Publications by authors named "Hyungjin Kim"

380 Publications

Extension of Coronavirus Disease 2019 on Chest CT and Implications for Chest Radiographic Interpretation.

Radiol Cardiothorac Imaging 2020 Apr 30;2(2):e200107. Epub 2020 Mar 30.

Department of Radiology, Seoul National College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C., S.H.Y., S.J.P., C.M.P., J.H.L., H. Kim, E.J.H., S.J.Y., J.G.N., C.H.L., J.M.G.); CHESS Center, The First Hospital of Lanzhou University, Lanzhou, China (Q.X., J.L.); Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (K.H.L.); Department of Internal Medicine, Incheon Medical Center, Incheon, Korea (J.Y.K.); Department of Radiology, Seoul Medical Center, Seoul, Korea (Y.K.L.); Department of Radiology, National Medical Center, Seoul, Korea (H. Ko); Department of Radiology, Myongji Hospital, Gyeonggi-do, Korea (K.H.K.); and Department of Radiology, Chonnam National University Hospital, Gwanju, Korea (Y.H.K.).

Purpose: To study the extent of pulmonary involvement in coronavirus 19 (COVID-19) with quantitative CT and to assess the impact of disease burden on opacity visibility on chest radiographs.

Materials And Methods: This retrospective study included 20 pairs of CT scans and same-day chest radiographs from 17 patients with COVID-19, along with 20 chest radiographs of controls. All pulmonary opacities were semiautomatically segmented on CT images, producing an anteroposterior projection image to match the corresponding frontal chest radiograph. The quantitative CT lung opacification mass (QCT) was defined as (opacity attenuation value + 1000 HU)/1000 × 1.065 (g/mL) × combined volume (cm) of the individual opacities. Eight thoracic radiologists reviewed the 40 radiographs, and a receiver operating characteristic curve analysis was performed for the detection of lung opacities. Logistic regression analysis was performed to identify factors affecting opacity visibility on chest radiographs.

Results: The mean QCT per patient was 72.4 g ± 120.8 (range, 0.7-420.7 g), and opacities occupied 3.2% ± 5.8 (range, 0.1%-19.8%) and 13.9% ± 18.0 (range, 0.5%-57.8%) of the lung area on the CT images and projected images, respectively. The radiographs had a median sensitivity of 25% and specificity of 90% among radiologists. Nineteen of 186 opacities were visible on chest radiographs, and a median area of 55.8% of the projected images was identifiable on radiographs. Logistic regression analysis showed that QCT ( < .001) and combined opacity volume ( < .001) significantly affected opacity visibility on radiographs.

Conclusion: QCT varied among patients with COVID-19. Chest radiographs had high specificity for detecting lung opacities in COVID-19 but a low sensitivity. QCT and combined opacity volume were significant determinants of opacity visibility on radiographs.Earlier incorrect version appeared online. This article was corrected on April 6, 2020 and December 14, 2020.© RSNA, 2020.
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http://dx.doi.org/10.1148/ryct.2020200107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233433PMC
April 2020

3-bit Multilevel Operation with Accurate Programming Scheme in TiOx/Al2O3 Memristor Crossbar Array for Quantized Neuromorphic System.

Nanotechnology 2021 Mar 22. Epub 2021 Mar 22.

Department of Electronic Engineering, Inha University, Hi-Tech Center 905, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Korea (the Republic of).

As interest in artificial intelligence (AI) and relevant hardware technologies has been developed rapidly, algorithms and network structures have become significantly complicated, causing serious power consumption issues because an enormous amount of computation is required. Neuromorphic computing, a hardware AI technology with memory devices, has emerged to solve this problem. For this application, multilevel operations of synaptic devices are important to imitate floating point weight values in software AI technologies. Furthermore, weight transfer methods to desired weight targets must be arranged for off-chip training. From this point of view, we fabricate 32×32 memristor crossbar array and verify the 3-bit multilevel operations. The programming accuracy is verified for 3-bit quantized levels by applying a reset-voltage-control programming scheme to the fabricated TiOx/Al2O3-based memristor array. After that, a synapse composed of two differential memristors and a fully-connected neural network for MNIST pattern recognition are constructed. The trained weights are post-training quantized in consideration of the 3-bit characteristics of the memristor. Finally, the effect of programming error on classification accuracy is verified based on the measured data, and we obtained 98.12% classification accuracy for MNIST data with the programming accuracy of 1.79% root-mean-square-error (RMSE). These results imply that the proposed reset-voltage-control programming scheme can be utilized for a precise tuning, and expected to contribute for the development of a neuromorphic system capable of highly precise weight transfer.
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http://dx.doi.org/10.1088/1361-6528/abf0ccDOI Listing
March 2021

Long-Wave Infrared Photodetectors Based on 2D Platinum Diselenide atop Optical Cavity Substrates.

ACS Nano 2021 Mar 22. Epub 2021 Mar 22.

Department of Electrical and Electronic Engineering, University of Melbourne, Victoria 3010, Australia.

Long-wave infrared (LWIR) photodetection is of high technological importance, having a wide range of applications that include thermal imaging and spectroscopy. Two-dimensional (2D) noble-transition-metal dichalcogenides, platinum diselenide (PtSe) in particular, have recently shown great promise for infrared detection. However, previous studies have mainly focused on wavelengths up to the short-wave infrared region. In this work, we demonstrate LWIR photodetectors based on multilayer PtSe. In addition, we present an optical cavity substrate that enhances the light-matter interaction in 2D materials and thus their photodetection performance in the LWIR spectral region. The PtSe photoconductors fabricated on the TiO/Au optical cavity substrate exhibit responsivities up to 54 mA/W to LWIR illumination at a wavelength of 8.35 μm. Moreover, these devices show a fast photoresponse with a time constant of 54 ns to white light illumination. The findings of this study reveal the potential of multilayer PtSe for fast and broadband photodetection from visible to LWIR wavelengths.
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http://dx.doi.org/10.1021/acsnano.0c09739DOI Listing
March 2021

Noninvasive optical assessment of implanted tissue-engineered construct success in situ.

