Asan Medical Center team led by Professor Young-Hak Kim of the Division of Cardiology and Professor Chang Hoon Ha of the Department of Convergence Medicine discovered a new therapeutic target related to atherosclerosis.

 

The research team selected CTRP9, one of the adipokines which is expected to be highly related to atherosclerosis and myocardial infarction, and conducted a study to identify a new therapeutic target.

 

First, the team treated laboratory cultured, human umbilical vein endothelial cells (HUVEC) with CTRP9 and found that angiogenesis increased by approximately 50%. This means the density and vascular homeostasis of vascular endothelial cells that constitute blood vessels have increased, which also means the blood vessels became healthier and stronger. The team then conducted an analysis of laboratory rats that had the CTRP9 gene removed and found that angiogenesis decreased by 80% compared to before the removal. In addition, when carotid artery ligation was used on laboratory rats to induce atherosclerosis followed by CTRP9 administration, atherosclerosis improved by about 40%. In case of rats with induced myocardial infarction, the symptoms of ischemic left ventricular dysfunction were reduced by 62%. An analysis was performed with blood samples kept for 100 atherosclerosis patients who were actually treated at Asan Medical Center, and the results showed that the blood CTRP9 level of the patient groups of potential coronary artery disease and myocardial infarction was significantly reduced by 70% compared to healthy individuals.

 

The research findings were recently published in ‘Science Advances,’ a sister journal of ‘Science.

Asan Medical Center (AMC) Cancer Institute’s CAR T Center announced that CAR T-cell therapy was successful in a baby patient Lee (female, 18 months) who had relapsed B-cell acute lymphoblastic leukemia. CAR T therapy is an cutting-edge treatment which involves extraction of T-cells from the patient’s blood, to which substances that attack cancer cells are attached and infused into the patient’s body again.

 

Baby Lee underwent hematopoietic stem cell transplantation January last year, but her leukemia relapsed in about half a year. There were very few academic reports worldwide on performing CAR T therapy in patients with leukemia who are less than one year old. However, CAR T therapy was the only hope to save baby Lee. It was also fortunate that insurance coverage for CAR T therapy became available April last year.

 

It was last October when AMC team led by Professor Ho Joon Im, Professor Kyung-Nam Koh, Professor Hyery Kim, and Professor Sung Han Kang of Pediatric Hematology and Oncology performed CAR T therapy. T-cells were collected from the baby’s blood, substances that attack cancer cells were attached to the T-cells and were together infused into the patient’s body again. Joint efforts were made by medical experts from different departments to closely examine possible side effects that may occur in babies, such as nervous system toxicity and cytokine release syndrome.

 

The results of the tests on bone marrow and microscopic residual tumor conducted one month after CAR T therapy in November demonstrated complete remission of the leukemia. To this day, baby Lee is healthy without any side effects.

The Arrhythmia Team (Professor Kee-Joon Choi, Professor Gi-Byoung Nam, Professor Jun Kim, Professor Min Soo Cho, and Professor Myung-Jin Cha of the Division of Cardiology) at Asan Medical Center (AMC) Heart Institute became the first in Korea to achieve 100 cases of Micra pacemaker implantation.

 

Micra is a 2.6cm-sized micro leadless pacemaker system which is inserted into the heart of arrhythmia patients with irregular heartbeat. A catheter is inserted through the upper thigh area to place Micra in the right ventricle of the heart. The main body is not visible on the outside and complications due to skin incision or wire is less likely to occur. It has also given greatly improved convenience in patients’ daily life when compared to conventional artificial pacemakers inserted into the skin under the collarbone, causing discomfort in movement.

 

Looking at the 100 cases of Micra pacemaker implantation performed by AMC Arrhythmia Team from February 2021 until recently, the average age of the patients was 72 years including 31 patients with an age of 80 years or above. There was not a single case where the pacemaker position had been changed after the implantation and the average time in implantation was less than 30 minutes which was reduced by more than 50% than before. Patients who experienced issues with their heartbeat due to infection at the pacemaker insertion site or problems with the main body or wiring could improve their quality of life by replacing the existing pacemaker to the Micra pacemaker.

The team led by Professor Sung Shin of the Division of Kidney and Pancreas Transplantation of Asan Medical Center (AMC) achieved 100 case of robot-assisted kidney transplantation. This has been achieved in 2 years and 3 months since the first robotic kidney transplantation performed on August 14, 2020.

 

Professor Shin’s team conducted a comparative analysis on 100 cases of robotic kidney transplantation and 690 cases of open kidney transplantation that were performed during the same period. According to the analysis, the two approaches were similar in terms of kidney function as the glomerular filtration rate (GFR) at 1 year after kidney transplantation was 68.8ml per minute for robot-assisted kidney transplantation and 67.6ml per minute for open kidney transplantation. The rate of rejection during the follow-up period for robot-assisted kidney transplantation and open kidney transplantation was 12% and 7%, respectively. When this was adjusted for variables related to immunological risk, robot-assisted kidney transplantation was demonstrated to have no statistically significant risk compared to open kidney transplantation.

 

Kidney transplantation is a highly advanced surgery that requires sophisticated micro-anastomosis skills. In robotic surgeries, the surgeons’ vision increases up to 10 times and robotic instrument’s free joint movement facilitates a more sophisticated surgery. While an incision of approximately 20cm was required for open kidney transplantation, robot-assisted kidney transplantation is possible with only an incision of around 6cm to place the kidney and 3 small holes about 1cm around the navel. There are only few surgical site infections or hernia complications due to small incision site. The surgical scope in the abdominal cavity is also reduced which leads to less intraoperative bleeding and early removal of surgical drainage tube. Recovery is fast, and patients can also be released from the hospital 2-3 days earlier than in open kidney transplantation cases.

Intravital images are widely used in preclinical trials because living tissues and cells of small animals can be observed in real time. Various diagnoses and therapy evaluation could be brought to the next level if clearer images can be obtained. Asan Medical Center (AMC) team led by Professor Jun Ki Kim of the Department of Convergence Medicine and Professor Sung Hoon Kim of the Department of Anesthesiology and Pain Medicine recently succeeded in acquiring high-quality fluorescent intravital images with a intravital microscopy through minimized small animal movement after injecting a dexmedetomidine that has a sedative effect.

 

As breathing and pulmonary circulation continue in small animals even under anesthesia, involuntary movements are unavoidable within the target tissues for imaging. AMC team conducted the study after acquiring fluorescent intravital images of small animals using a two-photon fluorescence excitation microscope and dexmedetomidine. Two-photon fluorescence excitation microscope is one of the high-end intravital microscopy and has taken care of photobleaching and photodamaging effects that occur in existing intravital microscopy. Dexmedetomidine injection is less invasive than conventional methods and relatively simply reduces involuntary movements such as breathing in small animals. A comparison was made for in vivo two-photon fluorescence excitation microscopy measurements before and after injecting dexmedetomidine into small animals, and the results demonstrated the resolution of fluorescent images and videos improved after injecting the medication as breathing or heart movements of small animals stabilized. It was also observed that the effect of dexmedetomidine decreased the blood flow rate in tissue.

 

This research was conducted as an R&D project of the Ministry of Health and Welfare and support project of the Ministry of Science and ICT. Also, it was published in the ‘Microscopy and Microanalysis,’ a renowned academic journal in the field of microscopy. At the same time, a high-quality fluorescent intravital image acquired through dexmedtomidine made the cover of the journal.

An accurate diagnosis of middle ear diseases such as otitis media is difficult to obtain in a short time using an otoendoscope (ear endoscope). Recently, research findings of Asan Medical Center (AMC) have been published that accurate middle ear disease diagnosis can be made by deep learning-based artificial intelligence.

 

AMC team led by Professor Joong Ho Ahn of the Department of Otolaryngology-Head and Neck Surgery and Professor Jihoon Kweon of the Biomedical Engineering Research Center used 6,630 examination images of patients who underwent otoendoscopy from January 2018 to December 2020, and developed an artificial intelligence algorithm that can diagnose middle ear diseases. The research team trained the artificial intelligence to first diagnose chronic otitis media and otitis media with effusion, and secondly diagnose attic cholesteatoma, myringitis, and otomycosis together that can often be observed in patients with otitis media. When the diagnostic accuracy was measured later, it was found that otitis media was diagnosed with approximately 95% accuracy and other diseases also with 96-98% accuracy.

 

In particular, the research team introduced the concept of a multi-class classification system to the artificial intelligence algorithm so that multiple middle ear diseases can be diagnosed together by artificial intelligence. So far, there has been no artificial intelligence that can diagnose a number of middle ear diseases at the same time. For example, when a patient has both otitis media and myringitis, artificial intelligence could diagnose only one of the two diseases.

 

The research findings were recently published in an international academic journal ‘PLOS One.’

A medical team led by Professor Yong-Hee Kim of the Department of Thoracic and Cardiovascular Surgery of Asan Medical Center (AMC) recently revealed that the team has performed Korea’s first successful robot-assisted surgery on Ms. Hong (68 years old) who had difficulty in daily life due to thoracic outlet syndrome. Ms. Hong went home two days after the operation in good health with almost no scar or pain because she underwent microinvasive surgery.

 

Previously, a long incision of about 10cm was made above the collarbone for thoracic outlet syndrome surgery. However, a clear vision was not ensured during surgery in patients who were overweight or too muscular. In addition, since the surgery is conducted in an extremely small area, there were cases where nearby nerves or blood vessels had been damaged. Many patients complained about the inconvenience of postoperative management as well because, after undergoing the operation, they had to leave the hospital with a drainage tube attached to their neck to prevent complications such as infection or swelling.

 

Late last month, AMC team led by Professor Yong-Hee Kim successfully performed Korea’s first robotic surgery on thoracic outlet syndrome. A hole with a diameter of 5mm and three holes with a diameter of 8mm were pierced in Ms. Hong’s armpit where robotic arms and an endoscope were inserted. With the broader view ensured through the endoscope, the team freely moved the robotic arms to successfully cut off the rib which pressured the nerves traveling to Ms. Hong’s right arm. Ms. Hong left the hospital two days after the operation in good health without pain or complication.

Asan Medical Center (AMC) has recently been certified with ISO 27701, a global standard for privacy information system, established by the International Organization for Standardization. In comparison with the previous ISO 27001 certification that AMC had maintained since 2010, ISO 27701 has an expanded scope of review to cover personal privacy. The Office for Information Security announced that AMC will take this ISO 27701 certification as an opportunity to further raise the level of personal information protection through reinforced monitoring on the use of hospital system data.

 

Meanwhile, AMC was awarded a commendation on September 30 at the 2nd Personal Information Protection Day event in recognition of its contribution to spreading personal information protection in the health care sector in Korea.

AMC team led by Professor Myung-Soo Choo of the Department of Urology and Professor Dong-Myung Shin of the Department of Biomedical Science recently revealed findings from a phase 1 clinical trial in which 3 patients with severe interstitial cystitis were administered with mesenchymal stem cells derived from human embryonic stem cells. The trial was the first of its kind in the world and the patients experienced temporary pain improvement without any adverse events including immune reaction.

