Bone Age Assessment Using Artificial Intelligence in Korean Pediatric Population: A Comparison of Deep-Learning Models Trained With Healthy Chronological and Greulich-Pyle Ages as Labels

Objective@#To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. @*Materials and Methods@#A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343;median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male:female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). @*Results@#Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. @*Conclusion@#The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.

Neonatal Risk Factors for Growth Retardation in Infants With Congenital Heart Disease

Background@#While the association of congenital heart disease (CHD) and growth retardation (GR) is known, data remain limited. This study investigated the incidence of GR and its neonatal risk factors in patients with CHD using nationwide population-based claims data.Method: The study population was extracted from Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD under one year of age. GR was defined as an idiopathic growth hormone deficiency or short stature on the claims data. We investigated the neonatal risk factors for GR. @*Results@#The number of patients diagnosed with CHD within the first year of birth was 133,739. Of these, 2,921 newborns were diagnosed with GR. The cumulative incidence of GR was 4.8% at 19 years of age for individuals diagnosed with CHD at infancy. In the multivariable analysis, the significant risk factors for GR were preterm birth, small for gestational age, low birth weight, respiratory distress, bronchopulmonary dysplasia, bacterial sepsis, necrotizing enterocolitis, feeding problems and cardiac procedure. @*Conclusion@#Several neonatal conditions were significant risk factors for GR in CHD patients, and appropriate monitoring and treatment programs are required in CHD neonates with these factors. Considering this study is limited to claims data, further studies are warranted, including genetic and environmental factors affecting GR in CHD patients.

Excision with Temporary Interphalangeal Joint Pin Fixation for Toe Ganglion Cysts

Background@#Toe ganglion cysts are often symptomatic and recurrent. Communicating lesions between ganglion cysts and the interphalangeal joint (IPJ) or tendon sheath make it difficult to prevent a recurrence. Temporary restriction of the joint and tendon motion can facilitate surgical site healing. This study analyzed the clinical results of temporary pin fixation of the IPJ after toe ganglion cyst excision. @*Methods@#Sixteen patients with symptomatic toe ganglion cysts underwent surgical treatment. Excision alone was initially performed on 10 patients. Six patients underwent temporary pin fixation of the IPJ after ganglion cyst excision. Repeat excision with pin fixation was performed for recurrence in two patients after excision only. Clinical evaluations and postoperative complications were analyzed. @*Results@#Fourteen of 16 toe ganglion cysts were located near the IPJ. Two cysts not adjacent to the joint completely healed after excision alone. Seven of 14 cysts near the joint recurred after initial excision alone and required repeated reoperation. Eight cysts did not recur after excision with pin fixation, including 2 that recurred after excision alone. @*Conclusions@#Temporary IPJ pin fixation after excision for ganglion cysts can be effective for preventing the recurrence of ganglion cysts adjacent to toe IPJ.

Application of the postnatal urinary tract dilation classification system to predict the need for surgical intervention among neonates and young infants

Purpose@#The aim of this study was to validate the postnatal urinary tract dilation (UTD) classification system by correlating it with the need for surgical intervention. @*Methods@#Young infants who underwent ultrasound (US) examinations for prenatal hydronephrosis were retrospectively identified. The kidney units (KUs; right, left, or bilateral) were graded from UTD P0 (very low risk) to P3 (high risk) based on seven US criteria from the UTD system. Surgery-free survival curves were constructed using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards regression analysis clustered by patients was performed. Interobserver agreement was analyzed using the weighted kappa coefficient. @*Results@#In total, 504 KUs from 336 patients (mean age, 18.3±15.9 days; range, 1 to 94 days; males, n=276) were included, with a median follow-up of 24.2 months. Fifty-eight KUs underwent surgical intervention. Significant differences were observed among the Kaplan-Meier curves stratified into UTD groups (P<0.001). The presence of anterior-posterior renal pelvic diameter ≥15 mm (hazard ratio [HR], 8.602; 95% confidence interval [CI], 1.558 to 43.065), peripheral calyceal dilation (HR, 8.190; 95% CI, 1.558 to 43.065), ureteral dilation (HR, 2.619; 95% CI, 1.274 to 5.380), parenchymal thickness abnormality (HR, 3.371; 95% CI, 1.574 to 7.223), bladder abnormality (HR, 12.209; 95% CI, 3.616 to 41.225) were significantly associated with the occurrence of surgery. The interobserver agreement was moderate to almost perfect agreement for US features (κ=0.564-0.898) and substantial for final UTD grades (κ=0.716). @*Conclusion@#The UTD classification system is reliable and appropriately stratifies the risk of surgical intervention.

