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Featured researches published by Myungsoo Park.


Korean Circulation Journal | 2017

Systematic Review of Treatment for Trapped Thrombus in Patent Foramen Ovale

Won-Woo Seo; Sung Eun Kim; Myungsoo Park; Jun-Hee Lee; Dae-Gyun Park; Kyoo-Rok Han; Dong-Jin Oh

Background and Objectives Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. Subjects and Methods A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. Results Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. Conclusion This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.


European Journal of Clinical Microbiology & Infectious Diseases | 2017

Mass spectrometric identification of phenol-soluble modulins in the ATCC® 43300 standard strain of methicillin-resistant Staphylococcus aureus harboring two distinct phenotypes

K.S. Jang; Myungsoo Park; Ji-Young Lee; Jwa-Young Kim

Staphylococcus aureus subsp. aureus Rosenbach (ATCC® 43300™) is a representative methicillin-resistant S. aureus (MRSA) strain that is used as a quality control strain for testing the methicillin susceptibility of clinical isolates. It has been consistently observed that colonies with two different colors (golden yellow and white) grow from the ATCC stock on blood agar plates. In this study, staphylococcal peptide and protein profiling was performed using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. From the extract of the potentially hemolytic 43300 strain, we identified a single significant peak at an observed mass-to-charge (m/z) value of 2306.9, which correlates well with the predicted mass of formylated phenol-soluble modulin α2, a major staphylococcal virulence factor. Subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis revealed that the hemolytic 43300 cells predominantly produced various phenol-soluble modulins (PSMs) and their export proteins, including four α type PSM peptides, PSMβ1, PSM-mec, PmtC and PmtD. However, none of the PSM peptides was detected in the presumably non-hemolytic 43300 strain, but the export proteins PmtC and PmtD. We found that this MRSA standard strain expresses two distinct phenotypes and that their phenotypic features are more likely associated with PSM toxin production. Therefore, careful attention is needed when MRSA reference strains are utilized for the diagnosis and susceptibility testing of MRSA in clinical settings.


Transplantation | 2018

Elevated High-Sensitivity Troponin I During Living Donor Liver Transplantation is Associated With Postoperative Adverse Outcomes

J. Park; Seung Hwa Lee; Sangbin Han; Ki Yoon Kim; Go Eun Kim; Myungsoo Park; Suk-Koo Lee; Gyu-Seong Choi; Soohyun Ahn; Hyeon Seon Ahn; Gaab Soo Kim

Background This study aimed to evaluate risk factors and postoperative clinical outcome associated with myocardial injury detected by an elevated high-sensitivity cardiac troponin I (hs-cTnI) immediately after living donor liver transplantation (LDLT). Methods Between January 2011 and December 2016, 313 adult recipients undergoing LDLT, with normal preoperative hs-cTnI were selected. Hs-cTnI level above 0.04 ng/mL according to 99th percentile reference limit was defined as myocardial injury. The recipients were divided into 2 groups according to postoperative hs-cTnI measured immediately after LDLT and postoperative clinical outcome was compared. Results The primary outcome was composite of death or graft failure during hospital stay. Risk factors associated with myocardial injury during LDLT was also evaluated. Of the 313 recipients with normal preoperative hs-cTnI level, 159 (50.8%) had elevated hs-cTnI level and 154 (49.2%) had normal level after LDLT. The incidence of all-cause death or graft failure during hospital stay was significantly higher in recipients with myocardial injury (1.9% vs 7.6%; hazard ratio, 4.15; 95% confidence interval, 1.01-17.14; P = 0.049). The same result was shown in propensity-matched population (0.9% vs 9.0%; hazard ratio, 9.08; 95% confidence interval, 1.16-71.01; P = 0.04). The results during 1-year follow-up were not consistent. Female sex, ischemia time, and presence of postreperfusion syndrome were independent predictors of myocardial injury during LDLT. Conclusions Myocardial injury detected by elevation of hs-cTnI level immediately after LDLT was independently associated with adverse outcome during hospital stay.