Tissue Eng Part C Methods 2021 Mar 17. Epub 2021 Mar 17.

University of Michigan, 1259, Dept. of Biomedical Engineering, Ann Arbor, Michigan, United States;

Quantitative diffuse reflectance spectroscopy (DRS) was developed for label-free, noninvasive, and real-time assessment of implanted tissue-engineered devices manufactured from primary human oral keratinocytes (six batches in two five-patient cohorts). Constructs were implanted in a murine model for one and three weeks. DRS evaluated construct success in situ using optical absorption (hemoglobin concentration and oxygenation, attributed to revascularization) and optical scattering (attributed to cellular density and layer thickness). Destructive pre- and post-implantation histology distinguished experimental control from stressed constructs, whereas noninvasive pre-implantation measures of keratinocyte glucose consumption and residual glucose in spent culture media did not. In constructs implanted for one week, DRS distinguished control due to stressed and compromised from healthy constructs. In constructs implanted for three weeks, DRS identified constructs with higher post-implantation success. These results suggest that quantitative DRS is a promising, clinically-compatible technology for rapid, noninvasive, and localized tissue assessment to characterize tissue-engineered construct success in vivo.
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http://dx.doi.org/10.1089/ten.TEC.2021.0018DOI Listing
March 2021

Effect of Threshold Voltage Window and Variation of Organic Synaptic Transistor for Neuromorphic System.

J Nanosci Nanotechnol 2021 Aug;21(8):4303-4309

Department of Electronic Engineering, Inha University, Incheon 22212, Korea.

Synaptic devices, which are considered as one of the most important components of neuromorphic system, require a memory effect to store weight values, a high integrity for compact system, and a wide window to guarantee an accurate programming between each weight level. In this regard, memristive devices such as resistive random access memory (RRAM) and phase change memory (PCM) have been intensely studied; however, these devices have quite high current-level despite their state, which would be an issue if a deep and massive neural network is implemented with these devices since a large amount of current-sum needs to flow through a single electrode line. Organic transistor is one of the potential candidates as synaptic device owing to flexibility and a low current drivability for low power consumption during inference. In this paper, we investigate the performance and power consumption of neuromorphic system composed of organic synaptic transistors conducting a pattern recognition simulation with MNIST handwritten digit data set. It is analyzed according to threshold voltage () window, device variation, and the number of available states. The classification accuracy is not affected by window if the device variation is not considered, but the current sum ratio between answer node and the rest 9 nodes varies. In contrast, the accuracy is significantly degraded as increasing the device variation; however, the classification rate is less affected when the number of device states is fewer.
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http://dx.doi.org/10.1166/jnn.2021.19393DOI Listing
August 2021

Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.

J Am Geriatr Soc 2021 Mar 8. Epub 2021 Mar 8.

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.

Background/objectives: Psychotropic and opioid medications are routinely prescribed for symptom management in hospice, but national estimates of prescribing are lacking. Changes in Medicare hospice payment in 2014 provide the first opportunity to examine psychotropic and opioid prescribing among hospice beneficiaries, and the factors associated with use of specific medication classes.

Design: Cross-sectional analysis of a 20% sample of traditional and managed Medicare with Part D enrolled in hospice, 2014-2016.

Setting: Beneficiaries enrolled in the Medicare hospice benefit.

Participants: Medicare beneficiaries ≥65 newly enrolled in hospice between July 1, 2014 and December 31, 2016 (N = 554,022).

Main Outcome: Prevalence of psychotropic and opioid medication prescribing by class and factors associated with prescribing.

Results: 70.3% of hospice beneficiaries were prescribed a psychotropic and 63.3% were prescribed an opioid. The most common psychotropic classes prescribed were: benzodiazepines (60.6%), antipsychotics (38.3%), antidepressants (18.4%), and antiepileptics (10.2%). Lorazepam (56.4%), morphine (52.8%), and haloperidol (28.6%) were received by the most beneficiaries. Prevalence of any psychotropic and opioid prescription was highest among beneficiaries who were female (76.7%), non-Hispanic white (76.6%), and those with cancer (78.9%). Compared to white beneficiaries, non-Hispanic black beneficiaries were less likely to receive nearly every class of medication, with significantly lower odds of receiving opioids (64.1% vs 57.9%; AOR 0.75, 95% CI 0.72-0.77) and benzodiazepines (61.6% vs 52.2%; AOR 0.66, 95% CI 0.64-0.68). Differences were seen across hospice diagnosis; those with cancer were more likely to receive opioids, benzodiazepines, and antipsychotics but less likely to receive antidepressants and antiepileptics.

Conclusions: Psychotropic and opioid medications are frequently prescribed in hospice. Observed variations in prescribing across race and ethnicity may reflect disparities in prescribing as well as patient preferences for care. Further work is important to understand factors driving prescribing given limited studies surrounding medication prescribing in hospice.
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http://dx.doi.org/10.1111/jgs.17085DOI Listing
March 2021

Factors associated with radiographic progression in patients with Takayasu's arteritis.

Clin Exp Rheumatol 2021 Feb 23. Epub 2021 Feb 23.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Objectives: To identify the factors related to radiographic progression in patients with Takayasu's arteritis (TAK).

Methods: A retrospective cohort study was conducted among patients with TAK who underwent computed tomography angiography (CTA) at least twice in a 2-5-year interval. Radiographic progression was defined as newly developed and/or aggravated (more than 20%) characteristic CTA findings. Correlation analysis was performed using a multivariate Cox regression model.

