Assessment of Automated Identification of Phases in Videos of Total Hip Arthroplasty Using Deep Learning Techniques

Background@#As the population ages, the rates of hip diseases and fragility fractures are increasing, making total hip arthroplasty (THA) one of the best methods for treating elderly patients. With the increasing number of THA surgeries and diverse surgical methods, there is a need for standard evaluation protocols. This study aimed to use deep learning algorithms to classify THA videos and evaluate the accuracy of the labelling of these videos. @*Methods@#In our study, we manually annotated 7 phases in THA, including skin incision, broaching, exposure of acetabulum, acetabular reaming, acetabular cup positioning, femoral stem insertion, and skin closure. Within each phase, a second trained annotator marked the beginning and end of instrument usages, such as the skin blade, forceps, Bovie, suction device, suture material, retractor, rasp, femoral stem, acetabular reamer, head trial, and real head. @*Results@#In our study, we utilized YOLOv3 to collect 540 operating images of THA procedures and create a scene annotation model.The results of our study showed relatively high accuracy in the clear classification of surgical techniques such as skin incision and closure, broaching, acetabular reaming, and femoral stem insertion, with a mean average precision (mAP) of 0.75 or higher. Most of the equipment showed good accuracy of mAP 0.7 or higher, except for the suction device, suture material, and retractor. @*Conclusions@#Scene annotation for the instrument and phases in THA using deep learning techniques may provide potentially useful tools for subsequent documentation, assessment of skills, and feedback.

The Therapeutic Effect of Hydraulic Distension with Pumping Technique on the Patient with Frozen Shoulder: Case Report

Frozen shoulder is a disease characterized by shoulder pain and limited range of motion. Conservative treatment is preceded by surgical treatment to reduce pain and recover range of motion. Hydraulic distention is a procedure in which a sufficient amount of solution is injected into the shoulder joint to rupture the rigid joint capsule. Recently, the method of continuously maintaining the expanded capsular state after injection without the process of rupturing the rigid joint has also been used. However, in order to obtain the maximal stretching effect, we proposed a ‘pumping technique’ that inflates and shrinks the rigid joint capsule by repeating the process of infusion and regurgitation of the injection fluid into the capsule. Our proposed ‘pumping technique’ was shown to be more effective in increasing range of motion than the conventional hydraulic distension. This ‘pumping technique’ can be suggested as an effective therapeutic option for frozen shoulder.

Segmental Motor Paresis Presenting with Abdominal Wall Pseudohernia due to Herpes Zoster: Case Report

Herpes zoster is characterized by vesicular eruption and rash of the skin in the affected dermatomes. Sensory symptoms such as pain and hypesthesia are often accompanied in patients with herpes zoster. While motor paralysis is uncommon, abdominal paralysis can result in rare complications such as abdominal wall pseudohernia. In the present report, we discuss the case of a 62 year-old man who presented with abdominal wall protrusion after herpes zoster infection involving the right T10-T12 dermatomes. Magnetic resonance imaging findings were not specifically correlated with abdominal wall protrusion. Needle electromyography revealed abnormal spontaneous activity in the right paraspinal muscles at the T10-T12 levels, rectus abdominis, and external oblique muscles. Dermatomal somatosensory evoked potentials (SEPs) exhibited prolonged latency in the right T10 and T12 dermatomes. These findings suggest that herpes zoster infection can affect both motor and sensory nerves.

Acute Pseudogout of the Neck: "Crowned Dens" Revisited

Calcium pyrophosphate dihydrate crystal deposition disease is associated with an acute mono- or pauciarthritis, termed "pseudogout" in elderly patients, involving a large joint (including the knees, ankles) or a chronic arthropathy manifesting as mild joint pain and stiffness. Pseudogout is a crystal-deposition disease of peripheral joints, usually encountered in elderly patients. However, acute presentation of pseudogout around the odontoid process comprises a "crowned-dens" appearance, and requires contemplation of differential diagnoses. We recently experienced a case of pseudogout in the cervical spine presenting with fever and acute neck pain that was successfully treated with a colchicine and low-dose oral steroid. We reported this case with a review of the relevant literature.

Effect of Formal Education Level on Measurement of Rheumatoid Arthritis Disease Activity

OBJECTIVE: The aim of this study is to analyze the capacity of three demographic variables - age, sex, and formal education level - as well as disease duration to explain variation in 7 Core Data Set variables and 4 indices used to assess rheumatoid arthritis (RA), in a cohort of Korean patients seen in usual care. METHODS: All RA Core Data Set measures were collected in usual care of 397 RA patients, including tender/swollen joint counts (TJC, SJC) 28, physician global estimate of status, erythrocyte sedimentation rate, C-reactive protein, and a multidimensional health assessment questionnaire to assess physical function, pain, and patient global estimate of status (PATGL). Four indices were computed: disease activity score with 28 joint count (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), and routine assessment of patient index data 3 (RAPID3). Descriptive statistics and multivariate generalized linear models were used in data analysis. RESULTS: Patients with lower education had higher scores, indicating greater severity, for all 7 Core Data Set measures and 4 indices (significant for TJC, function, pain, PATGL, DAS28, SDAI, CDAI, RAPID3). In a series of regressions that included age, sex, disease duration, and education, formal education level was the only significant variable to explain variation in TJC, pain, PATGL, physician global estimate of status (DOCGL), DAS28, SDAI, CDAI, and RAPID3. CONCLUSION: Significant associations with education were found in Korean RA patients according to most RA Core Data Set measures and 4 indices. Education was more likely than age, sex, or disease duration to explain variation in most measures and indices.