 

The research team administered mesenchymal stem cell therapy derived from human embryonic stem cells to the bladder mucosa in 3 patients with severe interstitial cystitis whose conditions had not improved with existing treatments. The therapy was administered to 5 bladder submucosa sites including Hunner lesions (ulcer-like lesions with a major clinical feature of interstitial cystitis) with a total dosage of 5cc, 1cc per session.
The progress of patients was observed over the next 12 months and the results showed that the pain was temporarily alleviated in all patients. 2 patients out of 3 particularly experienced temporary pain alleviation to the extent that they did not have to take existing therapy products even without cauterization of Hunner lesions. In addition, no obvious abnormalities were found in hematology, biochemistry, urinalysis, and abdominopelvic computer tomography (CT) tests.

 

This study confirmed the clinical safety of stem cells in treating interstitial cystitis for the first time. In recognition of such achievement, research findings were published in the latest issue of ‘Stem Cells Translational Medicine,’ a renowned journal in the field of stem cell research.

Asan Medical Center of ASAN Foundation (Chairman Chung Mong-Joon) has 5 out of 11 clinical specialties named among top 10 hospitals in the 'World’s Best Specialized Hospitals 2023' rankings by Newsweek, a U.S. weekly magazine. Asan Medical Center has been ranked world’s No. 3 in endocrinology, No. 4 in urology, No. 6 in gastroenterology, No. 7 in cancer, and No. 9 in Neurology, standing tall among world leading medical institutions. In addition to the world's top 10 clinical specialties, Asan Medical Center has been ranked world’s No. 12 in orthopedics, No. 26 in pulmonology, No. 39 in cardiology, No. 54 in cardiac surgery, and No. 60 in pediatrics, possessing 2 clinical specialties as world's top 30, 1 as top 50, and 2 as top 60. As a result, a total of 7 specialties have been ranked within top 30 in the world.

 

This year, endocrinology is particularly noticeable. AMC endocrinology has moved up two notches from last year and selected as one of the world's top 3 hospitals leading endocrine treatment along with Mayo Clinic and Massachusetts General Hospital of Harvard Medical School in the U.S.

 

Asan Medical Center has been ranked world’s top 4 in urology, included as one of the clinical specialties this year, along with Cleveland Clinic, Johns Hopkins Hospital, and Massachusetts General Hospital of Harvard Medical School in the U.S.

 

Meanwhile, Asan Medical Center has been ranked No. 30 hospital in the world and No. 1 hospital in Korea among 250 world-renowned hospitals released by Newsweek earlier this year.

A recent study showed that senior citizens are highly likely to develop impairments related to body movement, brain, vision, hearing, speech, or psychology if it takes more than 10 seconds to stand up from a chair, walk 3 meters and walk back to the chair and sit again.(Timed Up and Go(TUG) test)

 

Asan Medical Center (AMC) team led by Professor Ki Young Son of the Department of Family Medicine conducted a long-term follow-up study of 80,000 senior citizens aged 66 years old based on National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS) data to track their walking ability and disability incidence later on. The results revealed that senior citizens with impaired walking ability is 1.6 times more likely to develop disability than those without.

 

TUG test is a comprehensive assessment on physical functions of the elderly including a sense of balance, leg strength and walk speed which is performed as part of the health examination for senior citizens who have reached 66 years old, a transition period in life. In the test, one would stand up from a chair, walk 3 meters forward to pass the halfway point and walk back 3 meters to the chair to sit down again. If it takes more than 10 seconds to do this, the individual’s physical function is considered to be impaired.

 

Of the slightly more than 80,000 participants, 29% recorded an average of 11.76 seconds on the TUG test and diagnosed with impaired physical function. The other group composed of those who were diagnosed to have normal physical function recorded an average of 7.20 seconds, 4.6 seconds faster than the slower group.

 

Later, after a long-term follow-up on each participant to find out whether or not he/she was nationally registered as a disabled person, the incidence of disability in the normal TUG group was 0.215 when transformed to into 1,000 man-year (assuming that one-year observation was made on 1,000 patients). On the other hand, the abnormal TUG group’s disability development was 0.354 per 1,000 man-year, which was confirmed to be 1.6 times higher than the normal group. The types of impairment included brain damage, visual impairment, hearing disability, speech disorder, and mental disorder.

 

The research findings are published in ‘Plos One,’ an international journal at the level of SCIE (Science Citation Index Expanded).

Asan Medical Center (AMC) team led by Professor Jong-Woo Choi has successfully removed the huge tumor of Flangie. Flangie had molar tooth pain when he was 8 years old, so his mother pulled it out. Maybe due to the tooth extraction, inflammation began to occur in Flangie’s molar extraction area.

 

The inflammation, which was small in the beginning, gradually grew into a giant cell reparative granuloma. Giant cell reparative granuloma is a rare disease, known to occur in one out of every 1 million people. Initially, it can be easily treated with drugs, but in the case of Flangie, the tumor kept growing and later on protruded from his mouth due to delay in treatment. The tumor of Flangie was seriously gigantic in size among giant cell reparative granulomas.

 

Having neglected the tumor for more than a decade, Dr. Jae-hoon Lee, who is a medical missionary engaged in medical volunteer work in Madagascar, accidentally discovered Flangie in the early 2021. Dr. Lee judged that Flangie’s tumor was difficult to treat in Madagascar. When Dr. Lee was inquiring several Korean hospitals to treat Flangie, Asan Medical Center readily responded.

 

On September 16, AMC team led by Professor Jong-Woo Choi of the Department of Plastic Surgery performed more than eight hours of major surgery together with the Department of Dentistry and Department of Otolaryngology-Head and Neck Surgery. The surgery was to remove the giant cell reparative granulomas, which was as big as Flangie’s face, 15cm or more in size and 810g in weight. Also, the team rebuilt the lower jaw, which was not functioning properly due to the tumor, using Flangie’s calf bone, and aligned his mouth and lips which were stretched due to the tumor. Flangie regained his light-weight face and a bright smile and is set to return home on November 5. 

 

The entire treatment cost of Flangie will be supported by the Asan Foundation and Asan Medical Center.

Research team led by Professor Jung-Min Ahn and Professor Do-Yoon Kang of the Division of Cardiology at Asan Medical Center (AMC) randomized 880 coronary artery disease patients into two groups of PCI and CABG, and conducted a follow-up for about 12 years. Multivessel coronary artery disease patients in the research were 438 patients who underwent PCI with drug eluting stenting and 442 patients who underwent CABG from 27 medical institutions in South Korea between July 2008 and September 2013. The average follow-up period for the two patient groups was 11.8 years, and the incidence of death, stroke, and major cardiac event was 28.8% in the stenting group and 27.1% in the surgery group, displaying little difference. However, postoperative incidence of myocardial infarction was slightly higher in the stenting group with 7.1% compared to 3.8% of the surgery group, and the probability of reoperation due to recurrence was 22.6% in stenting and 12.7% in surgery, almost 10%p higher in stenting given the treatment characteristics. These numbers are not a direct cause of death, however, and it was explained by the researchers that PCI can sufficiently be an alternative in high-risk patients for whom surgery is difficult and those who are concerned about opening the chest for heart surgery.

 

This research was a follow-up to the research published in NEJM (New England Journal of Medicine), in 2015 by the team led by Professor Seung-Jung Park. The research was published in ‘Circulation’, the official academic journal of the American College of Cardiology.

On September 23, AMC Liver Transplantation Team of the Organ Transplantation Center achieved 8,000 cases of liver transplantation for the first time in the world. The 8,000th liver transplantation was a living donor liver transplantation in which a son donated part of his liver to save his father who was battling liver cancer.

 

Since the first deceased donor liver transplantation at Asan Medical Center in 1992, 6,658 cases of living donor liver transplantation and 1,342 cases of deceased donor liver transplantation have been performed at AMC (as of the end of September 2022). More than 500 cases of liver transplantation are annually performed safely with a success rate of 98%, the highest in the world.

 

Patients who underwent liver transplantation at AMC include ▲ the longest-term survivor of liver transplantation in South Korea (42 years old at the time), ▲ Korea’s first pediatric living donor liver transplantation patient (1994, 9 months old at the time), ▲ Korea’s first adult living donor liver transplantation patient (1997, 38 years old at the time), ▲ world’s first case of liver transplantation using modified right lobe graft (1999, 41 years old at the time), and ▲ world’s first case of 2-for-1 liver transplantation (2000, 49 years old at the time). All these patients have been living healthy since their surgeries.

 

85% of liver transplantation performed at AMC is living donor liver transplantation. Living donor liver transplantation is more complicated and accompanied by many complications compared to deceased donor liver transplantation, making it difficult to guarantee a high survival rate. However, AMC has achieved survival rates of 98% (1-year), 90% (3-year) and 89% (10-year) despite that severely-ill patients with a very low surgical success rate were not turned away.

Asan Medical Center (AMC) team led by Professor Hanjong Ahn, Professor In Gab Jeong, and Professor Jungyo Suh of the Department of Urology conducted a follow-up observation on 510 patients who underwent radical prostatectomy between 2000 and 2012 in four medical institutions in Korea (Asan Medical Center, Seoul National University Hospital, Samsung Medical Center, and Seoul National University Bundang Hospital) by dividing them into the robot-assisted surgery group (272 patients) and open surgery group (238 patients). The groups were then compared in terms of metastasis-free survival and recurrence-free survival in 5 years and 10 years.

 

It was found from the comparison that 5-year metastasis-free survival rates of robot-assisted surgery group and open surgery group were 82.1% and 86.1%, respectively, while 10-year metastasis-free survival rates were 66.7% for both robot-assisted and open surgery group, displaying no difference. Also, 5-year recurrence-free survival rates were 22.5% for robot-assisted surgery group and 20.5% for open surgery group. 10-year recurrence-free survival rates of robot-assisted surgery group and open surgery group were 13.9% and 11.6%, respectively.

 

This research was supported by the Korean Urological Oncology Society and research findings were published in the latest issue of the ‘Journal of Cancer Research and Clinical Oncology,’ an international academic journal.

Metastatic spinal tumors are cancer that has spread to the spine. Fixation of the spine with screw insertion is necessary to prevent vertebral collapse while removing the tumor by surgery. Previously, more than four vertebrae have been fixed with screws through open spine surgery with a long incision in the back, about 30cm, for stabilization of the spine. However, a recent study has revealed that short-segment fixation is sufficient according to patients.

 

From 2018 to 2020, AMC team led by Professor Jin Hoon Park and Specialist Hong Kyung Shin of the Department of Neurosurgery performed ‘customized short-segment fixation’ surgery method such as fixing only two joints of the existing spine after removing the tumor or treating compressed nerves on 105 patients with metastatic spinal tumors.

