EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial

Kang, Hyo Jae,Hwangbo, Bin,Lee, Geon-Kook,Nam, Byung-Ho,Lee, Hyun-Sung,Kim, Moon Soo,Lee, Jong Mog,Zo, Jae Ill,Lee, Hee Seok,Han, Ji-Youn BMJ Publishing Group Ltd 2014 Thorax Vol.69 No.3

<P><B>Background</B></P><P>The impact of procedure sequence and primary procedure has not been studied in the combined application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lung cancer staging.</P><P><B>Methods</B></P><P>In a randomised controlled trial, 160 patients with histologically confirmed or strongly suspected potentially operable non-small cell lung cancer were enrolled (Group A, n=80, EBUS-centred; Group B, n=80, EUS-centred). EBUS-TBNA and EUS-FNA with an ultrasound bronchoscope were used as the first procedures in Groups A and B, respectively, and secondary procedures (EUS-FNA in Group A, EBUS-TBNA in Group B) were added.</P><P><B>Results</B></P><P>Diagnostic values were evaluated in 148 patients (74 in each group). In Groups A and B the diagnostic accuracy (93.2% (95% CI 87.5% to 99.0%) vs 97.3% (95% CI 93.6% to 101.0%), p=0.245) and sensitivity (85.3% (95% CI 68.9% to 95.0%) vs 92.0% (95% CI 74.0% to 99.0%), p=0.431) in detecting mediastinal metastasis were not statistically different. In Group A, adding EUS-FNA to EBUS-TBNA did not significantly increase the accuracy (from 91.9% to 93.2%, p=0.754) or sensitivity (from 82.4% to 85.3%, p=0.742). In group B, adding EBUS-TBNA to EUS-FNA increased the accuracy (from 86.5% to 97.3%, p=0.016) and sensitivity (from 60.0% to 92.0%, p=0.008). There were no intergroup differences in procedure time, cardiorespiratory parameters during procedures, complications or patient satisfaction.</P><P><B>Conclusions</B></P><P>Using a combination of EBUS-TBNA and EUS-FNA in mediastinal staging, we found that diagnostic values and patient satisfaction were not different between the EBUS-centred and EUS-centred groups. However, the necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer.</P><P><B>Trial Registration number</B></P><P>ClinicalTrials.gov number NCT01385111.</P>

Randomised clinical trial of five ear acupuncture points for the treatment of overweight people

Yeo, Sujung,Kim, Kang Sik,Lim, Sabina BMJ Publishing Group Ltd 2014 ACUPUNCTURE IN MEDICINE Vol.32 No.2

<P><B>Objective</B></P><P>To evaluate the efficacy of the five ear acupuncture points (Shen-men, Spleen, Stomach, Hunger, Endocrine), generally used in Korean clinics for treating obesity, and compare them with the Hunger acupuncture point.</P><P><B>Methods</B></P><P>A randomised controlled clinical trial was conducted in 91 Koreans (16 male and 75 female, body mass index (BMI)≥23), who had not received any other weight control treatment within the past 6 months. Subjects were divided randomly into treatment I, treatment II or sham control groups and received unilateral auricular acupuncture with indwelling needles replaced weekly for 8 weeks. Treatment I group received acupuncture at the five ear acupuncture points, treatment II group at the Hunger acupuncture point only and the sham control group received acupuncture at the five ear acupuncture points used in treatment I, but the needles were removed immediately after insertion. BMI, waist circumference, weight, body fat mass (BFM), percentage body fat and blood pressure were measured at baseline and at 4 and 8 weeks after treatment.</P><P><B>Results</B></P><P>For the 58 participants who provided data at 8 weeks, significant differences in BMI, weight and BFM were found between the treatment and control groups. Treatment groups I and II showed 6.1% and 5.7% reduction in BMI, respectively (p<0.004). There were no significant differences between the two treatment groups.</P><P><B>Conclusions</B></P><P>This finding suggests that the five ear acupuncture points, generally used in Korean clinics, and the Hunger point alone treatment are both effective for treating overweight people.</P>

0199 Using machine learning to efficiently use multiple experts to assign occupational lead exposure estimates in a case-control study

Friesen, Melissa C,Locke, Sarah J,Zaebst, Dennis,Viet, Susan,Shortreed, Susan,Chen, Yu-Cheng,Koh, Dong-Hee,Pardo, Larissa,Schwartz, Kendra L,Davis, Faith G,Stewart, Patricia A,Colt, Joanne S,Purdue, M BMJ Publishing Group Ltd 2014 Occupational and environmental medicine Vol.71 No.suppl1

