ABSTRACT
Background: Various clinical applications have been attempted using artificial intelligence (AI) clinical decision support system (CDSS), and it has become a starting point for personalized cancer treatment. We aimed to identify the degree of agreement between the AI?CDSS, Watson for Oncology (WFO), and the clinician in treatment recommendations for Korean breast cancer patients and to provide guidelines for future improvement. Methods: One hundred and eighty?three breast cancer patients who underwent treatment at the Pusan National University Hospital between January 1, 2016 and May 31, 2017 were enrolled in this study. The concordance between WFO抯 and clinicians� treatment recommendations were examined according to various factors. Results: WFO gave the same treatment option recommendations as clinicians in 74 (40.4%) of the cases. According to the logistic regression, the difference in recommendation concordance between stage I and stage III was statistically significant (P = 0.004), and there was no difference among other factors. Conclusion: The concordance of treatment recommendations was low overall. However, this is largely attributable to the differences of medical insurance system and healthcare environment between the United States and Korea. In the future, region?specific features should be considered or reflected during the development of AI?CDSS.
ABSTRACT
The bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation. Patients with BAV are at higher risk of other congenital cardiovascular malformations and valvular dysfunction, including aortic stenosis/regurgitation and infective endocarditis. BAV may also be related to aortic wall abnormalities such as aortic dilatation, aneurysm, and dissection. The morphology of the BAV varies with the presence and position of the raphe and is associated with the type of valvular dysfunction and aortopathy. Therefore, accurate diagnosis and effective treatment at an early stage are essential to prevent complications in patients with BAV. This pictorial essay highlights the characteristics of BAV and its related congenital cardiovascular malformations, valvular dysfunction, aortopathy, and other rare cardiac complications using multimodal imaging.
ABSTRACT
Background@#The position of the eyebrows is critical when planning blepharoptosis surgery. However, insufficient scholarly attention has been paid to the details of postoperative eyebrow height changes at each anatomical landmark. This study investigated the effect of blepharoptosis surgery on brow height and evaluated the change in brow position. @*Methods@#After a retrospective review of 247 patients, this study analyzed 53 patients (106 eyelids) who underwent levator and Müller’s complex advancement between March 2010 and January 2022. Brow heights were measured from the distance between the upper brow margin of each landmark and horizontal line of pupillary center on a digital photograph. @*Results@#The mean change of eyebrow lowering was 1.54 mm (P<0.001) at the medial canthus, 1.29 mm (P<0.001) at the medial limbus, 1.44 mm (P<0.001) at the center of the pupil, 1.40 mm (P<0.001) at the lateral limbus, 1.15 mm (P=0.001) at the lateral canthus, and 0.75 mm (P=0.021) at the lateral eyebrow end. The brow change was most prominent at medial canthus and least prominent at the lateral brow end. The preoperative brow position was only statistically significant factor predicting brow height descent after surgery according to multiple linear regression analysis (R2=0.305, B=–0.375, P<0.001). @*Conclusions@#The eyebrows lowered in most patients after blepharoptosis surgery. The preoperative brow position is the most important factor in predicting the change in brow height after blepharoptosis surgery.
ABSTRACT
Purpose@#This study aimed to evaluate clinical significance and imaging findings of newly detected lesions on breast MRI while monitoring patients’ response to neoadjuvant chemotherapy (NAC). @*Materials and Methods@#We identified 291 patients with newly diagnosed breast cancer who underwent breast MRI to assess their response to NAC between January 2017 and August 2021. We evaluated 26 new lesions in 24 women (mean age, 49.8 years; range, 35–63 years) who were included in this study. Two radiologists assessed imaging findings of new lesions according to Breast Imaging Reporting and Data System (BI-RADS) lexicon 5th edition and evaluated follow-up MRI during NAC. Outcomes of new lesions were determined based on pathologic examination or imaging follow-up after surgery. @*Results@#All 26 new lesions were found on the first follow-up imaging. They disappeared or decreased in size on the second follow-up imaging. Lesion types included mass (n = 22, 84.6%) and non-mass enhancement (n = 4, 15.4%). The majority of the mass types showed oval to round shapes (22/22, 100%), circumscribed margins (21/22, 95.5%), and rim enhancement (18/22, 81.8%). Seven (26.9%) new lesions were ipsilateral to the index cancer, 7 (26.9%) were contralateral, and 12 (46.2%) were bilateral. None of these new lesions were malignant. @*Conclusion@#New lesions were detected in 4.7% of breast MRI during NAC. Most new lesions tended to
ABSTRACT
