Background/Aims: We investigated how interactions between humans and computer-aided detection (CADe) systems are influenced by the user’s experience and polyp characteristics. Methods: We developed a CADe system using YOLOv4, trained on 16,996 polyp images from 1,914 patients and 1,800 synthesized sessile serrated lesion (SSL) images. The performance of polyp detection with CADe assistance was evaluated using a computerized test module. Eighteen participants were grouped by colonoscopy experience (nurses, fellows, and experts). The value added by CADe based on the histopathology and detection difficulty of polyps were analyzed. Results: The area under the curve for CADe was 0.87 (95% confidence interval [CI], 0.83 to 0.91). CADe assistance increased overall polyp detection accuracy from 69.7% to 77.7% (odds ratio [OR], 1.88; 95% CI, 1.69 to 2.09). However, accuracy decreased when CADe inaccurately detected a polyp (OR, 0.72; 95% CI, 0.58 to 0.87). The impact of CADe assistance was most and least prominent in the nurses (OR, 1.97; 95% CI, 1.71 to 2.27) and the experts (OR, 1.42; 95% CI, 1.15 to 1.74), respectively. Participants demonstrated better sensitivity with CADe assistance, achieving 81.7% for adenomas and 92.4% for easy-to-detect polyps, surpassing the standalone CADe performance of 79.7% and 89.8%, respectively. For SSLs and difficult-to-detect polyps, participants' sensitivities with CADe assistance (66.5% and 71.5%, respectively) were below those of standalone CADe (81.1% and 74.4%). Compared to the other two groups (56.1% and 61.7%), the expert group showed sensitivity closest to that of standalone CADe in detecting SSLs (79.7% vs 81.1%, respectively). Conclusions CADe assistance boosts polyp detection significantly, but its effectiveness depends on the user’s experience, particularly for challenging lesions.

Background/Aims: We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease- modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. Methods: A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). Results: Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. Conclusions Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

No abstract available.
B-Lymphocytes* ; Bone Marrow* ; Genes, Immunoglobulin* ; Immunoglobulins* ; Lymphoma, Non-Hodgkin* ; Multiplex Polymerase Chain Reaction*

BACKGROUND: We comprehensively profiled cytogenetic abnormalities in multiple myeloma (MM) and analyzed the relationship between cytogenetic abnormalities of undetermined prognostic significance and established prognostic factors. METHODS: The karyotype of 333 newly diagnosed MM cases was analyzed in association with established prognostic factors. Survival analysis was also performed. RESULTS: MM with abnormal karyotypes (41.1%) exhibited high international scoring system (ISS) stage, frequent IgA type, elevated IgG or IgA levels, elevated calcium levels, elevated creatine (Cr) levels, elevated β2-microglobulin levels, and decreased Hb levels. Structural abnormalities in chromosomes 1q, 4, and 13 were independently associated with elevated levels of IgG or IgA, calcium, and Cr, respectively. Chromosome 13 abnormalities were associated with poor prognosis and decreased overall survival. CONCLUSIONS: This is the first study to demonstrate that abnormalities in chromosomes 1q, 4, and 13 are associated with established factors for poor prognosis, irrespective of the presence of other concurrent chromosomal abnormalities. Chromosome 13 abnormalities have a prognostic impact on overall survival in association with elevated Cr levels. Frequent centromeric breakpoints appear to be related to MM pathogenesis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Calcium/blood ; *Chromosome Aberrations ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 13 ; Chromosomes, Human, Pair 4 ; Creatine/blood ; Female ; Hemoglobins/analysis ; Humans ; Immunoglobulin A/blood ; Immunoglobulin G/blood ; Karyotyping ; Male ; Middle Aged ; Multiple Myeloma/*diagnosis/genetics/mortality ; Multivariate Analysis ; Prognosis ; Survival Rate ; Young Adult

