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Lee S, Kim HC, Jang Y, Lee HS, Ahn S, Lee S, Jung K, Park K, Jung K, Oh J, Lee S, Yu K, Jang I, Lee S, Chu K, Lee SK. Topiramate dosage optimization for effective antiseizure management via population pharmacokinetic modeling. Ann Clin Transl Neurol 2024; 11:424-435. [PMID: 38062636 PMCID: PMC10863906 DOI: 10.1002/acn3.51962] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Despite the suggested topiramate serum level of 5-20 mg/L, numerous institutions have observed substantial drug response at lower levels. We aim to investigate the correlation between topiramate serum levels, drug responsiveness, and adverse events to establish a more accurate and tailored therapeutic range. METHODS We retrospectively analyzed clinical data collected between January 2017 and January 2022 at Seoul National University Hospital. Drug responses to topiramate were categorized as "insufficient" or "sufficient" by reduction in seizure frequency ≥ 50%. A population pharmacokinetic model estimated serum levels from spot measurements. ROC curve analysis determined the optimal cutoff values. RESULTS A total of 389 epilepsy patients were reviewed having a mean dose of 178.4 ± 117.9 mg/day and the serum level, 3.9 ± 2.8 mg/L. Only 5.6% samples exhibited insufficient response, with a mean serum level of 3.6 ± 2.5 mg/L while 94.4% demonstrated sufficient response, with a mean 4.0 ± 2.8 mg/L, having no statistical significance. Among the 69 reported adverse events, logistic regression analysis identified a significant association between ataxia and serum concentration (p = 0.04), with an optimal cutoff value of 6.5 mg/L. INTERPRETATION This study proposed an optimal therapeutic concentration for topiramate based on patients' responsiveness to the drug and the incidence of adverse effects. We recommended serum levels below 6.5 mg/L to mitigate the risk of ataxia-related side effects while dose elevation was found unnecessary for suboptimal responders, as the drug's effectiveness plateaus at minimal doses.
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Affiliation(s)
- Seolah Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Hyun Chul Kim
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Han Sang Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Center for Hospital MedicineSeoul National University HospitalSeoulSouth Korea
| | - Seon‐Jae Ahn
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Center for Hospital MedicineSeoul National University HospitalSeoulSouth Korea
| | - Soon‐Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Keun‐Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Kyung‐Il Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
- Division of NeurologySeoul National University Hospital Healthcare System Gangnam CenterSeoulSouth Korea
| | - Ki‐Young Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Department of PharmacologyJeju National University College of MedicineJeju Special Self‐Governing ProvinceRepublic of Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Kyung‐Sang Yu
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - In‐Jin Jang
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Soyoung Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and HospitalSeoulSouth Korea
- Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical InnovationBiomedical Research Institute, Seoul National University College of Medicine and HospitalSeoulSouth Korea
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Kim Y, Jang Y, Lee S, Chu K. Autism-Like Presentation of Possible Autoimmune Encephalitis With Complete Recovery After Immunotherapy. J Clin Neurol 2024; 20:97-99. [PMID: 38179638 PMCID: PMC10782083 DOI: 10.3988/jcn.2023.0245] [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] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Yongmoo Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Seolah Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.
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Kim Y, Jang Y, Shin YW, Jeon D, Yoo JS, Park DK, Lee HS, Ahn SJ, Park KI, Jung KH, Lee ST, Lee SK, Chu K. Gut microbiome diversity in a febrile seizure mouse model. Encephalitis 2024; 4:11-17. [PMID: 38195066 PMCID: PMC11007404 DOI: 10.47936/encephalitis.2023.00206] [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: 10/24/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Purpose Febrile seizures at a young age can provoke late-onset temporal lobe epilepsy. Since recent evidence has suggested that the gut microbiome affects central nervous system pathology across the blood-brain barrier, we hypothesized that febrile seizures alter the composition of the gut microbiome to provoke epilepsy. Methods Third-generation C57BL/6 mice were separated into two groups (n = 5 each), and hot air was applied to only one group to cause febrile seizures. After two weeks of heat challenge, the fecal pellets acquired from each group were analyzed. Results The gut microbiota of fecal pellets from each group revealed five taxa at the genus level and eight taxa at the species level that were significantly different in proportion between the groups. Conclusion Although there was no significant difference in the overall diversity of the gut microbiota between the two groups, the identified heterogeneity may imply the pathognomonic causative relevance of febrile seizures and the development of epilepsy.
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Affiliation(s)
- Yongmoo Kim
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Yong-Won Shin
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | | | - Jung-seok Yoo
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Dong-Kyu Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Han Sang Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seon-Jae Ahn
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Il Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
- Division of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovation, Biomedical Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Jang Y, Lee K, Lee C, Chu K, Lee SK, Won J, Lee S. Teratoma pathology and genomics in anti-NMDA receptor encephalitis. Ann Clin Transl Neurol 2024; 11:225-234. [PMID: 37986706 PMCID: PMC10791014 DOI: 10.1002/acn3.51948] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Ovarian teratoma is a common occurrence in patients with anti-NMDA receptor encephalitis (NMDARe), and its removal is crucial for a favorable prognosis. However, the initial pathogenesis of autoimmunity in the encephalitic teratoma remains unclear. In this study, we aimed to investigate the genomic landscape and microscopic findings by comparing NMDARe-associated teratomas and non-encephalitic control teratomas. MATERIALS AND METHODS A prospective consecutive cohort of 84 patients with NMDARe was recruited from January 2014 to April 2020, and among them, patients who received teratoma removal surgery at Seoul National University Hospital were enrolled. We conducted a comparison of whole-exome sequencing data and pathologic findings between NMDARe-associated teratomas and control teratomas. RESULTS We found 18 NMDARe-associated teratomas from 15 patients and compared them with 17 non-encephalitic control teratomas. Interestingly, the genomic analysis revealed no significant differences in mutations between encephalitic and non-encephalitic teratomas. Pathologic analysis showed no discrepancies in terms of the presence of neuronal tissue and lymphocytic infiltration between the encephalitic teratomas (n = 14) and non-encephalitic teratomas (n = 18). However, rituximab-naïve encephalitic teratomas exhibited a higher frequency of germinal center formation compared to non-encephalitic teratomas (80% vs. 16.7%, P = 0.017). Additionally, rituximab-treated encephalitic teratomas demonstrated a reduced number of CD20+ cells and germinal centers in comparison to rituximab-naïve encephalitic teratomas (P = 0.048 and 0.023, respectively). DISCUSSION These results suggest that the initiation of immunopathogenesis in NMDARe-associated teratoma is not primarily attributed to intrinsic tumor mutations, but rather to immune factors present in the encephalitic patient group, ultimately leading to germinal center formation within the teratoma.
