing patient-centered symptom management and patient education.
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Affiliation(s)
- Jeong-Won Shin
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Beom-Joon Lee
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Soojin Chung
- Department of Nursing, Suwon Science College, Hwaseong, Republic of Korea
| | - Ki Seon Lee
- Accreditation & Evaluation Team 2, Korean Accreditation Board of Nursing Education, Seoul, Republic of Korea
| | - Kwan-Ll Kim
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Internal Medicine (Pulmonary & Allergy System), Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jee-In Hwang
- Department of Nursing, Kyung Hee University College of Nursing Science, Seoul, Republic of Korea.
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Lee SJ, Kim D, Suh CH, Shim WH, Heo H, Jo S, Chung SJ, Kim HS, Kim SJ. Detection rate of MR myelography without intrathecal gadolinium in patients with newly diagnosed spontaneous intracranial hypotension. Clin Radiol 2022; 77:848-854. [PMID: 35985843 DOI: 10.1016/j.crad.2022.06.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the detection rate of magnetic resonance (MR) myelography without intrathecal gadolinium for cerebrospinal fluid (CSF) leakage in patients with newly diagnosed spontaneous intracranial hypotension (SIH) and to validate a published scoring system for predicting CSF leakage. MATERIALS AND METHODS This retrospective, observational, single-institution study included patients with newly diagnosed SIH between March 2015 and April 2021. Patients were included if they (a) had newly diagnosed SIH and (b) underwent initial brain MR imaging and preprocedural MR myelography with two- and three-dimensional turbo spin-echo sequences. Patients who underwent spine surgery or procedures including epidural injection and acupuncture were excluded. The detection rate was defined as the proportion of patients with a true-positive MR myelography result among all patients with confirmed CSF leakage. The interobserver agreement for the MR myelography results between two radiologists was analysed using weighted kappa statistics. RESULTS A total of 136 patients (mean age, 48 years; 70 women) with suspected SIH were included. Of these patients, 120 (88%, 120/136) were confirmed to have CSF leakage. Of the patients with confirmed CSF leakage, 90 (75%, 90/120) had epidural fluid collection. The detection rate of MR myelography for CSF leakage was 88% (105/120). The interobserver agreement between the two readers for detecting CSF leakage (κ = 0.76) or epidural fluid collection (κ = 0.76) on MR myelography was high. Among 24 patients with normal brain MR imaging results, 16 had CSF leakage (67%, 16/24). CONCLUSIONS Non-invasive MR myelography without intrathecal gadolinium should be considered to detect CSF leakage in patients with suspected SIH.
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Affiliation(s)
- S J Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hwang J, Tchoe HJ, Chung S, Park E, Choi M. Experiences of using clinical pathways in hospitals: Perspectives of quality improvement personnel. Nurs Open 2022; 10:337-348. [PMID: 35986469 PMCID: PMC9748067 DOI: 10.1002/nop2.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/24/2022] [Accepted: 07/29/2022] [Indexed: 01/04/2023] Open
Abstract
AIM This study aimed to explore the experiences of quality improvement personnel in implementing clinical pathways (CPs) in Korean hospitals. DESIGN A qualitative study using focus-group interviews was conducted with healthcare professionals in charge of CP development and management in hospitals. METHODS Sixteen quality improvement personnel from eight tertiary and seven general hospitals were recruited using purposive sampling. The verbatim transcribed data were analysed using qualitative content analysis. RESULTS Three key themes emerged: (1) the primary focus of CP development on surgeries through concerted efforts between management and frontline healthcare professionals; (2) CP fidelity management using indicators and feedback to relevant staff or departments; and (3) positive outcomes, despite concerns about system safety. The factors affecting CP use included availability of clinical evidence, flexibility of CPs, top management and clinical leadership, physicians' perceptions of CPs, computerized support systems, and external policies and regulations.
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Affiliation(s)
- Jee‐In Hwang
- Kyung Hee University College of Nursing ScienceSeoulSouth Korea
| | - Ha Jin Tchoe
- National Evidence‐Based Healthcare Collaborating AgencySeoulSouth Korea
| | - Soojin Chung
- Department of NursingSuwon Science CollegeHwaseongSouth Korea
| | - Eunji Park
- National Evidence‐Based Healthcare Collaborating AgencySeoulSouth Korea
| | - Miyoung Choi
- National Evidence‐Based Healthcare Collaborating AgencySeoulSouth Korea
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Choi H, Ko Y, Lee CY, Chung SJ, Kim HI, Kim JH, Park S, Hwang YI, Jang SH, Jung KS, Kim YK, Park JY. Impact of COVID-19 on TB epidemiology in South Korea. Int J Tuberc Lung Dis 2021; 25:854-860. [PMID: 34615583 DOI: 10.5588/ijtld.21.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.
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Affiliation(s)
- H Choi
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Y Ko
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - C Y Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - S J Chung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, Korea
| | - H I Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J-H Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y I Hwang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S H Jang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - K-S Jung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y K Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J Y Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Zheng S, Chung SJ, Sim HCJ, Chlebicka TM, Chan YH, Lim TP, Kwa LHA, Chlebicki MP. Impact of formulary interventions on the minimum inhibitory concentration of methicillin-resistant Staphylococcus aureus to mupirocin, chlorhexidine, and octenidine in a Singapore tertiary institution. Eur J Clin Microbiol Infect Dis 2020; 39:2397-2403. [PMID: 32712737 DOI: 10.1007/s10096-020-03995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is an effective measure to prevent clinical infection but resistance is a concern. We aim to evaluate the impact of mupirocin (MUP) ointment formulary removal, plateauing use of chlorhexidine gluconate (CHG), and hospital-wide introduction of octenidine (OCT)-based products on the minimum inhibitory concentration (MIC) of MRSA to MUP, CHG, and OCT in our hospital. A prevalence study was conducted at three time points (TP) on consecutive MRSA screening isolates to evaluate for their MICs to MUP, CHG, and OCT using broth microdilution sensititre plates and detection of the ileS-2 gene encoding high-level MUP resistance in 2013 (pre-intervention TP1; n = 160), 2016 (early post-intervention TP2; n = 99) and 2017 (late post-intervention TP3; n = 76). Statistical analyses were performed using Chi square test with reference from TP1. There was a significant improvement in MUP susceptibility (MIC < 4 mcg/ml) from 71.9% (TP1) to 86.9% (TP2; p = 0.006) to 88.2% (TP3; p = 0.007). The prevalence of MUP high-level resistance (MIC > 256 mcg/ml) reduced from 25.0% (TP1) to 12.1% (TP2; p = 0.014) to 5.3% (TP3; p = 0.001). Likewise, the prevalence of isolates harboring the ileS-2 gene decreased from 28.1% (TP1) to 18.2% (TP2; p = 0.072) to 9.2% (TP3; p = 0.002). OCT MIC range remains stable at 0.5 to 1 mcg/ml across all three TPs. The proportion of isolates with reduced CHG susceptibility (MIC ≥ 4 mcg/ml) increased over the three TPs from 23.1 to 27.2% (p = 0.45) to 42.1% (p = 0.003). Active formulary regulations have an impact on the resistance profile of MRSA and can be used as a strategy to preserve the MRSA decolonization armamentarium.
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Affiliation(s)
- Shuwei Zheng
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
| | - S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - H C J Sim
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - T M Chlebicka
- University of New South Wales, Medicine, Sydney, Australia
| | - Y H Chan
- Biostatistics Unit, National University of Singapore, Singapore, Singapore
| | - T P Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - L H A Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - M P Chlebicki
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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Jung JH, Chung SJ, Yoo HS, Lee YH, Baik K, Ye BS, Sohn YH, Lee PH. Sex-specific association of urate and levodopa-induced dyskinesia in Parkinson's disease. Eur J Neurol 2020; 27:1948-1956. [PMID: 32441832 DOI: 10.1111/ene.14337] [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: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE As a major antioxidant, uric acid (UA) is known to be associated with the clinical progression of Parkinson's disease (PD). This study investigated whether baseline UA levels are associated with the risk for levodopa-induced dyskinesia (LID) in PD in a sex-dependent manner. METHODS In all, 152 patients with de novo PD (78 males and 74 females) who were followed up for >2 years were enrolled. The effect of baseline serum UA levels on LID-free survival was assessed by Cox regression, separately for sex, whilst being adjusted for potential confounding factors. The optimal UA level cut-off value to determine the high-risk group for LID was set using Contal and O'Quigley's method. RESULTS Levodopa-induced dyskinesia developed in 23 (29.5%) male patients and 30 (40.5%) female patients. Cox regression showed a significant interaction between UA level and sex. Higher UA levels were associated with a higher risk for LID in male PD patients (hazard ratio 1.380; 95% confidence interval 1.038-1.835; P = 0.027), although this relationship was not observed in female PD patients. The optimal UA level cut-off for LID in male PD was 7.2 mg/dl, and the high UA group had a 5.7-fold higher risk of developing LID than the low UA group. CONCLUSIONS Contrary to a presumptive beneficial role of UA, the present study demonstrated that higher UA levels are associated with increased risk of LID occurrence in male patients with PD, suggesting a sex-dependent role of UA in LID.