Usefulness of two-dimensional shear wave elastography in diagnosing hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation

Purpose@#This study aimed to evaluate the usefulness of two-dimensional shear wave elastography (2D-SWE) in diagnosing hepatic veno-occlusive disease (VOD) in pediatric patients. @*Methods@#This study retrospectively included pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) between November 2019 and January 2021. All 34 patients (8.7±5.0 years) were examined using 2D-SWE for an initial diagnosis. A subgroup analysis was performed using the data from follow-up examinations of patients diagnosed with VOD. The characteristics of the initial VOD diagnosis were compared with the longitudinal changes observed in VOD patients who underwent multiple ultrasound examinations. @*Results@#In total, 19 patients were diagnosed with VOD at 17.6±9.4 days after HSCT. All VOD patients showed hepatomegaly, ascites, and gallbladder wall thickening. Liver stiffness was higher in VOD patients than in non-VOD patients (12.4±1.1 vs. 6.3±0.8 kPa, P<0.001). Liver stiffness values above 7.2 kPa showed 84.2% sensitivity and 93.3% specificity in distinguishing VOD from non-VOD (area under the curve, 0.925; 95% confidence interval, 0.780 to 0.987; P<0.001). A subgroup analysis of 11 patients showed a linear decrease in liver stiffness values after VOD diagnosis with treatment (first, second, and third follow-ups; 13.5±1.7, 11.3±1.4, and 9.5±0.8 kPa, respectively), but without statistical significance in the pairwise analysis. @*Conclusion@#Liver stiffness measured using 2D-SWE increased in pediatric patients who develop VOD after HSCT. Therefore, liver stiffness can be a predictive and quantitative parameter for diagnosing VOD.

Building of Pediatric COVID-19 Module Clinic: A Novel Operation Model in Response to COVID-19 Pandemic

In mid-2022, as the wave of pediatric coronavirus disease 2019 (COVID-19) cases escalated in South Korea, a public-private partnership was made to establish a Pediatric COVID-19 Module Clinic (PMC). We describe the utilization of the first prototype children’s modular clinic in Korea University Anam Hospital functioning as the COVID-19 PMC. Between August 1 and September 30, 2022, a total of 766 children visited COVID-19 PMC. Daily number of patient visits to the COVID-19 PMC ranged between 10 and 47 in August; and less than 13 patients per day in September 2022. Not only the model provided timely care for the COVID-19 pediatric patients, but it also enabled safe and efficacious care for the non-COVID-19 patients in the main hospital building while minimizing exposure risk to severe acute respiratory syndrome coronavirus 2 transmission. Current description highlights the importance of spatial measures for mitigating in-hospital transmission of COVID-19, in specifically on pediatric care.

Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

Purpose@#This study evaluated the accuracy of attenuation imaging (ATI) for the assessment of hepatic steatosis in pediatric patients, in comparison with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP). @*Methods@#Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using the Spearman test. The AC cutoff value for discriminating hepatic steatosis corresponding to a CAP value of 241 dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of the association between AC and CAP. The diagnostic accuracy of AC cutoffs was estimated using the imperfect gold-standard methodology based on a two-level Bayesian latent class model. @*Results@#Seventy patients (median age, 12.5 years; interquartile range, 11.0 to 14.0 years; male:female, 58:12) were included. AC and CAP showed a moderate-to-good correlation (ρ =0.646, P<0.001). Multivariable regression analysis affirmed the significant association between AC and CAP (P<0.001). The correlation was not evident in patients with a body mass index ≥30 kg/m2 (ρ=-0.202, P=0.551). Linear regression revealed that an AC cutoff of 0.66 dB/cm/MHz corresponded to a CAP of 241 dB/m (sensitivity, 0.93; 95% confidence interval [CI], 0.85 to 0.98 and specificity, 0.87; 95% CI, 0.56 to 1.00). @*Conclusion@#ATI showed an acceptable correlation with CAP values in a pediatric population, especially in patients with a body mass index <30 kg/m2. An AC cutoff of 0.66 dB/cm/MHz, corresponding to a CAP of 241 dB/m, can accurately diagnose hepatic steatosis.

Re-Assessment of Applicability of Greulich and Pyle-Based Bone Age to Korean Children Using Manual and Deep Learning-Based Automated Method

Purpose@#To evaluate the applicability of Greulich-Pyle (GP) standards to bone age (BA) assessment in healthy Korean children using manual and deep learning-based methods. @*Materials and Methods@#We collected 485 hand radiographs of healthy children aged 2–17 years (262 boys) between 2008 and 2017. Based on GP method, BA was assessed manually by two radiologists and automatically by two deep learning-based BA assessment (DLBAA), which estimated GP-assigned (original model) and optimal (modified model) BAs. Estimated BA was compared to chronological age (CA) using intraclass correlation (ICC), Bland-Altman analysis, linear regression, mean absolute error, and root mean square error. The proportion of children showing a difference >12 months between the estimated BA and CA was calculated. @*Results@#CA and all estimated BA showed excellent agreement (ICC ≥0.978, p12 months in 44.3%, 44.5%, 39.2%, and 36.1% for radiologist 1, radiologist 2, original, and modified DLBAA models, respectively. @*Conclusion@#Contemporary healthy Korean children showed different rates of skeletal development than GP standard-BA, and systemic bias should be considered when determining children’s skeletal maturation.

Usefulness of Synthetic Osteoconductive Bone Graft Substitute with Zeta Potential Control for Intramedullary Fixation with Proximal Femur Nail Antirotation in Osteoporotic Unstable Femoral Intertrochanteric Fracture / 대한고관절학회지

Purpose@#This study was conducted in order to examine the usefulness of osteoconductive bone substitutes with zeta potential control (geneX® ds; Biocomposites, England) by comparing the complications and radiographic evaluation with or without geneX® ds augmentation for internal fixation with proximal femur nail antirotation (PFNA) for treatment of osteoporotic unstable intertrochanteric fractures. @*Materials and Methods@#A retrospective study of 101 patients who underwent fixation with PFNA in osteoporotic unstable intertrochanteric fractures was conducted from December 2015 to August 2020. The radiographic evaluation and complication rates were compared between patients with geneX® ds (Group A: 41 cases) and those without geneX® ds (Group B: 60 cases). @*Results@#In radiological valuation, the degree of blade sliding from the time immediately after surgery to one year after surgery was 1.4±1.2 mm and 5.8±2.7 mm in Group A and Group B, respectively (P<0.001). During the same time frame, a significant difference of 2.3±2.2° and 7.4±3.1° , respectively (P<0.001), in varus collapse, was observed for Group A and Group B. @*Conclusion@#Among patients fixed with PFNA for treatment of unstable intertrochanteric fractures, less blade sliding and varus collapse was observed for those with geneX® ds augmentation compared to those without it. In addition, there was no increase in the incidence of complications. The authors believe it can be regarded as a safe and effective additive for intramedullary fixation for treatment of unstable intertrochanteric fractures.

