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Performance of the EDACS-ADP incorporating high-sensitivity troponin assay:Do components of major adverse cardiac events matter?

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World Journal of Emergency Medicine 2024年第3期15卷 175-180页

作者： Yedalm yoo Shin Ahn Bora Chae Won young Kim Department of Emergency Medicine Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505Republic of Korea

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,respectively.CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.

关键词： Chest pain Major adverse cardiac event Acute coronary syndrome Emergency department

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Value of glucose transport protein 1 expression in detecting lymph node metastasis in patients with colorectal cancer

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World Journal of Clinical Cases 2024年第5期12卷 931-941页

作者： Hongsik Kim Song-Yi Choi Tae-young Heo Kyeong-Rok Kim Jisun Lee Min young yoo Taek-Gu Lee Joung-Ho Han Department of Internal Medicine Chungbuk National University HospitalCheongju 28644South Korea Department of Pathology Chungnam National University College of MedicineDaejeon 35015South Korea Information and Statistics Chungbuk National UniversityCheongju 28644South Korea Department of Radiology College of MedicineChungbuk National UniversityChungbuk National University HospitalCheongju-si 28644South Korea Department of Nuclear Medicine School of MedicineInha UniversityIncheon 22332South Korea Department of Surgery Chungbuk National UniversityCollege of MedicineCheongju-si 28644South Korea Department of Internal Medicen Chungbuk National UniversityCollege of medicineCheongju-si 28644South Korea

BACKGROUND There are limited data on the use of glucose transport protein 1(GLUT-1)expre-ssion as a biomarker for predicting lymph node metastasis in patients with colorectal cancer.GLUT-1 and GLUT-3,hexokinase(HK)-II,and hypoxia-induced factor(HIF)-1 expressions may be useful biomarkers for detecting primary tumors and lymph node metastasis when combined with fluorodeoxyglucose(FDG)uptake on positron emission tomography/computed tomography(PET/CT).AIM To evaluate GLUT-1,GLUT-3,HK-II,and HIF-1 expressions as biomarkers for detecting primary tumors and lymph node metastasis with 18F-FDG-PET/CT.METHODS This retrospective study included 169 patients with colorectal cancer who underwent colectomy and preoperative 18F-FDG-PET/CT at Chungbuk National University Hospital between January 2009 and May 2012.Two tissue cores from the central and peripheral areas of the tumors were obtained and were examined by a dedicated pathologist,and the expressions of GLUT-1,GLUT-3,HK-II,and HIF-1 were determined using immunohisto-chemical staining.We analyzed the correlations among their expressions,various clinicopathological factors,and the maximum standardized uptake value(SUVmax)of PET/CT.RESULTS GLUT-1 was found at the center or periphery of the tumors in 109(64.5%)of the 169 patients.GLUT-1 positivity was significantly correlated with the SUVmax of the primary tumor and lymph nodes,regardless of the biopsy site(tumor center,P<0.001 and P=0.012;tumor periphery,P=0.030 and P=0.010,respectively).GLUT-1 positivity and negativity were associated with higher and lower sensitivities of PET/CT,respectively,for the detection of lymph node metastasis,regardless of the biopsy site.GLUT3,HK-II,and HIF-1 expressions were not significantly correlated with the SUVmax of the primary tumor and lymph nodes.CONCLUSION GLUT-1 expression was significantly correlated with the SUVmax of 18F-FDG-PET/CT for primary tumors and lymph nodes.Clinicians should consider GLUT-1 expression in preoperative endoscopic biopsy in interpreting PET/CT findings.

关键词： 18F-FDG-PET-CT Biomarker Colorectal neoplasms Glucose transporter type 1 Lymph node

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Rapid species identification of pathogenic bacteria from a minute quantity exploiting three-dimensional quantitative phase imaging and artificial neural network

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Light(Science & Applications) 2022年第7期11卷 1595-1606页

作者： Geon Kim Daewoong Ahn Minhee Kang Jinho Park DongHun Ryu youngJu Jo Jinyeop Song Jea Sung Ryu Gunho Choi Hyun Jung Chung Kyuseok Kim Doo Ryeon Chung in young yoo Hee Jae Huh Hyun-seok Min Nam Yong Lee YongKeun Park Department of Physics Korea Advanced Institute of Science and TechnologyDaejeon 34141Republic of Korea KAIST Institute for Health Science and Technology KAISTDaejeon 34141Republic of Korea Tomocube Inc. Daejeon 34109Republic of Korea Smart Healthcare&Device Research Center Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Graduate School of Nanoscience and Technology Korea Advanced Institute of Science and TechnologyDaejeon 34141Republic of Korea Department of Biological Sciences Korea Advanced Institute of Science and TechnologyDaejeon 34141Republic of Korea Department of Emergency Medicine Bundang CHA HospitalSeongnam-siGyeonggi-Do 13496Korea Division of Infectious Diseases Department of Internal MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Department of Laboratory Medicine Seoul St.Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591Republic of Korea Department of Laboratory Medicine and Genetics Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Department of Applied Physics Stanford UniversityStanfordCA 94305USA Department of Physics Massachusetts Institute of TechnologyCambridgeMA 02139USA

