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Ha BJ, Kang SM, Choi BM, Cheong JH, Ryu JI, Won YD, Han MH. Stroke recurrence and osteoporotic conditions in postmenopausal patients with atherosclerotic ischemic stroke. Heliyon 2024; 10:e30196. [PMID: 38720741 PMCID: PMC11076908 DOI: 10.1016/j.heliyon.2024.e30196] [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: 12/24/2023] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
Recurrence after stroke is common, and associated with a high mortality rate. Degradation of the elastic tissue in the arterial wall has been shown to aggravate atherosclerosis in blood vessels. Considering that type 1 collagen is present in both bone and vascular smooth muscle cells, we explored whether osteoporotic conditions affect the likelihood of stroke recurrence in postmenopausal women following atherosclerotic ischemic stroke. To determine actual bone mineral density (BMD), the Hounsfield unit values in the frontal skull were evaluated using brain computed tomography (CT) scans taken at admission. A multivariate Cox regression analysis was also performed to examine if osteoporosis could independently predict stroke recurrence in postmenopausal patients with large artery atherosclerosis (LAA) or small vessel occlusion (SVO) stroke. This study included 2130 consecutive patients (both males and females aged 50 and older) with acute LAA or SVO strokes. After adjusting for all covariates, hypothetical osteoporosis was identified as an independent predictor of stroke recurrence in female patients ≥50 years with acute LAA or SVO stroke (hazard ratio, 1.84; 95 % confidence interval, 1.05 to 3.24; p = 0.034). Our findings showed that osteoporosis could potentially affect the recurrence of ischemic stroke in postmenopausal patients with LAA or SVO stroke.
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Affiliation(s)
| | | | - Bo Mi Choi
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Republic of Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Republic of Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Republic of Korea
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Choi BM, Cheong JH, Ryu JI, Won YD, Min KW, Han MH. Significant Genes Associated with Mortality and Disease Progression in Grade II and III Glioma. Biomedicines 2024; 12:858. [PMID: 38672212 PMCID: PMC11048596 DOI: 10.3390/biomedicines12040858] [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: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The Wnt/β-catenin pathway plays a critical role in the tumorigenesis and maintenance of glioma stem cells. This study aimed to evaluate significant genes associated with the Wnt/β-catenin pathway involved in mortality and disease progression in patients with grade II and III glioma, using the Cancer Genome Atlas (TCGA) database. METHODS We obtained clinicopathological information and mRNA expression data from 515 patients with grade II and III gliomas from the TCGA database. We performed a multivariate Cox regression analysis to identify genes independently associated with glioma prognosis. RESULTS The analysis of 34 genes involved in Wnt/β-catenin signaling demonstrated that four genes (CER1, FRAT1, FSTL1, and RPSA) related to the Wnt/β-catenin pathway were significantly associated with mortality and disease progression in patients with grade II and III glioma. We also identified additional genes related to the four significant genes of the Wnt/β-catenin pathway mentioned above. The higher expression of BMP2, RPL18A, RPL19, and RPS12 is associated with better outcomes in patients with glioma. CONCLUSIONS Using a large-scale open database, we identified significant genes related to the Wnt/β-catenin signaling pathway associated with mortality and disease progression in patients with grade II and III gliomas.
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Affiliation(s)
- Bo Mi Choi
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Gyeonggi-do, Republic of Korea; (B.M.C.); (J.H.C.); (J.I.R.); (Y.D.W.)
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Gyeonggi-do, Republic of Korea; (B.M.C.); (J.H.C.); (J.I.R.); (Y.D.W.)
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Gyeonggi-do, Republic of Korea; (B.M.C.); (J.H.C.); (J.I.R.); (Y.D.W.)
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Gyeonggi-do, Republic of Korea; (B.M.C.); (J.H.C.); (J.I.R.); (Y.D.W.)
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11759, Gyeonggi-do, Republic of Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Gyeonggi-do, Republic of Korea; (B.M.C.); (J.H.C.); (J.I.R.); (Y.D.W.)
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Yoon HG, Cheong JH, Ryu JI, Won YD, Min KW, Han MH. The genes significantly associated with an improved prognosis and long-term survival of glioblastoma. PLoS One 2023; 18:e0295061. [PMID: 38019838 PMCID: PMC10686432 DOI: 10.1371/journal.pone.0295061] [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: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Glioblastoma multiforme (GBM) is the most devastating brain tumor with less than 5% of patients surviving 5 years following diagnosis. Many studies have focused on the genetics of GBM with the aim of improving the prognosis of GBM patients. We investigated specific genes whose expressions are significantly related to both the length of the overall survival and the progression-free survival in patients with GBM. METHODS We obtained data for 12,042 gene mRNA expressions in 525 GBM tissues from the Cancer Genome Atlas (TCGA) database. Among those genes, we identified independent genes significantly associated with the prognosis of GBM. Receiver operating characteristic (ROC) curve analysis was performed to determine the genes significant for predicting the long-term survival of patients with GBM. Bioinformatics analysis was also performed for the significant genes. RESULTS We identified 33 independent genes whose expressions were significantly associated with the prognosis of 525 patients with GBM. Among them, the expressions of five genes were independently associated with an improved prognosis of GBM, and the expressions of 28 genes were independently related to a poorer prognosis of GBM. The expressions of the ADAM22, ATP5C1, RAC3, SHANK1, AEBP1, C1RL, CHL1, CHST2, EFEMP2, and PGCP genes were either positively or negatively related to the long-term survival of GBM patients. CONCLUSIONS Using a large-scale and open database, we found genes significantly associated with both the prognosis and long-term survival of patients with GBM. We believe that our findings may contribute to improving the understanding of the mechanisms underlying GBM.
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Affiliation(s)
- Hong Gyu Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Kyueng-Whan Min
- Department of Pathology Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
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Park J, Kang SM, Won YD, Han MH, Cheong JH, Ha BJ, Ryu JI. Risk Factors for Prevertebral Soft Tissue Swelling Following Single-Level Anterior Cervical Spine Surgery. J Korean Neurosurg Soc 2023; 66:716-725. [PMID: 37670434 PMCID: PMC10641418 DOI: 10.3340/jkns.2023.0123] [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: 06/16/2023] [Revised: 07/30/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. METHODS A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. RESULTS A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). CONCLUSION Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.
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Affiliation(s)
- Junsang Park
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Sang Mook Kang
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Byeong-Jin Ha
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Chung J, Cheong JH, Kim JM, Lee DH, Yi HJ, Choi KS, Ahn JS, Park JC, Park W. Is Fetal-Type Posterior Cerebral Artery a Risk Factor for Recurrence in Coiled Internal Carotid Artery-Incorporating Posterior Communicating Artery Aneurysms? Analysis of Conventional Statistics, Computational Fluid Dynamics, and Random Forest With Hyper-Ensemble Approach. Neurosurgery 2023; 93:611-621. [PMID: 37057916 DOI: 10.1227/neu.0000000000002458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/20/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The fetal-type posterior cerebral artery (FPCA) has been regarded as the risk factor for recurrence in coiled internal carotid artery-incorporating posterior communicating artery (ICA-PCoA) aneurysm. However, it has not been proven in previous literature studies. OBJECTIVE To reveal the impact of FPCA on the recurrence of ICA-PCoA aneurysms using conventional statistical analysis, computational fluid dynamics (CFD) simulation, and random forest with hyper-ensemble approach (RF with HEA). METHODS Vascular parameters and clinical information from patients who underwent coil embolization ICA-PCoA aneurysms from January 2011 to December 2016 were obtained. Conventional statistical analysis was applied to a total of 95 cases obtained from patients with a follow-up of more than 6 months. For CFD simulation, 3 sets of three-dimensional models were used to understand the hemodynamical characteristics of various FPCAs. The RF with HEA was applied to reinforce the clinical data analysis. RESULTS The conventional statistical analysis fails to reveal that FPCA is a risk factor. CFD analysis shows that the diameter of FPCA alone is less likely to be a risk factor. The RF with HEA shows that the impact of FPCA is also minor compared with that of the packing density in the recurrence of coiled ICA-PCoA aneurysms. CONCLUSION The gathered results of all 3 analyses show more clear evidence that FPCA is not a risk factor for coiled ICA-PCoA aneurysms. Hence, we may conclude that FPCA itself is doubtful to be the major risk factor in the recurrence of coiled ICA-PCoA aneurysms.
