Objective: This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD). Materials and Methods: We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters. Results: Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11–117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81; p = 0.034) and LS-VR (sHR, 0.71; p = 0.01) were independently associated with hepatic decompensation. The ∆LS-VR (sHR, 0.54; p = 0.002) was predictive of hepatic decompensation after adjusting for baseline variables. ∆LS-VR was an independent predictor of liver-related death or transplantation in patients with compensated ACLD (sHR, 0.46; p = 0.026) and decompensated ACLD (sHR, 0.61; p = 0.023). Conclusion MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.

Objective: We aimed to develop and test a deep learning algorithm (DLA) for fully automated measurement of the volume and signal intensity (SI) of the liver and spleen using gadoxetic acid-enhanced hepatobiliary phase (HBP)-magnetic resonance imaging (MRI) and to evaluate the clinical utility of DLA-assisted assessment of functional liver capacity. Materials and Methods: The DLA was developed using HBP-MRI data from 1014 patients. Using an independent test dataset (110 internal and 90 external MRI data), the segmentation performance of the DLA was measured using the Dice similarity score (DSS), and the agreement between the DLA and the ground truth for the volume and SI measurements was assessed with a Bland-Altman 95% limit of agreement (LOA). In 276 separate patients (male:female, 191:85; mean age ± standard deviation, 40 ± 15 years) who underwent hepatic resection, we evaluated the correlations between various DLA-based MRI indices, including liver volume normalized by body surface area (LV BSA), liver-to-spleen SI ratio (LSSR), MRI parameter-adjusted LSSR (aLSSR), LSSR x LV BSA, and aLSSR x LV BSA, and the indocyanine green retention rate at 15 minutes (ICG-R15), and determined the diagnostic performance of the DLA-based MRI indices to detect ICG-R15 ≥ 20%. Results: In the test dataset, the mean DSS was 0.977 for liver segmentation and 0.946 for spleen segmentation. The BlandAltman 95% LOAs were 0.08% ± 3.70% for the liver volume, 0.20% ± 7.89% for the spleen volume, -0.02% ± 1.28% for the liver SI, and -0.01% ± 1.70% for the spleen SI. Among DLA-based MRI indices, aLSSR x LV BSA showed the strongest correlation with ICG-R15 (r = -0.54, p < 0.001), with area under receiver operating characteristic curve of 0.932 (95% confidence interval, 0.895–0.959) to diagnose ICG-R15 ≥ 20%. Conclusion Our DLA can accurately measure the volume and SI of the liver and spleen and may be useful for assessing functional liver capacity using gadoxetic acid-enhanced HBP-MRI.

Objective: Although the liver-to-spleen volume ratio (LSVR) based on CT reflects portal hypertension, its prognostic role in cirrhotic patients has not been proven. We evaluated the utility of LSVR, automatically measured from CT images using a deep learning algorithm, as a predictor of hepatic decompensation and transplantation-free survival in patients with hepatitis B viral (HBV)-compensated cirrhosis. Materials and Methods: A deep learning algorithm was used to measure the LSVR in a cohort of 1027 consecutive patients (mean age, 50.5 years; 675 male and 352 female) with HBV-compensated cirrhosis who underwent liver CT (2007–2010).Associations of LSVR with hepatic decompensation and transplantation-free survival were evaluated using multivariable Cox proportional hazards and competing risk analyses, accounting for either the Child-Pugh score (CPS) or Model for End Stage Liver Disease (MELD) score and other variables. The risk of the liver-related events was estimated using Kaplan-Meier analysis and the Aalen-Johansen estimator. Results: After adjustment for either CPS or MELD and other variables, LSVR was identified as a significant independent predictor of hepatic decompensation (hazard ratio for LSVR increase by 1, 0.71 and 0.68 for CPS and MELD models, respectively; p < 0.001) and transplantation-free survival (hazard ratio for LSVR increase by 1, 0.8 and 0.77, respectively; p < 0.001). Patients with an LSVR of < 2.9 (n = 381) had significantly higher 3-year risks of hepatic decompensation (16.7% vs. 2.5%, p < 0.001) and liver-related death or transplantation (10.0% vs. 1.1%, p < 0.001) than those with an LSVR ≥ 2.9 (n = 646). When patients were stratified according to CPS (Child-Pugh A vs. B–C) and MELD (< 10 vs. ≥ 10), an LSVR of < 2.9 was still associated with a higher risk of liver-related events than an LSVR of ≥ 2.9 for all Child-Pugh (p ≤ 0.045) and MELD (p ≤ 0.009) stratifications. Conclusion The LSVR measured on CT can predict hepatic decompensation and transplantation-free survival in patients with HBV-compensated cirrhosis.

