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Prognostic Implication of Volumetric Quantitative CT Analysis in Patients with COVID-19: A Multicenter Study in Daegu, Korea

  • Byunggeon Park;Jongmin Park;Jae-Kwang Lim;Kyung Min Shin;Jaehee Lee;Hyewon Seo;Yong Hoon Lee;Jun Heo;Won Kee, Lee;Jin Young Kim;Ki Beom Kim;Sungjun Moon;Sooyoung, Choi
    • Korean Journal of Radiology
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    • v.21 no.11
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    • pp.1256-1264
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    • 2020
  • Objective: Lung segmentation using volumetric quantitative computed tomography (CT) analysis may help predict outcomes of patients with coronavirus disease (COVID-19). The aim of this study was to investigate the relationship between CT volumetric quantitative analysis and prognosis in patients with COVID-19. Materials and Methods: CT images from patients diagnosed with COVID-19 from February 18 to April 15, 2020 were retrospectively analyzed. CT with a negative finding, failure of quantitative analysis, or poor image quality was excluded. CT volumetric quantitative analysis was performed by automated volumetric methods. Patients were stratified into two risk groups according to CURB-65: mild (score of 0-1) and severe (2-5) pneumonia. Outcomes were evaluated according to the critical event-free survival (CEFS). The critical events were defined as mechanical ventilator care, ICU admission, or death. Multivariable Cox proportional hazards analyses were used to evaluate the relationship between the variables and prognosis. Results: Eighty-two patients (mean age, 63.1 ± 14.5 years; 42 females) were included. In the total cohort, male sex (hazard ratio [HR], 9.264; 95% confidence interval [CI], 2.021-42.457; p = 0.004), C-reactive protein (CRP) (HR, 1.080 per mg/dL; 95% CI, 1.010-1.156; p = 0.025), and COVID-affected lung proportion (CALP) (HR, 1.067 per percentage; 95% CI, 1.033-1.101; p < 0.001) were significantly associated with CEFS. CRP (HR, 1.164 per mg/dL; 95% CI, 1.006-1.347; p = 0.041) was independently associated with CEFS in the mild pneumonia group (n = 54). Normally aerated lung proportion (NALP) (HR, 0.872 per percentage; 95% CI, 0.794-0.957; p = 0.004) and NALP volume (NALPV) (HR, 1.002 per mL; 95% CI, 1.000-1.004; p = 0.019) were associated with a lower risk of critical events in the severe pneumonia group (n = 28). Conclusion: CRP in the mild pneumonia group; NALP and NALPV in the severe pneumonia group; and sex, CRP, and CALP in the total cohort were independently associated with CEFS in patients with COVID-19.

Effects of the interaction between seaweed consumption and the polygenic risk score on inflammation in Korean adults (한국 성인의 해조류 섭취와 다유전자 위험 점수 간의 상호작용이 염증에 미치는 영향)

  • Gayeon Hong;Dayeon Shin
    • Journal of Nutrition and Health
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    • v.57 no.2
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    • pp.211-227
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    • 2024
  • Introduction: Seaweed is a sustainable and underexplored source of bioactive compounds with potent anti-inflammatory activities. However, studies on the interaction between seaweed and genes on inflammation are limited. Purpose: We aimed to evaluate the relationships between seaweed consumption and the polygenic risk scores (PRS) and their interactions with high-sensitivity C-reactive protein (hs-CRP) levels. Methods: Information on seaweed consumption was collected using a food frequency questionnaire, which included laver, kelp, and sea mustard among the items consumed. A total of 31 hs-CRP-related single nucleotide polymorphisms (SNPs) were selected using genome-wide association studies and clumping analysis, and the individual PRS were calculated by weighting the effect size of each allele in the selected SNPs of 39,369 middle-aged (≥40 years) Koreans using the Korean Genome and Epidemiology Study (KoGES)-Health Examinees (HEXA) cohort data. To investigate the interaction between seaweed intake and the PRS on hs-CRP levels >1 mg/L, hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using multivariable Cox proportional hazards models. Results: During a mean follow-up period of 4.8 years, we recorded 436 patients with elevated hs-CRP levels. Women in the highest tertile of the PRS with the lowest quartile of seaweed intake had an increased incidence of elevated hs-CRP levels compared with women in the lowest tertile of the PRS with the lowest seaweed intake quartile (HR 2.34, 95% CI 1.23-4.45). No significant association was observed among the men. Conclusion: In conclusion, we identified a new interaction between the PRS, seaweed intake, and inflammation in Korean women, and this study suggests that the interaction between the identification of genetic predisposition and dietary seaweed intake may have an impact on determining the risk of developing hyperinflammation in the future.

Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality?