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Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University, Cheonan, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Han MH, Baek JM, Min KW, Cheong JH, Ryu JI, Won YD, Kwon MJ, Koh SH. DKK3 expression is associated with immunosuppression and poor prognosis in glioblastoma, in contrast to lower-grade gliomas. BMC Neurol 2023; 23:183. [PMID: 37149563 PMCID: PMC10163766 DOI: 10.1186/s12883-023-03236-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023] Open
Abstract
PURPOSE We previously reported that expression of dickkopf-3 (DKK3), which is involved in the Wnt/β-catenin pathway, is significantly associated with prognosis in patients with glioblastoma multiforme (GBM). The aim of this study was to compare the association of DKK3 with other Wnt/β-catenin pathway-related genes and immune responses between lower grade glioma (LGG) and GBM. METHODS We obtained the clinicopathological data of 515 patients with LGG (World Health Organization [WHO] grade II and III glioma) and 525 patients with GBM from the Cancer Genome Atlas (TCGA) database. We performed Pearson's correlation analysis to investigate the relationships between Wnt/β-catenin-related gene expression in LGG and GBM. Linear regression analysis was performed to identify the association between DKK3 expression and immune cell fractions in all grade II to IV gliomas. RESULTS A total of 1,040 patients with WHO grade II to IV gliomas were included in the study. As the grade of glioma increased, DKK3 showed a tendency to be more strongly positively correlated with the expression of other Wnt/β-catenin pathway-related genes. DKK3 was not associated with immunosuppression in LGG but was associated with downregulation of immune responses in GBM. We hypothesized that the role of DKK3 in the Wnt/β-catenin pathway might be different between LGG and GBM. CONCLUSION According to our findings, DKK3 expression had a weak effect on LGG but a significant effect on immunosuppression and poor prognosis in GBM. Therefore, DKK3 expression seems to play different roles, through the Wnt/β-catenin pathway, between LGG and GBM.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Jeong Min Baek
- Department of Translational Medicine, Graduate School of Biomedical Science & Engineering, Hanyang University, Hanyang University, Seoul, South Korea
| | - Kyueng-Whan Min
- Department of Pathology Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggi-do, Republic of Korea.
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University Guri Hospital, 11923 Gyeongchun-ro, Guri-Si, Gyeonggi-do, Republic of Korea.
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Han MH, Min KW, Noh YK, Kim JM, Cheong JH, Ryu JI, Won YD, Koh SH, Park YM. Identification of genes from ten oncogenic pathways associated with mortality and disease progression in glioblastoma. Front Oncol 2022; 12:965638. [PMID: 36033456 PMCID: PMC9399757 DOI: 10.3389/fonc.2022.965638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most malignant brain tumor with an extremely poor prognosis. The Cancer Genome Atlas (TCGA) database has been used to confirm the roles played by 10 canonical oncogenic signaling pathways in various cancers. The purpose of this study was to evaluate the expression of genes in these 10 canonical oncogenic signaling pathways, which are significantly related to mortality and disease progression in GBM patients. Clinicopathological information and mRNA expression data of 525 patients with GBM were obtained from TCGA database. Gene sets related to the 10 oncogenic signaling pathways were investigated via Gene Set Enrichment Analysis. Multivariate Cox regression analysis was performed for all the genes significantly associated with mortality and disease progression for each oncogenic signaling pathway in GBM patients. We found 12 independent genes from the 10 oncogenic signaling pathways that were significantly related to mortality and disease progression in GBM patients. Considering the roles of these 12 significant genes in cancer, we suggest possible mechanisms affecting the prognosis of GBM. We also observed that the expression of 6 of the genes significantly associated with a poor prognosis of GBM, showed negative correlations with CD8+ T-cells in GBM tissue. Using a large-scale open database, we identified 12 genes belonging to 10 well-known oncogenic canonical pathways, which were significantly associated with mortality and disease progression in patients with GBM. We believe that our findings will contribute to a better understanding of the mechanisms underlying the pathophysiology of GBM in the future.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
- *Correspondence: Kyueng-Whan Min, ; Yung-Kyun Noh,
| | - Yung-Kyun Noh
- Department of Computer Science, Hanyang University, Seoul, South Korea
- School of Computational Sciences, Korea Institute for Advanced Study, Seoul, South Korea
- *Correspondence: Kyueng-Whan Min, ; Yung-Kyun Noh,
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Young Mi Park
- Department of Pediatrics, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung-si, South Korea
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Han MH, Kim JM, Cheong JH, Ryu JI, Won YD, Nam GH, Kim CH. Efficacy of Cytokine-Induced Killer Cell Immunotherapy for Patients With Pathologically Pure Glioblastoma. Front Oncol 2022; 12:851628. [PMID: 35463313 PMCID: PMC9033287 DOI: 10.3389/fonc.2022.851628] [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: 01/20/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
The most common malignant central nervous system tumor is glioblastoma multiforme (GBM). Cytokine-induced killer (CIK) cell therapy is a promising type of adoptive cell immunotherapy for various cancers. We previously conducted a randomized clinical trial on CIK cell therapy in patients with GBM. The aim of this study was to evaluate the efficacy of CIK immunotherapy for patients with pathologically pure GBM, using data from our previous randomized clinical trial. The difference between overall survival (OS) and progression-free survival (PFS) according to CIK immunotherapy was analyzed using the Kaplan–Meier method. Hazard ratios were calculated using univariate and multivariate Cox regression analyses to determine whether CIK cell immunotherapy was independently associated with higher OS and PFS in patients with pure GBM. A total of 156 eligible patients were included in the modified intention-to-treat (mITT) population. We confirmed that 125 (80.1%) GBM samples were pure GBM tumors without the presence of other types of tumors. For patients with pure GBM, Kaplan-Meier analysis showed no significant difference in OS between the CIK cell treatment and control groups. However, multivariate Cox regression demonstrated CIK cell immunotherapy as an independent predictor of greater OS (hazard ratio, 0.59; 95% CI, 0.36–0.97; p = 0.038) and PFS (hazard ratio, 0.55; 95% CI, 0.36–0.84; p = 0.001) in patients with pathologically pure GBM in the mITT population. This study showed that CIK cell immunotherapy combined with conventional temozolomide chemoradiotherapy could prolong OS and PFS in patients with newly diagnosed pathologically pure GBM, with no significant adverse events related to treatment. However, unlike the results of multivariate Cox analysis, no statistical significance of CIK cell immunotherapy in OS in Kaplan-Meier analysis raises a question. Further studies are required to validate these results.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
- *Correspondence: Choong Hyun Kim, ; Je Il Ryu,
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Gun He Nam
- Development Division, GC Cell Corp., Yongin-si, South Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
- *Correspondence: Choong Hyun Kim, ; Je Il Ryu,
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Kang SM, Kim JM, Cheong JH, Ryu JI, Won YD, Kim YS, Han MH. Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma. Radiat Oncol 2021; 16:160. [PMID: 34425881 PMCID: PMC8383364 DOI: 10.1186/s13014-021-01890-7] [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: 05/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation treatment in patients with meningioma. METHODS A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after radiation. RESULTS A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based radiation treatment (hazard ratio 5.20; 95% confidence interval 1.11-24.46; p = 0.037). CONCLUSIONS Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based radiation treatment for intracranial meningioma. However, due to the study's small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made.
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Affiliation(s)
- Sang Mook Kang
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea.
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Won YD, Kim JM, Cheong JH, Ryu JI, Yi HJ, Han MH. Effect of Osteoporotic Condition on Ventriculomegaly and Shunt-Dependent Hydrocephalus After Subarachnoid Hemorrhage. Stroke 2021; 52:994-1003. [PMID: 33535781 DOI: 10.1161/strokeaha.120.031044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hydrocephalus is a common complication in aneurysmal rupture subarachnoid hemorrhage (SAH). As both the bone and arachnoid trabeculae are composed of type 1 collagen, we identified the possible relationship between bone mineral density and ventriculomegaly and shunt-dependent hydrocephalus (SDHC) development after aneurysmal rupture SAH in younger patients. METHODS We measured frontal skull Hounsfield unit (HU) values on brain computed tomography upon admission, and mean frontal skull HU values were used instead of T-score value. Hazard ratios were calculated using Cox regression analysis to identify whether osteoporotic condition is an independent predictor for ventriculomegaly and SDHC after surgical clipping for SAH in younger patients. RESULTS Altogether, 412 patients (≤65 years) who underwent surgical clipping for primary spontaneous SAH from a ruptured aneurysm were enrolled in this 11-year analysis in 2 hospitals. We observed that the first tertile group of skull HU was an independent predictor of SDHC after SAH compared with the third tertile of skull HU values (hazard ratio, 2.55 [95% CI, 1.25-5.20]; P=0.010). There were no significant interactions between age and skull HU with respect to ventriculomegaly and SDHC in younger patients. CONCLUSIONS Our study suggests a relationship between possible osteoporotic conditions and ventriculomegaly and SDHC development after SAH in younger patients. Our findings may be useful in predicting hydrocephalus in young SAH patients using a convenient method of measuring skull HU value on brain computed tomography upon admission.
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Affiliation(s)
- Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea (H.-J.Y.)
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
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11
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Ha BJ, Won YD, Ryu JI, Han MH, Cheong JH, Kim JM, Chun HJ, Bak KH, Bae IS. Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis. BMC Surg 2020; 20:269. [PMID: 33148220 PMCID: PMC7640472 DOI: 10.1186/s12893-020-00900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). METHODS We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery. RESULTS The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34-15.73; p = 0.015). CONCLUSION We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.
