Publications by authors named "Sang Min Lee"

865 Publications

Application of computer-aided diagnosis for Lung-RADS categorization in CT screening for lung cancer: effect on inter-reader agreement.

Eur Radiol 2021 Jul 30. Epub 2021 Jul 30.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea.

Objectives: To evaluate the effects of computer-aided diagnosis (CAD) on inter-reader agreement in Lung Imaging Reporting and Data System (Lung-RADS) categorization.

Methods: Two hundred baseline CT scans covering all Lung-RADS categories were randomly selected from the National Lung Cancer Screening Trial. Five radiologists independently reviewed the CT scans and assigned Lung-RADS categories without CAD and with CAD. The CAD system presented up to five of the most risk-dominant nodules with measurements and predicted Lung-RADS category. Inter-reader agreement was analyzed using multirater Fleiss κ statistics.

Results: The five readers reported 139-151 negative screening results without CAD and 126-142 with CAD. With CAD, readers tended to upstage (average, 12.3%) rather than downstage Lung-RADS category (average, 4.4%). Inter-reader agreement of five readers for Lung-RADS categorization was moderate (Fleiss kappa, 0.60 [95% confidence interval, 0.57, 0.63]) without CAD, and slightly improved to substantial (Fleiss kappa, 0.65 [95% CI, 0.63, 0.68]) with CAD. The major cause for disagreement was assignment of different risk-dominant nodules in the reading sessions without and with CAD (54.2% [201/371] vs. 63.6% [232/365]). The proportion of disagreement in nodule size measurement was reduced from 5.1% (102/2000) to 3.1% (62/2000) with the use of CAD (p < 0.001). In 31 cancer-positive cases, substantial management discrepancies (category 1/2 vs. 4A/B) between reader pairs decreased with application of CAD (pooled sensitivity, 85.2% vs. 91.6%; p = 0.004).

Conclusions: Application of CAD demonstrated a minor improvement in inter-reader agreement of Lung-RADS category, while showing the potential to reduce measurement variability and substantial management change in cancer-positive cases.

Key Points: • Inter-reader agreement of five readers for Lung-RADS categorization was minimally improved by application of CAD, with a Fleiss kappa value of 0.60 to 0.65. • The major cause for disagreement was assignment of different risk-dominant nodules in the reading sessions without and with CAD (54.2% vs. 63.6%). • In 31 cancer-positive cases, substantial management discrepancies between reader pairs, referring to a difference in follow-up interval of at least 9 months (category 1/2 vs. 4A/B), were reduced in half by application of CAD (32/310 to 16/310) (pooled sensitivity, 85.2% vs. 91.6%; p = 0.004).
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http://dx.doi.org/10.1007/s00330-021-08202-3DOI Listing
July 2021

Deep radiomics-based survival prediction in patients with chronic obstructive pulmonary disease.

Sci Rep 2021 Jul 26;11(1):15144. Epub 2021 Jul 26.

Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Heterogeneous clinical manifestations and progression of chronic obstructive pulmonary disease (COPD) affect patient health risk assessment, stratification, and management. Pulmonary function tests are used to diagnose and classify the severity of COPD, but they cannot fully represent the type or range of pathophysiologic abnormalities of the disease. To evaluate whether deep radiomics from chest computed tomography (CT) images can predict mortality in patients with COPD, we designed a convolutional neural network (CNN) model for extracting representative features from CT images and then performed random survival forest to predict survival in COPD patients. We trained CNN-based binary classifier based on six-minute walk distance results (> 440 m or not) and extracted high-throughput image features (i.e., deep radiomics) directly from the last fully connected layer of it. The various sizes of fully connected layers and combinations of deep features were experimented using a discovery cohort with 344 patients from the Korean Obstructive Lung Disease cohort and an external validation cohort with 102 patients from Penang General Hospital in Malaysia. In the integrative analysis of discovery and external validation cohorts, with combining 256 deep features from the coronal slice of the vertebral body and two sagittal slices of the left/right lung, deep radiomics for survival prediction achieved concordance indices of 0.8008 (95% CI, 0.7642-0.8373) and 0.7156 (95% CI, 0.7024-0.7288), respectively. Deep radiomics from CT images could be used to predict mortality in COPD patients.
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http://dx.doi.org/10.1038/s41598-021-94535-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313653PMC
July 2021

Mandibular skeletal posterior anatomic limit for molar distalization in patients with Class III malocclusion with different vertical facial patterns.

Korean J Orthod 2021 Jul;51(4):250-259

Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea.

Objective: The aim of this study was to compare the differences in mandibular posterior anatomic limit (MPAL) distances stratified by vertical patterns in patients with skeletal Class III malocclusion by using cone-beam computed tomography (CBCT).

Methods: CBCT images of 48 patients with skeletal Class III malocclusion (mean age, 22.8 ± 3.1 years) categorized according to the vertical patterns (hypodivergent, normodivergent, and hyperdivergent; n = 16 per group) were analyzed. While parallel to the posterior occlusal line, the shortest linear distances from the distal root of the mandibular second molar to the inner cortex of the mandibular body were measured at depths of 4, 6, and 8 mm from the cementoenamel junction. MPAL distances were compared between the three groups, and their correlations were analyzed.

Results: The mean ages, sex distribution, asymmetry, and crowding in the three groups showed no significant differences. MPAL distance was significantly longer in male (3.8 ± 2.6 mm) than in female (1.8 ± 1.2 mm) at the 8-mm root level. At all root levels, MPAL distances were significantly different in the hypodivergent and hyperdivergent groups ( < 0.001) and between the normodivergent and hyperdivergent groups ( < 0.01). MPAL distances were the shortest in the hyperdivergent group. The mandibular plane angle highly correlated with MPAL distances at all root levels ( < 0.01).

