Publications by authors named "Jeong Hyun Lee"

416 Publications

Image findings in patients with chronic invasive fungal infection of paranasal sinuses.

J Neuroradiol 2021 Feb 25. Epub 2021 Feb 25.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 05505, Republic of Korea.

Objectives: More clear classification of chronic invasive fungal infection of paranasal sinuses in the clinical presentation, radiologic findings, and pathology is needed. To describe the imaging findings of patients with chronic invasive fungal sinusitis (CIFS) and chronic granulomatous invasive fungal sinusitis (CGIFS).

Methods: Eleven patients with CIFS or CGIFS between January 2014 and July 2019 were included in this retrospective study. The demographic, pathologic, and imaging characteristics of the included patients were reviewed by rhinologist, pathologist, and radiologist, respectively. In terms of imaging analysis, overall lesions were categorized as diffuse infiltrative and mass-forming patterns.

Results: Among eleven patients, ten patients were aged ≥ 60 years (mean age 74.2 years) and nine had hypertension and/or diabetes mellitus. Aspergillus species were the most common pathogens (82%). Of the seven patients with CIFS, five (71%) had diffuse infiltrative patterns and two (29%) had mass-forming patterns, whereas all four patients (100%) with CGIFS had a mass forming pattern. All 11 patients showed both bony erosion and sclerosis. Almost all proven pathologic sites showed predominantly intermediate to high signal intensity on T1WI.

Conclusions: CIFS or CFIFS showed chronic course of rhinosinusitis in the patients with old age, imaging findings of bone erosion and sclerosis, and imaging patterns of diffuse infiltration or mass formation.
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http://dx.doi.org/10.1016/j.neurad.2021.02.005DOI Listing
February 2021

Ten-Year Prevalence Trends of Phenotypically Identified Community-Associated Methicillin-Resistant Strains in Clinical Specimens.

Ann Lab Med 2021 Jul;41(4):386-393

Chung-Ang University College of Medicine, Seoul, Korea.

Background: Community-associated methicillin-resistant (CA-MRSA) strains were first detected in hospitals in Korea between the late 2000s and early 2010s. However, there is limited information regarding the prevalence of CA-MRSA strains among hospital isolates and their phenotypic changes over the last decade. We investigated the prevalence trend of CA-MRSA strains isolated from different clinical specimens and their phenotypic changes between September 2009 and September 2019.

Methods: CA-MRSA strains were phenotypically identified by confirming their resistance to penicillin (PCN) and oxacillin (OXA) and evaluating their susceptibility to trimethoprim-sulfamethoxazole, rifampin, fusidic acid, tetracycline, and at least one of the following four antimicrobials: clindamycin (CLI), erythromycin (ERY), ciprofloxacin (CIP), and gentamicin (GEN). A CA-MRSA strain that exhibited resistance to ERY, CLI, CIP, or GEN was classified as having resistance pattern I, II, III, or IV, respectively, regardless of its resistance to other antimicrobial agents.

Results: Of the 8,278 MRSA isolates identified in specimens obtained two days after admission, 1,385 (16.73%) were CA-MRSA strains. The prevalence of CA-MRSA strains increased from 12.2% to 26.6% (3.21% per period, =0.05). Resistance type analysis revealed an increasing trend in the prevalence of PCN/OXA-resistant (1.84%; =0.049) and PCN/OXA/ERY/CLI/CIP-resistant (0.98%; =0.04) CA-MRSA strains and in resistance pattern III strains (2.08%; =0.004).

Conclusions: The prevalence of CA-MRSA strains in Korea has increased significantly over the last decade, and CA-MRSA strains have gained phenotypic diversity beyond PCN/OXA-resistance, including antimicrobial resistance to non-β-lactams, especially CIP.
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http://dx.doi.org/10.3343/alm.2021.41.4.386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884191PMC
July 2021

Recurrence and additional treatment of cystic thyroid nodules after ethanol ablation: validation of three proposed criteria.

Ultrasonography 2020 Nov 3. Epub 2020 Nov 3.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Purpose: We evaluated the use of three criteria to determine the need for additional treatment of cystic thyroid nodules after their recurrence following ethanol ablation (EA).

Methods: In total, 154 patients (male:female=30:124; mean age, 53.4 years; range, 23 to 79 years) with 154 thyroid nodules (49 cystic and 105 predominantly cystic nodules) who presented between January 2014 and August 2017 were enrolled. All patients underwent follow-up ultrasonography (US) 1 month after EA, and were divided into therapeutic success and failure groups. The patients were evaluated according to three previously suggested criteria for recommending additional treatment: nodules with ≥1 mL of remnant fluid, volume reduction <50%, and demonstration of a solid component with vascularity.

Results: Thyroid nodules treated by EA showed significant volume reduction (18.4±21.6 mL to 4.2±6.5 mL [1-month follow-up] to 1.9±3.3 mL [final follow-up], P<0.001) and clinical improvement. Additional treatment was unnecessary in 81%, 70%, and 71% of patients deemed to need it according to criteria 1, 2, and 3, respectively.

