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Pollalis D, Georgescu C, Wren JD, Tombulyan G, Leung JM, Lo PA, Bloemhof CM, Lee RH, Bae E, Bailey JK, Pennington BO, Khan AI, Kelly KR, Yeh AK, Sundaram KS, Humayun M, Louie S, Clegg DO, Lee SY. Rescuing Photoreceptors in RPE Dysfunction-Driven Retinal Degeneration: The Role of Small Extracellular Vesicles Secreted from Retinal Pigment Epithelium. bioRxiv 2024:2024.04.09.588773. [PMID: 38645051 PMCID: PMC11030310 DOI: 10.1101/2024.04.09.588773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Dysfunction of the retinal pigment epithelium (RPE) is a common shared pathology in major degenerative retinal diseases despite variations in the primary etiologies of each disease. Due to their demanding and indispensable functional roles throughout the lifetime, RPE cells are vulnerable to genetic predisposition, external stress, and aging processes. Building upon recent advancements in stem cell technology for differentiating healthy RPE cells and recognizing the significant roles of small extracellular vesicles (sEV) in cellular paracrine and autocrine actions, we investigated the hypothesis that the RPE-secreted sEV alone can restore essential RPE functions and rescue photoreceptors in RPE dysfunction-driven retinal degeneration. Our findings support the rationale for developing intravitreal treatment of sEV. We demonstrate that intravitreally delivered sEV effectively penetrate the full thickness of the retina. Xenogenic intraocular administration of human-derived EVs did not induce acute immune reactions in rodents. sEV derived from human embryonic stem cell (hESC)-derived fully differentiated RPE cells, but not sEV-depleted conditioned cell culture media (CCM minus sEV), rescued photoreceptors and their function in a Royal College of Surgeons (RCS) rat model. This model is characterized by photoreceptor death and retinal degeneration resulting from a mutation in the MerTK gene in RPE cells. From the bulk RNA sequencing study, we identified 447 differently expressed genes in the retina after hESC-RPE-sEV treatment compared with the untreated control. Furthermore, 394 out of 447 genes (88%) showed a reversal in expression toward the healthy state in Long-Evans (LE) rats after treatment compared to the diseased state. Particularly, detrimental alterations in gene expression in RCS rats, including essential RPE functions such as phototransduction, vitamin A metabolism, and lipid metabolism were partially reversed. Defective photoreceptor outer segment engulfment due to intrinsic MerTK mutation was partially ameliorated. These findings suggest that RPE-secreted sEV may play a functional role similar to that of RPE cells. Our study justifies further exploration to fully unlock future therapeutic interventions with sEV in a broad array of degenerative retinal diseases.
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Lee M, Kim S, Lee SY, Son JG, Park J, Park S, Yeun J, Lee TG, Im SG, Jeon JS. Hydrophobic surface induced pro-metastatic cancer cells for in vitro extravasation models. Bioact Mater 2024; 34:401-413. [PMID: 38282966 PMCID: PMC10819557 DOI: 10.1016/j.bioactmat.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
In vitro vascularized cancer models utilizing microfluidics have emerged as a promising tool for mechanism study and drug screening. However, the lack of consideration and preparation methods for cancer cellular sources that are capable of adequately replicating the metastatic features of circulating tumor cells contributed to low relevancy with in vivo experimental results. Here, we show that the properties of cancer cellular sources have a considerable impact on the validity of the in vitro metastasis model. Notably, with a hydrophobic surface, we can create highly metastatic spheroids equipped with aggressive invasion, endothelium adhesion capabilities, and activated metabolic features. Combining these metastatic spheroids with the well-constructed microfluidic-based extravasation model, we validate that these metastatic spheroids exhibited a distinct extravasation response to epidermal growth factor (EGF) and normal human lung fibroblasts compared to the 2D cultured cancer cells, which is consistent with the previously reported results of in vivo experiments. Furthermore, the applicability of the developed model as a therapeutic screening platform for cancer extravasation is validated through profiling and inhibition of cytokines. We believe this model incorporating hydrophobic surface-cultured 3D cancer cells provides reliable experimental data in a clear and concise manner, bridging the gap between the conventional in vitro models and in vivo experiments.
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Affiliation(s)
- Minseok Lee
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seunggyu Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Sun Young Lee
- Bioimaging Team, Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Gajeong-ro 267, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - Jin Gyeong Son
- Bioimaging Team, Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Gajeong-ro 267, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - Joonha Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seonghyeon Park
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jemin Yeun
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Tae Geol Lee
- Bioimaging Team, Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Gajeong-ro 267, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - Sung Gap Im
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
- KAIST Institute for the NanoCentury (KINC), Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jessie S. Jeon
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
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Choi MS, Chang JS, Kim K, Kim JH, Kim TH, Kim S, Cha H, Cho O, Choi JH, Kim M, Kim J, Kim TG, Yeo SG, Chang AR, Ahn SJ, Choi J, Kang KM, Kwon J, Koo T, Kim MY, Choi SH, Jeong BK, Jang BS, Jo IY, Lee H, Kim N, Park HJ, Im JH, Lee SW, Cho Y, Lee SY, Chang JH, Chun J, Lee EM, Kim JS, Shin KH, Kim YB. Corrigendum to 'Assessment of deep learning-based auto-contouring on interobserver consistency in target volume and organs-at-risk delineation for breast cancer: Implications for RTQA program in a multi-institutional study' [The Breast 73 (2024) 103599]. Breast 2024; 74:103624. [PMID: 38161095 PMCID: PMC10985602 DOI: 10.1016/j.breast.2023.103624] [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: 01/03/2024] Open
Affiliation(s)
- Min Seo Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Sungmin Kim
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hyejung Cha
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Juree Kim
- Department of Radiation Oncology, Ilsan CHA Medical Center, CHA University School of Medicine, Goyang, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, Republic of Korea
| | - Ki Mun Kang
- Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Taeryool Koo
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Mi Young Kim
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Im
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaehee Chun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eung Man Lee
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; Oncosoft Inc., Seoul, Republic of Korea.
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ahluwalia K, Du Z, Martinez-Camarillo JC, Naik A, Thomas BB, Pollalis D, Lee SY, Dave P, Zhou E, Li Z, Chester C, Humayun MS, Louie SG. Unveiling Drivers of Retinal Degeneration in RCS Rats: Functional, Morphological, and Molecular Insights. Int J Mol Sci 2024; 25:3749. [PMID: 38612560 PMCID: PMC11011632 DOI: 10.3390/ijms25073749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Retinal degenerative diseases, including age-related macular degeneration and retinitis pigmentosa, significantly contribute to adult blindness. The Royal College of Surgeons (RCS) rat is a well-established disease model for studying these dystrophies; however, molecular investigations remain limited. We conducted a comprehensive analysis of retinal degeneration in RCS rats, including an immunodeficient RCS (iRCS) sub-strain, using ocular coherence tomography, electroretinography, histology, and molecular dissection using transcriptomics and immunofluorescence. No significant differences in retinal degeneration progression were observed between the iRCS and immunocompetent RCS rats, suggesting a minimal role of adaptive immune responses in disease. Transcriptomic alterations were primarily in inflammatory signaling pathways, characterized by the strong upregulation of Tnfa, an inflammatory signaling molecule, and Nox1, a contributor to reactive oxygen species (ROS) generation. Additionally, a notable decrease in Alox15 expression was observed, pointing to a possible reduction in anti-inflammatory and pro-resolving lipid mediators. These findings were corroborated by immunostaining, which demonstrated increased photoreceptor lipid peroxidation (4HNE) and photoreceptor citrullination (CitH3) during retinal degeneration. Our work enhances the understanding of molecular changes associated with retinal degeneration in RCS rats and offers potential therapeutic targets within inflammatory and oxidative stress pathways for confirmatory research and development.
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Affiliation(s)
- Kabir Ahluwalia
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Zhaodong Du
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
| | - Juan Carlos Martinez-Camarillo
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Aditya Naik
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Biju B. Thomas
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Dimitrios Pollalis
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Physiology & Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Priyal Dave
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Eugene Zhou
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Zeyang Li
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Catherine Chester
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
| | - Mark S. Humayun
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Stan G. Louie
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.); (P.D.); (E.Z.); (Z.L.); (C.C.)
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (Z.D.); (J.C.M.-C.); (B.B.T.); (D.P.); (S.Y.L.); (M.S.H.)
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Leung J, Pollalis D, Nair GKG, Bailey JK, Pennington BO, Khan AI, Kelly KR, Yeh AK, Sundaram KS, Clegg DO, Peng CC, Xu L, Lee SY. Isolation and Characterization of Extracellular Vesicles Through Orthogonal Approaches for the Development of Intraocular EV Therapy. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 38466285 DOI: 10.1167/iovs.65.3.6] [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] [Indexed: 03/12/2024] Open
Abstract
Purpose Isolating extracellular vesicles (EVs) with high yield, replicable purity, and characterization remains a bottleneck in the development of EV therapeutics. To address these challenges, the current study aims to establish the necessary framework for preclinical and clinical studies in the development of stem cell-derived intraocular EV therapeutics. Methods Small EVs (sEVs) were separated from the conditioned cell culture medium (CCM) of the human embryogenic stem cell-derived fully polarized retinal pigment epithelium (hESC-RPE-sEV) by a commercially available microfluidic tangential flow filtration (TFF) device ExoDisc (ED) or differential ultracentrifugation (dUC). The scaling and concentration capabilities and purity of recovered sEVs were assessed. Size, number, and surface markers of sEVs were determined by orthogonal approaches using multiple devices. Results ED yielded higher numbers of sEVs, ranging from three to eight times higher depending on the measurement device, compared to dUC using the same 5 mL of CCM input. Within the same setting, the purity of ED-recovered hESC-RPE-sEVs was higher than that for dUC-recovered sEVs. ED yielded a higher concentration of particles, which is strongly correlated with the input volume, up to 10 mL (r = 0.98, P = 0.016). Meanwhile, comprehensive characterization profiles of EV surface markers between ED- and dUC-recovered hESC-RPE-sEVs were compatible. Conclusions Our study supports TFF as a valuable strategy for separating sEVs for the development of intraocular EV therapeutics. However, there is a growing need for diverse devices to optimize TFF for use in EV preparation. Using orthogonal approaches in EV characterization remains ideal for reliably characterizing heterogeneous EV.
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Affiliation(s)
- Justin Leung
- USC Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, United States
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California, United States
| | - Dimitrios Pollalis
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California, United States
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Gopa K G Nair
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California, United States
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Jeffrey K Bailey
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Britney O Pennington
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Amir I Khan
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Kaitlin R Kelly
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Ashley K Yeh
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- College of Creative Studies, Biology, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Kartik S Sundaram
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Biomolecular Science and Engineering, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Dennis O Clegg
- Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, United States
- Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California, United States
- Biomolecular Science and Engineering, University of California, Santa Barbara, Santa Barbara, California, United States
| | - Chen-Ching Peng
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
- Children's Hospital Los Angeles Vision Center, Los Angeles, California, United States
| | - Liya Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
- Children's Hospital Los Angeles Vision Center, Los Angeles, California, United States
| | - Sun Young Lee
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California, United States
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Ha SC, Nam E, Lee SY. Perceived Risk of Solitary Death and Depressive Symptoms Among Older Adults Living Alone in Seoul: Can Structural and Functional Social Support Buffer the Impact? J Appl Gerontol 2024; 43:251-260. [PMID: 37990529 DOI: 10.1177/07334648231211452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Although older adults living alone are at a greater risk of solitary death, there is a dearth of literature in this area. Using the 2018 Seoul Elderly Survey, we investigated the extent to which older adults living alone in Seoul perceive the risk of solitary death and examined the association between the perceived risk of solitary death and depressive symptoms. Additionally, we explored the role of structural and functional support in that association as a buffering factor. Results showed that more than half of the older adults living alone in Seoul perceived that they could be victims of solitary death. The perceived risk of solitary death among older adults living alone was independently associated with depressive symptoms. Additionally, the structural aspect of social support moderated the impact of the perceived risk of solitary death on depressive symptoms. Interventions that enhance the structural aspect of social support should be primarily considered.