Chemical Pneumonitis after Inhalation of Waterproofing Spray: A Case Report / 계명의대학술지

Waterproofing spray is commonly used to waterproof textile, tents, boots, etc. Chemical pneumonitis caused by inhalation of waterproofing spray has often been reported. Most waterproofing sprays contain a fluoropolymer in combination with hydrocarbons. However, chemical pneumonitis caused by waterproofing spray not containing fluoropolymer is uncommon. The authors are reporting a case of chemical pneumonitis caused by waterproofing spray, which contained hydrocarbon only. A 35-year-old man presented with dyspnea. The patient used a waterproofing spray on a tent for 30 minutes in a closed room. One hour and a half after spraying, the patient developed dyspnea, and his dyspnea had gotten worse. The patient's respiratory rate was fast, and the patient's arterial blood gas analysis showed hypoxemia. The chest X-ray and high resolution computed tomography showed bilateral ground-glass opacities and areas of consolidation in both lower lung fields. The patient was diagnosed with chemical pneumonitis caused by inhalation of waterproofing spray. Oxygen was given to the patient, and the patient was started on methylprednisolone intravenously. The patient's symptom improved after one day. After one week, most of symptoms of the patient improved and his chest X-ray showed improvement, so the patient was discharged. After discharge, oral prednisolone was prescribed instead of methylprednisolone, and was gradually tapered off. One month later, the patient's chest X-ray showed complete resolution.

A Case of Esophageal Small Cell Carcinoma with Gastric Metastasis andwithout Regional Lymph Node Involvement / 대한소화기내시경학회지

Small cell carcinoma is most frequently described as occurring in the bronchial tree. Extrapulmonary small cell carcinoma is a very rare disease and it has been reported in the esophagus, stomach, small intestine, pancreas, uterus, salivary gland and prostate. Primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement is very rare. We have experienced a case of primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement. The patient was treated with chemotherapy and this patient is alive at 40 months after the treatment.

Prophylactic Effect of Mitomycin C and Bacillus Calmette-Guerin in Stage T1 of the Superficial Bladder Cancer / 대한비뇨기과학회지

We compared the efficacy and toxicity of mitomycin C and Bacillus Calmette-Guerin (BCG) intravesical instillation in 86 patients with stage T1 of the superficial bladder tumor. Of them, 34 patients were received mitomycin C (40 mg/40 ml sodium chloride, once a week for 8 weeks) and 26 patients were received BCG (120 mg/50 ml sodium chlorids, once a week for 6 weeks) after transurethrat resection of bladder tumor and 24 patients (control) underwent transurethral resection alone. The mean follow up period was 24.8 months in control group, 26.8 months in mitomycin C group and 25.7 months in BCG group. The mean time to recur was 11.3 months in control group, 11.5 months in mitomcyin C group and 15.9 in BCG group but there was no significant difference among each groups (p>0.05). The overall recurrence rate was 34.6% in BCG group compared with 70.5% in mitomycin C group and 75.0% in control group, showing significant difference (p<0.05). Side effects were more common after BCG instillation than mitomycin C instillation. The most common side effect after BCG instillation was hematuria in 14 patients (53.8%). That of mitomycin C was cystitis in 10 patients (29.4%). Our study suggests that the prophylactic efficacy of BCG was significantly superior to that of mitomycin C, but there was no significant superiority regarding prophylactic effect of reduced mean time to recur in stage T1 bladder cancer patients. Additionally, further follow up studies were needed in mitomycln C.

Effect of FCL (5-FU, carboplatin, leucovorin) Chemotherapy in Advanced Head and Neck Cancer / 대한암학회지

PURPOSE: The purpose of this study was to evaluate the efficacy and the toxicities of recently developed second generation platinum, carboplatin in combination with 5-fluorouracil and leucovorin in head and neck cancer patients. PATIENTS AND METHODS: Between March 1993 and Apirl 1996, 22 patients with locally advanced/metastatic head and neck cancer were treated with FCL combination chemotherapy. Of these 20 patients were evaluable. RESULTS: Median age was 58 years. The number of patients with stage III and IV patients was 4 and 18 respectively. Among the 20 evaluable patients, 1 (7.2%) achieved a complete response and 8 (40%) achieved partial responses. The median duration of the response was 24 weeks and the median survival duration was 12 months. Out of 77 chemotherapy cycles, 1 patient (1.3%) had anemia of WHO grade 2, 7 patients (9.1%) experienced leukopenia (WHO grade > or =2) and 7 (9.1%) experienced thrombocytopenia (WHO grade > or =2). Non-hematologic toxicities were mild; nausea and voming of WHO grade > or =2 was 12 (15.6%), stomatitis (WHO grade > or =2) was 6 (7.8%). CONCLUSION: FCL chemotherapy was effective in locally advanced head and neck cancer. Toxocities were minimal compaired to cisplatin based combination chemotherapy.Further studies on increased dose of FCL chemotherapy in head and neck cancer patients is warranted.