Conclusions: MPAL distances were the shortest in patients with hyperdivergent patterns and showed a decreasing tendency as the mandibular plane angle increased. MPAL distances were significantly shorter (~3.16 mm) at the 8-mm root level.
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http://dx.doi.org/10.4041/kjod.2021.51.4.250DOI Listing
July 2021

New Method for Combined Quantitative Assessment of Air-Trapping and Emphysema on Chest Computed Tomography in Chronic Obstructive Pulmonary Disease: Comparison with Parametric Response Mapping.

Korean J Radiol 2021 Jul 1. Epub 2021 Jul 1.

Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: Emphysema and small-airway disease are the two major components of chronic obstructive pulmonary disease (COPD). We propose a novel method of quantitative computed tomography (CT) emphysema air-trapping composite (EAtC) mapping to assess each COPD component. We analyzed the potential use of this method for assessing lung function in patients with COPD.

Materials And Methods: A total of 584 patients with COPD underwent inspiration and expiration CTs. Using pairwise analysis of inspiration and expiration CTs with non-rigid registration, EAtC mapping classified lung parenchyma into three areas: Normal, functional air trapping (fAT), and emphysema (Emph). We defined fAT as the area with a density change of less than 60 Hounsfield units (HU) between inspiration and expiration CTs among areas with a density less than -856 HU on inspiration CT. The volume fraction of each area was compared with clinical parameters and pulmonary function tests (PFTs). The results were compared with those of parametric response mapping (PRM) analysis.

Results: The relative volumes of the EAtC classes differed according to the Global Initiative for Chronic Obstructive Lung Disease stages ( < 0.001). Each class showed moderate correlations with forced expiratory volume in 1 second (FEV) and FEV/forced vital capacity (FVC) ( = -0.659-0.674, < 0.001). Both fAT and Emph were significant predictors of FEV and FEV/FVC (R² = 0.352 and 0.488, respectively; < 0.001). fAT was a significant predictor of mean forced expiratory flow between 25% and 75% and residual volume/total vital capacity (R² = 0.264 and 0.233, respectively; < 0.001), while Emph and age were significant predictors of carbon monoxide diffusing capacity (R² = 0.303; < 0.001). fAT showed better correlations with PFTs than with small-airway disease on PRM.

Conclusion: The proposed quantitative CT EAtC mapping provides comprehensive lung functional information on each disease component of COPD, which may serve as an imaging biomarker of lung function.
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http://dx.doi.org/10.3348/kjr.2021.0033DOI Listing
July 2021

A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders.

Orthop J Sports Med 2021 Mar 11;9(3):2325967120986884. Epub 2021 Mar 11.

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

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage.

Purpose: To introduce a novel "retensioning technique" for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI).

Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively.

Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.
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http://dx.doi.org/10.1177/2325967120986884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237215PMC
March 2021

Disruption of the astrocyte-neuron interaction is responsible for the impairments in learning and memory in 5XFAD mice: an Alzheimer's disease animal model.

Mol Brain 2021 Jul 10;14(1):111. Epub 2021 Jul 10.

Department of Neurodegenerative Diseases Research Group, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41062, Republic of Korea.

The morphological dynamics of astrocytes are altered in the hippocampus during memory induction. Astrocyte-neuron interactions on synapses are called tripartite synapses. These control the synaptic function in the central nervous system. Astrocytes are activated in a reactive state by STAT3 phosphorylation in 5XFAD mice, an Alzheimer's disease (AD) animal model. However, changes in astrocyte-neuron interactions in reactive or resting-state astrocytes during memory induction remain to be defined. Here, we investigated the time-dependent changes in astrocyte morphology and the number of astrocyte-neuron interactions in the hippocampus over the course of long-term memory formation in 5XFAD mice. Hippocampal-dependent long-term memory was induced using a contextual fear conditioning test in 5XFAD mice. The number of astrocytic processes increased in both wild-type and 5XFAD mice during memory formation. To assess astrocyte-neuron interactions in the hippocampal dentate gyrus, we counted the colocalization of glial fibrillary acidic protein and postsynaptic density protein 95 via immunofluorescence. Both groups revealed an increase in astrocyte-neuron interactions after memory induction. At 24 h after memory formation, the number of tripartite synapses returned to baseline levels in both groups. However, the total number of astrocyte-neuron interactions was significantly decreased in 5XFAD mice. Administration of Stattic, a STAT3 phosphorylation inhibitor, rescued the number of astrocyte-neuron interactions in 5XFAD mice. In conclusion, we suggest that a decreased number of astrocyte-neuron interactions may underlie memory impairment in the early stages of AD.
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http://dx.doi.org/10.1186/s13041-021-00823-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272251PMC
July 2021

Prevalence and diagnostic values of laboratory animal allergy among research personnel.

Asian Pac J Allergy Immunol 2021 Jul 11. Epub 2021 Jul 11.

Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

Background: Laboratory animal allergy (LAA) has not been sufficiently investigated, although LAA is a relatively common work-related condition and important occupational hazard.

Objective: This study aimed to evaluate the prevalence of LAA and analyze the diagnostic value of serum specific IgE (sIgE) using the skin prick test (SPT) as a comparative standard.

Methods: Korean laboratory animal researchers who attended an annual symposium were requested to answer questionnaires regarding demographic characteristics, laboratory animal exposure, and symptoms related to laboratory animal exposure. A total of 213 participants underwent a SPT with mouse and rat epithelial allergen extract. We measured sIgE against rodent urine, epithelium, and serum allergens from 63 participants. SPT outcome served as the comparison method.

Results: Among 223 participants, 213 had direct/indirect exposure to mice or rats, and 30% and 14% of them complained of allergic symptoms after exposure to mouse and rat, respectively. Sensitization rates were 28% for mouse epithelium and 23% for rat epithelium. Compared to a positive SPT with wheal ≥ 3 mm, presence of sIgE against rodent allergens showed a higher positive predictive value of 87-91% at a cut-off level of 0.35 KUA/L. Agreement between SPT and sIgE test was determined to be fair to moderate.