Results: The cohort included 153 TAK patients with a mean CTA interval of 3.53 years, and 24 (15.7%) showed radiographic progression. Those with progression showed higher acute-phase reactant levels (erythrocyte sedimentation rate [ESR], 26.06 vs. 35.72 mm/h, p=0.040; C-reactive protein [CRP], 0.45 vs. 1.13 mg/dL, p<0.001), were younger at the initial CTA (43.70 vs. 31.81 years, p<0.001), and were more likely to be receiving immunosuppressants (14 [10.9%] vs. 7 [29.2%] patients, p=0.038). Multivariate Cox regression analysis revealed age at the initial CTA (hazard ratio [HR]=0.945, confidence interval [CI]=0.898-0.995, p=0.030) and area under the curve (AUC) of CRP levels (HR=2.126, CI=1.046-4.319, p=0.037) as significant factors for radiographic progression. In a subgroup of patients with high CRP levels, 30.4% (14/24) showed progression; only age at the initial CTA was significantly different (37.03 vs. 27.10 years, p=0.012) between those with and without progression.

Conclusions: Higher CRP levels and younger age were risk factors of radiographic progression in patients with TAK. In the high CRP group, younger patients are more prone to progression and may need aggressive anti-inflammatory treatment.
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February 2021

Central Tumor Location at Chest CT Is an Adverse Prognostic Factor for Disease-Free Survival of Node-Negative Early-Stage Lung Adenocarcinomas.

Radiology 2021 Feb 23:203937. Epub 2021 Feb 23.

From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.C., H.K., C.M.P., J.M.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (H.C.); Department of Radiology (H.K., C.M.P., J.M.G.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P., J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (C.M.P., Y.T.K., J.M.G.).

Background The prognostic value of primary tumor location in the central lung is unclear because of heterogeneity in definitions of central lung cancer (CLC). Purpose To validate the prognostic value of two recently proposed definitions of CLC by using a method designed to offset the shortcomings of existing evidence and investigate the prognostic implications of a quantitative definition of CLC at chest CT. Materials and Methods Patients with pathologic stage T1a-bN0M0 lung adenocarcinomas resected between 2009 and 2015 at a single tertiary care center were retrospectively identified. The primary end point was disease-free survival. The associations of multiple definitions of central tumor location with survival were evaluated by using multivariable Cox regression. Time-dependent discrimination measures and interreader agreement were assessed for each definition. Results A total of 436 patients (median age, 62 years [interquartile range, 55-69 years]; 245 women) were evaluated. Tumor location at CT in the inner one-third of the lung defined by concentric lines arising from the hilum was adversely associated with survival (five events among 34 patients with CLC and 27 events among 402 patients with peripheral lung cancer; adjusted hazard ratio, 2.90 [95% CI: 1.06, 7.96; = .04]) and showed moderate interreader agreement (Cohen κ = 0.52 [95% CI: 0.37, 0.68]). Quantitatively determined location in the inner two-thirds of the lung was also an independent prognostic factor (16 events among 130 patients with CLC and 16 events among 306 patients with peripheral lung cancer; adjusted hazard ratio, 2.77 [95% CI: 1.36, 5.65]; = .005), with higher interreader agreement (Cohen κ = 0.86 [95% CI: 0.80, 0.91]; < .001). The quantification-based definition exhibited higher time-dependent sensitivity (48.2% [14.27/29.61; 95% CI: 28.8, 67.6] vs 15.1% [4.47/29.61; 95% CI: 1.3, 28.9]; < .001). Conclusion Central lung cancer at chest CT, defined qualitatively or quantitatively, is an independent adverse prognostic factor in patients with node-negative, early-stage lung adenocarcinomas. The quantification-based approach has advantages in terms of time-dependent sensitivity and reproducibility. © RSNA, 2021 See also the editorial by Wandtke and Hobbs in this issue.
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http://dx.doi.org/10.1148/radiol.2021203937DOI Listing
February 2021

Harnessing mobile technology to reduce mental health disorders in college populations: A randomized controlled trial study protocol.

Contemp Clin Trials 2021 Feb 11;103:106320. Epub 2021 Feb 11.

Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Electronic address:

About a third of college students struggle with anxiety, depression, or an eating disorder, and only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach to detect mental health problems and engage college students in services. We have developed a transdiagnostic, low-cost mobile mental health targeted prevention and intervention platform that uses population-level screening to engage college students in tailored services that address common mental health problems. We will test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20+ colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or an eating disorder and who are not currently engaged in mental health services (N = 7884) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to referral, is associated with improved uptake, reduced clinical cases, disorder-specific symptoms, and improved quality of life and functioning. We will also test mediators, predictors, and moderators of improved mental health outcomes, as well as stakeholder-relevant outcomes, including cost-effectiveness and academic performance. This population-level approach to service engagement has the potential to improve mental health outcomes for the millions of students enrolled in U.S. colleges and universities.
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http://dx.doi.org/10.1016/j.cct.2021.106320DOI Listing
February 2021

Roles of SDE2 and TIMELESS at active and stalled DNA replication forks.

Mol Cell Oncol 2021 14;8(1):1855053. Epub 2020 Dec 14.

Department of Pharmacological Sciences, The State University of New York at Stony Brook, Stony Brook, NY, USA.

The fork protection complex (FPC), comprising the TIMELESS (TIM)-TIPIN heterodimer, acts as a scaffold of the replisome to support seamless DNA replication. We recently showed that SDE2, a PCNA-associated DNA replication stress regulator, maintains the integrity of the FPC, and together with TIM, protects stalled replication forks from nucleolytic degradation.
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http://dx.doi.org/10.1080/23723556.2020.1855053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849734PMC
December 2020

A Case Report of Loperamide-Induced Ventricular Storm.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:2324709621990768

Loma Linda University Medical Center, Loma Linda, CA, USA.

