Bone Suppression on Chest Radiographs for Pulmonary Nodule Detection: Comparison between a Generative Adversarial Network and Dual-Energy Subtraction

Objective@#To compare the effects of bone suppression imaging using deep learning (BSp-DL) based on a generative adversarial network (GAN) and bone subtraction imaging using a dual energy technique (BSt-DE) on radiologists’ performance for pulmonary nodule detection on chest radiographs (CXRs). @*Materials and Methods@#A total of 111 adults, including 49 patients with 83 pulmonary nodules, who underwent both CXR using the dual energy technique and chest CT, were enrolled. Using CT as a reference, two independent radiologists evaluated CXR images for the presence or absence of pulmonary nodules in three reading sessions (standard CXR, BSt-DE CXR, and BSp-DL CXR). Person-wise and nodule-wise performances were assessed using receiver-operating characteristic (ROC) and alternative free-response ROC (AFROC) curve analyses, respectively. Subgroup analyses based on nodule size, location, and the presence of overlapping bones were performed. @*Results@#BSt-DE with an area under the AFROC curve (AUAFROC) of 0.996 and 0.976 for readers 1 and 2, respectively, and BSp-DL with AUAFROC of 0.981 and 0.958, respectively, showed better nodule-wise performance than standard CXR (AUAFROC of 0.907 and 0.808, respectively; p ≤ 0.005). In the person-wise analysis, BSp-DL with an area under the ROC curve (AUROC) of 0.984 and 0.931 for readers 1 and 2, respectively, showed better performance than standard CXR (AUROC of 0.915 and 0.798, respectively; p ≤ 0.011) and comparable performance to BSt-DE (AUROC of 0.988 and 0.974; p ≥ 0.064). BSt-DE and BSp-DL were superior to standard CXR for detecting nodules overlapping with bones (p < 0.017) or in the upper/middle lung zone (p < 0.017). BSt-DE was superior (p < 0.017) to BSp-DL in detecting peripheral and sub-centimeter nodules. @*Conclusion@#BSp-DL (GAN-based bone suppression) showed comparable performance to BSt-DE and can improve radiologists’ performance in detecting pulmonary nodules on CXRs. Nevertheless, for better delineation of small and peripheral nodules, further technical improvements are required.

Low-Dose Abdominal CT Using a Deep Learning-Based Denoising Algorithm: A Comparison with CT Reconstructed with Filtered Back Projection or Iterative Reconstruction Algorithm

OBJECTIVE: To compare the image quality of low-dose (LD) computed tomography (CT) obtained using a deep learning-based denoising algorithm (DLA) with LD CT images reconstructed with a filtered back projection (FBP) and advanced modeled iterative reconstruction (ADMIRE).MATERIALS AND METHODS: One hundred routine-dose (RD) abdominal CT studies reconstructed using FBP were used to train the DLA. Simulated CT images were made at dose levels of 13%, 25%, and 50% of the RD (DLA-1, -2, and -3) and reconstructed using FBP. We trained DLAs using the simulated CT images as input data and the RD CT images as ground truth. To test the DLA, the American College of Radiology CT phantom was used together with 18 patients who underwent abdominal LD CT. LD CT images of the phantom and patients were processed using FBP, ADMIRE, and DLAs (LD-FBP, LD-ADMIRE, and LD-DLA images, respectively). To compare the image quality, we measured the noise power spectrum and modulation transfer function (MTF) of phantom images. For patient data, we measured the mean image noise and performed qualitative image analysis. We evaluated the presence of additional artifacts in the LD-DLA images.RESULTS: LD-DLAs achieved lower noise levels than LD-FBP and LD-ADMIRE for both phantom and patient data (all p < 0.001). LD-DLAs trained with a lower radiation dose showed less image noise. However, the MTFs of the LD-DLAs were lower than those of LD-ADMIRE and LD-FBP (all p < 0.001) and decreased with decreasing training image dose. In the qualitative image analysis, the overall image quality of LD-DLAs was best for DLA-3 (50% simulated radiation dose) and not significantly different from LD-ADMIRE. There were no additional artifacts in LD-DLA images.CONCLUSION: DLAs achieved less noise than FBP and ADMIRE in LD CT images, but did not maintain spatial resolution. The DLA trained with 50% simulated radiation dose showed the best overall image quality.

