Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate

정재승,손낙훈,이상은,홍성규,정창욱,곽철,김현회,홍성후,김용준,강석호,정진수,권태균,황의창,변석수 대한의학회 2018 Journal of Korean medical science Vol.33 No.43

Background: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). Methods: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. Results: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). Conclusion: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.

Application of Impulse Oscillometry in Adult Asthmatic Patients With Preserved Lung Function

김성렬,박경희,손낙훈,문진영,박혜정,김경철,Jung-Won Park,이재현 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.5

Purpose: It is difficult to assess airway obstruction using spirometry in adult asthmatic patients with preserved lung function. Impulse oscillometry (IOS) can detect not only airway resistance but also reactance. Therefore, IOS may be useful in assessing pulmonary function in such patients. We investigated the applicability of IOS for asthma patients with preserved lung function. Methods: Between 2015 and 2018, 1,248 adult asthmatic patients suspected of having asthma who visited the Allergy and Asthma Center of Severance Hospital underwent both spirometry and IOS. Consequently, 784 patients had asthma, 111 had chronic obstructive lung disease (COPD) or asthma-COPD overlap, and 7 had parenchymal lung disease. The remaining 346 patients had chronic cough without underlying lung or airway disease. Among the 784 asthmatic patients, 191 with decreased lung function (predicted forced expiratory volume in 1 second [FEV1] < 80%) were excluded. Propensity score matching was performed to adjust baseline characteristics between 346 non-asthmatic and 593 asthmatic patients with preserved lung function. Subsequently, we compared the spirometry and IOS parameters between the 329 asthmatic and 329 non-asthmatic patients. Results: Multiple logistic regression analysis showed that the area of reactance (AX) was associated with asthma with preserved lung function. In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of AX (AUC = 0.6823) for asthma was not significantly different from that of FEV1 (AUC = 0.6758). However, the AUC of a combination of AX and FEV1 (AUC = 0.7437) for asthma was significantly higher than that of FEV1 alone. The cutoff value of AX was 0.51 kPa/L in univariate ROC analysis. Conclusions: AX is associated with adult asthma with preserved lung function. Performing spirometry together with IOS is more beneficial than performing spirometry alone for diagnosing asthma in adult patients with preserved lung function.

Comparison of the Forefoot Pressure-Relieving Effects of Foot Orthoses

이태임,이은채,손낙훈,손민균 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.9

Purpose: Metatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad place-ment location remains a debated issue. We aimed to identify the most effective insole design that reduces forefoot plantar pres-sure and determine the optimal position for metatarsal pad placement. Materials and Methods: We recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking whileusing an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control),1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole(P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking pro-tocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proxi-mal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale. Results: The SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the locationof the metatarsal pad placement. Conclusion: Considering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shockabsorption may be more clinically useful.

Vaccine Effect on Household Transmission of Omicron and Delta SARS-CoV-2 Variants

김용찬,김봉영,손낙훈,Heo Namwoo,Nam Yooju,Shin Areum,Yang Andrew Jihoon,김민형,Kyong Taeyoung,Kang Eawha,Park Yoon Soo,김희정 대한의학회 2023 Journal of Korean medical science Vol.38 No.1

Background: We evaluated the household secondary attack rate (SAR) of the omicron and delta severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, according to the vaccination status of the index case and household contacts; further, in vaccinated index cases, we evaluated the effect of the antibody levels on household transmission. Methods: A prospective cross-sectional study of 92 index cases and 197 quarantined household contacts was performed. Tests for SARS-CoV-2 variant type and antibody level were conducted in index cases, and results of polymerase chain reaction tests (during the quarantine period) were collected from contacts. Association of antibody levels in vaccinated index cases and SAR was evaluated by multivariate regression analysis. Results: The SAR was higher in households exposed to omicron variant (42%) than in those exposed to delta variant (27%) (P = 0.040). SAR was 35% and 23% for unvaccinated and vaccinated delta variant exposed contacts, respectively. SAR was 44% and 41% for unvaccinated and vaccinated omicron exposed contacts, respectively. Booster dose immunisation of contacts or vaccination of index cases reduced SAR of vaccinated omicron variant exposed contacts. In a model with adjustment, anti-receptor-binding domain antibody levels in vaccinated index cases were inversely correlated with household transmission of both delta and omicron variants. Neutralising antibody levels had a similar relationship. Conclusion: Immunisation of household members may help to mitigate the current pandemic.