 

According to the research, the incidence of complications such as postoperative hematoma and recurrence was about 6% when spinal short-segment fixation surgery was applied simultaneously. Compared to the fact that complication rates were reported as high as 10~20% when only traditional surgical methods were applied, the risk of complications decreased significantly. In addition, several subjective quality of life measures (ECOG-PS, KPS, etc.) show that after surgery, quality of life has improved significantly to the point where patients are capable of ordinary daily lives. In the 1-year survival rate, there was no statistical difference between traditional surgical method and ‘customized short-segment fixation’ surgery method, not affecting cancer treatment.

 

The findings were recently published in the international journal ‘Medicine.’

Early detection is important for pancreatic cancer as it is one of the human solid tumors with the worst prognosis. However, CA19-9 currently in use as a marker for early diagnosis of pancreatic cancer has limitations due to insufficient accuracy.

 

Professor Song Cheol Kim of the Division of Hepatobiliary and Pancreatic Surgery and Professor Eunsung Jun of the Department of Convergence Medicine recently published the results of a study in ‘Gastroenterology’ that improved the accuracy of a pancreatic cancer diagnostic marker. The study was a multinational and multicenter research that was participated by diverse hospitals including the Beckman Research Institute in the U.S. and Prince of Wales Hospital, Chinese University of Hong Kong.

 

The research team conducted sampling of miRNA (micro RNA) panel, one of the tumor-derived exosomes from pancreatic cancer patients, and used machine learning algorithms on key miRNAs to develop a diagnostic method with 94% accuracy, 92% sensitivity and 97% specificity. It was also confirmed that the diagnostic accuracy further improved when used together with CA19-9. In particular, it showed excellent diagnostic performance for early pancreatic cancer diagnosis (stages 1 or 2).

 

In the meantime, a research team led by Professor Song Cheol Kim and Professor Suhwan Chang of the Department of Biomedical Sciences have demonstrated that GAL-3BP antibody is an important therapeutic target and can be used to significantly block the metastasis of pancreatic cancer. The findings of pancreatic cancer treatment using GAL-3BP antibody was published in the latest volume of ‘Proceedings of the National Academy of Science (PNAS)’ of the United States.

Schizophrenia is a mental illness that affects the overall personality such as a person’s thought, feeling, sensation, and behavior. Antipsychotic medication is the initial treatment method used to significantly relieve symptoms, but it may be less effective to 30~50% of patients with schizophrenia. Then, electroconvulsive therapy (ECT), involving electrical stimulation of the brain, can be performed which has been recently proven effective through a research.

 

AMC research team led by Professor Jungsun Lee and Specialist Sung Woo Joo of the Department of Psychiatry analyzed data from 2010 to 2019 of the Health Insurance Review and Assessment Service (HIRA) database in the Republic of Korea. Antipsychotic treatment discontinuation, psychiatric hospitalization, etc. of 1-year were used as measures of clinical outcomes of 380 schizophrenia patients having more than 6 ECT sessions. As a result, it was confirmed that the number of antipsychotic treatment discontinuations decreased by about 45% and the number of psychiatric hospitalization by about 31%.

 

The research team also analyzed the treatment progress of 1,140 patient controls matched with age, gender, and severity to compare the treatment effects of ECT and antipsychotic treatment. It was found that the number of antipsychotic treatment discontinuations in the group treated with drug alone decreased by about 13%, indicating that the reduction effect was not relatively high compared to the ECT group.

 

The results of this study were recently published in ‘Neuropsychiatric Disease and Treatment,’ an international journal covering research in psychiatry.

In the medical industry, it is important to undertake an appropriate external verification to determine the effectiveness of any machine-learning prediction model. Professor Sang-Wook Lee of the Department of Anesthesiology and Pain Medicine recently conducted a research, together with medical teams at Seoul National University Hospital, Ewha Womans University Mokdong Hospital and SMG-SNU Boramae Medical Center to predict 30-day post-operative mortality through cross-validation of machine-learning prediction models on each institution’s data.

 

From these four hospitals, the research team extracted 2001-2004 data of 450,000 people from the electronic record system and used artificial intelligence machine learning to study the data of each hospital. The team analyzed their blood test results and information including age, gender, body mass index, emergency surgery status, type of surgery, and anesthesia method. It was demonstrated from the results that, even with only a small number of input variables, the prediction success rate for 30-day post-operative mortality was over 10% higher than that of the previous models that use a large number of data variables. The effectiveness of prediction performance and clinical utility were confirmed through cross-validation of 4 machine-learning models that were based on different databases.

 

The research findings were recently published in ‘npj Digital Medicine,’ a renowned international journal in the field of medical informatics.

For the first time in the world, Asan Medical Center (AMC) team led by Professor Duk-Woo Park, Professor Seung-Jung Park, and Professor Do-Yoon Kang of the Division of Cardiology found that there is no difference in the incidence of major cardiovascular events or death in high-risk patients who underwent routine functional testing, compared with standard care, after PCI. This study has been published in the latest issue of the ‘New England Journal of Medicine (NEJM),’ a journal considered the textbook for worldwide medical professionals, and is expected to be reflected in the guidelines to refrain from mandatory stress testing on high-risk patients after PCI.

 

The NEJM is one of the world’s most prestigious medical journal with an impact factor (I.F.), reflecting the number of citations of published article, of 176.079. Over the past decades, clinical studies published in the NEJM have been reflected in textbooks, effecting the worldwide clinical practice. A total of 8 publications have been published in the NEJM by medical professionals at AMC Heart Institute as the first author or corresponding authors. AMC Heart Institute published 6 papers on the NEJM by the Interventional Team led by Professor Seung-Jung Park, who published Korea’s first paper on the NEJM in 2003, and Professor Duk-Hyun Kang, specialized in valve diseases, published 2 papers on the NEJM. In particular, Professor Seung-Jung Park is Asia’s first to be the corresponding author in all 6 papers on the NEJM, one of world’s best achievements.

 

AMC team led by Professor Duk-Woo Park conducted a multicenter, pragmatic, randomized superiority trial with 1,706 high-risk patients who underwent PCI at 11 hospitals in Korea. The trial compared 849 patients who performed routine functional testing 1 year after the procedure and 857 patients who only underwent standard-care strategy. As a result, at 2 years after PCI, the incidence of major clinical events was 5.5% in the group with routine stress functional testing and 6.0% in the group which did not. Thus, there was no significant difference between the two groups. Therefore, the team concluded that routine functional testing after 1 year of PCI in high-risk patients should be conducted when there are other clinical signs or symptoms suggestive of stent failure such as chest pain rather than mandatory testing.

 

The study has been published on the NEJM in real time while being announced as the ‘Late-breaking Science’ at the European Society of Cardiology (ESC) Congress 2022.

Mycosis fungoides often occurs in areas that are not exposed to sunlight. According to a recent research conducted by a research team at Asan Medical Center reported that the results are much worse in cases involving the head and neck. AMC research team led by Professor Woo Jin Lee and Professor Joon Min Jung of the Department of Dermatology analyzed treatment results between 1997 and 2020 of 124 patients who were treated for mycosis fungoides, which accounts for a great part of cutaneous lymphoma by dividing them into two groups depending on whether or not they had head and neck lesions. 39 patients (31.5%) had head and neck involvement and 85 patients (68.5%) did not. According to the analysis, 10-year survival of those with head and neck skin lesions was 53.4% while 94.6% for those without, which demonstrated a significant difference.

 

Also, among patients with head and neck skin lesions, 48.7% of the patients had mycosis fungoides metastasized to the skin, lymph nodes, bone marrow, blood, and more, whereas only 3.5% of the patients without head and neck involvement experienced metastasis to other organs. Also, the ‘large-cell transformation,’ in which malignant lymphocyte cells grow to the extent where it is difficult to treat, occurred in about 15% of the patients with head and neck skin lesions but only around 1% of the patients without.

 

The research findings of the study were recently published in the ‘Journal of the American Academy of Dermatology,’ a renowned global academic journal in the field of dermatology.

AMC Cancer Institute has recently opened the CAR T-Cell Therapy Center specialized in CAR T (Chimeric antigen receptor T cell) therapy. In addition, CAR T-Cell Therapy Center has started Kymriah (CAR T therapy) treatment, certified by Novartis and covered by the National Health Insurance.

 

CAR T therapy involves extraction of a patient’s own immune cells (T-cells) and engineering of the T-cells to express chimeric antigen receptors that react to certain cancer cells, after which the cells are infused into the patient again to destroy cancer cells. The therapy is applicable to patients who are 25 years or younger with recurrent or refractory B-cell acute lymphocytic leukemia and adult patients with recurrent or refractory diffuse large B-cell lymphoma.

 

So far, recurrent or refractory B-cell acute lymphocytic leukemia and recurrent or refractory diffuse large B-cell lymphoma have been difficult to cure with post-diagnosis life expectancy of only 6 months. However, it is known that the cancer is completely eradicated in approximately 80% of recurrent or refractory B-cell acute lymphocytic leukemia in pediatric patients and half of the adult patients with recurrent or refractory diffuse large B-cell lymphoma.

 

Adult patients will be treated by Professor Dok Hyun Yoon and Professor Hyungwoo Cho of Oncology and Professor Jung-hee Lee and Professor Han-seung Park of Hematology. Pediatric patients will be treated by Professor Ho Joon Im, Professor Kyung-Nam Koh, Professor Hyery Kim, and Professor Sung-Han Kang of Pediatric Hematology & Oncology.

A team led by Professor Dong-Myung Shin and Professor Jaekyoung Son of the Department of Biomedical Science, University of Ulsan College of Medicine, and Professor Bumsik Hong of the Department of Urology, Asan Medical Center discovered a mechanism that blocks cancer proliferation, unraveling new clues to advanced bladder cancer treatment.

 

In order to verify whether ID2 activation inhibits the stemness features (proliferation, self-renewal and invasive activity) of bladder cells induced through overexpression of TFCP2L1, the research team overexpressed TFCP2L1 and ID2 simultaneously in HT1197 and HT1376 cells that are subtypes of muscle-invasive bladder carcinoma. As a result, it was observed in both cells that the stemness feature of bladder cancer cells, which was increased due to overexpressed TFCP2L1, was inhibited by overexpression of ID2.

 

The research team also confirmed that CDK1 and ID2 showed an inverse correlation, and a clinical basis was obtained for bladder cancer treatment through CDK1 inhibition and ID2 activation. Accordingly, the research team sought to secure an in vivo basis for the treatment of bladder cancer based on the regulation of TFCP2L1-ID2 signaling system and designed a treatment method of using RO-3306 drug, which phosphorylates TFCP2L1 protein and specifically inhibits CKD1 protein, in combination with apigenin, a small molecule that promotes ID2 activation. Later, when a combination of RO-3306 and apigenin was injected into an orthotopic xenograft animal model of bladder cancer, bladder size and weight were significantly reduced, and the malignancy of bladder cancer was reduced as well, seen from a histological examination.

