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.

OBJECTIVE: To induce a mouse model of scleroderma with repeated bleomycin injections for research into human scleroderma at our research laboratory. METHODS: The protocol of Yamamoto et al. was replicated to establish the bleomycin-induced mouse model of scleroderma. RESULTS: A mouse model of scleroderma was induced by repeated subcutaneous injections of bleomycin. The dermal thickness increased with homogeneous and thickened collagen bundles. Semiquantitative measurements of dermal fibrosis were prominent in bleomycin-treated mice. CONCLUSION: A mouse model of scleroderma was induced with repeated injections of bleomycin at our laboratory.
Animals ; Bleomycin ; Collagen ; Fibrosis ; Humans ; Injections, Subcutaneous ; Mice ; Models, Animal

PURPOSE: To investigate the clinical effect and complications of patterned scanning laser photocoagulation with short exposure time in diabetic retinopathy. METHODS: A prospective study was performed on patients with diabetic retinopathy who required panretinal photocoagulation (PRP). Twenty-nine eyes of twenty five consecutive patients underwent patterned scanning laser photocoagulation with exposure time of 0.02 sec over the entire retina. Pain score at treatment, best-corrected visual acuity, the development of macular edema, regression of neovascularization in fluorescein angiography, and related complications were monitored during a three-month follow-up. RESULTS: Treatment time for PRP was much reduced to 6.1 min on the entire retina. Pain during the photocoagulation was moderate, and enabled patients to finish PRP with ease. During a three-month follow-up, visual acuity was well preserved. Foveal minimum thickness increased at 1 month after treatment and maintained in a study period of three months. Macular volume showed significant increase (3.6%) at 1 month after treatment, maximum increase (9.8%) at 2 months, and persistent increase (4.9%) at 3 months. In every patient with very severe nonproliferative diabetic retinopathy, retina was maintained, and in 10 of 18 eyes with proliferative diabetic retinopathy, neovascularization regressed during follow-up period. No significant complication occurred except a transient vitreous hemorrhage in one eye. CONCLUSIONS: Patterned scanning laser photocoagulation with short exposure time may induce transient macular edema, but the visual acuity was preserved without any other significant complication. It is considered to be a safe and efficient treatment method in diabetic retinopathy.
Diabetic Retinopathy ; Eye ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Light Coagulation ; Macular Edema ; Prospective Studies ; Retina ; Visual Acuity ; Vitreous Hemorrhage

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

Primary gastrointestinal lymphomas are quite rare with the stomach and small bowel being the most frequent site. Colon involvement is observed in only 10~20% of all gastrointestinal lymphomas. A colonic lymphoma presents with non-specific abdominal pain, weight loss, a change in bowel habits, bleeding, intestinal obstruction, intussusception and a palpable mass. A colonic lymphoma can be indicated using a barium enema, abdominal CT and colonoscopy. The correct diagnosis is obtained by a colonoscopic biopsy. We report a case of primary colonic non-Hodgkin's lymphoma with peritoneal carcinomatosis and a right pleural effusion.
Abdominal Pain ; Barium ; Biopsy ; Carcinoma* ; Colon* ; Colonoscopy ; Diagnosis ; Enema ; Hemorrhage ; Intestinal Obstruction ; Intussusception ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Pleural Effusion* ; Stomach ; Tomography, X-Ray Computed ; Weight Loss

BACKGROUND: Even after efficacious thrombolytic therapy in patients with acute myocardial infarction, ang-iographic studies demonstrated significant thrombotic remnants in many patients which makes it difficult to identify the morphological characteristics of the pure underlying plaque of the lesion. The purpose of the current study is to assess the morphological characteristics and calcification of the plaque, and the thrombi remnants in the occluded segments of infarct-related artery in acute myocardial infarction by intravascular ultrasound (IVUS). METHODS: Coronary angiography and IVUS studies for the infarct-related arteries were performed at about 6 days after the onset of chest pain in 22 patients (male 19 patients) with acute myocardial infarction (AMI). Fifteen patients had been treated with thrombolytics, and all patients received an intravenous infusion of heparin and oral aspirin. RESULTS: 1) Coronary angiography demonstrated total occlusion in 2 cases, and angiographic % diameter stenosis was 74.5+/-18.1%. 2) IVUS identified the soft plaque in 10 cases (45.5%) and the hard plaque with or without calcification (54.5%). Plaque rupture was observed in 4 cases, and in one case, slight depression of a part of the plaque without definite rupture suggestive of the plaque erosion was noted. Intraluminal echogenic material suggesting thrombi was documented in 8 (36.4%). 3) % Diameter and % luminal cross-sectional area stenosis on IVUS was 49.0+/-19.6% and 71.6+/-15.3%, respectively. The eccentricity index of the plaque was 3.1+/-1.7. 4) There was no complication during IVUS studies. CONCLUSIONS: IVUS studies in AMI were safe and feasible for identification of the morphological characteristics of the plaque like as plaque rupture and calcification, and presence of thrombi remnants, and it would contribute to decision making as regards the therapeutic measures according to the characteristics of the lesion.
Arteries ; Aspirin ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Decision Making ; Depression ; Heparin ; Humans ; Infusions, Intravenous ; Myocardial Infarction* ; Phenobarbital ; Rupture ; Thrombolytic Therapy ; Thrombosis ; Ultrasonography*