Necessity of developing a disability evaluation guideline

Although doctors expend their best effort in treating their patients’ illnesses or injuries, the patients may retain some disabilities even after treatment. Accordingly, some conflicts occur between the patients’ expectations of financial compensation for their disabilities and the financial manager’s policy to efficiently distribute limited resources. The mediation of these social conflicts requires the determination of the degree of physical disability, which can be done by doctors alone. Hence, a reliable disability evaluation guideline should be established. However, currently, only a few educational programs on disability evaluation are available for doctors and there is no reliable guideline for disability evaluation.Current Concepts: There were attempts to implement the American Medical Association guideline in Korea; however, it is currently not being used efficiently because it is quite complicated and unsuited to Korean settings. Mcbride’s disability evaluation, published 60 years ago, is being used, but it is not realistic and unreasonable in Korea. To prepare a standard guideline for disability evaluation, the Korean Academy of Medical Sciences published a booklet, “Disability Evaluation Guideline: Explanation and Case Studies”, based on the American Medical Association guideline. The academy published the booklet’s revised version (2nd edition), ‘Disability evaluation guideline and utilization’, in 2016. However, Korean Academy of Medical Sciences guideline still not being used because it is too complicated to use.Discussion and Conclusion: Fair disability evaluation is a social responsibility given to doctors, and there should be a useful guideline for disability evaluation that reflects the characteristics of each medical society or association.

Characteristics of Symptomatic Belching in Patients With Belching Disorder and Patients Who Exhibit Gastroesophageal Reflux Disease With Belching

Background/Aims@#Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. @*Methods@#Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidicon-acidic. Belch characteristics were compared between patients with BD and those with GERD. @*Results@#Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005).Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). @*Conclusions@#BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Body donation trends in Yonsei University: a statistical analysis of donor records / 대한해부학회지

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors’ records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors’ records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors’ records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.

Necessity of developing a disability evaluation guideline

Although doctors expend their best effort in treating their patients’ illnesses or injuries, the patients may retain some disabilities even after treatment. Accordingly, some conflicts occur between the patients’ expectations of financial compensation for their disabilities and the financial manager’s policy to efficiently distribute limited resources. The mediation of these social conflicts requires the determination of the degree of physical disability, which can be done by doctors alone. Hence, a reliable disability evaluation guideline should be established. However, currently, only a few educational programs on disability evaluation are available for doctors and there is no reliable guideline for disability evaluation.Current Concepts: There were attempts to implement the American Medical Association guideline in Korea; however, it is currently not being used efficiently because it is quite complicated and unsuited to Korean settings. Mcbride’s disability evaluation, published 60 years ago, is being used, but it is not realistic and unreasonable in Korea. To prepare a standard guideline for disability evaluation, the Korean Academy of Medical Sciences published a booklet, “Disability Evaluation Guideline: Explanation and Case Studies”, based on the American Medical Association guideline. The academy published the booklet’s revised version (2nd edition), ‘Disability evaluation guideline and utilization’, in 2016. However, Korean Academy of Medical Sciences guideline still not being used because it is too complicated to use.Discussion and Conclusion: Fair disability evaluation is a social responsibility given to doctors, and there should be a useful guideline for disability evaluation that reflects the characteristics of each medical society or association.

Characteristics of Symptomatic Belching in Patients With Belching Disorder and Patients Who Exhibit Gastroesophageal Reflux Disease With Belching

Background/Aims@#Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. @*Methods@#Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidicon-acidic. Belch characteristics were compared between patients with BD and those with GERD. @*Results@#Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005).Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). @*Conclusions@#BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Body donation trends in Yonsei University: a statistical analysis of donor records / 대한해부학회지

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors’ records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors’ records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors’ records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.