PLOS ONE | 2018

Association between perioperative β-blocker use and clinical outcome of non-cardiac surgery in coronary revascularized patients without severe ventricular dysfunction or heart failure

J. Park; Jeayoun Kim; Ji Hye Kwon; Soo Jung Park; Jeong Jin Min; Sangmin Maria Lee; Hyeon-Cheol Gwon; Young Tak Lee; Myungsoo Park; Seung Hwa Lee

Perioperative use of β-blocker has been encouraged in patients undergoing non-cardiac surgery despite weak evidence, especially in patients without left ventricular systolic dysfunction (LVSD) or heart failure (HF). This study evaluated the effects of perioperative β-blocker on clinical outcomes after non-cardiac surgery among coronary revascularized patients without LVSD or HF. Among a total of 503 patients with a history of coronary revascularization (either by percutaneous coronary intervention or coronary arterial bypass grafts) undergoing non-cardiac surgery, those without severe LVSD defined by ejection fraction over 30% or HF were evaluated. The primary outcome was a composite of death, myocardial infarction, repeat revascularization, and stroke during 1-year follow-up. Perioperative β-blocker was used in 271 (53.9%) patients. During 1-year follow-up, we found no significant difference in primary outcome between the two groups on multivariate analysis (hazard ratio [HR], 1.01; confidence interval [CI] 95%, 0.56–1.82; P = 0.963). The same result was shown in propensity-matched population (HR, 1.25; CI 95%, 0.65–2.38; P = 0.504). In coronary revascularized patients without severe LVSD or HF, perioperative β-blocker use may not be associated with postoperative clinical outcome of non-cardiac surgery. Larger registry data is needed to support this finding.


PLOS ONE | 2018

Corrected QT interval on the electrocardiogram after liver transplantation: Surrogate marker of poor clinical outcomes?

Seunghwa Lee; Myungsoo Park; Kyoung-Min Park; Hye-bin Gwag; J. Park; Jeayoun Kim; Gyu-Seong Choi; Suk-Koo Lee; Gaab Soo Kim

Background Prolongation of corrected QT interval (QTc) on the electrocardiogram is associated with cardiac arrhythmia and sudden death. Changes in the QTc (corrected QT) interval before and after liver transplantation (LT) for the treatment of liver cirrhosis (LC) and its association with clinical outcomes have not been fully evaluated. Methods From January 2011 to May 2016, consecutive 516 consecutive recipients were enrolled into LT registry and the median follow-up was 31 months (IQR 12–52). Patients with an available electrocardiogram before LT and 1 month after from LT were analyzed. Patients were divided into 2 groups according to prolonged QTc interval. The patient groups were analyzed separately according whether the electrocardiogram was preoperative or postoperative. The primary outcome was all-cause death during the follow-up period. Results A total of 283 patients were enrolled in the study. In the preoperative QTc prolongation group, there was not a significant rate difference in all-cause mortality in multivariate analysis (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.53–1.66; P = 0.26). However, in the postoperative QTc prolongation group, mortality was significantly increased (HR, 1.78; 95%CI, 1.05–3.03; P = 0.03) in patients who underwent LT. Conclusion In patients who underwent LT for LC, postoperative QTc prolongation on ECG, rather than preoperative, is associated with mortality. Larger clinical trials are needed to support this finding.


Korean Circulation Journal | 2018

A New Era of Targeting Pathogenic Immune Mechanisms in Cardiovascular Disease

Myungsoo Park; Jong-Chan Youn

https://e-kcj.org The 3-bromo-4, 5-dihydroxybenzaldehyde (BDB) is a natural compound from red algae, which has anti-inflammatory effect. BDB is reported to inhibit the production of interleukin (IL)-6 secreted from murine macrophages and to show the anti-inflammatory potency reducing infiltration of inflammatory cells.1) In this issue of the Korean Circulation Journal, Ji et al.2) investigated the potential role of BDB on cardiac function recovery after myocardial infarction (MI) in mice. More specifically, the present study aimed to investigate the effect of BDB on macrophage infiltration and related cytokines production in a mouse model of acute MI. MI leads to intense and complex inflammatory responses, and the inflammatory cascade causes post-infarction ventricular remodeling. Pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), IL-1β, IL-6 are overexpressed after MI and play a key role in activating inflammatory reaction. In particular, IL-6 activates the janus tyrosine kinase/signal transducer and activator of transcription (JAK/STAT) cascade to modulate the inflammatory and reparative response of myocardium, and have been a potential therapeutic target for patients with MI.3) In this study, BDB administration improved cardiac function recovery, and decreased mortality and infarcted size after MI. The anti-inflammatory effect of BDB reduced macrophage recruitment and inhibits the production of pro-inflammatory cytokines such as IL-6 as well as TNF-α, IL-1β, and monocyte chemoattractant protein (MCP)-1. Furthermore, BDB inhibited phosphorylation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), a protein that plays an important role in the production of IL-6 and TNF-α, suggesting a clue to explain the pharmacological mechanism of BDB.