<P><B>Objectives</B></P><P>We applied machine learning approaches to efficiently assist multiple experts to transparently estimate occupational lead exposure in a case-control study of renal cell carcinoma.</P><P><B>Method</B></P><P>We used hierarchical cluster models to classify the 7154 study jobs with occupational history and job/industry questionnaires into 360 groups with similar responses. Each group was reviewed independently by two or three experts and was assigned probabilities of lead exposure (<5%, ≥5– <50%, ≥50%) for three time periods (<1980, 1980–1994, ≥1995). When the group’s mean response pattern suggested within-group exposure variability, experts identified programmable conditions that defined the rating differences where possible or flagged the group for further review. After splitting jobs that overlapped time periods at the calendar cut point, the 9992 job/time periods were assigned their relevant expert/group/time period estimate. Classification and regression tree (CART) models were developed to predict each expert’s expected assignment, based on previous decisions, to assign estimates for jobs in groups that expert had not assessed and for jobs requiring further review.</P><P><B>Results</B></P><P>In preliminary analyses, CART models predicted 91–96% of the experts’ pre-1995 estimates and 77–96% of ≥1995 estimates. CART estimates were assigned to 3–48% of the job/time periods, varying by expert. Overall, 92% of the job/time periods were assigned the same estimate by at least two experts.</P><P><B>Conclusions</B></P><P>Our framework reduced the number of exposure decisions needed from each expert compared to job-by-job assessment. Future work will use CART models to identify differences between experts to be resolved and incorporate frequency and intensity of lead exposure estimates.</P>

Expression of stanniocalcin-1 in culprit coronary plaques of patients with acute myocardial infarction or stable angina

Lee, Cheol Whan,Hwang, Ilseon,Park, Chan-Sik,Lee, Hyangsin,Park, Duk-Woo,Kang, Soo-Jin,Lee, Seung-Whan,Kim, Young-Hak,Park, Seong-Wook,Park, Seung-Jung BMJ Publishing Group Ltd 2013 Journal of clinical pathology Vol.66 No.9

<P><B>Background</B></P><P>Stanniocalcin-1 (STC1) is involved in fundamental biological processes such as angiogenesis, inflammation and wound healing, but little is known about its expression in human coronary atherosclerotic plaques or its relationship to plaque instability.</P><P><B>Objective</B></P><P>STC1 expression was examined in the culprit coronary plaques of 70 patients with acute myocardial infarction (AMI; n=49) or stable angina (n=21) who underwent directional coronary atherectomy.</P><P><B>Methods</B></P><P>The specimens were stained with H&E, STC1-specific antibodies, and endothelial cells, macrophages and smooth muscle cell markers.</P><P><B>Results</B></P><P>The baseline characteristics of the two groups of patients were largely similar. CD31-immunopositive and CD68-immunopositive areas, indicative of the presence of endothelial cells and macrophages, respectively, were proportionately larger while areas immunopositive for α-actin, as a smooth muscle cell marker, were proportionately smaller in the AMI group than in the stable angina group. The proportion of STC1-immunopositive areas was significantly greater in the AMI group than in the stable angina group (20.0% (8.2–29.0%) vs 8.8% (3.9–19.4%), p=0.022). Areas positive for STC1 were independently correlated with those immunopositive for CD31 (r=0.42, p<0.001) and CD68 (r=0.40, p<0.001). STC1 immunoreactivity co-localised with CD31-immunopositive and CD68-immunopositive cells.</P><P><B>Conclusions</B></P><P>STC1 is differentially expressed in the culprit coronary plaques of patients with AMI versus those with stable angina. STC1 may play a role in plaque instability.</P>

Progressive change in peripapillary atrophy in myopic glaucomatous eyes

Song, Min Kyung,Sung, Kyung Rim,Shin, Joong Won,Kwon, Junki,Lee, Ji Yun,Park, Ji Min BMJ Publishing Group Ltd 2018 British journal of ophthalmology Vol.102 No.11

<P><B>Aim</B></P><P>To evaluate the progressive change in peripapillary atrophy (PPA) according to its shape and to explore the relationship between PPA progression and glaucoma worsening in myopic eyes.</P><P><B>Methods</B></P><P>A total of 159 eyes of 159 patients with myopic (axial length (AXL) >24 mm) glaucoma (mean follow-up 4.4 years, 35 eyes with minimal PPA, 40 concentric-type PPA eyes (>270° around the optic disc) and 84 eccentric-type PPA eyes (<270°)) were included. Sequential stereoscopic colour optic disc photographs were evaluated to qualitatively determine PPA progression. Factors associated with PPA progression were explored by Cox proportional hazard modelling in each PPA group.</P><P><B>Results</B></P><P>Patients with concentric PPA were older than patients with eccentric PPA (54.1±11.7 vs 44.1±11.7 years; P<0.001), and AXL was longer in the eccentric group than in the other groups (25.54±1.68 vs 25.28±1.53 vs 26.41±1.29 mm; P<0.001). Twenty-six eyes (65%) in the concentric group and 36 eyes (42.9%) in the eccentric group showed PPA progression. Older age (hazard ratio (HR) 1.059, P=0.008), worse baseline visual field mean deviation (HR 0.857, P=0.009) and greater baseline PPA area (HR 1.000, P=0.012) were associated with PPA progression in the concentric type. Glaucoma progression (HR 3.690, P=0.002) and longer AXL (HR 1.521, P=0.002) were associated with PPA progression in the eccentric type.</P><P><B>Conclusions</B></P><P>Relationship between glaucoma worsening and PPA progression was strongest in myopic glaucomatous eyes with eccentric type PPA.</P>

