Objective: The aim of the present study was to investigate the influence of comorbid oppositional defiant disorder (ODD) on clinical features and neuropsychological profiles of children with attention-deficit/hyperactivity disorder (ADHD). Methods: We divided the participants into three groups: the ADHD with ODD (ADHD/ODD) (n=36), ADHD without ODD (ADHDoODD) (n=307), and control groups (n=128). Parents of the participants completed the ADHD Rating Scale, Social Responsiveness Scale (SRS), Korean Personality Rating Scale for Children (K-PRC), and 10-item mania scale from the Parent General Behavior Inventory (P-GBI-10M). Neuropsychological profiles were assessed using the Advanced Test of Attention (ATA), Children’s Color Trails Test, and Stroop Color and Word Test. Results: The ADHD/ODD group had more ADHD symptoms and functional impairments in relationships with teachers and peers, and self-esteem than the ADHDoODD group. The ADHD/ODD group scored higher in Social Communication (p<0.001) and Autistic Mannerisms (p<0.001) subscales of SRS, P-GBI-10M (p<0.001), and Delinquency (p<0.001) and Psychosis (p<0.001) subscales of K-PRC than the ADHDoODD group. Commission Errors (p<0.001) and Response-Time Variability (p<0.001) in Visual ATA and Commission Errors (p<0.001) in Auditory ATA were significantly higher in the ADHD/ODD group than in the ADHDoODD group. Conclusion The present study suggests that patients with ADHD with ODD experience more ADHD symptoms and neuropsychological deficits than those with ADHD without ODD. These results also imply that comorbid ODD is associated with greater social impairment and emotional dysregulation.

Objective: Mobile-based cognitive training programs can be a viable alternative to in-person interventions, but their efficacies have not been established yet. In this study, we examined the efficacy of DoBrain, a mobile-based cognitive training program designed for children with developmental disabilities (DDs), in comparison with general educational apps named Junior Naver and Kakao Kids. Methods: Children aged 34 to 77 months were recruited and randomized at a 1:1 ratio to use DoBrain or general educational apps. Each group used the assigned app on a daily basis at home for 30 minutes for 24 weeks. Parents were instructed to help the children with the app usage. A total of 166 children completed the post-test visit (DoBrain group, n=85, 55.4±8.7 months old; general educational app group, n=81, 53.7±9.9 months old). The primary outcome was cognitive development measured by Psychoeducational Profile-Revised (PEP-R), administered at baseline and at post-test. Results: DoBrain had no superior effect over general educational apps on the PEP-R Developmental Quotient. When the changes before and after app usage were compared, the DoBrain group and the general educational app group both showed declines in imitation (adjusted p=0.049 and 0.022), perception (adjusted p=0.004 and <0.001), and gross motor (adjusted p=0.003 and 0.002) domains of the PEP-R. Among the DoBrain group, children with DD showed a significantly greater gain in the eye-hand coordination domain of PEP-R compared with those without DD (adjusted p=0.047). Conclusion DoBrain did not show a superior effect over general educational apps on overall cognitive development in preschool children, regardless of the presence of DD. Careful monitoring of the negative effect of mobile-based cognitive training programs is necessary.

Objectives: This study aimed to compare the utility of the Psychoeducational Profile-Revised (PEP-R), Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (K-WPPSI-IV), and Vineland Adaptive Behavior Scale, Second Edition (VABS-II) for evaluating developmental disabilities (DD) in preschool children. Additionally, we examined the correlations between the PEP-R, KWPPSI-IV, and VABS-II. Methods: A total of 164 children aged 37–84 months were assessed. Children’s development was evaluated using the PEP-R, K-WPPSIIV, VABS-II, Preschool Receptive-Expressive Language Scale, and Korean Childhood Autism Rating Scale, Second Edition. Results: Of the 164 children, 103 had typical development (TD) and 61 had DD. The mean of the PEP-R Developmental Quotient (DQ), K-WPPSI-IV Full-Scale Intelligence Quotient (FSIQ), and VABS-II Adaptive Behavior Composite (ABC) scores were significantly higher in the TD group than in the DD group (p<0.001). The estimated area under the curve of the PEP-R DQ, K-WPPSI-IV FSIQ, and VABS-II ABC scores was 0.953 (95% confidence interval [CI]=0.915–0.992), 0.955 (95% CI=0.914–0.996), and 0.961 (95% CI=0.932– 0.991), respectively, which did not indicate a statistically significant difference. The PEP-R DQ scores were positively correlated with the K-WPPSI-IV FSIQ (r=0.90, p<0.001) and VABS-II ABC scores (r=0.84, p<0.001). A strong correlation was observed between the KWPPSI-IV FSIQ and VABS-II ABC scores (r=0.89, p<0.001). Conclusion This study found that the PEP-R, K-WPPSI-IV, and VABS-II effectively distinguished DD from TD in preschool children, and no significant differences in utility were observed between them.

