Institute of Wonkwang Medical Science

Iksan, South Korea

Institute of Wonkwang Medical Science

Iksan, South Korea
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Kim Y.-D.,Wonkwang University | Kim Y.-D.,Institute of Wonkwang Medical Science | Ham H.-D.,Wonkwang University | Moon H.-S.,Interventional Treatment Center | Kim S.-H.,Chonnam National University
Journal of Korean Neurosurgical Society | Year: 2015

Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations. © 2015 The Korean Neurosurgical Society.

Kweon S.-S.,Chonnam National University | Lee Y.-H.,Wonkwang University | Lee Y.-H.,Institute of Wonkwang Medical Science | Shin M.-H.,Chonnam National University | And 8 more authors.
Circulation Journal | Year: 2012

Background: While prior epidemiological studies have examined the association between cigarette smoking and carotid atherosclerosis, few studies have evaluated the association of both cumulative smoking exposure and the duration of smoking cessation with carotid artery structure. Methods and Results: The study population consisted of 2,503 community-dwelling Korean males aged 50 years and older. Common carotid artery intima-media thickness (CCA-IMT), carotid plaque, and the internal diameter of the common carotid artery (CCA-diameter) were determined by high-resolution B-mode ultrasonography. Data on the characteristics of the subjects, including smoking status, pack-years of smoking, and years since quitting smoking, were collected using a standardized questionnaire. The current smokers had significantly greater CCA-IMT and CCA-diameter and a significantly higher risk of carotid plaque than did the subjects who had never smoked (P=0.009, <0.001, and 0.036, respectively). Dose-response relationships between pack-years and CCA-IMT and CCA-diameter were found among the current smokers (P=0.001 and <0.001, respectively); however, no significant association between pack-years and the carotid artery parameters was observed among the former smokers. For the former smokers, CCA-IMT and CCA-diameter tended to decrease with increasing years since quitting smoking (P=0.009 and 0.012, respectively), whereas no significant association with carotid plaque was found. Conclusions: Cumulative smoking exposure in current smokers and the duration of smoking cessation in former smokers are significant risk factors for carotid atherosclerosis.

Shin M.-H.,Chonnam National University | Kweon S.-S.,Chonnam National University | Choi J.-S.,Chonnam National University | Rhee J.-A.,Chonnam National University | And 8 more authors.
Journal of Epidemiology | Year: 2013

Background: Controversial results have been reported on the relationship between alcohol intake and metabolic syndrome (MetS). We examined the association of average volume of alcohol consumed and drinking patterns with MetS and its components. Methods: This study was conducted as a baseline survey for the Dong-gu Study of adults aged 50 years or older. Drinking patterns were assessed using a structured interview, and average volume of alcohol consumed was calculated. MetS was defined according to the updated version of the National Cholesterol Education Program. Results: Compared with individuals who never drank, the adjusted odds ratio (OR) for the prevalence of MetS was significantly higher in men who consumed 2.1 to 4.0 drinks/day (OR, 1.53; 95% CI, 1.17-2.00) and greater than 4.0 drinks/day (OR, 1.63; 95% CI, 1.23-2.14), whereas no significant association was observed in women. Significant dose-response relationships between average volume of alcohol consumed and all metabolic components were observed in men. A usual quantity of 5 to 6 drinks/drinking day (OR, 1.57; 95% CI, 1.19-2.09), 7 or more drinks/ drinking day (OR, 1.88; 95% CI, 1.45-2.44), and binge drinking on at least 1 occasion/week (OR, 1.33; 95% CI, 1.01-1.76) were associated with a significantly higher OR for prevalence of MetS in men; however, none of these drinking patterns were associated with MetS in women. Conclusions: Unhealthy drinking patterns such as high usual quantity and binge drinking were significantly associated with MetS, suggesting that the effect of alcohol consumption on MetS should be considered in the context of drinking pattern, particularly in men. © 2013 by the Japan Epidemiological Association.

Kim M.H.,Wonkwang University | Kim W.H.,Seoul National University | Kim C.G.,Wonkwang University | Kim C.G.,Institute of Wonkwang Medical Science | And 2 more authors.
Nuclear Medicine and Molecular Imaging | Year: 2015