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Affiliation(s)
- Seok Cheol Ha
- Policy Research Department, Seoul Welfare Foundation, Mapo-Gu, Seoul, Korea
| | - Eunji Nam
- Department of Social Welfare, Incheon National University, Yeonsu-Gu, Inchoen, Korea
| | - Sun Young Lee
- Department of Social Welfare, Gangneung-Wonju National University, Wonju-Si, Kangwon, Korea
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Pollalis D, Calle AG, Martinez-Camarillo JC, Ahluwalia K, Hinman C, Mitra D, Lebkowski J, Lee SY, Thomas BB, Ahmed F, Chan V, Junge JA, Fraser S, Louie S, Humayun M. Scaling up polarized RPE cell supernatant production on parylene membrane. Exp Eye Res 2024; 240:109789. [PMID: 38242423 DOI: 10.1016/j.exer.2024.109789] [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: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
Age-related macular degeneration (AMD), a leading cause of vision loss, primarily arises from the degeneration of retinal pigment epithelium (RPE) and photoreceptors. Current therapeutic options for dry AMD are limited. Encouragingly, cultured RPE cells on parylene-based biomimetic Bruch's membrane demonstrate characteristics akin to the native RPE layer. In this study, we cultivated human embryonic stem cell-derived polarized RPE (hESC-PRPE) cells on parylene membranes at both small- and large-scale settings, collecting conditioned supernatant, denoted as PRPE-SF. We conducted a comprehensive analysis of the morphology of the cultured hESC-RPE cells and the secreted growth factors in PRPE-SF. To evaluate the in vivo efficacy of these products, the product was administered via intravitreal injections of PRPE-SF in immunodeficient Royal College of Surgeons (iRCS) rats, a model for retinal degeneration. Our study not only demonstrated the scalability of PRPE-SF production while maintaining RPE cell phenotype but also showed consistent protein concentrations between small- and large-scale batches. We consistently identified 10 key factors in PRPE-SF, including BMP-7, IGFBP-2, IGFBP-3, IGFBP-4, IGFBP-6, MANF, PEDF, PDGF-AA, TGFβ1, and VEGF. Following intravitreal administration of PRPE-SF, we observed a significant increase in the thickness of the outer nuclear layer (ONL) and photoreceptor preservation in iRCS rats. Furthermore, correlation analysis revealed that IGFBP-3, IGFBP-4, MANF, PEDF, and TGFβ1 displayed positive associations with in vivo bioactivity, while GDF-15 exhibited a negative correlation. Overall, this study highlights the feasibility of scaling up PRPE-SF production on parylene membranes without compromising its essential constituents. The outcomes of PRPE-SF administration in an animal model of retinal degeneration present substantial potential for photoreceptor preservation. Moreover, the identification of candidate surrogate potency markers, showing strong positive associations with in vivo bioactivity, lays a solid foundation for the development of a promising therapeutic intervention for retinal degenerative diseases.
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Affiliation(s)
- Dimitrios Pollalis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Alejandra Gonzalez Calle
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Juan Carlos Martinez-Camarillo
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Kabir Ahluwalia
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; USC Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Cassidy Hinman
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Debbie Mitra
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Jane Lebkowski
- Regenerative Patch Technologies LLC, Menlo Park, CA 94028, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Biju B Thomas
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Faizah Ahmed
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Victoria Chan
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Jason A Junge
- Translational Imaging Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Scott Fraser
- Translational Imaging Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Stan Louie
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; USC Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Mark Humayun
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA.
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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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9
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Choi MS, Chang JS, Kim K, Kim JH, Kim TH, Kim S, Cha H, Cho O, Choi JH, Kim M, Kim J, Kim TG, Yeo SG, Chang AR, Ahn SJ, Choi J, Kang KM, Kwon J, Koo T, Kim MY, Choi SH, Jeong BK, Jang BS, Jo IY, Lee H, Kim N, Park HJ, Im JH, Lee SW, Cho Y, Lee SY, Chang JH, Chun J, Lee EM, Kim JS, Shin KH, Kim YB. Assessment of deep learning-based auto-contouring on interobserver consistency in target volume and organs-at-risk delineation for breast cancer: Implications for RTQA program in a multi-institutional study. Breast 2024; 73:103599. [PMID: 37992527 PMCID: PMC10700624 DOI: 10.1016/j.breast.2023.103599] [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: 09/18/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To quantify interobserver variation (IOV) in target volume and organs-at-risk (OAR) contouring across 31 institutions in breast cancer cases and to explore the clinical utility of deep learning (DL)-based auto-contouring in reducing potential IOV. METHODS AND MATERIALS In phase 1, two breast cancer cases were randomly selected and distributed to multiple institutions for contouring six clinical target volumes (CTVs) and eight OAR. In Phase 2, auto-contour sets were generated using a previously published DL Breast segmentation model and were made available for all participants. The difference in IOV of submitted contours in phases 1 and 2 was investigated quantitatively using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). The qualitative analysis involved using contour heat maps to visualize the extent and location of these variations and the required modification. RESULTS Over 800 pairwise comparisons were analysed for each structure in each case. Quantitative phase 2 metrics showed significant improvement in the mean DSC (from 0.69 to 0.77) and HD (from 34.9 to 17.9 mm). Quantitative analysis showed increased interobserver agreement in phase 2, specifically for CTV structures (5-19 %), leading to fewer manual adjustments. Underlying IOV differences causes were reported using a questionnaire and hierarchical clustering analysis based on the volume of CTVs. CONCLUSION DL-based auto-contours improved the contour agreement for OARs and CTVs significantly, both qualitatively and quantitatively, suggesting its potential role in minimizing radiation therapy protocol deviation.
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Affiliation(s)
- Min Seo Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Sungmin Kim
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hyejung Cha
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Juree Kim
- Department of Radiation Oncology, Ilsan CHA Medical Center, CHA University School of Medicine, Goyang, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, Republic of Korea
| | - Ki Mun Kang
- Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Taeryool Koo
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Mi Young Kim
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Im
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaehee Chun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eung Man Lee
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
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10
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Basak I, Wicky HE, McDonald KO, Xu JB, Palmer JE, Best HL, Lefrancois S, Lee SY, Schoderboeck L, Hughes SM. Correction: A lysosomal enigma CLN5 and its significance in understanding neuronal ceroid lipofuscinosis. Cell Mol Life Sci 2024; 81:45. [PMID: 38236309 PMCID: PMC10796411 DOI: 10.1007/s00018-023-05047-5] [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] [Accepted: 11/10/2023] [Indexed: 01/19/2024]
Affiliation(s)
- I Basak
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - H E Wicky
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - K O McDonald
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - J B Xu
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - J E Palmer
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - H L Best
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
- School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, CF10 3AX, Wales, UK
| | - S Lefrancois
- Centre INRS-Institut Armand-Frappier, INRS, H7V 1B7, Laval, Canada
- Department of Anatomy and Cell Biology, McGill University, H3A 2B2, Montreal, Canada
| | - S Y Lee
- Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, 66160, Kansas City, KS, USA
| | - L Schoderboeck
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand
| | - S M Hughes
- Neurodegenerative and Lysosomal Disease Laboratory, Department of Biochemistry, School of Biomedical Sciences, Brain Health Research Centre, University of Otago, 710 Cumberland Street, Dunedin, 9016, New Zealand.
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11
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Kim JC, Choi MG, Park JS, Lee SY, Park CW, Chung BY, Misery L, Kim HO. Sensitive skin is associated with contact sensitization and decreased nociceptive threshold. J Eur Acad Dermatol Venereol 2024; 38:e125-e127. [PMID: 37556672 DOI: 10.1111/jdv.19398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Affiliation(s)
- J C Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - M G Choi
- Department of Computer Science, Kwangwoon University, Seoul, South Korea
| | - J S Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - S Y Lee
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - C W Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - B Y Chung
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - H O Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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12
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Hwang IY, Woo GU, Lee SY, Yoo SH, Kim KH, Kim MS, Shin J, Jeong HJ, Jang MS, Baek SK, Jung EH, Lee DW, Cho B. Home-based supportive care in advanced cancer: systematic review. BMJ Support Palliat Care 2023:spcare-2023-004721. [PMID: 38160048 DOI: 10.1136/spcare-2023-004721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study systematically reviewed the literature on the effect of home-based supportive care (HbSC) programmes on the quality of life (QoL) of patients with advanced cancer. METHODS The research question 'Do home-based supportive care programmes for patients with advanced cancer improve their QoL?' was addressed. After registering the plan with PROSPERO (CRD42022341237), literature published from 1 January 1990 to 30 May 2023 was searched on PubMed, Embase, Cochrane database, CINAHL and Web of Science, and reviewed for inclusion based on predefined criteria. This review only included trial studies published in English. RESULTS Of 5,276 articles identified, 17 studies were judged suitable for inclusion in this review. The components of HbSC programmes included home visits, patient and caregiver education, home nursing, psychotherapy, exercise, telephone consultation, and multidisciplinary team meetings. Nine studies reported improvements in QoL, including social functioning, emotional functioning, and subjective QoL. CONCLUSION HbSC programmes appear to enable the improvement of the QoL of patients with advanced cancer. The area of QoL that shows improvement could vary depending on the HbSC components. More studies that address HbSC programmes are needed to select patients at the proper time and provide suitable programmes for patients to benefit most.
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Affiliation(s)
- In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Familly Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Go-Un Woo
- Department of Internal Medicine, Dongguk University Medical Center, Goyang, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Jin Jeong
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Seol Jang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Wook Lee
- Department of Occupational and Environmental Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Familly Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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13
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Tran TT, Lee G, Huh YH, Chung KH, Lee SY, Park KH, Kwon SH, Kook MS, Chun JS, Koh JT, Ryu JH. Disruption of cholesterol homeostasis triggers periodontal inflammation and alveolar bone loss. Exp Mol Med 2023; 55:2553-2563. [PMID: 38036731 PMCID: PMC10767058 DOI: 10.1038/s12276-023-01122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 12/02/2023] Open
Abstract
Oral diseases exhibit a significant association with metabolic syndrome, including dyslipidemia. However, direct evidence supporting this relationship is lacking, and the involvement of cholesterol metabolism in the pathogenesis of periodontitis (PD) has yet to be determined. In this study, we showed that high cholesterol caused periodontal inflammation in mice. Cholesterol homeostasis in human gingival fibroblasts was disrupted by enhanced uptake through C-X-C motif chemokine ligand 16 (CXCL16), upregulation of cholesterol hydroxylase (CH25H), and the production of 25-hydroxycholesterol (an oxysterol metabolite of CH25H). Retinoid-related orphan receptor α (RORα) mediated the transcriptional upregulation of inflammatory mediators; consequently, PD pathogenesis mechanisms, including alveolar bone loss, were stimulated. Our collective data provided direct evidence that hyperlipidemia is a risk factor for PD and supported that inhibition of the CXCL16-CH25H-RORα axis is a potential treatment mechanism for PD as a systemic disorder manifestation.
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Affiliation(s)
- Thanh-Tam Tran
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Gyuseok Lee
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Yun Hyun Huh
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Korea
| | - Ki-Ho Chung
- Department of Preventive and Public Health Dentistry, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Sun Young Lee
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Ka Hyon Park
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Seung Hee Kwon
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Jang-Soo Chun
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Korea
| | - Jeong-Tae Koh
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Je-Hwang Ryu
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju, Korea.
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Korea.
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14
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Kim SJ, Lee SH, Quang BD, Tran TT, Kim YG, Ko J, Choi WY, Lee SY, Ryu JH. Avenanthramide-C Shows Potential to Alleviate Gingival Inflammation and Alveolar Bone Loss in Experimental Periodontitis. Mol Cells 2023; 46:627-636. [PMID: 37641936 PMCID: PMC10590710 DOI: 10.14348/molcells.2023.0109] [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: 07/05/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
Periodontal disease is a chronic inflammatory disease that leads to the gradual destruction of the supporting structures of the teeth including gums, periodontal ligaments, alveolar bone, and root cementum. Recently, interests in alleviating symptoms of periodontitis (PD) using natural compounds is increasing. Avenanthramide-C (Avn-C) is a polyphenol found only in oats. It is known to exhibit various biological properties. To date, the effect of Avn-C on PD pathogenesis has not been confirmed. Therefore, this study aimed to verify the protective effects of Avn-C on periodontal inflammation and subsequent alveolar bone erosion in vitro and in vivo. Upregulated expression of catabolic factors, such as matrix metalloproteinase 1 (MMP1), MMP3, interleukin (IL)-6, IL-8, and COX2 induced by lipopolysaccharide and proinflammatory cytokines, IL-1β, and tumor necrosis factor α (TNF-α), was dramatically decreased by Avn-C treatment in human gingival fibroblasts and periodontal ligament cells. Moreover, alveolar bone erosion in the ligature-induced PD mouse model was ameliorated by intra-gingival injection of Avn-C. Molecular mechanism studies revealed that the inhibitory effects of Avn-C on the upregulation of catabolic factors were mediated via ERK (extracellular signal-regulated kinase) and NF-κB pathway that was activated by IL-1β or p38 MAPK and JNK signaling that was activated by TNF-α, respectively. Based on this study, we recommend that Avn-C may be a new natural compound that can be applied to PD treatment.
