Objective: This study evaluated the deep learning (DL) algorithm performance to detect lesions that suggest pneumonia in chest X-rays (CXR) of suspected coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study included consecutive patients who visited a screening clinic in Daegu, and were suspected to be afflicted with the COVID-19 during the COVID-19 epidemic. CXR were analyzed using the commercial artificial intelligence product that provides free online DL algorithms to the public for COVID-19. Computerized tomography was used as the standard reference. Performance of the DL algorithm was evaluated by the sensitivity and specificity, and results were compared to the CXR records of emergency physicians (EP) in charge of the actual screening triage clinic during the COVID-19 epidemic. Results: Totally, 114 patients were evaluated, of which 38 patients were positive for COVID-19. In 85 CXRs examined (36 COVID-19 and 49 non-COVID-19) with findings of pneumonia in computerized tomography, the DL algorithm showed significantly higher sensitivity as compared to the EP (DL, 98.8% [93.6%-99.9%] vs. EP, 85.9% [76.6%-92.5%]; P<0.01). Moreover, the DL algorithm showed significantly higher sensitivity for detecting CXRs with COVID-19 pneumonia, as compared to the EP (DL, 100.0% [90.3%-100%] vs. EP, 91.7% [77.5%-98.3%]; P=0.08). Conclusion We conclude that for examining the CXR of patients with suspected COVID-19, sensitivity of the DL algorithm is superior than the EP for detecting lesions suggesting pneumonia. Thus, the application of the DL algorithm is potentially useful in screening triage clinics to detect COVID-19 pneumonia.

Objective: This study evaluated the deep learning (DL) algorithm performance to detect lesions that suggest pneumonia in chest X-rays (CXR) of suspected coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study included consecutive patients who visited a screening clinic in Daegu, and were suspected to be afflicted with the COVID-19 during the COVID-19 epidemic. CXR were analyzed using the commercial artificial intelligence product that provides free online DL algorithms to the public for COVID-19. Computerized tomography was used as the standard reference. Performance of the DL algorithm was evaluated by the sensitivity and specificity, and results were compared to the CXR records of emergency physicians (EP) in charge of the actual screening triage clinic during the COVID-19 epidemic. Results: Totally, 114 patients were evaluated, of which 38 patients were positive for COVID-19. In 85 CXRs examined (36 COVID-19 and 49 non-COVID-19) with findings of pneumonia in computerized tomography, the DL algorithm showed significantly higher sensitivity as compared to the EP (DL, 98.8% [93.6%-99.9%] vs. EP, 85.9% [76.6%-92.5%]; P<0.01). Moreover, the DL algorithm showed significantly higher sensitivity for detecting CXRs with COVID-19 pneumonia, as compared to the EP (DL, 100.0% [90.3%-100%] vs. EP, 91.7% [77.5%-98.3%]; P=0.08). Conclusion We conclude that for examining the CXR of patients with suspected COVID-19, sensitivity of the DL algorithm is superior than the EP for detecting lesions suggesting pneumonia. Thus, the application of the DL algorithm is potentially useful in screening triage clinics to detect COVID-19 pneumonia.

In case of gingival recession or bone defect in maxillary anterior implant treatment, it is not easy to obtain satisfactory clinical results. In this case, loss of the labial alveolar plate was diagnosed in the maxillary right central incisor, so after tooth extraction, soft tissue was secured and implant placement with bone graft was planned. In addition, digital guide surgery was performed for the ideal implant position, and GBR (Guided Bone Regeneration) was accompanied with the xenogeneic bone and the autologous bone collected from the mandibular ramus since alveolar bone defects were extensive. After a sufficient period of osseointegration of the implant, a temporary prosthesis was fabricated through secondary stage surgery and impression taking, and through periodic external adjustment, the shape of soft tissue was improved. In the final prosthesis fabrication, a color tone of natural teeth was induced by an gold anodized customized abutment, and an aesthetic and functional zirconia prosthesis with reproducing the shape of the temporary prosthesis through intraoral scan was delivered.

Recently, new treatments for human heart disease such as ischemia, infarction, cardiomyopathy, coronary heart disease have been developed. transplantation various kinds of cells from skeletal muscle, endothelium, mesenchyme, hemopoietic tissue to injured area after infarction were challenged. It's so called 'Cell Transplantation'. This therapeutic strategy already adopted and got a good result in clinical trial. But several limitations are still remained, including ethics, donor cell numbers, side effects, therapeutic efficiency. In this research, we investigated the formation of intercellular junction and synchronous contraction between cardiomyocyte and H9c2 cell line in co-culture to establish experimental model in vitro for cell transplantation. For this purpose, two kinds of cells, primary cultured cardiomyocyte and H9c2 (cardiomyoblast cell line) were used. Cultured cardiomyocytes had repetitive contraction-relaxation pattern along longitudinal axis both in single and coculture. But their contractions were slower, less regular, less strong in co-culture than in cardiomyocyte culture only. H9c2 cells did not contracted actively themselves, but moved toward cardiomyocyte passively coincided with contraction. In contact region between two kinds of cells, there was no signal after immunocytochemical staining labeled with connexin43 (gap junction), desmoplakin (desmosome), N-cadherin (adherent junction) even though they had membrane contact. Moreover, F-actin and striation were less developed. These results suggested that co-culture system interfere with remodelling of contractile apparatus, intercellular junction formation as well as contraction-relaxation. Furthermore cardiomyocyte could not induce H9c2 cells differentiation into cardiomyocyte. Therefore, much more research would be essential for clinical application of cell transplantation and this study would be the basic source for further study of new therapy of myocardial disease and building up in vitro model.
Actins ; Axis, Cervical Vertebra ; Cadherins ; Cardiomyopathies ; Cell Count ; Cell Line* ; Cell Transplantation ; Coculture Techniques* ; Connexin 43 ; Coronary Disease ; Desmoplakins ; Endothelium ; Ethics ; Heart Diseases ; Humans ; Infarction ; Intercellular Junctions* ; Ischemia ; Membranes ; Mesoderm ; Models, Theoretical ; Muscle, Skeletal ; Myocytes, Cardiac* ; Tissue Donors ; Transplants

