1.Percutaneous placement of H-configured triple biliary and enteral stents through a single access: A solution for complex bilio-enteric obstruction
Gastrointestinal Intervention 2018;7(1):36-39
A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple's procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.
Adenocarcinoma
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Aged
;
Bile Ducts, Intrahepatic
;
Biliary Tract
;
Cholestasis
;
Common Bile Duct
;
Endoscopy
;
Extremities
;
Gastric Outlet Obstruction
;
Humans
;
Intestines
;
Jaundice
;
Male
;
Stents
2.Current Concepts in Management of Phalangeal Fractures
Yohan LEE ; Sunghun PARK ; Jun-Ku LEE
Journal of the Korean Fracture Society 2022;35(4):169-181
This review focused on the research published to date on the treatment of phalangeal fractures according to the anatomical location of the finger bones, excluding the thumb. In many finger fracture cases, conservative treatment should be prioritized over surgical treatment. The three determinants of surgical treatment are the presence of an intra-articular fracture, the stability of the fracture itself, and the degree of damage to the surrounding soft tissues. Surgical treatment is recommended when bone fragments of 3 mm or more and distal phalanx subluxation are present in the bony mallet finger, and the main surgical treatment is closed reduction and extension block pin fixation. It is essential to pay attention to rotational deformation asf ractures occur proximally. Since intra-articular fractures can cause stiffness and arthritis in the future, a computed tomography scan is recommended to confirm the fracture pattern. These fractures require anatomical reduction of the bone fragments within the joint, and the instability of the joint itself must be corrected. There are no superior surgical treatment methods. It is therefore advantageous for the surgeon to select a surgical method that he is familiar with and confident of performing, considering the fracture itself and various patient-related clinical factors. Nonunion is rare as a complication of a finger fracture, and finger stiffness is the most common complication. Ensuring rapid joint movement as soon as possible can reduce finger stiffness.
3.Joint Replacement Surgery in Patients with Rheumatoid Arthritis in South Korea:Analysis of a Large National Database
Han-Kook YOON ; Sang-Ok SEOK ; Hyun-Cheol OH ; Joong-Won HA ; Sunghun PARK ; Sang-Hoon PARK
Clinics in Orthopedic Surgery 2023;15(3):395-401
Background:
We aimed to investigate the current trend of joint replacement surgery incidence in patients with rheumatoid arthritis (RA) in South Korea and to compare the incidence of joint replacement surgery in each affected joint.
Methods:
We performed this big data analysis to investigate the current trend of joint replacement surgery incidence in patients with RA in South Korea and to compare the incidence of joint replacement surgery in each affected joint. This retrospective study was based on data from the Korea National Health Insurance claims database.
Results:
The prevalence of RA increased every year (0.13% in 2008, 0.25% in 2016). The number of newly diagnosed patients increased from 29,184 in 2010 to 38,347 in 2016. The incidence rate of joint replacement surgery in patients with RA increased from 0.72% in 2010 to 4.03% in 2016. The knee (68.3%) was the most commonly replaced joint. The relative risk (RR) of additional joint replacement surgery was highest for the shoulder joint (RR,1.454; 95% confidence interval, 0.763–2.771). The median time from diagnosis to surgery was the shortest in the elbow joint (379 days) and the longest in the shoulder joint (955 days). The median time for each joint was short in order of the elbows, ankles, hips, knees, and shoulders (p < 0.01).
Conclusions
The most frequently and initially replaced joints were different, but the prevalence and incidence of RA, as well as those of joint replacement surgery, have recently increased in South Korea. Joint replacement surgery in RA was the highest for the knee joint. The median time from diagnosis to surgery was shortest for the elbow, followed by the ankle, hip, knee, and shoulder. Regardless of whether patients are symptomatic, evaluation of large joints such as the knee, elbow, ankle, and hip should be considered from an early stage.
4.Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey.
Sung Won CHOI ; Da Jung PARK ; Jinseung KIM ; Tae jin PARK ; Jun Su KIM ; Sunghun BYUN ; Young Seok LEE ; Jung Hoon KIM
Korean Journal of Family Medicine 2016;37(1):64-70
BACKGROUND: An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. METHODS: The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12-18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. RESULTS: After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. CONCLUSION: Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.
