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Lee J, Jin YJ, Shin SK, Kwon JH, Kim SG, Yu JH, Lee JW, Kwon OS, Nahm SW, Kim YS. Clinical outcomes of transarterial chemoembolization in Child-Turcotte Pugh class A patients with a single small (≤3 cm) hepatocellular carcinoma. J Gastroenterol Hepatol 2024. [PMID: 38711168 DOI: 10.1111/jgh.16581] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/09/2024] [Accepted: 03/31/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND AIM Transarterial chemoembolization (TACE) is one of the standard modalities used to treat unresectable hepatocellular carcinoma (HCC), but the effectiveness of TACE for treating patients with a solitary small (≤3 cm) HCC and well-preserved liver function has not been definitively established. This study aimed to determine the therapeutic impact of TACE in patients with these characteristics. METHODS This multicenter (four university hospitals) retrospective cohort study analyzed the medical records of 250 patients with a solitary small (≤3 cm) HCC and Child-Turcotte-Pugh (CTP) class A liver function diagnosed over 10 years. Posttreatment outcomes, including overall survival (OS), recurrence-free survival (RFS), and adverse events, were assessed following TACE therapy. RESULTS One hundred and thirty-eight of the 250 patients (55.2%) treated with TACE achieved complete remission (CR). Overall median OS was 77.7 months, and median OS was significantly longer in the CR group than in the non-CR group (89.1 vs. 58.8 months, P = 0.001). Median RFS was 19.1 months in the CR group. Subgroup analysis identified hypertension, an elevated serum albumin level, and achieving CR as significant positive predictors of OS, whereas diabetes, hepatitis c virus infection, and tumor size (>2 cm) were poor prognostic factors of OS. CONCLUSIONS The study demonstrates the effectiveness of TACE as a viable alternative for treating solitary small (≤3 cm) HCC in CTP class A patients.
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Affiliation(s)
- Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, South Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soon Woo Nahm
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
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Ra H, Lee HY, Park DK, Kwon OS, Kim YJ. Better medical care quality in weekday daytime schedule with gastrointestinal hospitalists than conventional care teams. Hosp Pract (1995) 2023; 51:255-261. [PMID: 37929667 DOI: 10.1080/21548331.2023.2277676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This study sought to uncover whether having a gastrointestinal (GI) hospitalist available during weekday daytime hours results in higher-quality medical care compared to care provided by a team of residents. METHODS Our hospitalist GI team consisted of two gastroenterologists working weekday daytime hours and two physician assistants. The team of conventional care headed by thirteen professors, comprised twelve residents and eight physician assistants. We conducted a retrospective cohort study in South Korea between March 2 and December 9, 2020 The hospitalist team treated 528 patients, while the conventional care team treated 2,335. We assessed the medical parameters of length of stay (LOS), rates of in-hospital mortality, transfer to the intensive care unit, and readmission rate within 30 days. Furthermore, we gathered feedback from nurses working with both teams. RESULTS The study found that there was no significant difference in LOS between infections (P = 0.422) and other GI diseases like bleeding (P = 0.226). There was no significant difference in the rates of in-hospital mortality (P = 0.865) and transfer to the intensive care unit (P = 0.486) between the two teams. However, the hospitalist team had notably lower readmission rates than the conventional care team (P = 0.002) as well as a lower unscheduled readmission rate (P = 0.046). Furthermore, the survey results indicated that nurses who worked with the hospitalist team had significantly better responses than those who worked with the conventional care team (P < 0.001). CONCLUSIONS This study indicates that having GI hospitalists work weekday daytime hours improves patient care, and treatment and reduces readmission rates.
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Affiliation(s)
- Hannah Ra
- Division of Hospital Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hye Young Lee
- Division of Hospital Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Dong Kyun Park
- Division of Hospital Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Oh Sang Kwon
- Division of Hospital Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology, Department of internal medicine, Gachon University Gil Medical Center, Incheon, South Korea
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Lee JH, Shin SK, Kang SH, Kim TH, Yim HJ, Yim SY, Lee YS, Jung YK, Kim JH, Seo YS, Yeon JE, Kwon OS, Um SH, Byun KS. Long-Term Prediction Model for Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Receiving Antiviral Therapy: Based on Data from Korean Patients. J Clin Med 2022; 11:jcm11226613. [PMID: 36431090 PMCID: PMC9697157 DOI: 10.3390/jcm11226613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Predicting the development of hepatocellular carcinoma (HCC) is a key clinical issue in patients with chronic hepatitis B (CHB). The aim of this study was to develop a precise and simple HCC risk score for up to 10 years. A total of 1895 CHB patients treated with entecavir or tenofovir disoproxil fumarate were retrospectively recruited and randomized into derivation (n = 1239) and validation cohorts (n = 656). Variables proven to be independent risk factors for HCC in the derivation cohort were used to develop the prediction model. The ACCESS-HCC model included five variables (age, cirrhosis, consumption of ethanol, liver stiffness, and serum alanine aminotransferase). Areas under curves were 0.798, 0.762, and 0.883 for HCC risk at 3, 5, and 10 years, respectively, which were higher than those of other prediction models. The scores were categorized according to significantly different HCC incidences: 0-4, low; 5-8, intermediate; and 9-14, high-risk. The annual incidence rates were 0.5%, 3.2%, and 11.3%, respectively. The performance of this model was validated in an independent cohort. The ACCESS-HCC model shows improved long-term prediction and provides three distinct risk categories for HCC in CHB patients receiving antiviral therapy. Further research is needed for external validation using larger cohorts.
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Affiliation(s)
- Ji Hun Lee
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Inje University College of Medicine, Seoul 01757, Korea
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
| | - Tae Hyung Kim
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: (H.J.Y.); (T.H.K.)
| | - Hyung Joon Yim
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: (H.J.Y.); (T.H.K.)
| | - Sun Young Yim
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Young-Sun Lee
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Young Kul Jung
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Ji Hoon Kim
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Yeon Seok Seo
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Jong Eun Yeon
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Soon Ho Um
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
| | - Kwan Soo Byun
- Department of Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effect of the epicardial fat volume on the outcomes after a left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While the effect of a circumferential pulmonary vein isolation (CPVI) alone is unsatisfactory, that of an additional electrical posterior wall box isolation (POBI) is controversial in persistent atrial fibrillation (PeAF) patients. Increased epicardial adipose tissue (EAT) is associated with higher recurrence rates after AF catheter ablation (AFCA).
Purpose
We investigated the possible effects of a POBI on rhythm outcomes with varying EAT volumes.
Methods
We included 1,187 patients with PeAF undergoing a de novo AFCA (79.6% male, median age 60 years) into two groups including those receiving a CPVI alone (n=687) and those an additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the total EAT volume using propensity overlap weighting.
Results
A reduced total EAT volume was linearly associated with more favorable rhythm outcomes for an additional POBI treatment than for a CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (≤116.23 ml, the median value, n=594), an additional POBI was associated with a reduced AF recurrence risk as compared to a CPVI only (weighted hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56–0.99; weighted log-rank P=0.039). In contrast, among the remaining 593 patients with greater EAT volumes (>116.2 3mL), there was no difference in the AF recurrence risk between an additional POBI and CPVI alone (weighted HR 1.13, 95% CI 0.84–1.52; weighted log-rank P=0.410). Among 185 patients with a repeat ablation, the POBI reconnection rate tended to be higher in the large EAT group (75.0%) than small EAT group (55.4%, P=0.060).
Conclusion
While PeAF patients with a smaller EAT volume averted AF recurrence by an additional POBI after the CPVI, no benefit of the POBI was observed in those with a greater EAT volume. The EAT volume might identify AF patients likely to benefit from linear ablation in addition to the CPVI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Ministry of Science, ICT & Future Planning (MSIP)Korean Ministry of Health and Welfare
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - O S Kwon
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
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Lee J, Jin YJ, Shin SK, Kwon JH, Kim SG, Suh YJ, Jeong Y, Yu JH, Lee JW, Kwon OS, Nahm SW, Kim YS. Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:207-218. [PMID: 34814239 PMCID: PMC9013608 DOI: 10.3350/cmh.2021.0294] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). METHODS We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2-3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. RESULTS The median follow-up period was 64.8 months (interquartile range, 0.1-162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396-1.232) (P=0.215) and 1.698 (1.777-2.448) (P=0.005), respectively. CONCLUSION SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.
