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Jiwon Lee,1 Dong Woo Han,1 Na Young Kim,2 Keun-Su Kim,3 Yunil Yang,1 Juyeon Yang,4 Hye Sun Lee,4 Myoung Hwa Kim1 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea; 2Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 4Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Myoung Hwa Kim, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea, Fax +82-2-3463-0940, Email KMH2050@yuhs.acPurpose: Remimazolam is a newly developed ultra-short-acting benzodiazepine. We compared overall functional recovery, including the postoperative Quality of Recovery-15 (QoR-15) questionnaire scores, between balanced inhalational anesthesia using sevoflurane and total intravenous anesthesia (TIVA) with remimazolam in patients undergoing anterior cervical discectomy and fusion (ACDF).Patients and Methods: Seventy-two patients were randomized to the remimazolam (group R) or sevoflurane (group S) group. The primary outcome was the total QoR-15 score on postoperative day (POD) 1. We also assessed the total QoR-15 score on POD2, sub-scores of the QoR-15, perioperative parameters, and postoperative recovery profiles. Group-time interaction effects on the QoR-15 and its sub-scores were analyzed using a linear mixed model.Results: The total QoR-15 score on POD1 (120.2 in group R vs 114.3 in group S, P=0.189) was not statistically different between the groups. There were no significant group-time in

Min Choi,1 Hye Sun Lee,2 Sung Bin Cho3 1R&D Center, Shenb Co., Ltd, Seoul, Korea; 2Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea; 3Yonsei Seran Dermatology and Laser Clinic, Seoul, KoreaCorrespondence: Sung Bin Cho, Yonsei Seran Dermatology and Laser Clinic, Geumcheon REMAIN CITY 6F, 224 Siheung-daero, Geumcheon-gu, Seoul, 08628, Korea, Tel +82.2-2135-1375, Fax +82.70-8250-1375, Email drsbcho@gmail.comBackground: Radiofrequency (RF) oscillations generate thermal tissue reactions, the patterns of which vary depending on the mode and efficiency of energy delivery. The aim of our study was to analyze patterns of RF-induced thermal tissue reactions according to the modes of RF delivery, including continuous and gated modes, using an alternating current, invasive bipolar RF device.Methods: RF energies at frequencies of 1 and 2 MHz were delivered at respective experimental settings into ex vivo bovine liver tissue at a 0.5-mm microneedle penetration depth. The tissue samples were then evaluated thermometrically. A histologic study was performed to evaluate RF-induced thermal tissue reactions at a 3.0-mm microneedle penetration depth.Results: Thermal imaging study revealed homogenous, well-demarcated, square-shaped zones of RF-induced thermal reactivity on the treated area. Multivariate linear regression analysis revealed that higher temperature elevations immediately after RF treatment (∆T1) were positively associated with RF frequency, power, conduction time/pulse pack, and off-time between pulse packs and negatively associated with total off time. In the 1-MHz experimental setting, higher ∆T1 showed a positive association with power, conduction time/pulse pack, and off-time between pulse packs and a negative association with the number of pulse packs. In the 2-MHz setting, however, higher ∆T1 was positively associated with only total treatment time.Conclusion: Thermometric effects during bipolar and gated RF treatments are si

Hye Jung Park,1 Soyoung Jeon,2 Hye Sun Lee,2 Bo Yeon Kim,3 Yu Jin Chae,3 Gui Ok Kim,3 Jung-Won Park,4,5 Jae-Hyun Lee4,5 1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea; 4Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 5Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Jae-Hyun Lee, Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, Tel +82-2-2228-1977, Fax +82-2-393-6884, Email jhleemd@yuhs.acBackground: Although a wide variety of asthma medications have been developed and are used in clinical practice, there is limited evidence of their comparative effects on asthma exacerbations.Methods: We used claims data provided by the Health Insurance Review and Assessment Service. We selected subjects commencing asthma treatment between July 1, 2017 and June 30, 2018, with no change in drug regimen. The primary outcome was asthma exacerbation requiring systemic corticosteroids. Cox regression analysis was used to assess outcomes considering the exacerbation-free period.Results: Of the 254,951 asthma subjects, 107,694 subjects (42.2%) experienced asthma exacerbation. Inhaled corticosteroids (ICSs) (hazard ratio [HR], 0.378– 0.508), ICS-long-acting β2-agonist (LABAs) (HR, 0.284– 0.479), long-acting muscarine antagonists (LAMAs) (HR, 0.432– 0.572), leukotriene receptor antagonists (LTRAs) (HR, 0.371– 0.419), and xanthines (HR, 0.326– 0.482) significantly reduced the rate of first and second exacerbation of asthma (all P-values, < 0.001)

