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Lee JH, Song G, Lee J, Kang S, Moon KM, Choi Y, Shen J, Noh M, Yang D. Prediction of immunochemotherapy response for diffuse large B-cell lymphoma using artificial intelligence digital pathology. J Pathol Clin Res 2024; 10:e12370. [PMID: 38584594 PMCID: PMC10999948 DOI: 10.1002/2056-4538.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous and prevalent subtype of aggressive non-Hodgkin lymphoma that poses diagnostic and prognostic challenges, particularly in predicting drug responsiveness. In this study, we used digital pathology and deep learning to predict responses to immunochemotherapy in patients with DLBCL. We retrospectively collected 251 slide images from 216 DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), with their immunochemotherapy response labels. The digital pathology images were processed using contrastive learning for feature extraction. A multi-modal prediction model was developed by integrating clinical data and pathology image features. Knowledge distillation was employed to mitigate overfitting on gigapixel histopathology images to create a model that predicts responses based solely on pathology images. Based on the importance derived from the attention mechanism of the model, we extracted histological features that were considered key textures associated with drug responsiveness. The multi-modal prediction model achieved an impressive area under the ROC curve of 0.856, demonstrating significant associations with clinical variables such as Ann Arbor stage, International Prognostic Index, and bulky disease. Survival analyses indicated their effectiveness in predicting relapse-free survival. External validation using TCGA datasets supported the model's ability to predict survival differences. Additionally, pathology-based predictions show promise as independent prognostic indicators. Histopathological analysis identified centroblastic and immunoblastic features to be associated with treatment response, aligning with previous morphological classifications and highlighting the objectivity and reproducibility of artificial intelligence-based diagnosis. This study introduces a novel approach that combines digital pathology and clinical data to predict the response to immunochemotherapy in patients with DLBCL. This model shows great promise as a diagnostic and prognostic tool for clinical management of DLBCL. Further research and genomic data integration hold the potential to enhance its impact on clinical practice, ultimately improving patient outcomes.
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Affiliation(s)
- Jeong Hoon Lee
- Department of RadiologyStanford University School of MedicineStanfordCAUSA
| | - Ga‐Young Song
- Department of Hematology‐OncologyChonnam National University Hwasun HospitalHwasunRepublic of Korea
| | - Jonghyun Lee
- Department of Medical and Digital EngineeringHanyang University College of EngineeringSeoulRepublic of Korea
| | - Sae‐Ryung Kang
- Department of Nuclear MedicineChonnam National University Hwasun Hospital and Medical SchoolHwasun‐gunRepublic of Korea
| | - Kyoung Min Moon
- Division of Pulmonary and Allergy Medicine, Department of Internal MedicineChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulRepublic of Korea
- Artificial Intelligence, Ziovision Co., Ltd.ChuncheonRepublic of Korea
| | - Yoo‐Duk Choi
- Department of PathologyChonnam National University Medical SchoolGwangjuRepublic of Korea
| | - Jeanne Shen
- Department of Pathology and Center for Artificial Intelligence in Medicine & ImagingStanford University School of MedicineStanfordCAUSA
| | - Myung‐Giun Noh
- Department of PathologyChonnam National University Medical SchoolGwangjuRepublic of Korea
- Department of PathologySchool of Medicine, Ajou UniversitySuwonRepublic of Korea
| | - Deok‐Hwan Yang
- Department of Hematology‐OncologyChonnam National University Hwasun HospitalHwasunRepublic of Korea