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Affiliation(s)
- Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Incheon, Korea,Corresponding author : Jung Hyun Kwon Division of Hepatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea Tel: +82-32-280-5886, Fax: +82-32-280-5023 E-mail:
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea,Sang Gyune Kim Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5094, Fax: +82-32-621-5080 E-mail:
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Soon Woo Nahm
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Incheon, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
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Kim HJ, Kim JH, Yeon JE, Seo YS, Jang JW, Cho YK, Jang BK, Han BH, Lee C, Lee JH, Yoon JH, Kim KM, Kim MY, Kim DY, Park NH, Cho EY, Lee JS, Lee JW, Kim IH, Song BC, Lee BS, Kwon OS. A Multi-Center, Double-Blind Randomized Controlled Phase III Clinical Trial to Evaluate the Antiviral Activity and Safety of DA-2802 (Tenofovir Disoproxil Orotate) and Viread (Tenofovir Disoproxil Fumarate) in Chronic Hepatitis B Patients. J Korean Med Sci 2022; 37:e92. [PMID: 35315603 PMCID: PMC8938614 DOI: 10.3346/jkms.2022.37.e92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF, Viread®) had been used as a standard treatment option of chronic hepatitis B (CHB). This clinical trial was conducted to evaluate the efficacy and safety of DA-2802 (tenofovir disoproxil orotate) compared to TDF. METHODS The present study was a double blind randomized controlled trial. Patients with CHB were recruited from 25 hospitals in Korea and given DA-2802 at a dose of 319 mg once daily or Viread® at a dose of 300 mg once daily for 48 weeks from March 2017 to January 2019. Change in hepatitis B virus (HBV) DNA level at week 48 after dosing compared to baseline was the primary efficacy endpoint. Secondary efficacy endpoints were proportions of subjects with undetectable HBV DNA, those with normal alanine aminotransferase (ALT) levels, and those with loss of hepatitis B envelop antigen (HBeAg), those with loss of hepatitis B surface antigen (HBsAg). Adverse events (AEs) were also investigated. RESULTS A total of 122 patients (DA-2802 group: n = 61, Viread® group: n = 61) were used as full analysis set for efficacy analysis. Mean age, proportion of males, laboratory results and virologic characteristics were not different between the two groups. The change in HBV DNA level at week 48 from baseline was -5.13 ± 1.40 in the DA-2802 group and -4.97 ± 1.40 log10 copies/mL in the Viread® group. The analysis of primary endpoint using the nonparametric analysis of covariance showed statistically significant results (P < 0.001), which confirmed non-inferiority of DA-2802 to Viread® by a prespecified noninferiority margin of 1. The proportion of undetectable HBV DNA was 78.7% in the DA-2802 group and 75.4% in the Viread® group (P = 0.698). The proportion of subjects who had normal ALT levels was 75.4% in the DA-2802 group and 73.3% in the Viread® group (P = 0.795). The proportion of those with HBeAg loss was 8.1% in the DA-2802 group and 10.8% in the Viread® group (P = 1.000). No subject showed HBsAg loss. The frequency of AEs during treatment was similar between the two groups. Most AEs were mild to moderate in severity. CONCLUSION DA-2802 is considered an effective and safe treatment for patients with CHB. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02967939.
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Affiliation(s)
- Hyung Joon Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Division of Gastroenterology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jong Eun Yeon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeong Won Jang
- Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Kyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Kuk Jang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Hoon Han
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Changhyeong Lee
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Neung Hwa Park
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Young Cho
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - June Sung Lee
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - In Hee Kim
- Department of Gastroenterology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Byung-Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Division of Gastroenterology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Yoo HW, Park JY, Kim SG, Jung YK, Lee SH, Kim MY, Jun DW, Jang JY, Lee JW, Kwon OS. Regression of liver fibrosis and hepatocellular carcinoma development after HCV eradication with oral antiviral agents. Sci Rep 2022; 12:193. [PMID: 34996920 PMCID: PMC8742091 DOI: 10.1038/s41598-021-03272-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
We prospectively investigated the changes of liver stiffness (LS) and the occurrence of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication using direct antiviral agents (DAA) over three years. LS measurement using transient elastography and serum fibrosis surrogate markers before treatment and at 48, 96, 144 weeks after starting direct-acting antivirals (DAA) according to the protocol were evaluated. Patients were also compared with historical cohort treated with pegylated interferon (peg-IFN). Sustained viral response (SVR) was observed in 95.8%. LS value in the patients achieving SVR significantly decreased over time (19.4 ± 12.9 kPa [baseline], 13.9 ± 9.1 kPa [48 weeks], 11.7 ± 8.2 kPa [96 weeks], 10.09 ± 6.23 [144 weeks], all p < 0.001). With matched analysis, the decrease in LS value was significantly larger in DAA group than peg-IFN group at both 48 weeks (29% vs. 9%) and 96 weeks (39% vs. 17%). The incidence of HCC was not significantly different between DAA and peg-IFN groups (5.5% vs. 5.4%) at 144 weeks. HCV eradication with DAA can lead to improvement of liver stiffness over time. The regression of fibrosis was greater in the group with DAA than peg-IFN. Clinical trials registration: ClinicalTrials.gov (NCT02865369).
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Affiliation(s)
- Hae Won Yoo
- Department of Internal Medicine, SoonChunHyang University School of Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 14584, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Liver Center, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Sang Gyune Kim
- Department of Internal Medicine, SoonChunHyang University School of Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 14584, Korea.
| | | | - Sae Hwan Lee
- Soonchunhyang University College of Medicine Cheonan Hospital, Cheonan, Korea
| | | | | | - Jae Young Jang
- Soonchunhyang University College of Medicine Seoul Hospital, Seoul, Korea
| | | | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Choi SJ, Kim SM, Kim YS, Kwon OS, Shin SK, Kim KK, Lee K, Park IB, Choi CS, Chung DH, Jung J, Paek M, Lee DH. Magnetic Resonance-Based Assessments Better Capture Pathophysiologic Profiles and Progression in Nonalcoholic Fatty Liver Disease. Diabetes Metab J 2021; 45:739-752. [PMID: 33108854 PMCID: PMC8497935 DOI: 10.4093/dmj.2020.0137] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. METHODS A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). RESULTS MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). CONCLUSION Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.
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Affiliation(s)
- Seung Joon Choi
- Department of Radiology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yun Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Oh Sang Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung Kak Shin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kiyoung Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ie Byung Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Cheol Soo Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Hae Chung
- Department of Pathology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | | | - Dae Ho Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Corresponding author: Dae Ho Lee, https://orcid.org/0000-0002-8832-3052, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea E-mail:
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9
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Park JW, Kwon OS, Shim JM, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung BY, Lee MH, Kim YH, Pak HN. Artificial intelligence-predicted poor responders to catheter ablation for atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Although atrial fibrillation (AF) catheter ablation is effective for rhythm control, in some patients it is hard to maintain sinus rhythm in spite of repeated AF catheter ablation (AFCA) procedures and anti-arrhythmic drugs (AADs). We explored the pre-procedural predictors for poor responders to AFCA and tested whether artificial intelligence (AI) assists the prediction of poor responders in the independent cohort by determining the invasive parameters.
Methods
Among 1,214 patients who underwent AFCA and regular rhythm follow-up for 56.2 ± 33.8 months (59 ± 11 years, 73.5% male, 68.6% paroxysmal AF), we differentiated 92 poor responders defined as those with sustained AF despite repeat AFCAs, AADs, or electrical cardioversion. Using the Youden index, we identified advanced LA remodeling with lower LA voltage under 1.109mV. AI model, which was derived from development cohort using medical record, was applied to predict LA voltage <1.109mV in the independent cohort (n = 634, poor responders = 24) using a grad-cam score.