  • Mason D. Vialonga;Luke G. Menken;Alex Tang;John W. Yurek;Li Sun;John J. Feldman;Frank A. Liporace;Richard S. Yoon
    • Hip & pelvis
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    • v.34 no.1
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    • pp.25-34
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    • 2022
  • Purpose: Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(-) tests. Materials and Methods: A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19- tests. The primary outcome was mortality at 30-days and 90-days. Results: COVID-19+ patients had a higher mortality rate than COVID-19- patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion: Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.

Pareto Ratio and Inequality Level of Knowledge Sharing in Virtual Knowledge Collaboration: Analysis of Behaviors on Wikipedia (지식 공유의 파레토 비율 및 불평등 정도와 가상 지식 협업: 위키피디아 행위 데이터 분석)

  • Park, Hyun-Jung;Shin, Kyung-Shik
    • Journal of Intelligence and Information Systems
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    • v.20 no.3
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    • pp.19-43
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    • 2014
  • The Pareto principle, also known as the 80-20 rule, states that roughly 80% of the effects come from 20% of the causes for many events including natural phenomena. It has been recognized as a golden rule in business with a wide application of such discovery like 20 percent of customers resulting in 80 percent of total sales. On the other hand, the Long Tail theory, pointing out that "the trivial many" produces more value than "the vital few," has gained popularity in recent times with a tremendous reduction of distribution and inventory costs through the development of ICT(Information and Communication Technology). This study started with a view to illuminating how these two primary business paradigms-Pareto principle and Long Tail theory-relates to the success of virtual knowledge collaboration. The importance of virtual knowledge collaboration is soaring in this era of globalization and virtualization transcending geographical and temporal constraints. Many previous studies on knowledge sharing have focused on the factors to affect knowledge sharing, seeking to boost individual knowledge sharing and resolve the social dilemma caused from the fact that rational individuals are likely to rather consume than contribute knowledge. Knowledge collaboration can be defined as the creation of knowledge by not only sharing knowledge, but also by transforming and integrating such knowledge. In this perspective of knowledge collaboration, the relative distribution of knowledge sharing among participants can count as much as the absolute amounts of individual knowledge sharing. In particular, whether the more contribution of the upper 20 percent of participants in knowledge sharing will enhance the efficiency of overall knowledge collaboration is an issue of interest. This study deals with the effect of this sort of knowledge sharing distribution on the efficiency of knowledge collaboration and is extended to reflect the work characteristics. All analyses were conducted based on actual data instead of self-reported questionnaire surveys. More specifically, we analyzed the collaborative behaviors of editors of 2,978 English Wikipedia featured articles, which are the best quality grade of articles in English Wikipedia. We adopted Pareto ratio, the ratio of the number of knowledge contribution of the upper 20 percent of participants to the total number of knowledge contribution made by the total participants of an article group, to examine the effect of Pareto principle. In addition, Gini coefficient, which represents the inequality of income among a group of people, was applied to reveal the effect of inequality of knowledge contribution. Hypotheses were set up based on the assumption that the higher ratio of knowledge contribution by more highly motivated participants will lead to the higher collaboration efficiency, but if the ratio gets too high, the collaboration efficiency will be exacerbated because overall informational diversity is threatened and knowledge contribution of less motivated participants is intimidated. Cox regression models were formulated for each of the focal variables-Pareto ratio and Gini coefficient-with seven control variables such as the number of editors involved in an article, the average time length between successive edits of an article, the number of sections a featured article has, etc. The dependent variable of the Cox models is the time spent from article initiation to promotion to the featured article level, indicating the efficiency of knowledge collaboration. To examine whether the effects of the focal variables vary depending on the characteristics of a group task, we classified 2,978 featured articles into two categories: Academic and Non-academic. Academic articles refer to at least one paper published at an SCI, SSCI, A&HCI, or SCIE journal. We assumed that academic articles are more complex, entail more information processing and problem solving, and thus require more skill variety and expertise. The analysis results indicate the followings; First, Pareto ratio and inequality of knowledge sharing relates in a curvilinear fashion to the collaboration efficiency in an online community, promoting it to an optimal point and undermining it thereafter. Second, the curvilinear effect of Pareto ratio and inequality of knowledge sharing on the collaboration efficiency is more sensitive with a more academic task in an online community.

Prognostic Factors of Patients Requiring Prolonged Mechanical Ventilation in a Medical Intensive Care Unit of Korea

  • Kim, Mi Hyun;Cho, Woo Hyun;Lee, Kwangha;Kim, Ki Uk;Jeon, Doo Soo;Park, Hye-Kyung;Kim, Yun Seong;Lee, Min Ki;Park, Soon Kew
    • Tuberculosis and Respiratory Diseases
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    • v.73 no.4
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    • pp.224-230
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    • 2012
  • Background: We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ${\geq}21$ days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. Methods: During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. Results: The mean age of the patients was $61.3{\pm}14.5$ years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was $21.3{\pm}8.4$ days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. Conclusion: We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.