Objective: Measurement of the liver and spleen volumes has clinical implications. Although computed tomography (CT)volumetry is considered to be the most reliable noninvasive method for liver and spleen volume measurement, it has limitedapplication in clinical practice due to its time-consuming segmentation process. We aimed to develop and validate a deeplearning algorithm (DLA) for fully automated liver and spleen segmentation using portal venous phase CT images in variousliver conditions. Materials and Methods: A DLA for liver and spleen segmentation was trained using a development dataset of portal venousCT images from 813 patients. Performance of the DLA was evaluated in two separate test datasets: dataset-1 which included150 CT examinations in patients with various liver conditions (i.e., healthy liver, fatty liver, chronic liver disease, cirrhosis,and post-hepatectomy) and dataset-2 which included 50 pairs of CT examinations performed at ours and other institutions.The performance of the DLA was evaluated using the dice similarity score (DSS) for segmentation and Bland-Altman 95%limits of agreement (LOA) for measurement of the volumetric indices, which was compared with that of ground truth manualsegmentation. Results: In test dataset-1, the DLA achieved a mean DSS of 0.973 and 0.974 for liver and spleen segmentation, respectively,with no significant difference in DSS across different liver conditions (p = 0.60 and 0.26 for the liver and spleen, respectively).For the measurement of volumetric indices, the Bland-Altman 95% LOA was -0.17 ± 3.07% for liver volume and -0.56 ± 3.78%for spleen volume. In test dataset-2, DLA performance using CT images obtained at outside institutions and our institutionwas comparable for liver (DSS, 0.982 vs. 0.983; p = 0.28) and spleen (DSS, 0.969 vs. 0.968; p = 0.41) segmentation. Conclusion The DLA enabled highly accurate segmentation and volume measurement of the liver and spleen using portalvenous phase CT images of patients with various liver conditions.

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

PURPOSE: The purpose of this study was to evaluate clinical and radiological results after osteosynthesis of distal phalangeal nonunion with bone defect by using matchstick-shaped bone graft. MATERIALS AND METHODS: Fifteen distal phalangeal nonunions were treated with osteosynthesis using matchstick-shaped bone graft from September, 2009 to October, 2010. The mean age of patients was 36.1 years (range: 15 to 56 years). This study included 4 women and 10 men. The mean duration of follow-up was 16.8 months (range: 12 to 20 months). We evaluated radiographs, and measured postoperative visual analogue scale (VAS) score and pinch power. RESULTS: Union was achieved in all cases at a mean of postoperative 5.5 weeks (range: 4 to 6 weeks). The mean VAS score improved from 7.25 (range: 5 to 9) to 1.0 (range: 0 to 2) postoperatively. The mean postoperative pinch power was 7.75 lbs (range: 4 to 13 lbs) compared to opposite pinch power of 9.63 lbs (range: 5 to 15 lbs). There was no scar problem, pinch pain and other complication. CONCLUSION: Steosynthesis of distal phalageal nonunion with bone defect by using matchstick-shaped bone graft is technically feasible and simple in that it does not need volar incision and debridement. It is considered as an effective treatment option in distal phalangeal nonunion with bone defect.
Bone Transplantation ; Cicatrix ; Debridement ; Female ; Follow-Up Studies ; Humans ; Male ; Transplants

PURPOSE: The presence of normal fingernail is important for the hand function and cosmetic appearance. We studied the results of the microsurgical reconstruction of the defected fingernail using composite toenail transfer. MATERIALS AND METHODS: From March of 2004 to May of 2009, eleven fingernails were reconstructed using microsurgical composite toenail transfer in 10 patients with a mean age of 27 years (range, 13 to 47 years). There were three thumbs, five index fingers, and three long fingers. Whole fingernail was destructed in three cases and remaining eight cases had partial nail defect. Toenail was grafted from great toe in eight cases and from second toe in three cases. Five cases were harvested as an osteoonychocutaneous flap, two as a endoosteoonychocutaneous flap and four as an onychocutaneous flap. RESULTS: All cases survived without any tissue necrosis. One arterial obstruction had occurred one day after surgery, which was resolved by repeated decompression and reanastomosis of the artery. All fingernails regenerated successfully. According to the rating system including assessment of shape, size and thickness of nail, nail pinch, pain, and patient's satisfaction, ten cases were rated as excellent and one as good. All patient's were satisfied with their hand function and appearance. CONCLUSION: Microsurgical composite toenail transfer can be an acceptable surgical reconstruction for the fingernail defect after trauma, providing satisfactory hand functions and cosmetic appearance.
Arteries ; Cosmetics ; Decompression ; Fingers ; Hand ; Humans ; Nails ; Necrosis ; Thumb ; Toes ; Transplants