Results
The patients with lower LA voltage under 1.109mV showed significantly poorer rhythm outcomes (Log-rank p < 0.001). We determined invasive parameter LA voltage by using the multiple variables (age, female sex, AF type, CHA2DS2VASc score, LA dimension, E/em, hemoglobin, PR interval) and achieved relatively good prediction power of AI for LA voltage <1.109mV (AUC = 0.734, sensitivity 0.729, specificity 0.643) in the test cohort. In the independent cohort, the AI model showed good discrimination power for poor responders (AUC 0.751, p < 0.001) by estimating LA voltage, which is an invasive variable. The patients with predicted lower LA voltage (grad-cam score <0) showed poorer rhythm outcome after active rhythm control (Log-rank p < 0.001)
Conclusions
The patients with advanced atrial remodeling with low LA voltage, which can be predicted by an AI, showed significantly higher recurrence of AF after AFCA with AADs or cardioversion. AI may assist to select these poor responder patients before the AFCA procedure. Abstract Figure.
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Affiliation(s)
- JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - OS Kwon
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JM Shim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JY Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JI Choi
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - YH Kim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
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10
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Lee J, Kwon OS, Lee JS, Yu HT, Kim TH, Uhm JS, Joung BY, Lee MH, Pak HN. Left atrial wall stress and the outcome of catheter ablation for atrial fibrillation: artificial intelligence-based prediction of clinical outcome. Europace 2021. [DOI: 10.1093/europace/euab116.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Left atrial (LA) wall stress (LAW-str) may contribute to the mechanism of atrial fibrillation (AF).
Purpose
We explored the clinical characteristics and the rhythm outcome of AF depending on LAW-str among the patients who underwent AF catheter ablation (AFCA). We also tested whether artificial intelligence (AI) properly estimate LAW-str without invasive parameters.
Methods
We included 2223 patients (72.8% male, 59.0 [52.0–67.0] years old, 28.7% with persistent AF [PeAF]) who underwent radiofrequency catheter ablation (RFCA). LAW-str was calculated by the Law of Laplace using LA diameter (echocardiogram), peak LA pressure, and mean LA wall thickness (computed tomography) measured by customized software. Based on the quartile (Q1–4) or AI-estimated values of LAW-str, we compared clinical characteristics and rhythm outcome.
Results
LAW-str was independently associated with PeAF (p < 0.001), diabetes (p = 0.012) and vascular disease (p = 0.002), body mass index (p < 0.001), E/Em (p < 0.001), and mean LA voltage (p < 0.001). During 26.0 (12.0–52.0) months follow-up, clinical recurrence of AF was significantly higher in the Q4 of LAW-str group (log rank p = 0.001). LAW-str was independently associated with clinical recurrence after AFCA (HR 1.001 [1.000–1.002], p = 0.013). AI-based model using non-invasive parameters predicted Q4 of LAW-str with area under the curve (AUC) 0.734, which was similar to logistic regression based predictive model using all data including invasive parameters (AUC 0.726). Patients in Q4 of LAW-str showed consistently worse rhythm outcome regardless of the type of AF, sex, or AI-based prediction (p = 0.039).
Conclusions
The LAW-str seems to be associated with rhythm outcome of AFCA and AI can predict this complex parameter with moderate accuracy. TableMultivariateβ (95% CI)PPersistent AF31.08 (21.77-40.39)<0.001Diabetes mellitus15.36 (3.35-27.38)0.012Vascular disease22.27 (8.4-36.14)0.002Body mass index2.91 (1.53-4.29)<0.001E/Em4.95 (3.87-6.02)<0.001Mean LA voltage-22.24 (-27.96–16.52)<0.001Linear regression analysis for clinical variables predictive of LA wall stress (10^3 dyn/cm2).Abstract Figure. AF recurrence by LAW-str, AI-prediction
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Affiliation(s)
- J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - OS Kwon
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - BY Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Shin SK, Yim HJ, Kim JH, Lee CU, Yeon JE, Suh SJ, Jung YK, Kim YS, Kim JH, Kwon OS. Partial Virological Response after 2 Years of Entecavir Therapy Increases the Risk of Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Associated Cirrhosis. Gut Liver 2021; 15:430-439. [PMID: 33115966 PMCID: PMC8129658 DOI: 10.5009/gnl20074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background/Aims The clinical significance of partial virological response (PVR) in patients undergoing antiviral therapy is not well known. This study investigated whether PVR after 2 years of entecavir (ETV) therapy is associated with hepatocellular carcinoma (HCC) development in cirrhotic patients. Methods A total of 472 naïve patients with hepatitis B virus (HBV)-associated cirrhosis who were treated with ETV for at least 2 years were retrospectively enrolled. Clinical characteristics, laboratory data, PVR, and noninvasive fibrosis markers (aspartate aminotransferase to platelet ratio and FIB-4 index) at 2 years after ETV commencement were analyzed for HCC risk. Results After excluding those who developed HCC within 2 years of ETV therapy, 359 patients (mean age, 51±10 years; male 64.3%) were examined. During a median follow-up of 82 months, 80 patients developed HCC. In the univariate analysis, older age (hazard ratio [HR], 1.056; p<0.001), PVR (HR, 2.536; p=0.002), higher aspartate aminotransferase (HR, 1.018; p=0.005), lower albumin level (HR, 0.463; p<0.001), lower platelet count (HR, 0.993; p=0.01), and higher FIB-4 index (HR, 1.141; p<0.001) at 2 years after ETV commencement were risk factors for HCC. In the multivariate analysis, older age (HR, 1.046; 95% confidence interval [CI], 1.022 to 1.072; p<0.001), PVR (HR, 2.358; 95% CI, 1.310 to 4.245; p=0.004), and higher FIB-4 index (HR, 1.103; 95% CI, 1.035 to 1.177; p=0.003) were independent risk factors. Conclusions PVR and higher FIB-4 index after 2 years of ETV therapy were independent risk factors for HCC. Therefore, efforts to accomplish a complete virological response and reduce the FIB-4 index should be made. (Gut Liver 2021;15-439)
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Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, and 4Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | | | - Sang Jun Suh
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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12
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Kim NT, Lee YT, Park MS, Lee KM, Kwon OS, Sung KH. Changes in the bony alignment of the foot after tendo-Achilles lengthening in patients with planovalgus deformity. J Orthop Surg Res 2021; 16:118. [PMID: 33557891 PMCID: PMC7869243 DOI: 10.1186/s13018-021-02272-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in patients with planovalgus foot deformity. Methods Consecutive 97 patients (150 feet; mean age 10 years; range 5.1–35.7) with Achilles tendon contracture (ATC) and planovalgus foot deformity who underwent TAL were included. All patients underwent preoperative and postoperative weight-bearing anteroposterior (AP) or lateral (LAT) foot radiographics. Changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, LAT talo-1st metatarsal angle, and calcaneal pitch angle and the factors affecting such changes after TAL were analyzed using lineal mixed model. Results There were no significant change in AP talo-1st metatarsal angle and AP talo-2nd metatarsal angle after TAL in patients with cerebral palsy (CP) (p = 0.236 and 0.212). However, LAT talo-1st metatarsal angle and calcaneal pitch angle were significantly improved after TAL (13.0°, p < 0.001 and 4.5°, p < 0.001). Age was significantly associated with the change in LAT talo-1st metatarsal angle after TAL (p = 0.028). The changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, and calcaneal pitch angle after TAL were not significantly associated with the diagnosis (p = 0.879, 0.903, and 0.056). However, patients with CP showed more improvement in LAT talo-1st metatarsal angle (− 5.0°, p = 0.034) than those with idiopathic cause. Conclusion This study showed that TAL can improve the bony alignment of the foot in patients with planovalgus and ATC. We recommend that physicians should consider this study’s findings when planning operative treatment for such patients.
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Affiliation(s)
- Nak Tscheol Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Young Tae Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Sang Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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13
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Cho HJ, Shin SK, Kwon OS, Kim JH, Kim YS. Seroreversion and Acute Decompensation in Chronic Hepatitis B after Discontinuation of Oral Nucleotide Analog in the Patients Achieving HBsAg Loss. Korean J Gastroenterol 2020; 76:256-260. [PMID: 33234774 DOI: 10.4166/kjg.2020.111] [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] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/03/2022]
Abstract
Although rare patients with chronic hepatitis B can achieve HBsAg loss on oral nucleos(t)ide analog (NA), the optimal timing of stopping oral NAs safely has been considered when HBsAg and HBV DNA are negative in the serum because HBsAg loss induced by nucleos(t)ide analogs (NAs) appears to be durable if immunosuppressive therapy or chemotherapy are not done. On the other hand, the author experienced a case of HBsAg seroreversion and acute decompensation after the discontinuation of NA in a patient with HBsAg loss. This rare case highlights the need for the close monitoring of patients who achieved HBsAg loss and stopped NA.