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Affiliation(s)
- J H Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - K Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Yoo HS, Chung SJ, Lee YH, Ye BS, Sohn YH, Lee PH. Cognitive anosognosia is associated with frontal dysfunction and lower depression in Parkinson's disease. Eur J Neurol 2020; 27:951-958. [PMID: 32090410 DOI: 10.1111/ene.14188] [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] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Anosognosia refers to a deficit of self-awareness or impaired insight for cognitive and behavioral problems. Cognitive anosognosia was explored in de novo patients with Parkinson's disease (PD) and its relationship to cognitive function and neuropsychiatric symptoms was investigated. METHODS The cross-sectional study enrolled 340 drug-naïve patients with PD. According to the presence of mild cognitive impairment (MCI) and subjective cognitive complaint, patients were classified as patients with cognitive anosognosia (PD-CA, n = 74), with normal cognitive recognition (PD-NR, n = 184) or with cognitive underestimation (PD-CU, n = 82). After controlling for covariates, cognitive performance and neuropsychiatric symptoms were compared between the PD groups. RESULTS Cognitive anosognosia was found in 21.8% of patients with de novo PD. The PD-CA group showed poorer performance in all cognitive domains except for attention. Amongst PD patients with MCI, those with cognitive anosognosia showed lower composite z-scores in the Stroop color reading test than those without. The Beck Depression Inventory score in the PD-NR group was lower than that in the PD-CU group and higher than that in the PD-CA group. The Cognitive Complaints Interview score mediated the association between cognitive anosognosia and Beck Depression Inventory score. CONCLUSIONS Cognitive anosognosia in PD was associated with greater frontal dysfunction and lower depression. Since cognitive anosognosia has a harmful impact on PD patients and their caregivers due to overestimation of their abilities in everyday life, early identification of cognitive anosognosia in PD is important in management and prognosis.
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Affiliation(s)
- H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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11
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Yoo HS, Lee EC, Chung SJ, Lee YH, Lee SG, Yun M, Lee PH, Sohn YH, Seong JK, Ye BS. Effects of Alzheimer's disease and Lewy body disease on subcortical atrophy. Eur J Neurol 2019; 27:318-326. [PMID: 31487756 DOI: 10.1111/ene.14080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Subcortical structures are affected by neurodegeneration in Alzheimer's disease (AD) and Lewy body disease (LBD). Although the co-occurrence of AD and LBD pathologies and their possible interaction have been reported, the effect of AD and LBD on subcortical structures remains unknown. The effects of AD and LBD on subcortical atrophy and their relationship with cognitive dysfunction were investigated. METHODS The cross-sectional study recruited 42 patients with pure AD related cognitive impairment (ADCI), 30 patients with pure LBD related cognitive impairment (LBCI), 58 patients with mixed ADCI and LBCI, and 29 normal subjects. A general linear model was used to compare subcortical volume and shape amongst the groups, to investigate the independent and interaction effects of ADCI and LBCI on subcortical shape and volume, and to analyze the relationship between subcortical volume and cognitive dysfunction in each group. RESULTS Alzheimer's disease related cognitive impairment and LBCI were independently associated with subcortical atrophies in the hippocampus and amygdala and in the hippocampus and putamen respectively, but their interaction effect was not significant. Compared to the control group, the pure LBCI group exhibited additional local atrophies in the amygdala, caudate and thalamus. Subcortical atrophies correlated differently with cognitive dysfunction according to the underlying causes of cognitive dysfunction. CONCLUSIONS The patterns of subcortical atrophies and their correlation with cognitive dysfunction differ according to the underlying AD, LBD or concomitant AD and LBD.
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Affiliation(s)
- H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - E C Lee
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S G Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - M Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - J-K Seong
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea.,School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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12
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Chung SJ, Park YH, Yun HJ, Kwon H, Yoo HS, Sohn YH, Lee JM, Lee PH. Clinical relevance of amnestic versus non-amnestic mild cognitive impairment subtyping in Parkinson's disease. Eur J Neurol 2019; 26:766-773. [PMID: 30565368 DOI: 10.1111/ene.13886] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To clarify whether subtyping of amnestic and non-amnestic mild cognitive impairment (MCI) is clinically relevant in Parkinson's disease (PD) by analyzing patterns of neuroimaging and longitudinal cognitive changes. METHODS We performed comparative analyses of cortical thickness, hippocampal volume, white matter integrity and resting-state functional connectivity between the patients with de-novo PD with amnestic MCI (PD-aMCI) (n = 50) and non-amnestic MCI (PD-naMCI) (n = 50) subtypes. Additionally, we assessed the longitudinal rate of cognitive decline in each cognitive domain over time and the rate of dementia conversion in patients with de-novo PD-aMCI (n = 125) and PD-naMCI (n = 61). RESULTS The demographic data showed that scores in memory domains were lower in the PD-aMCI group compared with the PD-naMCI group. There were no significant differences in cortical thickness, hippocampal volume and white matter integrity between the two groups, although the PD-aMCI group exhibited more cortical thinning and hippocampal atrophy relative to the control group. The PD-aMCI group exhibited increased functional connectivity in the left posterior parietal region with the salience network relative to the PD-naMCI group. The longitudinal cognitive assessment demonstrated that patients with PD-aMCI exhibited a more rapid cognitive decline in frontal/executive function than those with PD-naMCI (P = 0.022). In addition, the PD-aMCI group had a higher risk of dementia conversion than the PD-naMCI group. CONCLUSIONS This study suggests that the designation of PD-MCI subtypes based on memory function would highlight the heterogeneity of functional correlates as well as the longitudinal cognitive prognosis.
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Affiliation(s)
- S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - Y-H Park
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - H J Yun
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.,Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Kwon
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul
| | - J-M Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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13
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Thien SY, Chung SJ, Tan AL, Hwang WYK, Tan BH, Tan TT. Recurrent trichosporonosis with central nervous system involvement in an allogeneic hematopoietic stem cell transplant recipient. Transpl Infect Dis 2016; 18:768-772. [PMID: 27425395 DOI: 10.1111/tid.12577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/14/2016] [Revised: 04/23/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
Abstract
Trichosporon is an ubiquitous yeast that has emerged as an opportunistic pathogen in the immunocompromised host. We describe a case of invasive trichosporonosis in an allogeneic hematopoietic stem cell transplant (allo-HSCT) recipient while on caspofungin antifungal prophylaxis. She developed disseminated trichosporonosis in the pre-engraftment period and was successfully treated with voriconazole. She later developed 2 further episodes of invasive trichosporonosis involving the central nervous system. This case highlights the challenges of managing trichosporonosis in allo-HSCT recipients and suggests the need for lifelong therapy in some patients.
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Affiliation(s)
- S Y Thien
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - A L Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - W Y K Hwang
- Department of Hematology, Singapore General Hospital, Singapore
| | - B H Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - T T Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore.
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14
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Affiliation(s)
- S J Chung
- Department of Neurology, University of Ulsan, Asan Medical Center, Songpa-gu, Seoul, Korea
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15
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Kim SW, Chung SJ, Oh YS, Yoon JH, Sunwoo MK, Hong JY, Kim JS, Lee PH. Cerebral Microbleeds in Patients with Dementia with Lewy Bodies and Parkinson Disease Dementia. AJNR Am J Neuroradiol 2015; 36:1642-7. [PMID: 26228888 DOI: 10.3174/ajnr.a4337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The burden of amyloid β is greater in patients with dementia with Lewy bodies than in those with Parkinson disease dementia, and an increased amyloid β load is closely related to a higher incidence of cerebral microbleeds. Here, we investigated the prevalence and topography of cerebral microbleeds in patients with dementia with Lewy bodies and those with Parkinson disease dementia to examine whether cerebral microbleeds are more prevalent in patients with dementia with Lewy bodies than in those with Parkinson disease dementia. MATERIALS AND METHODS The study population consisted of 42 patients with dementia with Lewy bodies, 88 patients with Parkinson disease dementia, and 35 controls who underwent brain MR imaging with gradient recalled-echo. Cerebral microbleeds were classified as deep, lobar, or infratentorial. RESULTS The frequency of cerebral microbleeds was significantly greater in patients with dementia with Lewy bodies (45.2%) than in those with Parkinson disease dementia (26.1%) or in healthy controls (17.1%; P = .017). Lobar cerebral microbleeds were observed more frequently in the dementia with Lewy bodies group (40.5%) than in the Parkinson disease dementia (17%; P = .004) or healthy control (8.6%; P = .001) group, whereas the frequencies of deep and infratentorial cerebral microbleeds did not differ among the 3 groups. Logistic regression analyses revealed that, compared with the healthy control group, the dementia with Lewy bodies group was significantly associated with the presence of lobar cerebral microbleeds after adjusting for age, sex, nonlobar cerebral microbleeds, white matter hyperintensities, and other vascular risk factors (odds ratio, 4.39 [95% CI, 1.27-15.25]). However, compared with the healthy control group, the Parkinson disease dementia group was not significantly associated with lobar cerebral microbleeds. CONCLUSIONS This study showed that patients with dementia with Lewy bodies had a greater burden of cerebral microbleeds and exhibited a lobar predominance of cerebral microbleeds than did patients with Parkinson disease dementia.