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Song GY, Kim HJ, Kim T, Ahn SY, Jung SH, Kim M, Yang DH, Lee JJ, Kim MY, Cheong JW, Jung CW, Jang JH, Kim HJ, Moon JH, Sohn SK, Won JH, Park SK, Kim SH, Choi CK, Kim HJ, Ahn JS, Kim DDH. Validation of the 2022 European LeukemiaNet risk stratification for acute myeloid leukemia. Sci Rep 2024; 14:8517. [PMID: 38609396 PMCID: PMC11014905 DOI: 10.1038/s41598-024-57295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to validate the 2022 European LeukemiaNet (ELN) risk stratification for acute myeloid leukemia (AML). A total of 624 newly diagnosed AML patients from 1998 to 2014 were included in the analysis. Genetic profiling was conducted using targeted deep sequencing of 45 genes based on recurrent driver mutations. In total, 134 (21.5%) patients had their risk classification reassessed according to the 2022 ELN risk stratification. Among those initially classified as having a favorable risk in 2017 (n = 218), 31 and 3 patients were reclassified as having intermediate risk or adverse risk, respectively. Among the three subgroups, the 2022 ELN favorable-risk group showed significantly longer survival outcomes than the other groups. Within the 2017 ELN intermediate-risk group (n = 298), 21 and 46 patients were reclassified as having favorable risk or adverse risk, respectively, and each group showed significant stratifications in survival outcomes. Some patients initially classified as having adverse risk in 2017 were reclassified into the intermediate-risk group (33 of 108 patients), but no prognostic improvements were observed in this group. A multivariable analysis identified the 2022 ELN risk stratification, age, and receiving allogeneic hematopoietic cell transplantation as significant prognostic factors for survival. The 2022 ELN risk stratification enables more precise decisions for proceeding with allogeneic hematopoietic cell transplantation for AML patients.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Hyeon-Jong Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - TaeHyung Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- The Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON, Canada
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
| | - Mi Yeon Kim
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Gwangju, Jeollanam-Do, Republic of Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Won Jung
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Jun Ho Jang
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Hee- Je Kim
- Department of Hematology, The Catholic University of Korea, Seoul, South Korea
| | - Joon Ho Moon
- Department of Hematology-Oncology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Sang Kyun Sohn
- Department of Hematology-Oncology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Jong-Ho Won
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Seong Kyu Park
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Sung-Hyun Kim
- Department of Hematology-Oncology, Dong-A University College of Medicine, Busan, South Korea
| | - Chang Kyun Choi
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Canter, Goyang, South Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Gwangju, Jeollanam-Do, Republic of Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Jeollanam-Do, Republic of Korea.
- Genomic Research Center for Hematopoietic Diseases, Chonnam National University Hwasun Hospital, Gwangju, Jeollanam-Do, Republic of Korea.
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, Republic of Korea.
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
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Lee J, Cha S, Kim J, Kim JJ, Kim N, Jae Gal SG, Kim JH, Lee JH, Choi YD, Kang SR, Song GY, Yang DH, Lee JH, Lee KH, Ahn S, Moon KM, Noh MG. Ensemble Deep Learning Model to Predict Lymphovascular Invasion in Gastric Cancer. Cancers (Basel) 2024; 16:430. [PMID: 38275871 PMCID: PMC10814827 DOI: 10.3390/cancers16020430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Lymphovascular invasion (LVI) is one of the most important prognostic factors in gastric cancer as it indicates a higher likelihood of lymph node metastasis and poorer overall outcome for the patient. Despite its importance, the detection of LVI(+) in histopathology specimens of gastric cancer can be a challenging task for pathologists as invasion can be subtle and difficult to discern. Herein, we propose a deep learning-based LVI(+) detection method using H&E-stained whole-slide images. The ConViT model showed the best performance in terms of both AUROC and AURPC among the classification models (AUROC: 0.9796; AUPRC: 0.9648). The AUROC and AUPRC of YOLOX computed based on the augmented patch-level confidence score were slightly lower (AUROC: -0.0094; AUPRC: -0.0225) than those of the ConViT classification model. With weighted averaging of the patch-level confidence scores, the ensemble model exhibited the best AUROC, AUPRC, and F1 scores of 0.9880, 0.9769, and 0.9280, respectively. The proposed model is expected to contribute to precision medicine by potentially saving examination-related time and labor and reducing disagreements among pathologists.