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Affiliation(s)
- Yoonhyuk Jang
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Kwanghoon Lee
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Cheol Lee
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Kon Chu
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Sang Kun Lee
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jae‐Kyung Won
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Soon‐Tae Lee
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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Jang Y, Lee HS, Kim MS, Lee J, Jung KY. Anti-seizure medication prescription in epilepsy patients in South Korea: A seven-year population-based retrospective cohort study. Seizure 2023; 109:70-76. [PMID: 37267669 DOI: 10.1016/j.seizure.2023.05.013] [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: 01/28/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to explore the natural history of patients with epilepsy using overall antiseizure-medication (ASM) treatment patterns on a nationwide scale in South Korea. METHODS We investigated a retrospective longitudinal cohort of patients with epilepsy in South Korea using nationwide data from the Korean National Health Information Database of the Health Insurance and Review Assessment Service between January 1st, 2009, and December 31st, 2018. Histories of each patient's ASM prescription were followed for up to 7 years from the index date, the first observed date of ICD-10 epilepsy diagnosis codes with at least one ASM prescription. RESULTS Of 82,390 incident patients analyzed, ten thousand and fifty-nine were followed up to seven years, and nearly 60% of them discontinued the ASM(s). The proportion of patients with possible drug-resistant epilepsy (DRE), who experience three or more types of ASMs, gradually increased, reaching approximately 8.8% of the total number of patients in the seventh year (6.45% for adults, 21.8% for children). The duration of progression for half of the patients with possible DRE was 1.29 years for children, 1.79 years for adults, and 1.62 years for mixed-age patients. However, even in the sixth year, 72 cases progressed to possible DRE, and 6 cases with possible DRE discontinued ASMs in the next year, showing a dynamic process. DISCUSSION Our population-based study showed the dynamic changes of anti-seizure medication prescription in epilepsy patients with real-world data, which slowly stabilizes over years after the first diagnosis of epilepsy.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Seoul National University Hospital Sensory Organ Research Institute, Seoul, Republic of Korea; Seoul National University Medical Research Center Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Jang Y, Jun JS, Jung KY. Trends in sleep duration in Korea: The Korean time use survey. Sleep Med 2023; 103:24-28. [PMID: 36738513 DOI: 10.1016/j.sleep.2023.01.025] [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: 10/20/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES An accurate assessment of sleep duration is important in that it can be one of the indicators of a country's overall health and well-being. The global trend in sleep duration is controversial according to study types. We investigated trends in sleep duration in South Korea with a time diary method. METHODS Data from the Korean Time Use Survey (KTUS) in 2004, 2009, 2014, and 2019, were analyzed. The KTUS is a nationwide, cross-sectional survey that measures daily time use patterns of individuals and has been performed every five years by Statistics Korea. For this survey, all participants were asked to record their activities for 2 continuous days in 10-min intervals. RESULTS Among the 168,682 people who completed the survey in 2004 through 2019, the final analytical sample consisted of 91,998 individuals. Over 15 years, the sleep duration of the Korean population increased from 411.1 min (SD 22.5) in 2004 to 434.5 min (SD 26.1) in 2019 (p for trend <0.001). This increase was observed for all age groups. Over the study period, while bedtime showed no significant change, wake time was generally delayed for all age groups. The increase in sleep duration in the Korean population was largely due to catch-up sleep on Saturdays, which was substantially prolonged with belated wake times. CONCLUSION Our nationwide time use survey data showed that sleep duration in South Korea has increased over the past 15 years but still has room for improvement in terms of weekday sleep duration.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
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Kim S, Moon J, Jung KH, Anh SJ, Lee HS, Jang Y, Park KI, Lee SK, Chu K. Clinicoradiologic data of familial cerebral cavernous malformation with age-related disease burden. Ann Clin Transl Neurol 2023; 10:373-383. [PMID: 36629374 PMCID: PMC10014009 DOI: 10.1002/acn3.51728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Familial cerebral cavernous malformation (FCCM) is an autosomal dominant disease induced by loss-of-function mutations in three CCM genes, KRIT1, CCM2, and PDCD10. However, previous studies paid little attention to analyzing the radiologic features and age-related disease burden according to the genes. Therefore, we retrospectively reviewed the genetic tests of our center's clinical FCCM patients. METHOD This study investigated clinical FCCM patients with multiple lesions or a family history of CCMs who underwent the FCCM gene (KRTI1, CCM2, and PDCD10) panel test. The clinical, genetic, and radiologic features were analyzed. RESULT Among the patients (n = 34) undergoing the FCCM gene test, twenty-seven patients had CCM confirmed by brain MRI, and twenty-one patients were considered to have FCCM (cohort 1). In cohort 1, thirteen patients had mutations in the FCCM gene, but eight did not. Cohort 2 comprised cohort 1 and four family members with the same mutation as the probands. Six novel variants in CCM genes were detected (KRIT1 c.22_26del, c.815dup, c.1094_1098del, c.1147-2A>G, c.2124dup, and PDCD10 c.150 + 1dup). Cohort 1 demonstrated that brainstem lesions were mostly associated with the mutation detection in CCM genes (brainstem, lateral temporal, and parietal lesions vs. lateral temporal and parietal lesions, AUC 0.928 vs. 0.779, P = 0.0389). The radiologic severity worsened according to age in the KRIT1 group compared with the Mutation not detected group (correlation coefficient 0.75 (P < 0.001) versus 0.53 (P = 0.004)). CONCLUSION The brainstem lesion could be the radiologic marker for FCCM with the mutation detected. The age-related disease burden regarding FCCM according to genetic information was demonstrated.
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Affiliation(s)
- Seondeuk Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Seon-Jae Anh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea
| | - Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 152, Teheran-ro, Gangnam-gu, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Kim S, Kim S, Jang Y, Chu K. Leptomeningeal Enhancement, a Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease With Caudate Nucleus Involvement: A Case Report and Literature Review. J Clin Neurol 2023; 19:210-213. [PMID: 36854340 PMCID: PMC9982174 DOI: 10.3988/jcn.2022.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 02/21/2023] Open
Affiliation(s)
- Seondeuk Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seoyeon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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Choi S, Jang Y, Kim H. A Deep Learning Approach to Imputation of Dynamic Pupil Size Data and Prediction of ADHD. INT J ARTIF INTELL T 2022. [DOI: 10.1142/s0218213023500203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Andersen D, Jang Y, Borzée A. Influence of landscape and connectivity on anuran conservation: population viability analyses to designate protected areas. Anim Conserv 2022. [DOI: 10.1111/acv.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Andersen
- Department of Life Science and Division of EcoScience Ewha Womans University Seoul Republic of Korea
| | - Y. Jang
- Department of Life Science and Division of EcoScience Ewha Womans University Seoul Republic of Korea
- Interdisciplinary Program of EcoCreative Ewha Womans University Seoul Republic of Korea
| | - A. Borzée
- Laboratory of Animal Behaviour and Conservation, College of Biology and the Environment Nanjing Forestry University Nanjing Jiangsu People's Republic of China
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Kim Y, Ryu J, Jang Y, Kim D, Bang Y, Choi S, Moon J, Kim H, Shin J. 138 Single-cell RNA-seq of dorsal root ganglion reveals neuroinflammatory process in atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Song BG, Woo JH, Yoon HK, Cho B, Lee HJ, Jung M, Jang Y. Predictors of critical illness among young males with chest pain, abdominal pain, or headaches in the Republic of Korea Army. Encephalitis 2022; 2:73-82. [PMID: 37469461 PMCID: PMC10295918 DOI: 10.47936/encephalitis.2021.00185] [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: 12/06/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 07/21/2023] Open
Abstract
Purpose Chest pain, abdominal pain, and headache are common symptoms associated with critical illness. Here, we aimed to evaluate predictors associated with critical illness in young males of the Republic of Korea Army. Methods We retrospectively reviewed previously healthy young males with chest pain, abdominal pain, or headaches who visited Armed Forces Seoul District Hospital between January 2019 and December 2020. Critical illness was defined as a condition that required hospitalization, a procedure or surgery, or referral to a tertiary hospital. The symptoms and signs of critical illness were evaluated. Results Of the 762 enrolled patients, a critical illness was diagnosed in 45 patients (5.9%). Among chest pain signs, palpitation (odds ratio [OR], 22.8; 95% confidence interval [CI], 5.08-102.4; p < 0.001), exertional dyspnea (OR, 16.3; 95% CI, 3.38-78.8; p = 0.001), duration (> 5 minutes) (OR, 7.54; 95% CI, 1.93-29.49; p = 0.004), and squeezing type (OR, 5.28; 95% CI, 1.11-25.11; p = 0.037) were significantly associated with critical illness. Among abdominal pain signs, right-lower-quadrant tenderness (OR, 11.87; 95% CI, 4.671-31.87; p < 0.001) was an alarming sign. For headaches, criticality was low (1.5%), and half of patients with critical illness were diagnosed incidentally regardless of headache. Conclusion We identified symptoms and signs significantly associated with critical illness in young male patients. This study might serve as a reference for deciding when to transfer soldiers in the field to a rear hospital, thereby contributing to the welfare and combat power of soldiers.
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Affiliation(s)
- Byeong Geun Song
- Department of Internal Medicine, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Jung Han Woo
- Department of Radiology, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Hyeon Kyung Yoon
- Hospital Headquarters, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Byeongwook Cho
- Department of Internal Medicine, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Hyun Jae Lee
- Department of Internal Medicine, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Moonki Jung
- Department of Internal Medicine, Armed Forces Seoul District Hospital, Seoul, Korea
| | - Yoonhyuk Jang
- Department of Neurology, Armed Forces Seoul District Hospital, Seoul, Korea
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13
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Jang Y, Moon J, Lee ST, Lee SK, Chu K. Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea. Encephalitis 2022; 2:65-72. [PMID: 37469460 PMCID: PMC10295915 DOI: 10.47936/encephalitis.2022.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 07/21/2023] Open
Abstract
Telemedicine is an emerging field of medicine that has become more important during the coronavirus disease 2019 (COVID-19) pandemic era and is being studied actively in various medical fields. In neurology, the introduction of telemedicine is accelerating worldwide under the label of teleneurology. So far, few studies have been conducted on telemedicine for patients with epilepsy. In nonmetropolitan areas, video-based clinics have been demonstrated to be effective for seizure control, and smartphone-based diagnosis has also been confirmed to be accurate. Indeed, after the onset of the COVID-19 pandemic, telemedicine has been used to treat patients with epilepsy around the world. Few studies have examined the use of telemedicine for patients with autoimmune encephalitis. One showed that telephone-based evaluation is sufficient to assess the cognitive reserve of leucine-rich glioma inactivated-1-antibody encephalitis patients, thereby diagnosing their dementia. Telephone-based outpatient clinics are temporarily permitted under Korean medical law, and telemedicine can be attempted for clinically stable patients with epilepsy in Korea. In addition, patients with autoimmune encephalitis in stable or improving status may also be candidates for treatment with telemedicine. This review presents evidence for the safety and efficacy of telemedicine to treat epilepsy and encephalitis patients and discusses indication guidelines. Based on our literature review and current Korean medical law, we suggest tentative guidelines for telemedicine in the fields of epilepsy and autoimmune encephalitis.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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14