Objective: Studies on the early trajectories of developmental disability (DD) are limited. This study aimed to evaluate the diagnostic stability and developmental trajectories of autism spectrum disorder (ASD) and intellectual disability (ID), and to determine baseline clinical characteristics that affect future diagnosis. Methods: We analyzed 192 children who were referred for possible DD through retrospective chart review. Clinical diagnosis was assessed once at baseline, aged 2–4, and at follow-up, aged 4–6. The participants’ developmental profiles were measured by Psychoeducational Profile-Revised (PEP-R), Vineland Social Maturity Scale (VSMS), Beery-Buktenica Developmental Test of Visual Motor Integration (VMI), and Childhood Autism Rating Scale (CARS). Results: On comparing the diagnostic change, 5% of children were no longer diagnosed as ASD, and 13% of children were no longer diagnosed as ID at follow-up. Trajectories of developmental profiles were compared between children with and without ID at follow-up, and significant time-by-group interaction were observed in PEP-R (p<0.001), VSMS (p<0.001), and VMI (p=0.003) scores, indicating that children without ID at follow-up showed significant improvement over time compared to children with ID. ASD diagnosis (p<0.001) and CARS score (p=0.007) at baseline were significantly associated with ASD at follow-up, while VSMS score (p=0.004) and VMI score (p=0.019) at baseline were significantly associated with ID at follow-up. Conclusion A subset of children lost their diagnosis at follow-up, and such diagnostic change was significantly more common in ID compared to ASD. Baseline autism symptomatology was related to ASD at follow-up, and baseline adaptive and visuo-motor function was related to ID at follow-up.

Objective: Investigation of new drugs (INDs) is a tremendously inefficient process in terms of time and cost. Drug repositioning is another method used to investigate potential new agents in well-known drugs. This study assessed the survival impact of metformin medication on ovarian cancer. Methods: A national sample cohort of the Korean National Health Insurance Service Data was analyzed. Cox proportional hazards regression was used to analyzing hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for underlying diseases and medications as confounding factors for overall survival (OS) and cancer-specific survival (CSS). Results: A total of 866 eligible patients were included from among 1,025,340 cohort participants. Among them, 101 (11.7%) were metformin users. No difference in OS was observed between non-users and users. No difference in OS was observed according to age and Charlson Comorbidity Index. Long-term metformin use (≥720 days) was associated with better OS (adjusted HR=0.244; 95% CI=0.090–0.664; p=0.006). A multivariate Cox proportional hazards model showed that long-term metformin use was an independent favorable prognostic factor for OS (HR=0.193; 95% CI=0.070–0.528; p=0.001) but not for CSS (HR=0.599; 95% CI=0.178–2.017; p=0.408). Conclusion Long-term metformin use reduced all-cause mortality, but not CSS in ovarian cancer. Whether metformin itself reduces deaths because of ovarian cancer requires further investigation.

