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The learning curve for robotic living donor right hepatectomy: Analysis of outcomes in 2 specialized centers
No full textRobotic surgery is an emerging minimally invasive option for living donor hepatectomy. Currently, there are no studies on the learning curve of robotic donor hepatectomy. Thus, we evaluated the learning curve for robotic donor right hepatectomy. We retrospectively reviewed prospectively collected data from consecutive living donors who underwent robotic hepatectomy at 2 specialized centers between 2016 and 2022. We estimated the number of cases required to achieve stable operating times for robotic donor right hepatectomy using cumulative sum (CUSUM) analysis. The complication rates were similar between the 2 centers (22.8% vs. 26.7%; p = 0.74). Most complications were graded as minor (70.4%). Analysis of the total operative time demonstrated that the learning curves reached a peak at the 17th case in center 1 and the 9th case in center 2. The average operation times for cases 1-17 versus 18-99 in center 1 were 603 versus 438 minutes (p < 0.001), and cases 1-9 versus 10-15 in center 2 were 532 versus 418 minutes (p = 0.002). Complication rates were lower after the learning curves were achieved, although this did not reach statistical significance. A comparison of outcomes between centers suggests that a standardized approach to this complex operation can be successfully transferred
Clinical characteristics and phenoconversion in isolated REM sleep behavior disorder: a prospective single-center study in Korea, compared with Montreal cohort
No full textStudy Objectives: Isolated rapid eye movement sleep behavior disorder is a prodromal synucleinopathy, but its conversion rate and subtypes can vary among different cohorts. We report the clinical characteristics and phenoconversion rate of the large single-center isolated rapid eye movement sleep behavior disorder cohort in Korea and compared it to the Montreal cohort. Methods: This prospective cohort study examined 238 patients with polysomnography confirmed isolated rapid eye movement sleep behavior disorder from Seoul National University Hospital (SNUH) who completed at least 1 follow-up evaluation. We compared the baseline and phenoconversion data of the SNUH cohort to those of 242 isolated rapid eye movement sleep behavior disorder patients in the Montreal cohort. Results: In the SNUH cohort, age at rapid eye movement sleep behavior disorder diagnosis was similar (66.4 ± 7.8 vs 65.6 ± 8.4, P = .265), but the proportion of men was lower (63.0% vs 74.0%, P = .01), and the duration of follow-up was shorter than that in the Montreal cohort (3.7 ± 2.0 vs 4.8 ± 3.6 years, P < .001). During follow-up, 34 (11.8%) patients in the SNUH cohort converted to neurodegenerative disease: 18 (52.9%) to Parkinson’s disease, 9 (26.5%) to dementia with Lewy bodies, and 7 (20.6%) to multiple system atrophy. The conversion rate in the SNUH cohort was 15% after 3 years, 22% after 5 years, and 32% after 7 years, which was significantly lower than that of the Montreal cohort (log-rank test, P = .002). Among phenoconversion subtype, fewer patients in the SNUH group than in the Montreal group converted to dementia with Lewy bodies (Gray’s test P = .001). Conclusions: Through a comparative analysis between the SNUH and Montreal cohorts, we identified a significant difference in phenoconversion rates, particularly for dementia with Lewy bodies patients. These findings underscore the importance of further research into the underlying factors, such as racial and geographical factors contributing to such disparities
Proximal Gastrectomy Is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer
No full textPURPOSE: Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach. MATERIALS AND METHODS: The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups. RESULTS: The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p < 0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p < 0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups. CONCLUSION: The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG
Assessing the Efficacy of Bortezomib and Dexamethasone for Induction and Maintenance Therapy in Relapsed/Refractory Cutaneous T-Cell Lymphoma: A Phase II CISL1701/BIC Study
No full textPURPOSE: This multicenter, open-label, phase II trial evaluated the efficacy and safety of bortezomib combined with dexamethasone for the treatment of relapsed/refractory cutaneous T-cell lymphoma (CTCL) in previously treated patients across 14 institutions in South Korea. MATERIALS AND METHODS: Between September 2017 and July 2020, 29 patients with histologically confirmed CTCL received treatment, consisting of eight 4-week cycles of induction therapy followed by maintenance therapy, contingent upon response, for up to one year. The primary endpoint was the proportion of patients achieving an objective global response. RESULTS: Thirteen of the 29 patients (44.8%) achieved an objective global response, including two complete responses. The median progression-free survival (PFS) was 5.8 months, with responders showing a median PFS of 14.0 months. Treatment-emergent adverse events were generally mild, with a low incidence of peripheral neuropathy and hematologic toxicities. Despite the trend toward shorter PFS in patients with higher mutation burdens, genomic profiling before and after treatment showed no significant emergence of new mutations indicative of disease progression. CONCLUSION: This study supports the use of bortezomib and dexamethasone as a viable and safe treatment option for previously treated CTCL, demonstrating substantial efficacy and manageability in adverse effects. Further research with a larger cohort is suggested to validate these findings and explore the prognostic value of mutation profiles
