Park S.-J.,University of Ulsan |
Ahn J.-M.,University of Ulsan |
Kim Y.-H.,University of Ulsan |
Park D.-W.,University of Ulsan |
And 21 more authors.
New England Journal of Medicine | Year: 2015
BACKGROUND: Most trials comparing percutaneous coronary intervention (PCI) with coronaryartery bypass grafting (CABG) have not made use of second-generation drug-eluting stents. METHODS: We conducted a randomized noninferiority trial at 27 centers in East Asia. We planned to randomly assign 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary end point was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years after randomization. Event rates during longer-term follow-up were also compared between groups. RESULTS: After the enrollment of 880 patients (438 patients randomly assigned to the PCI group and 442 randomly assigned to the CABG group), the study was terminated early owing to slow enrollment. At 2 years, the primary end point had occurred in 11.0% of the patients in the PCI group and in 7.9% of those in the CABG group (absolute risk difference, 3.1 percentage points; 95% confidence interval [CI], -0.8 to 6.9; P = 0.32 for noninferiority). At longer-term follow-up (median, 4.6 years), the primary end point had occurred in 15.3% of the patients in the PCI group and in 10.6% of those in the CABG group (hazard ratio, 1.47; 95% CI, 1.01 to 2.13; P = 0.04). No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke. However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG. CONCLUSIONS: Among patients with multivessel coronary artery disease, the rate of major adverse cardiovascular events was higher among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. Copyright © 2015 Massachusetts Medical Society.
Yang S.-J.,Gangnam Severance Hospital |
Stewart R.,King's College London |
Kim J.-M.,Chonnam National University |
Kim S.-W.,Chonnam National University |
And 4 more authors.
European Child and Adolescent Psychiatry | Year: 2013
Traditional bullying has received considerable research but the emerging phenomenon of cyber-bullying much less so. Our study aims to investigate environmental and psychological factors associated with traditional and cyber-bullying. In a school-based 2-year prospective survey, information was collected on 1,344 children aged 10 including bullying behavior/experience, depression, anxiety, coping strategies, self-esteem, and psychopathology. Parents reported demographic data, general health, and attention-deficit hyperactivity disorder (ADHD) symptoms. These were investigated in relation to traditional and cyberbullying perpetration and victimization at age 12. Male gender and depressive symptoms were associated with all types of bullying behavior and experience. Living with a single parent was associated with perpetration of traditional bullying while higher ADHD symptoms were associated with victimization from this. Lower academic achievement and lower self esteem were associated with cyber-bullying perpetration and victimization, and anxiety symptoms with cyber-bullying perpetration. After adjustment, previous bullying perpetration was associated with victimization from cyber-bullying but not other outcomes. Cyber-bullying has differences in predictors from traditional bullying and intervention programmes need to take these into consideration. © Springer-Verlag Berlin Heidelberg 2013.
A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer
Jang J.-Y.,Seoul National University |
Kang M.J.,Seoul National University |
Heo J.S.,Sungkyunkwan University |
Choi S.H.,Sungkyunkwan University |
And 8 more authors.
Annals of Surgery | Year: 2014
OBJECTIVE:: To prospectively evaluate the survival benefit of dissection of the nerve plexus and lymphadenectomy in patients with pancreatic head cancer. BACKGROUND:: Despite randomized controlled trials on the extent of surgery in pancreatic cancer, attempts have been made to perform more extended resections. METHODS:: A total of 244 patients were enrolled; of these, 200 were randomized to undergo standard resection or extended resection, with the latter including the dissection of additional lymph nodes and the right half of the nerve plexus around the superior mesenteric artery and celiac axis. We evaluated 167 patients from 7 centers who fulfilled all of the required criteria. RESULT:: Operation time was longer and estimated blood loss was higher in the extended resection group than in the standard resection group, but the R0 resection rate was comparable. The mean number of lymph nodes retrieved per patient was higher in the extended resection group than in the standard resection group (33.7 vs 17.3; P < 0.001). The morbidity rate was slightly higher in the extended resection group than in the standard resection group. Two patients in the extended resection group died in hospital. Median survival after R0 resection was similar in the extended resection and standard resection groups (18.0 vs 19.0 months; P = 0.239) regardless of lymph node metastasis. Adjuvant chemoradiation had a positive impact on overall survival. CONCLUSIONS:: This study suggests that extended lymphadenectomy with dissection of the nerve plexus does not provide a significant survival benefit compared with standard resection in pancreatic head cancer. Standard resection can be performed safely and efficiently, without negatively affecting oncologic efficacy or long-term survival, when compared with extended pancreaticoduodenal resection. (NCT00679913).