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Affiliation(s)
- Byeong Jin Ha
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea.
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - In-Suk Bae
- Department of Neurosurgery, Eulji University Eulji Hospital, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea
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Hwang M, Park HH, Han MH, Choi H, Lee KY, Lee YJ, Kim JM, Cheong JH, Ryu JI, Ko Y, Koh SH. Chemoradiotherapy Alters Protein Expression in Glioblastoma Multiforme. J Clin Neurol 2020; 16:725-728. [PMID: 33029989 PMCID: PMC7541983 DOI: 10.3988/jcn.2020.16.4.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mina Hwang
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Hyun Hee Park
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Myung Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea.
| | - Hojin Choi
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Kyu Yong Lee
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Young Joo Lee
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Seong Ho Koh
- Department of Neurology, Hanyang University Guri Hospital, Guri, Korea
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul, Korea.
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Ha BJ, Bae IS, Kim JM, Cheong JH, Ryu JI, Han MH. Effects of Possible Osteoporotic Conditions on the Recurrence of Chronic Subdural Hematoma. Front Neurol 2020; 11:538257. [PMID: 33071940 PMCID: PMC7542308 DOI: 10.3389/fneur.2020.538257] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/27/2020] [Indexed: 01/30/2023] Open
Abstract
The recurrence rate of chronic subdural hematoma (CSDH) has been reported to range from 2.3 to 33%. As bridging veins are composed of abundant collagen bundles and bone matrix, we aimed to investigate the possible associations between skull Hounsfield unit (HU) values and the recurrence of CSDH. We retrospectively enrolled patients with CSDH who underwent burr hole surgery. The HU values of the frontal skull were measured on brain CT scans. The cumulative hazard for recurrence was estimated according to predictive factors. To identify the independent predictors associated with the recurrence of CSDH, hazard ratios (HRs) were estimated using multivariate Cox regression analysis. A total of 208 consecutive patients who underwent burr hole trephination for CSDH over a 7-years period at a single institution were enrolled in this study. We found that age, greater midline shift (≥10.5 mm), lower skull HU (<769.5), and diabetes were independent predictors for the recurrence of CSDH (HR 1.06, 95% confidence interval [CI] 1.00–1.12, p = 0.042; HR 5.37, 95% CI 1.48–19.46, p = 0.010; HR 6.71, 95% CI 1.84–24.45, p = 0.004; and HR 3.30, 95% CI 1.05–10.43, p = 0.042, respectively). A relationship between possible low bone mineral density (BMD) and CSDH recurrence was observed. In addition, age, greater preoperative midline shift, and diabetes were also identified as predictive factors for recurrence. We expect that our findings may facilitate our understanding of the possible association between CSDH and BMD.
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Affiliation(s)
- Byeong Jin Ha
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - In-Suk Bae
- Department of Neurosurgery, Eulji University Hospital, Seoul, South Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, South Korea
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Jo KW, Kim H, Yoo DS, Hyun DK, Cheong JH, Park HK, Park BJ, Cho BM, Kim YW, Kim TH, Han I, Lee SW, Kwon TH. Current Status of Neurosurgical and Neurointensive Care Units in Korea : A Brief Report on Nationwide Survey Results. J Korean Neurosurg Soc 2020; 63:519-531. [PMID: 32664714 PMCID: PMC7365282 DOI: 10.3340/jkns.2020.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010.
Method This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010.
Results Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists’ work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists.
Conclusion We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.
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Affiliation(s)
- Kwang Wook Jo
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Sung Yoo
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Keun Hyun
- Department of Neurosurgery, Inha Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hae-Kwan Park
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Jin Park
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Byung Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Woo Kim
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Hee Kim
- Department of Anesthology and Pain Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Insoo Han
- Department of Anesthology and Pain Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taek Hyun Kwon
- Department of Neurosurgery, Korea Universuty Guro Hospital, Seoul, Korea
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Nam SH, Ryu JI, Cheong JH, Park KC, Ro SK. Spontaneously Resolved Lumbar Artery Injury after Blunt Trauma. J Trauma Inj 2020. [DOI: 10.20408/jti.2019.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Bae IS, Kim JM, Cheong JH, Ryu JI, Choi KS, Han MH. Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma? PLoS One 2020; 15:e0232631. [PMID: 32353054 PMCID: PMC7192490 DOI: 10.1371/journal.pone.0232631] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background and purpose Posttraumatic hydrocephalus affects 11.9%–36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH). Methods We measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis. Results A total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU ≤797.4 and internal occipital protuberance HU ≤586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH. Conclusions Our study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our findings provide deeper insight into the association between low bone mineral density and hydrocephalus after DC for traumatic acute SDH.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
- * E-mail:
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17
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Lee RH, Kim JM, Cheong JH, Ryu JI, Kim YS, Han MH. Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma. PLoS One 2020; 15:e0226312. [PMID: 32069308 PMCID: PMC7028281 DOI: 10.1371/journal.pone.0226312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 01/27/2023] Open
Abstract
Background and purpose Disruption of the tumor-brain barrier in meningioma plays a critical role in the development of peritumoral brain edema (PTBE). We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation in patients with intracranial meningioma. Methods We measured Hounsfield units (HU) of the frontal skull on simulation brain CT in patients who underwent linear accelerator (LINAC)-based radiation treatment for intracranial meningioma. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for several predictive factors. The cumulative hazard for PTBE was estimated and classified according to these factors. Hazard ratios were then estimated to identify independent predictive factors associated with the development of PTBE after radiation in intracranial meningioma patients. Results A total of 83 intracranial meningiomas in 76 patients who received LINAC-based radiation treatment in our hospital over an approximate 5-year period were included for the study. We found mean frontal skull HU ≤630.625 and gross tumor volume >7.194 cc to be independent predictors of PTBE after radiation treatment in patients with meningioma (hazard ratio, 8.41; P = 0.019; hazard ratio, 5.92; P = 0.032, respectively). In addition, patients who were ≥65 years showed a marginally significant association with PTBE. Conclusions Our study suggests that possible osteoporotic conditions, large tumor volume, and older age may be associated with PTBE occurrence after LINAC-based radiation treatment for intracranial meningioma. In the future we anticipate that these findings may enhance the understanding of the underlying mechanisms of PTBE after radiation in meningioma patients.
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Affiliation(s)
- Ryang-Hun Lee
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, Seongdong-gu, Seoul, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
- * E-mail:
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Bae IS, Kim JM, Cheong JH, Han MH, Ryu JI. Association between cerebral atrophy and osteoporotic vertebral compression fractures. PLoS One 2019; 14:e0224439. [PMID: 31689324 PMCID: PMC6830774 DOI: 10.1371/journal.pone.0224439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Osteoporotic vertebral compression fractures (OVCFs) have a serious impact on people's health and quality of life. The purpose of this study was to analyze brain volume in patients with osteoporosis using brain magnetic resonance imaging (MRI) and to investigate the relationship with osteoporotic vertebral compression fractures. MATERIALS AND METHODS We included 246 patients with osteoporosis who underwent thoracolumbar radiographs and brain MRI at our hospital. Clinical data on age, sex, bone mineral density, height, weight, osteoporosis medication, hypertension, diabetes, alcohol drinking, and smoking were collected. Intracranial cavity, brain parenchyma, and lateral ventricles volumes were measured using brain MRI with a semiautomated tool. RESULTS We founded an independent correlation between age and volume percentages of the brain parenchyma and lateral ventricles. We observed a statistically significant decrease in volume percentage of the brain parenchyma and an increase in volume percentage of the lateral ventricles with increasing age. In addition, we confirmed that patients with OVCF showed a significantly lower volume percentage of brain parenchyma than patients without OVCF. CONCLUSION We observed a significant association between OVCF and volume percentage of brain parenchyma. Degeneration of the brain may lead to a high incidence of falls, and OVCF may occur more frequently in patients with osteoporosis.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
- * E-mail:
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Hwang M, Han MH, Park HH, Choi H, Lee KY, Lee YJ, Kim JM, Cheong JH, Ryu JI, Min KW, Oh YH, Ko Y, Koh SH. LGR5 and Downstream Intracellular Signaling Proteins Play Critical Roles in the Cell Proliferation of Neuroblastoma, Meningioma and Pituitary Adenoma. Exp Neurobiol 2019; 28:628-641. [PMID: 31698554 PMCID: PMC6844835 DOI: 10.5607/en.2019.28.5.628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/31/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 12/15/2022] Open
Abstract
Leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5) has been reported to play critical roles in the proliferation of various cancer cells. However, the roles of LGR5 in brain tumors and the specific intracellular signaling proteins directly associated with it remain unknown. Expression of LGR5 was first measured in normal brain tissue, meningioma, and pituitary adenoma of humans. To identify the downstream signaling pathways of LGR5, siRNA-mediated knockdown of LGR5 was performed in SH-SY5Y neuroblastoma cells followed by proteomics analysis with 2-dimensional polyacrylamide gel electrophoresis (2D-PAGE). In addition, the expression of LGR5-associated proteins was evaluated in LGR5-inhibited neuroblastoma cells and in human normal brain, meningioma, and pituitary adenoma tissue. Proteomics analysis showed 12 protein spots were significantly different in expression level (more than two-fold change) and subsequently identified by peptide mass fingerprinting. A protein association network was constructed from the 12 identified proteins altered by LGR5 knockdown. Direct and indirect interactions were identified among the 12 proteins. HSP 90-beta was one of the proteins whose expression was altered by LGR5 knockdown. Likewise, we observed decreased expression of proteins in the hnRNP subfamily following LGR5 knockdown. In addition, we have for the first time identified significantly higher hnRNP family expression in meningioma and pituitary adenoma compared to normal brain tissue. Taken together, LGR5 and its downstream signaling play critical roles in neuroblastoma and brain tumors such as meningioma and pituitary adenoma.
