Differing benefits of artificial intelligence-based computer-aided diagnosis for breast US according to workflow and experience level

Purpose@#This study evaluated how artificial intelligence-based computer-assisted diagnosis (AICAD) for breast ultrasonography (US) influences diagnostic performance and agreement between radiologists with varying experience levels in different workflows. @*Methods@#Images of 492 breast lesions (200 malignant and 292 benign masses) in 472 women taken from April 2017 to June 2018 were included. Six radiologists (three inexperienced [<1 year of experience] and three experienced [10-15 years of experience]) individually reviewed US images with and without the aid of AI-CAD, first sequentially and then simultaneously. Diagnostic performance and interobserver agreement were calculated and compared between radiologists and AI-CAD. @*Results@#After implementing AI-CAD, the specificity, positive predictive value (PPV), and accuracy significantly improved, regardless of experience and workflow (all P<0.001, respectively). The overall area under the receiver operating characteristic curve significantly increased in simultaneous reading, but only for inexperienced radiologists. The agreement for Breast Imaging Reporting and Database System (BI-RADS) descriptors generally increased when AI-CAD was used (κ=0.29-0.63 to 0.35-0.73). Inexperienced radiologists tended to concede to AI-CAD results more easily than experienced radiologists, especially in simultaneous reading (P<0.001). The conversion rates for final assessment changes from BI-RADS 2 or 3 to BI-RADS higher than 4a or vice versa were also significantly higher in simultaneous reading than sequential reading (overall, 15.8% and 6.2%, respectively; P<0.001) for both inexperienced and experienced radiologists. @*Conclusion@#Using AI-CAD to interpret breast US improved the specificity, PPV, and accuracy of radiologists regardless of experience level. AI-CAD may work better in simultaneous reading to improve diagnostic performance and agreement between radiologists, especially for inexperienced radiologists.

Predictive performance of ultrasonography-based radiomics for axillary lymph node metastasis in the preoperative evaluation of breast cancer

Purpose@#The purpose of this study was to evaluate the predictive performance of ultrasonography (US)-based radiomics for axillary lymph node metastasis and to compare it with that of a clinicopathologic model. @*Methods@#A total of 496 patients (mean age, 52.5±10.9 years) who underwent breast cancer surgery between January 2014 and December 2014 were included in this study. Among them, 306 patients who underwent surgery between January 2014 and August 2014 were enrolled as a training cohort, and 190 patients who underwent surgery between September 2014 and December 2014 were enrolled as a validation cohort. To predict axillary lymph node metastasis in breast cancer, we developed a preoperative clinicopathologic model using multivariable logistic regression and constructed a radiomics model using 23 radiomic features selected via least absolute shrinkage and selection operator regression. @*Results@#In the training cohort, the areas under the curve (AUC) were 0.760, 0.812, and 0.858 for the clinicopathologic, radiomics, and combined models, respectively. In the validation cohort, the AUCs were 0.708, 0.831, and 0.810, respectively. The combined model showed significantly better diagnostic performance than the clinicopathologic model. @*Conclusion@#A radiomics model based on the US features of primary breast cancers showed additional value when combined with a clinicopathologic model to predict axillary lymph node metastasis.

Core-Needle Biopsy Does Not Show Superior Diagnostic Performance to Fine-Needle Aspiration for Diagnosing Thyroid Nodules

Development of the Korean Geriatric Loneliness Scale (KGLS)

PURPOSE: The purpose of this study was to develop and psychometrically test the Korean Geriatric Loneliness Scale (KGLS). METHODS: The initial items were based on in-depth interviews with 10 older adults. Psychometric testing was then conducted with 322 community-dwelling older adults aged 65 or older. Content, construct, and criterion-related validity, classification in cutoff point, internal consistency reliability, and test-retest reliability were used for the analysis. RESULTS: Exploratory factor analysis showed three factors, including 15 items explaining 91.6% of the total variance. The three distinct factors were loneliness associated with family relationships (34.3%), social loneliness (32.4%), and a lack of belonging (24.9%). As a result of confirmatory factor analysis, 14 items in the three-factor structure were validated. Receiver operating characteristic analysis demonstrated that the KGLS' cutoff point of 32 was associated with a sensitivity of 71.0%, specificity of 80.2%, and area under the curve of .83. Reliability, as verified by the test-retest intraclass correlation coefficient, was .89, and Cronbach's α was .90. CONCLUSION: As its validity and reliability have been verified through various methods, the KGLS can contribute to assessing loneliness in South Korean older adults.