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Affiliation(s)
- Su-Jin Kim
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Se Hui Lee
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Binh Do Quang
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Thanh-Tam Tran
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Young-Gwon Kim
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Jun Ko
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Weon-Young Choi
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Sun Young Lee
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
| | - Je-Hwang Ryu
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju 61186, Korea
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Do NT, Lee SY, Lee YS, Shin C, Kim D, Lee TG, Son JG, Kim SH. Time-sequential fibroblast-to-myofibroblast transition in elastin-variable 3D hydrogel environments by collagen networks. Biomater Res 2023; 27:103. [PMID: 37848974 PMCID: PMC10583321 DOI: 10.1186/s40824-023-00439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Fibrosis plays an important role in both normal physiological and pathological phenomena as fibroblasts differentiate to myofibroblasts. The activation of fibroblasts is determined through interactions with the surrounding extracellular matrix (ECM). However, how this fibroblast-to-myofibroblast transition (FMT) is regulated and affected by elastin concentration in a three-dimensional (3D) microenvironment has not been investigated. METHODS We developed an insoluble elastin-gradient 3D hydrogel system for long-lasting cell culture and studied the molecular mechanisms of the FMT in embedded cells by nanoflow LC-MS/MS analysis along with validation through real-time PCR and immunofluorescence staining. RESULTS By optimizing pH and temperature, four 3D hydrogels containing fibroblasts were successfully fabricated having elastin concentrations of 0, 20, 50, and 80% in collagen. At the low elastin level (20%), fibroblast proliferation was significantly increased compared to others, and in particular, the FMT was clearly observed in this condition. Moreover, through mass spectrometry of the hydrogel environment, it was confirmed that differentiation proceeded in two stages. In the early stage, calcium-dependent proteins including calmodulin and S100A4 were highly associated. On the other hand, in the late stage after several passages of cells, distinct markers of myofibroblasts were presented such as morphological changes, increased production of ECM, and increased α-SMA expression. We also demonstrated that the low level of elastin concentration induced some cancer-associated fibroblast (CAF) markers, including PDGFR-β, and fibrosis-related disease markers, including THY-1. CONCLUSION Using our developed 3D elastin-gradient hydrogel system, we evaluated the effect of different elastin concentrations on the FMT. The FMT was induced even at a low concentration of elastin with increasing CAF level via calcium signaling. With this system, we were able to analyze varying protein expressions in the overall FMT process over several cellular passages. Our results suggest that the elastin-gradient system employing nonlinear optics imaging provides a good platform to study activated fibroblasts interacting with the microenvironment, where the ECM plays a pivotal role.
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Affiliation(s)
- Nhuan T Do
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
- BioMedical Measurement, University of Science and Technology, 217 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
| | - Sun Young Lee
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
| | - Yoon Seo Lee
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
| | - ChaeHo Shin
- Interdisciplinary Materials Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
- Nanoconvergence Measurement, University of Science and Technology, 217 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
| | - Daeho Kim
- Bruker Nano Surface & Metrology, Bruker Korea, Seongnam, 13493, Republic of Korea
| | - Tae Geol Lee
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
- Nanoconvergence Measurement, University of Science and Technology, 217 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea
| | - Jin Gyeong Son
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea.
| | - Se-Hwa Kim
- Safety Measurement Institute, Korea Research Institute of Standards and Science, 267 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea.
- BioMedical Measurement, University of Science and Technology, 217 Gajeong-Ro, Yuseong-Gu, Daejeon, 34113, Republic of Korea.
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Ko JI, Choi SJ, Yoo SH, Cho B, Kim MS, Kim KH, Lee SY. Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study. Muscle Nerve 2023; 68:451-459. [PMID: 37540049 DOI: 10.1002/mus.27952] [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: 05/12/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION/AIMS Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. METHODS We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. RESULTS In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). DISCUSSION Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.
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Affiliation(s)
- Jung-In Ko
- Department of Emergency Medicine, National Medical Center, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Pyo JH, Lee SY, Lee IJ, Kim SM, Kim JW. Beneficial Role of Multi-Disciplinary Treatment for Anaplastic Thyroid Cancer with Initial Distant Metastasis. Int J Radiat Oncol Biol Phys 2023; 117:e616-e617. [PMID: 37785850 DOI: 10.1016/j.ijrobp.2023.06.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Anaplastic thyroid cancer (ATC) is a rare, highly aggressive tumor, with median survival around 5 months. Approximately half of the ATC patients presents with distant metastases at diagnosis, showing even more devastating prognosis, yet no outcome analysis had been reported. In this study, we aim to evaluate the clinical outcome of M1 ATC patients, and to define the group of patients who would benefit from local treatment based on multi-disciplinary approach. MATERIALS/METHODS A total of 133 histology-confirmed ATC patients underwent protocol-based multidisciplinary treatment including surgery and chemoradiotherapy (CRT) between May 2016 and January 2022. Patients received intensity-modulated radiotherapy of 30 fractions concurrently with paclitaxel on days 1, 8 and 15 every 4 weeks, and lenvatinib was added upon progression. After 18 fractions of CRT, interim response analysis using modified RECIST was conducted for adaptive treatment planning. We reviewed 58 patients with distant metastasis at diagnosis (stage IVC). Overall survival (OS) and progression-free survival (PFS) were measured from the day of diagnosis. RESULTS Most common metastatic site was lung (91.4%), followed by bone (31.0%) and brain (5.2%). Lenvatinib was added for 35 patients after any sign of progression. Fourteen patients received upfront surgery (16 debulking and 5 total) followed by adjuvant CRT in 16 patients. Thirty-one patients received upfront CRT with 2 patients receiving total resection after sufficient down-staging. Six (10%) patients could not complete radiotherapy but continued receiving systemic treatment. The median follow-up was 5.9 months. The median and 1-year OS were 6.2 months and 20.5%, and PFS were 3.7 months and 3.5%. Total RT dose over 60 Gy significantly improved median OS (7.5 vs 4.1 months, p = 0.012) and median PFS (4.4 vs 3.0, p = 0.010). Patients with less than 10 initial metastatic tumors showed better median OS (9.1 vs 4.6 months, p = 0.002) but not PFS (5.1 vs 3.6, p = 0.485). At interim analysis, early response (CR, PR and SD) of primary tumor was not associated with survival, while progression of distant metastases showed significantly worse median OS (9.8 vs 4.6 months, p = 0.001). More than 10 metastatic tumors (HR 2.73, 95% CI 1.32-5.66) and stable metastasis at interim analysis (HR 2.39, 95% CI 1.04-5.48) remained as significant factor in the multivariable cox regression analysis. Median OS and PFS of patients with less than 10 metastases showing no progression at interim analysis were 9.1 months, and 5.1 months. CONCLUSION Local treatment combined with chemotherapy for M1 ATC patients showed outcome comparable to those of non-metastatic ATC results. Active local treatment should be considered especially for patients with less than 10 metastases, and patients without distant progression in early response evaluation.
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Affiliation(s)
- J H Pyo
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S Y Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - I J Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S M Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J W Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
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Lee E, Kim S, Lee SY, Jeong J, Bang J, Oh J, Shin SD, Kim NJ, Choe PG, Oh MD. Risk Factors for the Prescription of Ineffective Antiviral Candidates for COVID-19 During the Early Pandemic Period in Korea. J Korean Med Sci 2023; 38:e280. [PMID: 37698205 PMCID: PMC10497349 DOI: 10.3346/jkms.2023.38.e280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although the evidence of treatment for coronavirus disease 2019 (COVID-19) changed rapidly, little is known about the patterns of potential pharmacological treatment during the early period of the COVID-19 pandemic in Korea and the risk factors for ineffective prescription. METHODS Using claims data from the Korean National Health Insurance System, this retrospective cohort study included admission episodes for COVID-19 from February to December 2020. Ineffective antiviral prescriptions for COVID-19 were defined as lopinavir/ritonavir (LPN/r) and hydroxychloroquine (HCQ) prescribed after July 2020, according to the revised National Institute of Health COVID-19 treatment guidelines. Factors associated with ineffective prescriptions, including patient and hospital factors, were identified by multivariate logistic regression analysis. RESULTS Of the 15,723 COVID-19 admission episodes from February to June 2020, 4,183 (26.6%) included prescriptions of LPN/r, and 3,312 (21.1%) included prescriptions of HCQ. Of the 48,843 admission episodes from July to December 2020, after the guidelines were revised, 2,258 (4.6%) and 182 (0.4%) included prescriptions of ineffective LPN/r and HCQ, respectively. Patient factors independently associated with ineffective antiviral prescription were older age (adjusted odds ratio [aOR] per 10-year increase, 1.17; 95% confidence interval [CI], 1.14-1.20) and severe condition with an oxygen requirement (aOR, 2.49; 95% CI, 2.24-2.77). The prescription of ineffective antiviral drugs was highly prevalent in primary and nursing hospitals (aOR, 40.58; 95% CI, 31.97-51.50), public sector hospitals (aOR, 15.61; 95% CI, 12.76-19.09), and regions in which these drugs were highly prescribed before July 2020 (aOR, 10.65; 95% CI, 8.26-13.74). CONCLUSION Ineffective antiviral agents were prescribed to a substantial number of patients during the first year of the COVID-19 pandemic in Korea. Treatment with these ineffective drugs tended to be prolonged in severely ill patients and in primary and public hospitals.
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Affiliation(s)
- Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seungyeon Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
- College of Pharmacy, Dankook University, Cheonan, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jihwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Thenappan A, Nanda A, Lee CS, Lee SY. Retinitis Pigmentosa Masquerades: Case Series and Review of the Literature. J Clin Med 2023; 12:5620. [PMID: 37685687 PMCID: PMC10489117 DOI: 10.3390/jcm12175620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Retinitis pigmentosa (RP) displays a broad range of phenotypic variations, often overlapping with acquired retinal diseases. Timely recognition and differentiation of RP masquerades is paramount due to the treatable nature of many such conditions. This review seeks to present examples of pseudo-RP cases and provide a comprehensive overview of RP masquerades. We first present two pseudo-RP cases, including comprehensive clinical histories and multimodal retinal imaging, to highlight the important role of accurate diagnoses that subsequently steered effective intervention. Subsequently, we conduct an in-depth review of RP masquerades to provide valuable insights into their key distinguishing features and management considerations. The recent approval of ocular gene therapy and the development of investigational gene-based treatments have brought genetic testing to the forefront for RP patients. However, it is important to note that genetic testing currently lacks utility as a screening tool for inherited retinal diseases (IRDs), including RP. The integrity of a precise clinical assessment remains indispensable for the diagnosis of both RP and RP masquerade conditions, thereby facilitating prompt intervention and appropriate management strategies.
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Affiliation(s)
- Abinaya Thenappan
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arjun Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Chang Sup Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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Lee SY, Kim EO, Jang D, Hwang S, Rhee KJ, Yun M. Method to Determine the Optimal Aptamer-to-Bead Ratio by Using Flow Cytometry. Scientifica (Cairo) 2023; 2023:5842652. [PMID: 37469438 PMCID: PMC10353897 DOI: 10.1155/2023/5842652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
Research on the effective attachment of aptamers to beads, which is essential for using aptamers, has made relatively little progress. Here, we demonstrate a new method based on flow cytometry to determine the optimal aptamer-to-bead ratio for aptamer immobilization. The fluorescence intensity increased with a gradual two-fold increase in the aptamer fluorescence concentration, peaked at an aptamer-to-bead ratio of 2.56 × 105, and tended to decrease at higher ratios. A similar pattern was observed in an additional analysis using fluorescence microscopy. However, measurement of the free aptamer concentration after the aptamer-bead conjugation reaction revealed a large aptamer loss compared to the 1.28 × 105 aptamer-bead ratio. In addition, the binding efficiency of the aptamer/bead to the target was highest at the aptamer-to-bead ratio of 1.28 × 105. Taken together, our data suggest that the proposed method is the best and easiest for determining the optimal aptamer-to-bead ratio.