Conclusions: Sensitization and allergy to mouse and rat were prevalent among laboratory personnel in Korea. When evaluating cases of potential LAA, the sIgE test can provide added diagnostic value if the skin test is positive. Careful interpretation of two tests is required to accurately diagnose LAA.
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http://dx.doi.org/10.12932/AP-220321-1094DOI Listing
July 2021

Peak expiratory flow during mechanical insufflation-exsufflation: endotracheal tube versus facemask.

Respir Care 2021 Jul 7. Epub 2021 Jul 7.

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

Mechanical insufflation-exsufflation (MI-E) applied through the endotracheal tube (ETT) can effectively eliminate airway secretions in intubated patients. However, the effect of the interface (ETT vs. facemask) on expiratory airflow generated by MI-E has not been investigated. This study aimed to investigate the effect of the ETT on peak expiratory flow (PEF), along with other associated factors that could influence PEF generated by MI-E. Intubated participants received two sessions of MI-E via ETT therapy per day for two consecutive days. One MI-E session consisted of five sets of either constant (+40/-40 cmHO) or incremental (+30/-30 to +50/-50 cmHO) pressure applications. Following extubation, MI-E sessions were repeated using facemask. Expiratory airflow during MI-E therapy was continuously measured and every PEF during each application was analysed using linear mixed-effect and generalised linear mixed models. A total of 12 participants (nine [75.0%] men; mean [SD] age, 74.0 [10.2] years) completed all MI-E sessions with both ETT and facemask interfaces. The PEF generated during MI-E treatment was influenced by the interface (ETT vs. facemask), pressure gradient, and number of session repetitions. Adjusted mean PEF values for MI-E via ETT and facemask at +40/-40 cmHO were -2.521 and -3.114 L/s, respectively, and -2.956 and -3.364 L/s at +50/-50 cmHO, respectively. At a pressure gradient of +40/-40 cmHO, only 172 of 528 MI-E trials via ETT (32.6%) achieved a PEF faster than -2.7 L/s, whereas 304 of 343 MI-E trials via facemask (88.6%) exceeded PEF < -2.7L/s. MI-E via ETT generated slower PEF than via facemask, suggesting that a higher-pressure protocol should be prescribed for intubated patients. An insufflation-exsufflation pressure up to +50/-50 cmHO could be considered to produce a PEF faster than 2.7 L/s, and the applications were safe and feasible for patients under invasive mechanical ventilation.
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http://dx.doi.org/10.4187/respcare.09150DOI Listing
July 2021

Importance of firm isthmic fixation in high-energy induced subtrochanteric fracture of the femur: retrospective observational study in a level I trauma center.

Eur J Trauma Emerg Surg 2021 Jun 17. Epub 2021 Jun 17.

Department of Orthopaedic Surgery, Bio-Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-Ro Seo-Gu, Busan, 49241, South Korea.

Introduction: This study aimed to report the surgical outcomes in patients with high-energy induced subtrochanteric fracture and determine the risk factors for nonunion using statistical analysis.

Methods: This study evaluated 88 patients with high-energy induced subtrochanteric fractures who underwent surgeries with indirect reduction technique and intramedullary nailing between March 2015 and December 2020. Outcome measures, including union time and nonunion incidence, were assessed by radiologic evaluation. Multiple logistic regression analyses were performed to identify the risk factors for nonunion, using age, sex, injury severity score, body mass index, preoperative mobility score, implant, and isthmic fixation as covariates.

Results: Five nonunions and two delayed unions were identified. The average union time was 17.4 weeks. Multiple logistic regression analyses showed that poor isthmic fixation was the only risk factor for nonunion (odds ratio 15.294, 95% confidence interval 1.603-145.894, P value 0.018). Out of five nonunion cases, four were confirmed as hypertrophic, and one was confirmed as atrophic.

Conclusion: Although surgical treatment using an indirect reduction technique and intramedullary nailing showed good outcomes, hypertrophic nonunion due to distal instability could occur if a firm fixation at the level of the isthmus cannot be achieved.

Level Of Evidence: Level III, retrospective cohort study.
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http://dx.doi.org/10.1007/s00068-021-01709-wDOI Listing
June 2021

The authors reply.

Crit Care Med 2021 Jul;49(7):e728-e729

All authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

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http://dx.doi.org/10.1097/CCM.0000000000005070DOI Listing
July 2021

Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate.

Injury 2021 Jun 2. Epub 2021 Jun 2.

Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address:

Aims: The prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery.

Patients And Methods: This retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality.

Results: Of the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality.

Conclusion: The mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.
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http://dx.doi.org/10.1016/j.injury.2021.05.045DOI Listing
June 2021

COVID-19 vaccine-induced acute generalized exanthematous pustulosis.

Korean J Intern Med 2021 Jun 16. Epub 2021 Jun 16.

Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

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http://dx.doi.org/10.3904/kjim.2021.198DOI Listing
June 2021

Posterior repair of isolated type 2 superior labrum anterior-posterior lesion prevents external rotation deficiency: long-term outcome study.

Knee Surg Sports Traumatol Arthrosc 2021 Aug 7;29(8):2656-2664. Epub 2021 Jun 7.

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

Purpose: This study aimed to evaluate the outcomes of arthroscopic type 2 superior labrum anterior-posterior (SLAP) lesion repair in the general population and compare clinical outcomes according to patient age and repair site.

Methods: Between 2005 and 2018, patients who underwent arthroscopic repair for isolated type 2 SLAP lesions were retrospectively reviewed. Baseline characteristics, pre- and postoperative [1-year and > 2-year (final)] shoulder range-of-motion, and functional scores, comprising the pain visual analogue scale (PVAS), functional VAS, and American Shoulder and Elbow Surgeons (ASES) score, were evaluated. Return to overhead activities and subjective satisfaction were assessed at the final follow-up, and patients were divided by age [group YB (< 40 years] and group OB (≥ 40 years)] and repair site [group P (only posterior labrum repair) and group AP (anterior and posterior labrum repair)]. Overall patient outcomes were analysed and compared between groups.

