Prediction of persistent hemodynamic depression after carotid angioplasty and stenting using artificial neural network model

Jeon, Jin Pyeong,Kim, Chulho,Oh, Byoung-Doo,Kim, Sun Jeong,Kim, Yu-Seop Van Gorcum 2018 Clinical neurology and neurosurgery Vol.164 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>To assess and compare predictive factors for persistent hemodynamic depression (PHD) after carotid artery angioplasty and stenting (CAS) using artificial neural network (ANN) and multiple logistic regression (MLR) or support vector machines (SVM) models.</P> <P><B>Patients and methods</B></P> <P>A retrospective data set of patients (n=76) who underwent CAS from 2007 to 2014 was used as input (training cohort) to a back-propagation ANN using TensorFlow platform. PHD was defined when systolic blood pressure was less than 90mmHg or heart rate was less 50 beats/min that lasted for more than one hour. The resulting ANN was prospectively tested in 33 patients (test cohort) and compared with MLR or SVM models according to accuracy and receiver operating characteristics (ROC) curve analysis.</P> <P><B>Results</B></P> <P>No significant difference in baseline characteristics between the training cohort and the test cohort was observed. PHD was observed in 21 (27.6%) patients in the training cohort and 10 (30.3%) patients in the test cohort. In the training cohort, the accuracy of ANN for the prediction of PHD was 98.7% and the area under the ROC curve (AUROC) was 0.961. In the test cohort, the number of correctly classified instances was 32 (97.0%) using the ANN model. In contrast, the accuracy rate of MLR or SVM model was both 75.8%. ANN (AUROC: 0.950; 95% CI [confidence interval]: 0.813–0.996) showed superior predictive performance compared to MLR model (AUROC: 0.796; 95% CI: 0.620–0.915, p<0.001) or SVM model (AUROC: 0.885; 95% CI: 0.725-0.969, p<0.001).</P> <P><B>Conclusions</B></P> <P>The ANN model seems to have more powerful prediction capabilities than MLR or SVM model for persistent hemodynamic depression after CAS. External validation with a large cohort is needed to confirm our results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Prediction of hemodynamic depression after CAS is possible using artificial neural network. </LI> <LI> Accuracy of artificial neural network was 98.7% with 0.961 of AUROC. </LI> <LI> It is feasible to use artificial neural network to predict high-risk patient of hemodynamic depression. </LI> </UL> </P>

Elevated Cellular Retinoic Acid Binding Protein-I in Cerebrospinal Fluid of Patients with Hemorrhagic Cerebrovascular Diseases : Preliminary Study

Jeon, Jin Pyeong,Cho, Won-Sang,Kang, Hyun-Seung,Kim, Jeong Eun,Kim, Seung-Ki,Oh, Chang Wan The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.57 No.2

Objective : Elevated cellular retinoic acid binding protein-I (CRABP-I) is thought to be related to the abnormal proliferation and migration of smooth muscle cells (SMCs). Accordingly, a higher CRABP-I level could cause disorganized vessel walls by causing immature SMC phenotypes and altering extracellular matrix proteins which could result in vulnerable arterial walls with inadequate responses to hemodynamic stress. We hypothesized that elevated CRABP-I level in the cerebrospinal fluid (CSF) could be related to subarachnoid hemorrhage (SAH). Moreover, we also extended this hypothesis in patients with vascular malformation according to the presence of hemorrhage. Methods : We investigated the CSF of 26 patients : SAH, n=7; unruptured intracranial aneurysm (UIA), n=7; arteriovenous malformation (AVM), n=4; cavernous malformation (CM), n=3; control group, n=5. The optical density of CRABP-I was confirmed by Western blotting and presented as mean${\pm}$standard error of the measurement. Results : CRABP-I in SAH ($0.33{\pm}0.09$) was significantly higher than that in the UIA ($0.12{\pm}0.01$, p=0.033) or control group ($0.10{\pm}0.01$, p=0.012). Hemorrhage presenting AVM (mean 0.45, ranged 0.30-0.59) had a higher CRABP-I level than that in AVM without hemorrhage presentation (mean 0.16, ranged 0.14-0.17). The CRABP-I intensity in CM with hemorrhage was 0.21 and 0.31, and for CM without hemorrhage 0.14. Overall, the hemorrhage presenting group (n=11, $0.34{\pm}0.06$) showed a significantly higher CRABP-I intensity than that of the non-hemorrhage presenting group (n= 10, $0.13{\pm}0.01$, p=0.001). Conclusion : The results suggest that elevated CRABP-I in the CSF could be related with aneurysm rupture. Additionally, a higher CRABP-I level seems to be associated with hemorrhage development in vascular malformation.

