We developed security function modules based DICOM standard, including Secure Connection of TLS, Digital Signature, and Media Security of CMS. Using DICOM standard security functions, medical equipment, modality, and PACS software are able to communicate and exchange information safely without sacrifice for the compatibility. TLS enables secure connection between modality. Digital Signature guarantees data integrity and authentication based on PKI technology. Lastly, CMS algorithm provides how to encrypt DICOM File based on Media Storage Security. Signed and encrypted images are only to be decrypted by patient or who has authority, and it is to be proved that those images are not changed.
Humans

Background and Objectives: Little is known about studies evaluating positive airway pressure (PAP) compliance after re-prescription. Therefore, the aim of this study was to investigate PAP compliance after re-prescription in obstructive sleep apnea (OSA) patients who failed initial PAP therapy. Methods: We retrospectively reviewed OSA patients who had received a re-prescription for PAP from March 2020 to June 2021. We compared the compliance rate between initial prescription and re-prescription for PAP and investigated the reasons for PAP failure after the first prescription. Results: A total of 10 consecutive OSA patients (mean age=45.6±13.7 years and male:female=8:2) who received a re-prescription for PAP were included. Of them, 8 patients (80%) met the compliance criteria (i.e., Korean National Health Insurance criteria) for PAP after re-prescription. The compliance rate increased from 36.3±18.2% (initial prescription) to 61.3±28.8% (re-prescription); this was not of statistical significance (p=0.074). PAP/mask-related discomfort was the most common reason for PAP failure, followed by nasal obstruction, unintentional mask removal, and pressure-related discomfort. Conclusion Even if initial PAP therapy fails, the proportion of patients who meet the compliance criteria may be improved through various forms of clinical aid and support after re-prescription of PAP.

Noonan syndrome is a condition involving facial, cardiovascular and skeletal abnormalities that may pose problems to anesthesiologists during surgery. Propofol, which is used as an induction agent for noncardiac surgery, produces little or no change in the heart rate. Remifentanil decreases the sympathetic and somatic responses to noxious stimuli and can be given in high doses without negative inotropic effects. We report successful management of a patient with Noonan syndrome, hypertrophic cardiomyopathy, and atrial fibrillation, undergoing laparoscopic cholecystectomy using the the total intravenous anesthesia with propofol and remifentanil.
Anesthesia, Intravenous* ; Atrial Fibrillation ; Cardiomyopathy, Hypertrophic ; Cholecystectomy, Laparoscopic ; Heart Rate ; Humans ; Noonan Syndrome* ; Propofol

Human immunodeficiency virus (HIV), when infected causes various systemic changes and is the cause of the fatal disease called acquired immune deficiency syndrome (AIDS). With the sharp increase of infection in women, pregnancy can be complicated by HIV infection. Although there have been astonishing developments in therapy there are still many risks in the pregnant HIV patients. The anesthetic management will depend on the patients clinical status, current treatment as well as the well-being of the fetus. We report a case of spinal anesthesia in a 36-year-old pregnant HIV patient undergoing cesarean section.
Acquired Immunodeficiency Syndrome ; Adult ; Anesthesia, Spinal ; Cesarean Section* ; Female ; Fetus ; HIV Infections ; HIV* ; Humans ; Pregnancy

Purpose: This study was conducted to develop a convolutional neural network (CNN) algorithm that can diagnose cervical foraminal stenosis using oblique radiographs and evaluate its accuracy. Materials and Methods: A total of 997 patients who underwent cervical MRI and cervical oblique radiographs within a 3-month interval were included. Oblique radiographs were labeled as “foraminal stenosis” or “no foraminal stenosis” according to whether foraminal stenosis was present in the C2–T1 levels based on MRI evaluation as ground truth. The CNN model involved data augmentation, image preprocessing, and transfer learning using DenseNet161. Visualization of the location of the CNN model was performed using gradient-weight class activation mapping (Grad-CAM). Results: The area under the curve (AUC) of the receiver operating characteristic curve based on DenseNet161 was 0.889 (95% confidence interval, 0.851–0.927). The F1 score, accuracy, precision, and recall were 88.5%, 84.6%, 88.1%, and 88.5%, respectively.The accuracy of the proposed CNN model was significantly higher than that of two orthopedic surgeons (64.0%, p<0.001; 58.0%, p<0.001). Grad-CAM analysis demonstrated that the CNN model most frequently focused on the foramen location for the determination of foraminal stenosis, although disc space was also frequently taken into consideration. Conclusion A CNN algorithm that can detect neural foraminal stenosis in cervical oblique radiographs was developed. The AUC, F1 score, and accuracy were 0.889, 88.5%, and 84.6%, respectively. With the current CNN model, cervical oblique radiography could be a more effective screening tool for neural foraminal stenosis.

