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.

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.

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.

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.

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.

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.

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.

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.

Association Study of Dopamine Transporter(DATI) G2319A Genetic Polymorphism in Alcohol Dependence

OBJECTIVE: Dopamine transporter is member of family of Na/Cl dependent neurotransmitter transporter, 12 transmembrane domain that has high substrate specificity, affinity. It is related with dopamine reuptake in presynaptic vesicle. DAT has a VNTR in its 3'-untranslated region(UTR), 3'-UTR VNTR polymorphism is related with modification of dopamine transmission. The association between with VNTR polymorphism and neuropsychiatric disorders such as alcohol dependence, and low activity ALDH has been studied but their relationship is unclear. We study about association of 3'-UTR VNTR of DAT gene and G2319A and alcohol dependence. METHOD: Group of Korea subjects were studied with alcohol dependence(n=49 male) compared to mentally healthy controls(n=53 male). The peripheral blood sample was acquired. and Polymerase Chain Reaction(PCR) amplification, Mspl procedure was done. RESULT: There was a significant difference between alcohol dependence group and normal control(genotype frequency p<0.05 allele frequency p<0.05) Allele A frequency and genotype(GG,GA) frequency was a significant difference between alcohol dependence group and normal control(p<0.05) CONCLUSION: Our study showed that genetic polymorphism of DAT1 G2319A had relation with alcohol dependence.

Polydipsia, Water Intoxication and Vasopressin in Psychiatric Patients / 대한정신약물학회지

There appeared remarkably common disorder of water balance in psychiatric patients. Approximately 30% of the chronic inpatient population drinks fluids excessively, so called polydipsic, while 5% suffers episodes of water intoxication. Water intoxication is a serious problem characterized by profound hyponatremia and a diverse neurologic signs ranging from ataxia, confusion to death. The cause of polydipsia is even less clear. Although previous studies have suggested that it is related to cognitive dysfunction the possibility of an abnormality in the osmoregulation of thirst has not been investigated. But there is the hypothesis that polydipsic, hyponatremic schizophrenics exhibit increased neuroendocrine and behavioral sensitivity to dopamine in mesolimbic tracts, in proportion to the severity of their osmoregulatory disturbance. In order to provide the optimal clinical management of these common disturbances, the author will review their pathophysiology, assessment, treatment and relationship with mental illness.

An Association Study of COMT Gene Polymorphism with Korean Schizophrenics

An association study with Korean schizophrenic patients(N=84) and normal controls(N=87) was performed to find the relationship between catechol-o-methyltransferase(COMT) gene polymorphism and schizophrenia using polymerase chain reaction-restriction fragment length polymorphism. When we compared the allele and genotype frequencies of Bg/I COMT gene polymorphism in schizophrenics and normal controls, there was no significant difference between two groups. Our results do not support an association between the Bg/I polymorphism of COMT gene and schizophrenia.

Factors Related to the Treatment Outcome in Adult Substance Abusers / 신경정신의학

OBJECTIVES: We investigated the factors related to the treatment outcome for substance abuse inpatients. METHODS: We reviewed the medical records of 97 patients who were discharged from the substance abuse treatment unit in Seoul National Mental Hospital. We then had follow-up telephone interview with 53 family memebers and/or patients of 97 patients. RESULTS: 1) Among 97 discharged patients, 59 patients were dropped out, 38 patients graduated successfully from the treatment program. The dropout group had shorter treatment period, were more often admitted involuntarily, had greater incidence of violence history and violated ward rules more often(p<.05). The main reasons for dropout were violation of rules(45.3%), escape during outdoor activities(3.7%), and refusal of return to the hospital(15.2%). 2) At the follow-up interview, 32 patients were abstaining from substances whereas 21 patients resumed use. The abuser group and more previous psychiatric admissions, more comorbid psychiatric disorders, and higher percentage of history of suicide attempts than the abstaining group(p<.05). 3) After the discharge from the hospital, 45% of patients showed to discontinue substance. Treatment graduates were more in recovery from substance abuse. The abstaining group had a higher percentage of employment than the abuser group(p<.05). CONCLUSION: The treatment outcome was more likely to be related with co-existing psychiatric problems such as previous psychiatric admission, comorbid psychiatric disorders, and history of suicide attempts. Therefore it is suggested that careful evaluation and appropriate treatment for such factors are needed for better treatment outcome. And psychiatric interview to enhance the motivation of patients is needed for completion of treatment.

Clinical characteristics of Narcotics and Hallucinogens

No abstract available.

Effect of Antipsychotic Drugs on Dopamine Transporter Function in CV(bDAT) Cells

CV(bDAT) cell line, expressing dopamine transporter stably, has been established by transfection of CV-1 cells with bovine dopamine transporter cDNA. Using CV(bDAT) cells, the effects of various antipsychotic drugs on dopamine uptake were investigated. All of antipsychotic drugs tested, inhibited the [3>H]dopamine uptake into CV(bDAT) cells with IC50s in the low to mid micromolar, implying that antipsychotic drugs may produce overflow of dopamine in the synaptic cleft of dopaminergic neuron.

Association between Alcohol Dependence and the Al Allele of the Dopamine D2 Receptor Gene TaqI A RFLP in Korean Population / 신경정신의학

OBJECTIVES: The existence of an allelic association between alcohol dependence and the TaqI 1 AI allele at the D, dopamine receptor(DRD2) locus has been proposed but still remains controversial. The purpose of the present study was to examine the allelic association of alcohol dependence and the TaqI A polymorphism of DRD2 gene in ethnically homogenous Korean population. METHODS: The subjects were 59 male patients diagnosed as alcohol dependence(DSM-RT) and the controls were 74 nonalcoholic male volunteers screened for alcohol problems in their 2nd degree relatives. The severity of alcohol dependence was estimated by the number of items of diagnostic level 1 of the Major Criteria for the Diagnosis of Alcoholism by National Council on Alcoholism(NCA). Genotyping was done by polymerase chain reaction(FCR) and the electrophoresis of the FCR products digested by TaqI RESULTS: The frequency of the A1 allele in alcoholic group(0.45) was higher than that in control group(0.34) but there was no significant difference between them(x2=2.98, p=0.08). The frequency of A1 allele in 47 more severe alcoholic patients who met five or more items of Major Criteria for the Diagnosis of Alcoholism by NCA was 0.48 and it was significantly higher compared with that in control group (x2=4.21, p=0.04). In less severe alcoholic patients, the frequency of A1 allele(0.33) was similar to that in control group(x2=0.04, p=0.85). The proportions of subjects with more severe alcoholism in the patients with A1A1, A1A2, and A2A2 were 92%, 77%, and 73%, respectively. CONCLUSION: An allelic association of more severe alcoholic subgroup and the TaqI Al allele of Da dopamine receptor gene was supported in Korean population. It is suggested that the TaqI A1 allele is related to or has a linkage disequilibrium with a genetic factor which may be one of the risk factors for susceptibility to more severe alcoholic subgroup in multifactorial-threshold etiologic model.