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Affiliation(s)
- Y Jang
- National Institute of Crop Science, Rural Development Administration, Miryang 50424, Korea
| | - H Yi
- National Institute of Crop Science, Rural Development Administration, Miryang 50424, Korea
| | - R Maharjan
- National Institute of Crop Science, Rural Development Administration, Miryang 50424, Korea
| | - M Jeong
- National Institute of Crop Science, Rural Development Administration, Miryang 50424, Korea
| | - Y Yoon
- National Institute of Crop Science, Rural Development Administration, Miryang 50424, Korea
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15
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Li Z, Siddiqi U, Patel A, Rasheed N, Jang Y, Cruz J, Hoang R, Hu K, Deji-Abiodun O, Rodgers D, Jeevanandam V, Olopade C. Impact of Obstructive Sleep Apnea on Clinical Outcomes Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Jang Y, Kim S, Kim N, Son H, Ha EJ, Koh EJ, Phi JH, Park C, Kim JE, Kim S, Lee SK, Cho W, Moon J, Chu K. Nanopore
16S
sequencing enhances the detection of bacterial meningitis after neurosurgery. Ann Clin Transl Neurol 2022; 9:312-325. [PMID: 35124895 PMCID: PMC8935320 DOI: 10.1002/acn3.51517] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
Objective Nosocomial bacterial meningitis is one of the major complications after neurosurgery. We performed nanopore 16S amplicon sequencing from cerebrospinal fluid (CSF) to evaluate bacterial meningitis in patients who underwent neurosurgery. Methods Among the patients who visited the neurosurgery department of Seoul National University Hospital between July 2017 and June 2020, those with clinically suspected bacterial meningitis were included. 16S rDNA PCR was performed from the CSF, and nanopore sequencing was performed for up to 3 h. The reads were aligned to the BLAST database. In each case, the culture and the 16S rRNA gene amplicon analysis were simultaneously performed and compared with each other, and we retrospectively reviewed the medical records. Genuine infection was determined by the identical results between conventional culture study and the sequencing, or clinically determined in cases with inconsistent results between the two methods. Results Of the 285 samples obtained from 178 patients who had 16S rDNA PCR, 41 samples (14.4%) were diagnosed with genuine infection. A total of 56.1% (23/41) of the samples with genuine infection showed a false‐negative culture test. In particular, 16S amplicon sequencing was useful in evaluating patients at the initial tests who had infection with intraventricular hemorrhage (Culture false‐negative rate = 100%), subarachnoid hemorrhage (Culture false‐negative rate = 77.8%), and systemic cancer (Culture false‐negative rate = 100%), which are risk factors for central fever. Moreover, 16S amplicon sequencing could suggest the possibility of persistent bacterial meningitis in empirical antibiotic use. Conclusion CSF nanopore 16S sequencing was more effective than conventional CSF culture studies in postoperative bacterial meningitis and may contribute to evidence‐based decisions for antibiotic maintenance and discontinuation.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Seondeuk Kim
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Narae Kim
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Hyoshin Son
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Eun Jin Ha
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Eun Jung Koh
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Ji Hoon Phi
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Chul‐Kee Park
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Jeong Eun Kim
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Seung‐Ki Kim
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
- Division of Pediatric Neurosurgery Seoul National University Children's Hospital Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
| | - Won‐Sang Cho
- Department of Neurosurgery Seoul National University College of Medicine, Seoul National University Hospital Seoul South Korea
| | - Jangsup Moon
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
- Department of Genomic Medicine Seoul National University Hospital Seoul South Korea
| | - Kon Chu
- Department of Neurology Seoul National University College of Medicine Seoul National University Hospital Seoul South Korea
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17
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Jang Y, Lee WJ, Lee HS, Chu K, Lee SK, Lee ST. Anakinra treatment for refractory cerebral autoinflammatory responses. Ann Clin Transl Neurol 2022; 9:91-97. [PMID: 35040583 PMCID: PMC8791800 DOI: 10.1002/acn3.51500] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 12/27/2021] [Indexed: 01/19/2023] Open
Abstract
Refractory cerebral autoinflammatory–autoimmune diseases are often associated with dysregulated innate immunity and are targeted by anakinra, an interleukin‐1 receptor antagonist. We analyzed the therapeutic effect of anakinra in refractory cerebral autoinflammatory response (CAIR) at a single institution from January 2017 to May 2021. In total, 12 patients with various etiologies were sympathetically treated with anakinra (100 mg/day subcutaneously). Four patients showed good responses, and among these patients, three patients had pathologically demonstrated CAIR. The other eight patients were nonresponsive. No patient had a serious adverse effect. Thus, anakinra may be a therapeutic option for refractory cerebral autoinflammatory diseases.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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18
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Jang H, Choi Y, Kwon E, Choi N, Jang Y, Song J, Shin S. Optimal application of compressive palatal stents following mesiodens removal in pediatric patients: A Randomized Controlled Trial. Med Oral Patol Oral Cir Bucal 2021; 26:e808-e814. [PMID: 34704974 PMCID: PMC8601646 DOI: 10.4317/medoral.24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is no scientific evidence supporting the choice of a palatal stent in patients who underwent removal of an impacted supernumerary tooth. We aimed to investigate the effects of palatal stents in patients who underwent supernumerary tooth removal through a palatal approach and to suggest the optimal stent thickness and material. Material and Methods We recruited 144 patients who underwent extraction of a supernumerary tooth between the maxillary anterior teeth. Subjects were assigned to a control group (CG) or one of four compressive palatal stent groups (CPSGs) classified by the thickness and material of the thermoplastic acrylic stent used. Palatal gingival swelling and objective indices (healing, oral hygiene, gingival, and plaque) were evaluated before surgery and on postoperative days (PODs) 3, 7, and 14; pain/discomfort and the Child Oral Health Impact Profile (COHIP) were assessed as subjective indices of the effects of the stent. Results The CPSGs showed faster healing than did the CG on PODs 7 (P<0.001) and 14 (P=0.043); swelling was measured by 1.64±0.88 mm and 4.52±0.39 mm, respectively. Although swelling was least in the 4-mm hard group (0.92±0.33 mm), the difference compared with that in the 2-mm hard group (1.01±0.18 mm) was not significant (P=0.077). The CPSGs showed better COHIP (P<0.001-0.036) and pain scores (P<0.001) than did the CG on PODs 1-3. Conclusions Compressive palatal stents reduce discomfort by decreasing pain and alleviating swelling. Although a stent is effective regardless of its thickness and material, 2-mm hard stents maximized such positive effects with minimal discomfort. Key words:Supernumerary tooth, tooth Extraction, postoperative care, oral Health, pediatric dentistry.
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Affiliation(s)
- H Jang
- Department of Oral and Maxillofacial surgery, Pusan National University, School of Dentistry, Korea Dental and Life Science Institute, School of Dentistry, Pusan National University, Korea Beomeo, Mulgeum, Yangsan, 50612, Republic of Korea
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19
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Jang Y, Kim S, Chu K, Lee SK, Lee ST. Paraneoplastic encephalitis associated with renal cell carcinoma. Encephalitis 2021; 1:73-78. [PMID: 37469845 PMCID: PMC10295882 DOI: 10.47936/encephalitis.2021.00059] [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: 03/27/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 07/21/2023] Open
Abstract
Purpose Paraneoplastic encephalitis is autoimmune encephalitis accompanied by tumors. Renal cell carcinoma (RCC) is a kidney cancer originating from various types of renal cells and rarely has been associated with paraneoplastic neurologic manifestation. We identified a case series of paraneoplastic encephalitis-associated RCC. Methods From a prospective institutional cohort, we identified autoimmune encephalitis patients with RCC. The association between RCC and encephalitis was determined by the following criteria: (1) possible autoimmune encephalitis according to the operational autoimmune encephalitis diagnostic criteria and (2) RCC simultaneously diagnosed with neurological manifestation of encephalitis. Results A total of three patients presented encephalitis accompanied by RCC. Two patients had clear cell RCC, and one had chromophobe RCC. All patients showed limbic encephalitis with cognitive decline, memory impairment, or seizure. Brain magnetic resonance imaging showed T2 hyperintensities at the mesial temporal lobe in two patients with clear cell RCC but no remarkable findings in one patient with chromophobe RCC. While one patient who had early surgery within one month of RCC onset had a favorable response to the treatment, the other two patients showed a partial response and a detrimental result. Conclusion Paraneoplastic encephalitis associated with RCC presented as limbic encephalitis and was responsive to immunotherapy combined with tumor resection. As our cases identified, RCC should be considered as a cause of seronegative autoimmune encephalitis.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - SeonDeuk Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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20
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Jang Y, Moon J, Kim N, Kim TJ, Jun JS, Shin YW, Chang H, Kang HR, Lee ST, Jung KH, Park KI, Jung KY, Chu K, Lee SK. A new rapid titration protocol for lamotrigine that reduces the risk of skin rash. Epilepsia Open 2021; 6:394-401. [PMID: 34033264 PMCID: PMC8166783 DOI: 10.1002/epi4.12495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/04/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Lamotrigine is one of the most widely used antiepileptic drugs, but it has a critical issue of a skin rash if the starting dose is too high or the escalation rate is too rapid. We investigated the efficacy and safety of a novel and rapid titration protocol for lamotrigine that takes only 11 days to reach a daily dose of 200 mg. Methods We prospectively enrolled 33 adult patients (age 18‐85) who were diagnosed with epilepsy and started lamotrigine administration for the first time at a single tertiary hospital. Our new protocol starts with a subthreshold dose of the drug and then administers a stepwise‐incremental dose until reaching the full therapeutic dose within 11 days. Results Of 29 patients analyzed, only two (6.9%) experienced idiosyncratic skin rash before the first follow‐up visit at 2 weeks (±3 days). In addition, a therapeutic concentration was reached in more than 75% of studied patients after 2 weeks of lamotrigine administration. Significance These findings demonstrate the value of the novel tolerance induction protocol for lamotrigine, which could widen the available application of lamotrigine in various situations. However, this study is a preliminary study limited by a small number of patients and its nonrandomized and open‐label design, so the current protocol needs more rigorous clinical evaluations before the application to the real clinical setting.