Impact of disease-related indicators on pain measures in rheumatoid arthritis: a biopsychosocial perspective
No full textObjective: Pain is a significant and debilitating symptom of rheumatoid arthritis (RA) that significantly affects the quality of life and functional ability of patients. In the present study, we examined the association between pain variables and disease activity markers in patients with RA. Methods: We enrolled 133 patients with RA and assessed their clinical characteristics, socioeconomic and psychological factors, and pain measures. The psychological factors assessed included depressive symptoms and pain catastrophizing. Results: The study cohort comprised predominantly female patients with RA with an average age of 55.5±10.1 years. Depressive symptoms had a mean score of 5.83±4.71, while pain catastrophizing had an average score of 14.36±10.70. The mean scores for pain intensity, and pain interference, were 2.98±1.75 and 19.54±16.17, respectively, with significant positive correlations observed with depressive symptoms. Hemoglobin and hematocrit levels were negatively correlated with pain intensity. Multivariable linear regression analysis revealed significant associations between depressive symptoms and pain intensity, catastrophizing, and interference. Other factors associated with pain intensity included tender joint count. Pain catastrophizing was associated with education and economic status. Pain interference was associated with sex and economic status. Conclusion: This study shows the influence of disease-related indicators and psychological factors on pain in patients with RA, with depressive symptoms playing a crucial role in predicting pain experience. Effective pain management strategies for RA should include the management of depressive symptoms, in addition to addressing disease-related indicators
Loliolide combats glutamate-induced neurotoxicity by oxidative stress through MAPK/Nrf2 pathway in hippocampal neuronal cells
No full textNeurodegenerative diseases are caused by neurons damage in the brain. Because damaged neurons are difficult to recover, preventing neurons damage may be the most fundamental way to reduce the incidence of the disease. Despite significant efforts to increase understanding of pathogenesis and finding potential treatments in neurodegeneration, there is still no satisfactory treatments for the disease. Excess glutamate generates reactive oxygen species (ROSs) and increases intracellular calcium levels, consequence neuronal dysfunction and cell death, which in turn leads to neurodegeneration. Therefore, the study focused on isolating loliolide from Sargassum horneri and exploring its neuroprotective effect in hippocampal neuronal cells. Loliolide could successfully restore cell viability against glutamate toxicity and reduce apoptosis by inhibiting sub-G1 population. Loliolide attenuated glutamate-induced apoptosis in HT22 cells by upregulating anti-apoptotic (Bcl-2) and downregulating pro-apoptotic (Bax, Caspase3, Caspase9, Cytochrome c, p53, and cleaved PARP) protein expression. Loliolide activates the nuclear factor erythroid-2-related factor 2 (Nrf2)/heme oxygenase 1 (HO-1) signaling pathway as well as reduced glutamate-induced oxidative stress by inhibiting mitogen-activated protein kinases (MAPKs; ERK, JNK, and p38) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathways (IκBα and NF-κB, and p65). Loliolide shows the ability to alleviate oxidative damage by activating the MAPK/Nrf2 signaling pathway in HT22 cells. These findings revealed pharmacological candidates for loliolide in the prevention and/or treatment of neurodegenerative diseases
Gastric emptying time and its correlation with cardiac MIBG in body-first and brain-first subtype Parkinson’s disease
No full textIntroduction: Recently, “body-first” and “brain-first” subtype in Parkinson's disease (PD) was proposed based on the propagation of α-synuclein. In isolated RBD considered as a premotor stage of body-first PD, α-synuclein was supposed to originate in the enteric nervous system and spreads via autonomic nervous system. Therefore, we hypothesized that body-first PD is more likely to have a delayed gastric emptying time and reduced cardiac sympathetic denervation. In this study, we aimed to assess gastric motility and its correlation with cardiac sympathetic denervation, dopamine transporter uptake in PD with the body-first PD in comparison with brain-first PD. Methods: We investigated gastric scintigraphy, dual-phase 18F-FP-CIT PET, and cardiac MIBG scintigraphy in patients with PD. Based on the presence of RBD and delayed H/M ratio in MIBG scintigraphy, we classified patients into the body-first PD and brain-first PD groups. Gastric emptying time (GET) was assessed by dynamic gastric scintigraphy, and half-emptying time (T1/2) was measured. Results: A total of 18 PD patients (mean age 68.8) were classified into body-first PD group (n = 10) and brain-first PD group (n = 8). Delayed GET was more prevalent in body-first PD group compared to brain-first PD (T1/2 > 110 min, 90.0 vs 37.5%, p = 0.043). Striatal dopamine depletion was similar between groups and no significant correlation with T1/2. Washout rate of cardiac MIBG showed a tendency of correlation with T1/2 (r = 0.454, p = 0.077). Conclusion: This study showed that body-first PD may be associated with a higher prevalence of delayed gastric emptying time compared to the brain-first PD, suggesting higher burden of gastrointestinal dysmotility in brain-first PD