BACKGROUND: Rotavirus is the leading cause of acute viral gastroenteritis, particularly in children, and is transmitted through the fecal-to-oral route by contaminated food or the environment. This study examined the contamination of the inner surfaces of domestic refrigerators with pathogens causing gastroenteritis. METHODS: Swab specimens from shelf surfaces of freezers and refrigerators were collected from 10 domestic refrigerators. Multiplex PCR for bacterial and viral pathogens causing acute gastroenteritis was performed. The VP7 and VP4 genes of rotavirus were amplified and then analyzed by DNA sequencing. RESULTS: Rotavirus was detected in five domestic refrigerators in the same apartment complex. All rotavirus samples showed the G1 genotype and the same DNA sequences. No pathogens causing acute gastroenteritis were identified in the other five domestic refrigerators. CONCLUSIONS: The inner surfaces of domestic refrigerators can be contaminated with pathogens causing acute gastroenteritis, such as rotavirus. Attention should be given to the hygiene of refrigerators. To estimate the contamination or hygienic status for food storage, testing for viral pathogens combined with ordinary bacterial cultures may be necessary.
Base Sequence ; Child ; Food Storage ; Foodborne Diseases ; Gastroenteritis ; Genotype ; Humans ; Hygiene ; Multiplex Polymerase Chain Reaction ; Rotavirus* ; Sequence Analysis, DNA

OBJECTIVE: The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria. METHODS: Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement. RESULTS: Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP). CONCLUSION: Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.
Arthritis, Rheumatoid ; Biological Products ; Biopsy ; Humans ; National Health Programs

PURPOSE: The accuracy of a gypsum model (GM), which was taken using a conventional silicone impression technique, was compared with that of a polyurethane model (PM), which was taken using an iTero(TM) digital impression system. MATERIALS AND METHODS: The maxillary first molar artificial tooth was selected as the reference tooth. The GMs were fabricated through a silicone impression of a reference tooth, and PMs were fabricated by a digital impression (n=9, in each group). The reference tooth and experimental models were scanned using a 3 shape convince(TM) scan system. Each GM and PM image was superimposed on the registered reference model (RM) and 2D images were obtained. The discrepancies of the points registered on the superimposed images were measured and defined as GM-RM group and PM-RM group. Statistical analysis was performed using a Student's T-test (alpha=0.05). RESULTS: A comparison of the absolute value of the discrepancy revealed a significant difference between the two groups only at the occlusal surface. The GM group showed a smaller mean discrepancy than the PM group. Significant differences in the GM-RM group and PM-RM group were observed in the margins (point a and f), mesial mid-axial wall (point b) and occlusal surfaces (point c and d). CONCLUSION: Under the conditions examined, the digitally fabricated polyurethane model showed a tendency for a reduced size in the margin than the reference tooth. The conventional gypsum model showed a smaller discrepancy on the occlusal surface than the polyurethane model.
Calcium Sulfate* ; Models, Theoretical ; Molar ; Polyurethanes* ; Silicones ; Tooth ; Tooth, Artificial

BACKGROUND: The heme oxygenase-1 gene (HMOX1) promoter polymorphisms modulate its transcription in response to oxidative stress. This study screened for HMOX1 polymorphisms and investigated the association between HMOX1 polymorphisms and coronary artery disease (CAD) in the Korean population. METHODS: The study population consisted of patients with CAD with obstructive lesions (n=110), CAD with minimal or no lesions (n=40), and controls (n=107). Thirty-nine patients with CAD with obstructive lesions underwent follow-up coronary angiography after six months for the presence of restenosis. The 5'-flanking region containing (GT)n repeats of the HMOX1 gene was analyzed by PCR. RESULTS: The numbers of (GT)n repeats in the HMOX1 promoter showed a bimodal distribution. The alleles were divided into two subclasses, S25 and L25, depending on whether there were less than or equal to and more than 25 (GT)n repeats, respectively. The allele and genotype frequencies among groups were statistically not different. More subjects in the S25-carrier group had the low risk levels of high sensitivity C-reactive protein (hsCRP) for the CAD than those in the non-S25 carrier group (P=0.034). Multivariate logistic regression analysis revealed that the genotypes of (GT)n repeats were not related to CAD status. The restenosis group in the coronary angiography follow-up did not show any significant difference in HMOX1 genotype frequency. CONCLUSIONS: The HMOX1 genotypes were not found to be associated with CAD, but the short allele carrier group contained more individuals with hsCRP values reflecting low risk of cardiovascular disease in the Korean population.
5' Untranslated Regions ; Adult ; Alleles ; Asian Continental Ancestry Group/*genetics ; C-Reactive Protein/analysis ; Coronary Angiography ; Coronary Artery Disease/*genetics/pathology ; Coronary Restenosis/complications/therapy ; Dinucleotide Repeats/genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Heme Oxygenase-1/*genetics ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Republic of Korea ; Risk Factors