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Affiliation(s)
- Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Rare Disease Center, Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Narae Kim
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong-Won Shin
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyeyeon Chang
- Department of Neurology, Konyang University Hospital, Daejeon, South Korea
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
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21
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Jang Y, Yoon S, Kim TJ, Lee S, Yu KS, Jang IJ, Chu K, Lee SK. Population pharmacokinetic model development and its relationship with adverse events of oxcarbazepine in adult patients with epilepsy. Sci Rep 2021; 11:6370. [PMID: 33737678 PMCID: PMC7973549 DOI: 10.1038/s41598-021-85920-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to develop a pharmacokinetic (PK) model of oxcarbazepine (OXC) and analyse the relationship between monohydroxylated derivative (MHD), an active metabolite of OXC, and the adverse events of OXC. We obtained 711 OXC samples from 618 patients with epilepsy who were enrolled in the Epilepsy Registry Cohort of Seoul National University Hospital from February 2011 to January 2014. The plasma PK model was developed using a nonlinear mixed-effect modelling method with NONMEM (ver 7.3). A one-compartment model with a first-order absorption model and proportional residual error adequately described the MHD concentration–time profiles. The only covariate incorporated for CL/F and V/F was body weight. Of the 447 patients analysed, 28 (6.26%) had dose-related adverse events (DRAEs), which were dizziness, somnolence, headache, and diplopia. For DRAE occurrence, the cut-off values of the MHD trough and AUC were 12.27 mg/L (specificity 0.570, sensitivity 0.643) and 698.5 mg h/L (specificity, sensitivity 0.571), respectively. Multivariate analysis showed the sole dizziness symptom was significantly associated with both the MHD trough and the AUC (p = 0.013, p = 0.038, respectively). We newly developed a population PK model using sparse sampling data from patients with epilepsy, and the model better reflects the actual clinical situation.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Seonghae Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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22
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Jang Y, Lee WJ, Lee HS, Chu K, Lee SK, Lee ST. Tofacitinib treatment for refractory autoimmune encephalitis. Epilepsia 2021; 62:e53-e59. [PMID: 33656171 DOI: 10.1111/epi.16848] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 01/15/2023]
Abstract
To treat intractable cases of autoimmune encephalitis, the need for novel immunotherapy that penetrates the blood-brain barrier (BBB) is increasing. Tofacitinib is a Janus kinase (JAK) inhibitor used to treat refractory immune-mediated diseases that effectively penetrates the BBB. Accordingly, tofacitinib could be a new option for patients with refractory autoimmune encephalitis. Patients treated with tofacitinib were selected from Seoul National University Hospital cohort for autoimmune encephalitis from April 2019 until July 2020. We retrospectively analyzed the efficacy of tofacitinib in patients with autoimmune encephalitis who showed insufficient responses to multimodal conventional immunotherapies. Tofacitinib was administered orally at a dose of 5 mg twice daily. A total of eight patients were treated with tofacitinib; two had good responses (clinical global impression-improvement score [CGI-I] = 1 or 2), three had partial responses (CGI-I = 3), and three showed no significant improvements (CGI-I = 4) in response to tofacitinib. The two good responders showed the improvement of chronic autoimmune meningoencephalitis and the cessation of the new-onset refractory status epilepticus in anti-myelin oligodendrocyte glycoprotein (MOG)-associated disorder, which was previously intractable to anesthetics and the other immunotherapies. No patients had serious side effects. Our findings suggest the potential of tofacitinib as a therapeutic option for central nervous system autoimmune diseases.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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23
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Jang Y, Kim JM, Moon J, Park KI, Lee ST, Jung KH, Lee SK, Chu K. Anti-N-methyl-D-aspartate receptor encephalitis 8 years after serial herpes simplex virus type 1 and human herpesvirus type 7 encephalitis. Encephalitis 2021; 1:25-29. [PMID: 37492495 PMCID: PMC10295876 DOI: 10.47936/encephalitis.2020.00066] [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: 11/23/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 07/27/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is triggered by herpesvirus encephalitis. Human herpesvirus type 7 (HHV-7) is a recently described herpesvirus for which neuroinvasion has been reported rarely. We report a case of anti-NMDAR encephalitis detected 8 years after recurrent herpes encephalitis associated with herpes simplex virus type 1 and HHV-7 in an immunocompetent host. Our case suggests that anti-NMDAR encephalitis may be triggered by HHV-7 meningoencephalitis in immunocompetent adults, and patients with a history of herpesvirus encephalitis should be vigilantly monitored.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Korea
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Shin HR, Jang Y, Shin YW, Chu K, Lee SK, Lee ST. High-Dose Diazepam Controls Severe Dyskinesia in Anti-NMDA Receptor Encephalitis. Neurol Clin Pract 2020; 11:e480-e487. [PMID: 34484945 DOI: 10.1212/cpj.0000000000001001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/21/2020] [Indexed: 01/06/2023]
Abstract
Objective Because there is no standard treatment to control dyskinesia in anti-NMDA receptor (NMDAR) encephalitis, we analyzed the therapeutic efficacy of high-dose diazepam in dyskinesia associated with NMDAR encephalitis. Methods We reviewed patients with NMDAR encephalitis with dyskinesia who were admitted to Seoul National University Hospital between November 2012 and July 2018. High-dose diazepam was administered orally or via a nasogastric tube 3-6 times a day. We assessed the treatment effect by comparing dyskinesia severity between the first day of the highest dose of diazepam and one week after the treatment. Results Among 68 patients with NMDAR encephalitis during the study period, 33 patients were treated with enteral diazepam (ranging from 6 to 180 mg) to control dyskinesia, along with immunotherapy. The severity of dyskinesia improved from average grade 2.4 ± 0.6 to 1.1 ± 0.7 after 1 week of the highest dose of diazepam (mean severity change -1.4 ± 0.6, 95% confidence interval -1.2 to -1.6; p < 0.001). No patients had serious adverse events except for mild sedation. Conclusions Dyskinesia in NMDAR encephalitis improved after treatment with enteral diazepam without significant side effects. This study suggests that enteral diazepam could be a treatment option for control dyskinesia in NMDAR encephalitis. Classification of Evidence This study provides Class IV evidence that for patients with dyskinesias associated with NMDAR encephalitis, enteral diazepam is effective and safe in dyskinesia control.
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Affiliation(s)
- Hye-Rim Shin
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
| | - Yoonhyuk Jang
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
| | - Yong-Won Shin
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
| | - Kon Chu
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
| | - Sang Kun Lee
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
| | - Soon-Tae Lee
- Department of Neurology (YJ, Y-WS, KC, SKL, S-TL), Seoul National University Hospital; Department of Neurology (H-RS), Dankook University Hospital, Cheonan; and Department of Neurosurgery (Y-WS), Seoul National University Hospital, South Korea
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Cha J, Son T, Ha J, Kim J, Hong S, Ahn C, Kim B, Ko Y, Choi D, Hong M, Jang Y. Machine learning for predicting fractional flow reserve based on optical coherence tomography in intermediate coronary stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Machine learning approaches using intravascular optical coherence tomography (OCT) to predict fractional flow reserve (FFR) have not been previously investigated. The objective of the study was to evaluate a machine learning method to estimate FFR based on intravascular OCT images in intermediate coronary lesions.
Methods
Data from both OCT- and wire-based FFR methods were obtained for lesions of the left anterior descending artery in 125 patients. Based on the total number of lesions, training and testing groups were partitioned at a ratio of 5:1. For the training group, 36 features, including 16 clinical and lesion characteristics, and 21 OCT features, were used to model machine learning-FFR. machine learning-FFR values were then derived for the testing group and compared with wire-based FFR values in terms of a diagnosis of ischemia (FFR <0.8).
Results
Clinical and lesion characteristics and OCT features between the training and testing groups were similar. During the machine learning modeling of the training group, six important features of machine learning-FFR were identified: minimal luminal area, percentage of the stenotic area, lesion length, proximal luminal area, pre-procedural platelet count, and hypertension. machine learning-FFR values showed a good correlation (r=0.853, P<0.001) with wire-based FFR values (Figure 1A). The diagnostic power of an FFR value less than 0.8, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of machine learning-FFR values for the testing group were 85.7%, 100%, 100%, 77.8%, and 90.5%, respectively (Figure 1B). Additionally, OCT-based machine learning-FFR values showed a good diagnostic accuracy compared with other image-based FFR values.