Results: This study included 54 patients (45 men) with a mean age of 37.1 ± 8.3 years. The mean follow-up was 90.8 ± 51.3 months. Two patients experienced early failure, and one patient had a ruptured biceps tendon during the follow-up period. Final functional scores improved compared to their preoperative scores in all patients, except three (all p < 0.001). Fifty patients (98.0%) were satisfied, and 39 patients (76.5%) were able to perform overhead sports without restriction. In 25 patients who attended more than 7 years of follow-up (mean, 11.3 ± 2.7 years), 21 patients (84%) had an ASES score ≥ 80, and all patients had PVAS ≤ 2. There was no significant difference in clinical outcomes between groups YB and OB. The final median external rotation was significantly more restricted in group AP than in group P (40 [25-65] vs. 60 [50-70], p = 0.002).

Conclusion: Arthroscopic type 2 SLAP repair induced good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age, due to the careful evaluation of patient history, physical examination, and imaging studies. However, performing only posterior repair seems sufficient since anterior labral SLAP lesion repair can limit ER. Isolated type 2 SLAP lesion posterior repair only is, thus, recommended to reduce external rotation deficit risk and increase satisfaction, regardless of patient age.

Study Design: Case series.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00167-021-06608-6DOI Listing
August 2021

Intralymphatic immunotherapy with tyrosine-adsorbed allergens: a double-blind, placebo-controlled trial.

Respir Res 2021 Jun 4;22(1):170. Epub 2021 Jun 4.

Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.

Background: Most previous studies used aluminum hydroxide-absorbed allergen extracts in evaluating the potential therapeutic roles of intralymphatic allergen-specific immunotherapy (ILAIT). In this study, we evaluated the therapeutic efficacy and safety of ILAIT with L-tyrosine-adsorbed allergen extracts of Dermatophagoides farinae, D. pteronyssinus, cat, dog, or mixtures thereof, in patients with allergic rhinitis induced by these allergens.

Methods: In this randomized, double-blind, placebo-controlled trial, study subjects received three intralymphatic injections of L-tyrosine-adsorbed allergen extracts (active group) or saline (placebo group) at 4-week intervals.

Results: Although ILAIT reduced daily medication use and skin reactivity to HDM and cat allergens at 4 months after treatment, overall symptom score on a visual analog scale (VAS), sinonasal outcome test-20 (SNOT-20), rhinoconjunctivitis quality of life questionnaire (RQLQ), daily symptom score (dSS), daily medication score (dMS), daily symptom medication score (dSMS), nasal reactivity to HDM allergen, and basophil activity to HDM, cat, and dog allergens at 4 months and 1 year after treatment were similar between the treatment and control groups. Intralymphatic injection was more painful than a venous puncture, and pain at the injection site was the most frequent local adverse event (12.8%); dyspnea and wheezing were the most common systemic adverse events (5.3%).

Conclusions: ILAIT with L-tyrosine-adsorbed allergen extracts does not exhibit profound therapeutic efficacy in allergic rhinitis and can provoke moderate-to-severe systemic reactions and cause pain at the injection site.

Trial Registration: clinicaltrials.gov: NCT02665754; date of registration: 28 January 2016.
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http://dx.doi.org/10.1186/s12931-021-01766-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178859PMC
June 2021

Ultrasound-guided needle decompression and steroid injection for calcific tendinitis of the shoulder: risk factors for repeat procedures and outcome analysis.

Clin Shoulder Elb 2021 Jun 1;24(2):55-65. Epub 2021 Jun 1.

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

Background: Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures.

Methods: Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed.

Results: We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, P=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6-8] vs. 8 [interquartile range, 7-9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001].

Conclusions: US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.
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http://dx.doi.org/10.5397/cise.2021.00101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181847PMC
June 2021

Preliminary Study of ADHD Biomarkers in Adults with Focus on Serum Iron and Transcranial Sonography of the Substantia Nigra.

Int J Environ Res Public Health 2021 05 3;18(9). Epub 2021 May 3.

Department of Psychiatry, Kyung Hee University College of Medicine, Seoul 20447, Korea.

As previous studies have reported abnormalities in the iron indices of peripheral blood and hyperechogenicity of the substantia nigra (SN) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), we aimed to examine the same in adults with ADHD using transcranial Doppler sonography (TCS). In addition, we compared the iron indices and TCS findings before and after methylphenidate (MPH) treatment. A total of 39 participants aged ≥19 years (13 patients and 26 healthy controls) were recruited from Kyung Hee University Hospital between October 2018 and September 2019. All subjects were clinically evaluated based on the ADHD diagnostic criteria in the DSM-5, the Adult ADHD Self-Report Scale, and the Diagnostic Interview for ADHD in Adults (DIVA-5). Further, the iron indices including serum iron, ferritin, and mean platelet volume were determined. Additionally, TCS focused on the midbrain and echogenicity of the SN was conducted. Follow-up for all items was conducted for five ADHD patients after MPH treatment. Patients with ADHD had significantly lower education levels (number of years) than controls. There were no statistically significant differences in serum iron indices or the echogenic area between ADHD and control groups. Further, there were no significant changes in iron indices or TCS findings after MPH medication. Unlike previous studies, this study showed no differences between patients with ADHD and controls. Therefore, it is important to determine if these null findings were due to different target populations (children vs. adults) or other factors, including ADHD subtypes.
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http://dx.doi.org/10.3390/ijerph18094875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125298PMC
May 2021

Development of Brain Metastases in Patients With Non-Small Cell Lung Cancer and No Brain Metastases at Initial Staging Evaluation: Cumulative Incidence and Risk Factor Analysis.

AJR Am J Roentgenol 2021 May 26. Epub 2021 May 26.