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Affiliation(s)
- Jonghyun Lee
- Department of Medical and Digital Engineering, Hanyang University College of Engineering, Seoul 04763, Republic of Korea;
| | - Seunghyun Cha
- Department of Pre-Medicine, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Gwangju 58128, Republic of Korea;
| | - Jiwon Kim
- NetTargets, 495 Sinseong-dong, Yuseong, Daejeon 34109, Republic of Korea
| | - Jung Joo Kim
- AMGINE, Inc., Jeongui-ro 8-gil 13, Seoul 05836, Republic of Korea;
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 25440, Republic of Korea; (N.K.); (S.G.J.G.)
| | - Seong Gyu Jae Gal
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 25440, Republic of Korea; (N.K.); (S.G.J.G.)
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Jeong Hoon Lee
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5101, USA;
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Clinical Medicine Research Center, Chonnam National University Hospital, 671 Jebongno, Gwangju 61469, Republic of Korea;
| | - Ga-Young Song
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun 58128, Republic of Korea; (G.-Y.S.); (D.-H.Y.)
| | - Deok-Hwan Yang
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun 58128, Republic of Korea; (G.-Y.S.); (D.-H.Y.)
| | - Jae-Hyuk Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun 58128, Republic of Korea (K.-H.L.)
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun 58128, Republic of Korea (K.-H.L.)
| | - Sangjeong Ahn
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea;
| | - Kyoung Min Moon
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
- Artificial Intelligence, ZIOVISION Co., Ltd., Chuncheon 24341, Republic of Korea
| | - Myung-Giun Noh
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun 58128, Republic of Korea (K.-H.L.)
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Kim YJ, Rho KN, Jeong S, Lee GW, Kim HO, Cho HJ, Bae WK, Oh IJ, Lee SW, Cho JH. CD5 Expression Dynamically Changes During the Differentiation of Human CD8 + T Cells Predicting Clinical Response to Immunotherapy. Immune Netw 2023; 23:e35. [PMID: 37670812 PMCID: PMC10475823 DOI: 10.4110/in.2023.23.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
Defining the molecular dynamics associated with T cell differentiation enhances our understanding of T cell biology and opens up new possibilities for clinical implications. In this study, we investigated the dynamics of CD5 expression in CD8+ T cell differentiation and explored its potential clinical uses. Using PBMCs from 29 healthy donors, we observed a stepwise decrease in CD5 expression as CD8+ T cells progressed through the differentiation stages. Interestingly, we found that CD5 expression was initially upregulated in response to T cell receptor stimulation, but diminished as the cells underwent proliferation, potentially explaining the differentiation-associated CD5 downregulation. Based on the proliferation-dependent downregulation of CD5, we hypothesized that relative CD5 expression could serve as a marker to distinguish the heterogeneous CD8+ T cell population based on their proliferation history. In support of this, we demonstrated that effector memory CD8+ T cells with higher CD5 expression exhibited phenotypic and functional characteristics resembling less differentiated cells compared to those with lower CD5 expression. Furthermore, in the retrospective analysis of PBMCs from 30 non-small cell lung cancer patients, we found that patients with higher CD5 expression in effector memory T cells displayed CD8+ T cells with a phenotype closer to the less differentiated cells, leading to favorable clinical outcomes in response to immune checkpoint inhibitor (ICI) therapy. These findings highlight the dynamics of CD5 expression as an indicator of CD8+ T cell differentiation status, and have implications for the development of predictive biomarker for ICI therapy.