 

The research findings were published in the June, 2022 issue of ‘Experimental and Molecular Medicine' (Impact Factor=12.178), a sister journal of 'Nature' and a renowned academic journal in the field of biochemistry and molecular biology.

As international exchanges, temporarily ceased due to the global COVID-19 outbreak, are resuming, many international physicians are flying in from abroad to learn the advanced medical skills of Asan Medical Center (AMC). In the first half of this year, 51 international physicians visited AMC for training and 50 more are scheduled to come in the second half.

 

A medical team from the Austral University Hospital of Argentina visited AMC on July 18 to learn the world-renowned medical skills and know-hows of AMC liver transplantation team.

Asan Medical Center (AMC) Heart Institute has been recently designated as Asia’s one and only Teaching Center of Excellence for TAVI (Transcatheter Aortic Valve Implantation) that can offer training programs to international medical professionals from abroad. Now, AMC is qualified to manage, supervise, and educate on every aspect of TAVI procedure including diagnostic approaches and treatment processes to global hospitals and medical professionals on their initial performance of TAVI.

 

Requirements to be selected as a TAVI Training Center of Excellence by Edward Lifesciences, a US-based global medical device manufacturer, are quite challenging to be met. The hospital should have sufficient experience of TAVI procedure, patients with severity or diverse cases, and procedural success rate with low incidence of complications after 30 days of the procedure. In addition to TAVI performance, medical professionals in the relevant fields such as Cardiology and Thoracic and Cardiovascular Surgery should be qualified ‘Proctors’ with capabilities for TAVI training, management, and supervision to conduct 1:1 training. The teamwork of all the relevant medical professionals is evaluated as well. Lastly, the hospital itself should also have facilities for TAVI treatment and training, and virtual and onsite training arrangements should be available. In the past, the TAVI Teaching Centers of Excellence were all hospitals in the U.S. and Europe. However, this year, hospitals in the Asia-Pacific region, AMC in South Korea and St Andrew’s War Memorial Hospital in Australia, have been designated for the first time in history.

 

TAVI Training Centers of Excellence are classified into different specialties depending on the institution’s experience on cardiac procedures and characteristics. AMC has been classified to specialize in ‘Minimalist TAVI’ characterized by the absence of general anesthesia, minimizing the patient burden, and ‘CT Imaging & Screening’ which involves image-based procedures.

Lymphedema is a condition associated with severe limb swelling and chronic inflammation as lymph flow becomes impaired either when lymph nodes with cancer metastasis are resected or chemotherapy is performed on the affected area. While there have been very few preventive or treatment measures for lymphedema so far, a research team of Asan Medical Center (AMC) developed an artificial structure that facilitates recovery of the damaged lymph node.

 

AMC research team led by Professor Jae Yong Jeon of the Department of Rehabilitation Medicine and Dr. Hwayeong Cheon, a researcher at the Biomedical Engineering Research Center developed a tool called ‘lymphatic channel sheet (LCS),’ a two-dimensional structure which contains micro-fluidic passages and designed to connect broken lymphatic vessels. The research team transplanted LCS on a lymph node resected from a small animal model with a lymphatic circulation disorder and discovered that the impaired lymph flow became successfully reconnected. Also, a comparative observation was made on swelling change in an LCS-transplanted small animal model and a lymph node resected small animal model. As a result, the swelling of the LCS-transplanted model showed a significant reduction from week 2 and returned to normal size in 7 weeks. On the other hand, no significant swelling reduction was observed from the lymph node resected model.

 

In the meanwhile, a biopsy of the inner part of the transplanted lymphatic channel sheet confirmed that microvessels and micro lymph nodes were generated inside the sheet. In other words, the lymphatic channel sheet not only maintains the lymph flow but offers an environment that aids lymph node regeneration.

 

The research team obtained a patent for the lymph channel sheet and the research findings were recently published in the ‘Journal of Bioengineering & Translation Medicine,’ an influential journal in the field of medical engineering.

The 18th Asan Rhinoplasty Symposium was held on May 14 virtually. The Symposium was attended by 1,100 medical professionals from 74 countries who shared the latest advances on rhinoplasty. Invited speakers included 26 world-renowned scholars from home and abroad including Professor Yong Ju Jang of the Department of Otolaryngology-Head and Neck Surgery, Professor Andres Gantous of the University of Toronto, Professor Derek Steinbacher of Yale University School of Medicine, Professor Grant Hamilton of Mayo Clinic, and Professor Amir Sazgar at Tehran University of Medical Sciences who delivered presentations and conducted discussions on various themes such as ▲ essential considerations in Asian rhinoplasty, ▲ costal cartilage support for the contracted nose, and ▲ skeletal reconstruction in severe post-rhinoplasty nasal deformity.

On June 22, Asan Foundation held an academic symposium to commemorate the 45th anniversary of its establishment at the International Conference Hall, Korea Press Center. The theme of the symposium was “Welfare in the Era of Catastrophic Crisis” and invited the relevant academia and experts. During the symposium, presentations were given by researchers and discussions were held with relevant experts regarding ‘Building a safety net for education and welfare in the post-COVID-19 era’ and ‘Influence of COVID-19 and emergency relief funds.’

 

Chairman Mong-Joon Chung of Asan Foundation introduced the founding spirit of Asan Foundation during his welcoming speech. “My father, the late Chairman Ju-yung Chung, established Asan Foundation to defeat the vicious cycle of illness and poverty. He stressed that helping those in need to alleviate relative deprivation, social disharmony, and distinction is the respect humans have for them”, and added, “I expect South Korea to develop into a society persevering through challenges with concern, consideration, and respect for our neighbors in need.”

 

Regarding ‘Building a safety net for education and welfare in the post-COVID-19 era, Professor Soon-yang Kim at the Department of Public and Social Policies, Yeungnam University, presented his analysis on educational inequality of the children of disadvantaged families in terms of educational environment, process and results, which was followed by policy-level proposals. Professor Jun Young Lee at the Department of Public Affairs and Economics, University of Seoul served as the moderator and debaters were Professor So-yeon Jung at the Department of Social Welfare, Seoul Women’s University and Professor Soon Woo Park at the Department of Social Welfare, Kongju National University. Regarding ‘Influence of COVID-19 and emergency relief funds’, Professor Jaehyun Nam at the Department of Social Welfare, Pusan National University presented a multifaceted analysis on the economic influence of emergency relief funds focusing on the disadvantaged, and Professor Hyung-Yong Kim at the Department of Social Welfare, Dongguk University and Associate Research Fellow Won-jin Lee of the Korea Institute for Health and Social Affairs attended as debaters. In the panel debate, Professor Jae-Sung Choi at the Department of Social Welfare, Yonsei University served as the moderator while all presenters, debaters, and Professor Seok-ho Kim at the Department of Sociology, Seoul National University participated to share comprehensive ideas on ‘Welfare in the Era of Catastrophic Crisis’ and debate on where our society should be headed.

 

Celebrating its 45th anniversary this year, Asan Foundation has hosted annual academic symposium since 1979 to promote development and improve welfare of our society.

Esophageal cancer surgery involves removing esophagus together with the tumor and reconstructing it using either stomach or colon. Surgical procedures take time because a wide range of incision is required and patients are often aged. The mortality risk is also high due to complications and inflammation. However, the mortality of patients who underwent esophageal cancer surgery at AMC last year recorded 0% as no death was reported in a month after surgery.

 

The total 177 cases of esophageal cancer surgery was performed at AMC last year. While few hospitals are globally known to perform more than 30 cases of esophageal cancer surgery a year, AMC is the one and only hospital without any death in one month after surgery. This is an outstanding performance in comparison of approximately 10% operative mortality in top ranking hospitals around the world.

 

AMC started performing esophageal cancer surgeries immediately after it opened in 1989, achieving 1,000 cases in 2011. Since 2017, AMC has been performing more than 150 cases annually. The Department of Thoracic and Cardiovascular Surgery (Division of Thoracic Surgery) is actively performing esophageal cancer surgeries using thoracoscope and robots in order to reduce thoracotomy as well as scars, pain, and postoperative complications caused by laparotomy. Among 177 patients who underwent esophageal cancer surgeries last year, 110 patients underwent robot-assisted surgeries with the da Vinci surgical system, accounting for approximately 62%, and 5 patients underwent thoracoscopic surgery.

 

In addition, AMC has strived to reduce operative mortality through customized patient treatment and systemized intensive care as it launched a multidisciplinary esophageal cancer treatment system for the first time in Korea 20 years ago. Medical professionals from the Department of Thoracic and Cardiovascular Surgery (Division of Thoracic Surgery) and diverse medical departments including the Division of Stomach Surgery, Division of Colon and Rectal Surgery, Department of Otolaryngology - Head and Neck Surgery, Department of Radiation Oncology, Division of Oncology, Division of Gastroenterology, Department of Radiology, and more are participating in the multidisciplinary esophageal cancer treatment.

Asan Medical Center (AMC) is offering virtual medical consultations for international patients. Last year, AMC participated in the ‘ICT-based Pre-consultation and Post-care Pilot Project’ hosted by the Korea Health Industry Development Institute (KHIDI) and provided virtual consultations to 102 Mongolian patients. This year, in addition to this project, AMC is expanding the global medical service coverage to patients in the Middle East, Vietnam, Russia, Australia, Kenya, and more. The number of patients who received the virtual consultation of AMC amounts to 266 in total.

 

Virtual consultations were held at Asan Medical International (AMI) meeting room on June 3rd. Professor Won-Kyung Cho and Professor Seo Young Kang of the International Healthcare Center provided virtual consultations to Mongolian patients as demonstrations to relevant individuals from the Ministry of Health and Welfare (MOHW) and KHIDI. The professors explained to the patients about their opinions on the disease and treatment plan.

 

An additional report was made at the demonstration on the achievements made from the last year’s ‘ICT-based Pre-consultation and Post-care Pilot Project.’ Through this project, AMC provided virtual consultations to 102 patients in Mongolia for from October to November of last year. This year, it is planned to achieve over 200 cases of virtual consultations and expand this service to patients in various countries.

 

AMC’s online medical services for patients in foreign countries are categorized into four areas: ‘pre consultation’ for case review and prescribing radiology report; ‘outpatient consultation by proxy’ offered by AMI on behalf of each medical department; ‘second opinion’ which provides a written opinion regarding a disease produced by a relevant expert; and, ‘virtual consultation’ through which the patient, local doctors, and AMC doctors are connected via video conference for collaborated treatment.

 

The online medical services delivered by AMC from January to May this year include 132 cases of 'pre consultation,' 86 cases of ‘outpatient consultation by proxy,’ 19 cases of ‘second opinion,’ and 29 cases of ‘virtual consultation.’ AMI seeks to further promote online medical services by, for example, raising the rate of actual medical treatment and the ratio of visitors to AMC, and is building collaborative partnership with 29 institutions in 12 countries. When the online medical services for patients in foreign countries are well established, AMC is expected to achieve enhanced global presence, reliability, and brand image.