BACKGROUND: The intestinal microflora varies according to the factors such as age, diet and environment. It is debated whether the changes of microbiota after birth are associated with atopic disease. The purpose of this study was to investigate colonization rates of some intestinal microflora during the initial 9 months after birth, and their association with the development of atopy. METHODS: Stool specimens were collected at 1, 3, 7 days and at 1, 2, 4, 6, 9 months after birth, and Escherichia coli, Lactobacillus, Bifidobacterium, Staphylococcus aureus were cultured with selective media. Diagnosis for atopy was accomplished via clinical history of atopy, serum total IgE, and skin prick test. RESULTS: By 12 months of age, among 48 infants, 36 (75.0%) were non-atopic while 12 (25.0%) had developed atopy. Although not statistically significant, the intestinal microflora of infants with atopy vs. non-atopy was characterized by being less often colonized with E. coli (12.5% vs. 52.4%; P=0.093) and S. aureus (0% vs. 38.1%; P=0.066) at three days after birth. Colonization rates of E. coli reached 50% after 3 days of birth in non-atopy group whereas this rate was not achieved until after 1 month in the atopy group. CONCLUSION: The intestinal colonization rates of bacteria in this study were not statistically different between atopy and non-atopy groups. Rapid colonization of E. coli and S. aureus was observed within 1 week after birth in the non-atopy group. The exact association between atopy and the bacterial colonization and/or diversity in the early days after birth has yet to be determined.
Bacteria ; Bifidobacterium ; Colon ; Diagnosis ; Diet ; Escherichia coli ; Humans ; Immunoglobulin E ; Infant* ; Lactobacillus ; Microbiota ; Parturition ; Skin ; Staphylococcus aureus

Translocation between chromosomes 1 and 19 is well documented in ALL. Here, we report a case of refractory anemia with ring sideroblasts associated with marked thrombocytosis with der(19)t(1;19). A 67-yr-old man was admitted to our hospital with anemia and thrombocytosis. The aspirated bone marrow showed erythroid and megakaryocytic hyperplasia and dyspoiesis. Iron staining showed that the ring sideroblasts increased in number. Bone-marrow cell karyotyping showed 46,XY,der(19)t(1;19)(q23;p13)[9]/46,XY,del(5)(q21)[2]/46,XY[9]. PCR analysis showed the absence of the TCF3-PBX1 rearrangement. The patient was treated with hydroxyurea and intermittent blood transfusion. It is known that t(1;19)(q23;p13) leads to a TCF3-PBX1 fusion gene, whose product is a powerful transcriptional activator that plays a key role in the development of ALL. However, t(1;19) has rarely been reported in myeloid neoplasms and the TCF3-PBX1 fusion gene has not been detected. This implies that other genes might be involved in the TCF3-PBX1 rearrangement, or an alternative TCF3-PBX1 fusion transcript with a different breakpoint has not been detected to date. Further research and case studies, including the use of molecular analysis techniques, are required to evaluate the clinical and prognostic significance of t(1;19) in the development of myeloid neoplasms.
Anemia ; Anemia, Refractory ; Blood Transfusion ; Bone Marrow ; Humans ; Hydroxyurea ; Hyperplasia ; Iron ; Karyotyping ; Polymerase Chain Reaction ; Thrombocytosis