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

While established guidelines give indications for performing staging brain MRI at initial non-small cell lung cancer (NSCLC) diagnosis, guidelines are lacking for performing surveillance brain MRI in patients without brain metastases at presentation. To estimate the cumulative incidence of, and risk factors associated with, brain metastasis development in patients with NSCLC without brain metastases at initial presentation. This retrospective study included 1495 patients with NSCLC (mean age 65±10 years; 920 men, 575 women) without brain metastases at initial evaluation that included brain MRI. Follow-up brain MRI was ordered at referrer physicians' discretion. MRI examinations were reviewed in combination with clinical records for brain metastasis development; patients not undergoing MRI were deemed to have not developed metastases through last clinical follow-up. Cumulative incidence of brain metastases was determined with death as a competing risk and stratified by clinical stage group, cell type, and epidermal growth factor receptor (EGFR) status. Univariable and multivariable Cox proportional hazards regression analyses were performed. A total of 258/1495 (17.3%) patients underwent follow-up brain MRI, and 72/1495 (4.8%) developed brain metastases at a median of 12.3 months after initial NSCLC diagnosis. Among the 72 patients developing metastases, 44% had no neurologic symptoms, and 58% had stable primary thoracic disease. Cumulative incidence of brain metastases at 6, 12, 18, and 24 months was 0.6%, 2.1%, 4.2% and 6.8%, respectively. Cumulative incidence was higher (P<.001) in clinical stage III-IV (1.3%, 3.9%, 7.7%, and 10.9%) than I-II (0.0%, 0.8%, 1.2%, and 2.6%) disease, and higher (P<.001) in EGFR positive (0.7%, 2.5%, 6.3%, and 12.3%) than EGFR negative (0.4%, 1.8%, 2.9%, and 4.4%) adenocarcinoma. Among 1109 patients with adenocarcinoma, independent risk factors for brain metastasis development were clinical stage III-IV (hazard ratio [HR]=9.39; P<.001) and EGFR positivity (HR=1.78; P=.04). Brain metastasis incidence over the study interval was 8.7% in clinical stage III-IV disease and 8.6% in EGFR positive adenocarcinoma. Clinical stage III-IV and EGFR positive adenocarcinoma are independent risk factors for brain metastasis development. Surveillance brain MRI may be warranted 12 months after initial evaluation in clinical stage III-IV disease or EGFR-positive adenocarcinoma.
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http://dx.doi.org/10.2214/AJR.21.25787DOI Listing
May 2021

Clinical impact of lymphatic spread in patients with limited-stage upper aerodigestive tract NK/T cell lymphoma.

Blood Res 2021 Jun;56(2):72-78

Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea.

Background: We investigated whether distance, that is, the degree of distance between the upper aerodigestive tract (UAT) mass and the farthest pathologic lymph node, was significantly associated with survival in patients with limited-stage UAT natural killer/T cell lymphoma (NKTCL).

Methods: A total of 157 patients who received chemotherapy (CTx) with/without radiotherapy (RTx) were enrolled.

Results: In the survival analysis, an elevated lactate dehydrogenase level [progression-free survival (PFS): hazard ratio (HR), 2.948; 95% confidence interval (CI), 1.606‒5.404; <0.001; overall survival (OS): HR, 2.619; 95% CI, 1.594‒4.822; =0.003], short distance (PFS: HR, 0.170; 95% CI, 0.071‒0.410; <0.001; OS: HR, 0.142; 95% CI, 0.050‒0.402; < 0.001), and CTx combined with RTx (HR, 0.168; 95%CI, 0.079‒0.380; <0.001; OS: HR, 0.193; 95% CI, 0.087‒0.429; <0.001) had an independent predictive value for PFS and OS.

Conclusion: The evaluation of the degree of lymphatic spread and local control by CTx combined with RTx is essential in patients with limited-stage UAT NKTCL.
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http://dx.doi.org/10.5045/br.2021.2020328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246034PMC
June 2021

Sleep Duration and Its Associations with Mortality and Quality of Life in Chronic Obstructive Pulmonary Disease: Results from the 2007-2015 KNAHNES.

Respiration 2021 May 21:1-7. Epub 2021 May 21.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Background: While extreme sleep duration negatively affects mortality and health-related quality of life (HRQOL) in general populations, the relationship remains uncertain in patients with chronic obstructive pulmonary disease (COPD).

Objectives: To evaluate the association between sleep duration and mortality and HRQOL in patients with COPD.

Methods: We analyzed 3,349 participants with COPD enrolled in the 2007-2015 Korea National Health and Nutrition Examination Survey (KNHANES). Participants aged 40 years or older with a smoking history and prebronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7 were eligible. The participants were categorized as short sleepers (<6 h), 6-8 h, and long sleepers (>8) according to self-reported sleep duration. The outcome variables were all-cause mortality and HRQOL. HRQOL was measured using the European Quality of Life-5 Dimensions (EQ-5D) index.

Results: During a median of 6.5 years, 386 (11.5%) participants died. In unadjusted Cox regression analysis, short sleepers with COPD had an increased risk of death (hazard ratio, 1.35; 95% confidence interval [CI]: 1.07-1.71). However, this association was not significant after adjusting for sociodemographic factors, BMI, FEV1, and comorbidities. In unadjusted and adjusted multiple linear regression, short sleepers had significantly worse HRQOL. The adjusted means of the EQ-5D index were 0.88 (95% CI: 0.87-0.89) for short sleepers, 0.90 (95% CI: 0.90-0.91) for 6- to 8-h sleepers, and 0.89 (95% CI: 0.87-0.91) for long sleepers (p = 0.01).

Conclusions: In patients with COPD, sleep duration was not associated with all-cause mortality. However, short sleep duration was significantly associated with worse HRQOL.
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http://dx.doi.org/10.1159/000516381DOI Listing
May 2021

Quantum State Learning via Single-Shot Measurements.

Phys Rev Lett 2021 Apr;126(17):170504

Electronics and Telecommunications Research Institute, Daejeon 34129, Korea.