The healthcare industry is in dire need of rapid microbial identification techniques for treating microbial infections.Microbial infections are a major healthcare issue worldwide,as these widespread diseases often develop into deadly symptoms.While studies have shown that an early appropriate antibiotic treatment significantly reduces the mortality of an infection,this effective treatment is difficult to practice.The main obstacle to early appropriate antibiotic treatments is the long turnaround time of the routine microbial identification,which includes time-consuming sample growth.Here,we propose a microscopy-based framework that identifies the pathogen from single to few cells.Our framework obtains and exploits the morphology of the limited sample by incorporating three-dimensional quantitative phase imaging and an artificial neural network.We demonstrate the identification of 19 bacterial species that cause bloodstream infections,achieving an accuracy of 82.5%from an individual bacterial cell or cluster.This performance,comparable to that of the gold standard mass spectroscopy under a sufficient amount of sample,underpins the effectiveness of our framework in clinical applications.Furthermore,our accuracy increases with multiple measurements,reaching 99.9%with seven different measurements of cells or clusters.We believe that our framework can serve as a beneficial advisory tool for clinicians during the initial treatment of infections.

关键词： artificial neural exploit

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Computed tomography coronary angiography after excluding myocardial infarction:high-sensitivity troponin versus risk score-guided approach

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World Journal of Emergency Medicine 2023年第6期14卷 428-433页

作者： Won Jae yoo Shin Ahn Bora Chae Won young Kim Department of Emergency Medicine Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505Republicof Korea

BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.

关键词： Chest pain Coronary artery disease Acute coronary syndrome Troponin HEART score

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Arterial stiffness expressed as brachial–ankle pulse wave velocity and gait assessment independent of lower extremity strength:a cross-sectional study in the older men population

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Journal of Geriatric Cardiology 2023年第2期20卷 91-99页

作者： Tae Kyung yoo Seunghee Lee Sae-Jong Park Jong-young Lee Department of Medicine MetroWest Medical CenterFraminghamUSA Department of Physical Education Korea UniversitySeoulSouth Korea Division of Sports Science Korea Institute of Sport ScienceSeoulSouth Korea Division of Cardiology Department of Internal MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea

BACKGROUND Older men are more vulnerable to fatal falls than women,and gait disturbances contribute to the risk of falls.Studies have assessed the association between arterial stiffness and gait dysfunction,but the results have been inconclusive.This study aimed to conduct a cross-sectional analysis to evaluate the association between brachial–ankle pulse wave velocity(baPWV)and gait assessment in older men.METHODS Data from the 2014–2015 Korea Institute of Sport Science Fitness Standards project were used for the analysis.The inclusion criteria were men aged>65 years with gait assessment[the 30-s chair stand test(30s-CST),the timed up and go(TUG)test,the figure-of-8 walk(F8W)test,the 2-min step test(2MST),and the 6-min walk test(6MWT)]and baPWV measurement data.Generalized linear regression analysis was conducted with multiple confounding factor adjustments,including lower extremity isometric strength.RESULTS A total of 291 participants were included in the analysis.The mean age was 71.38±4.40 years.The mean values were as follows:(1)30s-CST,17.48±5.00;(2)TUG test,6.01±1.10 s;(3)F8W test,25.65±4.71 s;(4)2MST,102.40±18.83 per 2 min;and(5)6MWT,500.02±85.65 m.After multivariable adjustment,baPWV was associated with the 6MWT(β=−0.037,95%CI:−0.072–−0.002),TUG test(β=0,95%CI:0.000–0.001),and F8W test(β=0.002,95%CI:0.000–0.004).baPWV was not associated with the 30s-CST and 2MST.CONCLUSIONS The current study showed a statistically significant association between gait assessments and arterial stiffness,independent of lower extremity strength.However,this association was modest.Future prospective studies are needed to elucidate the complex relationship between arterial stiffness and gait dysfunction.