Conclusion: The choice to perform additional treatment after EA should be made according to a combination of clinical problems and US features. Understanding this concept will be useful in planning further treatment following US-guided EA.
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http://dx.doi.org/10.14366/usg.20039DOI Listing
November 2020

Modulating the quantity of HIV Env-specific CD4 T cell help promotes rare B cell responses in germinal centers.

J Exp Med 2021 Feb;218(2)

Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA.

Immunodominance to nonneutralizing epitopes is a roadblock in designing vaccines against several diseases of high interest. One hypothetical possibility is that limited CD4 T cell help to B cells in a normal germinal center (GC) response results in selective recruitment of abundant, immunodominant B cells. This is a central issue in HIV envelope glycoprotein (Env) vaccine designs, because precursors to broadly neutralizing epitopes are rare. Here, we sought to elucidate whether modulating the quantity of T cell help can influence recruitment and competition of broadly neutralizing antibody precursor B cells at a physiological precursor frequency in response to Env trimer immunization. To do so, two new Env-specific CD4 transgenic (Tg) T cell receptor (TCR) mouse lines were generated, carrying TCR pairs derived from Env-protein immunization. Our results suggest that CD4 T cell help quantitatively regulates early recruitment of rare B cells to GCs.
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http://dx.doi.org/10.1084/jem.20201254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769167PMC
February 2021

The 'classic stromatolite' Cryptozoön is a keratose sponge-microbial consortium.

Geobiology 2021 Mar 15;19(2):189-198. Epub 2020 Dec 15.

Department of Earth and Planetary Sciences, University of Tennessee, Knoxville, TN, USA.

Animal evolution transformed microbial mat development. Canonically inferred negative effects include grazing, disturbance and competition for space. In contrast, ancient examples of cooperation between microbial mats and invertebrates have rarely been reported. Late Cambrian (~485 million years) Cryptozoön is widely regarded as the first stromatolite to have received a taxonomic name and has been compared with present-day examples at Shark Bay, Australia. Here, we show that Cryptozoön is an interlayered consortium of keratose ('horny') sponge and microbial carbonate in roughly equal proportions. Cryptozoön's well-defined layering reflects repeated alternation of sponge and microbial mat. Its distinctive lateral growth is due to the ability of keratosans to colonize steep and overhanging surfaces. Contrary to the perception of Phanerozoic stromatolites as anachronistic survivors in a eukaryotic world, Cryptozoön suggests mutualistic behaviour in which sponges and microbial mats cooperated to gain support, stability and relief, while sharing substrates, bacteria and metabolites. Keratosan-microbial consortia may have been mistaken for stromatolites throughout the record of the past 500 million years, and possibly longer.
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http://dx.doi.org/10.1111/gbi.12422DOI Listing
March 2021

MRI Predictors of Malignant Transformation in Patients with Inverted Papilloma: A Decision Tree Analysis Using Conventional Imaging Features and Histogram Analysis of Apparent Diffusion Coefficients.

Korean J Radiol 2020 Nov 30. Epub 2020 Nov 30.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis.

Materials And Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error.

Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively.

Conclusion: Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.
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http://dx.doi.org/10.3348/kjr.2020.0576DOI Listing
November 2020

Interobserver Reproducibility in Sonographic Measurement of Diameter and Volume of Papillary Thyroid Microcarcinoma.

Thyroid 2021 Jan 18. Epub 2021 Jan 18.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Active surveillance is recommended as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC), and determining meaningful changes in diameter and volume on ultrasonography (US) is critical. However, interobserver reproducibility of the sonographic measurement of maximum diameter and volume of PTMC has not been well established. We aimed to determine the reproducibility in the measurement of maximum diameter and volume of PTMC on US. Consecutive patients who underwent US for pathologically proven PTMC between December 2018 and December 2019 were retrospectively reviewed. Two observers independently performed sonographic measurement of each nodule using standardized measurement methods. Each observer measured maximum transverse, anteroposterior, and longitudinal nodule diameters, and using these, nodule volume was calculated using the ellipsoid formula. Interobserver reproducibility in the measurement of the maximum diameter and volume was assessed using percentage reproducibility coefficient (RC). Z-tests of the intraclass correlation coefficients (ICCs) were used to compare the interobserver reproducibility in subgroups defined according to sonographic characteristics, such as the presence of microcalcification, nodule size, and parenchymal heterogeneity. A total of 197 thyroid nodules from 188 patients were included in the study series. The percentage RCs were 71.8% [95% confidence interval, CI 65.4-79.7%] and 23.7% [CI 21.6-26.3%] for volume and maximum diameter measurements, respectively. There were no significant differences noted in the ICC values according to nodule orientation, presence of calcifications, size, or parenchymal heterogeneity. For PTMC, a difference of up to 24% in the maximum diameter and 72% in the volume may be considered to be within measurement error on US. This value may be used to determine the cutoff for defining meaningful change in the maximum diameter and volume for PTMC during active surveillance.
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http://dx.doi.org/10.1089/thy.2020.0317DOI Listing
January 2021

Three-dimensional CBCT based evaluation of the inferior part of the maxillary sinus: Retrospective Study.