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Affiliation(s)
- Young Ju Kim
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Kyung Na Rho
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Saei Jeong
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Gil-Woo Lee
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
| | | | - Hyun-Ju Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea
| | - Sung-Woo Lee
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Jae-Ho Cho
- Medical Research Center for Combinatorial Tumor Immunotherapy, Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasun 58128, Korea
- Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program, Chonnam National University Medical School, Hwasun 58128, Korea
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Lee SY, Lee J, Park HM, Kim CH, Kim HR. Effect of preoperative immunonutrition on fecal microbiota in colon cancer patients: a secondary analysis of a randomized controlled trial. Nutr Res Pract 2023; 17:475-486. [PMID: 37266110 PMCID: PMC10232208 DOI: 10.4162/nrp.2023.17.3.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to evaluate the effect of preoperative immunonutrition on the composition of fecal microbiota following a colon cancer surgery. MATERIALS/METHODS This study was a secondary analysis of a randomized controlled trial assessing the impact of preoperative immunonutrition on the postoperative outcomes of colon cancer surgery. Patients with primary colon cancer were enrolled and randomly assigned to receive additional preoperative immunonutrition or a normal diet alone. Oral nutritional supplementation (400 mL/day) with arginine and ω-3 fatty acids were administered to patients in the immunonutrition group for 7 days prior to surgery. Thirty-two fecal samples were collected from 16 patients in each group, and the composition of fecal microbiota was compared between the 2 groups. RESULTS At the phylum level, no significant difference was observed in the composition of microbiota between the 2 groups (Firmicutes, 69.1% vs. 67.5%, P = 0.624; Bacteroidetes, 19.3% vs. 18.1%, P = 0.663; Actinobacteria, 6.7% vs. 10.6%, P = 0.080). The Firmicutes/Bacteroidetes ratio (4.43 ± 2.32 vs. 4.55 ± 2.51, P = 0.897) was also similar between the 2 groups. At the genus level, the proportions of beneficial bacteria such as Faecalibacterium spp. (8.1% vs. 6.4%, P = 0.328) and Prevotella spp. (6.9% vs. 4.8%, P = 0.331) were higher, while that of Clostridium spp. was lower (0.5% vs. 1.2%, P = 0.121) in the immunonutrition group, but the difference was not significant. CONCLUSIONS Immunonutrition showed no significant association with the composition of fecal microbiota. The relationship between immunonutrition and the fecal microbiota should be investigated further in large-scale studies.
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Affiliation(s)
- Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun 58128, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun 58128, Korea
| | - Hyeong-min Park
- Department of Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun 58128, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun 58128, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun 58128, Korea
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Gu HM, Gu JS, Chung HS, Jung SI, Kwon D, Kim MH, Jung JH, Han MA, Kang SJ, Hwang EC, Dahm P. Fosfomycin for Antibiotic Prophylaxis in Men Undergoing a Transrectal Prostate Biopsy: A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2023; 59:911. [PMID: 37241143 PMCID: PMC10221023 DOI: 10.3390/medicina59050911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: To assess the effects of fosfomycin compared with other antibiotics as a prophylaxis for urinary tract infections (UTIs) in men undergoing transrectal prostate biopsies. Materials and Methods: We searched multiple databases and trial registries without publication language or status restrictions until 4 January 2022. Parallel-group randomized controlled trials (RCTs) and non-randomized studies (NRS) were included. The primary outcomes were febrile UTI, afebrile UTI, and overall UTI. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. The protocol was registered with PROSPERO (CRD42022302743). Results: We found data on five comparisons; however, this abstract focuses on the primary outcomes of the two most clinically relevant comparisons. Regarding fosfomycin versus fluoroquinolone, five RCTs and four NRSs with a one-month follow-up were included. Based on the RCT evidence, fosfomycin likely resulted in little to no difference in febrile UTIs compared with fluoroquinolone. This difference corresponded to four fewer febrile UTIs per 1000 patients. Fosfomycin likely resulted in little to no difference in afebrile UTIs compared with fluoroquinolone. This difference corresponded to 29 fewer afebrile UTIs per 1000 patients. Fosfomycin likely resulted in little to no difference in overall UTIs compared with fluoroquinolone. This difference corresponded to 35 fewer overall UTIs per 1000 patients. Regarding fosfomycin and fluoroquinolone combined versus fluoroquinolone, two NRSs with a one- to three-month follow-up were included. Based on the NRS evidence, fosfomycin and fluoroquinolone combined may result in little to no difference in febrile UTIs compared with fluoroquinolone. This difference corresponded to 16 fewer febrile UTIs per 1000 patients. Conclusions: Compared with fluoroquinolone, fosfomycin or fosfomycin and fluoroquinolone combined may have a similar prophylactic effect on UTIs after a transrectal prostate biopsy. Given the increasing fluoroquinolone resistance and its ease to use, fosfomycin may be a good option for antibiotic prophylaxis.