OBJECTIVE To know about the development trend of small nucleic acid drugs in the world ，to provide reference for the research and development of small nucleic acid drug in China. METHODS By searching the academic literature and patents related to small nucleic acid drugs through the Web of Science literature database and PatSnap patent database from Jan. 1980 to Dec. 2021，research and development situation of small nucleic acid drugs were revealed comprehensively by analyzing research enthusiasm，R&D countries ，R&D institutions and technical topics of small nucleic acid drugs. RESULTS & CONCLUSIONS A total of 59 819 documents and 37 645 patent groups were included. The global trend of small nucleic acid drug literature publication and patent application could be divided into three stages. From 2003 to 2021，the research enthusiasm for small nucleic acid drugs continued to increase. The United States ，China，Japan and Germany were the main research and development countries for small nucleic acid drugs. The number of document publications （25 703，15 927 papers）and patent applications （14 240、8 937 groups） in the United States and China were ahead of other countries ，and the research and development activities were relatively strong. Moreover，the number of document publications and patent applications in China in this field had grown rapidly in recent years. The R&D institution with the largest number of publications was the University of California （2 499 papers），the R&D institution with the largest number of patent applications was the American Ionis Corporation （1 378 groups），and the Chinese Academy of Sciences （1 580 papers）had been shortlisted among the top 10 document producing institutions in the world. However ，our country ’s research and development in this field are mostly based on basic research ，and the research on industrial application is slightly insufficient. The research focus in the field of small nucleic acid drugs mainly focuses on nucleic acid sequences and their modification and improvement and drug loading technology. RNA interference technology has gradually become a hot technology for small nucleic acid drugs.
ABSTRACT
Purpose@#This study aims to identify the relationship between nursing students’ social anxiety and communication ability, and in particular, to determine the mediating effect of self-efficacy. @*Methods@#A total of 187 nursing students enrolled at four universities in Korea completed surveys between August and September 2020. The measurements included the Global Interpersonal Communication Competence Scale, self-efficacy scales, and interaction anxiousness scales. Data were analyzed using descriptive statistics, an independent t-test, one-way ANOVA, Pearson’s correlation, multiple regression following the Baron and Kenny method, and bootstrapping for mediation. @*Results@#Communication ability was significantly negatively correlated with social anxiety (r=-.61, p<.001) and significantly positively correlated with self-efficacy (r=.77, p<.001). Furthermore, self-efficacy had a partial mediating effect on the relationship between social anxiety and communication ability. @*Conclusion@#The findings of this study suggest that communication ability can be improved if individual characteristics such as social anxiety and self-efficacy are considered. Therefore, when developing communication ability improvement programs for nursing students in the future, it is considered important to actively consider these personal characteristics.
ABSTRACT
Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.
ABSTRACT
Purpose@#This study aims to identify the relationship between nursing students’ social anxiety and communication ability, and in particular, to determine the mediating effect of self-efficacy. @*Methods@#A total of 187 nursing students enrolled at four universities in Korea completed surveys between August and September 2020. The measurements included the Global Interpersonal Communication Competence Scale, self-efficacy scales, and interaction anxiousness scales. Data were analyzed using descriptive statistics, an independent t-test, one-way ANOVA, Pearson’s correlation, multiple regression following the Baron and Kenny method, and bootstrapping for mediation. @*Results@#Communication ability was significantly negatively correlated with social anxiety (r=-.61, p<.001) and significantly positively correlated with self-efficacy (r=.77, p<.001). Furthermore, self-efficacy had a partial mediating effect on the relationship between social anxiety and communication ability. @*Conclusion@#The findings of this study suggest that communication ability can be improved if individual characteristics such as social anxiety and self-efficacy are considered. Therefore, when developing communication ability improvement programs for nursing students in the future, it is considered important to actively consider these personal characteristics.
ABSTRACT
Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.
ABSTRACT
Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.
ABSTRACT
Gastric malignant tumor is one of the most common and fatal tumors in the world. According to data in 2012, gastric cancer ranks the fifth and third in the incidence rate and tumor related mortality rate of malignant tumors worldwide. Therefore, gastric cancer is one of the diseases that seriously endanger people′s health. Laparoscopic surgery not only minimize surgical trauma, but also reduce complications and accelerate recovery of patients. Therefore, laparoscopic surgery has gradually replaced open surgery in the field of surgery. Based on related prospective, randomized researches and literatures, development history of laparoscopic surgery of gastric cancer, and combined with author′s clinical experience and the latest insights, the authors make an investigation on the laparoscopic surgery of gastric cancer.