Sci Rep 2020 12 3;10(1):21012. Epub 2020 Dec 3.

Department of Oral Anatomy, Dental College Dankook Institute For Future Science and Emerging Convergence, Dan-Kook University, Cheonan, 330-714, South Korea.

The maxillary sinus is the largest of the four paranasal sinuses in humans, and its close proximity to the teeth means that caution is required during dental treatment. In particular, implant surgeries involving the maxillary posterior teeth should include evaluating the inferior part of the maxillary sinus. The purpose of this study is to evaluate the differences by comparing the inferior part of the maxillary sinus based on the nasal cavity floor (NCF) between patients (male 30, female 30) genders through the use of the three-dimensional (3-D) program that can facilitate 3-D visualizations. The present study results obtained from 3-D visualizations using cone beam computed tomography (CBCT) data showed that the inferior part of the maxillary sinus was mostly larger in males than in females. In addition, the utilization of 3-D visualization data was more likely to assure accuracy than when using data obtained by two-dimensional (2-D) imaging. Therefore, 3-D visualizations of the inferior part of the maxillary sinus will contribute to accurate analyses of its anatomical structure during implant surgery and other operations. Further studies utilizing 3-D visualization will yield useful fundamental data and guidelines for future research.
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http://dx.doi.org/10.1038/s41598-020-78156-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713429PMC
December 2020

Monolithic hydrogel nanowells-in-microwells enabling simultaneous single cell secretion and phenotype analysis.

Lab Chip 2020 12;20(24):4539-4551

Department of Mechanical Engineering, University of British Columbia, Canada. and Centre for Blood Research, University of British Columbia, Canada and School of Biomedical Engineering, University of British Columbia, Canada and Vancouver Prostate Centre, Vancouver General Hospital, Canada.

Cytokine secretion is a form of cellular communication that regulates a wide range of biological processes. A common approach for measuring cytokine secretion from single cells is to confine individual cells in arrays of nanoliter wells (nanowells) fabricated using polydimethylsiloxane. However, this approach cannot be easily integrated in standard microwell plates in order to take advantage of high-throughput infrastructure for automated and multiplexed analysis. Here, we used laser micropatterning to fabricate monolithic hydrogel nanowells inside wells in a microwell plate (microwells) using polyethylene glycol diacrylate (PEGDA). This approach produces high-aspect ratio nanowells that retain cells and beads during reagent exchange, enabling simultaneous profiling of single cell secretion and phenotyping via immunostaining. To limit contamination between nanowells, we used methylcellulose as a media additive to reduce diffusion distance. Patterning nanowells monolithically in microwells also dramatically increases density, providing ∼1200 nanowells per microwell in a microwell plate. Using this approach, we profiled IL-8 secretion from single MDA-MB-231 cells, which showed significant heterogeneity. We further profiled the polarization of THP-1 cells into M1 and M2 macrophages, along with their associated IL-1β and CCL-22 secretion profiles. These results demonstrate the potential to use this approach for high-throughput secretion and phenotype analysis on single cells.
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http://dx.doi.org/10.1039/d0lc00965bDOI Listing
December 2020

Image-based phenotyping of disaggregated cells using deep learning.

Commun Biol 2020 Nov 13;3(1):674. Epub 2020 Nov 13.

Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada.

The ability to phenotype cells is fundamentally important in biological research and medicine. Current methods rely primarily on fluorescence labeling of specific markers. However, there are many situations where this approach is unavailable or undesirable. Machine learning has been used for image cytometry but has been limited by cell agglomeration and it is currently unclear if this approach can reliably phenotype cells that are difficult to distinguish by the human eye. Here, we show disaggregated single cells can be phenotyped with a high degree of accuracy using low-resolution bright-field and non-specific fluorescence images of the nucleus, cytoplasm, and cytoskeleton. Specifically, we trained a convolutional neural network using automatically segmented images of cells from eight standard cancer cell-lines. These cells could be identified with an average F1-score of 95.3%, tested using separately acquired images. Our results demonstrate the potential to develop an "electronic eye" to phenotype cells directly from microscopy images.
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http://dx.doi.org/10.1038/s42003-020-01399-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666170PMC
November 2020

Lactoferrin Induces Tolerogenic Bone Marrow-Derived Dendritic Cells.

Immune Netw 2020 Oct 29;20(5):e38. Epub 2020 Jul 29.

Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon, Korea.