关键词： stiffness sectional pulse

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Label-Free White Blood Cell Classification Using Refractive Index Tomography and Deep Learning

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Biomedical Engineering Frontiers 2021年第1期2卷 18-26页

作者： DongHun Ryu Jinho Kim Daejin Lim Hyun-Seok Min in young yoo Duck Cho YongKeun Park Department of Physics Korea Advanced Institute of Science and Technology(KAIST)Daejeon 34141Republic of Korea KAIST Institute for Health Science and Technology KAISTDaejeon 34141Republic of Korea Department of Health Sciences and Technology Samsung Advanced Institute For Health Sciences and TechnologySungkyunkwan UniversitySeoul 06355Republic of Korea Department of Health and Safety Convergence Science Korea UniversitySeoul 02841Republic of Korea Department of Laboratory Medicine and Genetics Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Tomocube Inc.Daejeon 34051Republic of Korea Department of Laboratory Medicine Seoul St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591Republic of Korea Stem Cell&Regenerative Medicine Institute Samsung Medical CenterSeoul 06531Republic of Korea

Objective and Impact Statement.We propose a rapid and accurate blood cell identification method exploiting deep learning and label-free refractive index(RI)tomography.Our computational approach that fully utilizes tomographic information of bone marrow(BM)white blood cell(WBC)enables us to not only classify the blood cells with deep learning but also quantitatively study their morphological and biochemical properties for hematology research.Introduction.Conventional methods for examining blood cells,such as blood smear analysis by medical professionals and fluorescence-activated cell sorting,require significant time,costs,and domain knowledge that could affect test results.While label-free imaging techniques that use a specimen’s intrinsic contrast(e.g.,multiphoton and Raman microscopy)have been used to characterize blood cells,their imaging procedures and instrumentations are relatively time-consuming and complex.Methods.The RI tomograms of the BM WBCs are acquired via Mach-Zehnder interferometer-based tomographic microscope and classified by a 3D convolutional neural network.We test our deep learning classifier for the four types of bone marrow WBC collected from healthy donors(n=10):monocyte,myelocyte,B lymphocyte,and T lymphocyte.The quantitative parameters of WBC are directly obtained from the tomograms.Results.Our results show>99%accuracy for the binary classification of myeloids and lymphoids and>96%accuracy for the four-type classification of B and T lymphocytes,monocyte,and myelocytes.The feature learning capability of our approach is visualized via an unsupervised dimension reduction technique.Conclusion.We envision that the proposed cell classification framework can be easily integrated into existing blood cell investigation workflows,providing cost-effective and rapid diagnosis for hematologic malignancy.

关键词： Blood diagnosis utilize

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Characterization of focal hypermetabolic thyroid incidentaloma: An analysis with F-18 fluorodeoxyglucose positron emission tomography/computed tomography parameters

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World Journal of Clinical Cases 2022年第1期10卷 155-165页

作者： Haejun Lee yoo Seung Chung Joon-Hyop Lee Ki-young Lee Kyung-Hoon Hwang Department of Nuclear Medicine Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea Department of Endocrine Surgery Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea Department of Endocrinology and Metabolism Gachon University College of MedicineGil Medical CenterIncheon 21565South Korea

BACKGROUND Incidentally found thyroid tumor(thyroid incidentaloma,TI)on F-18 fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PETCT)is reported in 2.5%-5%of patients being investigated for non-thyroid purposes.Up to 50%of these cases have been diagnosed to be malignant by cytological/histological results.Ultrasonography(US)and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake(hypermetabolism)that are 1 cm or greater in size.It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign.AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value.METHODS Totally,12761 images of patients who underwent F-18 FDG PET-CT for nonthyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed,and 339 patients[185 men(mean age:68±11.2)and 154 women(mean age:63±15.0)]were found to have abnormal,either focal or diffuse,thyroid FDG uptake.After a thorough review of their medical records,US,and cytological/histological reports,46 eligible patients with focal hypermetabolic TI were included in this study.The TIs were categorized as malignant and benign according to the cytological/histological reports,and four PET parameters[standardized uptake value(SUV)max,SUV_(peak),SUV_(mean),and metabolic tumor volume(MTV)]were measured on FDG PET-CT.Total lesion glycolysis(TLG)was calculated by multiplying the SUV_(mean) by MTV.Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions.Receiver operating characteristic(ROC)curve analysis was performed to identify a cut-off value.RESULTS Each of the 46 patients[12 men(26.1%;mean age:62±13.1 years)and 34 women(73.9%;mean age:60±12.0 years)]with focal hypermetabolic TIs had one focal hypermetabolic TI.Among them,26(56.5%)were malignant and 20(43.5%)were benign.SUV_(max),SUV_(peak),SUV_(mean),and TLG were all higher