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Affiliation(s)
- Mina Hwang
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Hyun-Hee Park
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Hojin Choi
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Kyu-Yong Lee
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Young Joo Lee
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Young-Ha Oh
- Department of Pathology, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, Seoul 04763, Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University Guri Hospital, Guri 11923, Korea.,Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul 04763, Korea
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Bae IS, Kim JM, Cheong JH, Ryu JI, Han MH. Association between bone mineral density and brain parenchymal atrophy and ventricular enlargement in healthy individuals. Aging (Albany NY) 2019; 11:8217-8238. [PMID: 31575827 PMCID: PMC6814624 DOI: 10.18632/aging.102316] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/21/2019] [Indexed: 01/01/2023]
Abstract
Bone, vascular smooth muscle, and arachnoid trabeculae are composed of the same type of collagen. However, no studies have investigated the relationship between bone mineral density deterioration and cerebral atrophy, both of which occur in normal, healthy aging. Accordingly, we evaluated whether bone mineral density was associated with brain parenchymal atrophy and ventricular enlargement in healthy individuals. Intracranial cavity, brain parenchyma, and lateral ventricles volumes were measured using brain magnetic resonance imaging (MRI) with a semiautomated tool. We included 267 individuals with no history of dementia or other neurological diseases, who underwent one or more dual-energy X-ray absorptiometry scans and brain MRIs simultaneously (within 3 years of each other) at our hospital over an 11-year period. We found that progression of brain parenchymal atrophy was positively associated with bone mineral density after full adjustment (B, 0.94; P < 0.001). In addition, individuals with osteoporosis showed more parenchymal atrophy among those younger than 80 years. In addition, we observed greater ventricular enlargement in individuals with osteoporosis among those older than 80 years. We believe that osteoporosis may play a role in the acceleration of parenchymal atrophy during the early-stages, and ventricular enlargement in the late-stages, of normal aging-related cerebral atrophy.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
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Han MH, Won YD, Na MK, Kim CH, Kim JM, Ryu JI, Yi HJ, Cheong JH. Association Between Possible Osteoporosis and Shunt-Dependent Hydrocephalus After Subarachnoid Hemorrhage. Stroke 2019; 49:1850-1858. [PMID: 29946014 DOI: 10.1161/strokeaha.118.021063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Pathological obstruction in arachnoid granulations after subarachnoid hemorrhage (SAH) can impede cerebrospinal fluid flow outward to the venous sinus and causing hydrocephalus. Because bone and arachnoid granulations share the same collagen type, we evaluated the possible relation between bone mineral density and shunt-dependent hydrocephalus after SAH. Methods- We measured Hounsfield units of the frontal skull on admission brain computed tomography in patients with SAH. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff Hounsfield unit in skull to predict osteopenia and osteoporosis in a large sample registry. According to the optimal cutoff skull Hounsfield unit values, study patients were then categorized as hypothetical normal, osteopenia, and osteoporosis. Odds ratios were estimated using logistic regression to determine whether the osteoporotic conditions are independent predictive factors for the development of shunt-dependent hydrocephalus after clipping for SAH. Results- A total of 447 patients (alive ≥14 days) with ruptured aneurysm SAH who underwent surgical clipping were retrospectively enrolled in this study during a 9-year period from 2 hospitals. We found that hypothetical osteoporosis was an independent predictor for shunt-dependent hydrocephalus after aneurysmal clipping for SAH after full adjustment for other predictive factors, including age (odds ratio, 2.08; 95% confidence interval, 1.06-4.08; P=0.032). Conclusions- Our study demonstrates a possible relation between possible osteoporosis and hydrocephalus after SAH. Hounsfield unit measurement on admission brain computed tomography may be helpful for predicting hydrocephalus during the clinical course of SAH in patients with osteoporosis or suspected osteoporosis.
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Affiliation(s)
- Myung-Hoon Han
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Yu Deok Won
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Min Kyun Na
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Choong Hyun Kim
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Jae Min Kim
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Je Il Ryu
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea (H.-J.Y.)
| | - Jin Hwan Cheong
- From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.)
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Nam MW, Kim JM, Cheong JH, Ryu JI, Han MH. Paradoxical relationship between body mass index and bone mineral density in patients with non-small cell lung cancer with brain metastasis. PLoS One 2019; 14:e0218825. [PMID: 31226155 PMCID: PMC6588256 DOI: 10.1371/journal.pone.0218825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background and purpose Low body mass index (BMI) at presentation has been reported to be associated with higher incidence and mortality of lung cancer, but studies on the relationship between brain metastasis and BMI at presentation are lacking. This study aimed to evaluate the association between brain metastasis and BMI and bone mineral density (BMD) in NSCLC. Methods We retrospectively enrolled patients with non–small cell lung cancer who underwent brain magnetic resonance imaging with contrast within 3 months of diagnosis. The BMI was collected, and the BMD was measured in Hounsfield unit (HU) on initial staging computed tomography scans. The independent relationship between BMI and BMD was assessed using multivariable linear regression according to the presence of brain metastasis. Results A total of 356 consecutive NSCLC patients were enrolled in the study over a 8-year period in a single institution. Lower BMI with higher BMD was an independent predictive factor for brain metastasis in patients with NSCLC, relative to the other group (HR, 2.03; 95% CI, 1.21 to 3.40; P = 0.007). We also found a significant negative correlation between BMI and BMD among patients with NSCLC with brain metastases (B, -3.343; 95% confidence interval, -6.352 to -0.333; P = 0.030). Conclusions Brain metastasis may possibly be associated with lower BMI and higher BMD in NSCLC patients. We expect that these results may facilitate future predictions of brain metastases during the clinical course of NSCLC and enhance our understanding of the underlying mechanisms that link brain metastases and lung cancer.
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Affiliation(s)
- Min Woo Nam
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Korea
- * E-mail:
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Jang SY, Kim CH, Cheong JH, Kim JM. Risk Factors of Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt. Korean J Neurotrauma 2018; 14:112-117. [PMID: 30402428 PMCID: PMC6218347 DOI: 10.13004/kjnt.2018.14.2.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/01/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022] Open
Abstract
Objective Placement of a ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid diversion. A rare complication is delayed intracranial hemorrhage (ICH) secondary to VP shunting, and only a few patients with this complication have been reported. We investigate the incidence and risk factors of delayed ICH development following VP shunt placement. Methods Over an 11-year period, 167 patients received a VP shunt for hydrocephalus, and of these, 138 patients were eligible for this study. All medical records and computed tomography scans obtained within 48 h after the operation and at postoperative day 7 were reviewed. The risk factors of developing delayed ICH (≥48 hr after VP shunt placement) were analyzed according to the demographic data, including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings. Results Delayed ICH following VP shunt placement developed in 34 (24.6%) of the 138 patients. Risk factors for developing delayed ICH were age (p=0.037) and the partial thromboplastin time (PTT) (p=0.032). Intraventricular hemorrhage after VP shunting was the most common complication, occurring in 16 cases. Hemorrhagic volume was <1 mL in 28 cases and >1 mL in 6 cases. Conclusion This study suggests that old age and delayed PTT are major risk factors for developing delayed ICH following VP shunting. Additionally, delayed ICH after VP shunting commonly occurs even when most patients are asymptomatic. Therefore, extra care should be taken to observe and follow-up with patients who have undergone VP shunt placement.