Association Study between Genetic Polymorphisms of CYP2C19 Gene and Essential Hypertension in Koreans

Ah-Ram Park(박아람),Eun-Soon Shin(신은순),Nak-Hoon Son(손낙훈),Yangsoo Jang(장양수),Dong-Jik Shin(신동직) 한국생명과학회 2010 생명과학회지 Vol.20 No.5

혈관 수축력 및 혈압 조절에 관여하는 것으로 알려진 아라키돈산을 물질 대사시키는 CYP2C19 유전자는 최근 심혈관 질환 관련 연구의 새로운 유전자로 제시되고 있다. 본 연구에서는 CYP2C19 유전자의 2 종류 다형성(CYP2C19<SUP>*</SUP>2와 CYP2C19<SUP>*</SUP>3)과 고혈압 간의 연관성을 조사하고자 하였다. 연세대학교 의료원 심장혈관병원에서 수집한 1,241명(환자군: 537명, 대조군: 704명)을 대상으로 SNaPShot™ assay를 이용하여 유전자형을 결정하였다. 두 종류의 다형성 가운데 CYP2C19<SUP>*</SUP>3의 대립인자형 및 유전자형의 빈도 분포가 환자군과 대조군 간에 유의한 차이를 나타냈다(p=0.019, p=0.023). 다중 로지스틱 회귀분석 결과, dominant model에서, CYP2C19<SUP>*</SUP>3 A 대립인자형은 본태성 고혈압과 매우 유의한 연관성을 나타냈다(OR, 0.723, p=0.032). 또한 CYP2C19 G-A haplotype은 고혈압 발생 위험을 매우 유의하게 감소시키는 것으로 조사되었다(OR, 0.714, p=0.015). 따라서 본 연구 결과는 CYP2C19<SUP>*</SUP>3 다형성이 본태성 고혈압 발생에 대한 보호 효과작용에 관여할 것이라는 증거를 제시하고자 한다. In humans, CYP2C19, a member of the cytochrome P450 subfamily, metabolizes arachidonic acid to produce epoxyicosanoid acids, which are involved in vascular tone and regulation of blood pressure (BP). Recent findings suggest that CYP2C19 gene polymorphisms might be considered as a novel candidate gene for cardiovascular disease. We thus focused on the Korean population to explore the association of two polymorphisms (CYP2C19<SUP>*</SUP>2 and <SUP>*</SUP>3) in this gene and essential hypertension (EH). A total of 1,241 participants (537 hypertensive subjects and 704 healthy controls) were recruited from the Yonsei Cardiovascular Genome Center in Korea. The CYP2C19 polymorphisms were genotyped using the SNaPShot™ assay. The allele and genotype frequencies of CYP2C19<SUP>*</SUP>3 showed significant difference between hypertensives and normotensives (P=0.019 and P=0.023, respectively). Logistic regression analysis indicated that the CYP2C19<SUP>*</SUP>3 A allele carriers were significantly associated with EH (OR, 0.723; 95% CI, 0.538-0.972, P=0.032) under a dominant model. In addition, CYP2C19 G-A haplotype (2C19<SUP>*</SUP>2 G-<SUP>*</SUP>3 A combination) was found to significantly reduce EH risk (OR, 0.714, P=0.015). We believe this provides evidence that CYP2C19<SUP>*</SUP>3 polymorphism may contribute to a protective effect in the development of EH.