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Affiliation(s)
- S W Kim
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Y-S Oh
- Department of Neurology (Y.-S.O., J.-S.K.), Catholic University College of Medicine, Seoul, South Korea
| | - J H Yoon
- Department of Neurology (J.H.Y.), Ajou University College of Medicine, Suwon, South Korea
| | - M K Sunwoo
- Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - J Y Hong
- Department of Neurology (J.Y.H.), Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - J-S Kim
- Department of Neurology (Y.-S.O., J.-S.K.), Catholic University College of Medicine, Seoul, South Korea
| | - P H Lee
- From the Department of Neurology (S.W.K., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea Severance Biomedical Science Institute (P.H.L.), Seoul, South Korea.
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16
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Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators? Singapore Med J 2015; 55:294-7. [PMID: 25017402 DOI: 10.11622/smedj.2014076] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in mid-2012, there has been controversy over the respiratory precaution recommendations in different guidelines from various international bodies. Our understanding of MERS-CoV is still evolving. Current recommendations on infection control practices are heavily influenced by the lessons learnt from severe acute respiratory syndrome. A debate on respiratory precautions for MERS-CoV was organised by Infection Control Association (Singapore) and the Society of Infectious Disease (Singapore). We herein discuss and present the evidence for surgical masks for the protection of healthcare workers from MERS-CoV.
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Affiliation(s)
- S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Level 3, The Academia, 20 College Road, Singapore 169856.
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17
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Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Authors’ reply. Singapore Med J 2014; 55:507. [DOI: 10.11622/smedj.2014125] [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: 11/18/2022]
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18
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Chung SJ, Hong JY, Lee JE, Lee PH, Sohn YH. Dental implants-induced task-specific oromandibular dystonia. Eur J Neurol 2013; 20:e80. [PMID: 23663539 DOI: 10.1111/ene.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
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19
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Park HJ, Kang MI, Kang Y, Chung SJ, Lee SW, Park YB, Lee SK. Two cases of refractory thrombocytopenia in systemic lupus erythematosus that responded to intravenous low-dose cyclophosphamide. J Korean Med Sci 2013; 28:472-5. [PMID: 23487584 PMCID: PMC3594614 DOI: 10.3346/jkms.2013.28.3.472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 12/07/2012] [Indexed: 11/20/2022] Open
Abstract
Treatment of thrombocytopenia in systemic lupus erythematosus (SLE) is considered in cases of current bleeding, severe bruising, or a platelet count below 50,000/µL. Corticosteroid is the first choice of medication for inducing remission, and immunosuppressive agents can be added when thrombocytopenia is refractory to corticosteroid or recurs despite it. We presented two SLE patients with thrombocytopenia who successfully induced remission after intravenous administration of low-dose cyclophosphamide (CYC) (500 mg fixed dose, biweekly for 3 months), followed by azathioprine (AZA) or mycophenolate mofetil (MMF). Both patients developed severe thrombocytopenia in SLE that did not respond to pulsed methylprednisolone therapy, and started the intravenous low-dose CYC therapy. In case 1, the platelet count increased to 50,000/µL after the first CYC infusion, and remission was maintained with low dose prednisolone and AZA. The case 2 achieved remission after three cycles of CYC, and the remission continued with low dose prednisolone and MMF.
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Affiliation(s)
- Hee-Jin Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-il Kang
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Kang
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-jin Chung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Kon Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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20
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Jang W, Han J, Park J, Kim JS, Cho JW, Koh SB, Chung SJ, Kim IY, Kim HT. Waveform analysis of tremor may help to differentiate Parkinson's disease from drug-induced parkinsonism. Physiol Meas 2013; 34:N15-24. [PMID: 23442947 DOI: 10.1088/0967-3334/34/3/n15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study, we analyzed the waveform characteristics of resting tremor by accelerometer recordings in patients with drug-induced parkinsonism (DIP) and Parkinson's disease (PD). We prospectively recruited 12 patients with tremulous PD and 12 patients with DIP presenting with resting tremor. Tremor was recorded from the more affected side and was recorded twice for a 60 s period in each patient. Peak frequency, amplitude and all harmonic peaks were obtained, and the asymmetry of the decay of the autocorrelation function, third momentum and time-reversal invariance were also computed using a mathematical algorithm. Among the parameters used in the waveform analysis, the harmonic ratio, time-reversal invariance and asymmetric decay of the autocorrelation function were different between PD and DIP at a statistically significant level (all p < 0.01). The total harmonic peak power and third momentum in the time series were not significantly different. The clinical characteristics of DIP patients may be similar to those of PD patients in some cases, which makes the clinical differentiation between DIP and PD challenging. Our study shows that the identification of parameters reflecting waveform asymmetry might be helpful in differentiating between DIP and PD.
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Affiliation(s)
- W Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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21
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Affiliation(s)
- S You
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
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Hong JH, Yoon EK, Chung SJ, Chung L, Cha SM, O'Mahony M, Vickers Z, Kim KO. Sensory characteristics and cross-cultural consumer acceptability of Bulgogi (Korean traditional barbecued beef). J Food Sci 2011; 76:S306-13. [PMID: 22417445 DOI: 10.1111/j.1750-3841.2011.02173.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Bulgogi (Korean traditional barbecued beef) is the most well-known Korean food to foreigners. There are, however, few studies on its sensory characteristics and consumer acceptability. This study was performed to identify the sensory attributes of Bulgogi samples prepared with different formulation and to compare the consumer acceptability in Korea and the United States. Bulgogi samples were prepared with varying levels of sugar and soy sauce with/without garlic or sesame oil. Descriptive analysis was conducted by 8 trained panelists. In consumer tests, 42 consumers in Seoul, Korea, 53 consumers in Davis (Calif., U.S.A.), and 39 consumers in St. Paul (Minn., U.S.A.) participated. Higher levels of sugar and soy sauce (SSS) significantly increased sweetness, saltiness, MSG taste, and soy sauce odor/flavor compared to the control made with the standard formula (CON). Elimination of sesame oil (ESO) significantly decreased sesame oil odor/flavor and oiliness, but increased green onion flavor. Elimination of garlic (EGC) significantly increased grilled beef odor/flavor, sesame oil odor/flavor, and oiliness, but decreased intensities of all the other attributes except bitterness. The consumers in Korea and the United States rated their overall liking for all samples similarly, preferring SSS to CON, EGC, and ESO. However Korean consumers seemed to detect the differences caused by formulation changes better than the U.S. consumers and these perceived differences seemed to impact the hedonic and the just-about-right ratings. Increase in soy sauce and sugar increased both Korean and the U.S. consumers' acceptability of Bulgogi, whereas eliminating garlic did not influence the consumer acceptability despite of its significant impact on sensory attributes. PRACTICAL APPLICATION The food industry is increasingly interested in ethnic foods that satisfy sophisticated appetite of today's consumers. Korean cuisine is recently gaining popularity and perceived as "adventurous and spicy," appealing to researchers and marketers in the food industry worldwide. However, it is not easy to develop a new product based on ethnic cuisine because nonsensory factors, such as food neophobia and openness to new culture, can evoke adverse responses from the consumers. A systematic sensory approach can guide the product development by identifying both sensory and nonsensory factors affecting consumer acceptability. This study investigated sensory attributes of Bulgogi (Korean traditional barbecued beef), one of the most famous Korean foods, and compared consumer acceptability between Korea and the United States. The outcomes of this study, such as flavor profiles, consumer responses, evaluation procedure, and approaches taken for cross-cultural comparison, will provide the food industries with valuable information that will help to develop effective strategies for commercializing ethnic foods including recipe development for Bulgogi marinades.