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Affiliation(s)
- Hye Jeong Cho
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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14
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Kim OH, Go SJ, Kwon OS, Park CY, Yu B, Chang SW, Jung PY, Lee GJ. Part 2. Clinical Practice Guideline for Trauma Team Composition and Trauma Cardiopulmonary Resuscitation from the Korean Society of Traumatology. J Trauma Inj 2020. [DOI: 10.20408/jti.2020.0020] [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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15
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Shin SK, Kim KO, Kim SH, Kwon OS, Choi CS, Jeong SH, Kim YS, Kim JH, Chung MH. Exogenous 8-hydroxydeoxyguanosine ameliorates liver fibrosis through the inhibition of Rac1-NADPH oxidase signaling. J Gastroenterol Hepatol 2020; 35:1078-1087. [PMID: 31907970 DOI: 10.1111/jgh.14979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Exogenous 8-hydroxydeoxyguanosine (8-OHdG) was suggested as an inhibitor of Rac1 and NADPH oxidase (NOX). The aim of this study was to evaluate the effects of the exogenous 8-OHdG on hepatic fibrogenesis in vitro and in vivo model of liver fibrosis. METHODS Adult Sprague-Dawley rats were allocated to sham-operated rats (n = 7), rats that underwent bile duct ligation (BDL) (n = 6), and BDL rats treated with 8-OHdG (60 mg/kg/day by gavage, n = 6). All rats were sacrificed on day 21. Double immunofluorescence staining between either NOX1 or NOX2 and α-smooth muscle actin (SMA) in liver was performed. Hepatic fibrotic contents were assessed by hydroxyproline assay and quantified by Sirius red staining. In vitro, hepatic stellate cell (HSC) line LX-2 and HHSteC cells were stimulated by angiotensin II (10 μM). The reactive oxygen species (ROS) production was measured by confocal microscopy. The expressions of NOX1, NOX2, α-SMA, transforming growth factor (TGF)-β1, and collagen Iα were analyzed by quantitative real-time polymerase chain reaction or immunoblotting. RESULTS The 8-OHdG treatment in BDL rats reduced the NOX1 and NOX2 protein expression, which overlapped with α-SMA compared with BDL rats. The 8-OHdG treatment in BDL rats significantly decreased the mRNA expression of NOX1, NOX2, α-SMA, TGF-β1, and collagen Iα, and fibrotic contents. Increases of ROS production, Rac1 activation, NOX1, NOX2, and fibronectin expression induced by angiotensin II in HSCs were attenuated by 8-OHdG. CONCLUSIONS Rac1 activation and NOX-derived ROS are implicated to liver fibrosis. The 8-OHdG ameliorates liver fibrosis through the inhibition of Rac1 activation and NOX-derived ROS.
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Affiliation(s)
- Seung Kak Shin
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyung-Ok Kim
- Gachon Medical Research Institute, Gachon University Gil Medical Center, Incheon, Korea
| | - Se-Hee Kim
- Gachon Medical Research Institute, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Cheol Soo Choi
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.,Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Sung Hwan Jeong
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yun Soo Kim
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Myung-Hee Chung
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea.,Gachon Advanced Institute for Health Sciences and Technology, Gachon University, Incheon, Korea
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16
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Hong SW, Kim J, Kwon OS, Lee MH, Gong HS, Baek GH. Radiographic Remodeling of the Proximal Phalangeal Head Using a Stretching Exercise in Patients With Camptodactyly. J Hand Surg Am 2020; 45:e1-e10. [PMID: 31005462 DOI: 10.1016/j.jhsa.2019.02.014] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/09/2019] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to verify proximal phalangeal head normalization after a stretching exercise in patients with infantile-type camptodactyly and to propose radiographic indices for quantifying bony deformities. METHODS Forty-eight fingers of 20 patients with camptodactyly were enrolled in this study. All patients and their parents received instruction on how to perform the stretching exercise. The qualitative assessments of proximal phalangeal head remodeling were conducted by consensus of 2 hand surgeons. Two radiographic parameters, head triangle ratio (HTR) and head angle (HA), were measured on finger lateral radiographs taken at the initial visit and at 12-month follow-up. The intra- and interobserver reliability of both parameters was assessed. Those parameters of the patients were compared with those of 177 fingers of 80 children without camptodactyly. The extent of proximal interphalangeal (PIP) joint flexion contracture was used to evaluate clinical outcomes resulting from nonsurgical treatment. RESULTS Qualitative assessments of proximal phalangeal head remodeling exhibited meaningful improvements. Both radiographic parameters showed significant change between their status before and after intervention and had excellent intra- and interobserver reliability. Average PIP joint flexion contracture significantly improved. In the noncamptodactyly group, neither parameter showed significant differences in accordance with finger types and age ranges. CONCLUSIONS Stretching improved movement within the proximal phalangeal joint and helped to restore proximal phalangeal head roundness and concentricity in patients with infantile-type camptodactyly. The HTR and HA would be useful indices for objectively assessing the degree of bony deformity in patients with camptodactyly. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Oh Sang Kwon
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Min Ho Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, South Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Shin SK, Lee JW, Ra H, Kwon OS, Shin JB, Jin YJ, Lee S, Han KJ, Kim YN, Kim TH, Kim YS, Kim JH. Durability of Sustained Virologic Response and Improvement of Fibrosis Markers after Daclatasvir and Asunaprevir Treatment in Genotype 1b Hepatitis C Virus-Infected Patients: a Real Life and Multicenter Study. J Korean Med Sci 2019; 34:e264. [PMID: 31650719 PMCID: PMC6813423 DOI: 10.3346/jkms.2019.34.e264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The long-term data with direct acting antiviral agents were rare. This study investigated the durability of a sustained virologic response (SVR) and the improvement of fibrosis after daclatasvir and asunaprevir (DCV/ASV) treatment in genotype 1b (GT1b) hepatitis C virus (HCV)-infected patients. METHODS A total of 288 HCV GT1b patients without baseline non-structural 5A (NS5A) resistance-associated substitution (RAS) treated with DCV/ASV were enrolled. Virologic response was measured at 12 weeks and 1 year after treatment completion. In cirrhotic patients, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) at baseline and 1 year after treatment completion were evaluated. RESULTS SVR12 was obtained in 278 patients (96.5%). Six patients who checked NS5A RAS after treatment failure were RAS positive. Only one patient showed no durability of SVR. In cirrhotic patients who achieved SVR12 (n = 59), the changes of albumin (3.8 [2.2-4.7] to 4.3 [2.4-4.9] g/dL; P < 0.001), platelet count (99 [40-329] to 118 [40-399] × 10³/mm³; P < 0.001), APRI (1.8 [0.1-14.8] to 0.6 [0.1-4.8]; P < 0.001), FIB-4 index (5.45 [0.6-32.8] to 3.3 [0.4-12.2]; P < 0.001), FI (5.5 [0.6-32.8] to 3.3 [0.4-12.2]; P < 0.001), and LSM (17.2 [5.3-48.0] to 11.2 [3.7-28.1] kPa; P = 0.001) between baseline and 1 year after treatment completion were observed. CONCLUSION DCV/ASV treatment for HCV GT1b infected patients without RAS achieved high SVR rates and showed durable SVR. Cirrhotic patients who achieved SVR12 showed the improvement of liver function and fibrosis markers.