PURPOSE: The objective of this study was to evaluate clinical results of dual miniplate fixation for comminuted or periarticular fractures of the hand. MATERIALS AND METHODS: Twenty cases in 18 patients who had comminuted or periarticular fractures of metacarpal or phalangeal bones were treated with dual miniplate fixation from April, 2007 to May, 2009. The mean followed up period was 14.7 months. Our study included comminuted or periarticular fractures which were difficult to keep the fixation by pining or single plating. We evaluated radiologic bony union, angular or rotational deformity, extensor tendon irritaion and total arc of motion. RESULTS: Bony union was achieved successfully after primary dual miniplate fixationin in 12 cases. In 7 cases with a nonunion following previous operative fixation, bony union was obtained by dual miniplate fixation and bone grafting. In one case who had received primary dual plate fixation, nonunion occurred due to massive bone defect. Bony union was obtained by secondary dual plate fixation and bone grafting. Postoperative rotational deformity, angular deformity and irritation symptom were not observed in all cases. Functionally acceptable range of active motion was restored by way of early active motion. CONCLUSION: The dual miniplate fixation is one of the useful method for comminuted metacarpal or phalangeal fractures which cannot obtain firm fixation by other methods.
Bone Transplantation ; Congenital Abnormalities ; Fractures, Comminuted ; Hand ; Humans ; Tendons

This study examined whether amifostine (WR-2721) could attenuate memory impairment and suppress hippocampal neurogenesis in adult mice with the relatively low-dose exposure of acute radiation syndrome (ARS). These were assessed using object recognition memory test, the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, and immunohistochemical markers of neurogenesis [Ki-67 and doublecortin (DCX)]. Amifostine treatment (214 mg/kg, i.p.) prior to irradiation significantly attenuated the recognition memory defect in ARS, and markedly blocked the apoptotic death and decrease of Ki-67- and DCX-positive cells in ARS. Therefore, amifostine may attenuate recognition memory defect in a relatively low-dose exposure of ARS in adult mice, possibly by inhibiting a detrimental effect of irradiation on hippocampal neurogenesis.
Acute Radiation Syndrome/drug therapy/*immunology/psychology ; Amifostine/*pharmacology/therapeutic use ; Animals ; Apoptosis/immunology ; Gamma Rays/*adverse effects ; Hippocampus/immunology ; Immunohistochemistry ; In Situ Nick-End Labeling ; Male ; Memory/*radiation effects ; Mice ; Mice, Inbred ICR ; Neurogenesis/immunology ; Radiation-Protective Agents/*pharmacology/therapeutic use

Inhibin, which is important for normal gonadal function, acts on the pituitary gonadotropins to suppress folliclestimulating hormone (FSH) secretion. The level and cellular localization of the inhibin isotypes, alpha, beta(A) and beta(B), in the testis of mice were examined during postnatal development in order to determine if inhibin expression is related to testicular maturation. Mouse testes were sampled on postnatal days (PNDs) 1, 3, 6, 18, 48 and 120, and analyzed by Western blotting and immunofluorescence. Western blot analysis showed very low levels of inhibin alpha, beta(A) and beta(B) expression in the testes at days 1 to 6 after birth. The levels then increased gradually from PND 18 to 48-120, and there were significant peaks at PND 48. Inhibin alpha, beta(A) and beta(B) were detected in testicular cells during postnatal development using immunohistochemistry. The immunoreactivity of inhibin alpha was rarely observed in testicular cells during PND 1 to 6, or in the cytoplasmic process of Sertoli cells surrounding the germ cells and interstitial cells during PND 18 to 120. Inhibin beta(A) and beta(B) immunoreactivity was rarely observed in the testis from PND 1 to 6. On the other hand, it was observed in some spermatogonial cells, as well as in the interstitial space between PND 48 and PND 120. We conclude that the expression of inhibin isotypes increases progressively in the testis of mice with increasing postnatal age, suggesting that inhibin is associated with a negative feedback signal for FSH in testicular maturation.
Aging/*physiology ; Animals ; Gene Expression Regulation/*physiology ; Inhibin-beta Subunits/genetics/*metabolism ; Inhibins/genetics/*metabolism ; Male ; Mice ; Mice, Inbred ICR ; Protein Isoforms/metabolism ; Protein Transport/*physiology ; Testis/*metabolism