Development of a Frailty Detection Model Using Machine Learning with the Korean Frailty and Aging Cohort Study Data / 대한의료정보학회지

Objectives@#This paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results. @*Methods@#This study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried’s frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization. @*Results@#During the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm. @*Conclusions@#The results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants’ health conditions and alert them regarding potential risks in advance.

The Effects of Acculturative Stress, Career Stress, and Social Support on Depression in Korean International Students in China

Purpose@#This study aimed to examine the level of acculturative stress, career stress, social support and depression, and identify factors affecting depression among Korean international students in China. @*Methods@#Data were collected from 157 Korean students studying in undergraduate, graduate, students exchange programs and language training courses in G university, J university, and S university in G city, Guangdong Province, China, from September 1 to October 27, 2017. The data were analyzed with descriptive statistics, t-test, ANOVA, and multiple linear regression. @*Results@#The mean acculturative stress was 62.24±18.08 out of 165, whereas the mean career stress was 65.47±19.79 out of 125. The mean social support was 95.03±14.64 out of 125, and the mean depression score was 13.83±9.24 out of 60. The factor that had the greatest effect on depression among the participants was acculturative stress (β=.26, p=.001), followed by career stress (β=.24, p=.002), frequency of weekly phone calls with family (β=.19, p=.006), source of tuition payment (β=.18, p=.009), and self-perceived health (β=.15, p=.040). The model explained 33% of the variance. @*Conclusion@#It is necessary to develop depression prevention and management programs as well as a customized health promotion program that account for the factors identified to have an effect on depression, namely, acculturative stress, career stress, frequency of weekly phone calls with family, source of tuition payment, and self-perceived health, and increase awareness of depression among international students.

The Effects of Acculturative Stress, Career Stress, and Social Support on Depression in Korean International Students in China

Purpose@#This study aimed to examine the level of acculturative stress, career stress, social support and depression, and identify factors affecting depression among Korean international students in China. @*Methods@#Data were collected from 157 Korean students studying in undergraduate, graduate, students exchange programs and language training courses in G university, J university, and S university in G city, Guangdong Province, China, from September 1 to October 27, 2017. The data were analyzed with descriptive statistics, t-test, ANOVA, and multiple linear regression. @*Results@#The mean acculturative stress was 62.24±18.08 out of 165, whereas the mean career stress was 65.47±19.79 out of 125. The mean social support was 95.03±14.64 out of 125, and the mean depression score was 13.83±9.24 out of 60. The factor that had the greatest effect on depression among the participants was acculturative stress (β=.26, p=.001), followed by career stress (β=.24, p=.002), frequency of weekly phone calls with family (β=.19, p=.006), source of tuition payment (β=.18, p=.009), and self-perceived health (β=.15, p=.040). The model explained 33% of the variance. @*Conclusion@#It is necessary to develop depression prevention and management programs as well as a customized health promotion program that account for the factors identified to have an effect on depression, namely, acculturative stress, career stress, frequency of weekly phone calls with family, source of tuition payment, and self-perceived health, and increase awareness of depression among international students.

Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix

OBJECTIVE: This study aimed to determine the factors affecting pathologic discrepancy and final diagnosis between colposcopic biopsy and pathology by loop electrosurgical excision procedure (LEEP). METHODS: Between 2004 and 2016, 1,200 patients who underwent LEEP were enrolled for this study. 667 underwent cervical cytology, human papillomavirus (HPV) test, colposcopic biopsy, and LEEP. We analyzed patient's age, menopausal status, number of delivery, abortion times, cervical cytology, number of punch biopsies, HPV type, LEEP, and interval between colposcopic biopsy and LEEP. RESULTS: Logistic regression analysis of the final diagnosis showed that age 30–39 years and other high HPV group types were associated with cancer diagnosis, whereas atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), and HPV type 16 affected the diagnosis of cervical intraepithelial neoplasia (CIN) 2. The overall concordance rate of histopathology between punch biopsy and LEEP was 43.3%. The rates of detecting a more severe lesion by LEEP than those by biopsy were 23.1%. The rates of a less severe lesion detected by LEEP than those by biopsy were 33.6%. Factors related with biopsy underestimation were as follows: < 1 vaginal delivery, HSIL, number of punch biopsies and HPV type. Punch biopsy number is a unique factor of biopsy overestimation. CONCLUSION: Patients with ASC-H, HSIL, and HPV type 16 may undergo conization immediately without colposcopic biopsy. We suggest that colposcopically directed 3 to 5 punch biopsies may be used to determine the need for conization.