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Affiliation(s)
- Sun Young Lee
- Lab of Functional Aptamer, Department of Bioindustry and Bioresource Engineering, College of Life Sciences, Sejong University, Seoul, Republic of Korea
- Resource Upcycling and Discovery Research Institute, Sejong University, Seoul, Republic of Korea
| | - Eun-Ok Kim
- Medical Science Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Daehyuk Jang
- Lab of Functional Aptamer, Department of Bioindustry and Bioresource Engineering, College of Life Sciences, Sejong University, Seoul, Republic of Korea
- Resource Upcycling and Discovery Research Institute, Sejong University, Seoul, Republic of Korea
| | - Soonjae Hwang
- Department of Biochemistry, Lee Gil Ya Cancer and Diabetes Institute, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Ki-Jong Rhee
- Department of Biomedical Laboratory Science, College of Software & Digital Healthcare Convergence, Yonsei University MIRAE Campus, Wonju, Gangwon-do, Republic of Korea
| | - Miyong Yun
- Lab of Functional Aptamer, Department of Bioindustry and Bioresource Engineering, College of Life Sciences, Sejong University, Seoul, Republic of Korea
- Resource Upcycling and Discovery Research Institute, Sejong University, Seoul, Republic of Korea
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Hwang IY, Han Y, Kim MS, Kim KH, Cho B, Choi W, Kim Y, Yoo SH, Lee SY. Preferred versus Actual Place of Care and Factors Associated with Home Discharge among Korean Patients with Advanced Cancer: A Retrospective Cohort Study. Healthcare (Basel) 2023; 11:1939. [PMID: 37444773 DOI: 10.3390/healthcare11131939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Respecting the preference for a place of care is essential for advance care planning in patients with advanced cancer. This retrospective study included adult patients with cancer referred to an inpatient palliative care consultation team at a tertiary acute care hospital in South Korea between April 2019 and December 2020. Patients' preference for place of care and demographic and clinical factors were recorded, and the actual discharge locations were categorized as home or non-home. Patients discharged home but with unintended hospital visits within 2 months were also investigated. Of the 891 patients referred to the palliative care consultation team, 210 (23.6%) preferred to be discharged home. Among them, 113 (53.8%) were discharged home. No significant differences were found between patients who preferred home discharge and those who did not. Home discharge was higher among female patients (p = 0.04) and lower in those with poor oral intake (p < 0.001) or dyspnea (p = 0.02). Of the 113 patients discharged home, 37 (32.8%) had unintended hospital visits within 2 months. Approximately one-quarter of hospitalized patients with advanced cancer preferred to be discharged home, but only half of them received the home discharge. To meet patients' preferences for end-of-life care, individual care planning considering relevant factors is necessary.
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Affiliation(s)
- In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Yohan Han
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Wonho Choi
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Ahluwalia K, Martinez-Camarillo JC, Thomas BB, Naik A, Gonzalez-Calle A, Pollalis D, Lebkowski J, Lee SY, Mitra D, Louie SG, Humayun MS. Polarized RPE Secretome Preserves Photoreceptors in Retinal Dystrophic RCS Rats. Cells 2023; 12:1689. [PMID: 37443724 PMCID: PMC10340490 DOI: 10.3390/cells12131689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Retinal degenerative diseases, including age-related macular degeneration (AMD) and retinitis pigmentosa, lack effective therapies. Conventional monotherapeutic approaches fail to target the multiple affected pathways in retinal degeneration. However, the retinal pigment epithelium (RPE) secretes several neurotrophic factors addressing diverse cellular pathways, potentially preserving photoreceptors. This study explored human embryonic stem cell-derived, polarized RPE soluble factors (PRPE-SF) as a combination treatment for retinal degeneration. PRPE-SF promoted retinal progenitor cell survival, reduced oxidative stress in ARPE-19 cells, and demonstrated critical antioxidant and anti-inflammatory effects for preventing retinal degeneration in the Royal College of Surgeons (RCS) rat model. Importantly, PRPE-SF treatment preserved retinal structure and scotopic b-wave amplitudes, suggesting therapeutic potential for delaying retinal degeneration. PRPE-SF is uniquely produced using biomimetic membranes for RPE polarization and maturation, promoting a protective RPE secretome phenotype. Additionally, PRPE-SF is produced without animal serum to avoid immunogenicity in future clinical development. Lastly, PRPE-SF is a combination of neurotrophic factors, potentially ameliorating multiple dysfunctions in retinal degenerations. In conclusion, PRPE-SF offers a promising therapeutic candidate for retinal degenerative diseases, advancing the development of effective therapeutic strategies for these debilitating conditions.
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Affiliation(s)
- Kabir Ahluwalia
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.)
| | - Juan-Carlos Martinez-Camarillo
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Biju B. Thomas
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Aditya Naik
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.)
| | - Alejandra Gonzalez-Calle
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Dimitrios Pollalis
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jane Lebkowski
- Regenerative Patch Technologies LLC, Menlo Park, CA 94028, USA;
| | - Sun Young Lee
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Physiology & Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Debbie Mitra
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
| | - Stan G. Louie
- Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; (K.A.); (A.N.)
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
| | - Mark S. Humayun
- USC Ginsburg Institute of for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA; (J.-C.M.-C.); (B.B.T.); (A.G.-C.); (D.P.); (S.Y.L.); (D.M.)
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Kim JS, Shin J, Kim NH, Lee SY, Yoo SH, Keam B, Heo DS. Use of high-flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life. Cancer Med 2023. [PMID: 37162306 DOI: 10.1002/cam4.6060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Few studies have focused on high-flow nasal cannula (HFNC) usage in the last few weeks of life. The aim of this study was to identify the status of HFNC use in patients with cancer at the end of life and the relevant clinical factors. METHODS We performed a retrospective cohort study in a tertiary hospital in the Republic of Korea. Among patients with cancer who died between 2018 and 2020, those who initiated HFNC within 14 days before death were included. Patients were categorized based on the time from HFNC initiation to death as imminent (<4 days) and non-imminent (≥4 days). RESULTS Among the 2191 deceased patients with terminal cancer, 329 (15.0%) were analyzed. The median age of the patients was 66 years, and 62.9% were male. The leading cause of respiratory failure was pneumonia (70.2%), followed by pleural effusion (30.7%) and aggravation of lung neoplasms (18.8%). Most patients were conscious (79.3%) and had resting dyspnea (76.3%) at HFNC initiation. Patients received HFNC therapy for a mean of 3.4 days in the last 2 weeks of life, and 62.6% initiated it within 4 days before death. Furthermore, female sex, no palliative care consultation, no advance statements in person on life-sustaining treatment, and no resting dyspnea were independently associated with the imminent use of HFNC. CONCLUSIONS Many patients with cancer started HFNC therapy at the point of imminent death. However, efforts toward goal-directed use of HFNC at the end-of-life stage are required.
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Affiliation(s)
- Jung Sun Kim
- Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Nam Hee Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Patient-Centered Clinical Research Coordinating Center, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Shon HK, Son JG, Lee SY, Moon JH, Lee GS, Kim KS, Lee TG. Comparison study of mouse brain tissue by using ToF-SIMS within static limits and hybrid SIMS beyond static limits (dynamic mode). Biointerphases 2023; 18:2893560. [PMID: 37255379 DOI: 10.1116/6.0002613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023] Open
Abstract
In the study of degenerative brain diseases, changes in lipids, the main component of neurons, are particularly important because they are used as indicators of pathological changes. One method for the sensitive measurement of biomolecules, especially lipids, is time-of-flight secondary ion mass spectrometry (ToF-SIMS) using pulsed argon cluster ions. In this study, biomolecules including various lipids present in normal mouse brain tissue were measured using ToF-SIMS equipped with pulsed argon cluster primary ions. Based on the ToF-SIMS measurement results, hybrid SIMS (OrbiSIMS), which is a ToF-SIMS system with the addition of an orbitrap mass analyzer, was used to directly identify the biomolecules by the region in the real tissue samples. For this, the results of ToF-SIMS, which measured the tissue samples from a single mouse brain within static limits, were compared with those from OrbiSIMS measured beyond the static limits in terms of the differences in molecular profiling. From this analysis, two types of positive and negative ions were selected for identification, with the OrbiSIMS MS/MS results indicating that the positive ions were glycerophosphocholine and the negative ions were glycerophosphoinositol and sulfatide, a sphingolipid. Then, to confirm the identification of the molecular candidates, lipids were extracted from mirror image tissue samples, and LC-MS/MS also using an orbitrap mass analyzer was performed. As a result, the direct identification of molecular candidate groups distributed in particular regions of the tissue samples via OrbiSIMS was found to be consistent with the identification results by LC-MS/MS for extracted samples.
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Affiliation(s)
- Hyun Kyong Shon
- Bioimaging Team, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Jin Gyeong Son
- Bioimaging Team, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Sun Young Lee
- Bioimaging Team, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Jeong Hee Moon
- Core Research Facility & Analysis Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea
| | - Ga Seul Lee
- Core Research Facility & Analysis Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea
| | - Kyoung-Shim Kim
- Laboratory Animal Resource Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea
| | - Tae Geol Lee
- Bioimaging Team, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
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Lee SY, Hwang SS, Park JH, Song KJ, Shin SD. Impact of Awareness Time Interval on the Effect of Bystander Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest: A Nationwide Study. Yonsei Med J 2023; 64:327-335. [PMID: 37114636 PMCID: PMC10151231 DOI: 10.3349/ymj.2022.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE The awareness time interval (ATI), the time from the witnessed event to emergency medical service (EMS) activation, is an important factor influencing out-of-hospital cardiac arrest (OHCA) outcomes. Since bystander cardiopulmonary resuscitation (BCPR) is provided after cardiac arrest is recognized, the effect of BCPR may vary depending on ATI delay. We aimed to investigate whether ATI modifies the effect of BCPR on OHCA outcomes. MATERIALS AND METHODS A population-based observational study was conducted with EMS-treated witnessed adult (≥18 years) OHCAs between 2013 and 2018. The exposure variable was provision of BCPR. The primary outcome was a good neurological outcome defined as cerebral performance category scale 1or 2 (good CPC). Multivariable logistic regression analysis was conducted using the ATI group (-1, 1-5, 5- min) as the interaction term. RESULTS Of 34366 eligible OHCAs, 65.5% received BCPR. EMS was activated within 1 min in 45.9%, within 1-5 min in 29.2%, and after 5 min in 24.9% cases. In the adjusted interaction model, compared with no BCPR, a longer ATI resulted in smaller adjusted odds ratios for good CPC in the BCPR group [5.33 (4.17-6.82) for ATI ≤1 min, 5.14 (4.00-6.60) for 1-5 min, and 2.14 (1.63-2.81) for ATI >5 min]. CONCLUSION The effect of BCPR on improving the chances for a good neurological outcome decreased as time from collapse to EMS activation increased. The importance of early recognition of OHCA and EMS activation should be emphasized in BCPR training.
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Affiliation(s)
- Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, College of Medicine, Seoul National University, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Seung-Sik Hwang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Public Health Sciences, Seoul National University Graduate School of Public Health, Seoul, Korea.
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Choi DH, Ro YS, Park JH, Lee SY, Hong KJ, Song KJ, Shin SD. Evaluation of Socioeconomic Position and Survival After Out-of-Hospital Cardiac Arrest in Korea Using Structural Equation Modeling. JAMA Netw Open 2023; 6:e2312722. [PMID: 37163262 PMCID: PMC10173021 DOI: 10.1001/jamanetworkopen.2023.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Importance The association between low socioeconomic position (SEP) and poor survival after out-of-hospital cardiac arrest (OHCA) has not been thoroughly investigated. Objectives To evaluate the association between individual SEP and survival after OHCA and to identify any mediating pathways using structural equation modeling (SEM). Design, Setting, and Participants This is a retrospective cohort study that used data collected from January 2013 to December 2019. Participants were adults with OHCA with a presumed cardiac etiology. The study was conducted in Korea, which has a universal health insurance system. Data were analyzed from January 2022 to February 2023. Exposures Individual SEP was measured by insurance type (National Health Insurance [NHI] and medical aid [MA]) and premiums. SEP was categorized into 5 groups, in which NHI beneficiaries were divided into quartiles (Q1, highest quartile; Q4, lowest quartile), and MA was the lowest SEP group. Main Outcomes and Measures The primary outcome was survival to discharge. The association between SEP and OHCA survival was examined using multivariable logistic regression, and mediating factors were identified using SEM. Results A total of 121 516 patients (median [IQR] age, 73 [60-81] years; 43 912 [36.1%] female patients) were included. Compared with the NHI Q1 group, individuals with lower SEP had lower odds of survival to discharge. The adjusted odds ratios of survival to discharge were 0.97 (95% CI, 0.94-1.00), 0.88 (95% CI, 0.85-0.91), 0.91 (95% CI, 0.88-0.94), and 0.53 (95% CI, 0.50-0.56) for the NHI Q2, NHI Q3, NHI Q4, and MA groups, respectively. Several factors were found to mediate the association of SEP and survival in the total study population, with mediating proportions of 15.1% (95% CI, 11.8%-18.4%) for witnessed status, 4.8% (95% CI, 3.5%-6.0%) for bystander cardiopulmonary resuscitation provision, 41.8% (95% CI, 35.4%-48.1%) for initial rhythm, and 9.4% (95% CI, 7.4%-11.4%) for emergency department level. Among patients who survived to hospital admission, the mediation proportions were 11.8% (95% CI, 6.7%-16.9%) for witnessed status, 3.7% (95% CI, 1.3%-6.1%) for bystander cardiopulmonary resuscitation provision, 56.2% (95% CI, 41.0%-71.4%) for initial rhythm, 10.7% (95% CI, 6.1%-15.3%) for emergency department level, 20.2% (95% CI, 14.0%-26.5%) for coronary angiography, and 4.2% (95% CI, 2.2%-6.1%) for targeted temperature management. Conclusions and Relevance In this cohort study of patients with OHCA, lower individual SEP was significantly associated with lower survival to discharge. Potentially modifiable mediators can be targeted for public health interventions to reduce disparities in survival among patients with OHCA of different SEP.