Yang H.C.,Research Institute and Hospital |
Yang H.C.,Seoul National University |
Noh D.,Seoul National University |
Noh D.,Gangnam Severance Hospital
Journal of Thoracic Disease | Year: 2015
Single incision thoracoscopic surgery (SITS) involves only one intercostal space with minimal skin incision, which means it can be the most minimally invasive technique up to date. We minimized the skin incision to a length of 2.5 cm to achieve the less chest wall trauma and the more cosmesis during SITS lobectomy for benign pulmonary disease. Four patients who had bronchiectasis [left lower lobe (LLL)], congenital lobar emphysema [left upper lobe (LUL)], aspergilloma [right upper lobe (RUL)], and hamartoma (RUL) were planned to undergo 2.5 cm SITS lobectomy. There were no conversion cases to multi-port video-assisted thoracic surgery (VATS) or thoracotomy. The mean operation time was 182±25 minutes. Chest drains were removed on postoperative day (POD) 2 in all patients. Three patients discharged on POD 3. One patient who discharged on POD 5 readmitted for delayed pleural effusion and treated with mini-tube insertion. There were no late complications or symptom relapses during the median follow-up of 13.5 months. A 2.5 cm SITS lobectomy can be alternative option for relatively young patients with benign lung disease. © Journal of Thoracic Disease.
Smolen J.S.,Medical University of Vienna |
Nash P.,University of Queensland |
Durez P.,Catholic University of Louvain |
Hall S.,Monash University |
And 10 more authors.
The Lancet | Year: 2013
Background Clinical remission and low disease activity are essential treatment targets in patients with rheumatoid arthritis. Although moderately active rheumatoid arthritis is common, treatment effects in moderate disease have not been well studied. Additionally, optimum use of biologics needs further investigation, including the use of induction, maintenance, and withdrawal treatment strategies. The aim of the PRESERVE trial was to assess whether low disease activity would be sustained with reduced doses or withdrawal of etanercept in patients with moderately active disease. Methods In a randomised controlled trial, patients aged between 18 and 70 years with moderately active rheumatoid arthritis (disease activity score in 28 joints [DAS28] >3.2 and ≥5.1) despite treatment with methotrexate were enrolled at 80 centres in Europe, Latin America, Asia, and Australia between March 6, 2008, and Sept 9, 2009. To be eligible, patients had to have been receiving 15.25 mg of methotrexate every week for at least 8 weeks. In an openlabel period of 36 weeks, all patients were given 50 mg etanercept plus methotrexate every week. To be eligible for a subsequent double-blind period of 52 weeks, participants had to have achieved sustained low disease activity. These patients were randomly assigned (1:1:1) by an interactive voice-response system to one of three treatment groups: 50 mg etanercept plus methotrexate, 25 mg etanercept plus methotrexate, or placebo plus methotrexate. Patients were stratified in blocks of three by DAS28 response (low disease activity or remission) at week 36. Patients, investigators, data analysts, and study staffwere all masked to treatment allocation. The primary endpoint was the proportion of patients with low disease activity at week 88 in the groups given 50 mg etanercept or placebo in the double-blind period. A conditional primary endpoint was the proportion of patients receiving 25 mg etanercept who achieved low disease activity. Modified intention-to-treat populations were used for analyses. This trial is registered with ClinicalTrials.gov, number NCT00565409. Findings 604 (72.4%) of 834 enrolled patients were eligible for the double-blind period, of whom 202 were assigned to 50 mg etanercept plus methotrexate, 202 to 25 mg etanercept plus methotrexate, and 200 to placebo plus methotrexate. At week 88, 166 (82.6%) of 201 patients who had received at least one dose of 50 mg etanercept and one or more DAS28 evaluations had low disease activity, compared with 84 (42.6%) of 197 who had received placebo (mean difference 40.8%, 95% CI 22.214.171.124%; p<0.0001). Additionally, 159 (79.1%) of 201 patients given 25 mg etanercept had low disease activity at week 88 (mean difference from placebo 35.9%, 126.96.36.199%; p<0.0001). Interpretation Conventional or reduced doses of etanercept with methotrexate in patients with moderately active rheumatoid arthritis more effectively maintain low disease activity than does methotrexate alone after withdrawal of etanercept. Funding Pfizer.