Impact of Repetitive Transcranial Magnetic Stimulation with Computerized Cognitive Enhancement Training on Change in Cognitive Function of Mild Cognitive Impairment Patients : Existing, Sham Treatment Controlled, Pilot Study

Development of the Korean Geriatric Loneliness Scale (KGLS)

PURPOSE@#The purpose of this study was to develop and psychometrically test the Korean Geriatric Loneliness Scale (KGLS).@*METHODS@#The initial items were based on in-depth interviews with 10 older adults. Psychometric testing was then conducted with 322 community-dwelling older adults aged 65 or older. Content, construct, and criterion-related validity, classification in cutoff point, internal consistency reliability, and test-retest reliability were used for the analysis.@*RESULTS@#Exploratory factor analysis showed three factors, including 15 items explaining 91.6% of the total variance. The three distinct factors were loneliness associated with family relationships (34.3%), social loneliness (32.4%), and a lack of belonging (24.9%). As a result of confirmatory factor analysis, 14 items in the three-factor structure were validated. Receiver operating characteristic analysis demonstrated that the KGLS' cutoff point of 32 was associated with a sensitivity of 71.0%, specificity of 80.2%, and area under the curve of .83. Reliability, as verified by the test-retest intraclass correlation coefficient, was .89, and Cronbach's α was .90.@*CONCLUSION@#As its validity and reliability have been verified through various methods, the KGLS can contribute to assessing loneliness in South Korean older adults.

Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis

PURPOSE: The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. METHODS: A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. RESULTS: Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. CONCLUSION: US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US.

Development of the Meaning in Life Scale for Older Adults

PURPOSE: The purpose of this study was to develop and test the psychometric properties of the newly developed instrument, Meaning in Life, for elderly Korean people. METHODS: Ten older adults participated in the qualitative research used to develop the initial items. Participants for the psychometric testing were 371 community-dwelling older adults. Validity and reliability analyses included content, construct, and criterion-related validities, internal consistency, and test-retest reliability. RESULTS: The Meaning in Life Scale consisted of 12 items with three distinct factors; value of life, source of life, and will to live, which explained 86.7% of the total variance. A three-factor structure was validated by confirmatory factor analysis. Criterion-related validity was supported by comparison with the Purpose in Life Test (r=.74). Reliabilities were secured with test-retest reliability of Intra-class Correlation Coefficient (ICC) .85 and the Cronbach's alpha coefficient .90. CONCLUSION: The results of this study indicate that this instrument is useful to measure meaning in life in Korean elders.

Predictors of Suicidal Ideation in Community-dwelling Older Men: A Comparison between Young-old and Old-old / 정신간호학회지

PURPOSE: This study was done to examine the prevalence of suicidal ideation and predictors of suicidal ideation in community-dwelling older men, comparing young-old (65 to 74) and old-old (75 and over). METHODS: The 2014 National Elderly Survey was used with a sample of 2,790 elderly men. Multivariable logistic regression analysis was used to identify the predictive factors for suicidal ideation in elderly men. RESULTS: The proportions of participants with suicidal ideation were significantly different between young-old and old-old men (χ²=4.46, p=.035). The multivariable logistic regression analyses revealed that being a recipient of basic livelihood security, experiencing discrimination, conflicting with children, and being depressed were significantly associated with suicidal ideation in young-old men. In old-old men, living arrangements, conflicting with children, and being depressed were significantly associated with suicidal ideation. CONCLUSION: Results indicate that the development of suicide prevention programs requires different approaches young-old and old-old men.