Loperamide is an easily accessible antidiarrheal medication. Unlike other medications in its class, loperamide is unique in that it causes euphoria at supratherapeutic levels due to its effect on opioid receptors. Unfortunately, with its growing abuse potential also comes increasing reports of cardiotoxicity including prolonged QT, torsades de pointes, and sudden cardiac death. We report a case of a 29-year-old female who presented with unstable arrhythmia that further progressed into electrical storm in the setting of loperamide toxicity. Due to its growing popularity and availability, it is important for clinicians to understand loperamide's mechanisms for causing toxicity as well as how to appropriately treat its complications.
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http://dx.doi.org/10.1177/2324709621990768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868485PMC
February 2021

Bipolar and Complementary Resistive Switching Characteristics and Neuromorphic System Simulation in a Pt/ZnO/TiN Synaptic Device.

Nanomaterials (Basel) 2021 Jan 27;11(2). Epub 2021 Jan 27.

Division of Electronics and Electrical Engineering, Dongguk University, Seoul 04620, Korea.

In this work, a ZnO-based resistive switching memory device is characterized by using simplified electrical conduction models. The conventional bipolar resistive switching and complementary resistive switching modes are accomplished by tuning the bias voltage condition. The material and chemical information of the device stack including the interfacial layer of TiON is well confirmed by transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS) analysis. The device exhibits uniform gradual bipolar resistive switching (BRS) with good endurance and self-compliance characteristics. Moreover, complementary resistive switching (CRS) is achieved by applying the compliance current at negative bias and increasing the voltage at positive bias. The synaptic behaviors such as long-term potentiation and long-term depression are emulated by applying consecutive pulse input to the device. The CRS mode has a higher array size in the cross-point array structure than the BRS mode due to more nonlinear I-V characteristics in the CRS mode. However, we reveal that the BRS mode shows a better pattern recognition rate than the CRS mode due to more uniform conductance update.
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http://dx.doi.org/10.3390/nano11020315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911158PMC
January 2021

A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data.

JAMA Netw Open 2021 01 4;4(1):e2034059. Epub 2021 Jan 4.

Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.

Importance: Simple measures of hypertension treatment, such as achievement of blood pressure (BP) targets, ignore the intensity of treatment once the BP target is met. High-intensity treatment involves increased treatment burden and can be associated with potential adverse effects in older adults. A method was previously developed to identify older patients receiving intense hypertension treatment by low BP and number of BP medications using national Veterans Health Administration and Medicare Part D administrative pharmacy data to evaluate which BP medications a patient is likely taking on any given day.

Objective: To further develop and validate a method to more precisely quantify dose intensity of hypertension treatment using only health system administrative pharmacy fill data.

Design, Setting, And Participants: Observational, cross-sectional study of 319 randomly selected older veterans in the national Veterans Health Administration health care system who were taking multiple BP-lowering medications and had a total of 3625 ambulatory care visits from July 1, 2011, to June 30, 2013. Measure development and medical record review occurred January 1, 2017, through November 30, 2018, and data analysis was conducted from December 1, 2019, to August 31, 2020.

Main Outcomes And Measures: For each BP-lowering medication, a moderate hypertension daily dose (HDD) was defined as half the maximum dose above which no further clinical benefit has been demonstrated by that medication in hypertension trials. Patients' total HDD was calculated using pharmacy data (pharmacy HDDs), accounting for substantial delays in refills (>30 days) when a patient's pill supply was stretched (eg, cutting existing pills in half). As an external comparison, the pharmacy HDDs were correlated with doses manually extracted from clinicians' visit notes (clinically noted HDDs). How well the pharmacy HDDs correlated with clinically noted HDDs was calculated (using C statistics). To facilitate interpretation, HDDs were described in association with the number of medications.

Results: A total of 316 patients (99.1%) were male; the mean (SD) age was 75.6 (7.2) years. Pharmacy HDDs were highly correlated (r = 0.92) with clinically noted HDDs, with a mean (SD) of 2.7 (1.8) for pharmacy HDDs and 2.8 (1.8) for clinically noted HDDs. Pharmacy HDDs correlated with high-intensity, clinically noted HDDs ranging from a C statistic of 92.8% (95% CI, 92.0%-93.7%) for 2 or more clinically noted HDDs to 88.1% (95% CI, 85.5%-90.6%) for 6 or more clinically noted HDDs.

Conclusions And Relevance: This study suggests that health system pharmacy data may be used to accurately quantify hypertension regimen dose intensity. Together with clinic-measured BP, this tool can be used in future health system-based research or quality improvement efforts to fine-tune, manage, and optimize hypertension treatment in older adults.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.34059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811181PMC
January 2021

CT quantification of the heterogeneity of fibrosis boundaries in idiopathic pulmonary fibrosis.

Eur Radiol 2021 Jan 13. Epub 2021 Jan 13.

Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Objectives: To quantify the heterogeneity of fibrosis boundaries in idiopathic pulmonary fibrosis (IPF) using the Gaussian curvature analysis for evaluating disease severity and predicting survival.

Methods: We retrospectively included 104 IPF patients and 52 controls who underwent baseline chest CT scans. Normal lungs below - 500 HU were segmented, and the boundary was three-dimensionally reconstructed using in-house software. Gaussian curvature analysis provided histogram features on the heterogeneity of the fibrosis boundary. We analyzed the correlations between histogram features and the gender-age-physiology (GAP) and CT fibrosis scores. We built a regression model to predict diffusing capacity of carbon monoxide (DLCO) using the histogram features and calculated the modified GAP (mGAP) score by replacing DLCO with the predicted DLCO. The performances of the GAP, CT-GAP, and mGAP scores were compared using 100 repeated random-split sets.