Effects on postoperative nausea and vomiting of nefopam versus fentanyl following bimaxillary orthognathic surgery: a prospective double-blind randomized controlled trial

BACKGROUND: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. METHODS: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. RESULTS: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. CONCLUSION: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.

Peritonitis Caused by Internal Migration of the Percutaneous Transhepatic Biliary Drainage Catheter / 대한췌담도학회지

Percutaneous transhepatic biliary drainage (PTBD) is a modality that is used to decompress obstructive jaundice due to impacted stones, benign stricture or cancer. The PTBD catheter is removed percutaneously after the restoration of internal biliary drainage. We experienced a case of a 62-year-old man with peritonitis due to the migration of the PTBD catheter into the peritoneal cavity; we successfully removed it using peroral endoscopy. Although rare, the PTBD catheter may migrate into the peritoneal cavity during the removal of it. In these cases, clinicians should consider the peroral endoscopic removal of the PTBD catheter.

Post-Operative Multiple Thrombosis Associated with Patent Foramen Ovale: Embolic Stroke, Right Atrial Thrombi, Pulmonary Embolism and Deep Vein Thrombosis

Patients undergoing total joint arthroplasty frequently develop post-operative complication, such as deep vein thrombosis and pulmonary thromboembolism. However, it is not common coexisting deep vein thrombosis, pulmonary thromboembolisms, right atrial thrombus and acute cerebral infarction raised by thrombus through patent foramen ovale. We reported the patient who had multiple thrombi which were accompanied with a cryptogenic ischemic stroke and associated with patent foramen ovale after operation.

Phlebosclerotic Colitis in a Healthy Young Woman

Phlebosclerotic colitis is a rare disease of intestinal ischemia and differentiating it from the typical ischemic colitis. It is caused by venous obstruction due to colonic and mesenteric venous calcification. We report a 36-year-old woman presenting with intermittent abdominal pain. Initial radiologic findings showed multiple tortuous thread-like calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. In the colonoscopy, edematous dark-bluish colonic mucosa, sclerotic colon wall, and multiple ulcers without clear boundaries were observed from the ascending colon to the transverse colon. In the sigmoid colon only showed the edematous dark-bluish colonic mucosa, sclerotic colon wall. On the basis of these findings, we diagnosed the patient as having phlebosclerotic colitis. We report a rare case of phlebosclerotic colitis in healthy young woman.

Use of post-operative negative-pressure wound therapy for gouty ulcer / 영남의대학술지

Gouty ulcer can be caused by the accumulation of clumps of uric acid in body tissues that lead to acute or chronic inflammation at sites of accumulation. Furthermore, tophi-inhibiting granulation tissue may form a canal that channels microbial infection from the underlying involved joint space, and thus, presents the risk of osteomyelitis development. Accordingly, gouty ulcer must be treated appropriately. In this case, refractory wounds on gouty ulcers at the left shin and left radial ankle were treated by surgical debridement. Negative-pressure wound therapy was used successfully to prevent post-operative delayed wound healing.

Bilateral recurrent laryngeal nerve palsy in a patient undergoing consecutive thyroid operations / 대한마취과학회지

No abstract available.

Foreign Body Removal by Snare Loop: During Intracranial Stent Procedure / 신경중재치료의학

We present a case of successful retrieval of an intracranial stent using a snare wire. A 52-year-old woman presented with left border zone infarction. On cerebral angiography, the C6 segment of the left internal carotid artery (ICA) showed significant stenosis. We attempted stenting of the lesion, although stent dislodgement occurred in the ICA C4 segment. We successfully removed it using a snare loop, and there were no complications during the procedure.