Conclusions
The OCT-based machine learning-FFR method can be used to simultaneously acquire information on both image and functional modalities using one invasive procedure, suggesting that it may be used to optimize treatments for intermediate coronary artery stenosis, as well as save time and cost.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Funded by the Korean government (MSIT) (no. 2017R1A2B2003191)
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Affiliation(s)
- J.J Cha
- Korea University Anam Hospital, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - T.D Son
- Yonsei University, Electrical Engineering, Seoul, Korea (Republic of)
| | - J Ha
- Yonsei University, Electrical Engineering, Seoul, Korea (Republic of)
| | - J.S Kim
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - S.J Hong
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - C.M Ahn
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - B.K Kim
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - Y.G Ko
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - D Choi
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M.K Hong
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - Y Jang
- Yonsei University College of Medicine, Severance Cardiovascular Hospital, Department of Internal Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Jang Y, Kim TJ, Moon J, Yang TW, Kim KT, Park BS, Lim JA, Jun JS, Lee ST, Jung KH, Park KI, Jung KY, Chu K, Lee SK. HLAs associated with perampanel-induced psychiatric adverse effects in a Korean population. Sci Rep 2020; 10:13667. [PMID: 32788606 PMCID: PMC7423598 DOI: 10.1038/s41598-020-70601-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
Perampanel (PER) is a new-generation antiepileptic drug that has an occasional but significant shortcoming, psychiatric adverse effects (PAEs). Recently, antiepileptic drug-related adverse reactions, such as skin rash and even PAEs, have been discovered to be correlated with certain human leukocyte antigen (HLA) types. Thus, we aimed to analyze specific HLA alleles as risk factors for PER-PAEs. We prospectively enrolled 17 patients with epilepsy who were prescribed PER between May 2016 and Jul 2018 at Seoul National University Hospital and developed PAEs while taking PER. Their HLA types were analyzed compared to those of 19 patients in the PAE-tolerant group and the general Korean population. In silico docking was performed with two different computational programs, AutoDock Vina and SwissDock, to theoretically evaluate the binding affinity of PER in the grooves of the specific HLA alleles. The HLA-DQB1*06:01, DRB1*08:03, and B*54:01 alleles were significantly associated with the patients who developed PER-PAEs compared with the general Korean population (odds ratio [OR] 3.94, p = 0.008, OR 9.24, p = 0.037, and OR 3.25, p = 0.041, respectively). As a haplotype, the combination of the three alleles was significantly more frequent in the PER-PAE group than in both the PER-tolerant group and the general Korean population. DQB1*06:01 and B*54:01 also demonstrated higher docking scores with PER than other alleles. This is the first study to analyze the association of PER-PAEs with specific HLA genotypes. Our results suggest that an HLA-associated genetic predisposition and a possible immunological mechanism are involved in the occurrence of PER-PAEs.
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Affiliation(s)
- Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jangsup Moon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Byeong-Su Park
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Chamjoeun Hospital, Gwangju, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyung-Il Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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Son H, Hong SB, Jang Y, Lee WJ, Sunwoo JS, Jeon D, Lee ST, Park KI, Lee SK, Chu K. Case study: mepolizumab prevents progression of eosinophilic granulomatosis with polyangiitis with involvement of the central nervous system which is refractory to conventional immunotherapy. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.160.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis involving small-sized vessel. It manifests mainly as asthma or eosinophilia, but the literature reported involvement of the central nervous system (CNS) in 5%, while isolated CNS involvement is very rare. We describe a case of isolated CNS involvement of EGPA which was refractory to conventional immunotherapy and treated with mepolizumab, an anti-interluekin-5 monoclonal antibody. A previously healthy 51-year-old man was referred to the neurology department for memory decline persisting for a month. Magnetic resonance imaging (MRI) showed the multifocal lesion in the periventricular and frontal lobe. Analysis of cerebrospinal fluid revealed an elevated protein concentration and leukocytosis. Considering his age, clinical course, and laboratory findings, steroid and intravenous immunoglobulin was started for autoimmune encephalopathy. Two months after discharge, the patient experienced new symptom – gait disturbance. The follow-up MRI showed increased extent of the previous lesions and the new lesions. To confirm the diagnosis, brain biopsy was done, and the finding was consistent with EGPA. We decided to start mepolizumab as second-line treatment, and observe the stationary course and absence of further progression of the lesion in the follow-up MRI. Mepolizumab for EGPA patients was introduced to achieve protocol-defined remission and clinical benefit compared to the placebo group in the several studies. Our case signifies possibility of mepolizumab to halt further progression of the disease clinically and radiologically, for the patient with isolated CNS involvement of EGPA which is unresponsiveness to conventional immunotherapy.
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Affiliation(s)
- Hyoshin Son
- 1Seoul National University College of Medicine, South Korea
| | - Sang Bin Hong
- 1Seoul National University College of Medicine, South Korea
| | - Yoonhyuk Jang
- 1Seoul National University College of Medicine, South Korea
| | - Woo-Jin Lee
- 1Seoul National University College of Medicine, South Korea
| | | | - Daejong Jeon
- 2korea advanced institute of science and technology, South Korea
| | - Soon-Tae Lee
- 1Seoul National University College of Medicine, South Korea
| | - Kyung-Il Park
- 1Seoul National University College of Medicine, South Korea
| | - Sang Kun Lee
- 1Seoul National University College of Medicine, South Korea
| | - Kon Chu
- 1Seoul National University College of Medicine, South Korea
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Ko Y, Lee G, Kim B, Park M, Jang Y, Lim W. Modification of the RANKL-RANK-binding site for the immunotherapeutic treatment of osteoporosis. Osteoporos Int 2020; 31:983-993. [PMID: 31863125 DOI: 10.1007/s00198-019-05200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
UNLABELLED Here, we proposed the use of mutated RANKL as an immunogen for active immunization and to induce anti-cytokine antibodies for osteoporosis treatment. INTRODUCTION Osteoclasts are responsible for bone resorption in bone-related disorders. Anti-cytokine therapeutic antibodies such as denosumab are effective for the treatment of osteoporosis. However, problems with antibody manufacturing and the immunogenicity caused by multiple antibody doses have led to the use of auto-cytokines as immunogens to induce anti-cytokine antibodies. METHODS RANKL was point-mutated based on the crystal structure of the complex of RANKL and its receptor RANK. RESULTS As a proof of concept, immunization with RANKL produced high levels of specific antibodies and blocked osteoclast development in vitro and inhibited osteoporosis in RANKL-treated or ovariectomized mouse models. CONCLUSIONS The results demonstrate the successful use of mutated RANKL as an immunogen for the induction of anti-RANKL immune response. This strategy is useful in general anti-cytokine immunotherapy to avoid toxic side effects of osteoporosis treatment.
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Affiliation(s)
- Y Ko
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea
| | - G Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea
| | - B Kim
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea
| | - M Park
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea
| | - Y Jang
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea
- Department of Premedical Program, School of Medicine, Chosun University, Gwangju, 61452, South Korea
| | - W Lim
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.
- Laboratory of Orthopaedic Research, Chosun University Hospital, Gwangju, 61453, South Korea.
- Department of Premedical Program, School of Medicine, Chosun University, Gwangju, 61452, South Korea.
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Lee WJ, Lee ST, Hong SB, Son H, Jang Y, Sunwoo JS, Park KI, Chu K, Lee SK. Immunotherapy in Probable autoimmune encephalitis without detected autoantibody. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.160.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Along with the rapidly expanding spectrum of autoimmune encephalitis (AE), probable AE with no detected autoantibody (AE-NoDab) has become a major category of AE. However, its clinical features, treatment, and prognosis were not demonstrated. In our institutional cohort of all consecutive patients with possible AE in 2012 – 2018, patients diagnosed with AE-NoDab were included in this study. AE-NoDab was subcategorized into limbic encephalitis (LE), acute disseminated encephalomyelitis (ADEM), and antibody negative probable AE (pAE). Patients’ clinical severity was assessed at every week for the first 12 weeks, at every month for the next 9 months, and then at every three months, using the modified Rankin scale (mRS) and the Clinical Assessment Scales in Autoimmune Encephalitis (CASE, score range 0–27) scores. Combination immunotherapy regimens used at each time point were categorized as steroid+immunoglobulin (SI), SI+Rituximab (anti CD-20 mAb, SIR), and SIR+ Tocilizumab (anti IL-6 mAb, SIRT). 136 patients (LE 52[38.2%], ADEM 14[10.3%], and pAE 70 [51.5%]) were followed-up for 39.0±19.6 (range 10–80) months. At last follow-up, 76 (55.9%) patients had favorable mRS outcomes (scores 0–2). Compared to 55 anti-NMDA receptor encephalitis patients, baseline severity was higher, use of immunotherapy was lower, and outcome was poorer in AE-NoDab. There was no difference in clinical characteristics, treatment, and outcomes among subcategories of AE-NoDab. In a linear mixed model analysis, using the SIRT regimen was more effective than conventional regimens such as SIR or SI in lowering CASE scores (both, P=0.001). Early diagnosis and use of combined immunotherapy consisting of SIRT is warranted to improve the poor outcomes of AE-NoDab.
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Affiliation(s)
- Woo-Jin Lee
- 1Seoul National University College of Medicine, South Korea
| | - Soon-Tae Lee
- 1Seoul National University College of Medicine, South Korea
| | - Sang Bin Hong
- 1Seoul National University College of Medicine, South Korea
| | - Hyoshin Son
- 1Seoul National University College of Medicine, South Korea
| | - Yoonhyuk Jang
- 1Seoul National University College of Medicine, South Korea
| | | | - Kyung-Il Park
- 1Seoul National University College of Medicine, South Korea
| | - Kon Chu
- 1Seoul National University College of Medicine, South Korea
| | - Sang Kun Lee
- 1Seoul National University College of Medicine, South Korea
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Jang Y, Moon J, Son H, Lee WJ, Sunwoo JS, Lee ST, Park KI, Jeon D, Chu K, Lee SK. A new rapid titration protocol for lamotrigine with reduced risk of skin rash. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.64.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Introduction
Lamotrigine is one of the most widely used antiepileptic drugs, but it has a critical issue of a skin rash if the starting dose is too high or the escalation rate is too rapid. We investigated the efficacy and safety of a novel and rapid titration protocol for lamotrigine that takes only 11 days to reach a daily dose of 200 mg.