Dendritic cells (DCs) are professional antigen-presenting cells (APCs) that initiate both T-cell responses and tolerance. Tolerogenic DCs (tDCs) are regulatory DCs that suppress immune responses through the induction of T-cell anergy and Tregs. Because lactoferrin (LF) was demonstrated to induce functional Tregs and has a protective effect against inflammatory bowel disease, we explored the tolerogenic effects of LF on mouse bone marrow-derived DCs (BMDCs). The expression of CD80/86 and MHC class II was diminished in LF-treated BMDCs (LF-BMDCs). LF facilitated BMDCs to suppress proliferation and elevate Foxp3 induced Treg (iTreg) differentiation in ovalbumin-specific CD4 T-cell culture. Foxp3 expression was further increased by blockade of the B7 molecule using CTLA4-Ig but was diminished by additional CD28 stimulation using anti-CD28 Ab. On the other hand, the levels of arginase-1 and indoleamine 2,3-dioxygenase-1 (known as key T-cell suppressive molecules) were increased in LF-BMDCs. Consistently, the suppressive activity of LF-BMDCs was partially restored by inhibitors of these molecules. Collectively, these results suggest that LF effectively causes DCs to be tolerogenic by both the suppression of T-cell proliferation and enhancement of iTreg differentiation. This tolerogenic effect of LF is due to the reduction of costimulatory molecules and enhancement of suppressive molecules.
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http://dx.doi.org/10.4110/in.2020.20.e38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609161PMC
October 2020

Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty.

Bone Joint J 2020 Nov;102-B(11):1438-1445

Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.

Aims: Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA.

Methods: Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD).

Results: In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD -3.11; 95% confidence interval (CI) -4.98 to -1.23), the ASES score (WMD -6.50; 95% CI -10.80 to -2.19), FF (WMD -6.3°; 95% CI -9.9° to -2.6°), and abduction (WMD -9.4°; 95% CI -17.8° to -1.0°), but not for ER (WMD -0.6°; 95% CI -3.7° to 2.5°).

Conclusion: The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: 2020;102-B(11):1438-1445.
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http://dx.doi.org/10.1302/0301-620X.102B11.BJJ-2020-0449.R1DOI Listing
November 2020

Comparison of the Joint Space in Different Types of Malocclusion Using Three-Dimensional Models.

Iran J Public Health 2020 Jul;49(7):1382-1384

Department of Oral Anatomy, College of Dentistry, Dankook University, Cheonan, South Korea.

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http://dx.doi.org/10.18502/ijph.v49i7.3596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548484PMC
July 2020

Correlation between Blood Pressure and Skin Health in Korean College Female Students.

Iran J Public Health 2020 Jul;49(7):1378-1379

Sports and Health Care Major, Korea National University of Transportation, Chungju-si, Republic of Korea.

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http://dx.doi.org/10.18502/ijph.v49i7.3594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548485PMC
July 2020

Oropharyngeal squamous cell carcinoma: radiomic machine-learning classifiers from multiparametric MR images for determination of HPV infection status.

Sci Rep 2020 10 16;10(1):17525. Epub 2020 Oct 16.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

We investigated the ability of machine-learning classifiers on radiomics from pre-treatment multiparametric magnetic resonance imaging (MRI) to accurately predict human papillomavirus (HPV) status in patients with oropharyngeal squamous cell carcinoma (OPSCC). This retrospective study collected data of 60 patients (48 HPV-positive and 12 HPV-negative) with newly diagnosed histopathologically proved OPSCC, who underwent head and neck MRIs consisting of axial T1WI, T2WI, CE-T1WI, and apparent diffusion coefficient (ADC) maps from diffusion-weighted imaging (DWI). The median age was 59 years (the range being 35 to 85 years), and 83.3% of patients were male. The imaging data were randomised into a training set (32 HPV-positive and 8 HPV-negative OPSCC) and a test set (16 HPV-positive and 4 HPV-negative OPSCC) in each fold. 1618 quantitative features were extracted from manually delineated regions-of-interest of primary tumour and one definite lymph node in each sequence. After feature selection by using the least absolute shrinkage and selection operator (LASSO), three different machine-learning classifiers (logistic regression, random forest, and XG boost) were trained and compared in the setting of various combinations between four sequences. The highest diagnostic accuracies were achieved when using all sequences, and the difference was significant only when the combination did not include the ADC map. Using all sequences, logistic regression and the random forest classifier yielded higher accuracy compared with the that of the XG boost classifier, with mean area under curve (AUC) values of 0.77, 0.76, and 0.71, respectively. The machine-learning classifier of non-invasive and quantitative radiomics signature could guide the classification of the HPV status.
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http://dx.doi.org/10.1038/s41598-020-74479-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568530PMC
October 2020

Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis.

Eur Radiol 2020 Oct 15. Epub 2020 Oct 15.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, South Korea.

Objectives: To summarize and compare unnecessary biopsy rates and diagnostic performance in the examination of thyroid nodules according to four representative US-based risk stratification systems.

Methods: MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating unnecessary biopsy rates according to at least one of the following guidelines: ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS. The unnecessary biopsy rates for each risk stratification system were pooled using a random-effects model. Meta-regression analyses were performed to explore heterogeneity. Diagnostic odds ratios (DORs) for the appropriate selection of thyroid nodules for fine-needle aspiration were also pooled using a bivariate random-effects model.