BACKGROUND: The several kinds of coronary stents have proven successful in their role to treat acute or subacute closures after balloon angioplasty as well as to reduce the restenosis rate in de novo lesions. However, investigations continue in order to develop an ideal stent with a strong, highly flexible, radial force, especially useful in cases of tortuous vessels, lesions at bends, and lesions distal to previously deployed stents. The NIR stent is a recently developed balloon-expandable, stainless-steel, slotted tube stent; it is designed for improved flexibility with a higher radial force when compared with the traditional Palmaz-Schatz stent. We report the immediate results of our experience with the NIR stent. The purpose of the present study was to assess the feasibility, safety and efficacy of the deployment of manually crimped NIR stents in patients with complex coronary anatomy as well as the clinical outcomes within the first month. METHODS: Between January and July 1997, 143 NIR stents were implanted in the coronary arteries of 124 patients (male 76%, mean age 56+/-10 years). Sixty-one patients had UAP, 43 had SA, and 20 patients had AMI. RESULTS: 1)Indications of stenting were de novo lesions in 123 (95%) and restenosis lesion in 6 (5%). 2)Frequency of used stent length was 16mm in 65 cases (46%), 32mm in 60 cases (42%), 25 mm in 12 cases (8%), and 9mm in 6 cases (4%). 3)Single stents were implanted in 115 (89%) lesions, and overlapping stenting with 2nd NIR stents in 14 (11%) lesions. 4)Procedural success rate (defined as the angiographically residual stenosis of <30% immediately after the procedure with no major clinical events within 4 weeks after the procedure) was 95.2% (118/124 pts). Angiographic success rate (defined as a residual stenosis of <30% without major dissection) was 96.1% (124/129 lesion). The procedural success rate and the angiographic success rate in calcified lesions and/or thrombi containing lesions were 100%. The procedural success rate and the angiographic success rate in cases of tortuous proximal vessels to the lesion were 91% and 91%, respectively. The procedural success rate and the angiographic success rate in more than 45 degrees angulated lesions were 98% and 94%, respectively. 5)The mean lumen diameter of target lesions was increased from 0.6+/-0.4mm to 3.1+/-0.5mm (p<0.001) after stent implantation. The percent of diameter stenosis was decreased from 82+/-12% to -1+/-13% (p<0.001) after stent implantation. The mean diameter of the reference artery was 3.1+/-0.6mm. 6)Incidence of peristent dissection after stenting was 6.2% (8/129 lesion). 7)The rate of stenting failure was 4.8% (6 pts). There were 2 cases of stent migration, 2 cases of failure to cross the lesion and 2 cases of procedure-related emergency CABG. CONCLUSION: There is a higher tendency for stent migration with manually crinped stents compared with that of premounted stents. However, coronary stenting with manually-crimped NIR stents can be safely performed and may be particularly useful in patients with unfavorable clinical and angiographic characteristics for percutaneous coronary intervention. Follow-up data is needed to assess long term patency of this stent.
Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Decompression Sickness ; Emergencies ; Follow-Up Studies ; Humans ; Percutaneous Coronary Intervention ; Pliability ; Stents*

OBJECTIVE: To investigate medical comorbidities and needs for medical and rehabilitation services of adults with cerebral palsy (CP) in Korea. METHODS: This was a prospective cross-sectional study. One hundred fifty-four adults with CP were enrolled in the study between February 2014 and December 2014. Information was obtained from participants regarding functional status, demographic and socioeconomic data, medical problems, and requirements for and utilization of medical and rehabilitation services. RESULTS: The participants included 93 males and 61 females with a mean age of 40.18±9.15 years. The medical check-up rate of adults with CP was lower than that of healthy adults and the total population with disabilities (53.2% vs. 58.6% vs. 70.4%). A quarter of the subjects failed to visit the hospital during the past year, and the main reason was the financial burden. Due to a cost burden and lack of knowledge, more than one-third of the subjects had unmet needs for rehabilitation services; the majority reported needs for rehabilitation services, such as physical therapy for pain management. CONCLUSION: The medical check-up rate was lower in the adults with CP, even though their medical comorbidities were not less than those of healthy people. Several non-medical reasons hindered them from receiving proper medical and rehabilitation services. Such barriers should be managed effectively.
Adult* ; Cerebral Palsy* ; Comorbidity ; Cross-Sectional Studies ; Female ; Humans ; Korea* ; Male ; Pain Management ; Prospective Studies ; Rehabilitation*

We recently established a novel disease entity presented as progressive respiratory failure associated with the inhalation of humidifier disinfectants. In April 2011, we encountered a series of peripartum patients with complaints of respiratory distress of unknown etiology, which was an uncommon phenomenon. Accordingly, we created a multidisciplinary team comprising intensivists, radiologists, pathologists, epidemiologists, and the Korea Centers for Disease Control and Prevention (KCDC). Further, we defined the disease entity and performed a case-control study, epidemiologic investigation, and animal study to determine the etiology. The study findings indicated that the lung injury outbreak was related to the inhalation of humidifier disinfectants and showed that household chemical inhalation can cause severe respiratory failure. Following the withdrawal of humidifier disinfectants from the Korean market in 2012, no such cases were reported. This tragic event is a warning that appropriate safety regulations and monitoring for potential toxic household chemicals are critical to protect public health.
Adult* ; Animals ; Case-Control Studies ; Centers for Disease Control and Prevention (U.S.) ; Disinfectants* ; Family Characteristics ; Humans ; Humidifiers* ; Inhalation* ; Korea ; Lung Injury* ; Lung* ; Peripartum Period ; Public Health ; Respiratory Insufficiency ; Social Control, Formal