Jung Hyun Kim,1 Jae-Hoon Lee,2 Hye Sun Lee,3 Su-Jin Shin,4 Eun Jung Park,1 Eun-Suk Cho,5 Seung Hyuk Baik,1 Kang Young Lee,6 Jeonghyun Kang1 1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea; 4Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 5Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 6Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Jeonghyun KangDepartment of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of KoreaTel +82-2-2019-3372Fax +82-2-3462-5994Email ravic@naver.comBackground: Recent data suggest that alterations in the neutrophil-to-lymphocyte ratio (NLR) in the perioperative periods can serve as prognostic factors. However, research on the clinical impact has been limited and even discordant in patients with colorectal cancer (CRC).Patients and Methods: The optimal cut-off value of preoperative NLR (NLR-pre), postoperative NLR (NLR-post), and its change (NLR-delta) were determined to maximize differences in overall survival (OS) between groups. Patients were categorized into four groups (NLR-trend) as follows: G1, low NLR-pre and NLR-post; G2, low NLR-pre and high NLR-post; G3, high NLR-pre and low NLR-post; and G4, high NLR-pre and NLR-post. Discriminatory performance was compared using integrated AUC (iAUC) between all indicators.Results: A total of 576 patients diagnosed with stage I–IV CRC were included. The cut-off points were determined as 2.33 for NLR-pre, 2.06 for NLR-pos

Jae-Min Park,1,2 Hye Sun Lee,3 Ju-Young Park,4 Dong-Hyuk Jung,5 Ji-Won Lee1 1Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea; 2Department of Medicine, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea; 3Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea; 4Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea; 5Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Gyeonggi-do, Republic of KoreaCorrespondence: Ji-Won LeeDepartment of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of KoreaTel +82 2 2019 3482Fax +82 2 3462 8209Email indi5645@yuhs.acPurpose: Limited evidence is available on whether the white blood cell (WBC) count is a predictor of type 2 diabetes mellitus (T2DM) in non-obese individuals. This study aimed to determine whether WBC count could be used as an indicator for the prediction of incident T2DM among non-obese individuals using a large, community-based Korean cohort that was observed over 10 years.Patients and methods: A total of 4211 non-obese adults without diabetes aged 40– 69 years were selected from the Korean Genome and Epidemiology Study. The participants were divided into four groups according to WBC count quartiles. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM, based on the American Diabetes Association criteria, using multivariate Cox proportional hazards regression models over 10 years after the baseline survey.Results: During the follow-up period, 592 (14.1%) participants had newly developed T2DM. The higher quartile of WBC count groups showed significantly higher cumulative T2DM incidence over 10 years after the baseline survey (log-rank test, P < 0.001). Comp

Yu-Jin Kwon,1– 3 Hyangkyu Lee,4 Chung Mo Nam,5 Hyuk-Jae Chang,6 Young-Ran Yoon,7 Hye Sun Lee,8 Ji-Won Lee1 1Department of Family Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea; 2Department of Medicine, Graduate School of Yonsei University College of Medicine, Seoul, Republic of Korea; 3Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; 4 Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea; 5Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 6Department of Internal Medicine, Division of Cardiology, Severance Cardiovascular Hosp, Yonsei University College of Medicine, Seoul, Republic of Korea; 7Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; 8Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Ji-Won LeeDepartment of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju‐ro, Gangnam‐gu, 06273, Seoul, 135-720, Republic of KoreaTel +82 2 2019 3480Fax +82 3462 8209Email indi5645@yuhs.acBackground: In clinical practice, concomitant treatment of orlistat with phentermine is commonly used off-label. However, clinical trials have not been performed to evaluate whether their combination improves metabolic parameters and cardiovascular risk factors other than weight loss. Therefore, we aimed to compare the efficacy of concomitant administration of orlistat and phentermine versus phentermine alone on the endothelial cell function in overweight and obese adults with back pain.Methods: We conducted a 12-week, double-blinded, placebo-controlled clinical trial involving 114 patients with a body mass index of ≥ 30 (obese) or ≥ 27 (overweight) with we