A novel machine-learning algorithm based on single-shot measurements, named single-shot measurement learning, is demonstrated achieving the theoretical optimal accuracy. The method is at least as efficient as existing tomographic schemes and computationally much less demanding. The merits are attributed to the inclusion of weighted randomness in the learning rule governing the exploration of diverse learning routes. These advantages are explored experimentally by a linear-optical setup that is designed to draw the fullest potential of the proposed method. The experimental results show an unprecedented high level of accuracy for qubit-state learning and reproduction exhibiting (nearly) optimal infidelity scaling, O(N^{-0.983}), for the number N of unknown state copies, down to <10^{-5} without any compensation for experimental nonidealities. Extension to high dimensions is discussed with simulation results.
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http://dx.doi.org/10.1103/PhysRevLett.126.170504DOI Listing
April 2021

A genome-wide association study (GWAS) for pH value in the meat of Berkshire pigs.

J Anim Sci Technol 2021 Jan 31;63(1):25-35. Epub 2021 Jan 31.

Department of Animal Biotechnology, Jeonbuk National University, Jeonju 54896, Korea.

The purpose of this study is to estimate the single nucleotide polymorphism (SNP) effect for pH values affecting Berkshire meat quality. A total of 39,603 SNPs from 1,978 heads after quality control and 882 pH values were used estimate SNP effect by single step genomic best linear unbiased prediction (ssGBLUP) method. The average physical distance between adjacent SNP pairs was 61.7kbp and the number and proportion of SNPs whose minor allele frequency was below 10% were 9,573 and 24.2%, respectively. The average of observed heterozygosity and polymorphic information content was 0.32 ± 0.16 and 0.26 ± 0.11, respectively and the estimate for average linkage disequilibrium was 0.40. The heritability of pH45m and pH24h were 0.10 and 0.15 respectively. SNPs with an absolute value more than 4 standard deviations from the mean were selected as threshold markers, among the selected SNPs, protein-coding genes of pH45m and pH24h were detected in 6 and 4 SNPs, respectively. The distribution of coding genes were detected at pH45m and were detected at pH24h.
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http://dx.doi.org/10.5187/jast.2021.e17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882839PMC
January 2021

Impact of Sleep Duration on Mortality and Quality of Life in Chronic Kidney Disease: Results from the 2007-2015 KNHANES.

Am J Nephrol 2021 6;52(5):396-403. Epub 2021 May 6.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Introduction: In the general population, short and long sleep durations have been associated with adverse health outcomes. However, this association remains unclear in patients with chronic kidney disease (CKD). We examined the relationship of sleep duration to mortality and health-related quality of life (HRQOL) in individuals with CKD.

Methods: A total of 1,783 adults with CKD who participated in the 2007-2015 Korea National Health and Nutrition Examination Survey were analyzed. CKD was defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m2. Participants were categorized into 3 groups according to self-reported sleep duration: <6 h (short sleepers), 6-8 h, and >8 h (long sleepers). The outcome variables were all-cause mortality and HRQOL. HRQOL was assessed using the European Quality of Life-5 Dimensions (EQ-5D) index.

Results: During a median of 6.4 years, 481 (27%) deaths occurred. In unadjusted Cox regression analysis, long sleepers with CKD had an increased risk of death (hazard ratio [HR], 1.62; 95% confidence interval [CI]: 1.26-2.09). This significant association remained after adjusting for age, sex, and BMI (HR, 1.36; 95% CI: 1.05-1.75); however, it was lost after adjusting for CKD stage, social and lifestyle factors, and presence of comorbidities (HR, 1.15; 95% CI: 0.89-1.49). Compared with 6- to 8-h sleepers with CKD, long sleepers with CKD had significantly worse HRQOL in multivariable linear regression models. The adjusted means of the EQ-5D index were 0.80 (95% CI: 0.77-0.82) for short sleepers, 0.81 (95% CI: 0.80-0.82) for 6- to 8-h sleepers, and 0.76 (95% CI: 0.73-0.79) for long sleepers (p = 0.01).

Discussion/conclusion: Long sleep duration is associated with poor HRQOL in Korean adults with CKD. The weak association between long sleep duration and mortality was attenuated after multivariable adjustment in this study.
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http://dx.doi.org/10.1159/000516096DOI Listing
May 2021

Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID-19 pandemic.

Int J Rheum Dis 2021 Jun 4;24(6):733-745. Epub 2021 May 4.

Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh.

Aim: To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process.

Results: Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence.

Conclusions: Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.
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http://dx.doi.org/10.1111/1756-185X.14124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206920PMC
June 2021

Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy.

Arthroscopy 2021 Apr 30. Epub 2021 Apr 30.

Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea.

Purpose: To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors.

Methods: The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined. Clinical outcome was measured according to the Knee Society objective and functional scores.

Results: Seventy-one patients who underwent MOWHTO with locking-plate fixation were analyzed. The respective mean medial and lateral JSWs on serial radiographs were as follows: 3.08 mm and 5.14 mm preoperatively, 3.10 mm and 4.63 mm postoperatively, 3.37 mm and 4.57 mm at 3 months, 3.40 mm and 4.59 mm at 6 months, 3.44 mm and 4.57 mm at 1 year, and 3.42 mm and 4.64 mm at 2 years. At 3 months, the medial JSW increased (P < .001), whereas the lateral JSW decreased immediately (P < .001). JSW showed no significant differences at other time points. Preoperative and postoperative JLCAs and medial femoral and tibial cartilage grades were associated with medial JSW changes (P = .021). However, no significant parameters were associated with decreases in the lateral JSW (P > .05). The postoperative Knee Society objective and functional scores improved and were maintained.

Conclusions: After MOWHTO, the medial JSW increased at 3 months postoperatively and the lateral JSW decreased immediately. The preoperative and postoperative JLCAs and the medial femoral and tibial cartilage grades were associated with the change in the medial JSW. However, no significant parameters were associated with the decrease in the lateral JSW.

Level Of Evidence: Level IV, case series of therapeutic study.
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http://dx.doi.org/10.1016/j.arthro.2021.04.007DOI Listing
April 2021

Nasal septal abscess with a dental origin: a case report and a review of the literature.