Parental Alcohol Problems and Children's Behavior & Psychosocial Characteristics

OBJECTIVES: Alcohol problems of parents have an influence on not only their psychological problems but also on their children's psychosocial adaptation. The purpose of this study was to compare the emotional and behavioral problems, including school bullying and social skills, between children of alcoholics (COAs) and children of non-alcoholics (non-COAs). METHODS: We recruited 4th grade children (n=741) from 7 primary schools in Seoul and their parents as subjects. The self-rated psychiatric symptoms were assessed with the Korean version of the Children of Alcoholics Screening Test (CAST-K), the Children's Depression Inventory (CDI), the Rosenberg's Self-esteem Scale (RSES), the School Bullying Scale, the Social Skill Rating Scale and the Korean version of Alcohol Expectancy Questionnaire-Adolescent (AEQ-A). The Attention-deficit Hyperactivity Disorder Rating Scale-IV (ARS) was completed by the parents. RESULTS: 518 children were non-COAs and 223 were COAs. The COAs showed higher CDI and ARS-IV scores and lower RSES scores than the non-COAs. Especially, the COAs also showed higher school bullying scale scores and lower cooperative scale scores on the social skill rating scales. But there was no difference of alcohol expectancy between the COAs and non-COAs. CONCLUSION: It was plausible that the COAs had more behavioral & psychosocial problems than the non-COAs among the school aged children. It is important to identify and intervene to solve the problems of peer relationships of school age COAs in order to prevent victimization by bullying and to improve psychosocial adaptation.

Alcohol Use during Pregnancy and Related Risk Factors in Korea

OBJECTIVE: The number of Korean women of childbearing age who drink alcohol and binge drink has increased remarkably in recent years. In the present study, we examined self-reported rates of alcohol use before and during pregnancy and identified maternal characteristics associated with drinking in pregnancy. METHODS: One thousand pregnant Korean women who visited the Department of Obstetrics and Gynecology (OB/GYN) completed a self-administered questionnaire that sought information on their demographic characteristics and incorporated features of the Alcohol Use Disorder Identification Test (AUDIT)-C to investigate their use of alcohol, including binge drinking, during three time periods ("in the year before this pregnancy," "during this pregnancy," and "in the previous 30 days"). RESULTS: Of these participants, 16.4% reported using alcohol during their pregnancy, 12.2% had used alcohol in the previous 30 days, and 1.7% reported binge drinking during their pregnancy. In the year before pregnancy, 77.1% had used alcohol, and 22.3% had binge drunk. The group using any amount of any alcohol during pregnancy showed a lower educational level, a lower rate of planned pregnancy, a lower level of knowledge relating to the risks of drinking alcohol during pregnancy, and a higher frequency of alcohol drinking in the year before pregnancy when compared with the abstinent group. Low educational level and unplanned pregnancy were revealed to be significant risk factors for alcohol consumption in pregnant women. CONCLUSION: This is the first study to examine any alcohol and binge alcohol drinking during pregnancy in Korea. Clinical attention and monitoring system on alcohol use during pregnancy are necessary in Korea.

Association between Dopamine D4 Receptor Gene Polymorphism and Scores on a Continuous Performance Test in Korean Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE: The aim of this study was to evaluate the association between a variable number of tandem repeats polymorphism at the dopamine D4 receptor gene (DRD4) and the performance of children with attention deficit hyperactivity disorder (ADHD) in a continuous performance test (CPT). METHODS: This study included 72 ADHD children (mean age=9.39+/-2.05 years) who were recruited from one child psychiatric clinic. The omission errors, commission errors, reaction time and reaction standardization in the CPT were computed. The number of 48-base pairs tandem repeats in the exon III of DRD4 was analyzed in a blind manner. RESULTS: The homozygosity of the 4-repeat allele at DRD4 was significantly associated with fewer commission errors (t=2.364, df=28.685, p=0.025) and standard deviation of reaction time (t=2.351, df=24.648, p=0.027) even after adjusting for age. The results of analyses of CPT measured values among three groups showed that the group with higher frequency of the 4-repeat allele showed a lower mean score of commission errors (F=4.268, df=2, p=0.018). CONCLUSION: These results suggest a protective role of 4-repeat allele of the DRD4 polymorphisms on commission errors in the CPT in children with ADHD.

EEG A1, A2, and Percent Asymmetry Indices in Major Depressive Disorder; The Importance of Symptom Severity of Depression and Anxiety / 신경정신의학

OBJECTIVES: In this study we investigated characteristics of asymmetry pattern of EEG in patients with major depressive disorder according to the severity of depression and anxiety symptoms, employing A1, A2, and Percent (PCT) asymmetry indices. METHODS: Subjects involved in this study were 11 healthy controls and 11 patients with major depressive disorder who have taken no medicines for four weeks just before the study. These subjects were selected so that the two groups can have no difference in gender and age. Beck Depression Inventory (BDI), 17-item Hamilton Depression Rating Scale (HDRS), Zung's Self-Rating Depression Scale (SDS) and Spielberger's State-Trait Anxiety Inventory (STAI) were used to evaluate depression and anxiety symptoms, respectively. Resting EEG was recorded from F3, F4, C3, C4, T7, T8, O1 and O2 electrode sites. RESULTS: The temporal region showed a difference in A1, A2, and PCT asymmetry indices between the depression group and the control group. Frontal (F3, F4) and temporal (T7, T8) regions showed correlation between STAI-T score and A1, A2, and PCT asymmetry indices. CONCLUSION: The results of this study showed that EEG A1, A2, and PCT asymmetry indices can be used as useful indices for depression. Also, it was found that trait anxiety had influence on A1, A2, and PCT asymmetry indices.