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Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jin Woo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hannah Ra
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| | - Jong Beom Shin
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Joo Jin
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sangheun Lee
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Ki Jun Han
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Young Nam Kim
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Lee H, Han SH, Lee MK, Kwon OS, Kim KH, Kim JS, Chon SH, Shinn SH. Large Focal Extrapleural Hematoma of Chest Wall: A Case Report. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2019.001] [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)
- Hohyoung Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Han
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Min Koo Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Kyoung Hwan Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Jung Suk Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Shinn
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
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19
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Lee H, Han SH, Lee MK, Kwon OS, Kim KH, Kim JS, Chon SH, Shinn SH. Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2018.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Hohyoung Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Han
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Min Koo Lee
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Kyoung Hwan Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Jung Suk Kim
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Sung Ho Shinn
- Departments of Trauma Surgery and Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
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20
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Kim KH, Han SH, Chon SH, Kim J, Kwon OS, Lee MK, Lee H. Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2018.054] [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)
- Kyoung Hwan Kim
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Sung Ho Han
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Joongsuck Kim
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Min Koo Lee
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
| | - Hohyoung Lee
- Department of Trauma Surgery, Trauma Center, Cheju Halla General Hospital, Jeju, Korea
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21
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Kim H, Park CY, Cho HM, Yeo KH, Kim JH, Yu B, Go SJ, Kwon OS. Development of Korean Teaching Model for Surgical Procedures in Trauma -Essential Surgical Procedures in Trauma Course-. Journal of Trauma and Injury 2019. [DOI: 10.20408/jti.2018.051] [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)
- Hohyun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
| | - Chan-Yong Park
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
- Department of Trauma Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Hyun-Min Cho
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
| | - Kwang-Hee Yeo
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
| | - Byungchul Yu
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
- Trauma Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung-Je Go
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
- Department of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Oh Sang Kwon
- Korean Association for Research, Procedure and Education on Trauma (KARPET), Seoul,Korea
- Traumatology, Regional Trauma Center, Cheju Halla General Hospital, Jeju, Korea
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22
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Park JW, Kim YJ, Kim DY, Bae SH, Paik SW, Lee YJ, Kim HY, Lee HC, Han SY, Cheong JY, Kwon OS, Yeon JE, Kim BH, Hwang J. Sorafenib with or without concurrent transarterial chemoembolization in patients with advanced hepatocellular carcinoma: The phase III STAH trial. J Hepatol 2019; 70:684-691. [PMID: 30529387 DOI: 10.1016/j.jhep.2018.11.029] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [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: 09/08/2018] [Revised: 11/08/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Sorafenib is first-line standard of care for patients with advanced hepatocellular carcinoma (HCC), yet it confers limited survival benefit. Therefore, we aimed to compare clinical outcomes of sorafenib combined with concurrent conventional transarterial chemoembolization (cTACE) vs. sorafenib alone in patients with advanced HCC. METHODS In this investigator-initiated, multicenter, phase III trial, patients were randomized to receive sorafenib alone (Arm S, n = 169) or in combination with cTACE on demand (Arm C, n = 170). Sorafenib was started within 3 days and cTACE within 7-21 days of randomization. The primary endpoint was overall survival (OS). RESULTS For Arms C and S, the median OS was 12.8 vs. 10.8 months (hazard ratio [HR] 0.91; 90% CI 0.69-1.21; p = 0.290); median time to progression, 5.3 vs. 3.5 months (HR 0.67; 90% CI 0.53-0.85; p = 0.003); median progression-free survival, 5.2 vs. 3.6 months (HR 0.73; 90% CI 0.59-0.91; p = 0.01); and tumor response rate, 60.6% vs. 47.3% (p = 0.005). For Arms C and S, serious (grade ≥3) adverse events occurred in 33.3% vs. 19.8% (p = 0.006) of patients and included increased alanine aminotransferase levels (20.3% vs. 3.6%), hyperbilirubinemia (11.8% vs. 3.0%), ascites (11.8% vs. 4.2%), thrombocytopenia (7.2% vs. 1.2%), anorexia (7.2% vs. 1.2%), and hand-foot skin reaction (10.5% vs. 11.4%). A post hoc subgroup analysis compared OS in Arm C patients (46.4%) receiving ≥2 cTACE sessions to Arm S patients (18.6 vs. 10.8 months; HR 0.58; 95% CI 0.40-0.82; p = 0.006). CONCLUSION Compared with sorafenib alone, sorafenib combined with cTACE did not improve OS in patients with advanced HCC. However, sorafenib combined with cTACE significantly improved time to progression, progression-free survival, and tumor response rate. Sorafenib alone remains the first-line standard of care for patients with advanced HCC. LAY SUMMARY For patients with advanced hepatocellular carcinoma requiring sorafenib therapy, co-administration with conventional transarterial chemoembolization did not improve overall survival compared to sorafenib alone. Therefore, sorafenib alone remains the first-line standard of care for patients with advanced hepatocellular carcinoma. Clinical Trial Number: NCT01829035.
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Affiliation(s)
| | | | | | - Si-Hyun Bae
- The Catholic University of Korea, South Korea; Seoul St. Mary's Hospital, South Korea
| | | | - Youn-Jae Lee
- Inje University Busan Paik Hospital, South Korea
| | | | - Han Chu Lee
- Asan Medical Center, University of Ulsan, South Korea
| | | | | | - Oh Sang Kwon
- Gachon University Gil Medical Center, South Korea
| | | | | | - Jaeseok Hwang
- Keimyung University Dongsan Medical Center, South Korea
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23
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Yoon HS, Bae JM, Yeom SD, Sim WY, Lee WS, Kang H, Lee YW, Kim KH, Kim DW, Kim MB, Kim SJ, Lew BL, Kwon OS, Huh CH, Lee DY, Ro BI, Park J, Kim BJ, Lee Y, Choi GS. Factors Affecting the Psychosocial Distress of Patients with Alopecia Areata: A Nationwide Study in Korea. J Invest Dermatol 2019; 139:712-715. [DOI: 10.1016/j.jid.2018.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 11/16/2022]
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Shin SK, Choi DJ, Kim JH, Kim YS, Kwon OS. Characteristics of contrast-enhanced ultrasound in distinguishing small (≤3 cm) hepatocellular carcinoma from intrahepatic cholangiocarcinoma. Medicine (Baltimore) 2018; 97:e12781. [PMID: 30313099 PMCID: PMC6203535 DOI: 10.1097/md.0000000000012781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to verify the characteristics of CEUS in distinguishing small (≤3 cm) hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).A total of 65 patients with a liver nodule (HCC, n = 58; ICC, n = 7) smaller than 3 cm who underwent liver CEUS and pathologic confirmation were retrospectively reviewed. CEUS findings were compared with histopathologic and clinical data.Arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS were observed in 77.6% (45/58) of HCCs and 85.7% (6/7) of ICCs. Time of arterial-phase hyperenhancement (11 seconds [6-20] vs 16 seconds [14-19], P = .008), time of portal-delayed-phase wash-out (65 seconds (15-260) vs 35 secconds (27-54), P = .002), and time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out (50 seconds [5-249] vs 19 seconds [13-35], P < .001) on CEUS were significantly different between HCCs and ICCs showing arterial-phase hyperenhancement and portal-delayed-phase wash-out. The sensitivity, specificity, positive predictive value, and negative predictive value of time interval more than 25 seconds between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS for the differentiation of HCCs and ICCs were 91.1%, 83.3%, 97.6%, and 55.6%, respectively.The time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS was the most sensitive indicator in distinguishing small HCC from ICC showing arterial-phase hyperenhancement and portal-delayed-phase wash-out.
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25
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Choi YI, Kim YS, Kim JH, Lee SH, Shin SG, Kim YS, Choi DJ, Choi SJ, Chung DH, Kwon OS. [Primary Hepatic Schwannoma]. Korean J Gastroenterol 2018; 72:150-154. [PMID: 30270598 DOI: 10.4166/kjg.2018.72.3.150] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.