Purpose: Although endovascular aneurysm repair (EVAR) has been shown to be superior to open surgical repair (OSR) for abdominal aortic aneurysm (AAA) treatment, no large-scale studies in the Korean population have compared outcomes and costs. Methods: The National Health Insurance Service database in Korea was screened to identify AAA patients treated with EVAR or OSR from 2008 to 2019. Perioperative, early postoperative, and long-term survival were compared, as were reinterventions and complications. Patients were followed-up through 2020. Results: Of the 13,631 patients identified, 2,935 underwent OSR and 10,696 underwent EVAR. Perioperative mortality rate was lower in the EVAR group (4.2% vs. 8.0%, P < 0.001) even after excluding patients with ruptured AAA (2.7% vs.3.3%, P = 0.003). However, long-term mortality rate per 100 person-years was significantly higher in the EVAR than in the OSR group (9.0 vs. 6.4, P < 0.001), and all-cause mortality was lower in the OSR group (hazard ratio, 0.9; 95% confidence interval, 0.87–0.97, P = 0.008). EVAR had a higher AAA-related reintervention rate per 100 person-years (1.75 vs. 0.52), and AAA-related reintervention costs were almost 10-fold higher with EVAR (US dollar [USD] 6,153,463) than with OSR (USD 624,216). Conclusion While EVAR may have short-term advantages, OSR may provide better long-term outcomes and costeffectiveness for AAA treatment in the Korean population, under the medical expense system in Korea.

Background: Ruptured abdominal aortic aneurysm (rAAA) is a serious complication of abdominal aortic aneurysm associated with high operative mortality and morbidity rates. The present study evaluated the perioperative and long-term outcomes of Korean patients with rAAA based on national health insurance claims data. Methods: The National Health Insurance Service (NHIS) database was searched retrospectively to identify patients with rAAA who underwent endovascular aneurysm repair (EVAR) and open surgical repair (OSR) from 2009 to 2018. Perioperative (≤ 30 days), early postoperative (≤ 3 month), and long-term (> 3 month) survival, reinterventions, and complications were assessed. Results: The search identified 1,034 patients with rAAA, including 594 who underwent EVAR and 440 who underwent OSR. When the study period was divided into two, the total numbers of patients with rAAA, patients who underwent EVAR, and octogenarians were higher during the second half. The perioperative mortality rate was 29.8% in the EVAR and 35.0% in the OSR group (P = 0.028). Hartmann’s procedure for bowel infarction was performed more frequently in the OSR than in the EVAR group (adjusted odds ratio, 6.28; 95% confidence interval [CI], 2.33–21.84; P = 0.001), but other complication rates did not differ significantly. All-cause mortality during the entire observation period did not differ significantly in the EVAR and OSR groups (adjusted hazard ratio, 1.17; 95% CI, 0.98–1.41; P = 0.087). Abdominal aortic aneurysm-related reintervention rate was significantly lower in the OSR group (adjusted hazard ratio, 0.31; 95% CI, 0.14–0.70; P = 0.005). Conclusion Although EVAR showed somewhat superior perioperative outcomes for rAAA, the long-term outcomes of EVAR after excluding initial 3 months were significantly worse than OSR. When anatomically feasible for both treatments, the perioperative mortality risk and reasonable prospects of long-term survival should be considered in rAAA.

Objective: To evaluate the diagnostic performance and image quality of 1.5-mm slice thickness MRI with deep learningbased image reconstruction (1.5-mm MRI + DLR) compared to routine 3-mm slice thickness MRI (routine MRI) and 1.5-mm slice thickness MRI without DLR (1.5-mm MRI without DLR) for evaluating temporal lobe epilepsy (TLE). Materials and Methods: This retrospective study included 117 MR image sets comprising 1.5-mm MRI + DLR, 1.5-mm MRI without DLR, and routine MRI from 117 consecutive patients (mean age, 41 years; 61 female; 34 patients with TLE and 83 without TLE). Two neuroradiologists evaluated the presence of hippocampal or temporal lobe lesions, volume loss, signal abnormalities, loss of internal structure of the hippocampus, and lesion conspicuity in the temporal lobe. Reference standards for TLE were independently constructed by neurologists using clinical and radiological findings. Subjective image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed. Performance in diagnosing TLE, lesion findings, and image quality were compared among the three protocols. Results: The pooled sensitivity of 1.5-mm MRI + DLR (91.2%) for diagnosing TLE was higher than that of routine MRI (72.1%, P < 0.001). In the subgroup analysis, 1.5-mm MRI + DLR showed higher sensitivity for hippocampal lesions than routine MRI (92.7% vs. 75.0%, P = 0.001), with improved depiction of hippocampal T2 high signal intensity change (P = 0.016) and loss of internal structure (P < 0.001). However, the pooled specificity of 1.5-mm MRI + DLR (76.5%) was lower than that of routine MRI (89.2%, P = 0.004). Compared with 1.5-mm MRI without DLR, 1.5-mm MRI + DLR resulted in significantly improved pooled accuracy (91.2% vs. 73.1%, P = 0.010), image quality, SNR, and CNR (all, P < 0.001). Conclusion The use of 1.5-mm MRI + DLR enhanced the performance of MRI in diagnosing TLE, particularly in hippocampal evaluation, because of improved depiction of hippocampal abnormalities and enhanced image quality.