Japanese Clinical Medicine | 2018

Clinical Outcome of Noncardiac Surgery in Patients With History of Coronary Artery Revascularization by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

J. Park; Seung Hwa Lee; Jeayoun Kim; Myungsoo Park; Hyeon-Cheol Gwon; Young Tak Lee; Sangmin Maria Lee

Objective: Although safety concerns still remain among patients undergoing unanticipated noncardiac surgery after prior percutaneous coronary intervention (PCI), it has not been directly compared with coronary artery bypass grafting (CABG). The objective of this study was to compare clinical outcomes after noncardiac surgery in patients with prior (>6 months) coronary revascularization by PCI or CABG. Methods: From February 2010 to December 2015, 413 patients with a history of coronary revascularization, scheduled for noncardiac surgery were identified. Patients were divided into PCI group and CABG group and postoperative clinical outcome was compared between 2 groups. The primary outcome was composite of all-cause death, myocardial infarction, and stroke in 1-year follow-up. Results: The 413 patients were divided according to prior coronary revascularization types: 236 (57.1%) into PCI and 177 (42.9%) into CABG group. In multivariate analysis within 1-year follow-up, there was no significant difference in clinical outcome which was composite of all-cause death, myocardial infarction, and stroke (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 0.76-2.93; P = .24). The same result was present in propensity-matched population analysis (HR: 1.43; 95% CI: 0.68-3.0; P = .34). Conclusions: In patients undergoing noncardiac surgery with prior coronary revascularization by PCI or CABG performed on an average of 42 months after PCI and 50 months after CABG, postoperative clinical outcome at 1-year follow-up is comparable.


Transplantation | 2014

Early Intra-Individual Variability in Tacrolimus Trough Concentrations Predicts Long-Term Pediatric Renal Transplant Outcome.: Abstract# A350

Seung-Kee Min; S. Kim; Hee Jung Kang; Chanjoong Choi; I. M. Jung; Myungsoo Park; Jong-Won Ha; A. Han