Reliability and validity of the Korean version of the University of California–Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract instrument in patients with systemic sclerosis

Background/Aims@#Systemic sclerosis (SSc) is associated with a wide range of gastrointestinal (GI) changes. The University of California–Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT 2.0) instrument is a self-administered GI assessment instrument for patients with SSc. We developed a Korean version of the UCLA SCTC GIT 2.0 instrument and evaluated its reliability and internal consistency. @*Methods@#The participants were 37 Korean patients with SSc. Translation and cross-cultural adaptation of the UCLA SCTC GIT 2.0 were performed according to international standardized guidelines. We evaluated reproducibility by calculating the intraclass correlation coefficients and assessed the internal consistency of the Korean version of the UCLA SCTC GIT 2.0. We assessed its construct validity by evaluating its correlations with the Short Form Health Survey version 2 and EQ-5D scores by means of Spearman correlation analyses. @*Results@#Patients with SSc were mostly women (89.19%) with a mean age of 52.2 years, median disease duration of 24 months, and median modified Rodnan total skin score of 4. The median total GIT score on the UCLA SCTC GIT 2.0 was 0.3. The UCLA SCTC GIT 2.0 Korean version showed excellent internal consistency (Cronbach’s α of total GIT score = 0.863). Most domains of the ULCA SCTC GIT 2.0 were correlated with those of the EuroQol (EQ)-5D score. @*Conclusions@#The Korean version of the UCLA SCTC GIT 2.0 has acceptable internal consistency, reliability, and validity. Therefore, it can be used to assess GIT involvement in Korean patients with SSc.

Efficacy and Safety of DWJ1252 Compared With Gasmotin in the Treatment of Functional Dyspepsia: A Multicenter, Randomized, Double-blind, Active-controlled Study

Background/Aims@#Prokinetics such as mosapride citrate CR (conventional-release; Gasmotin) are commonly used in functional dyspepsia (FD). This study aims to evaluate the efficacy and safety of once-a-day mosapride citrate SR (DWJ1252), a sustained-release formulation of mosapride citrate, compared with mosapride citrate CR 3 times a day, in patients with FD. @*Methods@#In this multicenter, randomized, double-blind, active-controlled, non-inferiority study, 119 patients with FD (by the Rome III criteria, 60 for mosapride citrate SR and 59 for mosapride citrate CR) were randomly allocated to mosapride citrate SR once daily or mosapride citrate CR thrice daily for 4 weeks in 16 medical institutions. Primary end point was the change in gastrointestinal symptom (GIS) score from baseline, assessed by GIS questionnaires on 5-point Likert scale after 4-week treatment. Secondary end points and safety profiles were also analyzed. @*Results@#The study included 51 and 49 subjects in the mosapride citrate SR and mosapride citrate CR groups, respectively. GIS scores at week 4 were significantly reduced in both groups (mean ± SD: − 10.04 ± 4.45 and − 10.86 ± 5.53 in the mosapride citrate SR and mosapride citrate CR groups, respectively; P < 0.001), and the GIS changes from baseline did not differ between the 2 groups (difference, 0.82 point; 95% CI, − 1.17, 2.81; P = 0.643). Changes in GIS at weeks 2 and 4 and quality of life at week 4, and the improvement rates of global assessments at weeks 2 and 4, did not differ between the groups. Adverse events were similar in the 2 groups, and there were no serious adverse events. @*Conclusion@#In patients with FD, mosapride citrate SR once daily is as effective as mosapride citrate CR thrice daily, with a similar safety profile.

Decreased 18F-Fluorodeoxyglucose Uptake in Lumbar Vertebrae of Stroke Patients

Background@#and Purpose We investigated 18F-fluorodeoxyglucose (FDG) uptake levels in the lumbar vertebrae, liver, and spleen of stroke patients with carotid atherosclerosis. @*Methods@#This study analyzed acute ischemic stroke patients with carotid atherosclerosis who underwent whole-body FDG positron-emission tomography between October 2015 and January 2017. FDG uptake in the lumbar vertebrae, liver, and spleen was measured and compared between stroke patients and control subjects without stroke history. Multivariate linear regression analysis was performed to identify independent factors related to FDG uptake in the proximal internal carotid artery (ICA). @*Results@#Twenty stroke patients aged 75.1±9.0 years (mean±standard deviation; 10 females) and 20 control subjects aged 62.9±10.7 years (6 females) were included. In comparison with the control group, the stroke group showed significantly higher FDG uptake in the proximal ICA (1.16±0.26 vs. 0.87±0.19, p<0.01), but significantly lower FDG uptake in the lumbar vertebrae (1.09±0.26 vs. 1.38±0.38, p=0.007) and liver (1.71±0.30 vs. 2.01±0.34, p=0.005). Multivariate linear regression analysis showed that the lumbar FDG uptake was negatively correlated with FDG uptake in the proximal ICA (standardized coefficient=-0.367, p=0.013) after adjusting for age and hypertension. @*Conclusions@#Stroke patients showed decreased FDG uptake in the lumbar vertebrae. Further studies are warranted to evaluate the pathophysiological link between cerebral atherosclerosis and bone.