Kim M.,Gangnam Severance Hospital |
Kim S.S.,Yonsei University |
Koh H.J.,Gangnam Severance Hospital |
Lee S.C.,Yonsei University
Optometry and Vision Science | Year: 2014
PURPOSE: To investigate choroidal thickness (CT) in healthy Korean subjects measured by enhanced depth imaging optical coherence tomography and its association with age, axial length, and refractive error. METHODS: Choroidal scans using enhanced depth imaging optical coherence tomography in each eye of 286 healthy eyes were obtained at the macula. Choroidal thickness was measured at the fovea. Two separate line scans were obtained (one horizontal and one vertical). RESULTS: The mean (±SD) age was 40.18 (±17.89) years (range, 13 to 75 years). The mean (±SD) subfoveal CT was 307.26 (±95.18) μm. Multivariable linear regression suggested that age and refractive error were the most significant factors associated with subfoveal CT (all p < 0.0001) with an adjusted R = 0.181. In subjects younger than 60 years, refractive error or axial length and age retained statistically significant correlation with subfoveal CT, whereas such a relationship was lost in subjects older than 60 years. CONCLUSIONS: The mean subfoveal CT measurement showed the most significant positive correlation with refractive error and the most significant negative correlation with age. For patients younger than 60 years, there was a significant correlation of subfoveal CT with age and refractive error or axial length, whereas such significant association was not observed in subjects older than 60 years. Copyright © 2014 American Academy of Optometry.
Kim H.,Yonsei University |
Kim J.-A.,Yonsei University |
Kim J.-A.,Gangnam Severance Hospital |
Son E.J.,Yonsei University |
Youk J.H.,Yonsei University
European Radiology | Year: 2013
Objectives: To evaluate the predictability of shear-wave ultrasound elastography (SWE) for thyroid malignancy and to compare the diagnostic performances of SWE and B-mode US. Methods: Retrospective review of 99 patients who underwent SWE before US-guided fine-needle aspiration of thyroid nodules was performed. SWE elasticity indices of the mean (Emean), maximum (Emax), and minimum (Emin) of nodules were measured. Diagnostic performance of SWE was compared with that of B-mode US. Results: Among a total of 99 nodules, 21 were papillary thyroid carcinoma (PTC) and 78 were benign. Emean, Emax, and Emin were significantly higher in PTCs than in benign nodules (P < 0.001). Sensitivity and specificity for predicting malignancy were 76.1 %, 64.1 % with E max (65 kPa), 61.9 %, 76.1 % with Emin (53 kPa), and 66.6 %, 71.6 % with Emean (62 kPa). Areas under the ROC curves (Az) of SWE values were not significantly different from those of US categories on B-mode US. However, combining Emean and Emin with B-mode US of probably benign lesions improved the specificity (P = 0.02, 0.007) for predicting PTC. Conclusions: The quantitative parameter of SWE was significantly higher in PTC than in benign nodules, and combined use of quantitative SWE and B-mode US provided higher specificity for predicting malignancy. Key Points: • Quantitative shear-wave elastography (SWE) helps differentiate benign from malignant nodules • SWE and conventional ultrasound have comparable diagnostic performance for predicting thyroid malignancy • Combined quantitative SWE and B-mode ultrasound is highly specific for thyroid malignancy © 2013 European Society of Radiology.