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Affiliation(s)
- Hui Mo Gu
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Jin Seok Gu
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Dongdeuk Kwon
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea;
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea;
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea;
| | - Seung Ji Kang
- Department of Infectious Disease, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA;
- Minneapolis VA Health Care System, Specialty Care, Minneapolis, MN 55417, USA
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Jo D, Jung YS, Song J. Lipocalin-2 Secreted by the Liver Regulates Neuronal Cell Function Through AKT-Dependent Signaling in Hepatic Encephalopathy Mouse Model. Clin Nutr Res 2023; 12:154-167. [PMID: 37214781 PMCID: PMC10193436 DOI: 10.7762/cnr.2023.12.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 05/24/2023] Open
Abstract
Hepatic encephalopathy (HE) associated with liver failure is accompanied by hyperammonemia, severe inflammation, depression, anxiety, and memory deficits as well as liver injury. Recent studies have focused on the liver-brain-inflammation axis to identify a therapeutic solution for patients with HE. Lipocalin-2 is an inflammation-related glycoprotein that is secreted by various organs and is involved in cellular mechanisms including iron homeostasis, glucose metabolism, cell death, neurite outgrowth, and neurogenesis. In this study, we investigated that the roles of lipocalin-2 both in the brain cortex of mice with HE and in Neuro-2a (N2A) cells. We detected elevated levels of lipocalin-2 both in the plasma and liver in a bile duct ligation mouse model of HE. We confirmed changes in cytokine expression, such as interleukin-1β, cyclooxygenase 2 expression, and iron metabolism related to gene expression through AKT-mediated signaling both in the brain cortex of mice with HE and N2A cells. Our data showed negative effects of hepatic lipocalin-2 on cell survival, iron homeostasis, and neurite outgrowth in N2A cells. Thus, we suggest that regulation of lipocalin-2 in the brain in HE may be a critical therapeutic approach to alleviate neuropathological problems focused on the liver-brain axis.
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Affiliation(s)
- Danbi Jo
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
- Biomedical Science Graduate Program (BMSGP), Chonnam National University, Hwasun 58128, Korea
| | - Yoon Seok Jung
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
- Biomedical Science Graduate Program (BMSGP), Chonnam National University, Hwasun 58128, Korea
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Yu SH, Jung SI, Ryu JW, Kim MS, Chung HS, Hwang EC, Kwon DD. Comparison of amikacin with fosfomycin as an add-on to ciprofloxacin for antibiotic prophylaxis in transrectal prostate biopsy: A single-center retrospective study. Investig Clin Urol 2022; 63:663-670. [PMID: 36347556 PMCID: PMC9643727 DOI: 10.4111/icu.20220147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To assess the effect of ciprofloxacin (CP) and fosfomycin compared with CP and amikacin in patients with a fluoroquinolone (FQ)-resistant rectal flora who have undergone transrectal ultrasound-guided prostate biopsy (TRUSPB). MATERIALS AND METHODS In total, 516 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups according to prophylactic antibiotics. Patients in both groups were administered CP (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and 1 day after biopsy. The amikacin group (n=260) was administered a single injection of amikacin (1 g, IV) 1 hour before TRUSPB, whereas the fosfomycin group (n=256) was administered fosfomycin (3 g, orally) the night before the procedure. The primary endpoint was the rate of infectious complications in the two groups. RESULTS Overall, 13 patients (2.5%) reported infectious complications: 12 patients (4.62%) in the amikacin group compared with 1 patient (0.39%) in the fosfomycin group (risk ratio, 0.09; 95% confidence interval [CI], 0.01-0.65), respectively, which was a statistically significant difference (p=0.017). This corresponds to a number needed to treat of 24 patients (95% CI, 15-65) to prevent one infectious complication. In the multivariate analysis to assess variables related to infectious complications, prophylactic antibiotics with added fosfomycin was associated with infectious complications (odds ratio, 0.060; 95% CI, 0.008-0.459). CONCLUSIONS In the era of FQ resistance, CP and fosfomycin may reduce the rate of infectious complications compared with CP and amikacin prophylaxis.