Results: Eight articles including 13,092 thyroid nodules met the eligibility criteria and were included. The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22-29%), 51% (95% CI, 44-58%), 38% (95% CI, 16-66%), and 55% (95% CI, 42-67%), respectively. The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001), and also lower than that of EU-TIRADS, but not reaching statistical significance (p = .087). The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6-9.6), 6.3 (95% CI, 4.5-8.8), and 4.5 (95% CI, 1.7-11.6), respectively, with the differences not being statistically significant.

Conclusions: ACR-TIRADS showed a lower unnecessary biopsy rate than the other risk stratification systems albeit DOR was comparable between ACR-TIRADS, ATA, and K-TIRADS. Future revisions of each system should be made by referring to ACR-TIRADS to reduce unnecessary biopsy rates.

Key Points: • The pooled unnecessary biopsy rates of ACR-TIRADS, ATA, EU-TIRADS, and K-TIRADS were 25% (95% CI, 22-29%), 51% (95% CI, 44-58%), 38% (95% CI, 16-66%), and 55% (95% CI, 42-67%), respectively. • The pooled unnecessary biopsy rate of ACR-TIRADS was significantly lower than that of ATA (p < .001) and K-TIRADS (p < .001). • The pooled DORs of ACR-TIRADS, ATA, and K-TIRADS were 5.9 (95% CI, 3.6-9.6), 6.3 (95% CI, 4.5-8.8), and 4.5 (95% CI, 1.7-11.6), respectively, with the differences not being statistically significant.
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http://dx.doi.org/10.1007/s00330-020-07384-6DOI Listing
October 2020

Three-dimensional visualization of the alveolar bone and posterior superior alveolar foramen in gender.

Surg Radiol Anat 2021 Feb 22;43(2):261-266. Epub 2020 Sep 22.

Department of Oral Anatomy, Dental College Dankook Institute For Future Science and Emerging Convergence, Dan-Kook University, Cheonan, 330-714, South Korea.

The present study applied a three-dimensional (3D) program to measure the distances from the maxillary sinus floor (MSF) to the lingual and buccal alveolar bone and also to the posterior superior alveolar foramen (PSAF), with the aim of determining differences according to gender. The study also attempted to verify the accuracy of measurements obtained from 3D images by performing comparisons with the results obtained in a preliminary study. The results showed that the alveolar bone length and the MAF-PSAF were generally larger in males than in females. It is also predicted that the accuracy of data obtained from a 3D program will be higher than that of data derived from conventional two-dimensional (2D) images. The accurate measurements obtained in this study are anticipated to prove useful in assessments related to dental implantation and anatomical structures. The fundamental data obtained in this study may also assist in setting the goals of future studies utilizing 3D programs.
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http://dx.doi.org/10.1007/s00276-020-02576-7DOI Listing
February 2021

The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis.

Eur Radiol 2020 Sep 19. Epub 2020 Sep 19.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: To review the diagnostic performance of CT and MRI for detecting extranodal extension (ENE) in head and neck squamous cell carcinoma (HNSCC) patients.

Methods: MEDLINE and EMBASE databases were searched up to October 7, 2019. Studies that evaluated the diagnostic performance of CT and/or MRI for detecting ENE in HNSCC patients were included. A 2 × 2 table was reconstructed for each study. Pooled sensitivity and specificity were calculated using the bivariate model and hierarchical summary receiver operating characteristic (HSROC) model. Subgroup analyses were performed according to HPV status and radiological features. Pooled correlation coefficient for interobserver agreement was calculated.

Results: Twenty-two studies including 2478 patients were included. The pooled sensitivity and specificity for detecting ENE were 73% (95% CI, 62-82%) and 83% (95% CI, 75-89%), respectively, for CT, and 60% (95% CI, 49-70%) and 96% (95% CI, 85-99%), respectively, for MRI. There was substantial heterogeneity for both CT and MRI. A threshold effect was present for MRI. On subgroup analysis, the pooled specificity of CT was significantly lower in patients with HPV+ OPSCC than in patients with HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%; p = 0.01). Central node necrosis showed significantly higher pooled sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed significantly higher pooled specificity (94% vs. 65%; p = 0.03). The pooled correlation coefficient was 0.72 (95% CI, 0.60-0.81).

Conclusion: Both CT and MRI show reasonable diagnostic performance for detecting ENE in HNSCC patients and interobserver agreement was substantial.

Key Points: • Pooled sensitivity and specificity were 73% and 83% for CT and 60% and 96% for MRI without significant difference. • Pooled specificity was lower for HPV+ OPSCC than for HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%, p = 0.01), likely due to central node necrosis. • Central node necrosis showed higher sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed higher specificity (94% vs. 65%; p = 0.03).
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http://dx.doi.org/10.1007/s00330-020-07281-yDOI Listing
September 2020

Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways.

Eur Radiol 2020 Sep 18. Epub 2020 Sep 18.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea.