Results: Patients with moderate-to-severe IPF had more numerous Gaussian curvatures at the fibrosis boundary, lower uniformity, and lower 10th to 30th percentiles of Gaussian curvature than controls or patients with mild IPF (all p < 0.0033). The 20th percentile was most significantly correlated with the GAP score (r = - 0.357; p < 0.001) and the CT fibrosis score (r = - 0.343; p = 0.001). More numerous Gaussian curvatures, higher entropy, lower uniformity, and 10th to 30th percentiles (p < 0.001-0.041) were associated with mortality. The mGAP score was comparable to the GAP and CT-GAP scores for survival prediction (mean C-indices, 0.76 vs. 0.79 vs. 0.77, respectively).

Conclusions: Gaussian curvatures of fibrosis boundaries became more heterogeneous as the disease progressed, and heterogeneity was negatively associated with survival in IPF.

Key Points: • Gaussian curvature of the fibrotic lung boundary was more heterogeneous in patients with moderate-to-severe IPF than those with mild IPF or normal controls. • The 20th percentile of the Gaussian curvature of the fibrosis boundary was linearly correlated with the GAP score and the CT fibrosis score. • A modified GAP score that replaced the diffusing capacity of carbon monoxide with a composite measure using histogram features of the Gaussian curvature of the fibrosis boundary showed a comparable ability to predict survival to both the GAP and the CT-GAP score.
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http://dx.doi.org/10.1007/s00330-020-07594-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804589PMC
January 2021

Protein corona components of polyethylene glycol-conjugated organosilica nanoparticles modulates macrophage uptake.

Colloids Surf B Biointerfaces 2021 Mar 30;199:111527. Epub 2020 Dec 30.

Department of Organ Anatomy and Nanomedicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan. Electronic address:

Fluorescent organosilica nanoparticles (FNP) conjugated with polyethylene glycol (PEG) of variant molecular weight (2 K, 12 K, 20 K, and 30 K) were prepared to investigate their cellular uptake by murine-derived macrophages. In a medium with FBS, the cellular uptake of FNP-PEGs was decreased as compared to a medium without FBS, indicating that protein corona on FNP-PEGs reduced cellular uptake. Bovine serum albumin (BSA) and hemoglobin (Hb) were detected as the most abundant components on all FNP-PEGs. Pre-coating of FNP-PEGs with BSA and Hb reduced the macrophage uptake in a medium without FBS, suggesting that these components might strengthen the stealth function of PEGs. Furthermore, there was more reduction in uptake of BSA- and Hb-coated FNP-PEGs from a medium with FBS than without FBS. BSA and Hb could be the stealth enhancement protein of FNP-PEGs in vitro.
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http://dx.doi.org/10.1016/j.colsurfb.2020.111527DOI Listing
March 2021

Pharmacists providing care in statewide physician organizations: findings from the Michigan Pharmacists Transforming Care and Quality Collaborative.

J Manag Care Spec Pharm 2020 Dec;26(12):1558-1566

University of Michigan College of Pharmacy, Ann Arbor.

Clinical services provided by pharmacists embedded in practices can improve patient outcomes within the primary care setting. Little is known about whether physician organizations (POs) will retain the services of clinical pharmacists after outside funding for a statewide implementation program is ended. To evaluate a statewide program, Michigan Pharmacists Transforming Care and Quality (MPTCQ), that incorporated pharmacists within 17 POs. A descriptive study was conducted using data collected from June 2016 to September 2018 from primary care clinical pharmacist encounters in POs participating in MPTCQ. Process outcomes included the number of participating POs, patient encounters, and average visits per patient. Analyses at the encounter level were stratified by 2 encounter types: disease state management (DSM) or comprehensive medication review (CMR). Separately by encounter type, pharmacist effect was described by the number, type, and reasons for medication changes, as well as medication adherence and cost barriers found and addressed. Clinical outcomes included hemoglobin A1c and blood pressure change. Sustainability and patient satisfaction of pharmacists providing clinical services are reported. Across 17 POs, 27 pharmacists participated in the MPTCQ program. Pharmacists completed 24,523 patient encounters for DSM with 5,942 patients, with an average of 5 visits per patient with diabetes and 2 visits for hypertension. Pharmacists made 15,153 therapeutic medication changes during visits for diabetes and hypertension, with approximately 70% related to efficacy. Pharmacists completed 4,203 CMR visits for 3,092 patients. During CMR visits, 1,296 therapeutic medication changes were recommended. Problems with medication cost were identified in 13% of CMR visits. Blood pressure and A1c levels decreased in patients managed by pharmacists. In 157 patients surveyed, 87% rated their pharmacists' care as excellent. Sixteen POs retained their pharmacists at the end of funding. A statewide provider-payer partnership successfully integrated and retained primary care pharmacists within POs. Pharmacists in the MPTCQ program contributed to improvements in disease control by changing medications to improve patient clinical outcomes. Support for MPTCQ was provided by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. Coe was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002241. Although BCBSM and MPTCQ work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to report.
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http://dx.doi.org/10.18553/jmcp.2020.26.12.1558DOI Listing
December 2020

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women.

Sci Rep 2020 11 27;10(1):20793. Epub 2020 Nov 27.

Department of Family Medicine and Supportive Care Centre, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09-1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74-0.87), regular physical activity (aHR 0.90; 95% CI 0.84-0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78-0.93), and cancer (aHR 0.77; 95% CI 0.64-0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.
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http://dx.doi.org/10.1038/s41598-020-77841-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695821PMC
November 2020

External validation and comparison of the Brock model and Lung-RADS for the baseline lung cancer CT screening using data from the Korean Lung Cancer Screening Project.

Eur Radiol 2020 Nov 25. Epub 2020 Nov 25.

Cancer Early Detection Branch, National Cancer Control Institute, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, 10408, South Korea.

