Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence / 대한배뇨장애요실금학회지

Purpose@#To develop an automatic interpretation system for uroflowmetry (UFM) results using machine learning (ML), a form of artificial intelligence (AI). @*Methods@#A prospectively collected 1,574 UFM results (1,031 males, 543 females) with voided volume>150 mL was labelled as normal, borderline, or abnormal by 3 urologists. If the 3 experts disagreed, the majority decision was accepted. Abnormality was defined as a condition in which a urologist judges from the UFM results that further evaluation is required and that the patient should visit a urology clinic. To develop the optimal automatic interpretation system, we applied 4 ML algorithms and 2 deep learning (DL) algorithms. ML models were trained with all UFM parameters. DL models were trained to digitally analyze 2-dimensional images of UFM curves. @*Results@#The automatic interpretation algorithm achieved a maximum accuracy of 88.9% in males and 90.8% in females when using 6 parameters: voided volume, maximum flow rate, time to maximal flow rate, average flow rate, flow time, and voiding time. In females, the DL models showed a dramatic improvement in accuracy over the other models, reaching 95.4% accuracy in the convolutional neural network model. The performance of the DL models in clinical discrimination was outstanding in both genders, with an area under the curve of up to 0.957 in males and 0.974 in females. @*Conclusions@#We developed an automatic interpretation algorithm for UFM results by training AI models using 6 key parameters and the shape of the curve; this algorithm agreed closely with the decisions of urology specialists.

Effects on Quality of Life in Patients with Neurogenic Bladder treated with Clean Intermittent Catheterization: Change from Multiple Use Catheter to Single Use Catheter

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.

Effects on Quality of Life in Patients with Neurogenic Bladder treated with Clean Intermittent Catheterization: Change from Multiple Use Catheter to Single Use Catheter

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

BACKGROUND: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2x2 anchor with 4x4 suture stands). METHODS: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. RESULTS: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. CONCLUSIONS: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

BACKGROUND: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2x2 anchor with 4x4 suture stands). METHODS: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. RESULTS: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. CONCLUSIONS: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.

The Clinical Results of ACL Reconstruction with the Bio-Transfix(R) Technique

PURPOSE: We wanted to evaluate the clinical results of ACL reconstructions with using four strands of an auto-hamstring tendon graft and a bioresorbable-Transfix device (Arthrex, Naples, FL) for femoral fixation. MATERIALS AND METHODS: From May 2005 to May 2007, a total of 108 cases that underwent arthroscopic ACL reconstruction with using hamstring tendons and a bioresorbable-Transfix device were followed-up for more than 1 year (Range: 12~32 months) postoperatively. The clinical results were evaluated by the preoperative and postoperative Lysholm knee scores, the International Knee Documentation Committee (IKDC) scoring system and a KT-1000 arthrometer. The radiological results were evaluated by the measurement method described by L'Insalata. RESULTS: Preoperatively, the mean Lysholm knee score was 70.8+/-6.8 (Range: 52.0~81.0) which improved to 94.2+/-4.8 (Range: 76.0~98.0) at the last follow up (p<0.05). According to the IKDC scoring system, 104 cases (96%) were categorized as normal or nearly normal and no case was categorized as severely abnormal at the last follow up (p<0.05). KT-1000 arthrometer instability was statistically improved from 8.8 mm (Range: 3~17 mm) to 2.1 mm (Range: 1~7 mm) (p<0.05). The femoral and tibial tunnels were statistically widened 22.7% and 12.7% on the AP view, respectively, and 17.4% and 8.4% on the lateral view, respectively, at the last follow up (p<0.05). CONCLUSION: ACL reconstruction using auto-hamstring tendons with a bioresorbable-Transfix device showed satisfactory results on the physical examination and functional evaluation.

Efficiency of Anterior Interbody Fusion using Cage and Plate in the Distractive Flexion Injury of Cervical Spine : Cage vs Tricortical Autoiliac Bone / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes. SUMMARY OF THE LITERATURE REVIEW: AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine. MATERIALS AND METHODS: We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system. RESULTS: All the cases were fused by 12.6+/-2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group II, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11) CONCLUSIONS: For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.

Reconstruction of the Extensor Pollicis Longus Tendon by Tendon Graft or Tendon Transfer

PURPOSE: To compare the clinical results of spontaneous rupture of extensor pollicis longus tendon treated by palmaris longus tendon graft (group I) versus extensor indicis proprius tendon transfer (group II). MATERIALS AND METHODS: Out of twenty-five patients who suffer from spontaneous extensor pollicis longus tendon rupture, twelve patients were treated by palmaris longus tendon graft and thirteen patients were treated by extensor indicis proprius tendon transfer. Postoperatively thumbs were immobilized with thumb spica splint for three weeks. Active and passive movement was allowed subsequently for six weeks. The functions of the thumbs were assessed by the Geldmacher criteria and statistically compared. RESULTS: The overall outcome was excellent in 5(20%) of patients and good in 17(68%) of patients and satisfactory in 3(12%) of patients. The mean scores using the Geldmacher criteria were 18.50 for palmaris longus tendon graft and 19.69 for extensor indicis proprius tendon transfer. No significant difference was noted between two groups. CONCLUSION: Both methods establish equally good clinical results in patient with chronic extensor pollicis longus tendon rupture. Extensor indicis proprius tendon transfer seems more available methods.

Comparison of the Results of Internal Fixation of Femoral Neck Fracture According to the Fixation Methods

PURPOSE: We wanted to compare the stability, the complications and the patients' functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck. MATERIALS AND METHODS: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIM(TM) score, the complications and the failure rate. RESULTS: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIMTM score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05). CONCLUSION: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.

Three Years Follow-up Results of High-flex Total Knee Arthroplasty

PURPOSE: To evaluate the Three years clinical results of a total knee arthroplasty using the NexGen LPS-Flex fixed bearing system. MATERIALS AND METHODS: One hundred knees(65 patients) which used the LPS-Flex system for primary TKA and were followed up for a minimum Three years were evaluated. Evaluations included preoperative and postoperative range of motion(ROM), factors affecting the postoperative ROM that included age of the patient, the body mass index, the flexion contracture, degree of varus deformity, and Hospital for Special Surgery score. RESULTS: Knee ROM increased from preoperative 122.8 degrees to postoperative 130.5 degrees. The mean HSS score improved from preoperative 58.4 to postoperative 91.3. The femoral-tibial angle was changed from preoperative 6.4 degrees varus to a pos- toperative 5.5 degrees valgus. The most important factor that influenced the range of motion after an arthroplasty was the preoperative range of motion. One deep infection developed, but was cured with synovectomy and administration of antibiotics. CONCLUSION: Primary TKR with NexGen LPS-Flex system showed satisfactory early results including excellent ROM. We found that preoperative ROM had a significant effect on postoperative ROM.