A-Ra Cho,1 Won-Jun Choi,2 Yu-Jin Kwon,1 Hye Sun Lee,3 Sung Gwe Ahn,4 Ji-Won Lee5 1Department of Family Medicine, Yong-in Severance Hospital, Yonsei University College of Medicine, Yong‑in 16995, Republic of Korea; 2Department of Medicine, Graduate School, Yonsei University, Seoul 03722, Republic of Korea; 3Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; 4Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; 5Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of KoreaCorrespondence: Ji-Won Lee Department of Family MedicineGangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of KoreaTel +82 2 2019 3482Email indi5645@yuhs.acIntroduction: The objective of this pilot randomized controlled trial was to investigate the combined effect of a Mediterranean diet and naltrexone/bupropion treatment on body weight, metabolic parameters, and quality of life in overweight or obese breast cancer survivors.Methods: Forty-four breast cancer survivors were randomly assigned to receive the Mediterranean diet plus naltrexone/bupropion medication (breast cancer survivor MeDiet+NB group) or the Mediterranean diet alone (breast cancer survivor MeDiet-only group). Twenty-eight age-matched non-cancer patients were instructed to consume the Mediterranean diet plus naltrexone/bupropion medication (non-cancer MeDiet+NB group). After the 8-week intervention, changes in body weight, metabolic parameters, nutrient intake, and quality of life of the three groups were assessed.Results: Significant weight loss of 2.8 kg was noted for the breast cancer survivor MeDiet+NB group, 1.8 kg for the breast cancer survivor MeDiet-only group, and 2.5 kg for the non-cancer MeDiet+NB group after 8 weeks (P < 0.05 versus b

BACKGROUND & AIMS: Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous entity with diverse etiologies, morphologies, and clinical outcomes. Recently, histopathological distinction of cholangiolocellular differentiation (CD) of iCCA has been suggested. However, its genome-wide molecular features and clinical significance remain unclear.METHODS: Based on CD status, we stratified iCCAs into iCCA with CD (n=20) and iCCA without CD (n=102), and performed an integrative analysis using transcriptomic and clinicopathological profiles.RESULTS: iCCA with CD revealed less aggressive histopathological features compared to iCCA without CD, and iCCA with CD showed favorable clinical outcomes of overall survival and time to recurrence than iCCA without CD (P < 0.05 for all). Transcriptomic profiling revealed that iCCA with CD resembled an inflammation-related subtype, while iCCA without CD resembled a proliferation subtype. In addition, we identified a CD signature that can predict prognostic outcomes of iCCA (CD_UP, n=486 and CD_DOWN, n=308). iCCAs were subgrouped into G1 (positivity for CRP and CDH2, 7%), G3 (positivity for S100P and TFF1, 32%), and G2 (the others, 61%). Prognostic outcomes for OS (P=0.001) and TTR (P=0.017) were the most favorable in G1-iCCAs, intermediate in G2-iCCAs, and the worst in G3-iCCAs. Similar result was confirmed in the iCCA set from GSE26566 (n=68).CONCLUSIONS: CD signature was identified to predict the prognosis of iCCA. The combined evaluation of histology of CD and protein expression status of CRP, CDH2, TFF1, and S100P might help subtyping and predicting clinical outcomes of iCCA. This article is protected by copyright. All rights reserved.

BackgroundMetabolic syndrome (MS) is known to increase the risk of various cardiometabolic diseases and in-sulin resistance (IR) has known to have central role in the development of MS. Many surrogate indices of IR have been proposed and the detection of MS might be a suitable model for assessing the accuracy of surrogate indices. The aims of our study are to invest the most appropriate index by assessment of the diagnostic capacity of IR among each surrogate index and identifying cut-off values for discriminating uncomplicated MS in Korean adults.MethodsA cross-sectional study was performed, assessing 294 Korean adults, 85 of whom were diagnosed with uncomplicated MS. The sensitivities and specificities of five surrogate IR indices were compared to discriminate MS from healthy subjects; these included fasting serum insulin, homeostasis model assessment-insulin resistance index, quantitative insulin sensitivity check index, McAuley index, and Disse index. Correlations between each index value were assessed using Pearson's and Spearman's correlation methods.ResultsThe McAuley index showed the highest area under the curve (0.85), specificity (86.12%), accuracy (82.31%), positive predictive value (68.13%), and negative predictive value (88.67%) to distinguish MS, with a cut-off point of 5.3 defined. Correlation coefficients of the five indices showed that the McAuley index had the strongest correlation with IR.ConclusionThe McAuley index showed the best accuracy in the detection of MS as a surrogate marker of IR. To establish more effective and accurate standards of measuring IR, comprehensive and multi-scaled studies are required.