Methods
We prospectively enrolled 33 adult patients (age 18–85) who were diagnosed with epilepsy and started lamotrigine administration for the first time at a single tertiary hospital. Our new protocol starts with a subthreshold dose of the drug and then administer a stepwise-incremental dose until reaching the full therapeutic dose within 11 days.
Results
Of 29 patients analyzed, only two (6.9%) experienced idiosyncratic skin rash before the first follow-up visit at 2 weeks (±3 days). In addition, a therapeutic concentration was reached in more than 75% of studied patients after 2 weeks of lamotrigine administration
Discussion
These findings demonstrate the value of the novel tolerance induction protocol for lamotrigine, which could widen the available application of lamotrigine in various situations.
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Affiliation(s)
| | - Jangsup Moon
- 1Seoul National University Hospital, South Korea
| | - Hyoshin Son
- 2Seoul National University College of Medicine, South Korea
- 3South Korea
| | - Woo-Jin Lee
- 1Seoul National University Hospital, South Korea
| | | | - Soon-Tae Lee
- 2Seoul National University College of Medicine, South Korea
| | - Kyung-Il Park
- 2Seoul National University College of Medicine, South Korea
| | - Daejong Jeon
- 1Seoul National University Hospital, South Korea
| | - Kon Chu
- 2Seoul National University College of Medicine, South Korea
| | - Sang Kun Lee
- 2Seoul National University College of Medicine, South Korea
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Jang Y, Kim DW, Yang KI, Byun JI, Seo JG, No YJ, Kang KW, Kim D, Kim KT, Cho YW, Lee ST. Clinical Approach to Autoimmune Epilepsy. J Clin Neurol 2020; 16:519-529. [PMID: 33029957 PMCID: PMC7541993 DOI: 10.3988/jcn.2020.16.4.519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022] Open
Abstract
Autoimmune epilepsy is a newly emerging area of epilepsy. The concept of “autoimmune” as an etiology has recently been revisited thanks to advances in autoimmune encephalitis and precision medicine with immunotherapies. Autoimmune epilepsy presents with specific clinical manifestations, and various diagnostic approaches including cerebrospinal fluid analysis, neuroimaging, and autoantibody tests are essential for its differential diagnosis. The diagnosis is often indeterminate despite performing a thorough evaluation, and therefore empirical immunotherapy may be applied according to the judgment of the clinician. Autoimmune epilepsy often manifests as new-onset refractory status epilepticus (NORSE). A patient classified as NORSE should receive empirical immunotherapy as soon as possible. On the other hand, a morecautious, stepwise approach is recommended for autoimmune epilepsy that presents with episodic events. The type of autoimmune epilepsy is also an important factor to consider when choosing from among various immunotherapy options. Clinicians should additionally take the characteristics of antiepileptic drugs into account when using them as an adjuvant therapy. This expert opinion discusses the diagnostic and treatment approaches for autoimmune epilepsy from a practical point of view.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Jong Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Joo No
- Department of Neurology, Samsung Noble County, Yongin, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.
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Kim YH, Her AY, Jeong MH, Kim BK, Lee SY, Hong SJ, Shin DH, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. P4393Current smoking and gender difference in South Korean AMI patients who underwent PCI with DES. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is some debate on whether or not there is a gender difference is present between current smoking and cardiovascular disease.
Purpose
We decide to evaluate the impact of sex difference on the 2-year clinical outcomes in Korean acute myocardial infarction (AMI) patients who currently smoke and who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
Methods
The data of this study was obtained from the Korea Acute Myocardial Infarction (KAMIR) registry. More than fifty high-volume universites or community hospitals with facilities for primary PCI and onsite cardiac surgery participated in this KAMIR registry. A total of 12565 current smoker AMI patients were enrolled and divided into the male (n=11767, 93.6%) or female (n=798, 6.4%) group. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), and total repeat revascularization.
Results
Before risk adjustment, the cumulative incidences of MACE (7.2% vs. 10.0%, hazard ratio [HR], 1.419; 95% confidence interval [CI], 1.125–1.790; P=0.003), all-cause death (HR, 1.988; 95% CI, 1.417–2.789; P<0.001), and re-MI (HR, 1.885; 95% CI, 1.154–3.078; P=0.011) were significantly higher in the female group compared with the male group. However, after adjustment the cumulative incidences of MACE (adjusted HR, 1.047; 95% CI, 0.756–1.450; P=0.782), all-cause death, re-MI, total repeat revascularization, TLR, TVR, and non-TVR were similar between the two groups.
Clinical outcomes at 2-year Outcomes Cumulative Events at 2-year (%) Unadjusted Adjusted* Propensity-score adjusted Male Female Log-rank Hazard Ratio (95% CI) p value Hazard Ratio (95% CI) p value Hazard Ratio (95% CI) p value MACE 819 (7.2) 78 (10.0) 0.003 1.419 (1.125–1.790) 0.003 1.047 (0.756–1.450) 0.782 1.133 (0.871–1.473) 0.352 All-cause death 283 (2.5) 38 (4.8) <0.001 1.988 (1.417–2.789) <0.001 0.764 (0.457–1.279) 0.306 1.105 (0.744–1.641) 0.620 Cardiac death 224 (1.9) 25 (3.2) 0.016 1.654 (1.094–2.500) 0.017 0.512 (0.261–1.005) 0.052 0.822 (0.511–1.322) 0.419 Re-MI 142 (1.3) 18 (2.4) 0.010 1.885 (1.154–3.078) 0.011 1.741 (0.887–3.419) 0.107 1.835 (1.109–3.375) 0.062 Total revascularization 444 (4.0) 27 (3.6) 0.594 0.900 (0.610–1.327) 0.594 1.069 (0.654–1.748) 0.789 0.956 (0.627–1.458) 0.835 TLR 121 (1.1) 8 (1.1) 0.956 0.980 (0.479–2.004) 0.956 0.955 (0.366–2.497) 0.926 0.868 (0.395–1.910) 0.726 TVR 228 (2.1) 14 (1.9) 0.726 0.908 (0.529–1.558) 0.726 1.051 (0.518–2.135) 0.890 0.935 (0.519–1.684) 0.823 Non-TVR 223 (2.0) 13 (1.7) 0.602 0.862 (0.493–1.508) 0.602 1.060 (0.536–2.097) 0.867 0.942 (0.514–1.726) 0.847
Conclusion
Before risk adjustment, a gender difference was suggested in the female group compared with the male in these current smoker South Korean AMI patients during a 2-year follow-up period. However, after adjustment, gender difference was not observed in these AMI patients with a history of current smoking.
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Affiliation(s)
- Y H Kim
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - A.-Y Her
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Hospital, Department of Cardiology, Gwangju, Korea (Republic of)
| | - B.-K Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - S.-Y Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology, Gunpo, Korea (Republic of)
| | - S.-J Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D.-H Shin
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - C.-M Ahn
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J.-S Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y.-G Ko
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D Choi
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M.-K Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y Jang
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Son H, Jang Y, Ahn J, Jung C, Ha T. P.1282, 6-Dimethoxy-1, 4-benzoquinone increases skeletal muscle mass through Akt/mTOR signaling pathway. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim YH, Her AY, Jeong MH, Kim BK, Lee SY, Hong SJ, Shin DH, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. P833Two-year clinical outcomes between statin with ACE inhibitor or ARB in patients with ST-segment elevation myocardial infarction after successful PCI with DES. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Limited comparative data are available.
Purpose
We decided to compare 2-year major clinical outcomes between statin with ACEI and statin ARB therapy in patients with STEMI after PCI with drug-eluting stents (DES).
Methods
A total 11706 STEMI patients who underwent PCI with DES and who prescribed statin were enrolled and they were divided into two groups, the statin with ACEI group (n=8705) and the statin with ARB group (n=3001). The primary endpoint was the major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR. The secondary endpoints were the cumulative incidences of individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR.
Results
Two PSM groups (2835 pairs, n=5670, C-statistic = 0.680) were generated. The relative risk of MACE was higher in the statin with ARB group compared to statin with ACEI groups after propensity score-matched (PSM) analysis (hazard ratio [HR]: 1.323, 95% confidence interval [CI]: 1.085–1.613, p=0.006). The relative risks of cardiac death (HR: 1.831, 95% CI: 1.199–2.740, p=0.005), total repeat revascularization (HR: 1.487, 95% CI: 1.133–1.950, p=0.004), and non-TVR (HR: 1.696, 95% CI: 1.122–2.564, p=0.012) were also higher in the statin with ARB group after PSM.
Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Statin + ACEI Statin + ARB Log-rank Propensity score matched Patients MACE 173 (6.5) 225 (8.5) 0.006 1.323 (1.085–1.613) 0.006 All-cause death 58 (2.2) 80 (3.0) 0.054 1.391 (0.992–1.950) 0.056 Cardiac death 35 (1.3) 63 (2.3) 0.004 1.831 (1.199–2.740) 0.005 Re-MI 39 (1.5) 44 (1.7) 0.548 1.141 (0.742–1.756) 0.548 Total repeat revascularization 88 (3.4) 128 (4.9) 0.004 1.487 (1.133–1.950) 0.004 TLR 26 (1.0) 40 (1.5) 0.075 1.561 (0.953–2.558) 0.077 TVR 53 (2.0) 71 (2.8) 0.086 1.364 (0.955–1.946) 0.088 Non-TVR 36 (1.4) 60 (2.3) 0.011 1.696 (1.122–2.564) 0.012 TVF 140 (5.3) 173 (6.6) 0.050 1.249 (1.000–1.561) 0.050
Conclusions
In this study, we suggest that the combination of statin with ACEI may be beneficial for reducing the cumulative incidences of MACE, total repeat revascularization rate, and non-TVR rather than the statin with ARB after PCI with DES in STEMI patients.