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Affiliation(s)
- Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Won Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Soo Kim
- Department of Urology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Kim YR, Choi CK, Lee YH, Choi SW, Kim HY, Shin MH, Kweon SS. Association between Albumin, Total Bilirubin, and Uric Acid Serum Levels and the Risk of Cancer: A Prospective Study in a Korean Population. Yonsei Med J 2021; 62:792-798. [PMID: 34427064 PMCID: PMC8382725 DOI: 10.3349/ymj.2021.62.9.792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE In this prospective study, we evaluated the association between the serum levels of antioxidants uric acid (UA), albumin, and total bilirubin and the risk of cancer in a Korean population. MATERIALS AND METHODS A total of 15882 subjects were followed up for cancer development and cancer-related death. During the follow-up period, 1619 cancer diagnoses and 617 cancer-related deaths were recorded. Cox proportional regression was performed to calculate the hazard ratio (HR) per standard deviation (SD) increment and 95% confidence interval (CI). The model was adjusted for covariates such as the age, sex, smoking, alcohol consumption, physical activity, education level, body mass index, and family history. Sensitivity analyses using the study subjects with physiological serum levels of each indicator were also performed. RESULTS UA levels were positively correlated with cancer risk (HR per SD increment 1.04; 95% CI, 1.01-1.09), and albumin levels were inversely associated with the overall cancer risk (HR, 0.92; 95% CI, 0.88-0.96) and cancer-related death (HR, 0.86; 95% CI, 0.80-0.93). Total bilirubin levels were negatively correlated with the risk of cancer-related death (HR, 0.91; 95% CI, 0.83-0.99). By cancer type, UA was positively associated with prostate cancer, total bilirubin was positively associated with liver cancer, and albumin was inversely associated with lung cancer. CONCLUSION The findings of this study support the role of antioxidants in carcinogenesis. Future large-cohort studies are needed to confirm the predictive value of albumin, UA, and total bilirubin levels in each type of cancer.
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Affiliation(s)
- Ye Rim Kim
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Chang Kyun Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Seong Woo Choi
- Department of Preventive Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Hye Yeon Kim
- Gwangju-Jeonnam Regional Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
- Gwangju-Jeonnam Regional Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea.
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Kim UJ, Lee SY, Lee JY, Lee A, Kim SE, Choi OJ, Lee JS, Kee SJ, Jang HC. Air and Environmental Contamination Caused by COVID-19 Patients: a Multi-Center Study. J Korean Med Sci 2020; 35:e332. [PMID: 32959546 PMCID: PMC7505729 DOI: 10.3346/jkms.2020.35.e332] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the extent of air and surface contamination of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in four health care facilities with hospitalized coronavirus disease 2019 (COVID-19) patients. METHODS We investigated air and environmental contamination in the rooms of eight COVID-19 patients in four hospitals. Some patients were in negative-pressure rooms, and others were not. None had undergone aerosol-generating procedures. On days 0, 3, 5, and 7 of hospitalization, the surfaces in the rooms and anterooms were swabbed, and air samples were collected 2 m from the patient and from the anterooms. RESULTS All 52 air samples were negative for SARS-CoV-2 RNA. Widespread surface contamination of SARS-CoV-2 RNA was observed. In total, 89 of 320 (27%) environmental surface samples were positive for SARS-CoV-2 RNA. Surface contamination of SARS-CoV-2 RNA was common in rooms without surface disinfection and in rooms sprayed with disinfectant twice a day. However, SARS-CoV-2 RNA was not detected in a room cleaned with disinfectant wipes on a regular basis. CONCLUSION Our data suggest that remote (> 2 m) airborne transmission of SARS-CoV-2 from hospitalized COVID-19 patients is uncommon when aerosol-generating procedures have not been performed. Surface contamination was widespread, except in a room routinely cleaned with disinfectant wipes.