Kim J.H.,Gangnam Severance Hospital |
Kim Y.H.,University of Pittsburgh |
Kim M.R.,Gangnam Severance Hospital |
Kim S.-C.,Gangnam Severance Hospital
British Journal of Dermatology | Year: 2011
Summary Background The treatment of pemphigus is still challenging and some patients with pemphigus are unresponsive to conventional immunosuppressive treatments. Rituximab, a chimeric monoclonal anti-CD20 antibody, binds to the CD20 antigen on the surface of B cells and has been reported to be effective for the treatment of recalcitrant pemphigus. Objective To compare the efficacy of different doses of rituximab in patients with pemphigus who were unresponsive to conventional therapies. Methods Twenty-seven patients with pemphigus who received different doses of rituximab (375 mg m -2 per infusion weekly) were analysed retrospectively. We divided the patients into two groups: group 1 (n = 12) received two infusions of rituximab and group 2 (n = 15) received three or more infusions of rituximab at 1-week intervals. The number of infusions was determined by the choice of each patient. The endpoints of the study were time to disease control, partial remission (PR) and complete remission (CR). Results There was no significant difference in time to achieve PR between the two groups (147 vs. 135 days, P = 0·65). However, group 2 demonstrated better outcomes than group 1 in time to CR (443 vs. 149 days, P = 0·06) and relapse rate (0% vs. 67%, P < 0·01). Conclusions We conclude that three or more infusions of rituximab are more effective than two infusions for the treatment of pemphigus. © 2011 British Association of Dermatologists.
Lee D.K.,Gangnam Severance Hospital |
Jahng J.H.,Gangnam Severance Hospital
Digestive Endoscopy | Year: 2010
The endoscopic method is accepted as a first treatment modality in the management of extrahepatic bile duct. Most large stones can be removed with basket and mechanical lithotripsy after endoscopic sphincterotomy. Currently, in treating large extrahepatic bile duct stones, endoscopic papillary large balloon dilation with mid-incision endoscopic sphincterotomy is actively performed instead of applying mechanical lithotripsy after full endoscopic sphincterotomy. Herein, we describe the conceptions, proper indications, methods and complications of endoscopic papillary large balloon dilation with regards to currently published reports. In addition, intracorporeal lithotripsy by peroral cholangioscopy with an ultra-slim upper endoscope is introduced, which is more convenient than previous conventional intracorporeal lithotripsy methods using mother-baby endoscopy or percutaneous transhepatic cholangioscopy. Lastly, biliary stenting with the choleretic agent administration method is briefly reviewed as an alternative treatment option for frail and elderly patients with large impacted common bile duct stones. © 2010 Japan Gastroenterological Endoscopy Society.
Kang D.-H.,Ewha Womans University |
Ha S.-K.,Gangnam Severance Hospital
Electrolyte and Blood Pressure | Year: 2014
Hyperuricemia is known to be associated with the presence of cardiovascular and metabolic syndrome and with the development of incipient kidney disease and an accelerated renal progression. However, an elevated uric acid level was not generally regarded as a true etiology or mediator, but an indicator of these diseases. Uric acid has recently regained the clinical interest and popularity based on emerging data suggesting the causative role of hyperuricemia in cardiovascular and renal disease. Experimental data demonstrates oxidative stress is one of the earliest phenomena observed in vascular, renal, liver cells and adipocytes exposed to uric acid. Since uric acid is one of the major antioxidants of plasma acting as a free radical scavenger and a chelator of transitional metal ion, uric acid-induced oxidative stress seems paradoxical. Data regarding the clinical implication of hyperuricemia is even more confusing, which defines hyperuricemia as a useless parameter to be eliminated from routine follow-up or a major risk factor to be therapeutic target. With a review of experimental and epidemiologic data, the presence of molecular switch to regulate the role of uric acid as anti- or pro-oxidant in different compartment of our body is suggested, which may shed light on understanding the paradoxical role of uric acid and solving the "uric acid debate". Copyright © 2014 The Korean Society of Electrolyte Metabolism.