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Affiliation(s)
- Se Youn Jang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Han KH, Won YD, Na MK, Han MH, Ryu JI, Kim JM, Kim CH, Cheong JH. Postpartum Superior Sagittal Sinus Thrombosis: A Case Report. Korean J Neurotrauma 2018; 14:146-149. [PMID: 30402435 PMCID: PMC6218358 DOI: 10.13004/kjnt.2018.14.2.146] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/15/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare disease. Early diagnosis and treatment are important, as CVST is potentially fatal. Pregnancy and puerperium are known risk factors for CVST. Here, we report the case of a patient who developed superior sagittal sinus thrombosis after a normal vaginal delivery. A 20-year-old woman presented with a headache and seizures two days after a normal vaginal delivery. Initially, brain computed tomography (CT) showed a subarachnoid hemorrhage in the right parietal lobe and sylvian fissure, together with mild cerebral edema. CT angiography revealed superior sagittal sinus thrombosis. Multiple micro-infarctions were seen on diffusion-weighted magnetic resonance images. An intravenous infusion of heparin and mannitol was administered immediately. Two days after treatment initiation, the patient showed sudden neurological deterioration, with left-sided hemiplegia. Brain CT showed moderate brain edema and hemorrhagic densities. Emergency decompressive craniectomy was performed, and heparin was re-administered on post-operative day (POD) 1. On POD 9, the patient's mental state improved from stupor to drowsy, but the left-sided hemiplegia persisted. CT angiography showed that the superior sinus thrombosis had decreased. Superior sagittal sinus thrombosis is an uncommon complication, with an unfavorable outcome, after delivery. Timely diagnosis and treatment are important for preventing neurological deterioration.
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Affiliation(s)
- Kun Hee Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Min Kyun Na
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Na MK, Won YD, Kim CH, Kim JM, Cheong JH, Ryu JI, Han MH. Opportunistic osteoporosis screening via the measurement of frontal skull Hounsfield units derived from brain computed tomography images. PLoS One 2018; 13:e0197336. [PMID: 29746570 PMCID: PMC5945032 DOI: 10.1371/journal.pone.0197336] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background and purpose Osteoporosis is one of the most common chronic metabolic diseases, but detection and treatment rates are low. The aim of the current study was to evaluate the correlation between frontal skull Hounsfield unit (HU) values from brain computed tomography (CT) scans and T-scores of the lumbar spine and femoral neck from dual-energy X-ray absorptiometry (DXA) scans. Methods Patients with < 1 year between brain CT and DXA scans were included in the study. The average frontal skull HU value used for analysis was defined as the average of four HU values of the frontal bone. A receiver operating characteristic curve was generated, and area under the curve (AUC) was used to determine the HU values of the frontal skull for predicting osteoporosis. The frontal skull HU value with the highest sensitivity and specificity was considered the optimal cutoff value. Results In total, 899 patients who underwent both brain CT and DXA scans at a single institution were enrolled. Average skull HU values differed significantly among patients in different bone mineral density categories (p < 0.001). There was a positive correlation between skull HU value and T-score (β = 105.06, p < 0.001, R2 = 0.343). The mean HU value in subjects with osteoporosis was 515, and the optimal cutoff value for the prediction of osteoporosis was 610 HU (AUC = 0.775, 95% CI 0.744–0.806, p < 0.001). Conclusions Clinical brain CT scans can assist in the detection of osteoporosis, and patients with an HU value < 610 as determined via brain CT may be considered for further evaluation for possible osteoporosis.
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Affiliation(s)
- Min Kyun Na
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Korea
- * E-mail:
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Ryu JI, Han MH, Kim JM, Kim CH, Cheong JH. Cervical Epidural Hematoma That Induced Sudden Paraparesis After Cervical Spine Massage: Case Report and Literature Review. World Neurosurg 2018; 112:217-220. [PMID: 29408299 DOI: 10.1016/j.wneu.2018.01.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most people understand spinal manipulation therapy to be a safe procedure, and in many cases treatment is provided without a diagnosis if there is musculoskeletal pain. Cervical epidural hematoma occurs in extremely rare cases after cervical manipulation therapy. This study reports a case of epidural hematoma that occurred in the anterior spinal cord after cervical massage. CASE DESCRIPTION A 38-year-old male patient was admitted to the emergency department for sudden weakness in the lower extremity after receiving a cervical spine massage. No fracture was found using cervical radiographs, and there were no particular findings on performing brain computed tomography or diffusion magnetic resonance imaging. However, using cervical magnetic resonance imaging, an acute epidural hematoma was observed in the anterior spinal cord from the C6 and C7 vertebrae to the T1 vertebra, compressing the spinal cord. There were no fractures or ligament injury. No surgical treatment was required as the patient showed spontaneous improvements in muscle strength and was discharged after just 1 week, following observation of the improvement in his symptoms. CONCLUSION Although cervical epidural hematoma after cervical manipulation therapy is extremely rare, if suspected, a thorough examination must be performed in order to reduce the chances of serious neurologic sequelae.
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Affiliation(s)
- Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Myung Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea.
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Kim YJ, Kim CH, Cheong JH, Kim JM. Relationship between expression of vascular endothelial growth factor and intratumoral hemorrhage in human pituitary adenomas. Tumori 2018; 97:639-46. [DOI: 10.1177/030089161109700517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Although pituitary adenoma is a primary brain tumor that occasionally accompanies intratumoral hemorrhage, there are little reports about the molecular mechanism of intratumoral bleeding in pituitary adenoma. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis and vascular permeability of various brain tumors. The authors studied the relationship between intratumoral hemorrhage and the expression of VEGF in human pituitary adenomas. Methods VEGF expression was assessed by reverse transcriptase polymerase chain reaction (RT-PCR) in 71 pituitary adenomas. Clinical factors to investigate were age, gender, hormonal functioning, and radiological findings of pituitary adenomas. Radiological findings which were investigated by magnetic resonance (MR) images were intratumoral hemorrhage, cystic change, tumor size, and cavernous sinus invasion. The relationship between these factors and VEGF expression was statistically analyzed. Results VEGF was expressed in 25 cases (35.2%). Functioning tumors, hemorrhage, cystic change, and cavernous sinus invasion were 32 (45.1%), 18 (25.4%), 12 (16.9%), and 21 (29.6%) respectively. The expression of VEGF showed a significant relationship with the intratumoral hemorrhage of the adenomas (P <0.001). However, age, gender, tumor size, hormonal functioning, cyst formation, and cavernous sinus invasion had no relationship with VEGF expression (P >0.05). Conclusions This study suggests that VEGF expression may be responsible for intratumoral hemorrhage of pituitary adenomas. Therefore, VEGF can be a novel target to prevent a catastrophic apoplexy in pituitary adenomas and to establish roles in angiogenesis-based therapeutics of pituitary adenomas.
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Affiliation(s)
- Young Jin Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Na MK, Won YD, Kim CH, Kim JM, Cheong JH, Ryu JI, Han MH. Early variations of laboratory parameters predicting shunt-dependent hydrocephalus after subarachnoid hemorrhage. PLoS One 2017; 12:e0189499. [PMID: 29232410 PMCID: PMC5726740 DOI: 10.1371/journal.pone.0189499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/27/2017] [Indexed: 01/30/2023] Open
Abstract
Background and purpose Hydrocephalus is a frequent complication following subarachnoid hemorrhage. Few studies investigated the association between laboratory parameters and shunt-dependent hydrocephalus. This study aimed to investigate the variations of laboratory parameters after subarachnoid hemorrhage. We also attempted to identify predictive laboratory parameters for shunt-dependent hydrocephalus. Methods Multiple imputation was performed to fill the missing laboratory data using Bayesian methods in SPSS. We used univariate and multivariate Cox regression analyses to calculate hazard ratios for shunt-dependent hydrocephalus based on clinical and laboratory factors. The area under the receiver operating characteristic curve was used to determine the laboratory risk values predicting shunt-dependent hydrocephalus. Results We included 181 participants with a mean age of 54.4 years. Higher sodium (hazard ratio, 1.53; 95% confidence interval, 1.13–2.07; p = 0.005), lower potassium, and higher glucose levels were associated with higher shunt-dependent hydrocephalus. The receiver operating characteristic curve analysis showed that the areas under the curve of sodium, potassium, and glucose were 0.649 (cutoff value, 142.75 mEq/L), 0.609 (cutoff value, 3.04 mmol/L), and 0.664 (cutoff value, 140.51 mg/dL), respectively. Conclusions Despite the exploratory nature of this study, we found that higher sodium, lower potassium, and higher glucose levels were predictive values for shunt-dependent hydrocephalus from postoperative day (POD) 1 to POD 12–16 after subarachnoid hemorrhage. Strict correction of electrolyte imbalance seems necessary to reduce shunt-dependent hydrocephalus. Further large studies are warranted to confirm our findings.