OBJECTIVE: We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). METHODS: We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. RESULTS: Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. CONCLUSION: The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion.
Animals ; Arm ; Body Height ; Diskectomy* ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Retrospective Studies

PURPOSE: To examine the use of ultrasound as an alternative imaging technique to block lumbar medial branches in chronic low back pain. MATERIALS AND METHODS: From August 2011 to September 2012, 27 patients with lumbar facet joint syndrome diagnosed by strict inclusion criteria among chronic low back pain patients have undergone medial branch block. All procedures have been performed by the same operator, and 23G, 10cm needle was placed and 0.5% lidocine was injected under ultrasound guide. To target medial branches from L1 to L5, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were followed up by Visual Analog Scale and Oswestry Disability Index at 1 week after medial branch block. RESULTS: VAS showed that preprocedure pain(7.0+/-1.4; mean+/-SD) significantly decreased after block(1.8+/-1.6)(p=0.0000). ODI also showed that preprocedure score(30.3+/-6.4) significantly decreased(9.0+/-7.7)(p=0.0000). Analysis of patient-reported pain and functional scores measured with VAS and ODI showed definite improvements after ultrasound-guided medial branch block. There was one complication of dizziness and weakness in both lower extremities immediate after procedure. CONCLUSION: Ultrasound guidance offers a reliable alternative to fluoroscopy or computed tomography for lumbar medial branch blocks and can be safely performed without radiation exposure.
Dizziness ; Fluoroscopy ; Humans ; Low Back Pain ; Lower Extremity ; Needles ; Zygapophyseal Joint

PURPOSE: To examine the use of ultrasound as an alternative imaging technique to block lumbar medial branches in chronic low back pain. MATERIALS AND METHODS: From August 2011 to September 2012, 27 patients with lumbar facet joint syndrome diagnosed by strict inclusion criteria among chronic low back pain patients have undergone medial branch block. All procedures have been performed by the same operator, and 23G, 10cm needle was placed and 0.5% lidocine was injected under ultrasound guide. To target medial branches from L1 to L5, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were followed up by Visual Analog Scale and Oswestry Disability Index at 1 week after medial branch block. RESULTS: VAS showed that preprocedure pain(7.0+/-1.4; mean+/-SD) significantly decreased after block(1.8+/-1.6)(p=0.0000). ODI also showed that preprocedure score(30.3+/-6.4) significantly decreased(9.0+/-7.7)(p=0.0000). Analysis of patient-reported pain and functional scores measured with VAS and ODI showed definite improvements after ultrasound-guided medial branch block. There was one complication of dizziness and weakness in both lower extremities immediate after procedure. CONCLUSION: Ultrasound guidance offers a reliable alternative to fluoroscopy or computed tomography for lumbar medial branch blocks and can be safely performed without radiation exposure.
Dizziness ; Fluoroscopy ; Humans ; Low Back Pain ; Lower Extremity ; Needles ; Zygapophyseal Joint

Purpose: Postoperative pancreatic fistula (POPF) is the most troublesome complication after pancreaticojejunostomy (PJ).This study aimed to compare the short-term outcomes of 2 different methods of duct-to-mucosa PJ; out-layer continuous suture anastomosis (OCA) and the modified Blumgart method (mBM). Methods: This retrospective cohort study enrolled patients who underwent curative-intent, open PD between 2015 and 2020. In mBM, 2 transpancreatic U-sutures were performed between the pancreatic margin and jejunum, with reinforced sutures in the central region. Patient demographics, diagnosis, intraoperative factors, postoperative complications, and POPF defined by the International Study Group on Pancreatic Fistula were investigated. Clinically relevant POPF (CR-POPF) included grades B and C POPF. Results: A total of 184 patients underwent OCA, and 96 patients underwent mBM. The mBM group had more patients who underwent neoadjuvant therapy. The fistula risk scores were comparable between the 2 groups. Both groups showed no significant differences in CR-POPF and overall surgical complication rates. The total operation time was comparable, although the operation time for PJ was shorter in mBM. Conclusion No significant differences were observed in the postoperative outcomes between each group; the operation time for PJ in mBM was shorter. Therefore, mBM may be considered for utilization in duct-to-mucosa PJ.

Background: Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. Methods: We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. Results: We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. Conclusion This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.

Background: Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. Methods: We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. Results: We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. Conclusion This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.