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Affiliation(s)
- Dong Hyun Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Young Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Dang H, Srinivasa S, Lee SY, Alprin C. A Case Study of Early Diagnosed Angelman Syndrome: Recognizing Atypical Clinical Presentations. Cureus 2023; 15:e39271. [PMID: 37342752 PMCID: PMC10279475 DOI: 10.7759/cureus.39271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Angelman syndrome (AS) is a rare pediatric neurological condition in which patients most commonly present with inappropriate laughter, microcephaly, speech difficulties, seizures, and movement disorders. AS can be diagnosed clinically and confirmed with genetic testing. In this case report, the patient presented with 9.3% weight loss at two days of age. Although there were multiple attempts at lactational counseling and nutritional guidance, the patient was admitted to the hospital due to failure to thrive. Due to continued global developmental delay and upper and lower extremities hypotonia by the age of nine months, the patient was referred to a neurologist. Brain MRI was negative, and genetic testing revealed 15q11.2q13.1 deletion, which is consistent with AS. Through different therapies and intervention, the patient showed slow improvements in symptoms. This case illustrates the importance of early recognition of nonspecific clinical manifestations of AS. The general management for all AS patients includes physical therapy, speech therapy, mobility support devices, education, and behavioral therapy as they progress through life. Establishing an early diagnosis has potential long-term benefits of improved quality of life and outcomes for patients via early interventions such as physical therapy starting at the age of six months to improve gross motor function. When infants present with nonspecific clinical presentations such as failure to thrive and hypotonia, clinicians should maintain a lower threshold for suspecting genetic conditions, which will facilitate early diagnosis of AS.
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Affiliation(s)
- Han Dang
- Pediatrics, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Sandhya Srinivasa
- Pediatrics, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Sun Young Lee
- Pediatrics, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Clifford Alprin
- Family Medicine, North San Antonio Healthcare Associates, San Antonio, USA
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Pollalis D, Nanda AV, Nair GKG, Lee SY. Fiji-Assisted Automatic Quantitative Volumetric Analysis of Choroidal Neovascularization in a Laser-Induced Choroidal Neovascularization Mouse Model. Transl Vis Sci Technol 2023; 12:10. [PMID: 37043336 PMCID: PMC10103716 DOI: 10.1167/tvst.12.4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Purpose The laser-induced choroidal neovascularization (CNV) mouse model is the most frequently used animal model of CNV. To test new therapeutic agents that suppress CNV, CNV measurement in an accurate, precise, and efficient manner is important. We present the utility of Fiji-assisted automatic volumetric quantification of CNV in comparison with two-dimensional CNV analyses. Methods Laser-induced CNV was induced in C57BL/6J mice according to the established protocol. After CNV induction, mice were treated with intravitreal injection of either phosphate-buffered saline solution (PBS) or Aflibercept, an anti- vascular endothelial growth factor agent. One week after intravitreal injection treatment, retina pigment epithelium/choroid flat mounts were stained with rhodamine-conjugated Griffonia simplicifolia lectin B4. Z-stacks of the entire CNV lesion obtained using laser confocal microscopy were converted to binary stacks using Fiji for volumetric analysis. Data from volumetric analysis and multiple area analyses from z-stack projection, the maximum, blindly selected, and mean area were compared using Fiji. Results Fiji-assisted automatic quantitative volumetric analysis of CNV was useful in detecting experimental outliers in laser-induced CNV genesis and provided accurate and precise measurements of total areas of CNV with a lower coefficient of variance (63%) than in multiple area analyses, including the z-stack projection, maximum, blindly selected, and mean areas (67%, 67%, 76%, and 69%, respectively). A lower coefficient of variance in volumetric analysis than in multiple area analyses resulted in increased statistical significance when comparing CNV lesions in PBS, and Aflibercept-treated groups; P = 0.004 in volumetric analysis versus P value range between 0.03 and 0.05 in multiple area analyses. Conclusions Fiji-assisted automatic quantitative volumetric analysis can be useful for accurate, precise, and efficient measurements of total areas of CNV. Translational Relevance Volumetric measurement for CNV lesions can be advantageous in verifying the efficacy of therapeutic agents in the laser-induced CNV mouse model.
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Affiliation(s)
- Dimitrios Pollalis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA, USA
| | - Arjun V Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Gopa Kumar Gopinadhan Nair
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Deptartment of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
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Lee SGW, Hong KJ, Lee SY, Do Shin S, Song KJ, Park JH, Choi S, Lee G, Pak J, Park YJ. Efficacy of distance training program for cardiopulmonary resuscitation utilizing smartphone application and home delivery system. Am J Emerg Med 2023; 66:67-72. [PMID: 36709543 DOI: 10.1016/j.ajem.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
AIM OF THE STUDY Community cardiopulmonary resuscitation (CPR) education is important for laypersons. However, during the COVID-19 pandemic, with social distancing, conventional face-to-face CPR training was unavailable. We developed a distance learning CPR training course (HEROS-Remote) using a smartphone application that monitors real-time chest compression quality and a home delivery collection system for mannikins. This study aimed to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality with that of conventional CPR training. METHODS We applied layperson CPR education with HEROS-Remote and conventional education in Seoul during the COVID-19 pandemic. Both groups underwent a 2-min post-training chest compression test, and we tested non-inferiority. Chest compression depth, rate, complete recoil, and composite chest compression score was measured. Trainees completed a satisfaction survey on CPR education and delivery. The primary outcome was the mean chest compression depth. RESULTS A total of 180 trainees were enrolled, with 90 assigned to each training group. Chest compression depth of HEROS-Remote training showed non-inferiority to that of conventional training (67.4 vs. 67.8, p = 0.78), as well as composite chest compression score (92.7 vs. 95.5, p = 0.16). The proportions of adequate chest compression depth, chest compression rate, and chest compressions with complete chest recoil were similar in both training sessions. In the HEROS-Remote training, 90% of the trainees were satisfied with CPR training, and 96% were satisfied with the delivery and found it convenient. CONCLUSION HEROS-Remote training was non-inferior to conventional CPR training in terms of chest compression quality. Distance learning CPR training using a smartphone application and mannikin delivery had high user satisfaction and was logistically feasible.
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Affiliation(s)
- Stephen Gyung Won Lee
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sun Young Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Public Health Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seulki Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gyeongmin Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jieun Pak
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Yong Joo Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Park Y, Shin YS, Kim K, Shin KH, Chang JH, Kim SS, Jung JH, Park W, Kim H, Kim YB, Ahn SJ, Kim M, Kim JH, Cha HJ, Kim TG, Park HJ, Lee SY. Omission of axillary lymph node dissection in patients with ypN+ breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06). Eur J Surg Oncol 2023; 49:589-596. [PMID: 36470801 DOI: 10.1016/j.ejso.2022.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We evaluated the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC). METHODS The medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. In total, 1273 patients from 12 institutions were included; all underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%). Univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed before and after propensity score matching (PSM). RESULTS The median follow-up was 75.3 months (range, 2.5-182.7). Axillary recurrence rates were 4.8% in the ALND group (n = 53) and 4.7% in the SLNBx group (n = 8). Before PSM, univariate analysis indicated that the 5-year OS rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002); multivariate analysis did not show a difference between groups (P = 0.325). After PSM, 258 and 136 patients were included in the ALND and SLNBx groups, respectively. There were no significant differences between the ALND and SLNBx groups in DFS (5-year rate, 75.8% vs. 76.9%, respectively; P = 0.406) or OS (5-year rate, 88.7% vs. 93.1%, respectively; P = 0.083). CONCLUSIONS SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.
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Affiliation(s)
- Younghee Park
- Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea
| | - Young Seob Shin
- Department of Radiation Oncology, University of Ulsan College of Medicine, South Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea.
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, South Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, South Korea
| | - Jin Hong Jung
- Department of Radiation Oncology, University of Ulsan College of Medicine, South Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, South Korea
| | - Sung Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, South Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, The Catholic University of Korea College of Medicine, South Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University School of Medicine, South Korea
| | - Hye Jung Cha
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, South Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, South Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, South Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Jeonbuk National University School of Medicine, South Korea
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Lee SI, Kang SB, Lee SY, Choi DS. The effect of regional distribution of isolation rooms in emergency departments on ambulance travel time during the COVID-19 pandemic. Clin Exp Emerg Med 2023:ceem.22.355. [PMID: 36787901 DOI: 10.15441/ceem.22.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/12/2022] [Indexed: 02/16/2023] Open
Abstract
Objective : The number and distribution of isolation rooms in Korea differ by region. The distribution of isolation beds in emergency departments may have affected ambulance travel time and burden on emergency medical service (EMS) during the COVID-19 pandemic. Methods : This retrospective observation study analyzed EMS records in four regions of the Gyeonggi Province, Korea, from January 01, 2019 to December 31, 2020. The main exposure was the number of emergency department isolation rooms in each region. The primary outcome was call-to-return time for the EMS. The interaction effect of the number of regional isolation rooms on the call-to-return time during the COVID-19 pandemic was analyzed using a generalized linear model (GLM) and logistic regression. Results : A total of 781,246 cases was included in the analyses. During the COVID-19 pandemic, the call-to-scene time (before 8 minutes vs. after 9 minutes, P<0.05) and call-to-return time (before 46 minutes vs. after 52 minutes, P<0.05) for emergency patients increased significantly compared to before the pandemic. As the number of regional isolation rooms increased, the effect of COVID-19 on the callto- return time decreased significantly in multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exponential beta coefficient [exp(β)], 1.33; with 12.24 isolation rooms per million population: adjusted exp(β), 1.18). As the number of regional isolation rooms increased, the effect of COVID-19 on the call-to-scene time decreased significantly in the multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exp(β), 1.20; with 12.24 isolation rooms per million population: adjusted exp(β), 1.09). Conclusion : During the pandemic, the increases in call-to-return time and call-to-scene time were smaller in regions with more isolation rooms per population.
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Affiliation(s)
- Soo In Lee
- Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
| | - Saee Byel Kang
- Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Sun Choi
- Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
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Lee SY, Jang DH, Kim H, Yun M. Removal and isolation of radioactive cobalt using DNA aptamers. RADIOCHIM ACTA 2023. [DOI: 10.1515/ract-2022-0112] [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: 02/05/2023]
Abstract
Abstract
Electricity generation using nuclear power has various advantages, such as carbon reduction, but the treatment of nuclear waste is emerging as a big issue in many countries. The development of technology that can selectively remove radionuclides from liquid radioactive waste is one of the ways to reduce nuclear waste. Here, we assessed a new way of removing radioactive cobalt from a liquid using an aptamer. Aptamers specifically binding cobalt ions were selected through systematic evolution of ligands by exponential enrichment (SELEX). Their binding strength and stability of their complexes with cobalt were analyzed through surface plasmon resonance assay and 2D program Mfold, respectively. The optimal aptamer/bead conjugate conditions for binding cobalt were established using an FA-C1 aptamer with the strongest binding to cobalt. Under these conditions, more than 80% of radioactive cobalt was removed, and more than 99.95% of removed cobalt was recovered. These results proved that radioactive cobalt removal using this aptamer can effectively reduce liquid radioactive waste. This means that the aptamer/bead complex can be utilized to remove various radioactive metal ions.