Objectives: To evaluate the efficacy of radiofrequency ablation (RFA) in patients with recurrent thyroid cancer invading the airways.

Methods: We reviewed patients who had undergone RFA for recurrent thyroid cancer in the central compartment after total thyroidectomy between January 2008 and December 2018. All tumors were classified according to their association with the laryngeal structure and trachea. The volume reduction rate (VRR) and complete disappearance rate were calculated, and their differences were determined relative to the association between the tumor and trachea. Complication rates associated with RFA were evaluated.

Results: The study population included 119 patients with 172 recurrent tumors. Mean VRR was 81.2% ± 55.7%, with 124 tumors (72.1%) completely disappearing after a mean follow-up of 47.9 ± 35.4 months. The complete disappearance rate of recurrent tumors not in contact with the trachea was highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion (p value < 0.001). The overall complication rate was 21.4%.

Conclusions: RFA is effective and safe for the local control of recurrent tumors in the central neck compartment after total thyroidectomy, even for tumors invading the airways, and may be considered an alternative to surgical resection. The inverse relationship between RFA efficacy and airway invasion suggests that early RFA may benefit patients with recurrent tumors in the central neck compartment.

Key Points: • RFA achieved a mean VRR of 81.2% ± 55.7% and complete disappearance of 124 tumors (72.1%) after a mean follow-up of 47.9 ± 35.4 months. • The complete disappearance rate of recurrent tumors not in contact with the trachea was the highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion. • Stent-assisted RFA may be a good alternative for palliative treatment of recurrent tumors with intraluminal tracheal invasion.
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http://dx.doi.org/10.1007/s00330-020-07283-wDOI Listing
September 2020

Associations between body mass index values and dermatological variables in college students.

Technol Health Care 2020 Sep 4. Epub 2020 Sep 4.

College of Humanities and Arts, Sports and Health Care Major, Korea National University of Transportation, Chungju-si, 27469, Korea.

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http://dx.doi.org/10.3233/THC-202509DOI Listing
September 2020

KR-39038, a Novel GRK5 Inhibitor, Attenuates Cardiac Hypertrophy and Improves Cardiac Function in Heart Failure.

Biomol Ther (Seoul) 2020 Sep;28(5):482-489

Therapeutics & Biotechnology Division, Korea Research Institute of Chemical Technology, Daejeon 34114, Republic of Korea.

G protein-coupled receptor kinase 5 (GRK5) has been considered as a potential target for the treatment of heart failure as it has been reported to be an important regulator of pathological cardiac hypertrophy. To discover novel scaffolds that selectively inhibit GRK5, we have identified a novel small molecule inhibitor of GRK5, KR-39038 [7-((3-((4-((3-aminopropyl)amino)butyl)amino)propyl) amino)-2-(2-chlorophenyl)-6-fluoroquinazolin-4(3H)-one]. KR-39038 exhibited potent inhibitory activity (IC value=0.02 μM) against GRK5 and significantly inhibited angiotensin II-induced cellular hypertrophy and HDAC5 phosphorylation in neonatal cardiomyocytes. In the pressure overload-induced cardiac hypertrophy mouse model, the daily oral administration of KR-39038 (30 mg/kg) for 14 days showed a 43% reduction in the left ventricular weight. Besides, KR-39038 treatment (10 and 30 mg/kg/ day, p.o.) showed significant preservation of cardiac function and attenuation of myocardial remodeling in a rat model of chronic heart failure following coronary artery ligation. These results suggest that potent GRK5 inhibitor could effectively attenuate both cardiac hypertrophy and dysfunction in experimental heart failure, and KR-39038 may be useful as an effective GRK5 inhibitor for pharmaceutical applications.
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http://dx.doi.org/10.4062/biomolther.2020.129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457178PMC
September 2020

CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease: multi-institutional case series.

Int J Ophthalmol 2020 18;13(8):1231-1237. Epub 2020 Aug 18.

Department of Radiology, Inje University Haeundae Paik Hospital, Busan 47392, Republic of Korea.

Aim: To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease (IgG4-MALT lymphoma), a rare but clinically important complication of ocular adnexal IgG4-related disease.

Methods: We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three tertiary and one secondary referral centers, between February 2003 and December 2016. Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified. CT and MR images were analyzed by consensus of two experienced head and neck radiologists.

Results: Lacrimal glands were the main site of involvement in all seven patients. The lesions typically showed well-demarcated margins, iso- to hyperattenuation on precontrast CT, T2 hypo- to isointensity, T1 isointensity, and homogenous internal architecture with homogenous enhancement pattern. Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images, respectively.

Conclusion: Unlike in typical ocular adnexal IgG4-related disease, T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases. Although the findings may be nonspecific, the possibility of accompanying MALT lymphoma may need to be considered, when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients. However, this is a case series of a very rare complication of ocular adnexal IgG4-related disease, and thus caution is warranted to generalize the conclusion.
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http://dx.doi.org/10.18240/ijo.2020.08.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387900PMC
August 2020

Sonographic Assessment of the Extent of Extrathyroidal Extension in Thyroid Cancer.