Objectives: To validate and compare the performance of the Brock model and Lung CT Screening Reporting and Data System (Lung-RADS) on nodules detected by baseline CT screening.

Methods: We performed a secondary analysis of the Korean Lung Cancer Screening Project (K-LUCAS; ClinicalTrials.gov , NCT03394703), a nationwide, multicenter, prospective cohort study. From April 2017 to December 2018, low-dose CT screening was performed on high-risk subjects. Discrimination and calibration of Brock models 2a and 2b (i.e., full model without and with spiculation, respectively) were assessed, and discrimination was compared with that of Lung-RADS, which utilized subjective assessment categories 2b (b stands for benign) and 4X.

Results: Of the 13,150 subjects, 4578 were eligible (median age 62 years; 4458 men; 9929 nodules including 40 lung cancers). Areas under the receiver operating characteristic curve were 0.96 (IQR 0.92-0.99) for Brock model 2a, 0.96 (IQR 0.92-0.99) for Brock model 2b, and 0.95 (IQR 0.91-0.99) for Lung-RADS (p = 0.32 and p = 0.34, respectively). At an equivalent cutoff of 5%, Brock model 2b (sensitivity 87.5% [35/40]; specificity 93.6% [9259/9889]; positive predictive value [PPV] 5.3% [35/665]; negative predictive value [NPV] 99.9% [9259/9264]) and Lung-RADS (sensitivity 87.5% [35/40]; specificity 93.3% [9222/9889]; PPV 5.0% [35/702]; NPV 99.9% [9222/9227]) performed similarly well (all p > 0.05). The calibration performance of both Brock models 2a and 2b was poor (both p < 0.001).

Conclusions: Lung-RADS, when reinforced with visual assessment-based categories, has a similar diagnostic performance to the Brock model for baseline CT scans.

Key Points: • Brock model 2b and Lung CT Screening Reporting and Data System (Lung-RADS) demonstrated a similar discrimination performance for lung cancer in the baseline CT screening (areas under the receiver operating characteristic curve 0.96 vs. 0.95; p = 0.34). • When visual assessment-based categories were removed from Lung-RADS, specificity and positive predictive value were lower than those of Brock model 2b (p = 0.001 and p = 0.02, respectively). • The Brock model showed poor calibration (p < 0.001).
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http://dx.doi.org/10.1007/s00330-020-07513-1DOI Listing
November 2020

2020 Clinical Practice Guideline for Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: A Consensus Statement and Recommendations of the Korean Society of Thoracic Radiology.

Korean J Radiol 2021 02 19;22(2):263-280. Epub 2020 Nov 19.

Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Percutaneous transthoracic needle biopsy (PTNB) is one of the essential diagnostic procedures for pulmonary lesions. Its role is increasing in the era of CT screening for lung cancer and precision medicine. The Korean Society of Thoracic Radiology developed the first evidence-based clinical guideline for PTNB in Korea by adapting pre-existing guidelines. The guideline provides 39 recommendations for the following four main domains of 12 key questions: the indications for PTNB, pre-procedural evaluation, procedural technique of PTNB and its accuracy, and management of post-biopsy complications. We hope that these recommendations can improve the diagnostic accuracy and safety of PTNB in clinical practice and promote standardization of the procedure nationwide.
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http://dx.doi.org/10.3348/kjr.2020.0137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817630PMC
February 2021

Machine learning to predict early TNF inhibitor users in patients with ankylosing spondylitis.

Sci Rep 2020 11 20;10(1):20299. Epub 2020 Nov 20.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

We aim to generate an artificial neural network (ANN) model to predict early TNF inhibitor users in patients with ankylosing spondylitis. The baseline demographic and laboratory data of patients who visited Samsung Medical Center rheumatology clinic from Dec. 2003 to Sep. 2018 were analyzed. Patients were divided into two groups: early-TNF and non-early-TNF users. Machine learning models were formulated to predict the early-TNF users using the baseline data. Feature importance analysis was performed to delineate significant baseline characteristics. The numbers of early-TNF and non-early-TNF users were 90 and 505, respectively. The performance of the ANN model, based on the area under curve (AUC) for a receiver operating characteristic curve (ROC) of 0.783, was superior to logistic regression, support vector machine, random forest, and XGBoost models (for an ROC curve of 0.719, 0.699, 0.761, and 0.713, respectively) in predicting early-TNF users. Feature importance analysis revealed CRP and ESR as the top significant baseline characteristics for predicting early-TNF users. Our model displayed superior performance in predicting early-TNF users compared with logistic regression and other machine learning models. Machine learning can be a vital tool in predicting treatment response in various rheumatologic diseases.
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http://dx.doi.org/10.1038/s41598-020-75352-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679386PMC
November 2020

Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction.

J Plast Reconstr Aesthet Surg 2021 01 21;74(1):30-40. Epub 2020 Oct 21.

Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States. Electronic address:

Background: Although acellular dermal matrix (ADM) is widely used in expander-implant-based breast reconstructions, previous analyses have been unable to demonstrate improvements in patient-reported outcomes (PROs) with this approach over non-ADM procedures. This study aims to develop a more selective, evidence-based approach to the use of ADM in expander-implant-based breast reconstruction by identifying patient subgroups in which ADM improved clinical outcomes and PROs.

Study Design: The Mastectomy Reconstruction Outcomes Consortium Study prospectively evaluated immediate expander-implant reconstructions at 11 centers from 2012 to 2015. Complications (any/overall and major), and PROs (satisfaction, physical, psychosocial, and sexual well-being) were assessed two years postoperatively using medical records and the BREAST-Q, respectively. Using mixed-models accounting for centers and with interaction terms, we analyzed for differential ADM effects across various clinical subgroups, including age, body mass index, radiation timing, and chemotherapy.