J Korean Assoc Oral Maxillofac Surg 2021 Apr;47(2):135-140

Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.

Since the first report of a nasal septal abscess (NSA) from a dental origin (1920), six articles have been published in the English literature to date. The most common cause of NSA is an infection of the nasal septal hematoma after trauma. This is a report of an uncommon cause of NSA with a dental origin. A PubMed search performed regardless of year and country using the terms ("nasal septal abscess") OR ("nasal septum abscess") initially yielded 229 articles. After screening, seven articles (eight patients) were selected. Addition of two related articles produced a total of nine articles (10 patients) to be included. The age of the included patients ranged from 7 to 69 years (mean, 32.82 years; standard deviation, ±23.86 years). The sex composition was as followed: males (n=7; 63.6%), females (n=4; 36.4%). Dental histories were various: periapical lesions, caries, extraction, endodontic therapy, and cystic lesions. The maxillary incisor dominated as the tooth of origin. Early diagnosis and treatment of NSAs are important to avoid not only facial deformity, but also severe complications (e.g., intracranial infection). If NSA is suspected in patients without facial trauma, the possibility of a dental origin, especially from the maxillary incisor area, should be considered.
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http://dx.doi.org/10.5125/jkaoms.2021.47.2.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084746PMC
April 2021

Comparisons between image quality and diagnostic performance of 2D- and breath-hold 3D magnetic resonance cholangiopancreatography at 3T.

Eur Radiol 2021 Apr 21. Epub 2021 Apr 21.

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

Objectives: To compare the image quality and diagnostic performance of 2D MRCP to those of breath-hold 3D MRCP using compressed sensing (CS-MRCP) and gradient and spin-echo (GRASE-MRCP) at 3T.

Methods: From January to November 2018, patients who underwent pancreatobiliary MRI including 2D MRCP and two breath-hold 3D MRCP using CS and GRASE at 3T were included. Three radiologists independently evaluated image quality, motion artifact, and pancreatic cyst conspicuity. Diagnostic performance was assessed for bile duct anatomic variation, bile duct, and pancreatic diseases using a composite algorithm as reference standards. Pancreatic lesion detectability and conspicuity were evaluated using JAFROC and generalized estimating equation analysis.

Results: One hundred patients (male = 50) were included. Bile duct anatomic variation, bile duct and pancreatic diseases were present in respectively 31, 15, and 79 patients. Breath-hold 3D MRCP provided better image quality than 2D MRCP (3.5 ± 0.6 in 2D MRCP; 4.0 ± 0.7 in GRASE-MRCP and 3.9 ± 0.8 in CS-MRCP, p < 0.001 for both). There was no difference in motion artifact between 2D and breath-hold 3D MRCP (p = 0.1). Breath-hold 3D CS-MRCP provided better pancreatic cyst conspicuity than 2D MRCP (2.7 [95% CI: 2.5-3.0] vs. 2.3 [95% CI: 2.1-2.5], p = 0.001). There were no significant differences between the diagnostic performance of the three sequences in the detection of bile duct anatomic variation or pancreatic lesions (p > 0.05).

Conclusion: Breath-hold 3D MRCP with GRASE or CS can provide better image quality than 2D MRCP in a comparable scan time.

Key Points: • Breath-hold 3D MRCP using compressed sensing (CS) or gradient and spin-echo (GRASE) provided a better image quality with less image blurring than 2D MRCP. • There were no significant differences between 2D MRCP and breath-hold 3D MRCP in either motion artifact or the number of non-diagnostic exams. • There were no significant differences between 2D MRCP and either type of breath-hold 3D MRCP in the diagnosis of bile duct anatomic variation or detection of pancreatic lesions.
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http://dx.doi.org/10.1007/s00330-021-07968-wDOI Listing
April 2021

CT radiomics-based prediction of anaplastic lymphoma kinase and epidermal growth factor receptor mutations in lung adenocarcinoma.

Eur J Radiol 2021 Jun 8;139:109710. Epub 2021 Apr 8.

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

Purpose: To develop and validate a CT-based radiomic model to simultaneously diagnose anaplastic lymphoma kinase (ALK) rearrangements and epidermal growth factor receptor (EGFR) mutation status of lung adenocarcinoma and to assess whether peritumoural radiomic features add value in the prediction of mutation status.

Methods: 503 patients with pathologically proven lung adenocarcinoma containing information on the mutation status were retrospectively included. Intratumoural and peritumoural radiomic features of the primary lesion were extracted from CT. We proposed two-level stepwise binary radiomics-based classification models to diagnose ALK (step1) and EGFR mutation status (step2). The performance of proposed models and added value of peritumoural radiomic features were evaluated by using the areas under receiver operating characteristic curves (AUC) and Obuchowski index in the development and validation sets.

Results: Regarding the prediction of ALK rearrangement, the diagnostic performance of the intratumoural radiomic model showed the AUC of 0.77 and 0.68 for the development and validation sets, respectively. As for EGFR mutation, the diagnostic performance of the intratumoural radiomic model showed the AUCs of 0.64 and 0.62 for the development and validation sets, respectively. The radiomics added value to the model based on clinical features (development set [radiomics + clinical model vs. clinical model]: Obuchowski index, 0.76 vs. 0.66, p < 0.001; validation set: 0.69 vs. 0.61, p = 0.075). Adding peritumoural features resulted in no improvement in terms of model performance.

Conclusion: The CT radiomics-based model allowed the simultaneous prediction of the presence of ALK and EGFR mutations while adding value to the clinical features.
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http://dx.doi.org/10.1016/j.ejrad.2021.109710DOI Listing
June 2021

Current smoking status as a predictor of cerebral infarction in men: a retrospective cohort study in South Korea.

BMJ Open 2021 04 14;11(4):e042317. Epub 2021 Apr 14.

Department of Occupational and Environmental Medicine, Kyung Hee University, Seoul, South Korea

Objectives: We examined the relationship between duration (pack-year) of smoking and the risk of developing cerebral infarction in Korean men.