Comparison of Double Maddox Rod Test and Bagolini Striated Lens Test for Superior Oblique Palsy

PURPOSE: We compared the results of the double Maddox rod test (DMRT), which is commonly performed in clinics as a subjective torsion test for superior oblique muscle palsy, with those of the Bagolini striated lenses test (BSLT) in a least dissociating condition to predict the cyclofusional capacity. METHODS: Twenty-five patients with acquired superior oblique muscle palsy were tested for degree of subjective torsion with DMRT and BSLT in primary position and down-gaze in Daegu Catholic University Hospital from May 2014 to March 2015. DMRT was performed in a dark room and BSLT in a lighted room. RESULTS: Mean extorsional degree in primary position was 3.40 ± 2.58° on DMRT and 1.88 ± 2.92° on BSLT, a significant difference (p = 0.000). In down-gaze, mean extorsional degree was 4.16 ± 2.90° with DMRT and 2.40 ± 2.90° with BSLT (p < 0.001). CONCLUSIONS: The subjective torsional measurement with BSLT was significantly smaller than with DMRT, and the cyclofusional capacity in patients with acquired superior oblique palsy was 1.5° in primary position and 1.8° in down-gaze. BSLT is helpful in addition to DMRT and fundus photograph for the evaluation of cyclotropia in patients with superior oblique muscle palsy, and this test may yield clinically important information for predicting the cyclofusional capacity of patients with superior oblique muscle palsy.

A Case of Acute Macular Neuroretinopathy after Non-ocular Trauma

PURPOSE: In the present study, an unusual case of traumatic retinopathy presenting as acute macular neuroretinopathy was reported. CASE SUMMARY: A 69-year-old male was involved in a car accident and experienced a left 5th rib fracture. There was no direct ocular trauma. However, after the accident he noticed paracentral scotoma and loss of vision in his left eye. At initial examination 4 days after the trauma, central visual acuity was hand motion and visual field test revealed central scotoma in the left eye. Spectral domain optical coherence tomography showed hyper-reflectivity of the outer nuclear layer and disruption of the ellipsoid zone. Fluorescein angiography did not show any leakage or vascular damage but near-infrared autofluorescence imaging showed a dark lesion in the macular area. Visual acuity was improved to 0.2 at 2 weeks after trauma and 0.6 at 6 months after trauma while mild ellipsoid zone defect and visual field defect persisted. CONCLUSIONS: Traumatic retinopathy presenting as acute macular neuroretinopathy is an uncommon disease causing paracentral scotomas after non-ocular trauma, and to the best of our knowledge, this is the first reported case in Korea.

Factors associated with Meaning in Life among Elderly Female Community Dwellers Living Alone

PURPOSE: This study was conducted to examine the factors associated with meaning in life among elderly female community dwellers aged 65 or older who were living alone. METHODS: A quota sample of 222 elderly female living alone was recruited. Data were analyzed with descriptive statistics, independent t-test, one-way ANOVA, Welch's test, Pearson's correlation, and multiple regression using the SPSS 22.0 program. RESULTS: The factors associated with meaning in life included age, education level, perceived economic status, perceived health status, social support, and loneliness. This regression model explained 66% of the variance in meaning in life. CONCLUSION: Based on the results, comprehensive nursing intervention programs for enhancing meaning in life are required.