Microarray Analysis of Gene Expression in Rat Glioma after Ethanol Treatment

Objetives: Identification of target genes for ethanol in neurons is important for understanding its molecular and cellular mechanism of action and the neuropathological changes seen in alcoholics. The purpose of this study is to identify of altered gene expression after acute treatmet of ethanol in rat gliom cells. METHODS: We used high density cDNA microarray chip to measure the expression patterns of multiple genes in cultured rat glioma cells. DNA microarrays allow for the simultaneous measurement of the expression of several hundreds of genes. RESULTS: After comparing hybridized signals between control and ethanol treated groups, we found that treatment with ethanol increased the expression of 15 genes and decreased the expression of 12 genes. Upregulated genes included Orthodenticle(Drosophila) homolog 1, procollagen type II, adenosine A2a receptor, GATA-bindning protein 2. Downregulated genes included diacylglycerol kinase beta, PRKC, Protein phosphatase 1, clathrin-associated protein 17, nucleoporin p58, proteasome. CONCLUSION: The gene changes noted were those related to the regulation of transcription, signal transduction, second messenger systems. modulation of ischemic brain injury, and neurodengeneration.Although some of the genes were previously known to be ethanol responsive, we have for the most part identified novel genes involved in the brain response to ethanol.

The Relationship of Alcohol Use and Stress / 신경정신의학

OBJECTIVES: This study was designed to assess the relationship between alcohol use and stress. METHODS: The study subjects were 1,261 people who drink among the 2,565 people who lived in Gangneung. We investigated the sociodemographic characteristics, Short Form-12 (SF-12), Global Assessment of Recent Stress (GARS) and Alcohol Use Disorder Identification Test (AUDIT). RESULTS: In Problem drinking group the GARS was significantly positively associated with the AUDIT (p=0.02). In Social drinking group sex (p<0.001) and age (p=0.02) is significantly associated with the AUDIT. CONCLUSION: This study showed the significantly positively association between stress and alcohol use. We think that the intervention and active management of the stress can prevent the alcohol problem.

Naltrexone influences protein kinase C epsilon and integrin alpha7 activity in SH-SY5Y neuroblastoma cells

Alcohol influences the neuroadaptation of brain cells where receptors and enzymes like protein kinase C (PKC) exist. Naltrexone acts on opioid receptors. However, other mechanisms of action remain unknown. We prepared SH-SY5Y neuroblastoma cells, and fed them with 150 mM ethanol for 72 h followed by treatment with naltrexone for 24 h. We performed microarray analysis and reverse transcriptase-polymerase chain reaction. Our results showed that PKC epsilon increased 1.90 times and showed an overall decreasing pattern as time increased. Phosphorylated ERK also increased 2.0 times according to the change of PKC epsilon. Integrin alpha7 increased 2.32 times and showed an increasing pattern as time increased. In conclusion, naltrexone influences PKC epsilon neuronal signaling system and endothelial adhesion molecule integrin alpha7 in addition to the well-known opioid system.

Effects of Venlafaxine and Dexamethasone Treatment on HSP70 Expression in Rat C6 Glioma Cells

OBJECT: The intracellular action of the antidepressant, venlafaxine, was studied in C6-gliomas using heat shock protein 70(HSP70) immunocytochemistry and HSP70 Western blots because HSP70 is associated with stress and depression. METHODS: To examine how the glucocorticoid affects the expression of HSP70 in nerve cells, the rat C6 glioma cell was treated with dexamethasone for 6 hours. In addition, venlafaxine was administered to the experimental groups of C6 glioma cells for 1, 6, 24, and 72 hours each, after which the expression of HSP70 was investigated. Finally, venlafaxine and dexamethasone were simultaneously administered to the experimental groups for 1, 6, 24, and 72 hours, followed by an investigation of the expression of HSP70. RESULTS: The short term(1 hour) venlafaxine treatment significantly increased the level of HSP70 expression. The short term treatment of venlafaxine with dexamethasone also increased the level of HSP70 expression but this reduction was not statistically significant. The long term(72 hours) venlafaxine with dexamethasone treatment significantly reduced the level of HSP70 expression. The long term treatment of venlafaxine also reduced the level of HSP70 expression but this reduction was not statistically significant. Dexamethasone(10uM, 6hours) did not affect the level of HSP70 expression compared with controls. CONCLUSION: Venlafaxine increases the expression of HSP70 at short term treatment, but prolonged treatment with dexamethasone suppresses the expression of HSP70.