Role of allostatic load and health behaviours in explaining socioeconomic disparities in mortality: a structural equation modelling approach

Kim, Gyu Ri,Jee, Sun Ha,Pikhart, Hynek BMJ Publishing Group Ltd 2018 Journal of epidemiology & community health Vol.72 No.6

<P>Conclusions Our findings provide support for the mediating role of AL and health behaviours in the link between SEP and mortality. Policies designed to reduce social disparities in mortality in the long term should primarily focus on reducing stress and promoting healthy lifestyles among the socially disadvantaged groups. Future studies should further assess the role of other mediators such as psychosocial factors, which may contribute to socioeconomic inequalities in mortality.</P>

Extrastriatal dopaminergic changes in Parkinson’s disease patients with impulse control disorders

Lee, Jee-Young,Seo, Seong Ho,Kim, Yu Kyeong,Yoo, Hye Bin,Kim, Young Eun,Song, In Chan,Lee, Jae Sung,Jeon, Beom S BMJ Publishing Group Ltd 2014 Journal of neurology, neurosurgery and psychiatry Vol.85 No.1

<P><B>Objective</B></P><P>To investigate the extrastriatal dopaminergic neural changes in relation to the medication-related impulse control disorders (ICD) in Parkinson's disease (PD).</P><P><B>Method</B></P><P>A total of 31 subjects (11 and 11 drug-treated PD patients with and without medication-related ICDs and 9 healthy controls) having no other co-morbid psychiatric disorders participated in this study. Each subject underwent dynamic <I>N</I>-(3-[<SUP>18</SUP>F]fluoropropyl)-2-carbomethoxy-3-(4-iodophenyl) nortropane (FP-CIT) positron emission tomography scans. Binding potentials (BP) at nucleus accumbens, amygdala, orbitofrontal and ventromedial prefrontal cortex (VMPFC), putamen and caudate nucleus were estimated, and whole brain parametric maps of [<SUP>18</SUP>F]-FP-CIT binding were analysed by original and putaminal normalised manners.</P><P><B>Results</B></P><P>Compared with the healthy controls, BPs at both VMPFCs were significantly high and the extrastriatal to putaminal BP ratios at all regions were approximately three times higher in both PD groups. The PD ICD patients showed significantly higher BPs at the right VMPFC and tendency to lower BPs at the left nucleus accumbens compared with those free of ICD. The ICD subjects also showed reduced uptakes at both ventral striatal regions in the original parametric analysis and higher uptakes at the left insular and right posterior cingulate cortex and lower uptakes at both ventral pallidums in the putaminal normalised parametric analysis compared with the non-ICD subjects.</P><P><B>Conclusions</B></P><P>A great gap in extrastriatal versus striatal dopaminergic fibre degenerations is an intrinsic condition predisposing to ICD in PD. Distinct pattern of extrastriatal changes between the ICD and non-ICD patients could provide a further insight into a mechanism of ICD in PD.</P>

Phase IIb multicentred randomised trial of besifovir (LB80380) versus entecavir in Asian patients with chronic hepatitis B

Lai, Ching-Lung,Ahn, Sang Hoon,Lee, Kwan Sik,Um, Soon Ho,Cho, Mong,Yoon, Seung Kew,Lee, Jin-Woo,Park, Neung Hwa,Kweon, Young-Oh,Sohn, Joo Hyun,Lee, Jiyoon,Kim, Jeong-Ae,Han, Kwang-Hyub,Yuen, Man-Fung BMJ Publishing Group Ltd 2014 Gut Vol.63 No.6