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Affiliation(s)
- Y H Kim
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - A.-Y Her
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - M.-H Jeong
- Chonnam National University Hospital, Department of Cardiology, Gwangju, Korea (Republic of)
| | - B.-K Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - S.-Y Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology, Gunpo, Korea (Republic of)
| | - S.-J Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D.-H Shin
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - C.-M Ahn
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J.-S Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y.-G Ko
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D Choi
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M.-K Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y Jang
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Kim YH, Her AY, Jeong MH, Kim BK, Lee SY, Hong SJ, Shin DH, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. P5362Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI).
Purpose
The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES.
Methods
Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n=15002) and the NSTEMI group (n=11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period.
Results
After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n=15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p=0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1).
Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value STEMI NSTEMI Log-rank Propensity score matched patients MACE 532 (7.2) 584 (8.1) 0.092 1.106 (0.984–1.244) 0.092 All-cause death 163 (2.2) 224 (3.1) 0.001 1.386 (1.133–1.696) 0.002 Cardiac death 121 (1.5) 148 (2.0) 0.088 1.232 (0.969–1.566) 0.089 Re-MI 117 (1.6) 107 (1.5) 0.545 0.922 (0.710–1.199) 0.545 Total revascularization 291 (4.1) 307 (4.4) 0.422 1.068 (0.910–1.254) 0.423 TLR 92 (1.3) 89 (1.2) 0.880 0.978 (0.731–1.309) 0.880 TVR 173 (2.4) 184 (2.6) 0.478 1.078 (0.876–1.327) 0.478 Non-TVR 123 (1.7) 130 (1.9) 0.593 1.070 (0.836–1.369) 0.539
Conclusion
The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.
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Affiliation(s)
- Y H Kim
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - A.-Y Her
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Hospital, Department of Cardiology, Gwangju, Korea (Republic of)
| | - B.-K Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - S.-Y Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology, Gunpo, Korea (Republic of)
| | - S.-J Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D.-H Shin
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - C.-M Ahn
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J.-S Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y.-G Ko
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D Choi
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M.-K Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y Jang
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Kim YH, Her AY, Jeong MH, Kim BK, Lee SY, Hong SJ, Shin DH, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. P5494Impact of the gender difference on long-term clinical outcomes in dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There are limited comparative data concerning long-term major clinical outcomes between male and female in dyslipidemic AMI patients after PCI with new-generation DES.
Purpose
We thought to investigate the impact of gender difference on the 2-year clinical outcomes.
Methods
Finally, a total of 2403 eligible dyslipidemic AMI patients who underwent PCI with new-generation DES were enrolled and they were separated into two groups; the male group (n=1800) and the female group (n=603). The primary endpoint was major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). The secondary endpoints were the incidence of the individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR
Results
Two propensity score-matched (PSM) groups (422 pairs, n=844, C-statistic = 0.850) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, re-MI, and TVF were significantly higher in the female group compared with the male group. However, after propensity score-matched (PSM) analysis, the cumulative incidences of MACE (HR, 0.971; 95% CI, 0.628–1.501; p=0.895), all-cause death (HR, 1.061; 95% CI, 0.536–2.100; p=0.865), re-MI (HR, 1.212; 95% CI, 0.433–2.907; p=0.813), and TVF (HR, 0.764; 95% CI, 0.474–1.229; p=0.267) were similar between the two groups. In addition, the cumulative incidences of cardiac death, TLR, TVR were not significantly different between the two groups (Table 1).
Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Male Female Log-rank Propensity score matched patients MACE 41 (10.4) 40 (10.3) 0.895 0.971 (0.628–1.501) 0.895 All-cause death 16 (4.0) 17 (4.2) 0.865 1.061 (0.536–2.100) 0.865 Cardiac death 13 (3.3) 9 (2.2) 0.391 0.691 (0.295–1.616) 0.393 Re-MI 8 (2.0) 9 (2.4) 0.813 1.212 (0.433–2.907) 0.813 TLR 7 (1.8) 6 (1.6) 0.781 0.857 (0.298–2.550) 0.781 TVR 16 (4.3) 10 (2.7) 0.236 0.623 (0.283–1.373) 0.241 TVF 39 (10.2) 30 (7.8) 0.265 0.764 (0.474–1.229) 0.267
Conclusion
The gender difference was not apparent in these dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES during 2-year follow-up period.
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Affiliation(s)
- Y H Kim
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - A.-Y Her
- Kangwon National University School of Medicine, Chuncheon City, Korea (Republic of)
| | - M.-H Jeong
- Chonnam National University Hospital, Department of Cardiology, Gwangju, Korea (Republic of)
| | - B.-K Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - S.-Y Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology, Gunpo, Korea (Republic of)
| | - S.-J Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D.-H Shin
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - C.-M Ahn
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J.-S Kim
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y.-G Ko
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - D Choi
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M.-K Hong
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Y Jang
- Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Jeon S, Jang Y, Min J, Kim D, Jeon H. Doxorubicin-loaded oligonucleotide conjugated gold nanoparticles: A promising drug delivery system for ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zheng M, Jang Y, Choi N, Kim DY, Han TW, Yeo JH, Lee J, Sung JH. Hypoxia improves hair inductivity of dermal papilla cells via nuclear NADPH oxidase 4-mediated reactive oxygen species generation'. Br J Dermatol 2019; 181:523-534. [PMID: 30703252 DOI: 10.1111/bjd.17706] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dermal papilla cells (DPCs) play a key role in hair regeneration and morphogenesis. Therefore, tremendous efforts have been made to promote DPC hair inductivity. OBJECTIVES The aim of this study was to investigate the mitogenic and hair inductive effects of hypoxia on DPCs and examine the underlying mechanism of hypoxia-induced stimulation of DPCs. METHODS DPCs' hair inductivity was examined under normoxia (20% O2 ) and hypoxia (2% O2 ). RESULTS Hypoxia significantly increased the proliferation and delayed senescence of DPCs via Akt phosphorylation and downstream pathways. Hypoxia upregulated growth factor secretion of DPCs through the mitogen-activated protein kinase pathway. Hypoxia-preconditioned DPCs induced the telogen-to-anagen transition in C3 H mice, and also enhanced hair neogenesis in a hair reconstitution assay. Injected green fluorescent protein-labelled DPCs migrated to the outer root sheath of the hair follicle, and hypoxia-preconditioning increased survival and migration of DPCs in vivo. Conditioned medium obtained from hypoxia increased the hair length of mouse vibrissa follicles via upregulation of alkaline phosphatase, vascular endothelial growth factor, and glial cell line-derived neurotrophic factor. We examined the mechanism of this hypoxia-induced stimulation, and found that reactive oxygen species (ROS) play a key role. For example, inhibition of ROS generation by N-acetylcysteine or diphenyleneiodonium treatment attenuated DPCs' hypoxia-induced stimulation, but treatment with ROS donors induced mitogenic effects and anagen transition. NADPH oxidase 4 is highly expressed in the DPC nuclear region, and NOX4 knockout by CRISPR-Cas9 attenuated the hypoxia-induced stimulation of DPCs. CONCLUSIONS Our results suggest that DPC culture under hypoxia has great advantages over normoxia, and is a novel solution for producing DPCs for cell therapy. What's already known about this topic? Dermal papilla cells (DPCs) play a key role in hair regeneration and morphogenesis, but they are difficult to isolate and expand for use in cell therapy. Tremendous efforts have been made to increase proliferation of DPCs and promote their hair formation ability. What does this study add? Hypoxia (2% O2 ) culture of DPCs increases proliferation, delays senescence and enhances hair inductivity of DPCs. Reactive oxygen species play a key role in hypoxia-induced stimulation of DPC. What is the translational message? Preconditioning DPCs under hypoxia improves their hair regenerative potential, and is a novel solution for producing DPCs for cell therapy to treat hair loss.
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Affiliation(s)
- M Zheng
- STEMORE Co. Ltd, Incheon, South Korea
| | - Y Jang
- STEMORE Co. Ltd, Incheon, South Korea
| | - N Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - D Y Kim
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - T W Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - J H Yeo
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - J Lee
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - J-H Sung
- STEMORE Co. Ltd, Incheon, South Korea.,College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
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Rhee M, Jang Y. COMPLETION OF ADVANCE DIRECTIVES IN OLDER ASIAN AMERICANS: ROLE OF CULTURAL FACTORS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Rhee
- University of Texas at Austin
| | - Y Jang
- The University of Texas at Austin
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Park N, Jang Y, Chung S, Chiriboga D. A COMPARATIVE STUDY OF THE ROLE OF SOCIAL NETWORKS ON DEPRESSIVE SYMPTOMS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Park
- University of South Florida
| | - Y Jang
- The University of Texas at Austin
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Cho Y, Hai A, Jang Y. THE IMPACT OF PERCEIVED DISCRIMINATION ON MENTAL DISTRESS IN OLDER ASIAN AMERICANS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Cho
- The University of Texas at Austin
| | - A Hai
- The University of Texas at Austin
| | - Y Jang
- The University of Texas at Austin
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Moon J, Jang Y, Kim N, Park WB, Park KI, Lee ST, Jung KH, Kim M, Lee SK, Chu K. Diagnosis of Haemophilus influenzae Pneumonia by Nanopore 16S Amplicon Sequencing of Sputum. Emerg Infect Dis 2018; 24:1944-1946. [PMID: 29989532 PMCID: PMC6154133 DOI: 10.3201/eid2410.180234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We used deep sequencing of the 16S rRNA gene from sputum to identify Haemophilus influenza in a patient with community-acquired pneumonia. This method may be more effective than conventional diagnostic tests in pneumonia patients because of its speed and sensitivity.