PURPOSE: To evaluate results at three months postoperatively on patient satisfaction and preoperative clinical factors affecting patient satisfaction after implantation of an AcrySof ReSTOR intraocular lens (IOL). METHODS: Thirty-three eyes of 33 patients who underwent implantation of spheric/aspheric AcrySof ReSTOR IOL at the Samsung Medical Center of Korea were enrolled in the present study. The uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and refractive error were recorded preoperatively and three months after surgery. A questionnaire to assess patient satisfaction was created (score range: 1-5, 5 being the maximum score). Patient age, preoperative UCDVA, BCDVA, corneal astigmatism, and asphericity of IOL were selected as preoperative factors influencing patient satisfaction. RESULTS: One hundred percent and 93.9% of the patients achieved UCDVA and BCDVA of 20/25 or better, respectively. The overall patient satisfaction score was 3.9+/-1.0/4.5+/-0.7 (p=0.073) and the score of intent to recommend ReSTOR IOL to others was 3.7+/-1.0/4.5+/-0.6 (p=0.013) with the spheric/aspheric IOL, respectively. The age of patients was negatively correlated with the score of overall satisfaction and the intent to recommend the procedure to others (p=0.024, 0.031). The overall patient satisfaction and intent to recommend of the patients who were less than 55 years old were significantly higher than those of the older patients (p=0.032, 0.039). CONCLUSIONS: High UCDVA and BCDVA resulted from the implantation of ReSTOR IOL. The younger the patients were, the higher the resulting patient satisfaction. Implantation of ReSTOR IOL in young patients is recommended.
Astigmatism ; Eye ; Humans ; Korea ; Lenses, Intraocular ; Patient Satisfaction ; Surveys and Questionnaires ; Refractive Errors ; Visual Acuity

Foreign body (FB) aspiration remains a serious health problem, particularly in children. The complications due to occlusion by FB or related to procedures for removal can lead to morbidity and mortality. Most of the FBs are located in the unilateral bronchus, however, the organic FB can be multiple or bilaterally located when children chewed the FB. Here, we present a case of successful retrieval of bilateral bronchial FBs. Preoperatively, FB in the left main bronchus was diagnosed, however, FB of the right upper bronchus was not definitive on X-ray and CT scan. During the rigid bronchoscopy, occult FB in the right upper bronchus was detected and successfully removed.

Purpose: An optimal once-daily radiotherapy (RT) regimen is under investigation for definitive concurrent chemoradiotherapy (CCRT) in limited disease small cell lung cancer (LD-SCLC). We compared the efficacy and safety of dose escalation with intensity-modulated radiotherapy (IMRT). Materials and Methods: Between January 2016 and March 2021, patients treated with definitive CCRT for LD-SCLC with IMRT were retrospectively reviewed. Patients who received a total dose <50 Gy or those with a history of thoracic RT or surgery were excluded. The patients were divided into two groups (standard and dose-escalated) based on the total biologically effective dose (BED, α/β = 10) of 70 Gy. The chemotherapeutic regimen comprised four cycles of etoposide and cisplatin. Results: One hundred and twenty-two patients were analyzed and the median follow-up was 27.8 months (range, 4.4 to 76.9 months). The median age of the patients was 63 years (range, 35 to 78 years) and the majority had a history of smoking (86.0%). The 1- and 3-year overall survival rates of the escalated dose group were significantly higher than those of the standard group (93.5% and 50.5% vs. 76.7% and 33.3%, respectively; p = 0.008), as were the 1- and 3-year freedom from in-field failure rates (91.4% and 66.5% vs. 73.8% and 46.9%, respectively; p = 0.018). The incidence of grade 2 or higher acute and late pneumonitis was not significantly different between the two groups (p = 0.062, 0.185). Conclusion Dose-escalated once-daily CCRT with IMRT led to improved locoregional control and survival, with no increase in toxicity.

Purpose: Surface-guided radiation therapy is an image-guided method using optical surface imaging that has recently been adopted for patient setup and motion monitoring during treatment. We aimed to determine whether the surface guide setup is accurate and efficient compared to the skin-marking guide in prostate cancer treatment. Materials and Methods: The skin-marking setup was performed, and vertical, longitudinal, and lateral couch values (labeled as "M") were recorded. Subsequently, the surface-guided setup was conducted, and couch values (labeled as "S") were recorded. After performing cone-beam computed tomography (CBCT), the final couch values was recorded (labeled as "C"), and the shift value was calculated (labeled as "Gap (M-S)," "Gap (M-C)," "Gap (S-C)") and then compared. Additionally, the setup times for the skin marking and surface guides were also compared. Results: One hundred and twenty-five patients were analyzed, totaling 2,735 treatment fractions. Gap (M-S) showed minimal differences in the vertical, longitudinal, and lateral averages (-0.03 cm, 0.07 cm, and 0.06 cm, respectively). Gap (M-C) and Gap (S-C) exhibited a mean difference of 0.04 cm (p = 0.03) in the vertical direction, a mean difference of 0.35 cm (p = 0.52) in the longitudinal direction, and a mean difference of 0.11 cm (p = 0.91) in the lateral direction. There was no correlation between shift values and patient characteristics. The average setup time of the skin-marking guide was 6.72 minutes, and 7.53 minutes for the surface guide. Conclusion There was no statistically significant difference between the surface and skin-marking guides regarding final CBCT shift values and no correlation between translational shift values and patient characteristics. We also observed minimal difference in setup time between the two methods. Therefore, the surface guide can be considered an accurate and time-efficient alternative to skin-marking guides.

OBJECTIVE: The present study aimed to investigate predictors for planned suicide attempters. METHODS: This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS: Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION: The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.
Depression ; Depressive Disorder, Major ; Divorce ; Emergency Service, Hospital ; Hope ; Humans ; Impulsive Behavior ; Mass Screening ; Psychopathology ; Risk Factors* ; Substance-Related Disorders ; Suicidal Ideation ; Suicide* ; Suicide, Attempted ; Widowhood