Rituximab is used during the pretreatment process of high-risk kidney transplantations to eliminate rejection reactions such as blood type mismatch or tissue incompatibility. It was suggested from recent research that patients who received kidney transplantation may experience an increased risk of cancer development due to side effects of rituximab. However, recent research publication indicated irrelevance between low-dose administration of rituximab and cancer development.

 

A research team led by Professor Hyunwook Kwon of the Division of Kidney and Pancreas Transplantation studied 2,895 patients who received kidney transplantation during the period of January 2008 and January 2018 to compare cancer incidence based on whether the patients received low-dose rituximab treatment. The patients were divided into 622 patients who received rituximab preoperatively and 2,273 patients who did not, and were subject to a follow-up observation for 72 months and 83 months, respectively, on average. As a result, cancer incidence was approximately 2.9% for rituximab untreated group and 1.9% for rituximab treated group, indicating no significant difference between the two groups.

 

While high-dose administration of rituximab was found to be associated with high cancer incidence in research findings so far, little research has been conducted on low-dose administration. This finding is meaningful in that cancer incidence can be minimized if careful control can be exercised to use a low dosage of rituximab in the pretreatment phase of kidney transplantation.
The research findings were recently published in the ‘Journal of the Korean Surgical Society.’

Although esophageal cancer is not one of the ten major cancers in terms of incidence, it is known to be difficult to treat as it has the fifth lowest 5-year survival rate of the ten.

 

When esophageal cancer is found in its early stage, patients can undergo surgery directly without radiation or chemotherapy. A recent research revealed that the incidence of postoperative complication is associated with the length of hospital stay depending on the preoperative nutritional status of the patients.

 

Professor Hee Kyoung Na of the Division of Gastroenterology and Professor Yong-Hee Kim of the Department of Thoracic and Cardiovascular Surgery at AMC led a research team to analyze preoperative nutritional status and postoperative prognosis of 274 patients who underwent surgery for esophageal cancer. The team reported that the incidence of complications including pneumonia was three times higher and the length of hospital stay was around 12 days longer in patients with poor nutritional status according to the findings.

 

This suggests the need for thorough management of preoperative nutritional status through dietary consultation with a specialist as patients may lose their appetite or experience weight loss with an upcoming esophageal cancer surgery in some cases.

 

The research team conducted an analysis on 274 patients who underwent surgery for squamous cell carcinoma without receiving radiation or chemotherapy for the period between January 2012 and December 2016. The patients were divided into a group of good nutritional status (N=239) and poor nutritional status (N=35) and analyzed for postoperative complication incidence and duration of hospital stay.

 

Nutritional status of the patients were measured using various nutritional assessment indexes and it was confirmed from the analysis that the NRS 2002 index recommended by the ESPEN (European Society for Clinical Nutrition and Metabolism) was significantly associated with postoperative prognosis. NRS 2002 is a nutritional screening tool used by a medical professional to examine BMI, weight change, eating habits and severity of the disease. Patients with a score less than three are considered to be in good nutritional status and those with a score greater than or equal to three are considered malnourished.

 

It was demonstrated from the statistical analysis on both groups for the incidence of postoperative complications including pneumonia, anastomotic leakage, and bleeding was approximately three times higher in the group of poor nutritional status compared to the group of good nutritional status.

 

When looking at the incidence of each complication, the incidence of pneumonia was 20% in the group of poor nutritional status which is extremely higher than 4.2% in the group of good nutritional status. The incidence of anastomotic leakage* was also higher in the group of poor nutritional status with 5.7% compared to 2.5% of the group of good nutritional status.
(* Anastomotic leakage: One of the postoperative complications occurring when anastomosis fails and results in leakage after restoring the esophagus using gastrointestinal tissue)

 

Again, the duration of postoperative hospitalization in the group of poor nutritional status was approximately 12 days longer than the average hospitalization of 17.3 days in the group of good nutritional status.

 

AMC Esophageal Cancer Center was the first in South Korea to adopt an integrated multidisciplinary approach to skillfully deal with esophageal cancer that is difficult to treat. The Center has been a pioneer in customized treatment for esophageal cancer patients by engaging various clinical departments including Gastroenterology, Thoracic and Cardiovascular Surgery, Stomach Surgery, Radiation Oncology, Radiology and Oncology to come together for discussion on treatment strategy.

 

In addition, the Center is also helping patients recover and maintain their nutritional conditions through pre- & post-operative nutritional status screening, a dedicated dietician offering informative advice to patients on recommended or contraindicated food products accordingly, and education on how to increase nutrition density of their meals.

 

The research findings were recently published in ‘Nutrition and Cancer,’ an international academic journal.

A research team led by Professor Tae-Bum Kim of the Division of Allergy and Professor Il-Young Jang of the Division of Geriatrics analyzed the association between sarcopenia and asthma using the data of 4,000 elderly individuals, 65 years or older, who participated in the National Health and Nutrition Examination Survey (2008-2011). As a result, it was found that elderly individuals who suffer from both asthma and sarcopenia tend to have serious lung capacity five times more than those who only have asthma.

 

The research team divided the asthma group according to muscle mass and compared their lung function indexes. While 9.07% of the group with asthma without sarcopenia had forced expiratory volume in 1 second (FEV1) less than 60%, the rate increased 5 times to 42.88% for the group with both asthma and sarcopenia.

 

Forced expiratory volume in 1 second is the volume of air exhaled in the first second during forced exhalation after maximal inspiration. If FEV1 is below 60% of the normal predictive value, the lung capacity is considered to be serious. There was also almost twice the rate of patients in the group with both asthma and sarcopenia who suffered from narrowed bronchial tubes and breathing difficulty. A relatively higher rate was observed to show serious reduction in lung capacity or narrowed bronchial tubes among elderly patients with asthma who are less engaged in physical activity.
The research findings were published in the latest issue of ‘Journal of Asthma,’ an international scientific journal in the field of asthma.

The 5-year survival rate of the patients who underwent breast surgery at Asan Medical Center (AMC) has reached over 95%. In an aim to analyze the change in the survival rate of breast cancer and factors influencing the chance, the team of Division of Breast Surgery studied 17,776 patients who underwent breast surgery between January 2000 and December 2013. The patients were divided into two groups according to the time of surgery: (1) between 2000 and 2007 (N=7,066) and (2) between 2008 and 2013 (N=10,710) to analyze their survival rate, recurrence rate, cancer progression, treatment method, and subtype.

 

According to the study, the 5-year survival rate after breast cancer surgery was 92.6% between 2000 and 2007 whereas it was 95.3% between 2008 and 2013 with an increase by 2.7%p. In addition, the rate of patients without breast cancer recurrence in 5 years also increased to 91.2% from 87.9%.

 

It was demonstrated that the rate of patients who have carcinoma in situ of the breast with the smallest tumor in size increased from 9.3% to 11%, and patient cases without any axillary node metastasis increased from 63.7% to 67%. In addition, the rate of patients with hormone-positive breast cancer and HER2-negative breast cancer that are known to have a relatively high survival rate compared to other subtypes of breast cancer increased from 51.4% to 59.4% while, on the other hand, the rate of patients for all other subtypes decreased.

 

A great increase from 44.7% to 66.7% was also observed in patients who underwent advanced breast conserving surgery which is to remove only the tumor lesion as much as possible in order to maintain the shape of the breast to the maximum extent possible. It was analytically interpreted that more patients have undergone breast conserving surgery as the rate of patients receiving chemotherapy as a preoperative treatment to reduce tumor size has increased from 0.1% to 12.2%.

 

The research findings were recently published in ‘PLoS One’ (IF=3.24), an international scientific journal.

While early gastric cancer can be treated by a relatively simple endoscopic procedure in some cases, surgical gastrectomy is performed upon the slightest possibility of lymph node metastasis because gastrectomy with lymph node dissection remains the standard treatment. Whether or not lymph node metastasis exists can be judged after surgery. However, findings reported from recent research suggested that the possibility of metastasis can be predicted before surgery.

 

AMC team of Professor Ji Yong Ahn and Professor Jin Hee Noh of the Division of Gastroenterology and Professor In-Seob Lee of the Division of Stomach Surgery analyzed 1,025 patients who underwent total gastrectomy due to early gastric cancer located in the upper stomach during the period between January 2001 and December 2017. The team developed a matrix for lymph node metastasis prediction depending on tumor size and depth as well as the presence of lymphovascular and neurological invasion. Tumor was categorized into two groups according to size (>=2cm or < 2cm), and the early-stage cancer was divided into 16 cases depending on whether the tumor invaded into mucosa, upper part of submucosa or even deeper.

 

The predicted possibilities of lymph node metastasis for each number of cases demonstrated statistical difference. For example, the possibility of lymph node metastasis was 1.3% when the tumor size was smaller than 1cm, the tumor invaded into the upper part of submucosa and lymphovascular or neurological invasion was not present. However, the possibility was approximately 75% when the tumor size exceeded 2cm, the tumor invaded into the lower part of submucosa and lymphovascular or neurological invasion was present. In order to test the data, the research team performed a statistical evaluation on the effectiveness of the prediction matrix for lymph node metastasis in early-stage gastric cancer and 83% accuracy was demonstrated as a result.

 

It is expected that the possibility of cancer metastasis and the quality of life of the patients will be considered together in the treatment of early gastric cancer, leading to more cases of first-attempt endoscopic resection or performing partial gastrectomy where the tumor is located to preserve the stomach.
The research findings were recently published in the Journal of Gastric Cancer (IF=3.72).

It is commonly understood that the incidence of cardiovascular disease increases when renal failure persists over at least 3 months or when one has chronic kidney disease with renal insufficiency. However, it is still not known exactly from what stage of renal failure the incidence of cardiovascular disease is impacted.

 

The team led by Professor Duk-Woo Park, Professor Seung-Jung Park, and Professor Tae-Oh Kim of the Division of Cardiology classified 10,354 patients who were treated for coronary artery disease depending on the severity of renal dysfunction and compared the incidence of death, spontaneous myocardial infarction, and stroke. The team revealed that, according to the research, the incidence of cardiovascular events was similar to that of individuals with normal kidney function in the case of mild renal dysfunction whereas moderate renal dysfunction was found to have a significant influence on cardiovascular events with 8.2% difference to individuals with normal kidney function.

 

The heart and kidney are known as body organs like brothers and sisters. Renal failure is particularly pointed out as an important risk factor for the prognosis of percutaneous coronary intervention (PCI) (stent insertion) or coronary artery bypass grafting (CABG) in coronary diseases treatment.

 

The research findings were published in the recent volume of the Journal of the American College of Cardiology (JACC, IF: 24.09), one of the most prestigious journals in the world in the field of cardiology.

 

The research team studied 6,466 patients who underwent PCI and 3,888 patients who underwent CABG during 2003 and 2018, all due to mutivessel cardiovascular disease.