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Affiliation(s)
- Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Yeob Lee
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Yeon Lee
- Department of Infectious Disease, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ahrang Lee
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Eun Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Ok Ja Choi
- Office for Infection Control, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ji Suk Lee
- Office for Infection Control, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seung Jung Kee
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea.
| | - Hee Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea.
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Park HY, Oh IJ, Kho BG, Kim TO, Shin HJ, Park CK, Kwon YS, Kim YI, Lim SC, Kim YC, Choi YD. Clinical Characteristics of Korean Patients with Lung Cancer Who Have Programmed Death-Ligand 1 Expression. Tuberc Respir Dis (Seoul) 2019; 82:227-233. [PMID: 30841018 PMCID: PMC6609527 DOI: 10.4046/trd.2018.0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/21/2018] [Accepted: 01/15/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Programmed death-ligand 1 (PD-L1), a transmembrane protein, binds to the programmed death-1 (PD-1) receptor, and anti-PD-1 therapy enables immune responses against tumors. This study aimed to assess clinical characteristics of PD-L1 expression using immunohistochemistry among Korean patients with lung cancer. METHODS We retrospectively reviewed the data of patients with pathologically proven lung cancer from a single institution. PD-L1 expression determined by Tumor Proportion Score (TPS) was detected using 22C3 pharmDx (Agilent Technologies) and SP263 (Ventana Medical Systems) assays. RESULTS From July 2016 to July 2017, 267 patients were enrolled. The main histologic type was adenocarcinoma (69.3%). Most participants were smokers (67.4%) and had clinical stage IV disease (60.7%). In total, 116 (42%) and 58 (21%) patients had TPS ≥1% and ≥50%, respectively. The patients were significantly older in TPS ≥1% group than in TPS <1% group (64.83±9.38 years vs. 61.73±10.78 years, p=0.014), not in TPS ≥50% cutoff value (64.69 ± 9.39 vs. 62.36 ± 10.51, p= 0.178). Regarding histologic grade, higher proportions of poorly differentiated tumor were observed in the TPS ≥1% (40.8% vs. 25.8%, p=0.020) and TPS ≥50% groups (53.2% vs. 27.2%, p=0.004). Among 34 patients examined with 22C3 and SP263 assays, 27 had positive results in both assays, with a cutoff of TPS ≥1% (r=0.826; 95% confidence interval, 0.736-0.916). CONCLUSION PD-L1 expression, defined as TPS ≥1%, was related to older age and poorly differentiated histology. There was a similar distribution of PD-L1 expression in both 22C3 and SP263 results.
