Research Team Led by Professor Byung Gun Lim at the Department of Anesthesiology and Pain Medicine Identified the Clinical Benefits and Effective Levels of Block Approach for Erector Spinae Plane Block (ESPB)

Clinical analgesic efficacy of ESPB was proven by a systematic review with meta-analysis of previously reported randomized controlled trials

‘Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis,’ written by a research team led by Professor Byung Gun Lim of Korea University Guro Hospital (including the first author, Assistant professor Seok Kyeong Oh) was published in the June issue of the Journal of Clinical Anesthesia (ISSN: 0952-8180, U.S.), an international journal of Anesthesiology and Perioperative Medicine.

Erector spinae plane block (ESPB) introduced in 2016 is a nerve block technique in which local anesthetic is injected into the fascial plane between the transverse process of the vertebra and the erector spinae muscles. It has been proven to be effective for various surgical procedures, including breast, thoracic and abdominal surgery. However, there has been little evidence to show its analgesic efficacy in lumbar spine surgery. This study was designed to demonstrate the efficacy of ESPB in lumbar spine surgery through a systematic review and meta-analysis of previously reported articles of randomized controlled trials.

The study was conducted on the patients who underwent lumbar spine surgery under general anesthesia. The group of patients who received ESPB was compared with a control group of patients who did not undergo the block technique or who were injected with a sham block (saline injection) instead of local anesthetic. The team compared the two groups based on the opioid consumption for 24 hours after surgery, postoperative pain score for 48 hours, incidence of postoperative nausea and vomiting, patient satisfaction and length of hospital stay.

Twelve randomized controlled trials comprising 665 participants were included and analyzed. Compared to the control, ESPB significantly reduced the opioid consumption for 24 hours after surgery, and lowered the pain scores at various time points (at rest or during movement) for 48 hours after surgery. Also, the ESPB group showed lower incidence of postoperative nausea and vomiting, a higher level of patient satisfaction, and shorter length of hospital stay. Furthermore, a subgroup analysis revealed an additional reduction in opioid consumption by the block approach at the vertebral level of incision or operation than that at the fixed thoracic or lumbar level.

This study demonstrated the clinical benefits of ESPB for the patients undergoing lumbar spine surgery. In particular, it found that performing such block technique at the corresponding vertebral level of incision or operation rather than fixed spine level was more effective in relieving postoperative pain.

“In patients undergoing lumbar spine surgery under general anesthesia at the clinical scene, performing ESPB on the vertebral level of incision or operation can be more effective to manage their postoperative pain,” said Professor Byung Gun Lim at the Department of Anesthesiology and Pain Medicine of Korea University Guro Hospital. He added: “By reducing the opioid consumption and its consequent complication risks, the block technique will also contribute positively to a higher level of patient satisfaction and improving the hospital bed occupancy rate.”

In the meantime, the Journal of Clinical Anesthesia, in which the results of this study were published, has the highest Journal Impact Factor (9.452) of medical journals in the Anesthesiology category (2020 Journal Impact Factor, Journal Citation Reports, Clarivate).

Korea and U.S. Joint Research Team Establishes New Genomic Subtypes of Liver Cancer

Research team from 5 universities in Korea, including Korea University, and MD Anderson Cancer Center in the U.S., announced new genomic subtypes of hepatocellular carcinoma (HCC). The first co-authors of this study are Professor Sun-young Yim, Division of Hepatology at Korea University Anam Hospital, Sang-hee Kang, Division of Colorectal Surgery at Korea University Guro Hospital, and Sung-hwan Lee, Division Hepatobiliary and Pancreatic Surgery at CHA Bundang Medical Center.

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HCC has various clinical features, and treatment can vary from one patient to another. Therefore, it is crucial to accurately identify the features of each patient's cancer to determine most relevant treatment. Currently, various classifications of HCC are available, but none of them are easy to use in clinical settings.

Integrating 16 existing genomic signatures for HCC subtypes, the research team established a new classification system of five subtypes - STM, CIN, IMH, BCM, and DLP - based on mRNA expressions.

  
The new subtypes indicate precise diagnosis, treatment, and prognosis features, so this new classification system is expected to make a significant contribution to the advancement of individually treatment. This study also provides a website where physicians can easily find the subtype of HCC simply by uploading the patient's genetic information on the website. (https://kasaha1.shinyapps.io/pics100)

The classification of the subtypes systematically divided patient groups into those with poor prognostic features based on stem cell characteristics and those with a high-level of immune activity who are more likely to respond to immunotherapy. This is expected to help provide customized treatment for each HCC patient.

Professor Sun-young Yim from Korea University Anam Hospital said, "Many universities and research institutes participated in this large-scale study and we will continue to define markers that may predict treatment response in liver cancer patients." 

Professor Kang from the Division of Colorectal Surgery at Korea University Guro Hospital said, "There are increasing number of treatment options and I hope that this system can help physicians to provide individualized treatment."

The study was published in the March 2022 online edition of Hepatology. Professors Kang, Yim, and Lee were listed in the biographical dictionary called 'Hanbitsa' in which researchers who have conducted influential research are listed.

Research Team Led by Professors Jong-Il Choi and Yun-Gi Kim of Korea University Anam Hospital Confirms Association Between Depression and Atrial Fibrillation

Our thoughts, memories, and emotions are the results of reactions in the brain. However, throughout human history, the mind and heart have been considered as the organs most closely related to each other. This perspective has persisted until today, and evidence to support this is found in linguistic and cultural traditions. Now, a study has revealed that the mind and heart are actually co-related, and the outcomes of the study have been published, drawing attention from around the world.