<P><B>Background</B></P><P>Besifovir (LB80380) is an acyclic nucleotide phosphonate effective in hepatitis B virus (HBV) DNA suppression for both treatment-naive and lamivudine-resistant chronic hepatitis B (CHB) patients in preliminary studies.</P><P><B>Design</B></P><P>We aimed to compare the safety and antiviral activity of two doses of besifovir (90 mg and 150 mg daily) with entecavir 0.5 mg daily in CHB patients. 114 patients were randomised to receive besifovir 90 mg daily (n=36), besifovir 150 mg daily (n=39) or entecavir 0.5 mg daily (n=39). HBV DNA and liver biochemistry, including serum L-carnitine levels, were monitored.</P><P><B>Results</B></P><P>At week 48, in the intention-to-treat population, the proportion of patients achieving undetectable HBV DNA (<20 IU/mL) were 63.6%, 62.9% and 58.3%, respectively (p>0.05). The serum mean log<SUB>10</SUB> HBV DNA changes from baseline for the HBeAg-positive patients were −5.84, −5.91 and −6.18, respectively; and for the HBeAg-negative patients were −4.65, −4.55 and −4.67, respectively (p>0.05). There were no differences in the proportions of patients achieving normalisation of alanine aminotransferase (91.7%, 76.9%, 89.7%, respectively) and HBeAg seroconversion (11.11%, 15%, 9.52%, respectively) among all three groups. None of the patients had resistant mutations or increase in serum creatinine of >0.5 mg/dL from baseline. 64 (94.1%) patients on besifovir had lowering of serum L-carnitine (not tested in entecavir patients). L-carnitine levels returned to normal with carnitine supplement.</P><P><B>Conclusions</B></P><P>At 48 weeks, 90 mg and 150 mg daily of besifovir were non-inferior to entecavir 0.5 mg daily in treatment-naive CHB patients. The only significant side effect of besifovir was L-carnitine depletion, requiring carnitine supplementation.</P>

Effect of vaccination with a porcine reproductive and respiratory syndrome subunit vaccine on sow reproductive performance in endemic farms

Jeong, Jiwoon,Kim, Seeun,Park, Changhoon,Kang, Ikjae,Park, Kee Hwan,Ham, Hee Jin,Chae, Chanhee BMJ Group Group Ltd 2018 The Veterinary record Vol.182 No.21

<P>The objective of this field study was to evaluate the reproductive performance of sows after vaccination with a porcine reproductive and respiratory syndrome (PRRS) subunit vaccine (PRRSFREE PRRS subunit vaccine, Reber Genetics, Taiwan, Republic of China) under field conditions. The study was performed in three farms with endemic infections with both PRRS virus (PRRSV)-1 and PRRSV-2, a situation representative of most Korean farms. Pregnant sows were immunised intramuscularly with 2.0 ml of the PRRS subunit vaccine at 58 and 79 days of gestation (eight and five weeks antepartum) according to the manufacturer's recommendation. Vaccination did not result in any observed adverse reaction. Vaccinated sows exhibited a significant improvement in reproductive performance (reduction of abortions) and litter characteristics (increase of weaned pigs) compared with unvaccinated sows. Vaccinated sows had significantly (P<0.05) higher PRRSV ELISA sample/positive ratio and number of PRRSV-specific interferon-y- secreting cells compared with the unvaccinated control group. The results of this study demonstrate that the PRRS subunit vaccine can improve the reproductive performance of sows in farms with endemic PRRSV infection.</P>

Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock

Park, Jin Sup,Cha, Kwang Soo,Lee, Dae Sung,Shin, Donghun,Lee, Hye Won,Oh, Jun-Hyok,Kim, Jeong Su,Choi, Jung Hyun,Park, Yong Hyun,Lee, Han Cheol,Kim, June Hong,Chun, Kook-Jin,Hong, Taek Jong,Jeong, Myu BMJ Publishing Group Ltd 2015 Heart Vol.101 No.15

<P><B>Objective</B></P><P>The value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD.</P><P><B>Methods</B></P><P>From 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75.7%) and multivessel revascularisation (n=124, 24.3%) groups. The primary outcomes were inhospital mortality and all-cause death during a median 194-day follow-up. A weighted Cox regression model was constructed to determine the HRs and 95% CIs for outcomes in the two groups.</P><P><B>Results</B></P><P>Compared with culprit vessel revascularisation, multivessel revascularisation had a significantly lower adjusted risk of inhospital mortality (9.3% vs 2.4%, HR 0.263, 95% CI 0.149 to 0.462, p<0.001) and all-cause death (13.1% vs 4.8%, HR 0.400, 95% CI 0.264 to 0.606, p<0.001), mainly because of fewer cardiac deaths (9.7% vs 4.8%, HR 0.510, 95% CI 0.329 to 0.790, p=0.002). In addition, multivessel revascularisation significantly decreased the adjusted risk of the composite endpoint of all-cause death, recurrent myocardial infarction and any revascularisation (20.3% vs 18.1%, HR 0.728, 95% CI 0.55 to 0.965, p=0.026).</P><P><B>Conclusions</B></P><P>This study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients.</P>