PURPOSE: Although the standard treatment for patients with locally advanced rectal cancer managed by preoperative chemoradiotherapy (CRT) is a radical resection, local excisions are used in highly-selective cases. Recently, transanal minimally-invasive surgery (TAMIS) has emerged as a feasible technique for local excision of midrectal lesions. We assess the feasibility of using TAMIS to treat patients with locally advanced rectal cancer who showed good response to CRT. METHODS: From October 2010 to June 2013, 35 consecutive patients with rectal cancer managed by using preoperative CRT underwent TAMIS. After a single-incision laparoscopic surgery port had been introduced into the anal canal, a full-thickness local excision with conventional laparoscopic instruments was performed. We retrospectively reviewed a prospectively collected database of these cases. RESULTS: Of the 35 patients analyzed, 18 showed pathologic complete responses and 17 had residual lesions (2 ypTis, 4 ypT1, 9 ypT2, and 2 ypT3); 34 (97.1%) showed clear deep, lateral margins. The median distance of lesions from the anal verge was 5 cm. All procedures were completed laparoscopically, and the median operating time was 84 minutes. No intraoperative events or morbidities were seen in any of the patients, except one with wound dehiscence, who was treated conservatively. The median postoperative hospital stay and follow-up period were 4 days and 36 months, respectively. During the study period, no patients died, but 5 (14.3%) experienced recurrence, including one recurrence at the TAMIS site. CONCLUSION: TAMIS seems to be a feasible, safe modality for treating patients with locally advanced rectal cancer who show good response to preoperative CRT.
Anal Canal ; Chemoradiotherapy* ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Prospective Studies ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Wounds and Injuries

Objective: To develop and validate a model using radiomics features from apparent diffusion coefficient (ADC) map to diagnose local tumor recurrence in head and neck squamous cell carcinoma (HNSCC). Materials and Methods: This retrospective study included 285 patients (mean age ± standard deviation, 62 ± 12 years; 220 male, 77.2%), including 215 for training (n = 161) and internal validation (n = 54) and 70 others for external validation, with newly developed contrast-enhancing lesions at the primary cancer site on the surveillance MRI following definitive treatment of HNSCC between January 2014 and October 2019. Of the 215 and 70 patients, 127 and 34, respectively, had local tumor recurrence. Radiomics models using radiomics scores were created separately for T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI), and ADC maps using non-zero coefficients from the least absolute shrinkage and selection operator in the training set. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of each radiomics score and known clinical parameter (age, sex, and clinical stage) in the internal and external validation sets. Results: Five radiomics features from T2WI, six from CE-T1WI, and nine from ADC maps were selected and used to develop the respective radiomics models. The area under ROC curve (AUROC) of ADC radiomics score was 0.76 (95% confidence interval [CI], 0.62–0.89) and 0.77 (95% CI, 0.65–0.88) in the internal and external validation sets, respectively. These were significantly higher than the AUROC values of T2WI (0.53 [95% CI, 0.40–0.67], p = 0.006), CE-T1WI (0.53 [95% CI, 0.40– 0.67], p = 0.012), and clinical parameters (0.53 [95% CI, 0.39–0.67], p = 0.021) in the external validation set. Conclusion The radiomics model using ADC maps exhibited higher diagnostic performance than those of the radiomics models using T2WI or CE-T1WI and clinical parameters in the diagnosis of local tumor recurrence in HNSCC following definitive treatment.