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Affiliation(s)
- Ha Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Bo Gun Kho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Ok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cheol Kyu Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yoo Duk Choi
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
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Kim MS, Chung HS, Hwang EC, Jung SI, Kwon DD, Hwang JE, Bae WK, Park JY, Jeong CW, Kwak C, Song C, Seo SI, Byun SS, Hong SH, Chung J. Efficacy of First-Line Targeted Therapy in Real-World Korean Patients with Metastatic Renal Cell Carcinoma: Focus on Sunitinib and Pazopanib. J Korean Med Sci 2018; 33:e325. [PMID: 30546281 PMCID: PMC6291404 DOI: 10.3346/jkms.2018.33.e325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To evaluate survival outcomes and prognostic factors for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) who received sunitinib (SU) and pazopanib (PZ) as first-line therapy in real-world Korean clinical practice. METHODS Data of 554 patients with mRCC who received SU or PZ at eight institutions between 2012 and 2016 were retrospectively reviewed. Based on the targeted therapy, the patients were divided into SU (n = 293) or PZ (n = 261) groups, and the clinicopathological variables and survival rates of the two groups were compared. A multivariable Cox proportional hazard model was used to determine the prognostic factors for OS. RESULTS The median follow-up was 16.4 months (interquartile range, 8.3-31.3). Patients in the PZ group were older, and no significant difference was observed in the performance status (PS) between the two groups. In the SU group, the dose reduction rate was higher and the incidence of grade 3 toxicity was more frequent. The objective response rates were comparable between the two groups (SU, 32.1% vs. PZ, 36.4%). OS did not differ significantly between the two groups (SU, 36.5 months vs. PZ, 40.2 months; log-rank, P = 0.955). Body mass index, Eastern Cooperative Oncology Group PS > 2, synchronous metastasis, poor Heng risk criteria, and liver and bone metastases were associated with a shorter OS. CONCLUSION Our real-world data of Korean patients with mRCC suggested that SU and PZ had similar efficacies as first-line therapy for mRCC. However, PZ was better tolerated than SU in Korean patients.
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Affiliation(s)
- Myung Soo Kim
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jun Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Ansan, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
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Son KC, Chung HS, Jung SI, Kim MS, Hwang EC, Kim JW, Kwon DD. Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora. J Korean Med Sci 2018; 33:e113. [PMID: 29629517 PMCID: PMC5890083 DOI: 10.3346/jkms.2018.33.e113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/26/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To investigate whether addition of amikacin to fluoroquinolone (FQ) antimicrobial prophylaxis reduces infections after transrectal ultrasound-guided prostate biopsy (TRUSPB). METHODS A total of 503 patients undergoing rectal swab were divided into three groups. Patients with FQ-sensitive rectal flora (group 1, n = 248) were administered ciprofloxacin before TRUSPB, and patients with FQ-resistant rectal flora were either administered ciprofloxacin (group 2, n = 97) or amikacin and ciprofloxacin (group 3, n = 158) before TRUSPB. RESULTS Based on the rectal swab, FQ resistance was 54.9%, and extended-spectrum β-lactamase (ESBL) positivity was 17.2%. The incidence of infectious complication in group 1 was 1.6%. Groups 2 and 3, with FQ-resistant rectal flora, tended to have increased infectious complications (5.2% and 4.4%, respectively) but the difference between those results is not statistically significant. The most common pathogens of infectious complications in patients with FQ-resistant rectal flora were FQ-resistant and ESBL-producing Escherichia coli. E. coli pathogens isolated in Group 3 were amikacin-susceptible species. The operation history and ESBL positivity of rectal flora increased the incidence of infectious complications (odds ratio [OR] = 3.68; P = 0.035 and OR = 4.02; P = 0.008, respectively). DM and antibiotics exposure were risk factors for FQ resistance (OR = 2.19; P = 0.002) and ESBL positivity of rectal flora (OR = 2.96; P = 0.005), respectively. CONCLUSION Addition of amikacin to ciprofloxacin prophylaxis could not reduce infectious complications in patients with FQ-resistant rectal flora. Despite the amikacin sensitivity of infectious complications, single-dose amikacin addition to ciprofloxacin prophylaxis has limitations.
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Affiliation(s)
- Kyung Chul Son
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Myung Soo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Kim HK, Yoon JH, Jeong YA, Kang HC. The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome. Endocrinol Metab (Seoul) 2016; 31:592-597. [PMID: 28029028 PMCID: PMC5195837 DOI: 10.3803/enm.2016.31.4.592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/19/2016] [Accepted: 10/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown. METHODS Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test. RESULTS Levels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001). CONCLUSION The HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.
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Affiliation(s)
- Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yun Ah Jeong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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