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Affiliation(s)
- Youn I Choi
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Seob Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Hee Lee
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Gak Shin
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Duck Joo Choi
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Joon Choi
- Departments of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hae Chung
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Departments of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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26
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Lee DM, Kwon OS, Choi YI, Shin SK, Jang SJ, Seo H, Lee JJ, Choi DJ, Kim YS, Kim JH. [Spontaneously Resolving of Huge Simple Hepatic Cyst]. Korean J Gastroenterol 2018; 72:86-89. [PMID: 30145861 DOI: 10.4166/kjg.2018.72.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Simple hepatic cysts are common benign liver lesions that usually have no malignant capability. They are generally asymptomatic and are often found incidentally by abdominal imaging procedures. Treatment becomes necessary, however, when huge hepatic cysts cause symptoms and develop complications, such as hemorrhage, adjacent organ damage, and infection. Several therapeutic options have been performed for symptomatic and huge cysts, including the aspiration of cystic fluid, infusion of various sclerosing agents, and surgical intervention. The optimal management of huge hepatic cysts is controversial and each option has its complications and limitations. This paper reports a case of a 66-year-old woman diagnosed with a simple hepatic cyst 2 years earlier, who was referred to hospital due to abdominal pain. The diagnosis was a huge hepatic cyst with symptoms by abdominal imaging studies. During the follow-up period, the huge cysts resolved spontaneously without treatment.
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Affiliation(s)
- Dong Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Youn I Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Jun Jang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyunjung Seo
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Joon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Duck Joo Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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27
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Han SH, Chon SH, Lee JH, Lee MK, Kwon OS, Kim KH, Kim JS, Lee HH, Chon JR. Esophageal Rupture Due to Diving in Shallow Waters. Journal of Trauma and Injury 2018. [DOI: 10.20408/jti.2018.31.1.16] [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)
- Sung Ho Han
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
| | - Soon-Ho Chon
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital , Jeju, Korea
| | - Jong Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital , Jeju, Korea
| | - Min Koo Lee
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
| | - Oh Sang Kwon
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
| | - Kyoung Hwan Kim
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
| | - Jung Suk Kim
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
| | - Ho hyoung Lee
- Department of Traumatology, Cheju Halla General Hospital , Jeju, Korea
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Han SH, Chon SH, Lee JH, Lee MK, Kwon OS, Kim KH, Kim JS, Lee HH. Rib Fixation for a Patient with Severely Displaced and Overlapped Costal Cartilage Fractures. Journal of Trauma and Injury 2018. [DOI: 10.20408/jti.2018.31.1.12] [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)
- Sung Ho Han
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Korea
| | - Jong Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Korea
| | - Min Koo Lee
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Kyoung Hwan Kim
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Jung Suk Kim
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Ho hyoung Lee
- Department of Traumatology, Cheju Halla General Hospital, Jeju, Korea
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Abstract
Non-alcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). NAFLD-related HCCs (NAFLD-HCCs) have the following clinical features: high body mass index, deranged lipid profiles, diabetes mellitus, hypertension, and metabolic syndrome. Among them, obesity, diabetes mellitus, and high Fe contents in the liver are risk factors of developing HCC in patients with NAFLD. Inflammatory cytokines, adipokines, insulin like growth factor-I, and lipotoxicity are intermingled and may cross react with each other to develop HCC. Because there is no guideline for early detection of HCC in patients with NAFLD, NAFLD-HCCs tend to be greater in size and in advanced stages when detected compared with hepatitis virus-related HCCs. Therefore, there is an urgent need of a surveillance program for the early detection of HCC. Treatment of NAFLD-HCCs is not different from other causes-related HCCs. However, patients with NAFLD-HCCs have cardiovascular disease and other metabolic problems, which may complicate treatment.
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Affiliation(s)
- Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Joon Hwan Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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30
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Shin SK, Kwon OS, Lee JJ, Park YH, Choi CS, Jeong SH, Choi DJ, Kim YS, Kim JH. Effect of Rifaximin on Hepatic Fibrosis in Bile Duct-ligated Rat Model. Korean J Gastroenterol 2017; 70:239-246. [PMID: 29161793 DOI: 10.4166/kjg.2017.70.5.239] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background/Aims The translocation of bacteria and their lipopolysaccharides from the gut can promote fibrosis in cirrhotic patients. The aim of this study was to investigate the effects of rifaximin on hepatic fibrosis in a bile duct-ligated rat model. Methods The bile duct ligation (BDL) was carried out for eight days (acute injury model: sham-operated rats [G1], BDL rats [G2], and BDL rats treated with rifaximin [G3]) or 22 days (chronic injury model: sham-operated rats [G4], BDL rats [G5], and BDL rats treated with rifaximin [G6]). Rifaximin (50 mg/kg/day) was administered daily via gavage after BDL. Liver function, serum tumor necrosis factor-alpha (TNF-α), and hepatic hydroxyproline levels were measured. Moreover, a histological analysis of fibrosis contents was performed using sirius red stain. Results In the acute injury model, the liver function and TNF-α level were not improved after the rifaximin treatment. The hydroxyproline levels (µg/g liver tissue) in G1, G2, and G3 were 236.4±103.1, 444.8±114.4, and 312.5±131.6, respectively; and fibrosis contents (%) were 0.22±0.04, 1.64±0.53, and 1.66±0.44, respectively. The rifaximin treatment did not ameliorate acute BDL-induced fibrosis. In the chronic injury model, the hydroxyproline levels in G4, G5, and G6 were 311.5±72.9, 1,110.3±357.9, and 944.3±209.3, respectively; and fibrosis contents (%) were 0.19±0.03, 5.04±0.18, and 4.42±0.68, respectively (G5 vs. G6, p=0.059). The rifaximin treatment marginally ameliorated chronic BDL-induced fibrosis. Conclusions Rifaximin did not reduce inflammation and fibrosis in bile duct-ligated rat model.
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Affiliation(s)
- Seung Kak Shin
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Sang Kwon
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Joon Lee
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yeon Ho Park
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Cheol Soo Choi
- Division of Endocrinology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Hwan Jeong
- Division Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Duck Joo Choi
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Kim EJ, Kim YS, Shin SK, Kwon OS, Choi DJ, Kim JH. Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound. Turk J Gastroenterol 2017; 28:446-452. [DOI: 10.5152/tjg.2017.17104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shin SK, Kim YS, Shim YS, Choi SJ, Park SH, Jung DH, Kwon OS, Choi DJ, Kim JH. Peritumoral decreased uptake area of gadoxetic acid enhanced magnetic resonance imaging and tumor recurrence after surgical resection in hepatocellular carcinoma: A STROBE-compliant article. Medicine (Baltimore) 2017; 96:e7761. [PMID: 28816953 PMCID: PMC5571690 DOI: 10.1097/md.0000000000007761] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recently, it has been suggested that peritumoral decreased uptake area (PDUA) in the hepatobiliary phase (HBP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) was associated with vascular invasion in hepatocellular carcinoma (HCC). We aimed to investigate correlations between microvascular invasion and PDUA, and elucidate the predictability of PDUA for tumor recurrence after resection.We retrospectively analyzed clinicopathological and radiological data from 126 consecutive patients with single HCC ≤5 cm without macrovascular invasion who underwent preoperative Gd-EOB-DTPA-enhanced MRI and surgical resection. The presence of a faint and hypointense area around the tumor in the HBP was defined as PDUA.Among 126 patients with HCCs, microvascular invasion was observed in 29 (23.0%) patients and PDUA was observed in 15 (11.9%) patients. PDUA [odds ratio (OR) 20.06, confidence interval (CI) 4.74-84.96, P < .001] was an independent risk factor for microvascular invasion. In multivariate survival analysis using Cox regression, PDUA [hazard ratio (HR) 4.51, CI 2.17-9.38, P < .001], pathologically confirmed satellite nodules (HR 5.18, CI 1.50-17.88, P = .009), and AFP (≥100 ng/mL, HR 2.28, CI 1.04-5.01, P = .040) were independent risk factors for recurrence after resection. Recurrence-free survival in the group with PDUA was significantly lower than that in the group without PDUA according to analysis using the Kaplan-Meier method with the log-rank test (P < .001).PDUA in the HBP of Gd-EOB-DTPA-enhanced MRI could be a useful preoperative predictor of microvascular invasion and independent prognostic factor after surgical resection in patients with single HCC ≤5 cm without macrovascular invasion.