Prevalence of Tardive Dyskinesia in Inpatients Using Antipsychotics / 대한정신약물학회지

OBJECTIVE: This study was to investigate the prevalence of tardive dyskinesia (TD) in Korean inpatients using antipsychotics and the relationship between TD and sociodemographic, clinical variables. METHODS: This study was done from January to Feburary, 2003, at the Seoul National Mental Hospital. A cross-sectional assessment of randomly selected inpatients (n=324;mean age=39.73+/-9.63years) with DSM-IV schizophrenia, schizoaffective, bipolar disorder was performed with standard rating instrument for TD and extrapyramidal symptoms. The relations between the prevalence of TD and sex, age, length of medication and dosage of antipsychotics, clozapine, and other psychotropic medication, EPS were analyzed with Chi-square test or t-test. RESULTS: Using Schooler and Kane's criteria, 20 subjects (6.17%) had TD. TD was significantly less prevalent in patients receiving clozapine. There was no other significant difference between the TD and without TD groups with respect to type of antipsychotics, other psychotropic drug, antiparkinsonian drug, mood stabilizer augmentation. CONCLUSION: The result of this study have confirmed the lower prevalence of TD among inpatients using antipsychotics compared to previous investigations. The study has also replicated the association of TD with older age. Clozapine use was associated with lower prevalence rate of TD.

Characterization of Differentially Expressed Genes upon Chronic Fluoxetine Treatment in Rat C6 Glioma Cells / 대한정신약물학회지

OBJECTIVE: The aim of this study was to identify diffrentially regulated genes after the treatment of fluoxetine in rat C6 glioma cells using cDNA microarray chip techniques and real-time RT-PCR. METHODS: Cells were incubated for 24 hours, and for 72 hours with or without 10 uM fluoxetine. Total RNAs extracted from cells were reversely transcribed to cDNA. These cDNA were used to carry out cDNA microarray chip. A part of the up-/down-regulated genes in cDNA microarray result were confirmed by real-time RT-PCR. RESULTS: 1) Genes in fluoxetinetreated cells for 72 hours (chronic treatment) were more regulated than that in fluoxetine-treated cells for 24 hours (acute treatment). 2) The expression level of Gs gene in fluoxetine-treated cells for 24 hours hardly altered, but that of Gs in fluoxetine-treated cells for 72 hours significantly increased. The expression of Gi2 also decreased in 72 hours in relation to 24 hours after the administration of fluoxetine. 3) The expression level of NCAM140 gene in fluoxetine-treated cells was higher than that in control cells. CONCLUSION: We identified genes (Gs, Gi2 and NCAM140) related to neural plasticity and intracellular signal transduction cascade from our result. This implies that fluoxetine may inhibit atrophy or death of impaired neural cells by promoting neurite outgrowth.

The functional domains of dopamine transporter for cocaine analog, CFT binding

Cocaine analogue, CFT (2beta-carbomethoxy-3beta-(4-fluorophenyl) tropane) binding to dopamine transporter (DAT) in different species is quite heterogeneous. CFT is scarcely detected in bovine DAT whereas it is conspicuous in humans. To examine the structural basis for this functional discrepancy, we analyzed transporter chimeras of these two DATs. The CFT binding activities are avid in all of the chimeric DATs of which both of the 3rd and the 6-8th transmembrane domain (TM) are composed of human DAT sequences. On the contrary, CFT binding activities were scarcely detected if either or both of two regions are replaced with bovine sequences. These findings indicate that the CFT binding absolutely requires human DAT sequences, at least, in the regions encompassing the 3rd and 6-8th transmembrane domain (TM), and that these regions might contribute to form the 3-dimensional pocket for CFT binding.