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Affiliation(s)
- J H Hong
- Dept. of Food Science and Enginering, Ewha Womans Univ., 11-1 Daehyun-Dong, Seodaemun-Gu, Seoul 120-750, Korea
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Piao ZH, Yoon SR, Kim MS, Jeon JH, Lee SH, Kim TD, Lee HG, Bae KH, Min JK, Chung SJ, Kim M, Cho YS, Oh DB, Park SY, Chung JW, Choi I. VDUP1 potentiates Ras-mediated angiogenesis via ROS production in endothelial cells. Cell Mol Biol (Noisy-le-grand) 2009; 55 Suppl:OL1096-OL1103. [PMID: 19267992] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/29/2008] [Indexed: 05/27/2023]
Abstract
Vitamin D3 up-regulated protein 1 (VDUP1) is a tumor suppressor of which expression is reduced in a variety of cancer cells, and enforced expression inhibits the tumor cell proliferation. It inhibits the activity of thioredoxin, thus contributing cellular ROS generation. Since ROS is a critical factor for angiogenesis, we investigated the role of VDUP1 in angiogenesis and endothelial proliferation. The expression of VDUP1 was upregulated by overexpression of an oncogene, Ras. Enforced expression of VDUP1 increases ROS production and proliferation of Ras-overexpressing endothelial cells. Overexpression of VDUP1 increases the resistance to the anchorage-dependent cell death and tube formation of the Ras-overexpressing endothelial cell. In addition, the removal of ROS by ROS scavenger attenuates the effect of VDUP1 on tube formation. These results suggest that VDUP1 is involved in Ras-mediated angiogenesis via ROS generation in endothelial cells.
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Affiliation(s)
- Z H Piao
- Korea Research Institute of Bioscience and Biotechnology, Stem Cell Research Center, Daejon, Republic of Korea
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Chung JH, Chung SJ, Lee S, Kirby BJ, Borchers JA, Cho YJ, Liu X, Furdyna JK. Carrier-mediated antiferromagnetic interlayer exchange coupling in diluted magnetic semiconductor multilayers Ga1-xMnxAs/GaAs:Be. Phys Rev Lett 2008; 101:237202. [PMID: 19113587 DOI: 10.1103/physrevlett.101.237202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Indexed: 05/27/2023]
Abstract
We report the antiferromagnetic (AFM) interlayer exchange coupling between Ga0.97Mn0.03As ferromagnetic semiconductor layers separated by Be-doped GaAs spacers. Polarized neutron reflectivity reveals a characteristic splitting at the wave vector corresponding to twice the multilayer period, indicating that the coupling between the ferromagnetic layers is AFM. When the applied field is increased to above the saturation field, this AFM coupling is suppressed. This behavior is not observed when the spacers are undoped, suggesting that the observed AFM coupling is mediated by doped charge carriers.
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Affiliation(s)
- J-H Chung
- Department of Physics, Korea University, Seoul 136-713, Korea
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25
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Leonard JP, Chung SJ, Nettleship I, Soong Y, Martello DV, Chyu MK. Stability of zinc oxide nanofluids prepared with aggregated nanocrystalline powders. J Nanosci Nanotechnol 2008; 8:6361-6366. [PMID: 19205207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aqueous zinc oxide (ZnO) suspensions were prepared using a two-step preparation method in which an aggregated nanocrystalline ZnO powder was dispersed in water using a polyelectrolyte. The fluid showed anomalously high thermal conductivity when compared with the Maxwell and Hamilton-Crosser predictions. However, analysis of the particle size distribution showed that the fluid contained aggregated 20 nm crystallites of ZnO with a high volume fraction of particles larger than 100 nm. Sedimentation experiments revealed that particles settled out of the stationary fluid over times ranging from 0.1 hours to well over 10,000 hours. The size of the particles remaining in suspension agreed well with predictions made using Stoke's law, suggesting flocculation was not occurring in the fluids. Finally, a new concept of nanofluid stability is introduced based on the height of the fluid, sedimentation, Brownian motion and the kinetic energy of the particles.
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Affiliation(s)
- J P Leonard
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 848 Benedum Hall, Pittsburgh, PA 15261, USA
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Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC, Song IS. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut 2008; 57:1360-5. [PMID: 18441006 DOI: 10.1136/gut.2007.147090] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has been associated with reflux oesophagitis. However, the relationship between metabolic syndrome characterised by visceral obesity and reflux oesophagitis is unclear. AIM To investigate whether metabolic syndrome or visceral obesity is a risk factor for reflux oesophagitis. METHODS A cross-sectional study of 7078 subjects undergoing upper endoscopy during health check-ups was conducted (3539 patients with reflux oesophagitis vs age- and sex-matched controls). We further analysed according to categories of visceral adipose tissue and subcutaneous adipose tissue area with 750 cases and age-, sex- and waist circumference-matched controls who underwent abdominal CT scan. RESULTS The prevalence of metabolic syndrome was higher in cases than controls (26.9% vs 18.5%, p<0.001). Multivariate analysis demonstrated that metabolic syndrome is associated with reflux oesophagitis (odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.26 to 1.60). Among the individual components of metabolic syndrome, waist circumference (OR = 1.47; 95% CI, 1.30 to 1.65) and triglyceride (OR = 1.20; 95% CI, 1.05 to 1.36) independently increased the risk for reflux oesophagitis. On sub-analysis, cases showed higher mean visceral adipose tissue area (cm(2)) (136.1 (SD 57.8) vs 124.0 (SD 54.7), p<0.001) and subcutaneous adipose tissue area (cm(2)) (145.9 (SD 56.8) vs 133.5 (SD 50.7), p<0.001). However, only visceral adipose tissue area was an independent risk factor for reflux oesophagitis after adjusting for multiple confounders including smoking, alcohol, body mass index (BMI) and subcutaneous adipose tissue area (OR = 1.60; 95% CI, 1.03 to 2.48, lowest quartile vs highest quartile). CONCLUSIONS Metabolic syndrome was associated with reflux oesophagitis. Abdominal obesity, especially visceral obesity, was an important risk factor for reflux oesophagitis.
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Affiliation(s)
- S J Chung
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
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Choi YH, Chung SJ, Lee MG. Pharmacokinetic interaction between DA-8159, a new erectogenic, and metformin in rats: competitive inhibition of metabolism via hepatic CYP3A1/2. Br J Pharmacol 2008; 153:1568-78. [PMID: 18204480 DOI: 10.1038/sj.bjp.0707680] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Erectile dysfunction is highly prevalent in diabetic patients and PDE V inhibitors are effective and safe for the treatment of erectile dysfunction in men with diabetes. Therefore, in this study we investigated whether a pharmacokinetic interaction occurs between DA-8159 and metformin, as both drugs are metabolized via hepatic CYP3A1/2 in rats. EXPERIMENTAL APPROACH DA-8159 (30 mg kg(-1)) and metformin (100 mg kg(-1)), both separately and together, were administered to rats either intravenously or orally. The V (max), K (m), CL(int), apparent inhibition constants (K (i)), [I]/K (i) and concentrations of each drug in the liver and intestine were then measured. KEY RESULTS After i.v. administration of both drugs simultaneously, the AUC of DA-8159 and metformin was significantly greater (21.2 and 33.9% increase for DA-8159 and metformin, respectively) than that of each drug alone. After p.o. administration of the drugs, the AUC of metformin was also significantly greater (20.7% increase) in the presence of DA-8159 than in its absence. However, the AUC of DA-8159 was similar in the absence and presence of metformin. CONCLUSIONS AND IMPLICATIONS The significantly greater AUC of metformin and DA-8159 after i.v. administration of both drugs and of metformin after p.o. administration of both drugs is probably due to competitive inhibition for the metabolism of these drugs via hepatic CYP3A1/2. However, the similar AUCs of DA-8159 in the absence and presence of metformin, after p.o. administration, indicates that the dose of metformin used was insufficient to inhibit the hepatic and intestinal metabolism of DA-8159.
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Affiliation(s)
- Y H Choi
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, South Korea
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Yoo HM, Kim SJ, Choi CG, Lee DH, Lee JH, Suh DC, Choi JW, Jeong KS, Chung SJ, Kim JS, Yun SC. Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography. AJNR Am J Neuroradiol 2008; 29:649-54. [PMID: 18202233 DOI: 10.3174/ajnr.a0920] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal CSF leak syndrome is a unique disorder caused by spinal CSF leak. In this study, we attempted to determine whether MR myelography (MRM) can detect the leakage site in the spine. MATERIALS AND METHODS We performed both MRM and radioisotope cisternography (RIC) in 15 patients with spinal CSF leak syndrome. Patients were included in this study if they had at least 2 of the following criteria: 1) orthostatic headache, 2) low CSF opening pressure, and 3) diffuse pachymeningeal enhancement on brain MR imaging. For comparison, we performed MRM in 15 subjects without symptoms of spinal CSF leak syndrome. MRM was performed with the 2D turbo spin-echo technique in the entire spine by using a 1.5T scanner. Two blinded radiologists evaluated the MRM findings in a total of 30 cases, composed of patient and control groups, with regard to the presence of leakage and the level of leakage if present. RIC was performed only in the patient group and was assessed by consensus among 3 physicians experienced in nuclear medicine. The diagnostic performance of MRM and RIC was evaluated on the basis of the clinical diagnosis of spinal CSF leak syndrome. RESULTS The sensitivity, specificity, and accuracy of MR myelography for detecting CSF leak was 86.7%, 86.7%, and 86.7% for reader 1, respectively, and 80.0%, 93.3%, and 86.7% for reader 2, respectively. The sensitivity of RIC was 93.3%. Agreement between the 2 techniques for the detection of CSF leak was substantial in reader 1 and moderate in reader 2 (kappa = 0.634 and 0.444, respectively). CONCLUSION MRM is an effective tool for detecting CSF leak in the spine in patients with spinal CSF leak syndrome.
