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The Potential Role of the Rapid Urease Test with the Sweeping Method in the Gray Zone of the Urea Breath Test after Helicobacter pylori Eradication
No full textBACKGROUND/AIMS: Although the urea breath test (UBT) is widely used as a representative monitoring test after Helicobacter pylori eradication, false-negative results can occur because of the gray zone related to its cutoff value. This study aimed to compare the diagnostic performances of the rapid urease test (RUT), the RUT with sweeping method, and the UBT, and to investigate the role of the sweeping method in the gray zone of UBT values. METHODS: We retrospectively reviewed 216 patients who received standard first-line H. pylori eradication treatments (n=216). All participants underwent to testing using the sweeping method and UBT on the same day. The sensitivity, specificity, and accuracy were analyzed to compare the two methods. RESULTS: The sensitivity (0.537 vs 0.806, p=0.002) and accuracy (0.843 vs 0.870, p=0.026) of the UBT were inferior to those of the sweeping method. A total of 31 individuals tested positive for H. pylori according to the UBT, whereas 54 individuals tested positive according to the sweeping method. In the group for which the gold standard definition indicated H. pylori positivity but UBT results were negative (n=31), all individuals had a UBT value under 2.5 per thousand. In the multivariate logistic regression model, a UBT value of 1.4 per thousand to 2.5 per thousand increased the risk of false-negative results by 6.5 times (odds ratio, 6.5; 95% confidence interval, 2.077 to 20.288; p=0.001). CONCLUSIONS: After H. pylori eradication, false-negative results can occur for individuals undergoing the UBT, primarily for values below the UBT cutoff. The RUT with the sweeping method can potentially help detect H. pylori in the gray zone of the UBT, improving diagnostic accuracy
Outcomes of pancreas transplantation over two decades: a single-center retrospective cohort study
No full textPURPOSE: Pancreas transplantation (PT) is a definitive treatment for diabetes mellitus (DM), restoring endogenous insulin secretion and improving glycemic control. Despite its efficacy, PT is less common in South Korea compared to Western nations. This study aims to report the clinical outcomes of PT over 2 decades at a single center, focusing on surgical techniques, complications, and graft survival. METHODS: A retrospective analysis of 69 PT recipients at Seoul National University Hospital between January 2002 and December 2023 was conducted. Data on recipient and donor demographics, surgical details, immunosuppressive regimens, and graft outcomes were collected. Graft survival was evaluated using Kaplan-Meier analysis, with subgroup comparisons using the log-rank test. Graft failure was defined as graft removal, PT re-registration, insulin dependence exceeding 0.5 units/kg/day for more than 90 days, or patient death. RESULTS: Among the 69 recipients, 50 (72.5%) had type 1 DM, and 18 (26.1%) had type 2 DM. Simultaneous pancreas-kidney (SPK) transplantations comprised 84.1% (n = 58), and pancreas-after-kidney (PAK) transplantations accounted for 10.1%. The 1-year and 5-year death-censored pancreas graft survival rates were 92.7% and 89.6%, respectively, with no significant difference between SPK and PAK (P = 0.330). Graft failure occurred in 10 patients, primarily due to pancreatitis and rejection. Donor-related factors, particularly anoxic brain injury, were significantly associated with lower graft survival (P = 0.045). CONCLUSION: PT outcomes in this cohort align with international standards, emphasizing the importance of donor selection and tailored immunosuppression. Expanding PT indications to include selective type 2 DM patients could benefit South Korea's PT programs with adequate resource allocation
Postoperative nausea and vomiting and recovery of heart rate variability following general anesthesia with propofol or sevoflurane: a randomized, double-blind preliminary study
No full textPURPOSE: Postoperative nausea and vomiting (PONV) remain significant complication after general anesthesia. Inhaled anesthetics are a known risk factor for PONV. Heart rate variability (HRV), an indicator of autonomic nervous system balance, is influenced by anesthetic agents and may be linked to PONV. This study aimed to compare HRV dynamics and their relationship with PONV between sevoflurane and propofol anesthesia. METHODS: This preliminary randomized double-blind study included 40 adult participants aged 20-60 years, with the American Society of Anesthesiologist Physical Status I or II, scheduled for elective breast surgery; the participants were randomly assigned to sevoflurane or propofol group. HRV was measured preoperatively and postoperatively, in the post-anesthetic care unit. Incidence (defined as the presence or absence of any PONV during the study period), severity (0-3 points), PONV impact scale, and patient satisfaction, were recorded postoperatively at 30 min, 3 h, and 1 and 2 days. RESULTS: There was no significant intergroup difference in demographics, type of surgery, anesthesia duration, and Apfel score. The sevoflurane group had a higher PONV incidence than the propofol group; significant intergroup differences in the PONV profile were mainly observed <30 min postoperatively in PONV frequency and severity and nausea severity. Although there was no significant intergroup difference in preoperative and postoperative frequency-domain parameters, total power (Ln), LF, LF (Ln), and HF (Ln), decreased postoperatively in the sevoflurane group. CONCLUSION: Sevoflurane use was associated with more frequent, severe PONV <30 min postoperatively than propofol use, without differences in HRV dynamics. With sevoflurane use, HRV parameters did not recover to preoperative levels and were potentially associated with PONV