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Affiliation(s)
- Min Kyun Na
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Je il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
- * E-mail:
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Han MH, Kim J, Choi KS, Kim CH, Kim JM, Cheong JH, Yi HJ, Lee SH. Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution. PLoS One 2017; 12:e0186973. [PMID: 29073210 PMCID: PMC5658131 DOI: 10.1371/journal.pone.0186973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Although the effect of weather and air pollution on the occurrence of subarachnoid hemorrhage (SAH) has been investigated, results have remained inconsistent. The present study aimed to determine the seasonality of aneurysmal subarachnoid hemorrhage occurrence and mortality. METHODS We used the National Inpatient Sample database to evaluate the effect of meteorological factors and air pollutants on patients with subarachnoid hemorrhage in Korea between 2011 and 2014. Monthly variations in SAH occurrence and mortality were analyzed using locally weighted scatter plot smoothing curves. Multivariate Poisson generalized linear regression models were used to evaluate potential independent meteorological and pollutant variables associated with SAH occurrence and mortality. RESULTS In total, 21,407 patients who underwent clip or coil treatment owing to aneurysmal SAH in Korea from January 1, 2011, to December 31, 2014, were included. The crude incidence rate of SAH in Korea was 10.5 per 100,000 people per year. An approximately 0.5% lower risk of SAH was observed per 1°C increase in mean monthly temperature (relative risk, 0.995; 95% confidence interval [CI], 0.992-0.997; p < 0.001), while an approximately 2.3% higher risk of SAH was observed per 1°C increase in mean monthly diurnal temperature. CONCLUSIONS We showed distinct patterns of seasonal and monthly variation in the occurrence and mortality of SAH. Our findings suggest that meteorological factors may play an important role in monthly variations in the occurrence of aneurysmal SAH.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Hambangmoe-ro, Yeonsu-gu, Incheon, Korea
- * E-mail:
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Momennejad I, Russek EM, Cheong JH, Botvinick MM, Daw ND, Gershman SJ. The successor representation in human reinforcement learning. Nat Hum Behav 2017; 1:680-692. [PMID: 31024137 PMCID: PMC6941356 DOI: 10.1038/s41562-017-0180-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 07/07/2017] [Indexed: 11/08/2022]
Abstract
Theories of reward learning in neuroscience have focused on two families of algorithms thought to capture deliberative versus habitual choice. 'Model-based' algorithms compute the value of candidate actions from scratch, whereas 'model-free' algorithms make choice more efficient but less flexible by storing pre-computed action values. We examine an intermediate algorithmic family, the successor representation, which balances flexibility and efficiency by storing partially computed action values: predictions about future events. These pre-computation strategies differ in how they update their choices following changes in a task. The successor representation's reliance on stored predictions about future states predicts a unique signature of insensitivity to changes in the task's sequence of events, but flexible adjustment following changes to rewards. We provide evidence for such differential sensitivity in two behavioural studies with humans. These results suggest that the successor representation is a computational substrate for semi-flexible choice in humans, introducing a subtler, more cognitive notion of habit.
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Affiliation(s)
- I Momennejad
- Department of Psychology, Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA.
| | - E M Russek
- Center for Neural Science, New York University, New York, NY, USA
| | - J H Cheong
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - M M Botvinick
- DeepMind and Gatsby Computational Neuroscience Unit, University College London, London, UK
| | - N D Daw
- Department of Psychology, Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - S J Gershman
- Department of Psychology, Center for Brain Science, Harvard University, Cambridge, MA, USA
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Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Bak KH, Chun HJ. Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis. Osteoporos Int 2017; 28:1931-1938. [PMID: 28255666 DOI: 10.1007/s00198-017-3972-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/02/2017] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines. INTRODUCTION Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA. METHODS The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI. RESULTS A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, -0.029; 95% CI, -0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, -0.036; 95% CI, -0.061 to -0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group. CONCLUSIONS Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.
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Affiliation(s)
- M H Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J I Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea.
| | - C H Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J M Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J H Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - K H Bak
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
| | - H J Chun
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
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Kim SH, Kang DS, Cheong JH, Kim JH, Song KY, Kong MH. Comparison of Complications Following Cranioplasty Using a Sterilized Autologous Bone Flap or Polymethyl Methacrylate. Korean J Neurotrauma 2017; 13:15-23. [PMID: 28512613 PMCID: PMC5432444 DOI: 10.13004/kjnt.2017.13.1.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/03/2016] [Accepted: 02/13/2017] [Indexed: 11/15/2022] Open
Abstract
Objective The aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI). Methods Between January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months. Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operation time, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR and SSI. Results A total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically significant difference between the groups (p=1.00). No statistically significant risk factors for SSI were found in either group. In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP (Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically significant risk factors for BFR were found in Group II. Conclusion CP using sterilized autologous bone result in a significant rate of BFR. PMMA, however, is a safe alloplastic material for CP, as it has low complication rate.
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Affiliation(s)
- Sung Hoon Kim
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Dong Soo Kang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Hee Kim
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Kwan Young Song
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Min Ho Kong
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
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Ryu JI, Han MH, Cheong JH, Kim JM, Kim CH. Current update of adoptive immunotherapy using cytokine-induced killer cells to eliminate malignant gliomas. Immunotherapy 2017; 9:411-421. [PMID: 28357913 DOI: 10.2217/imt-2017-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The therapeutic outcome for those with malignant glioma is poor, even though diverse therapeutic modalities have been developed. Immunotherapy has emerged as a therapeutic approach for malignant gliomas, making it possible to selectively treat tumors while sparing normal tissue. Here, we review clinical trials of adoptive immunotherapy approaches for malignant gliomas. We also describe a clinical trial that examined the efficacy and safety of autologous cytokine-induced killer (CIK) cells along with concomitant chemoradiotherapy for newly diagnosed glioblastoma. These CIK cells identify and kill autologous tumor cells. This review focuses on the use of adoptive immunotherapy for malignant gliomas and reviews the current literature on the concept of antitumor activity mediated by CIK cells.
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Affiliation(s)
- Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Republic of Korea
| | - Myung Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Republic of Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Republic of Korea
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Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Radiologic Findings and Patient Factors Associated with 30-Day Mortality after Surgical Evacuation of Subdural Hematoma in Patients Less Than 65 Years Old. J Korean Neurosurg Soc 2017; 60:239-249. [PMID: 28264246 PMCID: PMC5365301 DOI: 10.3340/jkns.2016.0404.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/20/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. Methods From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan–Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. Results We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52–0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27–4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20–4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27–3.58; p=0.005) were positively associated with 30-day mortality. Conclusion We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
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Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 2016; 127:1117-1125. [PMID: 27982768 DOI: 10.3171/2016.8.jns16867] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals. METHODS Kaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up. RESULTS This study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03-2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m2), and a bilateral operation. CONCLUSIONS This study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul; and
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Park JW, Cheong JH, Choi KS, Park DW, Ryu JI, Kim JM, Kim CH. Retrograde Stent-assisted Coil Embolization of Wide-neck or Branch-incorporated Posterior Communicating Artery Aneurysm. J Cerebrovasc Endovasc Neurosurg 2016; 18:124-128. [PMID: 27790404 PMCID: PMC5081498 DOI: 10.7461/jcen.2016.18.2.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 03/25/2016] [Accepted: 05/16/2016] [Indexed: 12/25/2022] Open
Abstract
Endovascular coil embolization using a balloon- or stent-assisted technique for the treatment of wide-necked posterior communicating artery (PcomA) aneurysms is well established. However, complete aneurysm occlusion with preservation of the PcomA can be difficult in case of wide-neck aneurysms with a PcomA incorporation. We present two cases of stent-assisted coil embolization using a retrograde approach through the posterior circulation for wide-neck or branch-incorporated PcomA aneurysms. Retrograde stenting was successful without periprocedural complications. These aneurysms were completely occluded. The patency of the PcomA was maintained in all cases.
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Affiliation(s)
- Jeong Woo Park
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Kyu Sun Choi
- Department of Neurosurgery, Asan Medical Center, Seoul, Korea
| | - Dong Woo Park
- Department of Neuroradiology, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Han MH, Kim JM, Yi HJ, Cheong JH, Ko Y, Kim CH, Kim YS. Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians. Cerebrovasc Dis 2016; 42:319-331. [PMID: 27245760 DOI: 10.1159/000446552] [Citation(s) in RCA: 4] [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: 02/15/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The volume of intracerebral hemorrhage (ICH) measured at hospital admission is the strongest predictor of clinical outcomes in patients with ICH. Despite the high incidence rate of ICH in Asians, there is lack of data regarding predictors of ICH volume in this ethnic group. The purpose of this study was to determine predictors of deep ICH volume and examine their effect on short-term mortality in Asians. METHODS Hematoma volume was measured using the ABC/2 method. ICH volume was transformed to the natural log scale to normalize distributions for all analyses. We estimated the coefficients of ICH volume based on relevant predictors using multivariable linear regression. We also determined the association between body mass index (BMI) and ICH volume using a regression line and a line determined by a locally weighted scatter plot smoothing. RESULTS A total of 1,039 patients from 2 twin hospitals in Korea who were admitted with primary spontaneous supratentorial deep ICH over a 12-year period were enrolled in this study. The median ICH volume was 19.7 ml. The average patient age was 59.2, and 62.4% of patients were men. The mean ICH volume showed a gradual, approximately 2% decrease per 1 BMI increase in the current study, after adjusting for all relevant variables (β = -0.024; SE 0.004; p < 0.001). In addition, patients with frequent alcohol consumption showed a 10% increase in mean ICH volume (β = 0.098; SE 0.041; p = 0.016), and patients undergoing warfarin treatment showed a 30% increase in mean ICH volume after full adjustment of all relevant variables (β = 0.296; SE 0.050; p < 0.001). Relative to overweight patients, there was a 47, 11, and 18% increase in admission mean ICH volume in underweight, normal weight and obese patients, respectively. Patients in the first quartile and underweight BMI groups had 1.45-fold (hazard ratio (HR) 1.45; 95% CI 1.03-2.03; p = 0.035) and 1.77-fold (HR 1.77; 95% CI 1.10-2.84; p = 0.019) higher increased risk of death during the first 3 months after ICH, retrospectively. In addition, patients in groups with frequent alcohol consumption and warfarin use both showed a significant association with mortality 90 days after ICH. CONCLUSIONS We demonstrated the association between various predictors and admission ICH volume with short-term mortality in Asians. Further studies are needed to account for these observations and determine their underlying mechanisms.