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Affiliation(s)
- H-M Yoo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kim HR, Kim KM, Chung SJ, Lee JW, Kim KO. Effects of steeping conditions of waxy rice on the physical and sensory characteristics of gangjung (a traditional Korean oil-puffed snack). J Food Sci 2007; 72:S544-50. [PMID: 17995619 DOI: 10.1111/j.1750-3841.2007.00501.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objectives of this study were to investigate the effects of steeping period (1, 11, and 21 d) and temperature (15, 25, and 35 degrees C) of waxy rice on the physical and sensory characteristics of Gangjung (a traditional Korean oil-puffed snack). Increasing the steeping period from 1 to 21 d and increasing the temperature from 15 to 35 degrees C markedly increased the oil absorption ratio of Gangjung. Textural analysis indicated that the number of peaks (representing the internal air cell characteristics) for Gangjung decreased in proportion with increasing steeping temperature and period, but that the hardness was affected significantly only by steeping period. Regarding the sensory characteristics of Gangjung, 5 appearance, 7 flavor, and 9 texture attributes were developed and evaluated by trained descriptive panelists. When the steeping temperature and the steeping period were increased, the degree of expansion, size, and degree of external roughness increased, while the strength of external color decreased. Regarding the flavor attributes, the intensity of sweetness and toasted carbohydrate food flavor tended to decrease with increasing steeping temperature and period, while sourness and butyric acid flavor, which are related to the fermentation of waxy rice, increased. Finally, the increased steeping temperature and period decreased the intensity of hardness, crispness, and toughness of Gangjung but increased the degree of fracture, degree of melting, and oiliness.
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Affiliation(s)
- H R Kim
- Rural Resources Development Inst., Natl. Inst. of Agricultural Science and Technology, RDA, Suwon, Gyeonggi-do 441-853, South Korea
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Kim JS, Chung SJ, Choi YS, Cheon JH, Kim CW, Kim SG, Jung HC, Song IS. Helicobacter pylori eradication for low-grade gastric mucosa-associated lymphoid tissue lymphoma is more successful in inducing remission in distal compared to proximal disease. Br J Cancer 2007; 96:1324-8. [PMID: 17406363 PMCID: PMC2360178 DOI: 10.1038/sj.bjc.6603708] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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] [Indexed: 12/18/2022] Open
Abstract
A series of studies has shown that Helicobacter pylori eradication induces remission in most patients with low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, there have been few reports about the effect of bacterial treatment on the gastric MALT lymphoma in Korea, a well-known H. pylori endemic area. A total of 111 H. pylori-infected patients were prospectively enrolled in Seoul National University Hospital and 99 among them were completely followed up according to our protocol. After H. pylori eradication, tumoural response was evaluated by endoscopy and histopathology every 2–3 months till complete remission (CR) and every 6 months after achieving CR. Median follow-up period was 41 months (range, 11–125 months). Helicobacter pylori was successfully eradicated in all 99 patients and CR was obtained in 84 (84.8%) of 99 patients. The median time to reach CR was 3 months and 94% of CR is in continuous complete remission. Five patients with CR relapsed after 10–22 months without the evidence of H. pylori reinfection. Cumulative recurrence rate was 2.3, 7.7 and 9.3% at 1, 2 and 3 years, respectively. Tumours were mainly located in distal stomach (67.7%) and tumours in distal stomach were associated with more favourable response than those in proximal stomach (P=0.001). Majority of patients with low-grade gastric MALT lymphoma treated by exclusive H. pylori eradication have a favourable long-term outcome, offering a real chance of cure. Tumour location could be a predictive factor for remission following H. pylori eradication.
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Affiliation(s)
- J S Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - S J Chung
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Y S Choi
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - J H Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - C W Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - S G Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - H C Jung
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - I S Song
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, South Korea. E-mail:
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Balaji S, Kokovkin VV, Chung SJ, Moon IS. Destruction of EDTA by mediated electrochemical oxidation process: monitoring by continuous CO2 measurements. Water Res 2007; 41:1423-32. [PMID: 17275873 DOI: 10.1016/j.watres.2006.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Revised: 11/29/2006] [Accepted: 12/06/2006] [Indexed: 05/13/2023]
Abstract
The mediated electrochemical oxidation (MEO) process with cerium(IV) in nitric acid as the oxidizing medium was employed for the destruction of ethylenediaminetetraacetic acid (EDTA) in batch and continuous feeding modes. A complete mineralization of EDTA to CO(2) and water was achieved. The system parameters studied were the temperature (343, 353 and 368 K), concentration of nitric acid (2, 3 and 4M), Ce(IV) concentration (0.7-0.95 M), aqueous EDTA concentration (67-268 mM) , flow rate of EDTA addition (3.0-7.5 ml/min), and feeding time (30 min and 2h). The batch process CO(2) pattern clearly showed two distinct kinetic regimes. Accordingly the overall CO(2) formation rate constants were evaluated for fast and slow processes using pseudo first-order kinetics. In case of continuous organic feeding, the CO(2) formation rate constant was obtained using a new proposed mathematical procedure based on geometrical progression. The only parameter in the calculations was the first-order rate constant. The theoretical CO(2) evolution pattern was fitted on to the experimental data to obtain the formation rate constants. The activation energy was calculated based on the CO(2) formation constants and presented. The application of mathematical procedure predicted a steady-state attainment of CO(2) evolution for the destruction process during a long-term organic feeding and observed experimentally.
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Affiliation(s)
- S Balaji
- Department of Chemical Engineering, Sunchon National University, 315, Maegok dong, Suncheon-540-742, Jeonnam, Republic of Korea
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Shin DY, Chung SJ, Lee S, Liu X, Furdyna JK. Stable multidomain structures formed in the process of magnetization reversal in GaMnAs ferromagnetic semiconductor thin films. Phys Rev Lett 2007; 98:047201. [PMID: 17358804 DOI: 10.1103/physrevlett.98.047201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Indexed: 05/14/2023]
Abstract
The process of magnetization reversal in ferromagnetic Ga(1-x)Mn(x)As epilayers has been systematically investigated using the planar Hall effect (PHE). Interestingly, we have observed a pronounced asymmetry in the PHE hysteresis when the range of the field scan is restricted to fields below the final magnetization transition. The observed behavior indicates that (a) multidomain structures are formed as M undergoes a reorientation, (b) the domain landscape formed in this way remains stable even after the magnetic field is switched off, and (c) the reorientation of magnetization directions corresponding to the transition points in PHE takes place separately within each domain.
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Affiliation(s)
- D Y Shin
- Physics Department, Korea University, Seoul 136-701, Korea
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Chung SJ, Balaji S, Matheswaran M, Ramesh T, Moon IS. Preliminary studies using hybrid mediated electrochemical oxidation (HMEO) for the removal of persistent organic pollutants (POPs). Water Sci Technol 2007; 55:261-6. [PMID: 17305148 DOI: 10.2166/wst.2007.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study investigates the hybrid mediated electrochemical oxidation (HMEO) technology, which is a newly developed non thermal electrochemical oxidation process for organic destruction. A combination of ozone and ultrasonication processes to the mediated electrochemical oxidation (MEO) process is termed as hybrid mediated electrochemical oxidation. The electrochemical cell was developed in this laboratory. In the present study, several organic compounds, such as phenol, benzoquinone and ethylenediaminetetraacetic acid (EDTA), were chosen as the model organic pollutants to be destructed by the hybrid process. The organic destruction was monitored based on the CO2 generation and total organic carbon (TOC) reduction. The HMEO process was found to be extremely effective in the destruction of all the target organics chosen in this study. The information obtained from this study will provide an insight in adopting this technique for dealing with more recalcitrant organics (POPs).
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Affiliation(s)
- S J Chung
- Department of Chemical Engineering, Sunchon National University, 315, Maegok, Sunchon, Jeonnam 540-742, Korea
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Abstract
Of 67 consecutive patients with spontaneous CSF hypovolemia (SCH), 11 (16.4%) had subdural hematoma (SDH). Patients with SDH were older (p = 0.005), more likely to be male (p = 0.035), and displayed longer time to diagnosis of SCH (p = 0.019) than those without SDH. All patients with SDH showed the findings of pseudo-subarachnoid hemorrhage on CT and responded favorably to epidural blood patches and neurosurgical drainage.