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Affiliation(s)
| | | | | | | | | | - Dong Hae Jung
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Shin SK, Kim YS, Choi SJ, Shim YS, Jung DH, Kwon OS, Choi DJ, Kim JH. Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis: A STARD-compliant article. Medicine (Baltimore) 2017; 96:e7278. [PMID: 28723741 PMCID: PMC5521881 DOI: 10.1097/md.0000000000007278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
It is difficult to characterize the nodular lesions in cirrhotic liver if typical enhancement pattern is not present on dynamic contrast-enhanced imagings. Although the signal intensity of the hepatobiliary phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) is helpful for characterization of the lesions, some dysplastic nodules may also exhibit low signal intensity in the hepatobiliary phase. We aimed to assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis.A total of 43 cirrhotic patients with a small (≤3 cm) liver nodule (n = 25, HCC; n = 18, dysplastic nodule) who underwent Gd-EOB-DTPA-enhanced MRI and pathologic confirmation were retrospectively reviewed. Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI.High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P = .039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P = .021) was more frequent observed in Edmonson grade II-III HCCs compared with those in grade I HCCs.The combination of DWI and T2WI is most useful for the differentiation of atypical small HCCs from dysplastic nodules showing low SI in the hepatobiliary phase. Combination of DWI and T2WI or pre-enhanced T1WI seems to be useful for predicting the histological grade of atypical HCCs.
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Affiliation(s)
| | | | | | | | - Dong Hae Jung
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Kang JG, Chon SH, Yie K, Lee MK, Kwon OS, Lee SH, Chon JR. Thoracoscopic Resection of the First Rib for Thoracic Outlet Syndrome: A Case Report. Journal of Trauma and Injury 2017. [DOI: 10.20408/jti.2017.30.2.63] [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)
- Jae Gul Kang
- Departments of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Departments of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Kilsoo Yie
- Departments of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Min Koo Lee
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Song Hyun Lee
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
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Lee SH, Yie K, Lee JH, Kang JG, Lee MK, Kwon OS, Chon SH. Thoracoscopy in Management of Chest Trauma: Our Three-year Jeju Experience. Journal of Trauma and Injury 2017. [DOI: 10.20408/jti.2017.30.2.33] [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)
- Sung Hyun Lee
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Kilsoo Yie
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Jong Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Jae Gul Kang
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Min Koo Lee
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Oh Sang Kwon
- Department of Trauma Surgery, Cheju Halla Hospital, Jeju, Korea
| | - Soon-Ho Chon
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla Hospital, Jeju, Korea
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Kim EJ, Yeon JE, Kwon OS, Lee HN, Shin SK, Kang SH, Byun KS, Kim JH, Kwon SY, Suh SJ, Yim HJ, Kim YS, Kim JH. Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis. Dig Dis Sci 2017; 62:808-816. [PMID: 28035553 DOI: 10.1007/s10620-016-4431-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/19/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. AIM This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. METHODS A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. RESULTS Median follow-up after ETV commencement was 43 (12-98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. CONCLUSIONS Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.
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Affiliation(s)
- Eui Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Jong Eun Yeon
- Department of Internal Medicine, Korea University Medical College, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 08308, South Korea
| | - Oh Sang Kwon
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
| | - Heon Nam Lee
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Seung Kak Shin
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Korea University Medical College, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 08308, South Korea
| | - Kwan Soo Byun
- Department of Internal Medicine, Korea University Medical College, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 08308, South Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, South Korea
| | - So Young Kwon
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, South Korea
| | - Sang Jun Suh
- Department of Internal Medicine, Korea University Medical College, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, South Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Medical College, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, South Korea
| | - Yun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Ju Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
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Shin SK, Park SY, Jung YK, Kim EJ, Lee HN, Lee JJ, Kwon OS, Choi DJ, Kim YS, Kim JH. [Prevalence, risk factors and clinical characteristics in patients with genotype 6 chronic hepatitis C: a single institute experience]. Korean J Gastroenterol 2017; 65:105-11. [PMID: 25716713 DOI: 10.4166/kjg.2015.65.2.105] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Hepatitis C genotypes 1 and 2 are widely distributed globally. In contrast, genotype 6 is found mainly in Southeast Asia, while genotype 6 is rare in Korea. This study aims to investigate the prevalence, risk factors and clinical characteristics of patients with genotype 6 chronic hepatitis C. METHODS We retrospectively identified 133 HCV-infected patients who underwent HCV genotype analysis between January 2012 and December 2012, and analyzed the prevalence, risk factors and clinical characteristics of patients diagnosed with genotype 6 chronic hepatitis C. RESULTS Among 133 patients, 53 patients (39.8%) were infected with genotype 1, 62 patients (46.6%) with genotype 2, 2 patients (1.5%) with genotype 3, 14 patients (10.5%) with genotype 6, and 2 patients (1.5%) with mixed genotypes (genotype 1 and 6). The risk factors associated with genotype 6 were acupuncture (n=4, 28.6%), intravenous drug use (n=3, 21.4%), tattoo (n=2, 14.3%), and transfusion (n=2, 14.3%). Of the 14 patients with genotype 6, 6 patients were treated with pegylated interferon and ribavirin. Five patients had reached the end of treatment. All patients reaching end of treatment for genotype 6 showed early virological response and sustained virological response. CONCLUSIONS The prevalence of genotype 6 is 10.5% and mixed infections of genotype 1 and 6 are 1.5% in patients with chronic hepatitis C. A major potential risk factor is intravenous drug use and the treatment response rate to pegylated interferon plus ribavirin is high in patients with genotype 6 chronic hepatitis C. Large scale multicenter studies are needed.
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Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Soo Yong Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Heon Nam Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong Joon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Duck Joo Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Abstract
Surgical bypass for peripheral arterial occlusive disease can be performed using different graft materials. Autogenous greater saphenous vein (GSV) is the treatment of choice because of its superior long-term patency. We report a case of femoropopliteal bypass with varicose GSV in a 77-year-old man who was presented with limb ischemia and both varicose veins. We successfully performed bypass with varicose vein. He has been doing well for 15 months after the operation, and a computed tomography angiography of the lower leg, performed on the 15th postoperative month, demonstrated widely patent femoropopliteal bypass graft and no structural change.
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Affiliation(s)
- Yun Su Mun
- Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, Seo-gu, Daejeon, South Korea
| | - Byung Sun Cho
- Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, Seo-gu, Daejeon, South Korea
| | - Je-Ho Jang
- Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, Seo-gu, Daejeon, South Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, Seo-gu, Daejeon, South Korea
| | - Oh Sang Kwon
- Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, Seo-gu, Daejeon, South Korea
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Kwon OS, Sul YH, Kim JS, Kim JD. Endovascular stent graft for traumatic splenic vein aneurysm via percutaneous transsplenic access. Ann Surg Treat Res 2016; 91:56-8. [PMID: 27433466 PMCID: PMC4942540 DOI: 10.4174/astr.2016.91.1.56] [Citation(s) in RCA: 5] [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: 02/18/2016] [Revised: 04/02/2016] [Accepted: 04/14/2016] [Indexed: 12/29/2022] Open
Abstract
Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.
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Affiliation(s)
- Oh Sang Kwon
- Department of Surgery, Cheju Halla General Hospital, Jeju, Korea
| | - Young Hoon Sul
- Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Joong Suck Kim
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Ji Dae Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
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Jin YJ, Lee JW, Kwon OS, Jung YK, Kwon JH, Jang JW, Kim YS, Kim TH, Jeon YS. Clinical effect of add-on Primovist-enhanced magnetic resonance imaging on preoperative tumor staging in hepatocellular carcinoma patients. J Surg Oncol 2016; 114:106-11. [PMID: 27332047 DOI: 10.1002/jso.24272] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 04/09/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS We analyzed the incidence of change of Barcelona Clinic Liver Cancer (BCLC) stage after add-on Primovist-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) patients with Barcelona Clinic Liver Cancer stage 0 or A as determined by liver dynamic computed tomography (LDCT). METHODS A total of 166 patients enrolled prospectively between August 2012 and December 2014 were retrospectively analyzed. The rates of stage change after Primovist-enhanced MRI and the treatment finally adopted in patients with stage change were evaluated. RESULTS Of the 166 patients, 24 (18.6%) had truly new HCCs. Forty-six (27.7%) and 120 (72.3%) patients had BCLC stages 0 and A, respectively, before Primovist-enhanced MRI, but after Primovist-enhanced MRI, 28 (16.9%), 134 (80.7%), and 4 (2.4%) patients had BCLC stages 0, A, and B, respectively. Tumor stage changed in 22 (13.3%) patients, from 0 to A (18, 39.1%) or A to B (4, 3.3%). CONCLUSIONS Add-on Primovist-enhanced magnetic resonance imaging can change BCLC stage with 13.3% in patients with BCLC 0 or A staged HCC, as determined by LDCT. J. Surg. Oncol. 2016;114:106-111. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Jeong Won Jang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
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Rim MY, Kwon OS, Ha M, Kim JS, Ko KI, Kim DK, Jang PK, Han JY, Park PH, Jung YK, Choi DJ, Kim YS, Kim JH. [Clinical features of non-alcoholic fatty liver disease in cryptogenic hepatocellular carcinoma]. Korean J Gastroenterol 2016; 63:292-8. [PMID: 24870301 DOI: 10.4166/kjg.2014.63.5.292] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. METHODS Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. RESULTS Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70 ± 11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56 ± 7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs.27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m(2) vs. 24.1 kg/m(2), p=0.042) than those in the HBV- HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). CONCLUSIONS Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.