Primary suction thrombectomy for acute ischemic stroke: A meta-analysis of the current literature

Jeon, Jin Pyeong,Kim, Sung-Eun,Kim, Chul Ho Van Gorcum 2017 Clinical neurology and neurosurgery Vol.163 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>We conducted a meta-analysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies (primary suction vs. stent retriever thrombectomy).</P> <P><B>Patients and methods</B></P> <P>We conducted a systemic literature review through an online data base from January 2004 through December 2016. The primary outcomes were rate of successful recanalization on final angiogram and good outcome three months after stroke onset. We used a fixed-effect model in cases with heterogeneity <50%.</P> <P><B>Results</B></P> <P>Fifteen articles were included. Primary suction thrombectomy achieved a successful recanalization rate of 85.2% (95% confidence interval [CI]: 79.9%–89.3%), a good clinical outcome rate of 52.7% (95% CI: 49.3%–56.2%) after the three-month follow-up, a mortality rate of 13.0% (95% CI: 8.9%–18.5%) and a symptomatic intracranial hemorrhage rate of 6.2% (95% CI: 4.8%–8.0%). The rates of recanalization (odds ratio [OR], 1.064; 95% CI: 0.202–5.608; p=0.571) and good outcomes (OR, 0.920; 95% CI: 0.570–1.486; p=0.735) did not differ significantly between primary suction thrombectomy and stent retriever thrombectomy.</P> <P><B>Conclusion</B></P> <P>Primary suction thrombectomy produced higher recanalization and good clinical outcome rates than did stent retriever thrombectomy. Larger-scale studies are necessary that consider factors such as occlusion site, stroke severity, and concomitant use of endovascular devices.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Primary suction thrombectomy showed a successful recanalization rate of 85.2%. </LI> <LI> Primary suction thrombectomy is technically feasible to treat hyperacute stroke. </LI> <LI> Mortality rate was similar between primary suction and stent retriever thrombectomy. </LI> </UL> </P>

Endovascular treatment of acute ischemic stroke in octogenarians: A meta-analysis of observational studies

Jeon, Jin Pyeong,Kim, Sung-Eun,Kim, Chul Ho Van Gorcum 2017 Clinical neurology and neurosurgery Vol.161 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>The aim of this study is to compare procedural outcomes after endovascular treatment (EVT) according to age (≥80 years vs. <80 years) and to examine treatment outcomes after mechanical thrombectomy using a stent retriever between the different age groups.</P> <P><B>Patients and methods</B></P> <P>A systemic literature review of an online database of articles published from January 2004 to February 2017 was conducted. The primary outcome was successful recanalization in the final angiogram and symptomatic intracranial hemorrhage (S-ICH) after EVT. The secondary outcome was good clinical outcome and mortality at 3 months. A random-effect model was used in cases of heterogeneity over 50%.</P> <P><B>Results</B></P> <P>Eight articles including 1711 patients compared outcomes according to age. Successful recanalization did not differ significantly between the two groups (≥80 years, n=214 (70.6%);<80years, n=1035 (73.5%); OR: 0.797; 95% CI: 0.599-1.060). Age ≥80 years did not significantly increase the risk of S-ICH (OR: 1.271; 95% CI: 0.784–2.060). Octogenarians showed lower good clinical outcome at 3 months (OR: 0.323; 95% CI: 0.233–0.448) and higher mortality (OR: 2.689; 95% CI: 2.050–3.527). Three studies including 670 patients (≥80 years, n=140;<80years, n=530) assessed outcomes after mechanical thrombectomy using a stent retriever. Successful recanalization (OR: 0.786; 95% CI: 0.507–1.218) and S-ICH (OR: 1.679; 95% CI: 0.918–3.071) did not significantly differ between the two groups.</P> <P><B>Conclusions</B></P> <P>Procedural outcomes such as successful recanalization and S-ICH after EVT in octogenarians are comparable to those seen in patients <80years. EVT is technically feasible to treat hyperacute stroke in octogenarians. Further large-scale studies dealing with various factors, such as occlusion site, stroke severity, comorbidities, and concomitant use of endovascular devices are required.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Procedural outcomes did not differ significantly between the different age groups. </LI> <LI> EVT is technically feasible to treat hyperacute stroke in octogenarians. </LI> <LI> Stent retriever thrombectomy showed 73.6% of recanalization rate in octogenarians. </LI> </UL> </P>

Blood Pressure Variability and Outcome in Patients with Acute Nonlobar Intracerebral Hemorrhage following Intensive Antihypertensive Treatment

Jeon, Jin Pyeong,Kim, Chulho,Kim, Sung-Eun Medknow PublicationsMedia Pvt Ltd 2018 Chinese medical journal : CMJ Vol.131 No.6