The implant overdenture on the edentulous mandible using CAD/CAM system: A case report / 대한치과보철학회지

Alveolar bone loss and deformation can be a risk factor in removable prosthetic restoration treatment for partially or fully edentulous patients. The use of implants to solve this problem could improve the support, retention and stability of removable restoration. Attachments used in implant overdenture are versatile. The attachment should be selected according to the patients' conditions. Milled bar has been chosen when readymade bar could not be used because of the narrow distance between implants or firm stability and support of supra-structure were needed. Milled bar design is able to provide cross arch stabilization and comfortability to patients. However, it needs skilled laboratory procedures. Recently, the fabrication of milled bar has become simple and its suitability has been improved through the development of CAD/CAM system. In a 67-year-old female Alzheimer's disease patient with 8 implant fixtures on the fully edentulous site of mandible, implant overdenture with using milled bar and magnet attachment was planned. As rapid treatment was required, CAD/CAM system was used to make a simple laboratory procedure instead of a traditional fabrication process. With this system, implant overdenture with milled bar can be fabricated esthetically and functionally.

Long-Term Outcomes after Cryotherapy for Conjunctival Mucosa-Associated Lymphoid Tissue Lymphomas

PURPOSE: To evaluate long-term outcomes after cryotherapy for conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas. METHODS: We retrospectively analyzed 11 eyes of 8 patients who underwent cryotherapy with a confirmed histopathological diagnosis of conjunctival MALT lymphoma between January 2006 and December 2010 and were followed up for at least a year. RESULTS: The mean patient age was 36.8 years and the average follow-up was 4.1 years. Complete remission was achieved in 3 patients (4 eyes) and recurrence occurred in 5 patients (7 eyes) after the first cryotherapy. After the third cryotherapy, complete remission was achieved in 2 patients (2 eyes) and recurrence occurred in 3 patients (5 eyes). Therefore, 3 patients (5 eyes) underwent radiotherapy and finally achieved complete remission. After cryotherapy, significant complications were not observed except mild symblepharon in 4 patients (6 eyes). CONCLUSIONS: Cryotherapy, although having a higher recurrence rate than radiotherapy, is a simple treatment modality with fewer complications for patients. In the conjunctival MALT lymphoma patients who cannot undergo radiotherapy, cryotherapy should be considered as an alternative treatment modality.

House-plant placement for indoor air purification and health benefits on asthmatics

OBJECTIVES: Some plants were placed in indoor locations frequented by asthmatics in order to evaluate the quality of indoor air and examine the health benefits to asthmatics. METHODS: The present study classified the participants into two groups: households of continuation and households of withdrawal by a quasi-experimental design. The households of continuation spent the two observation terms with indoor plants, whereas the households of withdrawal passed the former observation terms with indoor plants and went through the latter observation term without any indoor plants. RESULTS: The household of continuation showed a continual decrease in the indoor concentrations of volatile organic compounds (VOCs) during the entire observation period, but the household of withdrawal performed an increase in the indoor concentrations of VOCs, except formaldehyde and toluene during the latter observation term after the decrease during the former observation term. Peak expiratory flow rate (PEFR) increased in the households of continuation with the value of 13.9 L/min in the morning and 20.6 L/ min in the evening, but decreased in the households of withdrawal with the value of -24.7 L/min in the morning and -30.2 L/min in the evening in the first experimental season. All of the households exhibited a decrease in the value of PEFR in the second experimental season. CONCLUSIONS: Limitations to the generalizability of findings regarding the presence of plants indoors can be seen as a more general expression of such a benefit of human-environment relations.

Role of T-type Ca2+ Channels in the Spontaneous Phasic Contraction of Pregnant Rat Uterine Smooth Muscle