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Affiliation(s)
- Myung Hoon Han
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
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Ha BJ, Kim YS, Cheong JH. Large Mature Cystic Teratoma of the Third Ventricle in Infancy: A Case Report and Review of Literatures. Brain Tumor Res Treat 2016; 4:44-7. [PMID: 27195263 PMCID: PMC4868818 DOI: 10.14791/btrt.2016.4.1.44] [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: 07/21/2015] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 11/24/2022] Open
Abstract
Teratomas of the central nervous system are rare and are frequently found in children and young adults. Cystic teratomas found in infancy is a well-recognized but infrequent entity. Intracranial teratomas,like teratomas in general, tend to arise from midline structures such as the pineal gland, but has rarely been found in the third ventricle. We report a rare case of a 6-month-old infant with a mature cystic teratoma of the third ventricle with a review of literatures
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Affiliation(s)
- Byeong Jin Ha
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Ryu JI, Kim CH, Kim JM, Cheong JH. Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH). Journal of Trauma and Injury 2015. [DOI: 10.20408/jti.2015.28.4.223] [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: 11/05/2022] Open
Affiliation(s)
- Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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Park S, Lee JM, Kim JW, Cho DY, Yun HJ, Han DH, Cheong JH, Kim BN. Associations between serotonin transporter gene (SLC6A4) methylation and clinical characteristics and cortical thickness in children with ADHD. Psychol Med 2015; 45:3009-3017. [PMID: 26017091 DOI: 10.1017/s003329171500094x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common, highly heritable psychiatric disorder. Additionally, environmental factors such as perinatal stress and early adversities contribute to the occurrence and severity of ADHD. Recently, DNA methylation has emerged as a mechanism that potentially mediates gene-environmental interaction effects in the aetiology and phenomenology of psychiatric disorders. Here, we investigated whether serotonin transporter gene (SLC6A4) methylation patterns were associated with clinical characteristics and regional cortical thickness in children with ADHD. METHOD In 102 children with ADHD (age 6-15 years), the methylation status of the SLC6A4 promoter was measured. Brain magnetic resonance imaging was obtained and ADHD symptoms were evaluated. RESULTS A higher methylation status of the SLC6A4 promoter was significantly associated with worse clinical presentations (more hyperactive-impulsive symptoms and more commission errors). Additionally, a negative correlation was observed between SLC6A4 methylation levels and cortical thickness values in the right occipito-temporal regions. CONCLUSIONS Our results suggest that the SLC6A4 methylation status may be associated with certain symptoms of ADHD, such as behavioural disinhibition, and related brain changes. Future studies that use a larger sample size and a control group are required to corroborate these results.
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Affiliation(s)
- S Park
- Department of Psychiatry,Seoul National Hospital,Seoul,Republic of Korea
| | - J-M Lee
- Department of Biomedical Engineering,Hanyang University,Seoul,Republic of Korea
| | - J-W Kim
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University College of Medicine,Seoul,Republic of Korea
| | - D-Y Cho
- Lab Genomics Clinical Research Institute,Seoul,Republic of Korea
| | - H J Yun
- Department of Biomedical Engineering,Hanyang University,Seoul,Republic of Korea
| | - D H Han
- Department of Psychiatry,College of Medicine,Chung Ang University,Seoul,Republic of Korea
| | - J H Cheong
- Uimyung Research Institute for Neuroscience,Sahmyook University,Seoul,Republic of Korea
| | - B-N Kim
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University College of Medicine,Seoul,Republic of Korea
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Ryu JI, Cheong JH, Kim JM, Kim CH. A Primary Ossifying Intracranial Myxoma Arising from the Ethmoid Sinus. J Korean Neurosurg Soc 2015; 58:281-5. [PMID: 26539274 PMCID: PMC4630362 DOI: 10.3340/jkns.2015.58.3.281] [Citation(s) in RCA: 2] [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] [Received: 08/13/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/27/2022] Open
Abstract
Myxomas are rare benign tumors that originate from mesenchymal tissue. They usually develop in the atrium of the heart, the skin, subcutaneous tissue, or bone. Involvement of the skull base with an intracranial extension is very rare and not well-described in the literature. We report a rare case of primary intracranial ossifying myxoma arising from the anterior skull base and mimicking a huge chondrosarcoma, and we review the relevant literature.
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Affiliation(s)
- Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Park S, Lee JM, Kim JW, Cheong JH, Yun HJ, Hong YC, Kim Y, Han DH, Yoo HJ, Shin MS, Cho SC, Kim BN. Association between phthalates and externalizing behaviors and cortical thickness in children with attention deficit hyperactivity disorder. Psychol Med 2015; 45:1601-1612. [PMID: 25388623 DOI: 10.1017/s0033291714002694] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Previous studies have implicated the relationship between environmental phthalate exposure and attention deficit hyperactivity disorder (ADHD) symptoms of childhood, but no studies have been conducted in children who have a confirmed diagnosis of ADHD obtained through meticulous diagnostic testing. We aimed to determine whether phthalate metabolites in urine would be higher in children with ADHD than in those without ADHD and would correlate with symptom severity and cortical thickness in ADHD children. METHOD A cross-sectional examination of urine phthalate metabolite concentrations was performed; scores for ADHD symptoms, externalizing problems, and continuous performance tests were obtained from 180 children with ADHD, and brain-imaging data were obtained from 115 participants. For the control group, children without ADHD (N = 438) were recruited. Correlations between phthalate metabolite concentrations and clinical measures and brain cortical thickness were investigated. RESULTS Concentrations of phthalate metabolites, particularly the di(2-ethylhexyl) phthalate (DEHP) metabolite, were significantly higher in boys with ADHD than in boys without ADHD. Concentrations of the di-n-butyl phthalate (DBP) metabolite were significantly higher in the combined or hyperactive-impulsive subtypes compared to the inattentive subtype, and the metabolite was positively correlated with the severity of externalizing symptoms. Concentrations of the DEHP metabolite were negatively correlated with cortical thickness in the right middle and superior temporal gyri. CONCLUSIONS The results of this study suggest an association between phthalate concentrations and both the diagnosis and symptom severity of ADHD. Imaging findings suggest a negative impact of phthalates on regional cortical maturation in children with ADHD.
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Affiliation(s)
- S Park
- Department of Child and Adolescent Psychiatry,Seoul National Hospital,Seoul,Republic of Korea
| | - J-M Lee
- Department of Biomedical Engineering,Hanyang University,Seoul,Republic of Korea
| | - J-W Kim
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University Hospital,Seoul,Republic of Korea
| | - J H Cheong
- Uimyung Research Institute for Neuroscience,Sahmyook University,Seoul,Republic of Korea
| | - H J Yun
- Department of Biomedical Engineering,Hanyang University,Seoul,Republic of Korea
| | - Y-C Hong
- Department of Preventive Medicine,Seoul National University College of MedicineandInstitute of Environmental Medicine,Seoul,Republic of Korea
| | - Y Kim
- Department of Child and Adolescent Psychiatry,Seoul National Hospital,Seoul,Republic of Korea
| | - D H Han
- Department of Psychiatry,Chung Ang University,College of Medicine,Seoul,Republic of Korea
| | - H J Yoo
- College of Medicine and Behavioral Medicine Institute,Seoul National University,Seoul,Republic of Korea
| | - M-S Shin
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University Hospital,Seoul,Republic of Korea
| | - S-C Cho
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University Hospital,Seoul,Republic of Korea
| | - B-N Kim
- Division of Child and Adolescent Psychiatry,Department of Psychiatry,Seoul National University Hospital,Seoul,Republic of Korea
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43
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Kim JS, Cheong JH, Ryu JI, Kim JM, Kim CH. Bone Flap Resorption Following Cranioplasty after Decompressive Craniectomy: Preliminary Report. Korean J Neurotrauma 2015; 11:1-5. [PMID: 27169057 PMCID: PMC4847489 DOI: 10.13004/kjnt.2015.11.1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 09/28/2014] [Revised: 11/23/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty. Methods A total of 162 patients who underwent cranioplasty following DC due to life-threatening elevated intracranial pressure between October 2003 and December 2012, were included in our investigation. Follow-up exceeded one year. Results BFR occurred as a long-term complication in 9 of the 162 patients (5.6%). The affected patients consisted of individuals who had undergone DC for traumatic brain injury (TBI; n=4), for subarachnoid hemorrhage (SAH; n=3), for cerebral infarction (n=1), and intracerebral hemorrhage (n=1). Logistic regression analysis identified no significant risk factors for BFR. Conclusion TBI and SAH as initial diagnoses are more often associated with BFR than other diagnoses. This finding may influence future surgical decision making, especially in patients with possible risk factors for BFR. A prospective study with a large number of patients is needed to identify potential predictors of BFR such as bone flap sterilization and preservation.