 

According to the estimated glomerular filtration rate (eGFR)* which is a renal function index indicating how much blood the kidney can filter, the research subjects were classified into normal renal function (eGFR 90ml/min/1.73㎡ or above), mild dysfunction (eGFR 60~89ml/min/1.73㎡) and moderate dysfunction (eGFR 30~59ml/min/1.73㎡).

 

* Estimated glomerular filtration rate (eGFR): Estimation of renal function calculated using serum creatinine, additionally compensated for age and gender status to reflect actual renal function
After having the estimation further compensated for age, frequency of underlying diseases such as diabetes and hypertension and the degree of risk according to the severity of coronary artery diseases, an analysis was conducted on the probability of one or more cardiovascular events (death, spontaneous myocardial infarction, or stroke) between the normal function group and the mild renal dysfunction group, and between the normal function group and the moderate renal dysfunction group.

 

In the comparison between the normal function group and the mild renal dysfunction group, no significant difference was observed since renal dysfunction occurred in 18.0% of the normal function group and 19.6% in the mild renal dysfunction group. On the other hand, a significant difference was observed between the normal function group and moderate renal dysfunction group as renal dysfunction occurred in 25.4% and 33.6% in the groups, respectively.

 

This indicates that cardiovascular events such as death, spontaneous myocardial infarction, and stroke that are possible prognostic outcomes of PCI and CABG are impacted when the severity of renal dysfunction is moderate at the least.

 

Furthermore, the research team compared treatment outcomes of PCI and CABG according to the severity of renal dysfunction. As a result, no significant difference was demonstrated between percutaneous coronary intervention and coronary bypass surgery in all normal, mild, and moderate renal function.

 

In terms of severe- and end-stage renal dysfunction, it was reported from previous research that CABG produces better long-term treatment outcomes than PCI. Outcomes for mild and moderate renal failure have been revealed through this study more in detail.

Asan Medical Center (AMC) is actively taking the lead in health recovery and improved quality of life of patients with adrenal gland disorders by safely removing the adrenal glands through a small incision on the back of the patients suffering from severe hormonal disorder due to adrenal gland tumor.

 

AMC team of Professor Tae-Yon Sung, Professor Yumi Lee, Professor Won Woong Kim, and Professor Jae Won Cho of the Division of Endocrine Surgery has recently revealed that they have performing laparoscopic·robotic posterior retroperitoneal adrenalectomy on patients with adrenal gland disorders and achieved 1,000 cases April this year.

 

Retroperitoneal adrenalectomy considers the location of adrenal glands which is just above the kidney and behind the liver and stomach to make a small incision on a patient’s back, insert an endoscope or robotic arm and resect adrenal glands. In this way, unlike the conventional laparoscopic adrenalectomy through the abdomen, fasting is not required and complications are few as no other organs are disturbed. The length of hospital stay is also minimized to allow patients to be discharged in around 2 days after the surgery.

 

There was not even one instance among the 1,000 cases that required open surgery or led to any serious complications. Main causes include pheochromocytoma, Cushing syndrome and primary aldosteronism that account for 30%, respectively, and other causes include myelolipoma, early-stage adrenal cancer and adrenal metastatic cancer. While a considerable number of cases involved functional adrenal tumors (over-secretion of specific hormones), all patients were discharged from the hospital without any complication.

 

Adrenal glands release steroid hormone to control metabolism and immune reactions of one’s body. When an individual falls ill with pheochromocytoma or Cushing syndrome which involves abnormally excessive hormone secretion due to adrenal cancer or tumor, surgical intervention is necessary to remove the adrenal glands because this may lead to metabolic disorders such as high blood pressure, obese or diabetes.

 

It was conventional to perform the laparoscopic adrenalectomy which involves perforating 4 to 5 holes of 1-2 cm in size in the abdomen of a patient on the bed and inserting a laparoscopic device to cut off the adrenal glands. However, other organs such as stomach, small intestine, colon, liver and pancreas should first be pushed away and fixed to gain access to adrenal glands. The organs touched required two days on average to fully recover, thus a period of fasting has been inevitable so far.

 

AMC medical team of the Division of Endocrine Surgery chose to perforate 2 to 3 holes of 1-2 cm in size and insert an operative endoscopy or robotic arm to remove the adrenal glands. Since nearby organs are subject to minimized movement or operation in the process of surgery, the incidence of post-operative complications and patient inconvenience have dramatically reduced. In particular, the introduction of robotic surgery has contributed to reduced post-operative pain and greatly improved recovery speed as the number of incision has been reduced to one or two.

 

AMC has conducted more than 300 cases of robotic posterior retroperitoneal adrenalectomy to date. In 2018, the number of incision was reduced to 2 using da Vinci robots and a single-port robotic adrenalectomy has been adopted since 2021, making an incision for only one hole based on the da Vinci SP system. However, open surgery is conducted in case of advanced adrenal cancer in consideration of patient safety and disease characteristics.

 

In order to efficiently remove adrenal glands, access should be made from the retroperitoneal space and there are still few hospitals in South Korea that can conduct posterior retroperitoneal adrenalectomy. AMC has conducted posterior retroperitoneal adrenalectomy since the early days of hospital foundation, and it was after 2014 after the scope of applicable diseases was expanded that relevant surgeries have been actively carried out.

Asan Medical Center (AMC) has performed 4,371 cases of robotic surgeries last year alone, recording Korea’s highest number. It has been achieved after 15 years since the introduction of robotic surgery for the first time in 2007. AMC has expanded the application scope of minimally invasive robotic surgery to improve patient safety and post-operative quality of life. AMC is taking the lead in quantitative growth, with cumulative 10,000 cases in 2017 and 20,000 in 2021, and qualitative growth based on abundant clinical experience.

 

AMC performed 10,000 robotic surgeries in 2017, 10 years after the first introduction of the da Vinci robot system in 2007. Just four years later, in 2021, AMC surpassed 20,000 cases of robotic surgeries. Over the last five years, the number of robotic surgeries performed at AMC was 1,819 in 2017, 1,984 in 2018, 2,526 in 2019, 2,941 in 2020, and 4,371 in 2021.

 

Taking an in-depth look at the number of robotic surgeries conducted between 2007 and 2021, the Department of Urology performed the most cases of robotic surgery with 10,271 cases for prostate cancer and renal cancer. The Division of Hepatobiliary and Pancreatic Surgery performed 2,497 cases for pancreatic cancer and gallbladder diseases such as gallbladder cancer, and the Department of Obstetrics and Gynecology performed 2,302 cases for endometrial cancer, ovarian cancer and pelvic organ prolapse. The Division of Colon and Rectal Surgery performed 2,161 cases for diseases such as colon cancer and the Department of Thoracic and Cardiovascular Surgery 2,073 for cases such as esophageal cancer and heart valve diseases. In addition, the Division of Endocrine Surgery performed robotic surgery for thyroid cancer and adrenalectomy and the Division of Breast Surgery and the Department of Plastic Surgery for breast reconstructive surgery.

 

Many medical professionals visit AMC to learn state-of-the-art robotic surgery techniques and efficient operating systems. AMC opened the Robotic Surgery Training Center in 2013 and has been operating courses such as Basic Lab, Observation Course, Nurse Training Course, Fellowship Training Course, and workshop programs. In particular, the Robotic Surgery Training Center provides robotic surgery training programs in various clinical fields such as prostate cancer, colon cancer, and heart valve diseases which are popular among international physicians from Australia and Japan. The number of international physician training for robotic surgery is expected to increase as the COVID-19 pandemic situation improves.

Co-hosted by the Heart Institute of Asan Medical Center and the CardioVascular Research Foundation (CVRF), TCTAP 2022 Virtual was held for three days from April 27, 2022 on an online platform. TCTAP celebrates its 27th anniversary this year and is a representative international academic symposium in the Asia Pacific region attended by approximately 4,000 cardiology specialists from around 50 countries every year since 1995, when it was first held.

 

This is the third online TCTAP due to COVID-19 pandemic, which caught the attention of the audience with a more convenient online platform and a wider range of topics and programs. Throughout the symposium, a real-time chat service was offered for participants to share main themes and engage in Q&A with others while additional features included a metaverse platform where individuals can have discussions and exchange their opinions as well as virtual exhibitions, facilitating real-time participation in lectures.

 

The symposium was structured largely into four themes: ▲ TCTAP Workshop, involving lectures on key themes delivered by cardiac intervention specialists, ▲ Live Case Session, offering opportunities to learn the latest coronary intervention skills by watching videos filmed at renowned institutions home and abroad, ▲ KCTA Symposium and Partnership Session of worldwide heart associations, and ▲ Abstract Session and Case Session, sharing various recent knowledge and information. In particular, a great response was received for Live Case Session as it was participated by global medical institutions famous in the field of cardiology such as Humanitas Research Hospital (Italy), Cedars-Sinai Medical Center (U.S.), Los Robles Regional Medical Center (U.S.), and Minneapolis Heart Institute Foundation (U.S.) in addition to AMC.

 

Worldwide scholars in the field of cardiology were invited from 44 countries as speakers for TCTAP who delivered enthusiastic lectures on various topics from basic information to recent research trends including ▲ Coronary intervention for left main coronary artery disease, severely calcified coronary artery lesions, etc. and Treatment of valvular heart disease, ▲ Thoracic endovascular aortic repair, ▲ Cardiovascular imaging and physiology, and ▲ Structural heart disease.

Patients with metastatic or locally advanced but unresectable gastric cancer receive chemotherapy. However, not all patients have satisfactory prognosis of chemotherapy. The medical team composed of Korean and American physicians recently discovered biomarkers that can predict the chemotherapy efficacy for gastric cancer blood analysis.

 

Professor In-Seob Lee of the Division of Stomach Surgery, together with a medical team of the City of Hope Comprehensive Cancer Center (U.S.), conducted a blood-based genomic analysis on patients with metastatic or locally advanced but unresectable gastric cancer and discovered two miRNAs that are differently expressed in patients whose chemotherapy outcomes were poor.

 

The joint research team collected blood samples from twelve patients diagnosed with metastatic or locally advanced but unresectable gastric cancer in the U.S. and conducted RNA sequencing. Eight patients responded well to the fluoropyrimidine plus platinum therapy while the remaining four did not. In this process, nine miRNAs out of some 530 miRNAs were found differentially expressed in the group of non-responding patients.

 

Later, polymerase chain reaction (PCR) testing was conducted with blood samples collected before chemotherapy from twenty nine Korean patients with metastatic or locally advanced but unresectable gastric cancer to see if the same miRNA-based biomarker can also be applied in Korea. There were fifteen responders and fourteen non-responders.

 

It was revealed from the result that the fluoropyrimidine plus platinum therapy was not effective when two miRNAs (miR-30a-5p, miR-192-5p) are overexpressed. This finding is expected to serve as a crucial foundation in the future for the development and application of optimal chemotherapy customized to each individual patient.
This study is recently published in ‘Molecular Cancer,’ a world-renown scientific journal in the field of cancer research.