Results: Expander-implant-based breast reconstruction was performed in 1451 patients, 738 with and 713 without ADM. Major complication risk was higher in ADM users vs. nonusers (22.9% vs. 16.4% and p = 0.04). Major complication risk with ADM increased with higher BMI (BMI=30, OR=1.70; BMI=35, OR=2.29, interaction p = 0.02). No significant ADM effects were observed for breast satisfaction, psychosocial, sexual, and physical well-being within any subgroups.

Conclusion: In immediate expander-implant-based breast reconstruction, ADM was associated with a greater risk of major complications, particularly in high-BMI patients. We were unable to identify patient subgroups where ADM was associated with significant improvements in PROs. Given these findings and the financial costs of ADM, a more critical approach to the use of ADM in expander-implant reconstruction may be warranted.
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http://dx.doi.org/10.1016/j.bjps.2020.10.005DOI Listing
January 2021

Volume and Mass Doubling Time of Lung Adenocarcinoma according to WHO Histologic Classification.

Korean J Radiol 2021 03 30;22(3):464-475. Epub 2020 Oct 30.

Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

Objective: This study aimed to evaluate the tumor doubling time of invasive lung adenocarcinoma according to the International Association of the Study for Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) histologic classification.

Materials And Methods: Among the 2905 patients with surgically resected lung adenocarcinoma, we retrospectively included 172 patients (mean age, 65.6 ± 9.0 years) who had paired thin-section non-contrast chest computed tomography (CT) scans at least 84 days apart with the same CT parameters, along with 10 patients with squamous cell carcinoma (mean age, 70.9 ± 7.4 years) for comparison. Three-dimensional semiautomatic segmentation of nodules was performed to calculate the volume doubling time (VDT), mass doubling time (MDT), and specific growth rate (SGR) of volume and mass. Multivariate linear regression, one-way analysis of variance, and receiver operating characteristic curve analyses were performed.

Results: The median VDT and MDT of lung cancers were as follows: acinar, 603.2 and 639.5 days; lepidic, 1140.6 and 970.1 days; solid/micropapillary, 232.7 and 221.8 days; papillary, 599.0 and 624.3 days; invasive mucinous, 440.7 and 438.2 days; and squamous cell carcinoma, 149.1 and 146.1 days, respectively. The adjusted SGR of volume and mass of the solid-/micropapillary-predominant subtypes were significantly shorter than those of the acinar-, lepidic-, and papillary-predominant subtypes. The histologic subtype was independently associated with tumor doubling time. A VDT of 465.2 days and an MDT of 437.5 days yielded areas under the curve of 0.791 and 0.795, respectively, for distinguishing solid-/micropapillary-predominant subtypes from other subtypes of lung adenocarcinoma.

Conclusion: The tumor doubling time of invasive lung adenocarcinoma differed according to the IASCL/ATS/ERS histologic classification.
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http://dx.doi.org/10.3348/kjr.2020.0592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909861PMC
March 2021

Cell cycle dependence of apoptosis photo-triggered using peptide-photosensitizer conjugate.

Sci Rep 2020 11 5;10(1):19087. Epub 2020 Nov 5.

Department of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsushimanaka, Okayama, 700-8530, Japan.

Investigation of the relevance between cell cycle status and the bioactivity of exogenously delivered biomacromolecules is hindered by their time-consuming cell internalization and the cytotoxicity of transfection methods. In this study, we addressed these problems by utilizing the photochemical internalization (PCI) method using a peptide/protein-photosensitizer conjugate, which enables immediate cytoplasmic internalization of the bioactive peptides/proteins in a light-dependent manner with low cytotoxicity. To identify the cell-cycle dependent apoptosis, a TatBim peptide-photosensitizer conjugate (TatBim-PS) with apoptotic activity was photo-dependently internalized into HeLa cells expressing a fluorescent ubiquitination-based cell cycle indicator (Fucci2). Upon irradiation, cytoplasmic TatBim-PS internalization exceeded 95% for all cells classified in the G, S, and G/M cell cycle phases with no significant differences between groups. TatBim-PS-mediated apoptosis was more efficiently triggered by photoirradiation in the G/S transition than in the G and S/G/M phases, suggesting high sensitivity of the former phase to Bim-induced apoptosis. Thus, the cell cycle dependence of Bim peptide-induced apoptosis was successfully investigated using Fucci2 indicator and the PCI method. Since PCI-mediated cytoplasmic internalization of peptides is rapid and does not span multiple cell cycle phases, the Fucci-PCI method constitutes a promising tool for analyzing the cell cycle dependence of peptides/protein functions.
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http://dx.doi.org/10.1038/s41598-020-76100-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644668PMC
November 2020

SDE2 integrates into the TIMELESS-TIPIN complex to protect stalled replication forks.

Nat Commun 2020 10 30;11(1):5495. Epub 2020 Oct 30.

Department of Pharmacological Sciences, State University of New York at Stony Brook, Stony Brook, New York, 11794, USA.

Protecting replication fork integrity during DNA replication is essential for maintaining genome stability. Here, we report that SDE2, a PCNA-associated protein, plays a key role in maintaining active replication and counteracting replication stress by regulating the replication fork protection complex (FPC). SDE2 directly interacts with the FPC component TIMELESS (TIM) and enhances its stability, thereby aiding TIM localization to replication forks and the coordination of replisome progression. Like TIM deficiency, knockdown of SDE2 leads to impaired fork progression and stalled fork recovery, along with a failure to activate CHK1 phosphorylation. Moreover, loss of SDE2 or TIM results in an excessive MRE11-dependent degradation of reversed forks. Together, our study uncovers an essential role for SDE2 in maintaining genomic integrity by stabilizing the FPC and describes a new role for TIM in protecting stalled replication forks. We propose that TIM-mediated fork protection may represent a way to cooperate with BRCA-dependent fork stabilization.
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http://dx.doi.org/10.1038/s41467-020-19162-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603486PMC
October 2020

Prediction of visceral pleural invasion in lung cancer on CT: deep learning model achieves a radiologist-level performance with adaptive sensitivity and specificity to clinical needs.