Autophagic signatures in peripheral blood mononuclear cells from Parkinson's disease patients
No full textParkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor impairments and the accumulation of misfolded α-synuclein. Dysregulation of the autophagy-lysosomal pathway (ALP), responsible for degrading misfolded proteins, has been implicated in PD pathogenesis. However, current diagnostic approaches rely heavily on motor symptoms, which occur due to substantial neurodegeneration, limiting early detection and intervention. This study investigated the potential of ALP-associated proteins in peripheral blood mononuclear cells (PBMCs) as diagnostic biomarkers for early-stage PD. Quantitative analysis revealed a significant reduction in optineurin levels in PBMCs from PD patients, and the expression levels of various ALP-associated proteins were tightly correlated, suggesting a coordinated dysregulation of the pathway. Correlation analyses revealed associations between ALP-associated features and clinical characteristics, such as age of onset and motor impairment. Furthermore, the study identified multiple positive correlations among ALP-associated proteins and functional readouts, highlighting the interconnectivity within the pathway. Notably, a PBMC biomarker model incorporating lysosomal-associated membrane protein 1 and optineurin exhibited high diagnostic accuracy (86%) in distinguishing PD patients from controls. These findings highlight the potential of ALP-associated protein signatures in PBMCs as novel diagnostic biomarkers for early detection and intervention in PD, offering insights into the systemic manifestations of the disease
Association of Intensive Endoscopic Burden with Esophageal Cancer Detection: A Nationwide Cohort Study
No full textBackground/Aims: Early diagnosis of esophageal cancer (EC) remains challenging despite the increasing frequency of endoscopic screenings globally. The rapidly increasing number of endoscopic screenings performed over a certain period might influence diagnostic performance. This study evaluated the association between the number of endoscopic screenings and EC detection rates in a nationwide cohort. Methods: This retrospective population-based study used the Korean National Cancer Screening Program database, comprising 32,774,742 males and females aged ≥40 years between 2015 and 2019. Negative binomial regression model and least-squares mean evaluation were used to assess the association between month of the year and EC detection rates. Results: This study enrolled 28,032,590 participants who underwent upper endoscopy. The number of participants in the fourth quarter (October to December: 10,923,142 [39.0%]) was 2.1 times higher than that in the first quarter (January to March: 5,085,087 [18.1%]); this trend continued for all 5 years. Contrarily, detection rates for EC in the fourth quarter (0.08/1,000 person) were half that in the first quarter (0.15/1,000 person). The odds of detecting EC were lowest in November; in 2015 the odds were 0.57 (95% confidence interval, 0.41 to 0.79; p=0.001) times lower and in 2016, they were 0.51 (95% confidence interval, 0.37 to 0.68; p<0.001) times lower compared to January. The predicted detection rates showed a decreasing trend toward the end of the year (p>0.05 for all). Conclusions: The workload of endoscopists increased excessively with the rising number of endoscopies toward the end of the year, which was reflected by the decreased EC detection rates during this period
A single-cell RNA sequencing dataset of peripheral blood cells in long COVID patients on herbal therapy
No full textFollowing the coronavirus disease 2019 (COVID-19) pandemic, the rise of long COVID, characterized by persistent respiratory and cognitive dysfunctions, has become a significant health concern. This leads to an increased role of complementary and alternative medicine in addressing this condition. However, our comprehension of the effectiveness and safety of herbal medicines for long COVID remains limited. Here, we present a single-cell RNA sequencing (scRNA-seq) dataset of peripheral whole blood cells derived from participants in a clinical study involving three commercially available herbal medicines, targeting fatigue and brain fog in long COVID. The dataset comprises 181,205 quality control (QC)-passed cells, along with clinical metadata, enabling a comparative analysis of immune cell populations before and after treatment. To ensure the technical validity of our dataset, we implemented rigorous quality checks throughout stages of the study, including sample preparation, sequencing, and bioinformatic data analysis levels. This transcriptomic data may serve as a resource to deepen our insights into the role of herbal medicines in management of long COVID