Korean J Radiol 2020 10 17;21(10):1187-1195. Epub 2020 Jul 17.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Objective: This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers.

Materials And Methods: We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG.

Results: ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%).

Conclusion: Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.
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http://dx.doi.org/10.3348/kjr.2019.0983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458864PMC
October 2020

Assessing the diagnostic performance of thyroid biopsy with recommendations for appropriate interpretation.

Ultrasonography 2020 May 19. Epub 2020 May 19.

Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Purpose: The diagnostic performance of thyroid biopsy is influenced by several factors, including differences in the Bethesda categorization for malignancy, the inclusion or exclusion of non-diagnostic results, the definition used for the final diagnosis, and the definition of an inconclusive diagnosis. The purpose of this study was to provide an understanding of the factors influencing the diagnostic performance of thyroid biopsy.

Methods: We collected data retrospectively between January and December 2013 from a cohort of 6,762 thyroid nodules from 6,493 consecutive patients who underwent biopsy. In total, 4,822 nodules from 4,553 patients were included. We calculated the biopsy sensitivity according to the inclusion of different Bethesda categories in the numerator and the exclusion of non-diagnostic results, as well as the diagnostic accuracy according to different definitions of a benign diagnosis. We obtained the conclusive and inconclusive diagnosis rates.

Results: The sensitivity increased when more Bethesda categories were included in the numerator and when non-diagnostic results were excluded. When a benign thyroid nodule diagnosis was defined as benign findings on surgical resection, concordant benign results on at least two occasions, or an initial benign biopsy result and follow-up for more than 12 months, the accuracy was higher than when the diagnosis was based on surgical resection alone (68.7% vs. 91.1%). A higher conclusive diagnosis rate was obtained (78.3% vs. 72.8%, P<0.001) when Bethesda categories I and III were considered inconclusive.

Conclusion: Understanding the concepts presented herein is important in order to appropriately interpret the diagnostic performance of thyroid biopsy.
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http://dx.doi.org/10.14366/usg.19099DOI Listing
May 2020

Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation.

Endocrinol Metab (Seoul) 2020 06 24;35(2):407-415. Epub 2020 Jun 24.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.

Methods: Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.

Results: Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.

Conclusion: Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.
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http://dx.doi.org/10.3803/EnM.2020.35.2.407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386103PMC
June 2020

Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis.

Endocrinol Metab (Seoul) 2020 06 24;35(2):339-350. Epub 2020 Jun 24.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years.

Methods: Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis.

Results: The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery.

Conclusion: Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.
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http://dx.doi.org/10.3803/EnM.2020.35.2.339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386110PMC
June 2020

Ethylene regulates sulfur acquisition by regulating the expression of sulfate transporter genes in oilseed rape.

Physiol Plant 2020 Jun 25. Epub 2020 Jun 25.

Horticulture and Molecular Physiology Lab, School of Agricultural Innovations and Advanced Learning, Vellore Institute of Technology, Vellore, India.

To manage nutrient deficiencies, plants develop both morphological and physiological responses. The studies on the regulation of these responses are limited; however, certain hormones and signaling components have been largely implicated. Several studies depicted ethylene as a regulator of the response of some nutrient deficiencies like iron, phosphorous and potassium. The present study focused on the response of sulfur in the presence and absence of ethylene. The experiments were performed in hydroponic nutrient media, using oilseed rape grown with or without sulfur deficiency and ethylene treatments for 10 days. The ACC oxidase and ACC synthase were observed significantly reduced in sulfur-deficient plants treated with ethylene compared to control. The biomass and photosynthetic parameters, including the expression of multicomplex thylakoidal proteins showed a significant increase in sulfur deficient plants supplemented with ethylene. The enzymes related to sulfur regulation such as sulfate adenyltransferase, glutamine synthetase and O-acetylserine (thiol)lyase also showed similar results as shown by the morphological data. The relative expression of the sulfur transporter genes BnSultr1, 1, BnSultr1, 2, BnSultr4,1, BnSultr 4,2, ATP sulfurylase and OASTL increased in sulfur-deficient plants, whereas their expression decreased when ethylene was given to the plants. Fe and S nutritional correlations are already known; therefore, Fe-transporters like IRT1 and FRO1 were also evaluated, and similar results as for the sulfur transporter genes were observed. The overall results indicated that ethylene regulates sulfur acquisition by regulating the expression of sulfur transporter genes in oilseed rape (Brassica napus).
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http://dx.doi.org/10.1111/ppl.13157DOI Listing
June 2020

Choroid plexus changes on magnetic resonance imaging in multiple sclerosis and neuromyelitis optica spectrum disorder.

J Neurol Sci 2020 08 15;415:116904. Epub 2020 May 15.

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: To investigate alterations in the choroid plexus in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using brain magnetic resonance imaging (MRI).