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Affiliation(s)
- Min Young Rim
- Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea
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Shin SK, Kim JH, Park H, Kwon OS, Lee HJ, Yeon JE, Byun KS, Suh SJ, Yim HJ, Kim YS, Kim JH. Improvement of liver function and non-invasive fibrosis markers in hepatitis B virus-associated cirrhosis: 2 years of entecavir treatment. J Gastroenterol Hepatol 2015; 30:1775-81. [PMID: 26095700 DOI: 10.1111/jgh.13020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Entecavir (ETV) induces biochemical and histologic improvement of the liver in patients with chronic hepatitis B. This study aimed to confirm that 2 years of ETV treatment improves liver function and non-invasive fibrosis markers in patients with hepatitis B virus (HBV)-associated cirrhosis. METHODS A total 472 naïve patients with HBV-associated cirrhosis was treated with ETV for at least 2 years, between March 2007 and December 2012. Model for end-stage liver disease and Child-Pugh (CP) score were used to evaluate the improvement of liver function. Aspartate transaminase to platelet ratio index, FIB-4 index, and fibrosis index were used to evaluate the improvement of fibrosis. RESULTS The final 370 of 472 patients with HBV-associated cirrhosis were enrolled. Mean age was 51 ± 10 years, and 240 patients (64.9%) were men. The distribution of CP class was 71.1% in A, 24.6% in B, and 4.3% in C. Mean end-stage liver disease and CP score changed over the study period from 8.5 ± 4.6 to 6.2 ± 4.2 (P < 0.001) and from 6.2 ± 1.6 to 5.6 ± 0.9 (P < 0.001), respectively. Aspartate transaminase to platelet ratio index, FIB-4 index, and fibrosis index changed from 3.6 ± 4.5 to 1.5 ± 1.5 (P < 0.001), from 7.0 ± 6.2 to 3.9 ± 2.8 (P < 0.001), and from 3.3 ± 0.9 to 2.5 ± 1.1 (P < 0.001), respectively. CONCLUSIONS After 2 years of treatment, ETV improves liver function and non-invasive fibrosis markers in patients with HBV-associated cirrhosis.
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Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyeonsu Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hyun Jung Lee
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Jong Eun Yeon
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Kwan Soo Byun
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Sang Jun Suh
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
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Kim JB, Mun YS, Kwon OS, Lee MK, Park JS, Jang JH. Acute Acalculous Cholecystitis in Severe Trauma Patients: A Single Center Experience. JACS 2015. [DOI: 10.17479/jacs.2015.5.2.52] [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: 11/08/2022] Open
Affiliation(s)
- Jong Beom Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Yun Su Mun
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Oh Sang Kwon
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Joo Seung Park
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Je Ho Jang
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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Ye JB, Sul YH, Mun YS, Go SJ, Kwon OS, Ku GW, Lee MK. Wound Probing in Neck Trauma Patients. Journal of Trauma and Injury 2015. [DOI: 10.20408/jti.2015.28.3.198] [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)
| | | | | | | | | | - Gwan Woo Ku
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
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Ye JB, Sul YH, Go SJ, Kwon OS, Kim JS, Park SS, Ku GW, Lee MK, Kim YC. Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury. Journal of Trauma and Injury 2015. [DOI: 10.20408/jti.2015.28.3.211] [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)
- Jin Bong Ye
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Young Hoon Sul
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Seung Je Go
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Oh Sang Kwon
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joong Suck Kim
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Sang Soon Park
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Korea
| | - Gwan Woo Ku
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yeong Cheol Kim
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
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Shin SK, Kim YS, Choi SJ, Shim YS, Jung DH, Kwon OS, Choi DJ, Kim JH. Contrast-enhanced ultrasound for the differentiation of small atypical hepatocellular carcinomas from dysplastic nodules in cirrhosis. Dig Liver Dis 2015; 47:775-82. [PMID: 26043653 DOI: 10.1016/j.dld.2015.05.001] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/20/2015] [Accepted: 05/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to evaluate the usefulness of contrast-enhanced ultrasound for the differentiation of hepatocellular carcinomas from dysplastic nodules in cirrhotic patients with small liver nodules showing atypical or not coincidental typical vascular pattern on two dynamic imaging techniques (computed tomography and magnetic resonance imaging). METHODS A total of 46 patients with cirrhosis and a liver nodule smaller than 3cm showing an atypical or non-coincident typical vascular pattern on two dynamic imaging techniques, who underwent liver contrast-enhanced ultrasound and ultrasound-guided liver biopsy, were retrospectively reviewed. Contrast-enhanced ultrasound findings were compared with histopathological and clinical data, and with the two dynamic imaging findings. RESULTS Significantly different contrast-enhanced ultrasound enhancement patterns were observed among dysplastic nodules, Edmondson grade I and grade II-III hepatocellular carcinomas. Ten out of 11 (90.9%) non-hypervascular hepatocellular carcinomas on two dynamic imaging techniques showed a hypervascular pattern on contrast-enhanced ultrasound, and these made it possible to distinguish hepatocellular carcinomas from dysplastic nodules. CONCLUSION Contrast-enhanced ultrasound is useful for the differentiation of hepatocellular carcinomas from dysplastic nodules in cirrhotic patients with small liver nodules.
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Affiliation(s)
- Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yun Soo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Seung Joon Choi
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Dong Hae Jung
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Duck Joo Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Ju BK, Kim MS, Kim HK, Kim DS, Cho SJ, Yang JH, Park SH, Kim HS, Kwon OS, Kim TS. Evaluation of <sup>226</sup>Ra analysis methods using a gamma-ray spectrometer and a liquid scintillation counter. Analytical Science and Technology 2015. [DOI: 10.5806/ast.2015.28.3.228] [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: 11/11/2022]
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Yo IK, Kwon OS, Park JW, Lee JJ, Lee JH, Won IS, Na SY, Jang PK, Park PH, Choi DJ, Kim YS, Kim JH. The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B. Clin Mol Hepatol 2015; 21:32-40. [PMID: 25834800 PMCID: PMC4379195 DOI: 10.3350/cmh.2015.21.1.32] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/22/2014] [Accepted: 12/11/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS. METHODS Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of ≤0 or >0 kPa, respectively, over a 1-year period), and their data were compared. RESULTS No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic. CONCLUSIONS A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.
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Affiliation(s)
- In Ku Yo
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Oh Sang Kwon
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jin Woong Park
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jong Joon Lee
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jung Hyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - In Sik Won
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Sun Young Na
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Pil Kyu Jang
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Pyung Hwa Park
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Duck Joo Choi
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Yun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Ju Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
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Affiliation(s)
- Oh Sang Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Seong Han Choi
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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Kim JG, Mun YS, Kwon OS, Lee MK, Sung WY. Ischemic Stroke during Intensive Treatment of Cardiac Tamponade after Blunt Chest Trauma. JOURNAL OF ACUTE CARE SURGERY 2014. [DOI: 10.17479/jacs.2014.4.2.85] [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: 11/08/2022] Open
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