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Affiliation(s)
- Sun Young Lee
- Laboratory of Functional Aptamers, Department of Bioindustry and Bioresource Engineering , College of Life Sciences, Sejong University , Seoul , South Korea
- Resource Upcycling and Discovery Research Institute, Sejong University , Seoul , South Korea
| | - Dae Hyuk Jang
- Laboratory of Functional Aptamers, Department of Bioindustry and Bioresource Engineering , College of Life Sciences, Sejong University , Seoul , South Korea
- Resource Upcycling and Discovery Research Institute, Sejong University , Seoul , South Korea
| | - Hyuncheol Kim
- Environmental Radioactivity Assessment Team , Korea Atomic Energy Research Institute , Daejeon , South Korea
| | - Miyong Yun
- Laboratory of Functional Aptamers, Department of Bioindustry and Bioresource Engineering , College of Life Sciences, Sejong University , Seoul , South Korea
- Environmental Radioactivity Assessment Team , Korea Atomic Energy Research Institute , Daejeon , South Korea
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Kim Y, Park JH, Lee SY, Ro YS, Hong KJ, Song KJ, Shin SD, Do Shin S. Extracorporeal cardiopulmonary resuscitation location, coronary angiography and survival in out-of-hospital cardiac arrest. Am J Emerg Med 2023; 64:142-149. [PMID: 36528002 DOI: 10.1016/j.ajem.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The best location for safe and timely implementation of extracorporeal cardiopulmonary resuscitation (ECPR) is currently uncertain. We aimed to evaluate the association between the location of ECPR and survival outcomes in out-of-hospital cardiac arrest (OHCA) patients. We also evaluated whether the effects of ECPR location on survival differed between patients who underwent coronary angiography (CAG) and those who did not. METHODS We used data collected between 2013 and 2020 from a nationwide OHCA database. Adult OHCA patients with presumed cardiac etiology who underwent ECPR were included in the study. The primary outcome was survival to discharge. The main exposure was the ECPR location (emergency department [ED] or cardiac catheterization laboratory [Cath lab]). We compared primary outcomes of ECPR between the ED and Cath lab using multivariable logistic regression. The interaction between ECPR location and CAG was also evaluated. RESULTS Of 564 ECPR patients, 448 (79.4%) and 116 (20.6%) underwent ECPR in the ED and Cath lab, respectively. CAG was observed in 52.5% and 72.4% of the patients in the ED and Cath lab groups, respectively. There were no significant differences in survival to discharge between the ED and Cath lab groups (14.1% vs. 12.9%, p = 0.75, adjusted odds ratio [AOR] [95% confidence interval] 1.87 [0.85-4.11]). AOR of interaction analysis (95% CI) for survival to discharge of the ED group was 2.34 (1.02-5.40) in patients with CAG and 0.28 (0.04-1.84) in patients without CAG (p for interaction was 0.04). CONCLUSION In adult OHCA patients who underwent ECPR and CAG, ECPR in the ED shortened time to ECMO pump-on time and increased survival to discharge compared to ECPR in the Cath lab.
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Affiliation(s)
- Yoonjic Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Sun Young Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Public Healthcare Center, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
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Lee SY, Lee DH, Cho DH. Modulated electrohyperthermia in locally advanced cervical cancer: Results of an observational study of 95 patients. Medicine (Baltimore) 2023; 102:e32727. [PMID: 36701697 PMCID: PMC9857257 DOI: 10.1097/md.0000000000032727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Most federation of gynecology and obstetrics stage II or higher locally advanced cervical cancer (LACC) patients are treated with concurrent chemoradiotherapy (CCRT); however, recurrence is high, and the prognosis is poor. In this observational retrospective study, data from LACC patients treated with CCRT alone or combined with modulated electrohyperthermia (mEHT) were collected from 2011 to 2018. Ninety-five LACC patients, including 53 (%) treated with CCRT alone and 42 (%) treated with CCRT + mEHT, were enrolled. The complete remission rate significantly increased with CCRT + mEHT compared with CCRT alone among LACC cases with lymph node metastasis (45% vs 71%, P = .0377). Additionally, at the last follow-up point, the no-evidence-of-disease rate significantly improved with CCRT + mEHT compared with CCRT (58% vs 82%, P = .0315). Disease-free survival increased in the CCRT + mEHT group with lymph node metastasis (P = .04). The addition of mEHT to CCRT led to a better therapeutic response in LACC with regional lymph node metastasis without severe complications.
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Affiliation(s)
- Sun Young Lee
- Department of Radiation Oncology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dong Hyun Lee
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dong-Hyu Cho
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
- * Correspondence: Dong-Hyu Cho, Department of Obstetrics and Gynecology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea (e-mail: )
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Lee SY, Ro YS, Shin SD, Ko E, Kim SJ. Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019. Sci Rep 2023; 13:686. [PMID: 36639721 PMCID: PMC9839758 DOI: 10.1038/s41598-023-27947-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in the ED. A retrospective observational study was conducted using the National Emergency Department Information System (NEDIS) database. Patients who died during ED care between 2016 and 2019 were included. Palliative care-eligible disease was defined as cancer (C00-C99 of ICD-10), chronic respiratory disease (CRD, J44-J46), chronic liver disease (CLD, K70-K77), and heart failure (HF, I50). Among the 36,538,486 ED visits during 4 years, 34,086 ED deaths were included. The crude incidence rate of ED deaths per 100,000 person-year was steady between 16.6 in 2016 and 16.3 in 2019 (p-for-trend = 0.067). Only 3370 (9.9%) ED deaths were injury, while 30,716 (90.1%) deaths were related to diseases. The most common ED diagnosis was cardiac arrest (22.1%), followed by pneumonia (8.6%) and myocardial infarction (4.7%). In cases of disease-related ED deaths, about 34.0% stayed longer than 8 h in the ED (median (interquartile range): 4.5 (1.9-11.7) h) and 44.2% received cardiopulmonary resuscitation (CPR) at end-of-life time. A quarter of the disease-related ED deaths were diagnosed with palliative care eligible disease: cancer (16.9%), CLD (3.8%), HF (3.5%), and CRD (1.4%). Cancer patients received less CPR (23.4%) and stayed longer in the ED (median (interquartile range): 7.3 (3.2-15.9) h). Over the past 4 years, more than 30,000 patients, including 5200 cancer patients, died during care in the ED. A quarter of disease-related ED death were patients with palliative care-eligible condition and more than 30% of them stayed longer than 8 h in the ED before death. It is time to discuss about need of palliative care in the ED.
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Affiliation(s)
- Sun Young Lee
- grid.412484.f0000 0001 0302 820XPublic Healthcare Center, Seoul National University Hospital, Seoul, Korea ,grid.412484.f0000 0001 0302 820XLaboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Medicine, Seoul National University college of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. .,Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea. .,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. .,National Emergency Medical Center, National Medical Center, Seoul, Korea.
| | - Sang Do Shin
- grid.412484.f0000 0001 0302 820XLaboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea ,grid.412484.f0000 0001 0302 820XDepartment of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Korea ,grid.31501.360000 0004 0470 5905Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- grid.415619.e0000 0004 1773 6903National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Seong Jung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea. .,Department of Emergency Medicine, Chosun University Hospital, 365 Pilmun-Daero, Dong-Gu, Gwangju, 61453, Korea.
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Lee SY, Chae CH, Zrínyi M, Che X, Choi JY, Cho DH. Characterization of a conjugated polysuccinimide-carboplatin compound. Korean J Physiol Pharmacol 2023; 27:31-38. [PMID: 36575931 PMCID: PMC9806637 DOI: 10.4196/kjpp.2023.27.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022]
Abstract
Carboplatin, an advanced anticancer drug with excellent efficacy against ovarian cancer, was developed to alleviate the side effects that often occur with cisplatin and other platinum-based compounds. Our study reports the in vitro characteristics, viability, and activity of cells expressing the inducible nitric oxide synthase (iNOS) gene after carboplatin was conjugated with polysuccinimide (PSI) and administered in combination with other widely used anticancer drugs. PSI, which has promising properties as a drug delivery material, could provide a platform for prolonging carboplatin release, regulating its dosage, and improving its side effects. The iNOS gene has been shown to play an important role in both cancer cell survival and inhibition. Herein, we synthesized a PSI-carboplatin conjugate to create a modified anticancer agent and confirmed its successful conjugation. To ensure its solubility in water, we further modified the structure of the PSI-carboplatin conjugate with 2-aminoethanol groups. To validate its biological characteristics, the ovarian cancer cell line SKOV-3 and normal ovarian Chinese hamster ovary cells were treated with the PSI-carboplatin conjugate alone and in combination with paclitaxel and topotecan, both of which are used in conventional chemotherapy. Notably, PSI-carboplatin conjugation can be used to predict changes in the genes involved in cancer growth and inhibition. In conclusion, combination treatment with the newly synthesized polymer-carboplatin conjugate and paclitaxel displayed anticancer activity against ovarian cancer cells but was not toxic to normal ovarian cancer cells, resulting in the development of an effective candidate anticancer drug without severe side effects.
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Affiliation(s)
- Sun Young Lee
- Department of Radiation Oncology, Jeonbuk National University Medical School, Jeonju 54907, Korea,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | | | - Miklós Zrínyi
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, Budapest 1089, Hungary
| | - Xiangguo Che
- Department of Biochemistry & Cell Biology, School of Medicine, Kyungpook National University, Daegu 41940, Korea
| | - Je Yong Choi
- Department of Biochemistry & Cell Biology, School of Medicine, Kyungpook National University, Daegu 41940, Korea
| | - Dong-Hyu Cho
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea,Department of Obstetrics and Gynecology, Jeonbuk National University Medical School, Jeonju 54907, Korea,Correspondence Dong-Hyu Cho, E-mail:
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Choi JI, Kweon HY, Lee YL, Lee JH, Lee SY. Efficacy of Silkworm Pupae Extract on Muscle Strength and Mass in Middle-Aged and Older Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial. J Nutr Health Aging 2023; 27:578-585. [PMID: 37498105 DOI: 10.1007/s12603-023-1942-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES We investigated the efficacy and safety of silkworm pupae extract (SWP) consumption for 12 weeks on muscle mass and strength in middle-aged and older individuals with relatively low skeletal muscle mass who do regular low-intensity exercise. DESIGN A randomized double-blinded placebo-controlled trial. PARTICIPANTS The study was conducted with 54 participants with relatively low skeletal muscle mass (SMM) (64.4 ± 6.1 years; body mass index, 23.8 ± 2.4 kg/m2). INTERVENTION AND MEASUREMENTS Participants were randomly assigned to one of two groups: 1000 mg of SWP/day plus regular exercise (SWP group, n=27) or placebo plus regular exercise (placebo group, n=27). All participants were required to engage in 30-60 minutes/day of walking for ≥3 days/week for 12 weeks. The primary outcome was knee extension/flexion strength (Nm), measured at the velocity of 60°/s. Secondary outcomes included body composition, biomarkers (creatine kinase and creatinine), handgrip strength, and quality of life questionnaire. RESULTS Both the intention-to-treat (ITT) and per-protocol (PP) analyses revealed no significant impact of SWP on knee strength compared to the placebo group over 12 weeks. On the other hand, the SWP group had significantly greater increases in right-handgrip strength by 1.94 kg (95% CI: 0.08-3.79; p = 0.041) and left-handgrip strength by 1.83 kg (0.25-3.41; p = 0.024) compared to the placebo group in the ITT population, after 12 weeks. Moreover, in the PP population, the SWP group revealed an even greater increase in right-handgrip strength by 2.07 kg (0.15-3. 98; p = 0.035) and left-handgrip strength by 2.21 kg (0.60-3.83; p = 0.008) for the 12-week period. However, this study resulted in a failure to detect significant differences in the body composition, biomarkers, quality of life questionnaire, physical activity, and caloric intake between the groups. None of the participants in the SWP group experienced any significant adverse events. In the placebo group, two participants experienced urticaria and allergic side effects, leading to their withdrawal from the study and two exhibited elevated levels of liver enzyme and increased diastolic blood pressure, respectively at 12 weeks. CONCLUSION SWP, in addition to low-intensity exercise, may enhance handgrip strengths in middle-aged and older adults with relatively lower SMM. Future studies need to use a large sample size over longer periods to validate our findings. This trial was registered at clinicaltrials.gov as NCT04994054.