A research team led by Professors Jong-Il Choi and Yun-Gi Kim from the Department of Cardiology, Kyu-man Han from the Department of Psychiatry at KU Anam Hospital, and Professor Kyung-do Han from the Department of Statistics and Actuarial Science at Soongsil University found a close relationship between depression and atrial fibrillation. To date, the risk of atrial fibrillation in people with depression has not been clearly understood, but the research team revealed the relationship between diseases involving the mind and heart by assessing big data from Korea.

The research team analyzed 10 years of data for 5 million people 20 years or older without any heart conditions among those who received a national health screening in 2009. The study found that the risk of atrial fibrillation was 1.25 times higher in patients with depression: 1.17 times higher in the absence of a recurrence of a depressive episode, and 1.32 times higher in those with recurring episodes. In particular, the lower the age, the higher the risk of development, and the highest association was found in those aged 20 to 39, who have a 1.58 times higher risk.

Professor Choi said, "If you have depression, you should check your heart condition on a regular basis in addition to your mental health so that you can prevent atrial fibrillation, which can cause severe complications, such as cerebral infarction, dementia, and heart failure." He also stressed, "According to this study, the risk of developing atrial fibrillation is higher in young people with depression, and you should keep in mind that you are vulnerable even though you are still young. Especially those who have depression are recommended to have regular medical check-ups because early diagnosis and active treatment increase the possibility of curing atrial fibrillation."

The study, titled "Association of Depression with Atrial Fibrillation in South Korean Adults," was published in the sister journal of the American Medical Association, American Medical Association Network Open.

Research Team Led by Professor Woong Sun of KU College of Medicine Succeeds in Developing Spinal-Cord Organoids Recapitulating Neural-Tube Morphogenesis

It is getting close to predict and prevent neural tube defects, one of the main congenital developmental disorders.

A research team led by Professor Woong Sun from the Department of Anatomy at KUCM succeeded in producing spinal-cord organoids that simulate neural tube formation, proving the potential for using organoid-based drug screening platforms.

Under the leadership of Professor Sun's team, the research was conducted in collaboration with a number of institutions, including teams led by Dr. Il-joo Cho from the Korea Institute of Science and Technology, Sang-hyuk Lee from Ewha Womans University, and InterMinds (CEO, Jong-jin Kim), an AI venture firm.

An organoid is a miniaturized and simplified version of an organ produced in vitro from stem cells. Because organoids are generated through the process resembling to the in vivo development, they also show realistic micro-anatomy. Since animal testing has clear limitations when it comes to studying human disease mechanisms and developing new drugs as well as ethical concerns, organoids have emerged as a better alternative that can be used to meet different purposes in various fields, such as exploring human developmental processes, identifying the causes of diseases, developing new drugs, and forecasting side effects.

Neural tube defects are one of the most common types of congenital deformities and are found in about 300,000 fetuses worldwide each year. The neural tube is an early developmental tissue that gives rise to the central nervous system, which is composed of the brain and spinal cord, and the tube-forming early morphogenic process is unique and differs from that of other tissues.

During fetal development, certain cells located on the back of the embryo change shape and begin to form the neural tube. This process is called neural tube formation or neurulation, and failure of this process may cause an abnormal neural tube folding, a neural tube defect, one of the most common congenital developmental disorders. In humans, the neural tube formation process takes place during the third week of pregnancy, making it extremely difficult to study the human-specific neural tube morphogenesis process as well as its mechanisms and abnormal folding prevention methods.

Launched in 2015 to develop spinal-cord organoids, Professor Sun's team established a method of producing spinal-cord organoids that mimic neural tube formation, and the team went through a process to verify that the organoids are similar to actual human spinal cord tissues through the analysis of histology, transcription, and electrophysiology. A verification test also confirmed that the manufacturing technology performs well in terms of reproducibility and quantification, which are important factors in the application of organoids to clinical technology.

In particular, the combination of stem cell culture technology, the latest 3D imaging technology, and deep learning artificial intelligence technology enabled high-throughput screening (HTS), and as a result, drug reactivity to thousands of organoids was verified quickly and efficiently.

The research team selected a total of six types of anticonvulsants, including a group of dangerous drugs that increased the likelihood of neural tube defects when administered in pregnant women, and conducted neural tube defect modeling. In the test, abnormal morphogenesis and neural tube structures were observed only in the risk drug treatment group, which was similar to the reports of previous clinical studies. Thus, the team successfully verified that the spinal-cord organoid model could be used in a lab as a toxicology test.

Professor Sun said, "The spinal-cord organoid our team developed can support preclinical study of drug development and proves the potential for using an organoid-based platform to improve the efficiency of drug safety tests. Now we can make models for not only neural tube deficiency, but also various brain diseases."

This study was conducted as a project of the National Research Foundation of Korea with support from the Ministry of Science and ICT. The study was published in the latest issue (March 28) of Nature's sister magazine, Nature Biomedical Engineering, under the title "Production of human spinal-cord organoids recapitulating neural-tube morphogenesis."

Professor Sun graduated from Seoul National University in 1991 and received master's and doctorate degrees from the same school. He studied at Osaka University in Japan and Wake Forest University in the United States, and he has been teaching at the KUCM Department of Anatomy since 2002. He was the dean in charge of research exchange at Korea University and is currently serving as the general director of the Asia-Pacific Society for Neurochemistry and editor-in-chief of the International Journal of Stem Cells. He won the 2017 Korea University Friendship Association’s Academic Award and the 18th Pfizer Medical Award in 2020. In 2021, his book, I Want to Make a Brain, a record of his organoid research, was published, and his study was selected in 2018 by the Korea University Medical Center as one of the "Top 10 Future Medicine Technologies" that will lead the next generation of biomedical development.