Severance Biomedical Science Institute

Seoul, South Korea

Severance Biomedical Science Institute

Seoul, South Korea
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Choi Y.S.,Yonsei University | Shim J.-K.,Yonsei University | Song J.W.,Yonsei University | Kim J.C.,Severance Biomedical Science Institute | And 3 more authors.
Clinical Journal of Pain | Year: 2013

Objectives: In this randomized-controlled study, we investigated the effects of combined administration of pregabalin and dexamethasone on postoperative pain and analgesic requirements, and functional outcome in patients who underwent lumbar spinal surgery. Methods: One hundred eight patients were randomized to group C (placebo+placebo), group P (pregabalin+placebo), or group PD (pregabalin+dexamethasone). According to their allocated group, patients received placebo or pregabalin 150 mg every 12 hours starting 1 hour before anesthetic induction for a total of 8 doses. Dexamethasone 16 mg or normal saline was injected before the induction of anesthesia. The pain intensity, analgesic requirements, and side effects were assessed in the postoperative period: postanesthesia care unit, 12, 24, 48, and 72 hours. Pain intensity and daily activity performance were also assessed 1, 3, and 6 months after surgery. Results: Compared with group C, the pain scores were lower in group PD at 24 hours after surgery (P=0.011). The frequency of additional rescue analgesic administration was significantly lower in group PD until 48 hours after surgery (P<0.05) and in group P at 24 to 48 hours (P=0.005) relative to group C. Back pain intensity at work was lower (P=0.048) and daily activity performance was better (P=0.006) in group PD compared with group C at 1 month after surgery. CONCLUSIONS:: Combined administration of pregabalin and dexamethasone conferred analgesic benefits superior to those of pregabalin alone. This regimen also helped facilitate return to normal daily activity after surgery. © 2012 by Lippincott Williams & Wilkins.

Choi Y.S.,Yonsei University | Shim J.K.,Yonsei University | Kim J.C.,Yonsei University | Kang K.-S.,Soonchunhyang University | And 4 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objective: Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Methods: Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. Results: There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. Conclusions: In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay. Copyright © 2011 by The American Association for Thoracic Surgery.

Lee H.,Institute of Vision Research | Chung J.L.,Yonsei University | Kim E.K.,Institute of Vision Research | Kim E.K.,Konyang University | And 3 more authors.
Journal of Cataract and Refractive Surgery | Year: 2012

Purpose: To compare the corneal astigmatism measurements from 6 instruments in preoperative assessment for toric intraocular lens (IOL) implantation. Setting: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. Design: Prospective comparative observational study. Methods: This study included patients with cataract and more than 1.00 diopter (D) of corneal astigmatism. For preoperative evaluation of toric IOL implantation, the net astigmatism was evaluated using manual keratometry, autokeratometry, partial coherence interferometry (PCI) (IOLMaster), corneal topography/ray-tracing aberrometry (iTrace), scanning-slit topography (Orbscan), and Scheimpflug imaging (Pentacam). All net astigmatisms were converted to polar values. Using the astigmatism measurements from manual keratometry as a standard, Bland-Altman analysis, linear mixed-model, and bivariate graphic analysis were performed. Results: The study group comprised 257 eyes of 141 patients. Bland-Altman plots showed good agreement between manual keratometry and each instrument for polar values. There was no significant between-instrument difference in KP(90) and KP(135) in the linear mixed model analysis or in bivariate polar values in bivariate confidence ellipses. Conclusion: The corneal astigmatism measurements from autokeratometry, PCI, corneal topography/ray-tracing aberrometry, scanning-slit topography, and Scheimpflug imaging were comparable to those from manual keratometry and can be used interchangeably with manual keratometry to measure corneal astigmatism. Financial Disclosure: No author has a financial or proprietary interest in any material or method Mentioned © 2012 2012 ASCRS and ESCRS.

Lee J.E.,Yonsei University | Cho K.H.,Yonsei University | Song S.K.,Korea University | Kim H.J.,Yonsei University | And 4 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2014

Background Parkinson's disease with mild cognitive impairment (PD-MCI) is a heterogeneous entity in terms of cognitive profiles and conversion to dementia. However, the risk factors for ongoing cognitive decline in patients with PD-MCI are not clearly defined. Methods 51 patients with PD-MCI were prospectively followed-up for a minimum of 2 years. Subjects were classified as MCI converters (n=15) or MCI nonconverters (n=36) based on whether they were subsequently diagnosed with PD dementia. We explored cognitive profiles and neuroanatomical characteristics of PD-MCI converters using voxel based morphometry (VBM) of grey matter (GM) density and region of interest based volumetric analysis of the substantia innominata (SI). Results PD-MCI converters showed more severe cognitive deficits in frontal executive functions, immediate verbal memory and visual recognition memory compared with PD-MCI non-converters. VBM analysis revealed that PD-MCI converters had significantly lower GM density in the left prefrontal areas, left insular cortex and bilateral caudate nucleus compared with that in PD-MCI nonconverters. The mean normalised SI volume was significantly smaller in both PD-MCI converters (1.19±0.35, p<0.001) and PD-MCI non-converters (1.52±0.27, p<0.001) compared with that in controls (1.87±0.19). PD-MCI converters had a significantly smaller normalised SI volume than PD-MCI nonconverters (p<0.001). Conclusions Our data show that atrophy in the frontostriatal areas and cholinergic structures, as well as frontal lobe associated cognitive performance, may act as predictors of dementia in PD-MCI patients, suggesting distinctive patterns of cognitive profiles and a neuroanatomical basis for progressive PD-MCI.