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Affiliation(s)
- S J Chung
- Department of Neurology, Asan Medical Center, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
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Affiliation(s)
- S J Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
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Choi JS, Lee SH, Chung SJ, Yoo KH, Sung KW, Koo HH. Assessment of converting from intravenous to oral administration of cyclosporin A in pediatric allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2006; 38:29-35. [PMID: 16715103 DOI: 10.1038/sj.bmt.1705402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the administration method during a transition period from continuous intravenous (i.v.) infusion to oral administration of cyclosporin A (CsA). Thirty-two pediatric hematopoietic stem cell transplant (HSCT) recipients, between the ages of 8 months and 15.6 years (median 7.1 years) participated in this study. The pharmacokinetic properties of CsA was evaluated during the transition period from i.v. to oral CsA. The daily oral dose of CsA was three times higher than the i.v. dose. Oral dosing began immediately after the continuous infusion was discontinued. Whole-blood CsA concentrations were measured by a monoclonal fluorescence polarization immunoassay (FPIA). The mean+/-s.d. value of bioavailability (F), maximum concentration (C(max)), half-life (t(1/2)) of CsA were 43.1+/-14.4%, 1135.3+/-340.6 ng/ml and 3.1+/-1.2 h, respectively. Mean clearance (CL)+/-s.d. was 480.9+/-103.7, 414.9+/-137.1 and 320+/-51.8 ml/h/kg in patients <20, 20-40 and >40 kg of body weight, respectively. The CsA CL of younger children was significantly greater than for older children (P=0.044). CsA trough levels were maintained within the therapeutic range throughout the transition period. Therefore, our findings suggest that the immediate administration of an oral formulation, after discontinuation of the continuous infusion, would be practical and effective for routine clinical use.
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Affiliation(s)
- J S Choi
- Division of Pharmaceutical Services, Samsung Medical Center, Seoul, Korea
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Yang SG, Kim DD, Chung SJ, Shim CK. Stable bioavailability of cyclosporin A, regardless of food intake, from soft gelatin capsules containing a new self-nanoemulsifying formulation. Int J Clin Pharmacol Ther 2006; 44:233-9. [PMID: 16724578 DOI: 10.5414/cpp44233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM We recently succeeded in preparing soft gelatin capsules containing a new self-nanoemulsifying formulation consisting of cyclosporin A (CsA), triacetin, polyoxyl 40 hydrogenated castor oil, polysorbate 20, medium chain triglycerides and medium chain mono- and diglycerides. The soft capsules containing the new formulation exhibited a significantly improved physical stability in terms of the appearance of the gelatin capsule shells and the composition of the fill mass during long-term storage, compared to commercially available soft capsules containing CsA, in which ethanol was employed as a cosolvent of CsA. In the present study, the influence of a fat-rich meal on the bioavailability of CsA from the soft capsule containing the new formulation (test drug) was evaluated and the results compared to those obtained with a representative soft capsule of CsA. VOLUNTEERS AND METHODS A randomized, open-label, 3-way crossover study was performed in the test capsules and reference soft capsules, in a fasted state or after a fat-rich breakfast. 18 healthy male volunteers received a single dose of the reference formulation (Neoral, Novartis AG, Basel, Switzerland) or test formulation (2 capsules each, 200 mg as CsA) with 240 ml of water with a 1-week washout period between the treatments, after a fat-rich (670 kcal, 45 g fat) breakfast (for the test drug, Treatment A; for the reference drug, Treatment B) or a 12-h fasting (for the test drug, Treatment C). Serial blood samples, collected over a 24-h period after the administration, were assayed for blood CsA concentrations using a specific monoclonal radioimmunoassay. RESULTS The differences in bioavailability parameters (i.e., AUC(0-24h), AUC(0-infinity) and C(max)) between the treatments were within the range of 80-125% of the reference treatment. An analysis of variance (ANOVA) revealed no significant differences (p > 0.05) between subjects, formulations or periods. The 90% confidence intervals (CI) indicated that the differences between the treatments (Treatments A and B, Treatments A and C) were also within the criteria. CONCLUSION These results indicate that the bioavailability of CsA from the test drug is equivalent to reference in the fed state, and is likely to be less influenced by a fat-rich meal. Therefore, the new formulation of CsA using triacetin appears to have an advantage over the commercial soft capsules of CsA using a volatile cosolvent such as ethanol.
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Affiliation(s)
- S G Yang
- Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, Korea
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Januszewski AS, Thomas MC, Chung SJ, Karschimkus CS, Rowley KG, Nelson C, O'Neal D, Wang Z, Best JD, Jenkins AJ. Plasma low-molecular weight fluorescence in type 1 diabetes mellitus. Ann N Y Acad Sci 2005; 1043:655-61. [PMID: 16037289 DOI: 10.1196/annals.1333.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Characteristic tissue fluorescence is associated with advanced glycation end product (AGE) accumulation in experimental diabetes models, but its utility in patients with type 1 diabetes remains to be established. We studied 148 patients with type 1 diabetes and 77 healthy age-matched control subjects. Low-molecular weight (LMW) fluorophore levels were estimated in plasma samples obtained after an overnight fast. Intra- and interassay coefficients of variation were 4.7% and 6.4%, respectively. LMW fluorophore levels were significantly higher in patients with diabetes than in control subjects (6.3 +/- 0.6 AU/mL vs. 4.1 +/- 0.3; P = 0.007). However, all of this difference came from patients with microvascular complications (n = 67, 7.5 +/- 1.3). There was no significant difference in LMW fluorescence between complication-free patients (4.4 +/- 0.2) and control subjects (P > 0.05). On multivariate analysis, LMW fluorophores correlated with measures of renal function (P < 0.05) but not with diabetes per se. In addition, there was no correlation between LMW fluorophores and the markers of oxidative stress or systemic inflammation. Longitudinal and interventional studies are required to determine whether the association between LMW fluorophores and nephropathy is cause or effect.
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Affiliation(s)
- A S Januszewski
- University of Melbourne, Department of Medicine, St. Vincent's Hospital, Princes & Regent Streets, Fitzroy, 3065 Melbourne, Australia
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De TK, Bergey EJ, Chung SJ, Rodman DJ, Bharali DJ, Prasad PN. Polycarboxylic acid nanoparticles for ophthalmic drug delivery: an ex vivo evaluation with human cornea. J Microencapsul 2005; 21:841-55. [PMID: 15799540 DOI: 10.1080/02652040400008515] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In ophthalmic drug delivery, a major problem is retaining an adequate concentration of a therapeutic agent in the pre-corneal area. Polycarboxylic acid carriers such as polyacrylic acid and polyitaconic acid in sub-colloidal, nanoparticulate hydrogel form have a strong potential for sustained release of a drug in ocular delivery. Formulations have been prepared of brimonidine loaded in polycarboxylic (polyacrylic and polyitaconic) acid nanoparticles for potential ophthalmic delivery. These particles were prepared by a reverse micro-emulsion polymerization technique with sizes in the range of 50 nm. The loading efficiencies of the drug brimonidine in the particles were shown to be between 80-85% for polyacrylic acid nanoparticles and between 65-70% for polyitaconic nanoparticles. The loading efficiency was also found to be pH dependent. In a preliminary biocompatibility test, human corneal epithelial cells incubated with polyacrylic acid nanoparticles were found to retain their viability, whereas polyitaconic acid nanoparticles were found to be toxic. Two-photon laser scanning microscopic studies of the fluorescently labelled polyacrylic acid nanoparticles and human cornea shows that they are adhesive on the corneal surface. The polyacrylic acid nanoparticles demonstrated a controlled release of the opthalmological drug (Brimonidine) through the human cornea as compared to that of the commercial formulation, Alphagan.
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Affiliation(s)
- T K De
- Institute for Lasers, Photonics and Biophotonics, Department of Chemistry, SUNY at Buffalo, Buffalo, NY 14260, USA
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Chung SJ, Kwon SU, Kim JS. Headache Caused by Alternating Intracranial Hypertension and Intracranial Hypotension: A Case Report. Cephalalgia 2004; 24:235-7. [PMID: 15009019 DOI: 10.1111/j.1468-2982.2004.00637.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hwa Jung B, Chul Chung B, Chung SJ, Shim CK. Different pharmacokinetics of nicotine following intravenous administration of nicotine base and nicotine hydrogen tartarate in rats. J Control Release 2001; 77:183-90. [PMID: 11733086 DOI: 10.1016/s0168-3659(01)00452-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pharmacokinetics of nicotine was studied in rats following intravenous (i.v.) administration of nicotine base (NB) and nicotine hydrogen tartarate salt (NS) at a nicotine dose of 1 mg/kg. The area under the plasma concentration-time curve (AUC), mean residence time (MRT), systemic clearance (CL), distribution volume at steady state (V(ss)) and terminal plasma half-life (T(1/2,beta)) of nicotine were compared between NB and NS. Compared to NS, NB exhibited higher and sustained plasma nicotine levels, thereby yielding significantly (P<0.05) larger AUC (66.3 vs. 27.7 microg ml/min), MRT (165.7 vs. 58.3 min), T(1/2,beta) (144.2 vs. 51.4 min) and a lower CL (18.3 vs. 46.3 ml/min per kg). The V(ss) was comparable between the two compounds. The metabolic conversion to cotinine from NS was threefold larger than that from NB. The plasma protein binding and distribution to blood cells were comparable between the compounds. The apparent partition coefficient (APC) of NS decreased as a function of its concentration, while that of NB remained nearly constant. Particles of different mean sizes were observed for the 1% (w/v) aqueous solutions of NS (388.6 nm) and NB (123.8 nm). Different metabolism and/or elimination between NB and NS appear to be mainly responsible for their different pharmacokinetics.