On a recent study performed by AMC research team, laparoscopic sleeve gastrectomy (LSG) showed favorable surgical outcomes with few postoperative complications.

 

Among bariatric surgeries, laparoscopic sleeve gastrectomy (LSG) is the most common procedure that induces weight loss by eliminating the greater curvature of the stomach which leaves behind a narrow gastric tube. AMC team led by Professor Moon-Won Yoo and Professor Chang Seok Ko of the Division of Stomach Surgery analyzed 50 patients with morbid obesity, an average body mass index (BMI) of 37 or higher, who underwent LSG between November 2018 and April 2020. Patients showed few postoperative complications such as bleeding or fistula. In particular, no special complications were found in patients with high-risk factors requiring intensive management such as dilated cardiomyopathy and end-stage renal disease.

 

Meanwhile, 25 patients who completed 6 months of follow-up after surgery had seen decreases in mean body weight from around 110kg to 87kg and mean BMI from 38.9 to 30.8. Also, the mean EWL, an index that evaluates the extent of weight loss exceeding the weight corresponding to BMI 25, increased over 60%.

 

The results of this study were recently published in the ‘Journal of Metabolic and Bariatric Surgery.’

Asan Medical Center is the one and only Korean hospital to be named among top 30 in Newsweek’s 'World’s Best Hospitals 2022' rankings.

 

Newsweek with Statista, the global market and consumer data firm, ranked the 'World’s Best Hospitals 2022' by putting together recommendations from over 80,000 medical experts in 27 countries and released the results on its official website.

 

AMC ranked No. 30 hospital in the world, moving up four notches from last year, and stood tall among world leading hospitals in the U.S., Canada, Germany, and more. Also, for the fourth consecutive year, AMC defended its title as No. 1 hospital in Korea.

 

In this year’s selection of 250 best hospitals shortlisted from some 2,200 hospitals across the world, Mayo Clinic (U.S.) ranked No.1, followed by Cleveland Clinic (U.S.), Massachusetts General Hospital (U.S.), Toronto General Hospital (Canada), and Charité-Universitätsmedizin Berlin (Germany).

 

The ranking’s evaluation criteria is composed of △ on-line surveys collected from over 80,000 doctors, health care professionals, and hospital managers in 27 countries (55%), △ medical performance indicators (30%), and △ patient satisfaction survey results (15%). For Korean hospitals, quality indicators of ICU, acute disease, cancer disease, and drug evaluations as well as patient satisfaction of nurse services, physician services, hospital environment, dosing and treatment process, etc. performed by HIRA (Health Insurance Review & Assessment Service) were included in the criteria.

 

AMC already joined the world’s top-ranking in 8 specialties of Newsweek’s World’s Best Specialized Hospitals 2022, announced last year. Named as one of the world’s top 5 cancer hospitals by Newsweek, AMC ranked No. 5 in endocrinology, No. 8 in gastroenterology, No. 8 in neurology, No. 12 in orthopedics, No. 27 in pulmonology, No. 35 in cardiology, and No. 52 in cardiac surgery.

 

AMC has been successfully positioned as a quaternary health care provider treating critically ill patients from home and abroad. This has been possible with all-emergency crisis response system and ‘Asan Global Standard,’ the in-house produced standard guideline for medical services, for patient safety and medical quality improvement and performing more than 70,000 cases of advanced surgeries per year.

 

In particular, AMC is the world-leading hospital in advanced surgeries in that one-out-of-nine cancer surgeries and one-out-of-four organ transplants in South Korea are performed at AMC. A great number of international physicians from some 90 countries including the U.S., China, and Saudi Arabia are visiting AMC to learn advanced medical technology and cutting edge research system. AMC is also delivering advanced medical technology to medically underdeveloped countries through the ‘Asan in Asia’ project.

Recently, Surface-guided Radiation Therapy (SGRT) has become a new paradigm for radiation therapy. SGRT is a state-of-the-art radiation therapy technology with a pinpoint accuracy between medical device and treatment site using 3D camera units.

 

Align RT uses a technology that constructs 3D images through three cameras installed on the ceiling and accurately pinpoints the medical device and treatment site. Therefore, patient can enjoy marker-less treatment, with no change in his or her daily life.

 

AMC and Vision RT signed an agreement on March 11 regarding operating Asia Training Center. AMC is the world's 7th and Asia’s 1st training center and will provide high-quality education to national and international medical staffs and specialists in the related fields.

 

Through this agreement, AMC will be provided with the latest equipment and software, educational support, and more. AMC is also expected to serve as an educational hub for Asian users of Align RT and lead the field of SGRT.

 

AMC introduced three Align RTs in 2021 and has treated more than 20,000 cases a year, including breast cancer, prostate cancer, and lung cancer. Cancer patients who received SGRT show high satisfaction with the accurate and marker-free treatment.

Mitral regurgitation is abnormal reversal in the blood flow of the heart which occurs when the mitral valve located between the left atrium and left ventricle does not close tightly due to aging, heart disease, and more. Its treatment was burdensome for elderly or high-risk patients with other medical conditions because the only treatment was through open-heart surgery.

 

Asan Medical Center is improving the quality of life for patients by performing MitraClip procedure to safely treat mitral regurgitation in elderly and high-risk patients who are not suitable for open-heart surgery.

 

AMC team led by Professor Dae-Hee Kim and Professor Do-Yoon Kang of Division of Cardiology performed Korea’s first 50 cases of MitraClip procedure, reducing the burden on patients and safely treating mitral regurgitation.

 

MitraClip procedure reduces blood reflux by “clipping” mitral valve which helps to remove gaps that occur every time the valve opens and closes. Without chest opening, a thin tube is inserted through the groin vein to reach the inside of the heart, and the clip is mounted on the mitral valve using a 3D ultrasound to confirm the exact position of the clip and the anatomical structure of the mitral valve in real time.

 

Of the 50 patients, 40% were elderly patients, aged 80 or older, and the STS score of patients were averaged on 10%. When STS score is 8% or higher, a patient is classified as a high-risk patient and has a high risk in surgical procedure.

 

Despite these elderly and high-risk patient groups, the success rate of MitraClip procedures at Asan Medical Center is 94%. The 1-month survival rate is 98%, which was similar to the success rate and survival rate reported in the U.S. mitral valve surgery database. Also, there were no procedure-specific complications.

Asan Foundation held the 15th Asan Award in Medicine Ceremony on March 21st, 2022. The Award was founded in 2008 to recognize and celebrate the outstanding achievements of national and international medical scientists in the fields of basic and clinical medicine. The Asan Award in Medicine Ceremony had been attended by more than 300 people including the laureates, their family members, and fellow medical scientists, but unfortunately, due to the COVID-19 outbreak, only the winners and their spouse were invited this year.

 

The laureates of the Award in Basic Medicine and the Award in Clinical Medicine were each prized with KRW 300 million. In addition, the laureates of the Award for Young Medical Scientists were awarded KRW 50 million each.

 

Professor Eui-Cheol Shin at KAIST Graduate School of Medicine has been honored with the Award in Basic Medicine. He has been acknowledged in his study on characterization of human immune responses against hepatitis viruses over the past 20 years.

 

Professor Jeong Min Lee at the Department of Radiology of Seoul National University College of Medicine won the Award in Clinical Medicine for his achievement in image-based diagnosis and prognosis prediction of hepatocellular carcinoma and validation of therapeutic effect of "No-Touch" radiofrequency ablation for small hepatocellular carcinoma.

 

The Award for Young Medical Scientists is presented to medical scientists who are under 40 years old. The winners were Professor Sung-Yon Kim at the Department of Chemistry Institute of Molecular Biology and Genetics of Seoul National University for his study in elucidation of neural circuit mechanisms underlying behavioral and physiological responses to survival needs and Professor Chong Hyun Suh at the Department of Radiology of Asan Medical Center for the establishment of imaging strategies for brain metastasis from lung cancer and CNS lymphoma and Development of a deep learning-based Alzheimer's disease classification algorithm.

International patients who wish to experience Korea’s advanced medical care are unable to do so due to travel restrictions amid COVID-19. In consideration of such difficulty, medical specialist in Korea are helping these patients to find better treatment options through ICT-based remote consultation.

 

To support those in need, Asan Medical Center (AMC) participated in the ‘ICT-based Pre-consultation and Post-care Pilot Project’ hosted by Korea Health Industry Development Institute (KHIDI) from September to November, 2021. As a result, AMC successfully consulted 102 Mongolian patients.

 

Pre-consultation service is a process for international patients to get their inquiries, including both medical and non-medical, answered before their visit to Korea. Post-care service is for the patients to have their treatment progress regularly followed up when they return to their own country after receiving treatment in Korea.

Asan Medical Center (AMC) has again been recognized as Korea’s Most Admired Hospital, for the 16th consecutive year. It is awarded to hospitals that receive the best evaluation from patients, caregivers, and healthcare professionals for their excellent medical performance and social contribution.

 

The survey analyzed the results of approximately 12,000 people, including industry executives, securities analysts, and general consumers, evaluating the quality of detailed factors such as ▲ innovation ability, ▲ management capability, ▲ employee values, ▲ customer values, ▲ social values, and ▲ image value over the past four months from September 2021.

 

AMC received 7.43 points in total, including evaluation for the quality of 12 detailed and overall factors, far ahead of other hospitals (average 6.86 points). The scores for the quality of ▲ medical service, ▲ welfare and working environment, ▲ talent development, ▲ preference, ▲ innovation activities, ▲ reliability, etc. were evenly high.

 

AMC has also been named as Korea’s Top 30 Corporations, which is selected throughout all industries in Korea, for 9 consecutive years, on par with leading companies representing each industry. In particular, among all domestic companies, AMC ranked 16th and 19th in innovation ability and image value, respectively.

Lung Transplantation Team of Asan Medical Center successfully performed the 200th case of lung transplantation by transplanting the lungs of a brain-dead person to a patient suffering from interstitial lung disease accompanied by pulmonary arterial hypertension.

 

AMC Lung Transplantation Team has gradually increased surgical experience, starting with transplanting the lungs of brain-dead people into patients with idiopathic pulmonary fibrosis in 2008. So far, 199 cases of brain-dead lung transplantations and one case of living-donor lung transplantation have been performed on patients with end-stage lung failure. Since 2019, more than 30 lung transplantations have been performed every year, responsible for one out of four lung transplantations in Korea.

 

Among the COVID-19 related lung transplantations, there was also an overseas Korean in her 50s living in Mexico, the other side of the globe. The patient, who suffered from severe pulmonary fibrosis, was transferred to Asan Medical Center by air ambulance, relying on a mechanical device. She miraculously recovered after undergoing lung transplantation in September 2020.