ABSTRACT
PURPOSE: This study used a system dynamics methodology to identify correlation and nonlinear feedback structures among factors affecting adolescent cyberbullying victims (CV) in Korea and to construct and verify a simulation model. METHODS: Factors affecting CV were identified by reviewing a theoretical background in existing literature and referencing various statistical data. Related variables were identified through content validity verification by an expert group, after which a causal loop diagram (CLD) was constructed based on the variables. A stock-flow diagram (SFD) using Vensim Professional 7.3 was used to establish a CV model. RESULTS: Based on the literature review and expert verification, 22 variables associated with CV were identified and the CLD was prepared. Next, a model was developed by converting the CLD to an SFD. The simulation results showed that the variables such as negative emotions, stress levels, high levels of conflict in schools, parental monitoring, and time spent using new media had the strongest effects on CV. The model's validity was verified using equation check, sensitivity analysis for time-step and simulation with 4 CV adolescent. CONCLUSION: The system dynamics model constructed in this study can be used to develop intervention strategies in schools that are focused on counseling that can prevent cyberbullying and assist in the victims' recovery by formulating a feedback structure and capturing the dynamic changes observed in CV. To prevent cyberbullying, it is necessary to develop more effective strategies such as prevention education, counseling and treatment that considers factors pertaining to the individual, family, school, and media.
Subject(s)
Adolescent , Humans , Bullying , Counseling , Education , Korea , Nonlinear Dynamics , ParentsABSTRACT
OBJECTIVE: To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp. MATERIALS AND METHODS: Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B. RESULTS: Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups. CONCLUSION: CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.
Subject(s)
Female , Humans , Male , Image Enhancement , Image Processing, Computer-Assisted , Lower Extremity , Noise , Phlebography , Popliteal Vein , Retrospective Studies , Signal-To-Noise Ratio , Veins , Vena Cava, Inferior , Venous ThrombosisABSTRACT
OBJECTIVE: To investigate the efficacy of motion-correction algorithm (MCA) in improving coronary artery image quality and measurement accuracy using an anthropomorphic dynamic heart phantom and 256-detector row computed tomography (CT) scanner. MATERIALS AND METHODS: An anthropomorphic dynamic heart phantom was scanned under a static condition and under heart rate (HR) simulation of 50–120 beats per minute (bpm), and the obtained images were reconstructed using conventional algorithm (CA) and MCA. We compared the subjective image quality of coronary arteries using a four-point scale (1, excellent; 2, good; 3, fair; 4, poor) and measurement accuracy using measurement errors of the minimal luminal diameter (MLD) and minimal luminal area (MLA). RESULTS: Compared with CA, MCA significantly improved the subjective image quality at HRs of 110 bpm (1.3 ± 0.3 vs. 1.9 ± 0.8, p = 0.003) and 120 bpm (1.7 ± 0.7 vs. 2.3 ± 0.6, p = 0.006). The measurement error of MLD significantly decreased on using MCA at 110 bpm (11.7 ± 5.9% vs. 18.4 ± 9.4%, p = 0.013) and 120 bpm (10.0 ± 7.3% vs. 25.0 ± 16.5%, p = 0.013). The measurement error of the MLA was also reduced using MCA at 110 bpm (19.2 ± 28.1% vs. 26.4 ± 21.6%, p = 0.028) and 120 bpm (17.9 ± 17.7% vs. 34.8 ± 19.6%, p = 0.018). CONCLUSION: Motion-correction algorithm can improve the coronary artery image quality and measurement accuracy at a high HR using an anthropomorphic dynamic heart phantom and 256-detector row CT scanner.
Subject(s)
Coronary Vessels , Heart Rate , Heart , PhenobarbitalABSTRACT
PURPOSE@#This study used a system dynamics methodology to identify correlation and nonlinear feedback structures among factors affecting adolescent cyberbullying victims (CV) in Korea and to construct and verify a simulation model.@*METHODS@#Factors affecting CV were identified by reviewing a theoretical background in existing literature and referencing various statistical data. Related variables were identified through content validity verification by an expert group, after which a causal loop diagram (CLD) was constructed based on the variables. A stock-flow diagram (SFD) using Vensim Professional 7.3 was used to establish a CV model.@*RESULTS@#Based on the literature review and expert verification, 22 variables associated with CV were identified and the CLD was prepared. Next, a model was developed by converting the CLD to an SFD. The simulation results showed that the variables such as negative emotions, stress levels, high levels of conflict in schools, parental monitoring, and time spent using new media had the strongest effects on CV. The model's validity was verified using equation check, sensitivity analysis for time-step and simulation with 4 CV adolescent.@*CONCLUSION@#The system dynamics model constructed in this study can be used to develop intervention strategies in schools that are focused on counseling that can prevent cyberbullying and assist in the victims' recovery by formulating a feedback structure and capturing the dynamic changes observed in CV. To prevent cyberbullying, it is necessary to develop more effective strategies such as prevention education, counseling and treatment that considers factors pertaining to the individual, family, school, and media.