Adolescent*
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Education
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Female
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Humans
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Korea*
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Obesity*
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Odds Ratio
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Parents
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Pediatric Obesity
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Residence Characteristics*
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Risk-Taking*
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Social Class*
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Social Problems
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Socioeconomic Factors
5.Cyclic Phytosphingosine-1-Phosphate Primed Mesenchymal Stem Cells Ameliorate LPS-Induced Acute Lung Injury in Mice
Youngheon PARK ; Jimin JANG ; Jooyeon LEE ; Hyosin BAEK ; Jaehyun PARK ; Sang-Ryul CHA ; Se Bi LEE ; Sunghun NA ; Jae-Woo KWON ; Seok-Ho HONG ; Se-Ran YANG
International Journal of Stem Cells 2023;16(2):191-201
Background and Objectives:
O-cyclic phytosphingosine-1-phosphate (cP1P) is a synthetic chemical and has a structure like sphingosine-1-phosphate (S1P). S1P is known to promote cell migration, invasion, proliferation, and anti-apoptosis through hippocampal signals. However, S1P mediated cellular-, molecular mechanism is still remained in the lung.Acute lung injury (ALI) and its severe form acute respiratory distress syndrome (ARDS) are characterized by excessive immune response, increased vascular permeability, alveolar-peritoneal barrier collapse, and edema. In this study, we determined whether cP1P primed human dermal derived mesenchymal stem cells (hdMSCs) ameliorate lung injury and its therapeutic pathway in ALI mice.
Methods:
and Results: cP1P treatment significantly stimulated MSC migration and invasion ability. In cytokine array, secretion of vascular-related factors was increased in cP1P primed hdMSCs (hdMSCcP1P ), and cP1P treatment induced inhibition of Lats while increased phosphorylation of Yap. We next determined whether hdMSCcP1P reduce inflammatory response in LPS exposed mice. hdMSCcP1P further decreased infiltration of macrophage and neutrophil, and release of TNF-α, IL-1β, and IL-6 were reduced rather than naïve hdMSC treatment. In addition, phosphorylation of STAT1 and expression of iNOS were significantly decreased in the lungs of MSCcP1P treated mice.
Conclusions
Taken together, these data suggest that cP1P treatment enhances hdMSC migration in regulation of Hippo signaling and MSCcP1P provide a therapeutic potential for ALI/ARDS treatment.
6.Isolation and Identification of Terpenoids from the Fruits of Acanthopanax chiisanensis.
Jeong Min LEE ; Sunghun CHO ; Myoung Hee LEE ; Seon Haeng CHO ; Chun Geon PARK ; Sanghyun LEE
Natural Product Sciences 2015;21(2):82-86
Phytochemical constituents were isolated from the fruits of Acanthopanax chiisanensis by repeated column chromatography. Their structures were identified as beta-sitosterol (1), daucosterol (2), sesamin (3), chiisanogenin (4), and 22alpha-hydroxy chiisanogenin (5) by spectroscopic analysis (MS, 1H-, and 13C-NMR). Compounds 1 - 5 were isolated for the first time from the fruits of A. chiisanensis.
Eleutherococcus*
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Araliaceae
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Chromatography
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Fruit*
;
Terpenes*
7.Familial Hemiplegic Migraine with Prolonged Coma and Cerebellar Atrophy: CACNA1A T666M Mutation in a Korean Family.
Kyung Ho CHOI ; Jang Su KIM ; Seo Young LEE ; Suk Won RYU ; Sam Su KIM ; Seung Hwan LEE ; Sunghun KIM ; Hee Kwon PARK
Journal of Korean Medical Science 2012;27(9):1124-1127
We report the first Korean patient with familial hemiplegic migraine type 1, with clinical and multimodal imaging findings. A 43-yr-old man was admitted for right hemianopia and aphasia, followed by coma. MRI showed only cerebellar atrophy. CT angiography showed mild vasodilation of intracranial blood vessels and increased vascularity in the left hemisphere and perfusion-weighted imaging showed elevated cerebral blood flow. Gene analysis of the patient and his mother led to the identification of a heterozygous point mutation (1997C-->T, T666M) in exon 16 of the CACNA1A gene. Familial hemiplegic migraine should be considered in patients with episodic neurological dysfunction with cerebellar atrophy.
Asian Continental Ancestry Group/*genetics
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Atrophy/genetics/metabolism
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Calcium Channels/*genetics
;
Cerebellum/blood supply/*pathology
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Cerebral Angiography
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Coma/*diagnosis
;
Exons
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Heterozygote
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Humans
;
Magnetic Resonance Imaging
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Male
;
Migraine with Aura/*diagnosis/genetics
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Point Mutation
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Republic of Korea
;
Tomography, X-Ray Computed
8.Identification of Immunodominant B-cell Epitope Regions of Reticulocyte Binding Proteins in Plasmodium vivax by Protein Microarray Based Immunoscreening.