Lee J.E.,Yonsei University | Cho K.H.,Yonsei University | Ham J.H.,Yonsei University | Song S.K.,Korea University | And 3 more authors.
Parkinsonism and Related Disorders | Year: 2014

Objective: To explore whether olfactory performance acts as a cognitive reserve in non-demented patients with Parkinson's disease (PD). Methods: Patients with non-demented PD (n=119) underwent T1-weighted MRI and olfactory identification tests. According to their olfactory performance, PD patients were subdivided into three groups of high score (PD-H, n=38), middle score (PD-M, n=48), and low score (PD-L, n=33). We investigated the pattern of gray matter (GM) density according to olfactory performance using voxel-based morphometry (VBM) and analyzed the correlation between GM density and olfactory performance. Results: No significant differences in demographic characteristics were observed among the groups. A neuropsychological test showed that cognitive deficits in verbal memory function were more severe in the PD-L group than in the PD-H group. However, a VBM analysis revealed that patients in the PD-H group possessed significantly decreased GM density in the bilateral temporal areas, orbitofrontal areas, mesiofrontal areas extending into the cingulate gyrus, and prefrontal areas, compared with patients in the PD-L group. No areas exhibiting a significant difference in GM density were observed between the PD-H and PD-M groups. Olfactory performance in patients with PD was negatively correlated with both the brain GM volume and intracerebral volume; in particular, GM density in the caudate nucleus and putamen exhibited a negative correlation with olfactory performance. Conclusions: Our data show that a high olfactory performance may compensate GM volume loss in order to minimize the exhibition of cognitive impairment and thus may act as a cognitive reserve in non-demented patients with PD. © 2013 Elsevier Ltd.

Lee J.E.,Yonsei University | Park H.-J.,Yonsei University | Park H.-J.,Severance Biomedical Science Institute | Song S.K.,Korea University | And 4 more authors.
Neurology | Year: 2010

Objective: To explore the neuroanatomic basis of amnestic mild cognitive impairment (aMCI) in patients with Parkinson disease (PD; aMCI-PD) and without PD (aMCI-PD). Methods: A total of 119 patients with aMCI (aMCI-PD, n = 78, and aMCI-PD, n = 41) underwent T1-weighted MRI, and the image data were analyzed using voxel-based morphometry. Results: No significant differences in demographic characteristics or general cognition were found between patients with aMCI-PD and aMCI-PD. Comparisons of neuropsychological tests between groups revealed that patients with aMCI-PD had lower scores in delayed verbal and visual recognition memory, whereas visuospatial dysfunction was more severe in patients with aMCI-PD. Gray matter (GM) density in the right temporal and posterior cingular cortices was significantly lower in the aMCI-PD group compared with controls. In contrast, GM density in the aMCI-PD group was significantly lower in the precuneus and left prefrontal and primary motor areas relative to controls. A direct comparison between groups showed that decreased GM density in aMCI-PD relative to aMCI-PD was localized in the right temporal and anterior prefrontal areas, whereas decreased GM density in aMCI-PD relative to aMCI-PD was involved in the bilateral precuneus, left primary motor, and right parietal areas. Memory decline was correlated with temporal area atrophy in aMCI-PD and with posterior cingulate cortex atrophy in aMCI-PD. ConclusionS: Our data suggest that different neuroanatomic systems underlie memory dysfunction in patients with aMCI-PD and aMCI-PD. Copyright © 2010 by AAN Enterprises, Inc.

Shin J.,Yonsei University | Choi S.,Yonsei University | Lee J.E.,Yonsei University | Lee H.S.,Yonsei University | And 3 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2012

Background: White matter hyperintensities (WMH) in the cholinergic pathways show a stronger correlation with cognitive performance than general WMH in Alzheimer's disease. However, the role of WMH within the cholinergic pathways in cognitive dysfunction has not been investigated in Parkinson's disease (PD). Method: The severity of WMH within the cholinergic pathways of PD subgroups with intact cognition (PD-IC, n=44), mild cognitive impairment (PD-MCI, n=87) and dementia (PDD, n=40) were compared using the Cholinergic Pathways Hyperintensities Scale (CHIPS), and the correlation between the CHIPS score and performance on individual tests of cognitive subdomains were analysed. Results The mean CHIPS score was significantly higher in patients with PDD compared with those with PD-IC (p=0.03) or PD-MCI (p=0.015). The CHIPS score in patients with PD was negatively correlated with general cognition assessed using the Mini-Mental State Examination (r=-0.28, p<0.001) and positively with the Unified Parkinson's Disease Rating Scale motor score (r=0.24, p=0.002). The CHIPS score showed a significant correlation with cognitive performance on individual cognitive subdomains and had the highest independent correlations with contrasting programme (β=-0.33, p<0.001) and forward digit span (β=-0.17, p=0.04). Conclusions: This study demonstrated that the burden of WMH within cholinergic pathways was significantly higher in patients with PDD relative to other groups, and that cholinergic WMH was significantly correlated with a decline in frontal executive function and attention.