A350 Early Intra-Individual Variability in Tacrolimus Trough Concentrations Predicts Long-Term Pediatric Renal Transplant Outcome. S. Min, S. Kim, H. Kang, S. Min, C. Choi, S. Kim, I. Jung, M. Park, J. Ha, A. Han. Seoul National University College of Medicine, Seoul, Kosovo, Republic of. Background. High intra-individual variability in tacrolimus (TAC) trough concentrations can be expected in poorly adherent pediatric/adolescent patients. Therefore we investigated whether high intra-individual variability (IIV) in TAC trough levels has an impact on the long-term renal transplant outcome in a pediatric population. Method. We included 68 children (11.0±4.1 yr) who had undergone renal transplantation between January 2001 and October 2010. The IIV in TAC trough concentrations was calculated using all tacrolimus trough concentrations over one year after transplantation. The mean IIV in TAC trough concentrations was 35.3±7.2 (%). Results. The baseline characteristics were not different between the patients with higher TAC IIV (n=31) and those with lower TAC IIV (n=37). The patients with higher TAC IIV showed lower renal graft survival (P=0.038) and had higher probability of chronic allograft nephropathy development (P=0.056) compared to the patients with lower TAC IIV. The patients with higher TAC IIV also had a signifi cantly higher risk in late acute rejection (P=0.010). The antibody-mediated rejection was developed in 4 patients and mainly occurred in the patients with higher TAC IIV (3 cases). Although renal Function was stable in both groups until 5 years after transplantation, the patients with higher TAC IIV have showed rapidly deteriorating renal function since 5 years after transplantation (P<0.05 in all time points up to 8 years after transplantation). Conclusion. Higher IIV in tacrolimus trough concentration in early period after transplantation leads to a faster decline in renal function and predicts poor renal transplant outcome in a pediatric population. Abstract# A351 An Update On the Utility of Protocol Biopsies at Three and Six Months in an Era With Better DSA Monitoring and Induction Immunosuppression in Pediatric Kidney Transplant Patients. A. Gallo, C. Gowdy, J. Berumen, T. Todo, W. Concepcion. Surgery Department, Stanford University, Palo Alto, CA. A351 An Update On the Utility of Protocol Biopsies at Three and Six Months in an Era With Better DSA Monitoring and Induction Immunosuppression in Pediatric Kidney Transplant Patients. A. Gallo, C. Gowdy, J. Berumen, T. Todo, W. Concepcion. Surgery Department, Stanford University, Palo Alto, CA. INTRODUCTION: Protocol biopsies (PB) remain part of the management of pediatric renal transplant recipients because of their ability to detect subclinical acute rejection (SCR). We sought to examine if changes in induction therapy and closer surveillance of donorspecifi c antibodies (DSAs) have eliminated the need for three and six month protocol biopsies by decreasing the incidence of SCR . METHODS: A single-institution, retrospective review from 2008 to 2011 was conducted. 112 consecutive pediatric kidney transplant patients were evaluated, 81 of whom underwent a 3 month PB and 58 of whom underwent a 6 month PB. Excluded patients were those who did not receive PBs or who were biopsied for clinical suspicion, increasing creatinine or changes in donor-specifi c antibody profi les. Data collected included immunosuppression, rejection, EBV, BK, and CN toxicity on biopsy pathology, biopsy related management changes, complications, and hospital readmissions. RESULTS: All patients were induced with Daclizumab or antithymocyte globulin. The 3 and 6 month biopsies showed 1.2% and 5% BK nephropathy, 8.6% and 5% with CN toxicity and 6.2% and 10% with evidence of SCR. 72% of the 3 month patients were steroid free as were 51% of the six month patients. 63% of the SCR was in steroid free patients. Eight of the SCRs had change in management with admission for treatment. Minimal changes were made with CN toxicity because 3 months is a scheduled decrease in goal levels. Of the 3 month patients, fi ve had immediate complications: three developed hematuria requiring admissions, two developed AV fi stulas, and one had bowel on pathology. One patient developed BK and PTLD after increasing immunosuppression in response to SCR. Two of the 6 month biopsy patients had formation of AV fi stulas and one had post procedure urinary retention requiring admission. CONCLUSION: We conclude that three month PBs lead to potential complications without signifi cant changes in patient management due to a low incidence of SCR. Although the incidence of SCR is higher at six months it is still lower than previously reported. Further correlation with antibody mediated rejection and DSA data is on-going to see if clinical suspicion can negate pure protocol biopsies. This data suggests we should rethink the utility of PBs to prevent unnecessary complications, hospital admissions, and their associated increased costs. Abstract# A352 Novel Use of Dried Blood Spots for Home Monitoring in Children After Kidney Transplanation. A. Al-Uzri, M. Munar, K. Freeman, S. Iragorri, R. Jenkins, D. Rozansky, D. Koop. Oregon Health & Science University, Portland, OR. PURPOSE: The use of dried blood spots (DBS) for home monitoring is limited due to unsatisfactory