1.Magnetic Resonance-Based Assessments Better Capture Pathophysiologic Profiles and Progression in Nonalcoholic Fatty Liver Disease
Seung Joon CHOI ; Seong Min KIM ; Yun Soo KIM ; Oh Sang KWON ; Seung Kak SHIN ; Kyoung Kon KIM ; Kiyoung LEE ; Ie Byung PARK ; Cheol Soo CHOI ; Dong Hae CHUNG ; Jaehun JUNG ; MunYoung PAEK ; Dae Ho LEE
Diabetes & Metabolism Journal 2021;45(5):739-752
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.
2.Magnetic Resonance-Based Assessments Better Capture Pathophysiologic Profiles and Progression in Nonalcoholic Fatty Liver Disease
Seung Joon CHOI ; Seong Min KIM ; Yun Soo KIM ; Oh Sang KWON ; Seung Kak SHIN ; Kyoung Kon KIM ; Kiyoung LEE ; Ie Byung PARK ; Cheol Soo CHOI ; Dong Hae CHUNG ; Jaehun JUNG ; MunYoung PAEK ; Dae Ho LEE
Diabetes & Metabolism Journal 2021;45(5):739-752
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.
3.Evaluation of prognostic factors in patients with relapsed AML: Clonal evolution versus residual disease.
Hyojeong KIM ; Young Mi SEOL ; Moo Kon SONG ; Young Jin CHOI ; Ho Jin SHIN ; Sang Hyuk PARK ; Eun Yup LEE ; Joo Seop CHUNG
Blood Research 2016;51(3):175-180
BACKGROUND: It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission. METHODS: We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital. RESULTS: The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031). CONCLUSION: The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.
Busan
;
Chromosome Aberrations
;
Classification
;
Clonal Evolution*
;
Cytarabine
;
Diagnosis
;
Disease-Free Survival
;
Granulocyte Colony-Stimulating Factor
;
Hematology
;
Humans
;
Karyotype
;
Leukemia, Myeloid, Acute
;
Medical Records
;
Prognosis
;
Proportional Hazards Models
;
Recurrence
4.Clinical Significance of a Large Difference (> or = 2 points) between Biopsy and Post-prostatectomy Pathological Gleason Scores in Patients with Prostate Cancer.
Changhee YOO ; Cheol Young OH ; Jin Seon CHO ; Cheryn SONG ; Seong Il SEO ; Hanjong AHN ; Tae Kon HWANG ; Jun CHEON ; Kang Hyun LEE ; Tae Gyun KWON ; Tae Young JUNG ; Moon Kee CHUNG ; Sang Eun LEE ; Hyun Moo LEE ; Eun Sik LEE ; Young Deuk CHOI ; Byung Ha CHUNG ; Hyung Jin KIM ; Wun Jae KIM ; Seok Soo BYUN ; Han Yong CHOI
Journal of Korean Medical Science 2011;26(4):507-512
We investigated the clinical significance of large difference (> or = 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS > or = 2, n = 30), B (changed in pGS < or = 1, n = 1,361; control group), and C (increased in pGS > or = 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.
Age Factors
;
Aged
;
Biopsy
;
Humans
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Neoplasm Staging
;
Prognosis
;
*Prostatectomy
;
Prostatic Neoplasms/*pathology/surgery
;
Recurrence
;
Severity of Illness Index
5.Nomogram to Predict Insignificant Prostate Cancer at Radical Prostatectomy in Korean Men: A Multi-Center Study.
Jae Seung CHUNG ; Han Yong CHOI ; Hae Ryoung SONG ; Seok Soo BYUN ; Seong Il SEO ; Cheryn SONG ; Jin Seon CHO ; Sang Eun LEE ; Hanjong AHN ; Eun Sik LEE ; Tae Kon HWANG ; Wun Jae KIM ; Moon Kee CHUNG ; Tae Young JUNG ; Ho Song YU ; Young Deuk CHOI
Yonsei Medical Journal 2011;52(1):74-80
PURPOSE: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS: The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS: Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION: Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
Aged
;
Asian Continental Ancestry Group
;
Humans
;
Logistic Models
;
Male
;
Middle Aged
;
*Nomograms
;
Prostatectomy
;
Prostatic Neoplasms/*diagnosis/surgery
6.Predictability of Impending Events for Death within 48 Hours in Terminal Cancer Patients.
In Cheol HWANG ; Chung Hyun CHOI ; Kyoung Kon KIM ; Kyoung Shik LEE ; Heuy Sun SUH ; Jae Yong SHIM
Korean Journal of Hospice and Palliative Care 2011;14(1):28-33
PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
Blood Pressure
;
Caregivers
;
Dyspnea
;
Humans
;
Medical Records
;
Oxygen
;
Palliative Care
;
Prognosis
;
Terminally Ill
7.Predictive Value of Post-Transplant Bone Marrow Plasma Cell Percent in Multiple Myeloma Patients Undergone Autologous Transplantation.
In Hye HWANG ; Joo Seop CHUNG ; Ho Jin SHIN ; Young Jin CHOI ; Moo Kon SONG ; Young Mi SEOL ; Goon Jae CHO ; Bo Gwang CHOI ; Mun Ki CHOI ; Bo Kyung CHOI ; Kang Hee AHN ; Kyung Hwa SHIN ; Hee Sun LEE ; Hyung Seok NAM ; Jong Min HWANG
The Korean Journal of Internal Medicine 2011;26(1):76-81
BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (> or = 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (> or = 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp > or = 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp > or = 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp > or = 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.