Idiopathic Photoreceptoritis: An Unusual Variant of Outer Retinopathy
No full textPURPOSE: To report an unusual case of progressive photoreceptor disruption following a herpetic labial infection. METHOD: Case report of a patient with severe idiopathic photoreceptoritis. RESULTS: A 46-year-old female patient presented with blurred vision and inferior photopsia in her right eye one week after a herpetic labial eruption. Initial examination revealed mild vitreous inflammation and focal photoreceptor alterations in the superior periphery of the right retina. Despite oral valaciclovir, the disease progressed rapidly, prompting referral to a tertiary care center. Autofluorescence and optical coherence tomography showed diffuse photoreceptor damage with impending foveal involvement. Extensive workup, including viral markers, was inconclusive. Given the temporal association with the herpetic infection and the sight-threatening progression, treatment was escalated to intravenous acyclovir and subsequently foscarnet for 2 weeks, which slowed down disease progression. The frontal margin of retinal foci stabilized with no further progression, while ellipsoid zone restoration was achieved following systemic corticosteroids and interferon alpha-2a. CONCLUSION: The term "photoreceptoritis" describes conditions involving diffuse photoreceptor damage, predominantly unilateral, without primary choriocapillaritis. This case highlights a severe form of photoreceptoritis with diffuse photoreceptors loss, likely triggered by a herpetic labial infection. The disease was stabilized with antiviral therapy, while structural recovery of the photoreceptors was achieved through anti-inflammatory and immunosuppressive treatments. This report underscores the importance of a multidisciplinary approach to managing atypical retinal inflammatory disorders
CPPpred-En: Ensemble framework integrating a protein language model and conventional features for highly accurate cell-penetrating peptide prediction
No full textCell-penetrating peptides (CPPs) have gained significant attention for biomedical applications, including drug delivery and therapeutic development, due to their ability to penetrate cell membranes. The accurate prediction of CPPs is critical for accelerating the design and development of novel peptide-based therapies. Approaches for CPP prediction primarily depend on either peptide characteristic-based conventional features or one or two protein language models (PLMs), but these methods often fail to fully leverage the potential of combining diverse features. To address this limitation, we propose CPPpred-En, a prediction model that evaluates multiple conventional and PLM-based features across various machine learning classifiers, selects high-performing feature-classifier combinations, and integrates them through ensemble learning. The CPPpred-En model, which was trained on both the CPP924 and MLCPP 2.0 datasets, outperformed existing state-of-the-art predictors, achieving an accuracy (Acc) of 97.27 % and a matthews correlation coefficient (MCC) of 0.964 on the CPP924 dataset and an Acc of 96.10 % and an MCC of 0.707 on the MLCPP 2.0 dataset. The ensemble-based strategy demonstrated robustness across different datasets, highlighting the strong ability of the model to generalise. The combination of conventional and PLM features in an ensemble framework is promising approach for improving peptide-based therapeutics. The CPPpred-En model is a highly accurate and reliable tool for the identification of CPPs and their application in drug delivery and targeted therapy
Analysis of outcomes according to start timing of adjuvant chemotherapy in patients with gastric cancer: a retrospective nationwide cohort study