Jin Hee HAN ; Jian LI ; Bo WANG ; Seong Kyun LEE ; Myat Htut NYUNT ; Sunghun NA ; Jeong Hyun PARK ; Eun Taek HAN
The Korean Journal of Parasitology 2015;53(4):403-411
Plasmodium falciparum can invade all stages of red blood cells, while Plasmodium vivax can invade only reticulocytes. Although many P. vivax proteins have been discovered, their functions are largely unknown. Among them, P. vivax reticulocyte binding proteins (PvRBP1 and PvRBP2) recognize and bind to reticulocytes. Both proteins possess a C-terminal hydrophobic transmembrane domain, which drives adhesion to reticulocytes. PvRBP1 and PvRBP2 are large (> 326 kDa), which hinders identification of the functional domains. In this study, the complete genome information of the P. vivax RBP family was thoroughly analyzed using a prediction server with bioinformatics data to predict B-cell epitope domains. Eleven pvrbp family genes that included 2 pseudogenes and 9 full or partial length genes were selected and used to express recombinant proteins in a wheat germ cell-free system. The expressed proteins were used to evaluate the humoral immune response with vivax malaria patients and healthy individual serum samples by protein microarray. The recombinant fragments of 9 PvRBP proteins were successfully expressed; the soluble proteins ranged in molecular weight from 16 to 34 kDa. Evaluation of the humoral immune response to each recombinant PvRBP protein indicated a high antigenicity, with 38-88% sensitivity and 100% specificity. Of them, N-terminal parts of PvRBP2c (PVX_090325-1) and PvRBP2 like partial A (PVX_090330-1) elicited high antigenicity. In addition, the PvRBP2-like homologue B (PVX_116930) fragment was newly identified as high antigenicity and may be exploited as a potential antigenic candidate among the PvRBP family. The functional activity of the PvRBP family on merozoite invasion remains unknown.
Epitopes, B-Lymphocyte/*chemistry/genetics/*immunology
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Female
;
Humans
;
Immunodominant Epitopes/chemistry/genetics/*immunology
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Malaria, Vivax/immunology/*parasitology
;
Middle Aged
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Plasmodium vivax/chemistry/genetics/*immunology
;
Protein Structure, Tertiary
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Protozoan Proteins/chemistry/genetics/*immunology
;
Reticulocytes/*parasitology
9.Knowledge and Acceptability of the COVID-19 Vaccine Among Obstetricians and Gynecologists in Korea, and Factors Affecting Its Recommendation in the Pregnant Population
Bo Yun CHOI ; Heesu YOON ; Won Joon SEONG ; Geum Joon CHO ; Sunghun NA ; Young Mi JUNG ; Hyun Sun KO ; Joong Shin PARK
Journal of the Korean Society of Maternal and Child Health 2022;26(4):245-253
Purpose:
To analyze the overall knowledge and attitude of healthcare providers regarding coronavirus disease (COVID-19) vaccine recommendations for pregnant women and factors affecting these opinions in Korea.
Methods:
We conducted a nationwide survey study of obstetricians and gynecologists registered in the Korean Society of Obstetrics and Gynecology. The knowledge, attitude, and factors affecting COVID-19 vaccination in pregnant women were investigated.
Results:
Among 258 participants, 182 (70.5%) answered that they recommended COVID-19 vaccination for pregnant women, while 76 (29.5%) answered that they did not. The administrative district of the physician's healthcare center and knowledge regarding adverse reactions to the COVID-19 vaccine were factors affecting opinions on vaccine recommendation. Physicians working in metropolitan cities were 7.3 times more likely to recommend COVID-19 vaccination to pregnant women than those working in Seoul. Physicians aware of the COVID-19 vaccine safety profiles in pregnant women were 25.36 times more likely to recommend vaccines than those who were not. A significantly higher proportion of the recommended group provided vaccine information to pregnant women compared to the nonrecommended group and also recommended booster shot vaccination. Guidelines from academic societies (70.9%) and from government and public centers (64.8%) were important factors in the recommendation group, while additional study results (57.1%) were important factors in the nonrecommendation group. This information will be useful for future reference regarding vaccine recommendations.
Conclusion
Providing guidelines and recent data regarding COVID-19 vaccination in pregnant populations to healthcare providers will promote obstetricians and gynecologists to recommend vaccination to pregnant patients and will thereby contribute to achieving herd immunity in Korea.
10.Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth
Shinyoung KIM ; Hyun Soo PARK ; Hayan KWON ; Hyun Joo SEOL ; Jin Gon BAE ; Ki Hoon AHN ; Sunghun NA ; Se Jin LEE ; Mi Young LEE ; Seung Mi LEE ; Dong Wook KWAK ; Jung Yoon PARK ; In Yang PARK ; Hye Sung WON ; Moon Young KIM ; Hyun Sun KO ; Han Sung HWANG ;
Journal of Korean Medical Science 2020;35(11):66-
BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.CONCLUSION: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.