Although extracellular Ca2+ entry through the voltage-dependent Ca2+ channels plays an important role in the spontaneous phasic contractions of the pregnant rat myometrium, the role of the T-type Ca2+ channels has yet to be fully identified. The aim of this study was to investigate the role of the T-type Ca2+ channel in the spontaneous phasic contractions of the rat myometrium. Spontaneous phasic contractions and [Ca2+]i were measured simultaneously in the longitudinal strips of female Sprague-Dawley rats late in their pregnancy (on day 18~20 of gestation: term=22 days). The expression of T-type Ca2+ channel mRNAs or protein levels was measured. Cumulative addition of low concentrations (<1 micrometer) of nifedipine, a L-type Ca2+ channel blocker, produced a decrease in the amplitude of the spontaneous Ca2+ transients and contractions with no significant change in frequency. The mRNAs and proteins encoding two subunits (alpha1G, alpha1H) of the T-type Ca2+ channels were expressed in longitudinal muscle layer of rat myometrium. Cumulative addition of mibefradil, NNC 55-0396 or nickel induced a concentration-dependent inhibition of the amplitude and frequency of the spontaneous Ca2+ transients and contractions. Mibefradil, NNC 55-0396 or nickel also attenuated the slope of rising phase of spontaneous Ca2+ transients consistent with the reduction of the frequency. It is concluded that T-type Ca2+ channels are expressed in the pregnant rat myometrium and may play a key role for the regulation of the frequency of spontaneous phasic contractions.

Perinatal Outcomes of Triplet Pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.

Perinatal Outcomes of Triplet Pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.

Eisenmenger syndrome in pregnancy at second and third trimester / 대한산부인과학회지

OBJECTIVE: Because women with Eisenmenger syndrome are counseled strongly not to conceive, pregnancy cases with Eisenmenger syndrome are rare in clinical situation. We performed this study to analyze pregnancies at second and third trimester complicated by Eisenmenger syndrome and to evaluate changes during pregnancy and their outcomes. METHODS: Medical records were reviewed retrospectively for Eisenmenger syndrome patients who delivered at second and third trimester at Seoul National University Hospital from January 1989 to October 2005. RESULTS: Among the total of 6 pregnant women, 4 women delivered after 34 weeks and 2 women had therapeutic termination during second trimester. All 4 women who delivered after 34 weeks were categorized as class III by New York Heart Association classification. Maternal mortality rate was 33% (2 of 6 cases). All mortality cases were patients who delivered after 34 weeks. All neonates were small for gestational age with no neonatal death. There was no neonatal morbidity except one case of congenital atrial septal defect. CONCLUSION: Maternal mortality occurred in half of the women who continued their pregnancy beyond second trimester. We think that pregnancy should be still discouraged in patients with Eisenmenger syndrome and that therapeutic abortion should be offered in early pregnancy period.

Ultrasonographic indicators in predicting postnatal outcomes of antenatally detected ventriculomegaly / 대한산부인과학회지

OBJECTIVE: The aim of this study was to find out the prognostic indicators of antenatally detected ventriculomegaly. METHODS: During the study period (Nov. 1995 through Jan. 2003), we identified 96 cases of fetal ventriculomegaly and reviewed their antenatal and postnatal follow-up records retrospectively. Excluding cases of termination before viable stage and incomplete follow-up, 68 cases were evaluated. Severe ventriculomegaly (fetal hydrocephalus; n=30) was defined as lateral ventricular atrial width (LVAW) greater than 15 mm, and mild ventriculomegaly (n=38) was defined as LVAW between 10 and 15 mm. Subgroup of LVAW <12 mm (n=23) was also analyzed. Antenatal workup included detailed ultrasonography, TORCH test and karyotyping. Outcome parameters were the presence of progressive lesion, NICU admission, shunt operation and critical damage that included delayed development, cerebral palsy and death after live birth. RESULTS: Overall survival rate was 89.7% (61/68) and the median postnatal follow-up duration was 17.0 (0.0-69.3) months. Severe ventriculomegaly group showed higher incidence of progressive lesion, NICU admission and shunt operation than did mild group. Within mild ventriculomegaly group, critical damage was more common in cases with associated anomalies, and this difference was present even in the subgroup of LVAW <12 mm (2/16 vs. 4/7, p<0.05). CONCLUSION: In mild ventriculomegaly group, comprehensive antenatal workup including detailed ultrasonography is important because associated anomaly is a poor prognostic factor, even in cases of LVAW <12 mm. In terms of critical damage such as developmental delay, cerebral palsy and postnatal death, the prognosis of cases with mild ventriculomegaly is also guarded.