The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis

Background/Aims@#Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can serve as biomarkers for diagnosing and assessing disease activity in ulcerative colitis (UC). We investigated their clinical significance in UC. @*Methods@#We analyzed 48 patients with UC who underwent measurement of fecal calprotectin (FC) and endoscopy and 96 age- and sex-matched healthy controls. NLR and PLR were compared between the patients and healthy controls. The endoscopic activity was divided into 2 groups: group 1 (mild to moderate inflammation) and group 2 (severe inflammation) according to the Mayo endoscopic subscore in UC. @*Results@#To diagnose UC, the optimal cutoff of NLR and PLR was 2.26 (sensitivity 54.2%; specificity 90.6%; positive likelihood ratio 5.778, 95% confidence interval [CI] 2.944–11.339; area under the curve [AUC] 0.774, 95% CI, 0.690–0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%; positive likelihood ratio 3.778, 95% CI 1.821–7.838; AUC 0.654, 95% CI 0.556–0.753), respectively. The optimal cutoff to differentiate group 1 and group 2 was 3.44, 175.9, and 453 µg/g for NLR, PLR, and FC, respectively (sensitivity, 63.6% vs. 90.9% vs. 81.8%; specificity, 81.1% vs. 78.4% vs. 73.0%; positive likelihood ratio, 3.364 vs. 4.205 vs. 3.027; AUC, 0.714 vs. 0.897 vs. 0.813). PLR had the highest AUC and positive likelihood ratio. @*Conclusions@#NLR and PLR help differentiate patients with UC from healthy controls. NLR, PLR, and FC indicate endoscopic activity and may reflect intestinal mucosal conditions.

Association between the Use of Diuretics and Size Reduction in Pediatric Atrial Septal Defect

Background and Objectives@#While diuretics are sometimes used in atrial septal defect (ASD) treatment, their effect on ASD size reduction remains unclear. We aimed to evaluate the efficacy of diuretics in ASD size reduction in pediatric patients. @*Methods@#We retrospectively reviewed the medical records of patients with secundum ASD (size ≥10 mm), between 2005 and 2019. Patients were divided into two groups based on the diuretic administration. @*Results@#Of the 73 enrolled patients, 40 received diuretics. The initial age at ASD diagnosis (2.8±1.7 vs. 2.5±2.0 years, p=0.526) and follow-up duration (22.3±11.4 vs. 18.7±13.2 months, p=0.224) were not significantly different between the groups. The ASD diameter at the initial diagnosis (13.7±2.0 vs. 13.5±3.4 mm, p=0.761) and the indexed ASD diameter (25.5±5.9 vs. 26.9±10.3 mm/m2 , p=0.493) were also not significantly different between two groups. The ASD diameter significantly increased in the non-diuretic group during follow-up (0.0±2.9 vs. +2.6±2.0 mm, p<0.001). The indexed ASD diameter significantly decreased in the diuretic group during follow-up (−5.7±6.5 vs. +0.2±3.9 mm/m 2 , p<0.001). In the linear mixed model analysis, diuretic use was associated with ASD diameter decrease (p<0.001) and indexed ASD diameter reduction (p<0.001) over time. Device closure was more frequently performed in the diuretic (75.0%) than in the non-diuretic group (39.4%). @*Conclusions@#Patients receiving diuretics are less likely to undergo surgery. The diuretics administration may be associated with the use of smaller ASD devices for transcatheter treatment through ASD size reduction.