Shin S.,Yonsei University | Lee J.E.,Yonsei University | Hong J.Y.,Yonsei University | Sunwoo M.-K.,Yonsei University | And 3 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2012

Background: Visual hallucinations (VH), which are common in patients with Parkinson's disease (PD), lead to increased disability and are a significant predictor of the development of dementia. However, the neuroanatomical basis for VH in non-demented PD patients remains controversial. Methods: A total of 110 patients with PD were classified into PD with VH (n=46) and PD without VH (n=64) groups, depending on the presence of VH assessed by the caregiver-based structured interview of the Neuropsychiatric Inventory. We performed voxel-based morphometry (VBM) for grey matter (GM) volume and a region-of-interest-based volumetric analysis of the substantia innominata (SI) between two groups. Results: The comprehensive neuropsychological assessment showed that PD patients with VH showed more severe cognitive deficits in delayed visual memory and frontal executive functions compared with those without VH. A VBM analysis revealed that PD patients with VH had significantly lower GM volume in the right orbitofrontal, left temporal and left thalamic areas compared with those without VH. The normalised SI volume was significantly reduced in PD patients with VH compared with those without VH (1.28±0.22 vs 1.41±0.25, p=0.005). Conclusions: The present study demonstrates that non-demented PD patients with VH exhibited a smaller volume in the frontal, temporal and thalamic areas as well as the SI, suggesting that PD hallucinators may have distinctive neuroanatomical bases relative to PD non-hallucinators.

Sunwoo M.K.,Yonsei University | Hong J.Y.,Yonsei University | Choi J.,Yonsei University | Park H.J.,Severance Biomedical Science Institute | And 3 more authors.
Neurology | Year: 2013

Objective: The clinical characteristics of postoperative delirium are similar to core features of α-Synuclein-related cognitive disorders, such as dementia with Lewy bodies or Parkinson disease dementia. We therefore investigated the α-Synuclein pathology in patients who experienced postoperative delirium after gastrectomy for stomach cancer. Method: Patients with and without postoperative delirium were selected among patients undergoing total gastrectomy for primary gastric cancer from 2007 to 2011 (each n 5 16) at the university hospital. Immunohistochemical staining for α-Synuclein of both normal and phosphorylated form was performed in the myenteric plexus. A logistic regression analysis was applied to identify independent predictors of postoperative delirium. Results: No significant differences were observed for age, sex, operation time, or onset of delirium after total gastrectomy between patients with and without postoperative delirium. Patients with postoperative delirium had a higher frequency of intensive care unit admissions (43.8 vs 6.3%, p 5 0.037) and α-Synuclein-positive pathologies of normal (56.3 vs 12.5%, p 5 0.023) and phosphorylated form (43.8 vs 6.3%, p 5 0.037) compared with those without postoperative delirium. A logistic regression analysis revealed that immunoreactivity for normal α-Synuclein (odds ratio [OR] 9.20) and intensive care unit admission (OR 11.97) were independently associated with postoperative delirium. Conclusion: These results suggest that underlying α-Synuclein pathologies in the stomach are associated with postoperative delirium, implying that postoperative delirium represents a preclinical stage of α-Synuclein related to cognitive disorders. © 2013 American Academy of Neurology.

Lee S.-M.,Yonsei University | Kim H.J.,Yonsei University | Kim S.Y.,Severance Biomedical Science Institute | Kwon M.-K.,Severance Biomedical Science Institute | And 6 more authors.
Biomaterials | Year: 2014

To investigate the possibility of treating multidrug-resistant tumors with targeted chemo-photothermal treatment, we conducted invitro and invivo studies using a doxorubicin (DOX)-resistant DLD-1 cell line (DLD-1/DOX) and nude mice with human xenograft tumors, respectively. The chemo-photothermal treatment consisted of DOX-loaded-poly(lactic co-glycolic acid)-Au half-shell nanoparticles with targeting moieties of anti-death receptor-4 monoclonal antibody conjugated to the Au surface. The cells or xenografted tumors treated with nanoparticles were exposed to near infrared light for 10min, which caused an increase in temperature to 45°C. Chemo-photothermal treatment resulted in a large reduction in the rate of tumor xenograft growth on DLD-1/DOX tumor-bearing mice with a much smaller dose of DOX than conventional DOX chemotherapy. These results demonstrate that targeted chemo-photothermal treatment can provide high therapeutic efficacy and low toxicity in the treatment of multidrug-resistant tumors. © 2013 Elsevier Ltd.

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