Adult
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Antineoplastic Combined Chemotherapy Protocols/therapeutic use
;
Bone Marrow/*pathology
;
Combined Modality Therapy
;
Female
;
*Hematopoietic Stem Cell Transplantation
;
Humans
;
Male
;
Middle Aged
;
Multiple Myeloma/mortality/pathology/*therapy
;
Plasma Cells/*pathology
;
Predictive Value of Tests
;
Retrospective Studies
;
Transplantation, Autologous
8.The risk factors for herpes zoster in bortezomib treatment in patients with multiple myeloma.
Yang Seon YI ; Joo Seop CHUNG ; Moo Kon SONG ; Ho Jin SHIN ; Young Mi SEOL ; Young Jin CHOI ; Goon Jae CHO ; Gyeong Won LEE ; Joon Ho MOON ; In Hye HWANG ; Kang Hee AHN ; Hee Sun LEE ; Kyung Hwa SHIN ; Jong Min HWANG
Korean Journal of Hematology 2010;45(3):188-192
BACKGROUND: Bortezomib has significant activity in treating multiple myeloma (MM). The risk of herpes zoster (HZ) has been reported to increase significantly with bortezomib treatment, but the predisposing factors for HZ are not clear. This study is a retrospective analysis of the relevant risk factors for HZ in Korean MM patients treated with bortezomib. METHODS: Sixty-six patients with refractory or relapsed MM who underwent chemotherapy with bortezomib were included in the study. Prophylactic antiviral drugs were not used for treatment. The following parameters were reviewed: age, gender, stage and type of MM, extent of previous treatment, history of HZ, duration from the time of diagnosis to the time of bortezomib treatment initiation, and absolute lymphocyte counts (ALC) at the time of bortezomib treatment initiation. RESULTS: The incidence of HZ was 16.7%. There were no intergroup differences between the HZ-positive and the HZ-negative groups with regard to a history of HZ, number of previous treatments, and exposure to steroids before bortezomib treatment. The median duration from the time of MM diagnosis to the time of bortezomib treatment initiation in the HZ-positive group was significantly shorter than that in the HZ-negative group. The median ALC at the time of bortezomib initiation in the HZ-positive group was significantly lower than that in the HZ-negative group. CONCLUSION: Bortezomib itself might act as a risk factor for HZ by inhibiting cell-mediated immunity, and patients with low ALC at the time of bortezomib treatment initiation were at greater risk of HZ during bortezomib treatment.
Antiviral Agents
;
Boronic Acids
;
Herpes Zoster
;
Humans
;
Immunity, Cellular
;
Incidence
;
Lymphocyte Count
;
Multiple Myeloma
;
Protease Inhibitors
;
Pyrazines
;
Retrospective Studies
;
Risk Factors
;
Steroids
;
Bortezomib
9.Clinical Significance of Left Ventricular Torsional Parameters during Supine Bicycle Cardiopulmonary Exercise Echocardiography.
Se Ryung CHOO ; Wook Jin CHUNG ; Young Woo JANG ; Jeong Min BONG ; Mi Seung SHIN ; Kwang Kon KOH ; Tae Hoon AHN ; In Suk CHOI ; Eak Kyun SHIN
Journal of Cardiovascular Ultrasound 2009;17(1):2-9
BACKGROUND: Left ventricular (LV) torsion plays an important role in both LV systolic and diastolic function. Notwithstanding the fact that speckle tracking imaging echocardiography (STI) is a validated method to measure LV torsion, few data regarding the clinical significance of LV torsional parameters using STI on exercise capacity during exercise echocardiography were reported. METHODS: Fifty four participants completed the supine bicycle cardiopulmonary exercise echocardiography under a symptom-limited protocol. LV torsion was defined as the net difference between LV peak apical rotation, and basal rotation divided by LV diastolic longitudinal length. LV basal, and apical short-axis rotations at each stage were analyzed by STI. RESULTS: LV torsion measurement was feasible in 43/54 (80%) at peak exercise. The LV torsions were increased during exercise, and even until the recovery. Peak twisting, and untwisting velocities were significantly increased during exercise, but were decreased at recovery. As expected, baseline torsion was positively correlated with LV ejection fraction and baseline apical peak untwisting velocity has correlation with E/E' (r=0.50, p<0.01 and r=0.30, p<0.05, respectively). Interestingly, apical peak twisting velocity at peak exercise was significantly correlated with maximal O2 consumption and VO2 interval change (r=0.50, p<0.01 and r=0.33, p<0.05, respectively). CONCLUSION: It was feasible to measure LV torsion by STI at every step during exercise echocardiography, although the feasibility was relatively low at peak exercise. LV torsional parameters during exercise showed significant relations with exercise capacity as well as LV systolic and diastolic functions.
Echocardiography
;
Track and Field
;
Ventricular Function, Left
10.Influence of Lactate Dehydrogenase and Cyclosporine A Level on the Incidence of Acute Graft-versus-host Disease After Allogeneic Stem Cell Transplantation.
Moo Kon SONG ; Joo Seop CHUNG ; Young Mi SEOL ; Bo Ran KWON ; Ho Jin SHIN ; Young Jin CHOI ; Goon Jae CHO
Journal of Korean Medical Science 2009;24(4):555-560
Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.
Acute Disease
;
Adult
;
Cyclosporine/*blood
;
Female
;
Graft vs Host Disease/*epidemiology/etiology
;
Humans
;
L-Lactate Dehydrogenase/*blood
;
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
;
Leukemia, Myeloid, Acute/therapy
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Predictive Value of Tests
;
Retrospective Studies
;
Risk Factors
;
*Stem Cell Transplantation
;
Transplantation, Homologous

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