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Affiliation(s)
- Ji Sang Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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44
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Jang SY, Kim CH, Cheong JH, Kim JM. Concomitant Subdural Hemorrhage and Intracerebral Hemorrhage due to Brain Metastasis of the Hepatocellular Carcinoma. Brain Tumor Res Treat 2015; 3:48-51. [PMID: 25977908 PMCID: PMC4426278 DOI: 10.14791/btrt.2015.3.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/06/2014] [Accepted: 12/17/2014] [Indexed: 01/30/2023] Open
Abstract
Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0×3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.
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Affiliation(s)
- Se Youn Jang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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45
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Jang SY, Kim CH, Kim JM, Cheong JH, Park SG. A muliticenter retrospective study of the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease. J Epilepsy Res 2014; 4:62-8. [PMID: 25625090 PMCID: PMC4295055 DOI: 10.14581/jer.14013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/27/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE This study is to investigate the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease as antiepileptic drugs (AEDs) in 94 korean multicenters. METHODS A total of 7,152 patients who had taken topiramate for at least 3 months between August 2008 and February 2009 were eligible to participate in this study. We evaluated demographic data, disease entities, duration of topiramate administration, initial and subsequent dosage adjustment, concomitant AEDs, the frequency of seizure reduction, and adverse events. RESULTS Topiramate was commonly prescribed in stroke (38%) and head trauma group (36%). In the dosage of topiramate, the mean initial dosage was 65 mg/day, and the mean maintenance dosage was adjusted into 105 mg/day. The mean duration of the initial dosage for topiramate administration was 24 days, and the mean duration of the maintenance dosage was 125 days, respectively. Among groups with prophylactic administration, 98% did not develop convulsion and among groups with therapeutic administration, 2% was ineffective to control seizure. After taking topiramate, 2% patients showed adverse events, that sensory aberration was the most common. CONCLUSIONS These results suggest that topiramate prescribe widely in diverse neurosurgical disorders, and effective in reduction of seizure frequency, and does not cause serious adverse effects comparable with old AEDs.
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Affiliation(s)
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - Sang Geun Park
- Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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46
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Kim SP, Kang DS, Cheong JH, Kim JH, Song KY, Kong MH. Clinical analysis of epidural fluid collection as a complication after cranioplasty. J Korean Neurosurg Soc 2014; 56:410-8. [PMID: 25535519 PMCID: PMC4273000 DOI: 10.3340/jkns.2014.56.5.410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022] Open
Abstract
Objective The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. Methods From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. Results Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. Conclusion EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.
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Affiliation(s)
- Seung Pil Kim
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Dong Soo Kang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Hee Kim
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Kwan Young Song
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Min Ho Kong
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
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Bae DH, Kim CH, Cheong JH, Kim JM. Adulthood benign triton tumor developed in the orbit. J Korean Neurosurg Soc 2014; 56:146-8. [PMID: 25328653 PMCID: PMC4200363 DOI: 10.3340/jkns.2014.56.2.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/03/2014] [Revised: 01/09/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022] Open
Abstract
Benign triton tumor (BTT) or neuromuscular hamartoma is an uncommon tumor composed of mature neural and well-differentiated striated muscular elements. Its development is exceptionally rare in the adult and head region. This report describes a case of adulthood BTT that occurred in the orbit. The patient was a 53-year-old woman who presented with right periorbital swelling and pain in eyeball over 2 months. Magnetic resonance imaging revealed a well-enhancing mass surrounding optic nerve and ocular muscles in the right retrobulbar area. The tumor was subtotally removed via transcranial approach. Its pathological diagnosis was confirmed to be a neuromuscular hamartoma. She developed diplopia postoperatively. Adulthood BTT should be considered in the differential diagnosis of head and neck tumors. It is also important to make adequate therapeutic strategy to avoid postoperative neural dysfunction.
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Affiliation(s)
- Dong Hyeon Bae
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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48
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Jang SY, Kim CH, Cheong JH, Kim JM. Extracranial extension of intracranial atypical meningioma en plaque with osteoblastic change of the skull. J Korean Neurosurg Soc 2014; 55:205-7. [PMID: 25024824 PMCID: PMC4094745 DOI: 10.3340/jkns.2014.55.4.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 05/28/2013] [Revised: 11/19/2013] [Accepted: 04/15/2014] [Indexed: 11/27/2022] Open
Abstract
Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.
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Affiliation(s)
- Se Youn Jang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
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Abstract
Based on the work of both Eysenck and Nideffer, we hypothesized that higher ranking players (HRP) would have lower competitive anxiety and more flexible attention-shifting, compared to lower ranking players (LRP). In addition, different patterns of attention (low anxiety and flexible attention) would be represented by a different pattern of brain activity within the temporal lobe and dorsolateral prefrontal cortex. In accordance with the rookie draft ranking, the players were classified into 2 groups: HRP (top 30% of those selected in the draft) vs. LRP (bottom 30% of those selected in the draft). For assessment of executive function, a computerized version of the Wisconsin Card-sorting Test (WCST) was used. Brain activity was assessed using 1.5-Tesla functional magnetic resonance imaging. In response to scenes depicting baseball errors, HRP showed increased activation in the left cingulate cortex and decreased activation in right middle temporal gyrus, compared to LRP. In response to the simplified WCST in the scanner, HRP showed increased activation in left superior frontal cortex (DLPFC), compared to LRP. The present results suggest that HRP may demonstrate elevated cingulate activation and lower temporal cortex activation in response to scenes depicting baseball errors.
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Affiliation(s)
- D H Han
- Psychiatry, Chung Ang University Hospital, Seoul, Republic of Korea
| | - B N Kim
- Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - J H Cheong
- Uimyung Research Institute for Neuroscience, Samyook University, Seoul, Republic of Korea
| | - K D Kang
- Sports Industrial Information, Chung Ang University, AnSung, Republic of Korea
| | - P F Renshaw
- Psychiatry and Brain Institute, University of Utah, Salt lake, Utah, United States
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50
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Cho I, An JY, Kwon IG, Choi YY, Cheong JH, Hyung WJ, Noh SH. Risk factors for double primary malignancies and their clinical implications in patients with sporadic gastric cancer. Eur J Surg Oncol 2013; 40:338-44. [PMID: 24342136 DOI: 10.1016/j.ejso.2013.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 10/08/2013] [Accepted: 10/30/2013] [Indexed: 01/12/2023] Open
Abstract
AIMS We carried out a large scale study to identify the risk factors for double primary malignancy (DPM) development in gastric cancer patients and to evaluate the clinical implications for these patients. METHODS A total of 2593 patients who underwent gastrectomy for primary gastric cancer from January 2005 to November 2010 were reviewed with regard to DPM. We compared the clinicopathological characteristics, risk factors for developing DPM, and prognosis between the DPM+ group and the DPM- group. RESULTS Of the 2593 patients, 152 (5.9%) were diagnosed with DPM. The most common accompanying malignancies were colorectal, lung and thyroid. Multivariate analysis indicated that age (p = 0.016) and MSI status (p = 0.002) were associated with a higher frequency of DPM. 30.3% of patients were diagnosed with DPM within 1 year around perioperative period and 53.3% of patients had DPM detected during 5 years of post-operative follow up periods. Although there was no significant difference in overall survival between the DPM+ and DPM- group, DPM+ patients had a worse prognosis than DPM- patients in stage I gastric cancer. CONCLUSIONS Gastric cancer patients over the age of 60 or with a MSI-high status had an increased risk for developing DPM. Further, in stage I gastric cancer, the presence of DPM was associated with a worse prognosis. Therefore, careful pre- and postoperative surveillance is especially important in these patients.
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Affiliation(s)
- I Cho
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - J Y An
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - I G Kwon
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Y Y Choi
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - J H Cheong
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - W J Hyung
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - S H Noh
- Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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