Purpose: The folate receptor (FR) is an attractive molecular target since it is overexpressed in a variety of human tumors. The purpose of the present study was to synthesize and evaluate the feasibility of a novel 99mTc-ECG-EDA (Glu-Cys-Gly-ethylenediamine)-folate as an FR-positive tumor imaging agent in a mouse tumor model. Materials and Methods: ECG-EDA-folate was synthesized using solid phase peptide synthesis (SPPS) and radiolabeled with 99mTc using tripeptide ECG as a chelator. FR-positive KB cells were inoculated in athymic nude mice. Following injection of 99mTc-ECG-EDA-folate, serial scintigraphy and micro-SPECT/CT imaging were performed at various time points with and without pre-administration of excess free folate. Mean count densities (MCD) for regions of interest drawn on KB tumors and major normal organs at each time point were measured, and uptake ratios of tumor to normal organs were calculated. Results: ECG-EDA-folate was labeled with 99mTc with high radiolabeling efficiency and stability (>96 %). FR-positive tumors were clearly visualized on both scintigraphy and micro-SPECT/CT images and the tumor uptake of 99mTc-ECG-EDA-folate was markedly suppressed with faint visualization of tumors by pre-administration of excess free folate on serial planar scintigraphy, indicating FR-specific binding of the agent. Furthermore, semiquantitative analysis of MCD data showed again that both tumor MCD and tumor-to-normal organ ratios decreased considerably by pre-administration of excess free folate, supporting FR-specific tumor uptake. Tumor-to-normal organ ratios approximately increased with time after injection until 4 h. Conclusion: The present study demonstrated that 99mTc-ECG-EDA-folate can bind specifically to FR with clear visualization of FR-positive tumors in a mouse tumor model. © 2015, Korean Society of Nuclear Medicine.

Kim Y.D.,Wonkwang University | Kim Y.D.,Institute of Wonkwang Medical Science | Moon H.S.,Interventional Pain Treatment Center
Korean Journal of Pain | Year: 2015

Background: Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea. Methods: Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained. Results: Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest. Conclusions: More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur. © The Korean Pain Society, 2015.

Kim C.G.,Wonkwang University | Kim C.G.,Institute of Wonkwang Medical Science | Kim W.H.,Wonkwang University | Kim M.H.,Wonkwang University | And 2 more authors.
Nuclear Medicine and Molecular Imaging | Year: 2013

Purpose: The purpose of this study was to estimate lean body mass (LBM) using CT (LBM CTs) and compare the results with LBM estimates of four different predictive equations (LBM PEs) to assess whether LBM CTs and LBM PEs can be used interchangeably for SUV normalization. Methods: Whole-body F-18 FDG PET/CT studies were conducted on 392 patients. LBM CT1 is modified adipose tissue-free body mass, and LBM CT2 is adipose tissue-free body mass. Four different PEs were used for comparison (LBM PE1-4). Agreement between the two measurement methods was assessed by Bland-Altman analysis. We calculated the difference between two methods (bias), the percentage of difference, and the limits of agreement, expressed as a percentage. Results: For LBM CTs vs. LBM PEs, except LBM PE3, the ranges of biases and limits of agreement were -3.77 to 3.81 kg and 26.60-35.05 %, respectively, indicating the wide limits of agreement and differing magnitudes of bias. For LBM CTs vs. LBM PE3, LBM PE3 had wider limits of agreement and greater positive bias (44.28-46.19 % and 10.49 to 14.04 kg, respectively), showing unacceptably large discrepancies between LBM CTs and LBM PE3. Conclusion: This study demonstrated that there are substantial discrepancies between individual LBM CTs and LBM PEs, and this should be taken into account when LBM CTs and LBM PEs are used interchangeably between patients. © 2013 Korean Society of Nuclear Medicine.

Kim W.H.,Wonkwang University | Kim C.G.,Wonkwang University | Kim C.G.,Institute of Wonkwang Medical Science | Kim D.-W.,Wonkwang University | Kim D.-W.,Institute of Wonkwang Medical Science
Nuclear Medicine and Molecular Imaging | Year: 2012

Purpose: Standardized uptake values (SUVs) normalized by lean body mass (LBM) determined by CT were compared with those normalized by LBM estimated using predictive equations (PEs) in normal liver, spleen, and aorta using 18F-FDG PET/CT. Methods: Fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) was conducted on 453 patients. LBM determined by CT was defined in 3 ways (LBM CT1-3). Five PEs were used for comparison (LBM PE1-5). Tissue SUV normalized by LBM (SUL) was calculated using LBM from each method (SUL CT1-3, SUL PE1-5). Agreement between methods was assessed by Bland-Altman analysis. Percentage difference and percentage error were also calculated. Results: For all liver SUL CTs vs. liver SUL PEs except liver SUL PE3, the range of biases, SDs of percentage difference and percentage errors were -0. 17-0. 24 SUL, 6. 15-10. 17 %, and 25. 07- 38. 91 %, respectively. For liver SUL CTs vs. liver SUL PE3, the corresponding figures were 0. 47-0. 69 SUL, 10. 90-11. 25 %, and 50. 85-51. 55 %, respectively, showing the largest percentage errors and positive biases. Irrespective of magnitudes of the biases, large percentage errors of 25. 07-51. 55 % were observed between liver SUL CT1-3 and liver SUL PE1-5. The results of spleen and aorta SUL CTs and SUL PEs comparison were almost identical to those for liver. Conclusion: The present study demonstrated substantial errors in individual SUL PEs compared with SUL CTs as a reference value. Normalization of SUV by LBM determined by CT rather than PEs may be a useful approach to reduce errors in individual SUL PEs. © 2012 Korean Society of Nuclear Medicine.

