No abstract available.

OBJECTIVES: A healthcare decision-making support model and rule management system is proposed based on a personalized rule-based intelligent concept, to effectively manage chronic diseases. METHODS: A Web service was built using a standard message transfer protocol for interoperability of personal health records among healthcare institutions. An intelligent decision service is provided that analyzes data using a service-oriented healthcare rule inference function and machine-learning platform; the rules are extensively compiled by physicians through a developmental user interface that enables knowledge base construction, modification, and integration. Further, screening results are visualized for the self-intuitive understanding of personal health status by patients. RESULTS: A recommendation message is output through the Web service by receiving patient information from the hospital information recording system and object attribute values as input factors. The proposed system can verify patient behavior by acting as an intellectualized backbone of chronic diseases management; further, it supports self-management and scheduling of screening. CONCLUSIONS: Chronic patients can continuously receive active recommendations related to their healthcare through the rule management system, and they can model the system by acting as decision makers in diseases management; secondary diseases can be prevented and health management can be performed by reference to patient-specific lifestyle guidelines.
Chronic Disease* ; Decision Support Systems, Clinical ; Delivery of Health Care* ; Expert Systems ; Health Records, Personal ; Humans ; Knowledge Bases ; Life Style ; Mass Screening ; Self Care

A new antireflux surgical technique was introduced by Gil Vernet in 1984, which is simple and rapidly accomplished without mobilization of the distal ureter. The technique involves a single stitch that implicates the trigone, effectively lengthening the intramural segment of terminal ureter, which is particularly effective in patients with megatrigone. We applied this new technique in 2 children with vesicoureteral reflux, of whom one had unilateral grade III reflux and the other bilateral grade II and grade IV reflux. Vesicoureteral reflux and urinary tract infection were lost at follow up voiding cystourethrogram and urinalysis 4 months after operation. We think that this new technique is excellent method in surgical treatment of vesicoureteral reflux.
Child ; Follow-Up Studies ; Humans ; Ureter ; Urinalysis ; Urinary Tract Infections ; Vesico-Ureteral Reflux

No abstract available.
Plasma ; Protein C Deficiency* ; Protein C* ; Purpura Fulminans* ; Purpura* ; Warfarin

Nevus sebaceus is a hamartoma of both epithelial and non-epithelial components, which that undergoes age-related change. It commonly affects the head and neck, particularly the scalp. In 10-20% of nevus sebaceus cases, secondary benign or malignant neoplasms such as syringocystadenoma papilliferum, trichoblastoma or basal cell carcinoma occur between 40-80 years of age. In only rare instances does a sebaceous carcinoma develop within a nevus sebaceus. To our knowledge, only 3 cases of sebaceous carcinoma in nevus sebaceus have been reported in the Korean dermatologic literature. We present a case of a sebaceous carcinoma arising from nevus sebaceus in a 46-year-old Korean man.
Carcinoma, Basal Cell ; Hamartoma ; Head ; Humans ; Middle Aged ; Neck ; Nevus* ; Scalp

Eosinophilic pustular folliculitis (EPF) is a rare dermatosis of unknown cause. It is characterized by recurrent crops of sterile, pruritic, follicular papulopustules on the face, trunk, and extremities. Although various treatments have been attempted for EPF, including systemic corticosteroid dapsone, cetrizine, UVB phototherapy, as well as cyclosporin, no uniformly effective treatment has been found. We describe a 20-year-old man with long standing EPF which was resistant to various treatments, but who responded dramatically to indomethacin.
Cyclosporine ; Dapsone ; Eosinophils* ; Extremities ; Folliculitis* ; Humans ; Indomethacin* ; Phototherapy ; Skin Diseases ; Young Adult

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Displacement (Psychology) ; Hand ; Humans ; Median Nerve ; Radius ; Sensitivity and Specificity

Objective: : Deep learning is a machine learning approach based on artificial neural network training, and object detection algorithm using deep learning is used as the most powerful tool in image analysis. We analyzed and evaluated the diagnostic performance of a deep learning algorithm to identify skull fractures in plain radiographic images and investigated its clinical applicability. Methods: : A total of 2026 plain radiographic images of the skull (fracture, 991; normal, 1035) were obtained from 741 patients. The RetinaNet architecture was used as a deep learning model. Precision, recall, and average precision were measured to evaluate the deep learning algorithm’s diagnostic performance. Results: : In ResNet-152, the average precision for intersection over union (IOU) 0.1, 0.3, and 0.5, were 0.7240, 0.6698, and 0.3687, respectively. When the intersection over union (IOU) and confidence threshold were 0.1, the precision was 0.7292, and the recall was 0.7650. When the IOU threshold was 0.1, and the confidence threshold was 0.6, the true and false rates were 82.9% and 17.1%, respectively. There were significant differences in the true/false and false-positive/false-negative ratios between the anteriorposterior, towne, and both lateral views (p=0.032 and p=0.003). Objects detected in false positives had vascular grooves and suture lines. In false negatives, the detection performance of the diastatic fractures, fractures crossing the suture line, and fractures around the vascular grooves and orbit was poor. Conclusion : The object detection algorithm applied with deep learning is expected to be a valuable tool in diagnosing skull fractures.

A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Additionally, we indentified decreased muscle stiffness which was demonstrated by a decrease in the color-coded scale and shear velocity, and an increase in the strain ratio using dynamic sonoelastography.
Botulinum Toxins ; Cerebral Palsy ; Child ; Elasticity Imaging Techniques ; Humans ; Muscle Spasticity ; Muscle, Skeletal ; Muscles ; Sprains and Strains

BACKGROUND: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. METHODS: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. RESULTS: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. CONCLUSION: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
Antirheumatic Agents* ; Arthritis, Rheumatoid* ; Delivery of Health Care ; Health Care Costs ; Humans ; Injections, Subcutaneous* ; Outpatients ; Palliative Care ; Rheumatology ; Abatacept ; Adalimumab ; Etanercept