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Jang Y, Woo KA, Lee ST, Park SH, Chu K, Lee SK. Cerebral autoinflammatory disease treated with anakinra. Ann Clin Transl Neurol 2018; 5:1428-1433. [PMID: 30480037 PMCID: PMC6243374 DOI: 10.1002/acn3.656] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/26/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Interest in autoimmune encephalitis has been growing since the discovery of various autoimmune antibodies, such as N‐methyl D‐aspartate receptors antibody and leucine‐rich glioma‐inactivated 1 antibody. However, in contrast to autoimmune encephalitis associated with dysregulated adaptive immunity in the brain, the question of whether innate immunity‐mediated autoinflammatory diseases exist in the brain has drawn much attention. Herein, we report a patient with microglia‐dominant acute autoinflammatory encephalitis successfully treated with anakinra, an including interleukin‐1 receptor blocker. In comparison to systemic autoinflammatory disease, we term this encephalitis cerebral autoinflammatory disease. Cerebral autoinflammatory disease could suggest new conceptual approaches to patients previously diagnosed with an unspecified encephalitis.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Kyung Ah Woo
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Soon-Tae Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Sung-Hye Park
- Department of Pathology Seoul National University Hospital Seoul South Korea
| | - Kon Chu
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea
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Jang Y, Jang E. A Study of Mental Disorder Classification using Electro-cardiac Signal During Executing a Series of Mental Tasks. Int J Psychophysiol 2018. [DOI: 10.1016/j.ijpsycho.2018.07.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jang Y, Lee ST, Bae JY, Kim TJ, Jun JS, Moon J, Jung KH, Park KI, Irani SR, Chu K, Lee SK. LGI1 expression and human brain asymmetry: insights from patients with LGI1-antibody encephalitis. J Neuroinflammation 2018; 15:279. [PMID: 30253786 PMCID: PMC6156957 DOI: 10.1186/s12974-018-1314-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/12/2018] [Indexed: 12/29/2022] Open
Abstract
Background While brain asymmetry has been a fascinating issue in neuroscience, the critical mechanism remains to be elucidated. Based on some index cases with asymmetric 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) uptake in leucine-rich glioma-inactivated 1 (LGI1)-antibody encephalitis, we hypothesized LGI1 expression could be asymmetrically distributed in the human brain. Methods We enrolled 13 patients who were diagnosed with LGI1-antibody encephalitis between June 2012 and January 2018 at Seoul National University Hospital. Their pretreatment 18F-FDG-PET images were analyzed to find asymmetry between the left and right hemispheres. Guided by these observations, expression of LGI1 in the human hippocampus and the globus pallidus of both cerebral hemispheres was studied in nine post-mortem human brains. Results Eleven of the 13 LGI1-antibody encephalitis patients (84.6%) showed asymmetrical FDG high uptake in the hippocampus: nine (81.8%) on the left hippocampus and two (18.2%) on the right. In the basal ganglia, seven patients (53.8%) showed asymmetry: four (57.1%) on the left and three (42.9%) on the right. The asymmetry was not evident in the laterality of faciobrachial dystonic seizures, brain MRI, and EEG. When the expression of LGI1 protein was analyzed in nine post-mortem human brains by western blotting, LGI1 expression was higher on eight left globus pallidus samples (88.89%, P = 0.019) and on four left hippocampal samples (44.44%, P = 0.652), compared to their right hemisphere samples. Conclusions Imaging parameters from patients with LGI1-antibody encephalitis and studies of LGI1 protein expression suggest that LGI1 is asymmetrically distributed in the human brain. These observations have implications for our understanding of human brain development. Electronic supplementary material The online version of this article (10.1186/s12974-018-1314-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji-Yeon Bae
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurology, National Center for Mental Health, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Lee O, Kim K, Kim J, Kim YD, Pak H, Hong G, Chim CY, Uhm J, Cho I, Joung B, Yu C, Lee H, Kang W, Heo J, Jang Y. P3830Favorable neurological outcomes of left atrial appendage occlusion versus non-vitamin K antagonist oral anticoagulants after stroke in atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Lee
- Severance Hospital, Cardiology, Yongin, Korea Republic of
| | - K Kim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - J Kim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - Y D Kim
- Severance Hospital, Neurology, Seoul, Korea Republic of
| | - H Pak
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - G Hong
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - C Y Chim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - J Uhm
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - I Cho
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - B Joung
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - C Yu
- Korea University Anam Hospital, Cardiology, Seoul, Korea Republic of
| | - H Lee
- Sejong General Hospital, Cardiology, Seoul, Korea Republic of
| | - W Kang
- Gil Hospital, Cardiology, Incheon, Korea Republic of
| | - J Heo
- Severance Hospital, Neurology, Seoul, Korea Republic of
| | - Y Jang
- Severance Hospital, Cardiology, Seoul, Korea Republic of
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Lee SH, Lee CJ, Lee Y, Park S, Kang SM, Choi D, Jang Y, Lee JH. P6271Variants of CETP, LIPC, and SCARB1 genes in Korean patients with very high HDL-cholesterol levels. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S.-H Lee
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - C J Lee
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - Y Lee
- Kyung Hee University, Clinical Pharmacology and Therapeutics, Seoul, Korea Republic of
| | - S Park
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - S.-M Kang
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - D Choi
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - Y Jang
- Yonsei University College of Medicine, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - J H Lee
- Kyung Hee University, Clinical Pharmacology and Therapeutics, Seoul, Korea Republic of
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Jang Y, Lee ST, Chu K, Lee SK. A Psychiatric Side Effect of Levetiracetam Can Mimic a Relapse of Anti-Leucine-Rich Glioma Inactivated 1 Encephalitis. J Clin Neurol 2018; 14:413-414. [PMID: 29856163 PMCID: PMC6031996 DOI: 10.3988/jcn.2018.14.3.413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Jang Y, Moon J, Jun JS, Kim TJ, Park KI, Lee ST, Jung KH, Lee SK, Chu K. Case of Rickettsia typhi-induced Brain Abscess Mimicking Brain Tumor. Osong Public Health Res Perspect 2018; 9:122-125. [PMID: 30023157 PMCID: PMC6037395 DOI: 10.24171/j.phrp.2018.9.3.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Murine typhus is one of the most prevalent rickettsial infections in the world, caused by the bacterial genus Rickettsia. Though the disease manifests a relatively benign clinical course with fever, rash, and headache being the 3 classic symptoms, neurological complications may arise in patients that could become permanent. In this case study, a patient with a brain abscess caused by R typhi infection is described. Based upon the recent reemergence of arthropod-borne disease, the findings in this case are significant; R typhi can cause a brain abscess that mimics a brain tumor, which delays the diagnosis and appropriate management of the disease. Murine typhus should always be considered when performing the differential diagnosis of brain abscesses in South Korea.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Sun Jun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
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Park NS, Jang Y, Lee BS, Chiriboga DA, Chang S, Kim SY. Associations of a social network typology with physical and mental health risks among older adults in South Korea. Aging Ment Health 2018; 22:631-638. [PMID: 28290722 DOI: 10.1080/13607863.2017.1286456] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) develop an empirical typology of social networks in older Koreans; and (2) examine its effect on physical and mental health. METHOD A sample of 6900 community-dwelling older adults in South Korea was drawn from the 2014 Korean National Elderly Survey. Latent profile analysis (LPA) was conducted to derive social network types using eight common social network characteristics (marital status, living arrangement, the number and frequency of contact with close family/relatives, the number and frequency of contact with close friends, frequency of participation in social activities, and frequency of having visitors at home). The identified typologies were then regressed on self-rated health and depressive symptoms to explore the health risks posed by the group membership. RESULTS The LPA identified a model with five types of social network as being most optimal (BIC = 153,848.34, entropy = .90). The groups were named diverse/family (enriched networks with more engagement with family), diverse/friend (enriched networks with more engagement with friends), friend-focused (high engagement with friends), distant (structurally disengaged), and restricted (structurally engaged but disengaged in family/friends networks). A series of regression analyses showed that membership in the restricted type was associated with more health and mental health risks than all types of social networks except the distant type. CONCLUSION Findings demonstrate the importance of family and friends as a source of social network and call attention to not only structural but also non-structural aspects of social isolation. Findings and implications are discussed in cultural contexts.
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Affiliation(s)
- N S Park
- a School of Social Work, University of South Florida , Tampa , FL , USA
| | - Y Jang
- b School of Social Work, The University of Texas at Austin , Austin , TX , USA
| | - B S Lee
- c Department of Mental Health Law and Policy , University of South Florida , Tampa , FL , USA
| | - D A Chiriboga
- d Department of Child and Family Studies , University of South Florida , Tampa , FL , USA
| | - S Chang
- e Department of Social Welfare , Kyungsung University , Busan , South Korea
| | - S Y Kim
- e Department of Social Welfare , Kyungsung University , Busan , South Korea
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