 

The survival rate of AMC Lung Transplantation Team is the highest in the world. Approximately 70% of the 200 lung transplantation patients showed a 1-year survival rate of 80%, a 3-year survival rate of 71%, a 5-year survival rate of 68%, and a 7-year survival rate of 60%, even though they were critically ill patients on extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. This exceeds the 1-year survival rate of 85%, 3-year survival rate of 67% and 5-year survival rate of 61% of the International Society for Heart and Lung Transplantation (ISHLT), whose survival rate is the accrued data of leading lung transplantation centers around the world.

 

Behind the world-class lung transplantation survival rate is the multidisciplinary treatment system unique to AMC Lung Transplantation Team. In addition to the accumulated surgical experience of the surgeon, all medical staffs of the Dept. of Thoracic and Cardiovascular Surgery, Div. of Pulmonology and Critical Care Medicine, Dept. of Anesthesiology and Pain Medicine, Div. of Infectious Diseases, Dept. of Rehabilitation Medicine, Dept. of Psychiatry, Organ Transplantation Center, OR, ward, etc. have formed the Lung Transplantation Team to significantly reduce postoperative bleeding and complications.

On February 8th, ASAN Foundation (Chairman Mong-Joon Chung) and Asan Medical Center held an opening ceremony of the Center for Infection Control (CIC), an independent building specifically for infectious diseases.

The opening ceremony was attended by Chairman Mong-Joon Chung (ASAN Foundation), Chairman Seong Wook Park (Asan Healthcare System), President Seung-Il Park (Asan Medical Center), Professor Je-Hwan Lee (Vice President & Chief Medical Officer, AMC), Director Jong-Min Song (Clinical Support), Director Sung-Han Kim (Center for Infection Control), and more.

AMC Center for Infection Control (CIC) is a freestanding building where ER and outpatient care will be operated exclusively for confirmed and suspected patients of infectious disease. It is designed to prevent any infectious disease from spreading throughout the medical process including testing, hospitalization, and surgery. CIC is first-of-its-kind established by a private hospital in Korea.

 

A negative pressure system is applied throughout CIC to make sure the air inside does not flow out of the building. Outpatient facilities, ER, wards, ICU, CT imaging lab, and operating room are all operated in a separate building.

 

CIC is the first proactive infection control model in Korea that can deal with various risks from respiratory infection, imported infectious disease, etc. around the clock even when there is no highly infectious disease outbreak.

 

AMC Center for Infection Control (CIC) will also be equipped with the following: negative pressure isolation ER with 29 negative pressure monitoring single-beds and 12 seats for mild symptom patients, negative pressure isolation wards with 15 beds (12 negative pressure isolation beds and 3 high-level negative pressure isolation beds), negative pressure isolation ICU with 13 beds, outpatient facilities for the Division of Infectious Diseases and Division of Pulmonology and Critical Care Medicine (6 outpatient offices), 1 negative pressure operating room, 1 general negative pressure imaging lab, and 1 negative pressure CT imaging lab.

 

CIC was first planned in 2015 during the MERS outbreak in Korea. With further outbreaks of new infectious diseases such as Ebola and Zika, the need for isolated space to treat confirmed or suspected patients with high-risk imported infectious diseases emerged.

During the planning phase, AMC benchmarked distinguished global hospitals such as Emory University Hospital and their infection control systems. Emory University Hospital was then designated by the Centers for Disease Control and Prevention to treat patients infected with Ebola virus.

 

The idea was to construct an independent building fully equipped with negative pressure facilities to set up a safe medical care environment by taking preventive actions against new infectious diseases and separating non-infected patients from possibly contagious respiratory tract infection.

 

AMC Center for Infection Control (CIC) is designed to operate in 3-stages according to infectious disease crisis response situation, which allows CIC to flexibly operate the wards. CIC will also have specialists residing on a regular basis to maintain its response capability to infectious diseases. Even if a COVID-19 patient is hospitalized, other patients on the same negative pressure isolation ward can still be treated safely because patient flow will be completely separated.

 

Upon its initiation on February 10th, CIC will first put intensive efforts to treat critically ill patients in response to the sharp increase of COVID-19 patients with the omicron variant. CIC is expected to play a significant role in securing beds, currently falling short amid the COVID-19 pandemic, for critically ill patients.

 

Once the COVID-19 pandemic subsides, CIC will be used as a treatment facility exclusively for patients with respiratory infection such as tuberculosis, measles, varicella, influenza, etc. and as well as high-risk imported infectious disease patients. CIC’s goal is to treat infection patients with efficiency even when there is no pandemic outbreak caused by high-risk pathogens such as COVID-19.

AMC research team led by Professor Namkug Kim (Department of Convergence Medicine), Professor Jung-Min Koh (Division of Endocrinology and Metabolism), and researcher Miso Jang (Department of Convergence Medicine) developed a deep learning AI algorithm to screen people who are at high risk of osteoporosis with 90% accuracy, using just simple chest x-ray images.

 

The research team collected 11,037 test results from patients older than 40 years who visited AMC Health Screening and Promotion Center from 2012 to 2019 to receive chest x-ray screening and bone density scans using dual energy X-ray absorptiometry (DXA) on the same day.

 

The test results were learned by a deep learning-based AI algorithm. Bone density scans were done for lumbar spine, femoral neck, and total hip joint. The patients were then categorized into normal, osteopenia, and osteoporosis according to their test results.

 

The effectiveness of the AI algorithm developed by the research team was assessed using 1,989 internal data set. It was discovered that patients with osteoporosis were screened with an accuracy of approximately 91% using only the chest x-ray results, and when 1,089 external data set was applied, the accuracy was approximately 88%. The AI algorithm took 11 minutes to read the internal data set and was able to screen the patients who are highly likely to develop osteoporosis in less than 4 seconds per case.

 

The research findings are published in the latest online issue of the Journal of Bone and Mineral Research (IF=6.741), one of the highest-ranked journals in the field.

The number of surgeries performed at AMC in 2021 was 71,844. This achievement came in 6 years after recording 60,000 surgeries a year in 2015. The achievement is meaningful, in particular, as AMC is recognized to have a world-class competence in advanced surgeries, performing one out of nine cancer surgeries and one out of four organ transplants in Korea.

 

AMC has also engaged the OR Steering Committee to carry out various activities to ensure that operating rooms are managed efficiently. The activities include sharing information on operating rooms that became vacant earlier than expected and automated text alarm notification for completed anesthesia induction. As a result, operating room availability improved by 6~8% and the number of surgeries substantially went up as well. 

 

The total number of patients who visited Asan Medical Center in 2021 was 3,589,623. The number was 3,100,479 in 2020 which fell from 3,120,449 recorded in 2019 as there were less outpatients and more isolation beds due to COVID-19. However, a huge recovery was observed in 2021 with an increase by 15.7%. By patient type, 3,439,834 were outpatients and 149,789 were inpatients. Compared to 2,961,233 outpatients and 139,246 inpatients in 2020, the numbers increased by 16.1% and 7.5%, respectively.

 

The number of international patients who visited AMC was 13,587 which recorded an increase by 15.3% compared to 11,784 in 2020. The numbers by nationality are as follows: 4,315 (31.8%) patients from the U.S., 2,045 from Mongolia (15.1%), 1,241 (9.1%) from the UAE, 1,042 (7.7%) from China, 615 (4.5%) from Japan, 614 (4.5%) from Saudi Arabia, and 516 (3.8%) from Vietnam.

AMC has finished setting up a digital pathology system, and all the analog pathology activities were 100% digitalized. This transition was made with an aim to maximize the efficiency of pathological diagnosis and ultimately realize patient-customized precision medical services.

 

In conventional, analog histopathology testing, doctors from each field received specimen slides, including tissues relevant to their field, to provide a microscopic diagnosis. The doctors physically stored the slides in a separate space afterward. In the digital system, specimens are scanned first, and codes are generated for each scanned specimen to be sorted automatically based on the assigned codes. The slides are then displayed directly on the screen and digitally stored. Work efficiency has greatly increased for the entire process, including slide preparation, arrangement, sorting, reading, and storage.

 

Some of the advantages of digital pathology are as follows: (a) slides can be read immediately without any preparation needs after scanning, (b) slides can be moved with enhanced precision, and (c) slides can be read more precisely, as they can be zoomed in with higher magnification compared to a microscope. In particular, it is encouraging that the time spent for reviewing was significantly reduced, as the slides were linked with AMIS 3.0 to facilitate comparison and confirmation of a patient’s medical history and biopsy information. The digital pathology system is anticipated to bring positive change to the conventional histopathology that has been holding on to the traditional methodology.

 

AMC’s efforts in setting up the digital pathology system were as follows: (a) eleven scanners were purchased for digital conversion of diagnostic slides, (b) an independent 10G network was installed, and (c) infrastructure was put in place by installing a high-capacity server at petabyte level and extending the data storage. Additional efforts were made to realign the overall business operation by optimizing the pathology lab process and building AMC’s unique interface.

 

Furthermore, it was arranged to link a variety of pathology data with AMIS 3.0 so that slide data could be checked immediately in different places such as the Multidisciplinary Cancer Care Center or student training sites. The digital system was developed to promote organic interconnection with other AI programs, including the morphometry software co-developed by AMC and Vuno.

 

The Department of Pathology plans to scan 900,000 slides a year through the digital pathology system. Another plan involves scanning 4 million slides that were processed from 2010 to 2020. This is the largest pathological diagnosis of big data worldwide, and it is expected to be put to good use in future software development.

Last year alone, 1,102,350 patients, 1,023,048 outpatients and 79,302 inpatients, visited AMC Cancer Institute. The total number of cancer patient is consistently increasing every year; 906,985 in 2016, 917,679 in 2017, 963,856 in 2018, 994,272 in 2019, and 1,037,050 in 2020. The number of patients newly diagnosed with cancer was 35,114, approximately 18% increase from 29,764 in 2020.

 

AMC Cancer Institute performed 22,839 cases of cancer surgeries in 2021, increase of 3,519 cases from 19,320 cases in 2020. Among the total number of surgeries performed in AMC, cancer surgeries account for approximately 31.8%. A total of 5,742 multidisciplinary clinics, where 5 to 6 specialists collaborate to provide customized cancer care for each patient such as cancer diagnosis, surgery and chemo-radiotherapy, opened, and 22,242 cases of specialized cancer treatment were performed. The number of chemotherapy and radiotherapy recorded 215,793 and 117,680, respectively. 4,593 cases of NGS (Next Generation Sequencing) genetic testing, which has received much attention in the precision medicine era, were performed. The number is showing a constant increase from 1,810 in 2018, 2,843 in 2019, and 3,831 in 2020.

 

A total of 557 articles were written by AMC Cancer Institute specialists throughout 2021. The number of articles published in journals with a citation index of 20 or higher including the 'Journal of Clinical Oncology' and 'Nature' was 35, increase of 10 articles compared to last year. The number of articles published in journals with a citation index of 5 or higher was 131. The total number of clinical trials conducted according to research plan was 430.