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Affiliation(s)
- J I Choi
- Sang Yeoup Lee, Family Medicine Clinic, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea, Telephone: +82-55-390-1442, E-mail: , Fax: +82-51-510-8125
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Youn SH, Lee SY. Advanced stage cutaneous T-cell lymphoma treated with high-dose external beam radiation therapy: A case report. Medicine (Baltimore) 2022; 101:e32239. [PMID: 36595796 PMCID: PMC9794289 DOI: 10.1097/md.0000000000032239] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The treatment for advanced-stage or refractory cutaneous T-cell lymphoma (CTCL) is largely palliative. Due to the rarity of the disease, there are few randomized controlled trials and large-scale prospective studies. Therefore, the treatment of advanced-stage CTCL remains challenging. PATIENT CONCERNS AND DIAGNOSIS A 64-years-old man who had received narrowband UVB phototherapy for several years presented with a generalized rash with widespread polycyclic erosions and painful ulcers on his hands and feet. We restaged him as stage III CTCL. INTERVENTIONS AND OUTCOMES He was treated with high-dose radiation for curative purposes and 3-dimensional conformal radiation therapy to both hands and feet. At the 2-year follow-up after the end of radiotherapy, the irradiated skin had recovered to normal soft, smooth skin with localized fibrosis and hypopigmented skin. He reported an excellent quality of life, and his hands and feet were free to move. CONCLUSION CTCL at an advanced stage could require dose escalation with local radiotherapy for curative purposes. High-dose 3-dementional conformal radiation therapy could be effective and has tolerable toxicities.
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Affiliation(s)
- Sang Hee Youn
- Departments of Radiation Oncology, Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sun Young Lee
- Departments of Radiation Oncology, Jeonbuk National University Hospital-Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- * Correspondence: Sun Young Lee, Department of Radiation Oncology, Jeonbuk National University Hospital, 634-18 Keuman-dong, Dukjin-gu, Jeonju, 54907, Republic of Korea (e-mail: )
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Jeon SY, Yoon HB, Park JE, Lee SY, Yoon JW. A qualitative study on the internal response of medical students during the transgender healthcare education: a focus on professional identity. Korean J Med Educ 2022; 34:281-297. [PMID: 36464899 PMCID: PMC9726236 DOI: 10.3946/kjme.2022.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This qualitative study examined the inner response of medical students who participated in a transgender healthcare education program. The factors that effected the inner response were investigated in order to suggest strategies for improving the effectiveness of the transgender healthcare education program. METHODS The transgender healthcare education program consisted of 2 hours of lectures and 2 hours of clinical role-play over 3 weeks. Eight 4-year medical students in Seoul, South Korea, were selected considering gender, the route of admission to medical school, and religion. Each student was interviewed individually for approximately 30 minutes 3 times before, during, and after the educational program, and interviews were analyzed using thematic analysis. RESULTS By attending the transgender healthcare education program, students have shown three types of inner response-confusion, acceptance, and negotiation. The students' personal identities and professional identities influenced these responses. In particular, students' existing professional identities motivated them to learn about transgender healthcare and played a key role in resolving the discomfort that occurred during the educational program. Through the transgender healthcare education, students were able to reduce prejudice against transgender people, understand the unique medical needs of the transgender population and increase their self-efficacy related to transgender health care. CONCLUSION The transgender healthcare education program allowed medical school students to acquire medical knowledge related to transgender patients and increase their cultural competence as future medical professionals. In addition, as the professional identity is critical in educating transgender healthcare, it should be considered thoroughly in order to effectively educate the medical students.
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Affiliation(s)
| | - Hyun Bae Yoon
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Young Lee
- Public Helathcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jung won Yoon
- Department of Obstetrics and Gynecology, National Medical Center, Seoul, Korea
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Lee SY, Park JH, Choi YH, Lee J, Ro YS, Hong KJ, Song KJ, Shin SD. Individual socioeconomic status and risk of out-of-hospital cardiac arrest: A nationwide case-control analysis. Acad Emerg Med 2022; 29:1438-1446. [PMID: 36153694 DOI: 10.1111/acem.14599] [Citation(s) in RCA: 5] [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: 07/05/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Area-level socioeconomic status (SES) is associated with the incidence of out-of-hospital cardiac arrest (OHCA); however, the effects of individual-level SES on OHCA occurrence are unknown. This study investigated whether individual-level SES is associated with the occurrence of OHCA. METHODS This case-control study used data from the nationwide OHCA registry and the National Health Information Database (NHID) in Korea. All adult patients with OHCA of a medical etiology from 2013 to 2018 were included. Four controls were matched to each OHCA patient based on age and sex. The exposure was individual-level SES measured by insurance type and premium, which is based on income in Korea. National Health Insurance (NHI) beneficiaries were divided into four groups (Q1-Q4), and medical aid beneficiaries were separately classified as the lowest SES group. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the outcomes were calculated. Stratified analyses were conducted according to age and sex. RESULTS A total of 105,443 cases were matched with 421,772 controls. OHCA occurred more frequently in the lower SES groups. Compared with the highest SES group (Q1), the aORs for OHCA occurrence increased as the SES decreased (aORs [95% CI] were 1.21 [1.19-1.24] for Q2, 1.33 [1.31-1.36] for Q3, 1.32 [1.30-1.35] for Q4, and 2.08 [2.02-2.13] for medical aid). Disparity by individual-level SES appeared to be greater in males than in females and greater in the young and middle-aged adults than in older adults. CONCLUSIONS Low individual-level SES was associated with a higher probability of OHCA occurrence. Efforts are needed to reduce SES disparities in the occurrence of OHCA.
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Affiliation(s)
- Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.,College of Medicine, Seoul National University, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Young Ho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jungah Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Kim M, Park B, Kim H, Kim YJ, Choi DJ, Chung W, Kim YJ, Shin HS, Im JH, Suh CO, Kim JH, Ha B, Kim MY, Park J, Lee J, Ahn SJ, Lee SY, Kusumawidjaja G, Lim F, Cho WK, Kim H, Choi DH, Park W. Dummy run quality assurance study in the Korean Radiation Oncology Group 19 − 09 multi-institutional prospective cohort study of breast cancer. Radiat Oncol 2022; 17:186. [PMID: 36384804 PMCID: PMC9670516 DOI: 10.1186/s13014-022-02140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/02/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Korean Radiation Oncology Group (KROG) 19 − 09 prospective cohort study aims to determine the effect of regional nodal irradiation on regional recurrence rates in ypN0 breast cancer patients. Dosimetric variations between radiotherapy (RT) plans of participating institutions may affect the clinical outcome of the study. We performed this study to assess inter-institutional dosimetric variations by dummy run. Methods Twelve participating institutions created RT plans for four clinical scenarios using computed tomography images of two dummy cases. Based on a reference structure set, we analyzed dose-volume histograms after collecting the RT plans. Results We found variations in dose distribution between institutions, especially in the regional nodal areas. Whole breast and regional nodal irradiation (WBI + RNI) plans had lower inter-institutional agreement and similarity for 95% isodose lines than WBI plans. Fleiss’s kappa values, which were used to measure inter-institutional agreement for the 95% isodose lines, were 0.830 and 0.767 for the large and medium breast WBI plans, respectively, and 0.731 and 0.679 for the large and medium breast WBI + RNI plans, respectively. There were outliers in minimum dose delivered to 95% of the structure (D95%) of axillary level 1 among WBI plans and in D95% of the interpectoral region and axillary level 4 among WBI + RNI plans. Conclusion We found inter-institutional and inter-case variations in radiation dose delivered to target volumes and organs at risk. As KROG 19 − 09 is a prospective cohort study, we accepted the dosimetric variation among the different institutions. Actual patient RT plan data should be collected to achieve reliable KROG 19 − 09 study results.
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Abstract
PURPOSE To discuss the role of advanced retinal implants in retinitis pigmentosa and age-related macular degeneration. DESIGN Presented by Mark S. Humayun as the Charles Schepen's Lecture on the Retina Subspecialty Day of the American Academy of Ophthalmology in 2021. PARTICIPANTS The details of subjects, participants, and controls are provided in the references pertaining to each study. METHODS Review of published literature and clinical trials. MAIN OUTCOME MEASURES Visual and anatomic outcomes from retinal implants. RESULTS Retinal implants have been researched over the past few decades, and some have been advanced into the clinic. Two types of implants-bioelectronic and stem cell-based-have shown promising results in restoring some level of vision in patients with inherited retinal degeneration and geographic atrophy. These implants differ in their constructions, locations of implantation, and safety profiles. The results from some of these retinal implants have shown signs of efficacy, and 1 retinal implant, the Argus II, has been approved by the United States Food and Drug Administration. CONCLUSIONS Careful consideration of the design of the implant and associated surgical techniques are necessary to obtain a stable and effective long-term interface between the implant and the retina.
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Affiliation(s)
- Mark S Humayun
- University of Southern California Roski Eye Institute, University of Southern California Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Biomedical Engineering, Denney Research Center, University of Southern California, Los Angeles, California.
| | - Sun Young Lee
- University of Southern California Roski Eye Institute, University of Southern California Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Jung E, Park JH, Lee SY, Ryu YS, Shin SD, Ryu HH. Risk of hypertension on the incidence of out-of-hospital cardiac arrest. J PAK MED ASSOC 2022; 72:1688-1693. [PMID: 36280957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To analyse the effect of hypertension on the occurrence of out-of-hospital cardiac arrest, and to find out whether the effect is dependent on the use of anti-hypertensive drugs. METHODS The case-control study used secondary data from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance project and comprised patients with presumed cardiac aetiology adult out-of-hospital cardiac arrest assessed by emergency medical service from 27 participating emergency departments from January 2016 to December 2017. Controls matched for age, gender and county were recruited from the Korea National Health and Nutrition Examination Survey database in a 4:1 ratio. Multivariate logistic regression analysis was used to analyse the effects of hypertension and the administration of anti-hypertensive medication on out-of-hospital cardiac arrest incidence. Data was analysed using SAS 9.4. RESULTS Of the 7330 subjects, 1,466(20%) were patients and 5864(80%) were controls. Hypertension was found in 662(45.2%) patients and 3,190(54.4%) controls. Hypertension lowered the incidence of out-of-hospital cardiac arrest (adjusted odds ratio: 0.69 [95% confidence interval: 0.60-0.80]); in the medication group 0.64(0.55-0.75), and 1.12(0.83-1.49) in the non-medication group. CONCLUSIONS Administration of anti-hypertensive medications in patients of hypertension may help reduce the incidence of out-of-hospital cardiac arrest. Active hypertension diagnosis and anti-hypertensive medications to reduce the incidence of out-of-hospital cardiac arrest is critical.
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Affiliation(s)
- Eujene Jung
- Chonnam National University Hospital, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Sun Young Lee
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Young Sun Ryu
- Department of Emergency Medicine, Seoul National University, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University, South Korea
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McClard CK, Pollalis D, Jamshidi F, Kingsley R, Lee SY. Utility of No-Charge Panel Genetic Testing for Inherited Retinal Diseases in a Real-World Clinical Setting. J Vitreoretin Dis 2022; 6:351-357. [PMID: 36213299 PMCID: PMC9542391 DOI: 10.1177/24741264221100936] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To show the utility of genetic testing in inherited retinal disease (IRD) patients. METHODS This retrospective cohort study was performed at a single academic center and comprised 59 patients clinically diagnosed with IRD who had testing via the Invitae IRD Panel (Invitae Corp). Samples were collected from August 2019 to April 2021. The rates of genetic diagnosis and disease-category specific results (ie, positive, undetermined, negative) were assessed. RESULTS Testing results were returned a mean of 20 days (range, 14-28 days) after submission. Of the samples, 50.8% (30/59) had a diagnostic yield. By disease category, the yield was 46.4% (13/28) nonsyndromic retinitis pigmentosa (RP), 50.0% (4/8) syndromic RP, 46.2% (6/13) macular dystrophies, 75.0% (3/4) cone or cone-rod dystrophies, and 80.0% (4/5) other retinopathies; there were no cases of rod dystrophies. The results were undetermined in 47.5% of patients (28/59) because of identification of only 1 recessive mutation (5.1%; 3/59), 1 recessive mutation and at least 1 variant of uncertain significance (VUS) (13.6%; 8/59), or VUS only (28.8%; 17/59). One patient (1.7%) received negative testing results with no mutations or VUS identified. CONCLUSIONS Open-access, no-charge panel testing offers a reasonable diagnostic yield. Accurate clinical diagnosis of IRD before testing and acknowledgment of the limitations of panel testing are critical. The results add to the current estimates of the value of genetic testing for retina specialists in the management of IRD.