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Affiliation(s)
- B Hwa Jung
- Department of Pharmaceutics, College of Pharmacy, Seoul National University, San 56-1, Shinlim-Dong, Kwanak-Gu, 151-742, Seoul, South Korea
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Park HW, Chung SJ, Kuh HJ, Chung SJ, Lee MG, Shim CK. The transport of a hepatoprotective agent, isopropryl 2-(1-3-dithiethane-2-ylidene)-2[N-(4-methyl-thiazole-2-yl) carbamoyl] acetate (YH439), across Caco-2 cell monolayers. Arch Pharm Res 2001; 24:584-9. [PMID: 11794540 DOI: 10.1007/bf02975170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Isopropryl 2-(1-3-dithiethane-2-ylidene)-2[N-(4-methyl-thiazole-2-yl) carbamoyl] acetate (YH439) is currently under phase II clinical trials by the Yuhan Research Center for use as a hepatoprotective agent. Unfortunately, the oral bioavailbility of YH439, which is sparingly soluble in water (i.e., 0.3 microg/ml or 0.91 microM at room temperature), reportedly, is negligible regardless of the dose administered to rats in the 10-300 mg/kg range. The bioavailability of the compound increased up to 24%, when administered in the form of a micellar solution (700 microg/ml or 2.1 mM for YH439) at a dose of 10 mg/kg, suggesting that its limited solubility is associated with its negligible bioavailability. In order to obtain additional information concerning the bioavailability of YH439, the mechanism(s) involved in gastrointestinal (GI) absorption were investigated in the present study. For this purpose, the transport of YH430 across a Caco-2 cell monolayer was measured in a Transwell. A permeability of 4.07 x 10(-5) cm/s was obtained for the absorptive (i.e., apical to basolateral direction) transport of 0.42 pM YH439, implicating that the in vivo GI absorption is nearly complete. The absorptive transport exhibited a slight concentration-dependency with an intrinsic clearance (CLi) of 0.38 microLL/cm2/sec, which accounted for 28.1% of the total intrinsic clearance (i.e., CLi plus the intrinsic clearance for the linear component) of the transport. Thus, saturation of the absorption process appears to be a minor factor in limiting the bioavailability of the compound. The apparent permeability of YH439 from the basolateral to the apical direction (i.e., efflux, 6.67 x 10(-5) cm/s) was comparable to that for absorptive transport, but, interestingly, a more distinct concentration-dependency was observed for this transport. However, the efflux does not appear to influence the bioavailability of the compound, as evidenced by the sufficiently high permeability in the absorption direction. Rather, a reportedly extensive first-pass hepatic metabolism appears to be a principal factor in limiting the bioavailability. In this respect, reducing the first-pass metabolism by some means would lead to a higher bioavailability of the compound. Thus, elevation of the absorption rate of YH439 becomes a necessity. From a practical point of view, increasing the concentration of YH439 in the GI fluid appears to be a feasible way to increase the absorption rate, because the compound is primarily absorbed via a linear mechanism. In summary, the solubilization of YH439, as previously demonstrated for a micellar solution of the compound, appears to be a practical way to increase the oral bioavailability of YH439.
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Affiliation(s)
- H W Park
- College of Pharmacy, Seoul National University, Korea
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Kim YG, Kim B, Kim MK, Chung SJ, Han HJ, Ryu JA, Lee YH, Lee KB, Lee JY, Huh W, Oh HY. Medullary nephrocalcinosis associated with long-term furosemide abuse in adults. Nephrol Dial Transplant 2001; 16:2303-9. [PMID: 11733620 DOI: 10.1093/ndt/16.12.2303] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of furosemide is well recognized as a predisposing factor of nephrocalcinosis in infants. Although furosemide is widely used for various medical conditions in adults, its association with nephrocalcinosis in adults is not well established. METHODS We studied 18 consecutive adult patients (male:female ratio 1:17, age range 21-59 years) who habitually took furosemide to control weight or oedema for long periods of time (range 3-25 years). The daily dose of continuous intake of furosemide ranged from 40 to 2800 mg. Nephrocalcinosis was evaluated using renal ultrasonography (US), computed tomography (CT), or kidney biopsies. RESULTS Renal US and CT revealed bilateral nephrocalcinosis of the medullary pyramids in 15 (83.3%) out of 18 patients. The duration of furosemide abuse was similar between nephrocalcinosis positive (NC(+)) and nephrocalcinosis negative (NC(-)) groups. The daily dose of furosemide was nearly 10 times higher in the NC(+) group (range 120-2800 mg, mean 538 mg) than the NC(-) group (range 40-80 mg, mean 67 mg). All patients showed variable degrees of renal insufficiency and there was no difference in creatinine clearance between the NC(+) and NC(-) groups (P>0.05). Kidney biopsies performed in three patients showed focal tubulo-interstitial fibrosis and atrophy and calcifications were observed in outer medullary tubulo-interstitium. CONCLUSIONS Long-term furosemide abuse can cause medullary nephrocalcinosis in adults, and the risk of developing of nephrocalcinosis seems to be correlated with the daily dose of furosemide. We suggest that long-term furosemide abuse should be suspected in adult patients when medullary nephrocalcinosis is incidentally detected by US or CT.
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Affiliation(s)
- Y G Kim
- Department of Nephrology, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
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Kim YG, Cho MK, Kwon JW, Kim SG, Chung SJ, Shim CK, Lee MG. Effects of cysteine on the pharmacokinetics of intravenous phenytoin in rats with protein-calorie malnutrition. Int J Pharm 2001; 229:45-55. [PMID: 11604257 DOI: 10.1016/s0378-5173(01)00815-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effects of cysteine on the pharmacokinetics of phenytoin and one of its metabolites, 5-(p-hydroxyphenyl)-5-phenylhydantoin (pHPPH) were investigated after intravenous administration of phenytoin, 25 mg/kg, to control rats (4-week fed on 23% casein diet) and rats with PCM (protein-calorie malnutrition, 4-week fed on 5% casein diet) and PCMC (PCM with oral cysteine supplementation, 250 mg/kg, twice daily starting from the fourth week). In rats with PCM and PCMC, the phenytoin hydroxylation (to form pHPPH) activities were significantly smaller (164, 103 and 95.3 pmol/min per mg protein for the control rats, and rats with PCM and PCMC, respectively) than that in control rats. In rats with PCMC, the intrinsic clearance of phenytoin, CL(int) was significantly slower than those in control rats and rats with PCM (0.175, 0.131 and 0.044 ml/min). The above data suggested that the formation of pHPPH could be reduced in rats with PCM and PCMC. This was supported by significantly smaller 24-h urinary excretion of pHPPH (54.7, 35.6 and 32.5% of intravenous dose of phenytoin) in rats with PCM and PCMC than that in control rats. In rats with PCM, the maximum velocity (0.344, 0.203 and 0.196 microg/min), apparent volume of distribution in central compartment (44.4, 65.4 and 72.2 ml/kg) of phenytoin, and total area under the plasma concentration-time curve from time zero to time infinity (609, 714 and 1210 microg min/ml), renal clearance (20.5, 13.4 and 4.67 ml/min per kg) and 24-h urinary excretion (54.7, 35.6 and 32.5% of intravenous dose of phenytoin) of pHPPH were not returned to control levels by cysteine supplementation (rats with PCMC). This could be mainly due to the fact that the phenytoin hydroxylation activity in rats with PCMC was not returned to control level.
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Affiliation(s)
- Y G Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, San 56-1, Shinlim-Dong, Kwanak-Gu, 151-742, Seoul, South Korea
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Shin MS, Chung SJ, Hong KE. Comparative study of the behavioral and neuropsychologic characteristics of tic disorder with or without attention-deficit hyperactivity disorder (ADHD). J Child Neurol 2001; 16:719-26. [PMID: 11669344 DOI: 10.1177/088307380101601003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To study the nature of the comorbidity of tic disorder and attention-deficit hyperactivity disorder (ADHD), patients with tic disorder with or without ADHD were compared on the basis of clinical ratings and neuropsychologic tests. Seventy-eight children were involved in this study: 16 with tic disorder, 19 with comorbid tic disorder and ADHD, 21 with ADHD, and 22 normal controls. Rating scales for ADHD, the Child Behavior Checklist and the Yale Global Tic Severity Scale, were completed in clinical groups. To identify differences in neuropsychologic function among the four groups, the results of seven neuropsychologic tests of global cognitive abilities, attention, information-processing capacity, and fine motor skill were compared. On most behavioral and neuropsychologic tests, the tic disorder with ADHD and the ADHD groups demonstrated similar performance patterns and marked deficits compared with the tic disorder and the control groups, whereas in most of the attention tests, the ADHD group made more commission errors than the tic disorder with ADHD group. These findings suggest that the tic disorder with ADHD group has marked cognitive deficits and behavioral disturbance similar to the ADHD group, whereas the tic disorder group is more similar to the controls. The tic disorder with ADHD group might represent a true comorbidity of the two disorders.