blood sampling and analytical diffi culties. The aim of this study is to validate the DBS method as a home monitoring device for children with kidney transplantation. METHODS: This is a longitudinal prospective trial. Patients are asked to obtain monthly DBS samples at home over 12 months and mail them back to the lab. Additional DBS samples are obtained within 30 minutes from getting a routine IV blood draws in clinical lab. We report here our preliminary analysis of two aspects of the trial: 1) The correlation between Tacrolimus (TAC) and creatinine (Cr) levels measured by DBS with those obtained by IV blood draws in clinical lab; 2) To measure the percent of DBS fi lter papers that are mailed back to the lab on time, and collected properly for analysis. DBS are analyzed for TAC and Cr using tandem mass spectrometry (LC-MS/MS) and are compared to TAC and Cr values analyzed in clinical lab. RESULTS: 24 children are included in the analysis, 15 are males with a mean age of 15 ±4.53 years. Three adolescents opted out of the study within 4 weeks of enrollment due to psychosocial reasons and one patient exited the study after loss of renal graft. A total of 36 DBS samples were received from patients at time of reporting. Correlation between TAC (18 samples) and Cr levels (15 samples) with DBS and clinical lab are shown below. Only 6/36 (16.6%) samples (from 4 patients), were never received, while 4/36 (11.1%) were late, thus requiring a reminder from our offi ce. 100% of DBS samples were collected properly for analysis. Mean days reported between mailing the fi lter paper from home to receiving it in our lab was 7.05 ± 6.15. CONCLUSION: Our preliminary results show signifi cant correlation between TAC and Cr levels obtained by DBS and clinical lab. The majority of patients properly completed the DBS at home and mailed them back on time. Collection and analysis of the longitudinal data are still ongoing. Home DBS monitoring for TAC and Cr may become a promising alternative to standard blood draws in clinical lab for transplant recipients. DISCLOSURES: Al-Uzri, A.: Grant/Research Support, Astellas Pharma US Inc., Other, Alexion Pharamceutical, Expert panel meeting. Abstract# A353 Immune Correlates of Persistent Epstein-Barr Virus Viremia in Pediatric Renal Transplant Patients. G. Paulsen, M. Li, D. Feig, M. Shimamura. Pediatrics, University of Alabama, Birmingham, AL. A353 Immune Correlates of Persistent Epstein-Barr Virus Viremia in Pediatric Renal Transplant Patients. G. Paulsen, M. Li, D. Feig, M. Shimamura. Pediatrics, University of Alabama, Birmingham, AL. Background: EBV viremia is common in pediatric renal transplant recipients, but correlates of progression to post-transplant lymphoproliferative disease (PTLD) remain poorly defi ned. Persistent EBV viremia is a risk factor for PTLD, and correlates of persistent viremia may be associated with risk for PTLD. Purpose: The purpose of this study is to examine the relationship between circulating lymphocyte subsets and NK cells and persistent EBV viremia in pediatric renal transplant patients. Methods: Serial prospectively collected peripheral blood mononuclear cell samples were isolated from pediatric renal transplant patients following transplantation. CD4+ T cell subsets, CD4+ and CD8+ effector memory cells, and NK cells were analyzed by fl ow cytometry for surface markers and intracellular cytokine staining before and after phorbol myristate acetate/ionomycin stimulation. Results: 31 samples were obtained from 11 renal transplant patients over six months. Six renal transplant patients had negative EBV PCR results at all time points. Five patients were EBV PCR positive, one of whom became EBV PCR negative, while four remained persistently positive with average PCR viral load of 9,024 copies/ml [range 515-34,710]. When compared to EBV PCR negative patients, persistently EBV positive patients had an increased frequency of circulating CD4+ T cells (56.4% vs 42.9%). Conversely, the frequency of CD4+ IFNγ+ cells after stimulation was decreased in EBV positive patients compared to EBV negative patients (0.8% vs 1.8%). Persistently EBV positive patients also had fewer CD4+/CCR4+ Th2 cells than EBV negative patients (3.8% vs 7.1%), as well as fewer CD4+ IL-4+ cells after stimulation (0.7% vs 2.7%). No difference was seen in the frequency of CD4+ or CD8+ effector memory, or NK cells. Conclusions: In this small cohort of prospectively analyzed pediatric renal transplant patients, persistent EBV viremia was associated with a relative increase in circulating CD4+ T cells, but a less robust CD4+IFNγ+ Th1 response when co


Journal of Cardiac Failure | 2016

Does Hypertension Influence Prognosis of Hypertrophic Cardiomyopathy

Dae-Gvun Park; Myungsoo Park


Transplantation | 2014

Sustained Effect of Donor Action Program in the Era of Decreasing Number of Potential Donors in Korea.: Abstract# D2700

Suk-Koo Lee; Kee-Taek Jang; Jung Mi Oh; E. Noh; J. Kwon; S. I. Kim; Myungsoo Park; Jong-Won Ha

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J. Park

Samsung Medical Center

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Jeayoun Kim

Samsung Medical Center

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Suk-Koo Lee

Samsung Medical Center

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