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Affiliation(s)
- Cynthia K. McClard
- Ophthalmology, Dean McGee Eye
Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
| | - Dimitrios Pollalis
- Ophthalmology, Dean McGee Eye
Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
- USC Roski Eye Institute, USC Ginsburg
Institute for Biomedical Therapeutics and Department of Ophthalmology, Keck School
of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Farzad Jamshidi
- Ophthalmology, Dean McGee Eye
Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
| | - Ronald Kingsley
- Ophthalmology, Dean McGee Eye
Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
| | - Sun Young Lee
- Ophthalmology, Dean McGee Eye
Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
- USC Roski Eye Institute, USC Ginsburg
Institute for Biomedical Therapeutics and Department of Ophthalmology, Keck School
of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Physiology, University of
Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Pollalis D, Kim D, Nair GKG, Kang C, Nanda AV, Lee SY. Intraocular RGD-Engineered Exosomes and Active Targeting of Choroidal Neovascularization (CNV). Cells 2022; 11:cells11162573. [PMID: 36010651 PMCID: PMC9406786 DOI: 10.3390/cells11162573] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To assess the transretinal penetration of intravitreally injected retinal multicell-derived exosomes and to develop exosome-based active targeting of choroidal neovascularization (CNV) by bioengineering with ASL, which is composed of a membrane Anchor (BODIPY), Spacer (PEG), and targeting Ligands (cyclic RGD peptide). Methods: Retinal multicell-derived exosomes were recovered from a whole mouse retina using differential ultracentrifugation. Their size, number, and morphology were characterized using nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM). Exosome markers were confirmed using an exosome detection antibody array. Intravitreal injection of fluorescent (PKH-26)-labeled or engineered ASL exosomes (1 × 106 exosomes/μL) were given to the wild-type mouse or laser-induced CNV mouse model. Retinal uptake of exosomes was assessed by in vivo retinal imaging microscopy and histological staining with DAPI, GSA, and anti-integrin αv for retinal sections or choroid/RPE flat mounts. Active targeting of CNV was assessed by comparing retinal uptake between areas with and without CNV and by colocalization analysis of ASL exosomes with integrin αv within CNV. Staining with anti-F4/80, anti-ICAM-1, and anti-GFAP antibodies on retinal sections were performed to identify intracellular uptake of exosomes and immediate reactive retinal gliosis after exosome treatment. Results: An average of 2.1 × 109 particles/mL with a peak size of 140 nm exosomes were recovered. Rapid retinal penetration of intravitreally injected exosomes was confirmed by retinal imaging microscopy at 3 and 24 h post-injection. Intravitreally delivered PKH-26-labeled exosomes reached inner and outer retinal layers including IPL, INL, OPL, and ONL at 1 and 7 days post-injection. Intravitreally injected ASL exosomes were predominantly delivered to the area of CNV including ONL, RPE, and choroid in laser-induced CNV mouse models with 89.5% of colocalization with integrin αv. Part of exosomes was also taken intracellularly to vascular endothelial cells and macrophages. After intravitreal injection, neither naive exosomes nor ASL exosomes induced immediate reactive gliosis. Conclusions: Intravitreally delivered retinal multicell-derived exosomes have good retinal penetration, and ASL modification of exosomes actively targets CNV with no immediate reactive gliosis. ASL exosomes have a great potential to serve as an intraocular drug delivery vehicle, allowing an active targeting strategy.
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Affiliation(s)
- Dimitrios Pollalis
- USC Roski Eye Institute, USC Ginsburg Institute for Biomedical Therapeutics, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Dongin Kim
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Gopa Kumar Gopinadhan Nair
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Changsun Kang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Arjun V. Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Sun Young Lee
- USC Roski Eye Institute, USC Ginsburg Institute for Biomedical Therapeutics, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Correspondence:
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Han YH, Yoo SH, Lee SY, Hwang IY, Kim KH, Cho B, Kim MS, Choi W, Kim Y. The Medical Needs and Characteristics of Cancer and Progressive Neurologic Disease Patients Who Use Home-Based Medical Care in Korea: A Retrospective Study for 2011-2020. J Am Med Dir Assoc 2022; 23:1634-1641.e2. [PMID: 35926572 DOI: 10.1016/j.jamda.2022.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/08/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the needs and characteristics of patients with cancer and neurologic disorders requiring home-based medical care (HBMC). DESIGN Retrospective observational study. SETTING AND PARTICIPANTS Patients receiving HBMC on discharge from a tertiary hospital in Korea during 2011-2020. METHODS Patients were classified into 3 disease groups: cancer, progressive neurologic disorders (NR), and others. Characteristics and medical needs were assessed in each disease group. Medical needs were categorized based on functional items requiring support or management at the time of registration: respiratory, feeding, urinary system, drain tube, central catheter, wound, medication, and other. Patients with multiple medical needs were assigned to multiple categories. Patients who used HBMC for more than 3 months were defined as long-term users; their characteristics were evaluated in the same way. RESULTS Of the total 655 patients, 47.0% (308) had cancer and 17.3% (113) were NR patients. Among all patients, 78.8% were partially dependent (44.0%) or completely dependent (34.8%) in daily activities, and there were more dependent patients in the NR group (80.5%) than cancer (26.6%). Patients with cancer needed central catheter management the most (43.5%), followed by wound care (36.7%), feeding support (35.1%), and drain tube management (22.1%). NR patients required feeding support the most (80.5%), followed by respiratory support (43.4%), wound care (41.6%), and urinary system support (19.5%). Of all patients, 30.2% (198) were long-term users (NR, 37.9%; cancer, 35.4%). Long-term users were common among patients who needed respiratory support (59.4%), feeding support (48.75), and urinary system support (34.6%). CONCLUSIONS AND IMPLICATIONS Homebound patients with cancer and progressive neurologic disorders need medical services at home after discharge. Patients who need feeding and respiratory support usually use HBMC for more than 3 months. Further studies are needed to design an optimal HBMC that continuously provides medical services to patients with serious illnesses living at home.
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Affiliation(s)
- Yo Han Han
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonho Choi
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yejin Kim
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
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Lee SH, Lee SY, Park JH, Song KJ, Shin SD. Effects of a designated ambulance team response on prehospital return of spontaneous circulation and advanced cardiac life support of out-of-hospital cardiac arrest: A nationwide natural experimental study. PREHOSP EMERG CARE 2022:1-8. [PMID: 35816697 DOI: 10.1080/10903127.2022.2099601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study aimed to investigate the effects of adding advanced cardiac life support (ACLS) training to an existing basic life support program and the operation of a designated team response for patients with out-of-hospital cardiac arrest (OHCA) on prehospital return of spontaneous circulation (ROSC) and ACLS management. METHODS A natural experimental study was conducted for emergency medical service (EMS)-treated adult patients with OHCA in 2020. In 2019, a quarter of the EMS clinicians were trained in a 3-day ACLS courses, and they were designated to be dispatched first in suspected OHCA. Some were dispatched only to major emergencies, such as OHCA and myocardial infarction (dedicated team), while others were dispatched to all emergencies with priority to major ones (non-dedicated team). The exposure was the ambulance response type: dedicated, no-dedicated, and basic teams (others). The primary outcome was prehospital ROSC. The secondary outcomes were prehospital ACLS (advanced airway management and intravenous access). A multivariable logistic regression analysis was conducted to investigate the effect of ambulance response type on study outcomes. RESULTS Among 23,512 eligible patients with OHCA, 54.8% (12,874) were treated by the basic team, 36.5% (8,580) by the non-dedicated ACLS team, and 8.8% (2,058) were treated by the dedicated ACLS team. Prehospital ROSC was greater for the designated team than for the basic team (dedicated ACLS team 13.8%, non-dedicated ACLS team 11.3%, and basic team 6.7%) (p <0.01). In the final logistic regression analysis, compared with the basic team, the designated ACLS team was associated with a higher probability of prehospital ROSC (AOR (95% CIs), 1.88 (1.68-2.09) compared to the non-dedicated ACLS team, and 2.46 (2.09-2.90) compared to the dedicated ACLS team), prehospital advanced airway management (1.72 (1.57-1.87) and 1.73 (1.48-2.03), respectively), and intravenous access (2.29 (2.16-2.43) and 2.76 (2.50-3.04), respectively). CONCLUSION Additional ACLS training and operation of a designated OHCA team response were associated with higher rates of prehospital ROSC and prehospital ACLS provision. However, further research is needed to find the optimal operation for EMS to improve survival outcomes.
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Affiliation(s)
- Seung Hyo Lee
- National Fire Agency, Sejong, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.,Seoul National University, College of Medicine, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital and Seoul National University, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital and Seoul National University, Seoul, Korea
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Jang Y, Kim TH, Lee SY, Ro YS, Hong KJ, Song KJ, Shin SD. Association of transport time interval with neurologic outcome in out-of-hospital cardiac arrest patients without return of spontaneous circulation on scene and the interaction effect according to prehospital airway management. Clin Exp Emerg Med 2022; 9:93-100. [PMID: 35843609 PMCID: PMC9288882 DOI: 10.15441/ceem.21.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study analyzed the association of transport time interval (TTI) with survival rate and neurologic outcome in out-of-hospital cardiac arrest (OHCA) patients without return of spontaneous circulation (ROSC) and the interaction effect of TTI according to prehospital airway management. Methods A retrospective observational study based on the nationwide OHCA database from January 2013 to December 2017 was designed. Emergency medical service (EMS)-treated OHCA patients aged ≥18 years were included. TTI was categorized into four groups of quartiles (≤4, 5–7, 8–11, ≥12 minutes). The primary outcome was favorable neurologic outcome at discharge. The secondary outcome was survival to discharge from the hospital. Multivariable logistic regression was used to analyze outcomes according to TTI. A different effect of TTI according to the administration of prehospital EMS advanced airway was evaluated. Results In total, 83,470 patients were analyzed. Good neurologic recovery decreased as TTI increased (1.0% for TTI ≤4 minutes, 0.9% for TTI 5–7 minutes, 0.6% for TTI 8–11 minutes, and 0.5% for TTI ≥12 minutes; P for trend <0.05). The adjusted odds ratio of prolonged TTI (≥12 minutes) was 0.73 (95% confidence interval, 0.57–0.93; P<0.01) for good neurologic recovery. However, the negative effect of prolonged TTI on neurological outcome was insignificant when advanced airway or entotracheal intubation were performed by EMS providers (adjusted odds ratio, 1.17; 95% confidence interval, 0.42–3.29; P=0.76). Conclusion EMS TTI was negatively associated with the neurologic outcome of OHCA without ROSC on scene. When advanced airway was performed on scene, TTI was insignificantly associated with the outcome.
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Lee SY, Song KJ, Lim CS, Chai YJ, Lee SY, Lee SGW. Risk factors for the deterioration of patients with mild COVID-19 admitted to a COVID-19 community treatment center. J Korean Med Assoc 2022. [DOI: 10.5124/jkma.2022.65.6.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The rapid increase in the number of coronavirus disease (COVID-19) patients led to the operation of COVID-19 facilities for patients with mild COVID-19 in South Korea. We analyzed the correlation and effect of risk factors associated with the worsening of patients with mild COVID-19 leading to their transfer from a community treatment center to a hospital.Methods: This retrospective cohort observational study included 1,208 COVID-19 patients with mild symptoms who were admitted to the Namsan Community Treatment Center between June 2020 and January 2021. A chi-square test was performed to examine the differences in the transfer rate by age, sex, nationality, presence of symptoms at admission, and season, and a multivariable logistic regression analysis was performed to examine the association of variables to the hospitalization rate.Results: Of the 1,208 patients, 212 (17.5%) were transferred to a hospital due to clinical deterioration. Increasing odds of hospital transfer were associated significantly with higher age and presentation in autumn, whereas sex and symptomatic illness at admission did not show a statistically significant association.Conclusion: The findings indicate the importance of the initial risk classification of COVID-19 patients based on thorough assessment and close monitoring, timely allocation of appropriate resources to high-risk groups that are likely to develop severe disease, and reduction of medical resource wastage and limiting of administrative force to ensure that patients receive the best treatment.
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Kim JS, Lee SY, Lee MS, Yoo SH, Shin J, Choi W, Kim Y, Han HS, Hong J, Keam B, Heo DS. Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea. Palliat Care 2022; 21:105. [PMID: 35668487 PMCID: PMC9170493 DOI: 10.1186/s12904-022-00988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED. Methods We conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status. Results Of all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%). Conclusions Patients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00988-3.
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Affiliation(s)
- Jung Sun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Min Sung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Jeongmi Shin
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Wonho Choi
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung Sook Han
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jinui Hong
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Dae Seog Heo
- Patient-Centered Clinical Research Coordinating Center, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
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