关键词： Thyroid incidentaloma Malignancy Fluorodeoxyglucose positron emission tomography/computed tomography Standardized uptake value Cut-off

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Purtscher-like retinopathy with macular ischemia as the initial presentation of Behcet's disease

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International Journal of Ophthalmology(English edition) 2022年第3期15卷 520-522页

作者： Min Ho Shin Woong Sun yoo Ji Sung Jung In young Chung Department of Ophthalmology Chosun University HospitalGwangju 61453Republic of Korea Department of Ophthalmology Gyeongsang National University HospitalJinju 52727Republic of Korea

Dear Editor,We would like to present a case report of Purtscher-like retinopathy (PLR) with macular ischemia as the initial presentation of Behcet’s disease (BD).

关键词： ischemia Behcet macular

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Rare case of hepatocellular carcinoma metastasis to urinary bladder:A case report

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World Journal of Clinical Cases 2022年第16期10卷 5470-5478页

作者： Yohan Kim young Seok Kim Jeong-Ju yoo Sang Gyune Kim Susie Chin Ahrim Moon Department of Gastroenterology Soonchunhyang University Hospital BucheonBucheon B14200202Gyeonggi-doSouth Korea Division of Gastroenterology and Hepatology Department of Internal MedicineSoonchunhyang University Bucheon HospitalBucheon B14200202Gyeonggi-doSouth Korea Department of Pathology Soonchunhyang University Bucheon HospitalBucheon B14200202Gyeonggi-doSouth Korea Department of Pathology Soonchunhyang University Bucheon HospitalSoonchunhyang University College of MedicineBucheon B14200202Gyeonggi-doSouth Korea

BACKGROUND Hepatocellular carcinoma(HCC)is a primary liver cancer with high prevalence and mortality.There are many cases of advanced HCC at the time of diagnosis.Treatment methods and prognosis are different depends on whether metastasis is present.Thus,it is necessary to make an accurate evaluation at the time of diagnosis.Extrahepatic metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the peritoneum.Metastasis to the urinary bladder alone is rare.Here,we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old woman.CASE SUMMARY A 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal findings.Thus,liver dynamic computed tomography(CT)was performed.The patient visited the hospital for further examination.Ultrasound and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment 8.The patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver biopsy.Afterwards,she underwent two transcatheter arterial chemoembolizations within five months for HCC.During follow-up,a newly appeared bladder tumor was found on liver dynamic CT.She underwent transurethral resection of the bladder tumor for diagnosis and treatment.The tissue was confirmed as metastatic HCC.CONCLUSION Although rare,metastasis to urinary bladder from HCC can occur without evidence of other distant metastases.Thus,regular follow-up imaging examination and clinical attention are required.

关键词： Hepatocellular carcinoma Metastasis Urinary bladder Case report

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Electrical resistivity evolution in electrodeposited Ru and Ru-Co nanowires

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Journal of Materials Science & Technology 2022年第10期105卷 17-25页

作者： Jun Hwan Moon Seunghyun Kim Taesoon Kim yoo Sang Jeon Yanghee Kim Jae-Pyoung Ahn young Keun Kim Department of Materials Science and Engineering Korea UniversitySeoul 02841Republic of Korea Institute of Engineering Reserch Korea UniversitySeoul 02481Republic of Korea Advanced Analysis Center Korea Institute of Science and TechnologySeoul 02792Republic of Korea Research Resources Division Korea Institute of Science and TechnologySeoul 02792Republic of Korea

Nanoscale ruthenium(Ru)-based materials are promising replacements for existing multilayered Cu interconnects in integrated circuits.However,it is not easy to apply the results of previously reported studies directly to the electrochemical damascene process because the previous studies have mainly focused on thin flms by dry deposition.Here,we report the electrical resistivity and microstructure of electrodeposited Ru nanowires.We estimate that the resistivity value of a 10 nm diameter Ru nanowire to be71.6μΩcm after analyzing the resistivity values of individual nanowires with various diameters.Furthermore,we investigate the electrical properties of Ru_(x)Co_(1-x)nanowires where x is 0.04–0.99 at.%as possible replacements of the current Ta N barrier structures.Over the entire composition range,the resistivity values of alloys are much lower than that of the conventional Ta N.Additionally,Ru and Ru-alloy nanowires surrounded by dielectric silica are thermally stable after 450°C heat treatment.Therefore,the nanoscale Ru and Ru-Co alloys possessing low resistivity values can be candidates for the interconnect and barrier materials,respectively.

关键词： Ruthenium(Ru) Ruthenium-cobalt(Ru-Co) Nanowire Electrical resistivity Microstructure Electrodeposition

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