Eom K.S.,Institute of Wonkwang Medical Science | Kim D.W.,Institute of Wonkwang Medical Science | Kang S.D.,Institute of Wonkwang Medical Science
Clinical Neurology and Neurosurgery | Year: 2010

We present the first case of a bilateral diffuse intracerebral hemorrhagic infarction following cranioplasty using an autologous bone graft. The case is that of a 63-year-old man who had undergone previous decompressive craniectomy due to right middle cerebral artery and posterior cerebral artery territory infarction. In order to avoid this extremely rare complication, the possible pathogenic mechanism underlying the deleterious cascade following cranioplasty is discussed. © 2009 Elsevier B.V. All rights reserved.

Hwang K.-E.,Wonkwang University | Park D.-S.,Institute of Wonkwang Medical Science | Kim Y.-S.,Wonkwang University | Kim B.-R.,Wonkwang University | And 6 more authors.
International Journal of Oncology | Year: 2013

The expression levels of Prx1 are frequently elevated in several human cancers, including lung cancer and may confer increased resistance to treatment. In this study, we investigated the role of Prx1 in docetaxel-induced apoptosis in A549 lung cancer cells. To test whether Prx1 knockdown affected the sensitivity of A549 cells to docetaxel treatment, we generated short hairpin RNA (shRNA) constructs targeting Prx1 and analyzed the effect of Prx1 knockdown on growth and apoptosis. Tumor growth was evaluated in scrambled shRNA- or shPrx1-infected A549 cell tumors receiving docetaxel treatment. In addition, mechanistic information was gathered by western blot analysis from cell lysates of scrambled- and shPrx1-infected A549 cells pretreated with or without LY294002 and subsequently treated with docetaxel. We found that Prx1 knockdown resulted in enhanced docetaxel-induced cytotoxicity in a dose-dependent manner. In vivo, the growth rate of shPrx1-infected A549 tumors was significantly reduced compared to that of scrambled shRNAinfected A549 tumors. Prx1 knockdown also augmented the inhibitory effects of docetaxel on tumor growth. Prx1 knockdown increased the apoptotic potential through activation of the caspase cascade and suppressed docetaxel-induced phosphorylation of Akt and its substrate forkhead box O1 (FOXO1). Moreover, treatment with the phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002 reduced the phosphorylation of FOXO1 and increased the cytotoxicity of docetaxel in A549 cells. Our findings suggest that Prx1 may modulate the chemosensitivity of lung cancer to docetaxel through suppression of FOXO1-induced apoptosis.

Yun K.H.,Wonkwang University | Yun K.H.,Institute of Wonkwang Medical Science | Rhee S.J.,Wonkwang University | Park H.-Y.,Institute of Wonkwang Medical Science | And 7 more authors.
International Heart Journal | Year: 2010

Clopidogrel is used with aspirin as a standard combined treatment in patients with acute coronary syndrome. A proton pump inhibitor (PPl) is often administered to patients receiving antiplatelet therapy. However, PPI use with clopidogrel was recently shown to result in increased risk of major cardiovascular events when compared to clopidogrel use alone. Therefore, the aim of the present study was to evaluate the effects of omeprazole, a PPI, on the antiplatelet effect of clopidogrel. We divided 20 healthy volunteers into 2 groups (n = 10 each). Twenty-four hours after a 300 mg loading dose of clopidogrel, one group received a dosage of 75 mg/day of clopidogrel and a placebo for 14 days, followed 3 weeks later by the same protocol but with coadministration of 75 mg/day clopidogrel and 20 mg/day omeprazole instead. The other group received the same treatment but in reverse order. Antiplatelet activity was assessed in terms of the P2Y12 reaction unit (PRU) and percentage inhibition using a VerifyNow P2Y12 assay system. The PRU of the omeprazole-treated subjects was significantly higher than that of the omeprazole-untreated subjects on day 14 (281.3 ± 54.0 versus 240.0 ± 72.2, P = 0.048). The percentage inhibition showed a decrease after the 14-day omeprazole treatment (22.7 ± 29.9% versus 35.1 ± 18.7%, P = 0.014). Consequently, omeprazole reduces the antiplatelet effect of clopidogrel, suggesting that careful treatment planning is required when administering omeprazole to patients on clopidogrel therapy.

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