Distinctions Between Clinicopathological Factors and Prognosis of Alpha-fetoprotein Negative and Positive Hepatocelluar Carcinoma Patients

  • Xu, Jia;Liu, Chang;Zhou, Lei;Tian, Feng;Tai, Ming-Hui;Wei, Ji-Chao;Qu, Kai;Meng, Fan-Di;Zhang, Ling-Qiang;Wang, Zhi-Xin;Zhang, Jing-Yao;Chang, Hu-Lin;Liu, Si-Nan;Xu, Xin-Shen;Song, Yan-Zhou;Liu, Jun;Zhang, Peng
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.2
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    • pp.559-562
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    • 2012
  • Serum alpha-fetoprotein (AFP) is a significant marker for clinical diagnosis and prognosis evaluation in hepatocellular carcinoma (HCC) patients. However, some proportion of liver cancer patients are AFP-negative (AFP ${\leq}$20ng/ml). In order to study the differences between clinicopathological factors and prognosis of alpha-fetoprotein negative and positive patients, a total of 114 cases (41 AFP-negative and 73 AFP-positive) were selected for our research. By systematically statistical analysis, the results demonstrated that compared with AFP-negative patients, AFP-positive examples were more likely to feature cirrhosis nodules, non-complete neoplasm capsules, and a poor Edmondson-steiner grade. Furthermore, AFP-negative patients demonstrated a favorable long-term prognosis. By univariate analysis and multivariate analysis with Cox's proportional hazards model, multiple tumors were found to be independent risk factors for worse survival of AFP negative patients; however, less tumor-free margins, multiple tumors and Edmondson-steiner grades III/IV, proved to be independent risk factors leading to a poor prognosis of AFP positive cases. Finally, we can infer that high levels of AFP signify a highly malignant tumor and unfavorable prognosis.

Citrus Ethanol Extracts Promotes Innate Immune Response by Activating NF-κB (유자 에탄올 추출물의 면역력 증진 효과)

  • Yang, Jiwon;Jeon, Hyelin;You, Yang Hee;Kim, Jin Young;Choi, Hyo-Kyoung;Choi, Kyung-Chul;Jun, Woo Jin;Yoon, Ho-Geun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.44 no.9
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    • pp.1256-1263
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    • 2015
  • Citrus junos Sieb. ex Tanaka has been traditionally called Yuza in Korea and is used as a cuisine material or tea as well as medicinal herb. In this study, we evaluated the immune-enhancing effect of Citrus junos ethanol extract (CJE) on RAW264.7 mouse macrophage and primary immunocytes. CJE treatment showed increased macrophage activity in a dose-dependant manner. CJE also enhanced natural killer (NK) cell activity. We measured lactate dehydrogenase (LDH) level as a measurement of NK cell cytotoxicity against YAC-1 lymphoma cells. CJE treatment showed an increased LDH level in a dose-dependent manner. Finally, we evaluated the effect of CJE on mouse primary splenocyte proliferation. CJE treatment slightly increased splenocyte proliferation compared to the control. The results of this study suggest that CJE can help immune function via macrophage cytokine production, increased NK cell activity, and splenocyte proliferation.

Suppression of 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced skin inflammation in mice by transduced Tat-Annexin protein

  • Lee, Sun-Hwa;Kim, Dae-Won;Eom, Seon-Ae;Jun, Se-Young;Park, Mee-Young;Kim, Duk-Soo;Kwon, Hyung-Joo;Kwon, Hyeok-Yil;Han, Kyu-Hyung;Park, Jin-Seu;Hwang, Hyun-Sook;Eum, Won-Sik;Choi, Soo-Young
    • BMB Reports
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    • v.45 no.6
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    • pp.354-359
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    • 2012
  • We examined that the protective effects of ANX1 on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced skin inflammation in animal models using a Tat-ANX1 protein. Topical application of the Tat-ANX1 protein markedly inhibited TPA-induced ear edema and expression levels of cyclooxygenase-2 (COX-2) as well as pro-inflammatory cytokines such as interleukin-1 beta (IL-$1{\beta}$), IL-6, and tumor necrosis factor-alpha (TNF-${\alpha}$). Also, application of Tat-ANX1 protein significantly inhibited nuclear translocation of nuclear factor-kappa B (NF-${\kappa}B$) and phosphorylation of p38 and extracellular signal-regulated kinase (ERK) mitogen-activated protein kinase (MAPK) in TPA-treated mice ears. The results indicate that Tat-ANX1 protein inhibits the inflammatory response by blocking NF-${\kappa}B$ and MAPK activation in TPA-induced mice ears. Therefore, the Tat-ANX1 protein may be useful as a therapeutic agent against inflammatory skin diseases.