Methods: We prospectively recruited consecutive patients with MS or NMOSD from July 2018 to February 2019. The inclusion criterion was brain MRI within three months from onset of acute neurological symptoms. The thickness and enhancement ratio of the choroid plexus on gadolinium-enhanced T1-weighted images of patients with MS (n = 51), patients with NMOSD (n = 32), and healthy controls (HCs, n = 28) were compared.

Results: MRI in patients with MS or NMOSD showed a comparably thick but more enhanced choroid plexus compared with that of HCs. In the axial view, enhancement ratios of the lateral ventricle of MS and NMOSD patients and HCs were 1.64 ± 0.34, 1.65 ± 0.25, and 1.39 ± 0.17, respectively (P > .999 for MS vs. NMOSD; P = .001 for MS vs. HCs; P = .001 for NMOSD vs. HCs).

Conclusions: The choroid plexus was significantly more enhanced on brain MRI of patients with MS or NMOSD than on that of HCs, suggesting the involvement of the choroid plexus in the autoimmune inflammatory processes in MS and NMOSD.
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http://dx.doi.org/10.1016/j.jns.2020.116904DOI Listing
August 2020

Diagnostic Performance of Four Ultrasound Risk Stratification Systems: A Systematic Review and Meta-Analysis.

Thyroid 2020 08 19;30(8):1159-1168. Epub 2020 May 19.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Several ultrasound (US)-based risk stratification systems have been increasingly used for the optimal management of thyroid nodules. However, there are considerable discrepancies across these systems. This study aimed to summarize and compare the category-based diagnostic performance in the detection of thyroid cancer of different US-based risk stratification systems from four societies: the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS), the American Thyroid Association (ATA), the Korean Thyroid Association/Korean Society of Thyroid Radiology (KTA/KSThR; K-TIRADS), and the European Thyroid Association (EU-TIRADS). MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating the category-based diagnostic performance according to at least one of the following guidelines: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. A subgroup analysis on nodules of 1 cm or larger and a meta-regression analysis to identify factors associated with the diagnostic performance were performed. A total of 29 articles including 33,748 thyroid nodules met the eligibility criteria and were included in the analysis. For ACR-TIRADS, the pooled sensitivity and specificity were, respectively, 66% and 91% for category 5 and 95% and 55% for category 4 or 5. For ATA, the pooled sensitivity and specificity were, respectively, 74% and 88% for category 5 and 91% and 64% for category 4 or 5. For K-TIRADS, the pooled sensitivity and specificity were, respectively, 55% and 95% for category 5 and 89% and 64% for category 4 or 5. For EU-TIRADS, the pooled sensitivity and specificity were, respectively, 82% and 90% for category 5 and 96% and 52% for category 4 or 5. Study location, proportion of female patients and malignant nodules, and study design were associated with study heterogeneity. The overall diagnostic performance of the four US-based risk stratification systems was comparable.
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http://dx.doi.org/10.1089/thy.2019.0812DOI Listing
August 2020

Discrepancy between true ankle dorsiflexion and gait kinematics and its association with severity of planovalgus foot deformity.

BMC Musculoskelet Disord 2020 Apr 16;21(1):250. Epub 2020 Apr 16.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, South Korea.

Background: In planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait. Results of standard 3D gait analysis may misinterpret the true ankle dorsiflexion because it recognizes the entire foot as a single rigid segment. We performed this study to investigate whether the severity of planovalgus deformity is associated with the discrepancy between the value of ADF evaluated by physical examination and 3-dimensional (3D) gait analysis. In addition, we aimed to identify the radiographic parameters associated with this discrepancy and their relationships.

Methods: Consecutive 40 patients with 65 limbs (mean age, 11.7 ± 5.5 years) with planovalgus foot deformity and triceps surae contracture were included. All patients underwent 3D gait analysis, and weightbearing anteroposterior (AP) and lateral (LAT) foot radiographs. ADF with knee extension was measured using a goniometer with the patient's foot in an inverted position.

Results: Twenty-one limbs underwent operation for planovalgus foot deformity, and 56 limbs underwent operation for equinus deformity. The difference between ADF on physical examination and ADF at initial contact on gait analysis was 17.5 ± 8.4°. Differences between ADF on physical examination and ADF at initial contact on gait analysis were significantly associated with the LAT talus-first metatarsal angle (p = 0.008) and calcaneal pitch angle (p = 0.006), but not associated with the AP talus-first metatarsal angle (p = 0.113), talonavicular coverage angle (p = 0.190), talocalcaneal angle (p = 0.946), and naviculocuboid overlap (p = 0.136).

Conclusion: The discrepancy between ADF on physical examination and 3D gait analysis was associated with the severity of planovalgus deformity, which was evaluated on weightbearing LAT foot radiographs. Therefore, physicians should be cautious about interpreting results from 3D gait analysis and perform a careful physical examination to assess the degree of equinus deformity in patients with planovalgus foot deformity.
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http://dx.doi.org/10.1186/s12891-020-03285-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164230PMC
April 2020