Design: Retrospective cohort study.

Setting: National Health Insurance Service-National Sample Cohort in Korea.

Participants: Of 125 743 male participants from the National Health Insurance System undergoing medical health check-up in 2009, 114 377 were included in the final analysis.

Primary And Secondary Outcome Measures: Development of cerebral infarction according to smoking duration after adjusting for age, body mass index, systolic blood pressure, fasting blood glucose, total cholesterol, γ-glutamyltransferase, estimated glomerular filtration rate, alcohol intake and physical activity.

Results: During 495 827.3 person-years of follow-up, 1450 incident cases of cerebral infarction developed between 2009 and 2013. The multivariate adjusted HRs (95% CI) for cerebral infarction between groups 2, 3 and 4 by duration of smoking were 1.02 (0.88 to 1.19), 1.36 (1.19 to 1.56) and 1.49 (1.28 to 1.74), respectively. In our secondary analysis by smoking status, the HR (95% CI) of former smokers showed a significant relationship in the unadjusted model but did not show statistically significant associations in the multivariate adjusted model. The HR (95% CI) of current smokers showed significant relationship in both the unadjusted and multivariate adjusted models (p for trend <0.001).

Conclusions: The study indicates that the prolonged duration of smoking (pack-year) increases the risk of cerebral infarction. Current smoking poses a higher risk for the development of cerebral infraction than former smoking among Korean men, indicating that current smoking cessation would be more protective.
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http://dx.doi.org/10.1136/bmjopen-2020-042317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054067PMC
April 2021

Radiomics approach for survival prediction in chronic obstructive pulmonary disease.

Eur Radiol 2021 Apr 13. Epub 2021 Apr 13.

Department of Medicine, RCSI & UCD Malaysia Campus, 4 Jalan Sepoy Lines, 10450, George Town, Penang, Malaysia.

Objectives: To apply radiomics analysis for overall survival prediction in chronic obstructive pulmonary disease (COPD), and evaluate the performance of the radiomics signature (RS).

Methods: This study included 344 patients from the Korean Obstructive Lung Disease (KOLD) cohort. External validation was performed on a cohort of 112 patients. In total, 525 chest CT-based radiomics features were semi-automatically extracted. The five most useful features for survival prediction were selected by least absolute shrinkage and selection operation (LASSO) Cox regression analysis and used to generate a RS. The ability of the RS for classifying COPD patients into high or low mortality risk groups was evaluated with the Kaplan-Meier survival analysis and Cox proportional hazards regression analysis.

Results: The five features remaining after the LASSO analysis were %LAA, AWT_Pi10_6, AWT_Pi10_heterogeneity, %WA_heterogeneity, and VA. The RS demonstrated a C-index of 0.774 in the discovery group and 0.805 in the validation group. Patients with a RS greater than 1.053 were classified into the high-risk group and demonstrated worse overall survival than those in the low-risk group in both the discovery (log-rank test, < 0.001; hazard ratio [HR], 5.265) and validation groups (log-rank test, < 0.001; HR, 5.223). For both groups, RS was significantly associated with overall survival after adjustments for patient age and body mass index.

Conclusions: A radiomics approach for survival prediction and risk stratification in COPD patients is feasible, and the constructed radiomics model demonstrated acceptable performance. The RS derived from chest CT data of COPD patients was able to effectively identify those at increased risk of mortality.

Key Points: • A total of 525 chest CT-based radiomics features were extracted and the five radiomics features of %LAA, AWT_Pi10_6, AWT_Pi10_heterogeneity, %WA_heterogeneity, and VA were selected to generate a radiomics model. • A radiomics model for predicting survival of COPD patients demonstrated reliable performance with a C-index of 0.774 in the discovery group and 0.805 in the validation group. • Radiomics approach was able to effectively identify COPD patients with an increased risk of mortality, and patients assigned to the high-risk group demonstrated worse overall survival in both the discovery and validation groups.
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http://dx.doi.org/10.1007/s00330-021-07747-7DOI Listing
April 2021

Percutaneous removal of common bile duct stones using a modified balloon technique.

Medicine (Baltimore) 2021 Apr;100(14):e24486

Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.

Abstract: To evaluate the effectiveness of percutaneous removal of common bile duct (CBD) stones using a modified balloon technique (balloon catheter sphincteroplasty and expulsion of the stones using half-captured balloons within the sheath) in patients difficult to treat with endoscopy.Fifty patients underwent a modified balloon technique (balloon group), and 53 patients underwent CBD stone removal by the basket method (stone basket group) between 2016 and 2019. We compared the balloon and stone basket groups to evaluate the effectiveness of the modified balloon technique. Outcome variables such as demographics, technical success rates, procedural details, and complications were analyzed. Statistical analysis was performed using Student t test, Fisher exact test, or the χ2 test.The technical success rate in the balloon group was 66% (33/50) in 1 session, 32% (16/50) in 2 sessions, and 2% (1/50) in 3 sessions. That of the stone basket group was 45% (24/53) in 1 session, 38% (20/53) in 2 sessions, and 17% (9/53) in 3 sessions.The total procedure time was significantly shorter in the balloon group (29.5 ± 15.1 minutes) than in the stone basket group (41.7 ± 20.2 minutes) (P < .01), whereas the number of stones was higher in the balloon group than in the stone basket group (P = .03). Maximal stone size, balloon size, pancreatitis, and hospitalization stay did not show statistical differences between the 2 groups. Most complications (9 patients, balloon group; 8 patients, stone basket group) were mild and transient. Major complications occurred in one patient in the stone basket group, who experienced hemobilia due to arterial injury caused by percutaneous transhepatic biliary drainage, which was treated by endovascular embolization without mortality.The modified balloon technique is an effective and safe treatment method for CBD stone removal in patients presenting difficulties in the endoscopic approach.
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http://dx.doi.org/10.1097/MD.0000000000024486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036119PMC
April 2021
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