Independent and Additive Interaction Between Tumor Necrosis Factor β +252 Polymorphisms and Chronic Hepatitis B and C Virus Infection on Risk and Prognosis of Hepatocellular Carcinoma: a Case-Control Study

  • Jeng, Jen-Eing;Wu, Hui-Fang;Tsai, Meng-Feng;Tsai, Huey-Ru;Chuang, Lea-Yea;Lin, Zu-Yau;Hsieh, Min-Yuh;Chen, Shinn-Chern;Chuang, Wan-Lung;Wang, Liang-Yen;Yu, Ming-Lung;Dai, Chia-Yen;Tsai, Jung-Fa
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.23
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    • pp.10209-10215
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    • 2015
  • To assess the contribution of tumor necrosis factor $(TNF){\beta}$ +252 polymorphisms to risk and prognosis of hepatocellular carcinoma (HCC), we enrolled 150 pairs of sex- and age-matched patients with HCC, patients with cirrhosis alone, and unrelated healthy controls. $TNF{\beta}$ +252 genotypes were determined by polymerase chain reaction with restriction fragment length polymorphism. Multivariate analysis indicated that $TNF{\beta}$ G/G genotype [odds ratio (OR), 3.64; 95%CI, 1.49-8.91], hepatitis B surface antigen (OR, 16.38; 95%CI, 8.30-32.33), and antibodies to hepatitis C virus (HCV) (OR, 39.11; 95%CI, 14.83-103.14) were independent risk factors for HCC. There was an additive interaction between $TNF{\beta}$ G/G genotype and chronic hepatitis B virus (HBV)/HCV infection (synergy index=1.15). Multivariate analysis indicated that factors associated with $TNF{\beta}$ G/G genotype included cirrhosis with Child-Pugh C (OR, 4.06; 95%CI, 1.34-12.29), thrombocytopenia (OR, 6.55; 95%CI, 1.46-29.43), and higher serum ${\alpha}$-fetoprotein concentration (OR, 2.53; 95%CI, 1.14-5.62). Patients with $TNF{\beta}$ G/G genotype had poor cumulative survival (p=0.005). Cox proportional hazard model indicated that $TNF{\beta}$ G/G genotype was a biomarker for poor HCC survival (hazard ratio, 1.70; 95%CI, 1.07-2.69). In conclusion, there are independent and additive effects between $TNF{\beta}$ G/G genotype and chronic HBV/HCV infection on risk for HCC. It is a biomarker for poor HCC survival. Carriage of this genotype correlates with disease severity and advanced hepatic fibrosis, which may contribute to a higher risk and poor survival of HCC. Chronic HBV/HCV infected subjects with this genotype should receive more intensive surveillance for early detection of HCC.

Elevated Platelets Enhance Cancer Cell Migration, Promote Hematogenous Metastasis and Associate with a Poor Prognosis in Advanced Non-small Cell Lung Cancer Cases

  • Li, Yan;Miao, Li-Yun;Xiao, Yong-Long;Cai, Hou-Rong;Zhang, De-Ping
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.1
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    • pp.139-143
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    • 2014
  • Although correlations between platelets and lung cancer has been recognized, effects on non-small cell lung cancer (NSCLC) metastasis remain to be determined in detail. In the present study, wound healing assays revealed a role of platelets in NSCLC cell migration. Thus the mean migration rate of lung adenocarcinoma A549 cells was significantly elevated after co-culture with platelets ($81.7{\pm}0.45%$ vs $41.0{\pm}3.50%$, P<0.01). Expression of GAPDH was examined by reverse transcription-polymerase chain reaction to study the effect of platelets on NSCLC cell proliferation. The result showed that the proliferation of A549 and SPC-A1 cells was not affected. Mouse models were established by transfusing A549 cells and SPC-A1 cells into mice lateral tail veins. We found tumor metastasis nodules in lungs to be increased significantly after co-transfusion with platelets (in A549, $4.33{\pm}0.33$ vs $0.33{\pm}0.33$, P=0.01; in SPC-A1, $2.67{\pm}0.33$ vs $0.00{\pm}0.00$, P=0.01). In addition, consecutive inoperable patients with newly diagnosed NSCLC (TNM stage III or IV) between January 2009 and December 2011 were retrospectively reviewed. Using the Kaplan-Meier method, NSCLC patients with a high platelet counts demonstrated a significantly shorter progression free survival compared with those with a low platelet count (> $200{\times}10^9/L$, 3 months versus ${\leq}200{\times}10^9/L$, 5 months, P=0.001). An elevated platelet count was also identified as an independent prognostic factor by Cox regression analysis for prgression free survival (adjusted hazard ratio: 1.69; 95% CI: 1.16, 2.46; P=0.006). This study suggested that platelets might contribute to the hematogenous metastatic process by promoting cancer cell migration, which eventually affects the prognosis of NSCLC.