Metastatic thyroid C-cell carcinoma in a beagle dog / 대한수의학회지

An adult beagle dog was presented with a cervical mass detected by palpation and computed tomography. Fine needle aspirates revealed numerous epithelial cells with plasmacytoid appearance and frequent naked nuclei. Histologically, the mass consists of multiple packets of neoplastic cells and extensive areas of necrosis and fibrosis. Neoplastic cells were also found in submandibular lymph nodes. Immunohistochemistry showed that neoplastic cells were positive for calcitonin and negative for thyroglobulin. Based on these findings, the cervical mass was diagnosed as thyroid C-cell carcinoma. Almost one year after the surgical excision, the dog remains healthy without any symptom of recurrence or metastasis.

Lymph Node Metastasis in the Biliary Tract Carcinoma: CT Evaluation

PURPOSE:The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinome. MATERIALS AND METHODS: We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocarcinoma, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. RESULTS:The overall incidence of nodal metastases was 59.8 % (55/92); 66.7 % in peripheral cholangiocarcinoma, 54.5 % in hilar cholangiocarcinoma, 55.6 % in gallbladder carcinoma, and 42.9 % in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarci nome. CONCLUSION:The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma.

Stromal invasion of cervical carcinoma: Comparison of MRI and surgical pathology findings

In consecutive 56 patients with cervical carcinoma, we retrospectively analyzed the accuracy of magnetic resonance imaging (MRI) in regard of determining the depth of stromal invasion and reviewed the pitfalls in MRI interpretation. All patients underwent hysterectomy and were categorized into 3 groups: (1) no stromal invasion, (2) invasion to inner 2/3 of stromal thickness, (3) invasion to outer 1/3 of stromal thickness. In each group, MR image was analyzed for the size of the tumor mass and the ratio of spared stromal thickness to normal stromal full thickness (invasion ratio). Most tumor masses were not detected in the group of no stromal invasion. The degree of the depth of stromal invasion increased with the tumor size, and invasion ratio decreased as stromal invasion deepened. Overall accuracy for stromal invasion on MRI was 69.6%,and positive predictive value (PPV) for no stromal invasion was relatively lower than those of the other two groups. MRI is a promising modality to evaluate stromal invasion of cervical carcinoma by measuring the tumor size and invasion ratio, if MRI is performed prior to biopsy in axial scan perpendicular to the endocervical long axis.

Chest CT findings after pneumonectomy for lung cancer

Evaluation of postpneumonectomy space (PPS) by CT in patients with lung cancer for operation-related complication or tumor recurrence is critical, but often difficult. We retrospectively analysed CT scans of 38 patients who underwent pneumonectomy for lung cancer. CT scans were obtained on 7-10th post-operative day for baseline image and at varying intervals of 2 to 24 months thereafter. Usual postoperative findings in patients without complication included mediastinal shifting, changes in subpleural space, changes in parietal pleura, and herniation of contralateral lung. Four patients had postoperative complications including empyema(n=3) and bronchopleural fistula(n=2). Twelve patients showed findings of tumor recurrence such as lymph node metastasis, local recurrence, and pericardial and contralateral pleural effusion. By comparing follow-up CT with baseline CT, we were able to detect early cancer recurrence and postoperative complications. Our results indicate that serial chest CT play an important role in the evaluation of the patients who underwent pneumonectomy for lung cancer.

CT staging of hypopharyngeal carcinoma CT staging of hypopharyngeal carcinoma

No abstract available.