Eur Radiol 2021 May 30;31(5):2866-2876. Epub 2020 Oct 30.

Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.

Objectives: To develop and validate a preoperative CT-based deep learning model for the prediction of visceral pleural invasion (VPI) in early-stage lung cancer.

Methods: In this retrospective study, dataset 1 (for training, tuning, and internal validation) included 676 patients with clinical stage IA lung adenocarcinomas resected between 2009 and 2015. Dataset 2 (for temporal validation) included 141 patients with clinical stage I adenocarcinomas resected between 2017 and 2018. A CT-based deep learning model was developed for the prediction of VPI and validated in terms of discrimination and calibration. An observer performance study and a multivariable regression analysis were performed.

Results: The area under the receiver operating characteristic curve (AUC) of the model was 0.75 (95% CI, 0.67-0.84), which was comparable to those of board-certified radiologists (AUC, 0.73-0.79; all p > 0.05). The model had a higher standardized partial AUC for a specificity range of 90 to 100% than the radiologists (all p < 0.05). The high sensitivity cutoff (0.245) yielded a sensitivity of 93.8% and a specificity of 31.2%, and the high specificity cutoff (0.448) resulted in a sensitivity of 47.9% and a specificity of 86.0%. Two of the three radiologists provided highly sensitive (93.8% and 97.9%) but not specific (48.4% and 40.9%) diagnoses. The model showed good calibration (p > 0.05), and its output was an independent predictor for VPI (adjusted odds ratio, 1.07; 95% CI, 1.03-1.11; p < 0.001).

Conclusions: The deep learning model demonstrated a radiologist-level performance. The model could achieve either highly sensitive or highly specific diagnoses depending on clinical needs.

Key Points: • The preoperative CT-based deep learning model demonstrated an expert-level diagnostic performance for the presence of visceral pleural invasion in early-stage lung cancer. • Radiologists had a tendency toward highly sensitive, but not specific diagnoses for the visceral pleural invasion.
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http://dx.doi.org/10.1007/s00330-020-07431-2DOI Listing
May 2021

Prospective evaluation of an assessment tool for technical performance of duodenoscopes.

Dig Endosc 2020 Oct 2. Epub 2020 Oct 2.

Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, Florida, USA.

Objective: While single-use and detachable-tip duodenoscopes have been recently developed to overcome risks of infection transmission, there are no reliable tools to objectively assess their technical performance. We evaluated the reliability and validity of a newly developed tool to assess the technical performance of reusable duodenoscopes.

Methods: An assessment tool was developed to measure duodenoscope performance based on three distinct criteria: maneuverability, mechanical/imaging characteristics and ability to perform requisite interventions. The assessment tool was tested prospectively on duodenoscopes used in endoscopic retrograde cholangiopancreatography (ERCP) procedures at nine academic medical centers over a 6-month period. The main outcome was reliability of the duodenoscope assessment tool, which was estimated using Cronbach's coefficient alpha (α). The secondary outcome was validity of the assessment tool.

Results: The assessment tool evaluated technical performance of reusable duodenoscopes in 1080 ERCP procedures. Indications were biliary in 92.8% and pancreatic in 7.2% procedures. The overall Cronbach's coefficient α for maneuverability was 0.81, assessment of mechanical/imaging characteristics was 0.92, and ability to perform requisite interventions was 0.87. On multiple linear regression analysis, prolonged procedure duration, older patient age and pancreatic interventions were significantly positively associated with higher (worse) scores.

Conclusions: The newly developed assessment tool appears reliable and valid for evaluating the technical performance of duodenoscopes. Registration: ClinicalTrials.gov Identifier: NCT04004533.
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http://dx.doi.org/10.1111/den.13856DOI Listing
October 2020

Short course of voriconazole therapy as a risk factor for relapse of invasive pulmonary aspergillosis.

Sci Rep 2020 09 30;10(1):16078. Epub 2020 Sep 30.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography. Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1-12.3; P = 0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2-17.5; P = 0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Longer duration of therapy should be considered for those at higher risk of relapse.
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http://dx.doi.org/10.1038/s41598-020-73098-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527978PMC
September 2020

Increased Overall Heart Rate Irregularity Risk by Hyperuricemia in the General Population: Results from the Korean National Health and Nutrition Examination Survey.

Medicina (Kaunas) 2020 Sep 24;56(10). Epub 2020 Sep 24.

Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Hyperuricemia is one of the well-known cardiovascular risk factors. There is a growing interest in the association between hyperuricemia and arrhythmia. We used the representative sample data of Korean population to study the association between hyperuricemia and heart rate irregularity (HRI) that reflects total arrhythmia. We performed weighted multivariate logistic regression analysis to assess the association between hyperuricemia and HRI. Of the 10,827 subjects, 1308 (13.2%) had hyperuricemia and 130 (1%) had HRI. In the presence of hyperuricemia, HRI was three times higher than that in the absence of hyperuricemia (OR 2.98, 95% CI 1.71-5.18). The risk of HRI was highest in subjects with both hypertension and hyperuricemia. In the subgroup analysis, the association of hyperuricemia with HRI was most pronounced in the smoker group. Hyperuricemia was highly correlated with HRI in adult Korean representative sample data. Hyperuricemia was associated with a nearly tripled risk for HRI. Hypertension has a synergistic effect with hyperuricemia on HRI. Further research is warranted to clarify the relationship between hyperuricemia and arrhythmia and its mechanism.
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http://dx.doi.org/10.3390/medicina56100501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600340PMC
September 2020