ABSTRACT
BACKGROUND: Multiple approaches for nipple reconstruction exist, and none is considered superior to all others. The star flap is one of the most popular methods for nipple reconstruction, but gradual height loss is a major concern. We present a new modification of the star flap that incorporates a de-epithelialized dermal flap, along with the associated surgical results. METHODS: We reviewed the medical records of patients who underwent nipple reconstruction using the modified star flap method. The design was different from the conventional star flap in that the lateral wings were changed into a trapezoidal shape and de-epithelialized dermal flaps were added. The patients were followed up at 2, 4, 6, and 12 months postoperatively, and nipple height was measured. The postoperative nipple height achieved using the modified method was compared with that obtained using the traditional method. RESULTS: From February 2013 to June 2017, 32 patients received surgery using the modified star flap, and 18 patients who underwent nipple reconstruction before 2013 comprised the conventional method group. All patients had undergone breast reconstruction with an abdominal tissue-based flap. The mean follow-up period was 14.4 months in the modified method group and 17.3 months in the conventional method group. The mean maintenance of projection at 12 months postoperatively was 56.28%±18.58% in the modified method group, and 44.23%±14.15% in the conventional method group. This difference was statistically significant (P<0.05). CONCLUSIONS: The modified method using a de-epithelialized dermal flap provides reliable maintenance of projection in patients who have undergone abdominal tissue-based breast reconstruction.
Subject(s)
Female , Humans , Follow-Up Studies , Mammaplasty , Medical Records , Methods , Nipples , Surgical FlapsABSTRACT
Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.
Subject(s)
Female , Humans , Middle Aged , Follow-Up Studies , Mandible , Mandibular Prosthesis Implantation , Mandibular Reconstruction , Postoperative Complications , Prostheses and Implants , Recurrence , Thigh , Titanium , Tongue Neoplasms , TransplantsABSTRACT
Ultrasonography-guided core needle biopsy has been standard of care for diagnosing suspicious breast lesion. The procedure is safe and has a low rate of complications. Most common complication might be bleeding or hematoma, which could be avoided by careful process or changing it to excisional biopsy or managed by proper management. Rarely, Post-procedural arteriovenous fistula is reported in almost all body fields, which is life quality threatening, not life-threatening. Most of them occur with obvious vessel injury, and their primary end-point of management is the obliteration of fistula by thrombosis. However, we experienced a case of iatrogenic arteriovenous fistula after core needle biopsy for breast lesion with small vessel injury which was not but small ones, and its thrill did not disappear even after thrombosis. We would like to share our clinical learnings from surgical management process of this rare complication.
Subject(s)
Arteriovenous Fistula , Biopsy , Biopsy, Large-Core Needle , Breast , Fistula , Hematoma , Hemorrhage , Iatrogenic Disease , Quality of Life , Standard of Care , ThrombosisABSTRACT
The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis (ILNM) in patients with penile squamous cell carcinoma (PSCC). The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization (WHO) histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- A nd multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage (P = 0.000), pathological tumor stage (P = 0.016), histologic grade (P = 0.000), and risk group of histological subtypes (P = 0.029) as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate-(HR: 3.66, 95% CI: 1.30-10.37, P = 0.021) and high-risk groups (HR: 28.74, 95% CI: 2.37-348.54, P = 0.008) were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.
ABSTRACT
PURPOSE@#To compare image qualities of 80 kVp CT venography (CTV) and 120 kVp CTV by model-based iterative reconstruction (MBIR) at the same radiation dose.@*MATERIALS AND METHODS@#Sixty-nine patients that underwent CTV using 80 kVp (36 patients, group 1) or 120 kVp (33 patients, group 2) with MBIR at the same radiation dose were enrolled, and objective and subjective image qualities were assessed independently by two radiologists.@*RESULTS@#Mean vascular enhancement and contrast-to-noise ratio were significantly higher in group 1 than in group 2 for inferior vena cavas, femoral veins, and popliteal veins (p < 0.001), and there was significantly lower objective image noise in group 1 (p < 0.001). Subjective analysis revealed image quality was significantly higher in group 1 and image noise was significantly higher in group 2 (p < 0.001). Mean dose-length products was not significantly lower in group 1 (356.1 ± 153.7 mGy cm) than in group 2 (370.1 ± 77.1 mGy cm) (p = 0.635).@*CONCLUSION@#CTV at 80 kVp with MBIR is a better protocol than CTV at 120 kVp with MBIR at the same radiation dose.