No full textBACKGROUND: Gastrectomy with D2 lymph node dissection followed by adjuvant chemotherapy (AC) with S-1 or capecitabine/oxaliplatin (CAPOX) is the standard treatment for stage II and III gastric cancer (GC). However, there is no established guideline for the start timing of AC. METHODS: We analyzed data from the Korean Health Insurance Review and Assessment Service on 19 140 GC patients who received AC with S-1 (n = 10 442) or CAPOX (n = 8698) between January 2014 and December 2018. Patients were categorized based on AC initiation timing: within 6 weeks (n = 12 843), 6-8 weeks (n = 5386), and >8-16 weeks (n = 911). RESULTS: Initiating AC within 6 weeks significantly improved 5-year disease-free survival (DFS) and overall survival (OS) compared to later initiation, with consistent findings across both S-1 and CAPOX groups (all P < .005). These associations remained significant in multivariable analysis and after propensity score matching (all P < .0001). However, this nationwide big-data analysis has limitations, including potential survival status misclassification and the absence of some important variables such as pathologic stage, performance status, and postoperative complications. CONCLUSION: To optimize outcomes, AC for GC should be initiated within 6 weeks after gastrectomy, provided patients have fully recovered
FDA-approved phensuximide inhibits RIPK1-dependent immunogenic cell death
No full textReceptor-interacting serine/threonine kinase 1 (RIPK1) is a pivotal protein controlling cell death and inflammation. RIPK1 is an attractive therapeutic target, given that the inhibition of RIPK1 kinase activity has been shown to be effective in animal models of human diseases such as autoimmune and neurodegenerative diseases. Here, we screened a collection of drugs with structural similarity to necrostatin-1 (Nec-1), an inhibitor of RIPK1, to assess their abilities to regulate RIPK1-mediated immunogenic cell death. Through this small-scale screening of drugs from ongoing clinical trials and FDA-approved drugs, we discovered that the drug phensuximide could prevent necroptosis by targeting RIPK1 kinase activity. Importantly, phensuximide, which has already been approved by the FDA for the treatment of epilepsy, effectively prevents the kinase activity of RIPK1 without affecting the NF-kappaB and MAPK pathways. The potency of phensuximide is that it protects against both LPS- and TNF-induced systemic inflammatory response syndrome (SIRS), which are sepsis models involving RIPK1 kinase activity. Our findings suggest that phensuximide may serve as a promising strategy for targeting RIPK1-mediated diseases
Diagnosis of trigeminal neuralgia based on plain skull radiography using convolutional neural network
No full textThis study aimed to determine whether trigeminal neuralgia can be diagnosed using convolutional neural networks (CNNs) based on plain X-ray skull images. A labeled dataset of 166 skull images from patients aged over 16 years with trigeminal neuralgia was compiled, alongside a control dataset of 498 images from patients with unruptured intracranial aneurysms. The images were randomly partitioned into training, validation, and test datasets in a 6:2:2 ratio. Classifier performance was assessed using accuracy and the area under the receiver operating characteristic (AUROC) curve. Gradient-weighted class activation mapping was applied to identify regions of interest. External validation was conducted using a dataset obtained from another institution. The CNN achieved an overall accuracy of 87.2%, with sensitivity and specificity of 0.72 and 0.91, respectively, and an AUROC of 0.90 on the test dataset. In most cases, the sphenoid body and clivus were identified as key areas for predicting trigeminal neuralgia. Validation on the external dataset yielded an accuracy of 71.0%, highlighting the potential of deep learning-based models in distinguishing X-ray skull images of patients with trigeminal neuralgia from those of control individuals. Our preliminary results suggest that plain x-ray can be potentially used as an adjunct to conventional MRI, ideally with CISS sequences, to aid in the clinical diagnosis of TN. Further refinement could establish this approach as a valuable screening tool
Renal and Safety Outcomes of SGLT2 Inhibitors in Patients with Type 2 Diabetes: A Nationwide Observational Cohort Study
No full textBackground/Objectives: Evidence on the renal benefits and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the Asia region is still lacking. This study aimed to evaluate the renal and safety outcomes of SGLT2is compared with dipeptidyl peptidase-4 inhibitors (DPP4i) using real-world data. Methods: A retrospective cohort study was conducted using the nationwide claims data in Republic of Korea. We evaluated kidney outcomes (any new-onset kidney events, acute kidney injury (AKI), chronic kidney disease (CKD), and kidney failure) as primary outcomes and safety outcomes (infection, hemodynamic adverse events, and fracture). Propensity score matching was used to adjust confounders, and the hazard ratios were calculated using the Cox proportional hazards model. Results: The study included 13,649 patients in the SGLT2i group and 35,043 in the DPP4i group after the matching. The SGLT2i group had a lower risk of kidney diseases, AKI, and CKD (HR 0.88 [0.61-0.74]) than the DPP4i group. For secondary outcomes, the risk of genital infection was higher (HR 2.38 [2.12-2.68]), and the risk of hyperkalemia was lower in the SGLT2i group than in the DPP4i group (HRs 0.49 [0.36-0.67]). Conclusions: The SGLT2 inhibitors had a lower risk of new-onset kidney outcomes and CKD than the DPP4 inhibitors. A high incidence of genital infection and a low incidence of hyperkalemia were shown in the SGLT2 inhibitor