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Affiliation(s)
- M S Shin
- Department of Child Psychiatry, Seoul National University College of Medicine, Korea
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Sung JJ, Lao WC, Lai MS, Li TH, Chan FK, Wu JC, Leung VK, Luk YW, Kung NN, Ching JY, Leung WK, Lau J, Chung SJ. Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies. Gastrointest Endosc 2001; 54:454-8. [PMID: 11577306 DOI: 10.1067/mge.2001.118254] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A "test-and-treat" strategy for H pylori infection has been recommended in Europe and North America as safe and cost-effective for management of patients with dyspepsia. The primary aim of this study was to determine the frequency of gastroesophageal cancer in 2 groups of patients with dyspepsia: those 45 years of age or younger without "alarm" symptoms (low-risk group) and patients over 45 years of age or any patient with "alarm" symptoms (high-risk group). A secondary aim was to determine the frequency of gastric cancer among patients in the low-risk group with or without a positive serology for H pylori. METHODS Patients with persistent dyspepsia were recruited from 4 regional hospitals in Hong Kong. Those in the low-risk group were evaluated for H pylori by using a whole blood serology test; they underwent endoscopy within 1 week. Those in the high-risk group and those taking nonsteroidal anti-inflammatory drugs (NSAIDs) underwent endoscopy promptly. Alarm symptoms were as follows: weight loss (10 or more pounds over 8 weeks), recurrent vomiting, dysphagia, bleeding, or anemia. RESULTS Of 2627 patients enrolled, 1017 were in the low-risk group and 1610 in the high-risk group. Twenty-three patients (0.9%) had gastroesophageal cancers (20 gastric, 3 esophageal). Four patients with cancer (17.4%) were in the low-risk group (3 gastric, 1 esophageal); all except the patient with esophageal cancer had a positive serology test. In the high-risk group, 19 patients had cancer (17 gastric, 2 esophageal). CONCLUSION Gastric cancer is relatively frequent among young patients with dyspepsia who have no alarm features in Hong Kong. This finding raises concerns as to the safety of the "test-and-treat" strategy for the management of patients with dyspepsia in Asia.
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Affiliation(s)
- J J Sung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Chung SJ, Chung S, Lee HS, Kim EJ, Oh KS, Choi HS, Kim KS, Kim YJ, Hahn JH, Kim DH. Mechanistic insight into the inactivation of carboxypeptidase A by alpha-benzyl-2-oxo-1,3-oxazolidine-4-acetic acid, a novel type of irreversible inhibitor for carboxypeptidase A with no stereospecificity. J Org Chem 2001; 66:6462-71. [PMID: 11559199 DOI: 10.1021/jo010421e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
On the basis of the active site topology and enzymic catalytic mechanism of carboxypeptidase A (CPA), a prototypical zinc-containing proteolytic enzyme, alpha-benzyl-2-oxo-1,3-oxazolidine-4-acetic acid (1), was designed as a novel type of mechanism-based inactivator of the enzyme. All four possible stereoisomers of the inhibitor were synthesized in an enantiomerically pure form starting with optically active aspartic acid, and their CPA inhibitory activities were evaluated to find that surprisingly all of the four stereoisomers inhibit CPA in a time dependent manner. The inhibited enzyme did not regain its enzymic activity upon dialysis. The inactivations were prevented by 2-benzylsuccinic acid, a competitive inhibitor that is known to bind the active site of the enzyme. These kinetic results strongly support that the inactivators attach covalently to the enzyme at the active site. The analysis of ESI mass spectral data of the inactivated CPA ascertained the conclusion from the kinetic results. The values of second-order inhibitory rate constants (k(obs)/[I](o)) fall in the range of 1.7-3.6 M(-1) min(-1). The lack of stereospecificity shown in the inactivation led us to propose that the ring cleavage occurs by the nucleophilic attack at the 2-position rather than at the 5-position and the ring opening takes place in an addition-elimination mechanism. The tetrahedral transition state that would be generated in this pathway is thought to be stabilized by the active site zinc ion, which was supported by the PM3 semiemprical calculations. In addition, alpha-benzyl-2-oxo-1,3-oxazolidine-5-acetic acid (18), a structural isomer of 1 was also found to inactivate CPA in an irreversible manner, reinforcing the nucleophilic addition-elimination mechanism. The present study demonstrates that the transition state for the inactivation pathway plays a critical role in determining stereochemistry of the inactivation.
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Affiliation(s)
- S J Chung
- Center for Biofunctional Molecules and Division of Molecular and Life Sciences, Pohang University of Science and Technology, San 31 Hyojadong, Pohang 790-784, Korea
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Abstract
Prevention of cyclosporin A (CsA) adsorption onto the inner surface of Transwell during transport experiments, by the addition of human plasma to the receiver compartment (basolateral side), was investigated. The addition of plasma to a level of 50% (v/v) of the transport medium led to a reduction in the adsorption of CsA (0.1 microM) down to a level of 5%. As a result, the apical to basolateral flux of CsA across the Caco-2 cell monolayer in the presence of 50% (v/v) plasma was estimated to be 2.7-fold higher than that obtained in the absence of plasma. Thus, the adsorption problem can be overcome simply by the addition of an appropriate volume of human plasma to the transport medium. This method appears to be applicable to the routine estimation of CsA flux across epithelial cell monolayers using Transwell.
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Affiliation(s)
- Y J Lee
- Department of Pharmaceutics, College of Pharmacy, Seoul National University San 56-1, Shinlim-dong, Kwanak-gu, Seoul 151-742, South Korea
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Abstract
The objective of this study was to examine whether ion pair complexation with endogenous bile salts in hepatocytes contributes to the preferential biliary excretion of organic cations (OCs). Tributylmethylammonium (TBuMA; mol wt 200) and triethylmethylammonium (TEMA; mol wt 116) were selected as model OCs that exhibit significant and negligible biliary excretion, respectively, in rats. The apparent lipophilicity of TBuMA, but not that of TEMA, was increased by the presence of either rat bile or specific bile salts, suggesting the formation of lipophilic ion pair complexes for TBuMA with bile salts in the liver. The uptake of TBuMA into canalicular liver plasma membrane (cLPM) vesicles, but not that of TEMA, was increased in the presence of bile salts, with a significant increase for both ATP-dependent transport and passive diffusion. The uptake of TBuMA in the presence of the bile salts was inhibited by representative P-glycoprotein (P-gp) substrates and vice versa, suggesting the involvement of P-gp in the canalicular excretion of TBuMA-bile salt complexes in vivo. Increased affinity toward P-gp is suggested as the mechanism responsible for the increased ATP-dependent transport for the ion pair complexes. We propose that ion pair formation with bile slats in hepatocytes may be responsible for the preferential biliary excretion of high-molecular-weight OCs including TBuMA.
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Affiliation(s)
- I S Song
- Department of Pharmaceutics, College of Pharmacy, Seoul National University, Seoul 151-742, Korea
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Abstract
Nasal absorption of procyclidine, a synthetic anticholinergic compound, was investigated in Wistar rats and Beagle dogs. The dosing solution was prepared by dissolving 14C-procyclidine in 50% ethanolic saline. The dosing solution was administered intravenously and intranasally to rats at a dose of 0.6 mg/kg (i.e., 60 microl/kg in the form of a 1% w/v solution), and intravenously, orally and intranasally to dogs at a dose of 0.3 mg/kg (i.e., 6 microl/kg in the form of a 5% w/v solution). Blood samples were taken from an artery of the animals through the catheter for periods of 1200 (for rats) and 1,440 min (for dogs), and the radioactivity in the samples was determined by liquid scintillation counting. The nasal bioavailability of procyclidine in rats and dogs, based on the radioactivity, was calculated to be 81.1 and 98.6%, respectively. In both rats and dogs, the plasma profiles of procyclidine following nasal administration were very close to those following intravenous administration, leading to nearly superimposable profiles between the two protocols. In dogs, nasal administration resulted in significantly higher plasma concentrations during the first 30 min period compared to oral administration, suggesting the superiority of the nasal route over the oral route in terms of a prompt expression of the pharmacological effect of the drug. The results obtained in this study indicate that procyclidine is rapidly and nearly completely absorbed via the nasal route. In conclusion, nasal administration represents a viable alternative to intravenous administration in the case of procyclidine.
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Affiliation(s)
- E J Jang
- Department of Pharmaceutics, College of Pharmacy, Seoul National University, Kwanak-gu, Seoul, Korea
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