<P><B>Background:</B></P><P>Blood pressure (BP) variability has been associated with stroke risk. We elucidated the association between systolic BP (SBP) variation and outcomes in patients with nonlobar intracerebral hemorrhage (ICH) following intensive antihypertensive treatment upfront.</P><P><B>Methods:</B></P><P>We screened consecutive patients with spontaneous ICH who underwent intensive antihypertensive treatments targeting BP <140 mmHg between 2008 and 2016. SBPs were monitored hourly during the acute period (≤7 days after symptom onset) in the intensive care unit. SBP variability was determined in terms of range, standard deviation (SD), coefficient of variation (CoV), and mean absolute change (MAC). The primary outcomes included hematoma growth and poor clinical outcome at 3 months (modified Rankin Scale [mRS] score ≥3. The secondary outcome was an ordinal shift in mRS at 3 months.</P><P><B>Results:</B></P><P>A total of 104 individuals (mean age, 63.0 ± 13.5 years; male, 57.7%) were included in this study. In multivariable model, MAC (adjusted odds ratio [<I>OR</I>], 1.11; 95% confidence interval [<I>CI</I>]: 1.02–1.21; <I>P</I> = 0.012) rather than the range of SD or CoV, was significantly associated with hematoma growth even after adjusting for mean SBP level. Sixty-eight out of 104 patients (65.4%) had a poor clinical outcome at 3 months. SD and CoV of SBP were significantly associated with a 3-month poor clinical outcome even after adjusting for mean SBP. In addition, in multivariable ordinal logistic models, the MAC of SBP was significantly associated with higher shift of mRS at 3 months (adjusted <I>OR</I>, 1.08; 95% <I>CI</I>: 1.02–1.15; <I>P</I> = 0.008).</P><P><B>Conclusions:</B></P><P>The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH. Therefore, sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.</P>

A Recent Update of Clinical and Research Topics Concerning Adult Moyamoya Disease

Jeon, Jin Pyeong,Kim, Jeong Eun The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.6

A better understanding of moyamoya disease (MMD), such as natural clinical course, surgical outcomes and research, has been obtained. This review article focuses on an giving an update for adult MMD in the Korean population. In this paper, we mainly discuss the results of our domestic investigations including meta-analysis, and related subjects from other countries.

혈소판활성인자에 의해 유발된 비부비동염 흰쥐 모델

김진평,김은아,전시영,황의기 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.7

한국(韓國)의 문화(文化) : "이공계 글쓰기 예문 예제집"을 활용한 팀티칭 수업과 그 실제

남진숙 ( Jin Sook Nam ),이평전 ( Pyeong Jeon Lee ) 한국사상문화학회 2010 韓國思想과 文化 Vol.53 No.-

Endoscope‐assisted intraoral resection of external dermoid cyst

Kim, Jin Pyeong,Park, Jung Je,Jeon, Sea‐,Yuong,Ahn, Seong‐,Ki,Hur, Dong Gu,Kim, Dae‐,Woo,Park, Hyun Woo,Woo, Seung Hoon,Rosenthal, Eben L. Wiley Subscription Services, Inc., A Wiley Company 2012 Head & neck Vol.34 No.6

<P><B>Abstract</B></P><P><B>Background</B></P><P>Surgical removal of a dermoid cyst is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar.</P><P><B>Methods</B></P><P>We report the case of a 17‐year‐old woman with a submental mass. We implemented a modified approach to dermoid cyst removal through the floor of the mouth using an endoscope system.</P><P><B>Results</B></P><P>The patient received a modified approach to dermoid cyst removal and remains free of disease 6 months after excision.</P><P><B>Conclusion</B></P><P>Resection of the submental type dermoid cyst can be performed by an intraoral endoscope‐assisted approach through the floor of the mouth. We describe the procedure of the endoscope‐assisted intraoral resection. © 2011 Wiley Periodicals, Inc. Head Neck, 2011</P>

A Preliminary Study of the Association between SOX17 Gene Variants and Intracranial Aneurysms Using Exome Sequencing

Park, Jeong Jin,Kim, Bong Jun,Youn, Dong Hyuk,Choi, Hyuk Jai,Jeon, Jin Pyeong The Korean Neurosurgical Society 2020 Journal of Korean neurosurgical society Vol.63 No.5

Objective : Conflicting results regarding SOX17 genes and the risk of intracranial aneurysms (IA) exist in the Korean population, although significant positive correlations were noted in genome-wide association studies in European and Japanese populations. Therefore, we aimed to investigate an association between SOX17 gene variants and IA using exome sequencing data. Methods : This study included 26 age-gender matched IA patients and 26 control subjects. The SOX17 gene variants identified from whole-exome sequencing data were examined. Genetic associations to estimate odds ratio (OR) and 95% confidence interval (CI) were performed using the software EPACTS. Results : The mean age of the IA and control groups were 51.0±9.3 years and 49.4±14.3 years, respectively (p=0.623). Seven variants of SOX17, including six single nucleotide polymorphisms and one insertion and deletion, were observed. Among these variants, rs12544958 (A>G) showed the most association with IA, but the association was not statistically significant (OR, 1.97; 95% CI, 0.81-4.74; p=0.125). Minor allele frequencies of the IA patients and controls were 0.788 and 0.653, respectively. None of the remaining variants were significantly associated with IA formation. Conclusion : No significant association between SOX17 gene variants and IA were noted in the Korean population. A large-scale exome sequencing study is necessary to investigate any Korean-specific genetic susceptibility to IA.