Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

이재철,장해동,Joonghyun Ahn,최성우,강덕원,신병준 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: A retrospective cohort study. Purpose: To compare the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) supplemented with plate fixation using allograft with those who underwent ACDF using tricortical iliac autograft. Overview of Literature: As plate fixation is becoming popular, it is reported that ACDF using allograft may have similar outcomes compared with ACDF using autograft. Methods: Forty-one patients who underwent ACDF supplemented with plate fixation were included in this study. We evaluated 24 patients who used cortical ring allograft filled with demineralized bone matrix (DBM) (group A) and 17 patients who used tricortical iliac autograft (group B). In radiological evaluations, fusion rate, subsidence of grafted material, cervical lordosis, fused segmental lordosis, and radiological adjacent segment degeneration (ASD) were observed and analyzed with preoperative and postoperative plain radiographs. Clinical outcomes were evaluated using the Neck Disability Index score, Odom criteria, and Visual Analog Scale score of neck and upper extremity pain. Radiological union was determined by dynamic radiographs using cutoff values of 1 mm of interspinous motion as the indication of pseudarthrosis. Results: There was no significant difference in the fusion rate, graft subsidence, cervical lordosis, fused segmental lordosis, and ASD incidence between the groups. Operative time was shorter in group A (136 min) than in group B (141 min), but it was not significant (p>0.05). Blood loss was greater in group B (325 mL) than in group A (210 mL, p=0.013). There was no difference in the clinical outcomes before and after surgery. Conclusions: In ACDF with plate fixation, cortical ring allograft filled with DBM group showed similar radiological and clinical outcomes compared with those of the autograft group. If the metal plate is reinforced, using cortical ring allograft could be a viable alternative to autograft.

Machine Learning-Based Predictor for Neurologic Outcomes in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation

( Tae Wan Kim ),( Joonghyun Ahn ),( Jeong-am Ryu ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Clinical Outcomes Associated with Degree of Hypernatremia in Neurocritically Ill Patients

Yun Im Lee,Joonghyun Ahn,Jeong-Am Ryu 대한신경외과학회 2023 Journal of Korean neurosurgical society Vol.66 No.1

Objective : Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia. Methods : Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis. Results : Among 1146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p<0.001 and p=0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR], 4.58; 95% confidence interval [CI], 2.15–9.75 and adjusted OR, 6.93; 95% CI, 3.46–13.90, respectively) and 28-day mortality (adjusted OR, 3.51; 95% CI, 1.54–7.98 and adjusted OR, 10.60; 95% CI, 5.10–21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p=0.720 and p=0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate. Conclusion : Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

Additive prognostic values of NT-proBNP and exercise stress echocardiography in asymptomatic patients with degenerative mitral regurgitation and preserved left ventricular ejection fraction

Park, Sung-Ji,Cho, Eun Jeong,Ahn, Joonghyun,Carriere, Keumhee,Kim, Eun Kyoung,Lee, Ga Yeon,Chang, Sung-A,Choi, Jin-Oh,Lee, Sang-Chol,Park, Seung Woo Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.236 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Exercise stress echocardiography (ESE) can be used to identify left ventricular (LV) dysfunction in asymptomatic chronic MR. NT-proBNP is the best marker for monitoring LV dysfunction.</P> <P><B>Objective</B></P> <P>The aim of this study was to estimate the complementary prognostic value of ESE and NT-proBNP in asymptomatic degenerative MR with preserved LV ejection fraction (EF).</P> <P><B>Methods</B></P> <P>Symptom-limited treadmill ESE was performed in 114 asymptomatic with significant degenerative MR (ERO >20mm, RV >30ml), LV end-systolic diameter <40mm and preserved LV function (EF >60%). Post-exercise EF increase of >4% was defined as contractile reserve (CR)+.</P> <P><B>Results</B></P> <P>MV operation was performed in 19 (16.7%) and new-onset LV systolic dysfunction was developed in 23 (20.2%) patients over 3.5±1.5years. Based on ROC curve analysis, a NT-pro BNP of 100 was deemed the most relevant cutoff value to predict primary outcome with Youden's index=131.84. In sequential Cox models, a model based on clinical data and resting echocardiography variables (χ<SUP>2</SUP> =6.87) was improved by NT-proBNP (χ<SUP>2</SUP> =13.9) and presence of CR in ESE (χ<SUP>2</SUP> =20.8; <I>p</I> =0.0002).</P> <P><B>Conclusions</B></P> <P>In asymptomatic moderate to severe or severe degenerative MR and preserved LVEF, the presence of CR in ESE and NT-proBNP provide important incremental clinical determinants. In particular, the prognosis is markedly poor for those with high NT-proBNP but with absence of CR than low NT-proBNP with presence of CR.</P>

Diagnostic Performance of Cardiac CT and Transthoracic Echocardiography for Detection of Surgically Confirmed Bicuspid Aortic Valve: Effect of Calcium Extent and Valve Subtypes

Jeongju Kim,Sung Mok Kim,Joonghyun Ahn,Jihoon Kim,Yeon Hyeon Choe 대한영상의학회 2023 대한영상의학회지 Vol.84 No.6

Purpose This study aimed to compare the diagnostic performance of cardiac CT and transthoracic echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve (BAV) subtype. Materials and Methods This retrospective study included 266 consecutive patients (106 with BAV and 160 with tricuspid aortic valve) who underwent cardiac CT and TTE before aortic valve replacement. Cardiac CT was used to evaluate the morphology of the aortic valve, and a calcium scoring scan was used to quantify valve calcium. The aortic valves were classified into fused and two-sinus types. The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for intraoperative inspection. Results CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy than TTE in detecting BAV (p < 0.001, p < 0.001, and p = 0.003, respectively). The TTE sensitivity tended to decrease as valvular calcification increased. The error rate of TTE for CT was 10.9% for the twosinus type of BAV and 28.3% for the fused type (p = 0.044). Conclusion Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help diagnose BAV, particularly in patients with severe valvular calcification.

A New Method for Aortic Valve Planimetry with High-Resolution 3-Dimensional MRI and Its Comparison with Conventional Cine MRI and Echocardiography for Assessing the Severity of Aortic Valvular Stenosis

Kim Hae Jin,Choe Yeon Hyeon,Kim Sung Mok,Kim Eun Kyung,Lee Mirae,Park Sung-Ji,Ahn Joonghyun,Carriere Keumhee C. 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.8

Objective: We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. Materials and Methods: We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. Results: The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2, 0.82 ± 0.34 cm2, and 0.80 ± 0.26 cm2, respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). Conclusion: High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.

Modified residual SYNTAX score and clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention

Park, Taek Kyu,Hahn, Joo-Yong,Yang, Jeong Hoon,Song, Young Bin,Choi, Seung-Hyuk,Choi, Jin-Ho,Lee, Sang Hoon,Ahn, Joonghyun,Carriere, Keumhee Cho,Gwon, Hyeon-Cheol Europa Digital and Publishing 2017 EuroIntervention Vol.13 No.1

<P>Conclusions: Complete revascularisation of lesions with >70% diameter stenosis in vessels 22.5 mm is better than ICR, and is a reasonable goal for patients with multivessel disease.</P>