Objectives: Early hemorrhage detection in intensive care units (ICUs) enables timely intervention and reduces the risk of irreversible outcomes. In this study, we aimed to develop a machine learning model to predict hemorrhage by learning the patterns of continuously changing, real-world clinical data. Methods: We used the Medical Information Mart for Intensive Care databases (MIMIC-III and MIMIC-IV). A recurrent neural network was used to predict severe hemorrhage in the ICU. We developed three machine learning models with an increasing number of input features and levels of complexity: model 1 (11 features), model 2 (18 features), and model 3 (27 features). MIMIC-III was used for model training, and MIMIC-IV was split for internal validation. Using the model with the highest performance, external verification was performed using data from a subgroup extracted from the eICU Collaborative Research Database. Results: We included 5,670 ICU admissions, with 3,150 in the training set and 2,520 in the internal test set. A positive correlation was found between model complexity and performance. As a measure of performance, three models developed with an increasing number of features showed area under the receiver operating characteristic (AUROC) curve values of 0.61–0.94 according to the range of input data. In the subgroup extracted from the eICU database for external validation, an AUROC value of 0.74 was observed. Conclusions Machine learning models that rely on real clinical data can be used to predict patients at high risk of bleeding in the ICU.

OBJECTIVE: The authors investigated the changes of cortical sensorimotor activity in functional MRI (fMRI) and functional recovery in spinal cord injury (SCI) patients who had been treated by bone marrow cell transplantation. METHODS: Nineteen patients with SCI were included in this study; ten patients with clinical improvement and nine without. The cortical sensorimotor activations were studied using the proprioceptive stimulation during the fMRI. RESULTS: Diagnostic accuracy of fMRI with neurological improvement was 70.0% and 44.4% for sensitivity and specificity, respectively. Signal activation in the ipsilateral motor cortex in fMRI was commonly observed in the clinically neurological improved group (p-value=0.002). Signal activation in the contralateral temporal lobe and basal ganglia was more commonly found in the neurological unimproved group (p-value<0.001). Signal activation in other locations was not statistically different. CONCLUSION: In patients with SCI, activation patterns of fMRI between patients with neurologic recovery and those without varied. Such plasticity should be considered in evaluating SCI interventions based on behavioral and neurological measurements.
Basal Ganglia ; Bone Marrow Cells ; Bone Marrow Transplantation ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex ; Plastics ; Sensitivity and Specificity ; Spinal Cord Injuries* ; Temporal Lobe

Purpose: To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. Materials and Methods: We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. Results: Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). Conclusion Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

Purpose: Three years of adjuvant imatinib is the standard treatment for resected gastrointestinal stromal tumors (GISTs) with rupture, but the recurrence rate is prominently high. We aimed to investigate the efficacy and safety of 5-year adjuvant imatinib compared with 3-year treatment in patients with a ruptured GIST following surgical resection. Materials and Methods: A total of 51 patients were included in the analysis. The assessment of GIST rupture was based on Nishida’s classification. Twenty patients who were diagnosed before November 2013 were treated with 5 years of imatinib, and 31 patients who were diagnosed after November 2013 were treated with 3 years of imatinib. We retrospectively compared the clinical outcomes of the two groups. Results: Baseline characteristics and the incidence of the adverse events were generally comparable between the two groups. During a median follow-up duration of 43.8 months and 104.2 months in the 3- and 5-year group, 8 and 9 patients had a disease recurrence, respectively. The 5-year group showed better recurrence-free survival (RFS) than the 3-year group. In multivariate analysis, low mitotic index was a significant independent favorable prognostic factor for RFS, while 5-year imatinib treatment was marginally associated with a favorable RFS. Conclusion Five years of adjuvant imatinib treatment in patients with ruptured GIST was associated with favorable survival outcomes with manageable toxicity profiles. Our findings warrant validation and confirmation in future studies.

Purpose: To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. Materials and Methods: We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. Results: Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). Conclusion Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

A survey was performed in Korea to monitor the prevalence of five bovine arboviruses [Akabane virus, Aino virus, Chuzan virus, bovine ephemeral fever (BEF) virus, and Ibaraki virus] in arthropod vectors, such as Culicoides species. To determine the possible applications of survey data in annual monitoring and warning systems in Korea, we examined the prevalence of bovine arboviruses in arthropod vectors using RT-PCR. To compare the sensitivity and specificity of virus detection, nested PCR was also performed in parallel for all five viruses. Using the RT-PCR, the detection limits were at least up to 10(1.5), 10(2.8), 10(2.0), 10(1.8), and 10(4.0) TCID50/ml for Akabane virus, Aino virus, Chuzan virus, BEF virus, and Ibaraki virus, respectively. When nested PCR was performed using 1 micronl of PCR product, the detection limits were increased, to 10(0.05), 10(1.8), 10(1.0), 10(0.008), and 10(2.0) TCID50/ml for Akabane virus, Aino virus, Chuzan virus, BEF virus, and Ibaraki virus, respectively. Thus, nested PCR increased the sensitivity of the virus detection limit by 1~2 log. We pooled 30~40 mosquitoes in one sample. We collected 113 samples in 2006, 135 samples in 2007, and 100 samples in 2008. Among these samples, Chuzan virus and BEF virus genes were detected at a range between 0.82% and 1.19%, and Akabane virus, Aino virus, and Ibaraki virus genes were detected at less than 0.20%. These data may provide some insight into future epidemiological studies of bovine arboviral diseases in Korea.
Animals ; Arboviruses ; Arthropod Vectors ; Arthropods ; Cattle ; Ceratopogonidae ; Culicidae ; Ephemeral Fever ; Epidemiologic Studies ; Korea ; Limit of Detection ; Organothiophosphorus Compounds ; Palyam Virus ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Viruses

Aino virus infection is characterized by abortion, stillbirth, and congenital abnormalities such as arthropgryposis-hydranencephaly syndrome in calves. In Korea, Aino virus infection was first reported in 1997 by researchers who were investigating the cause of newborn calf deformities. Given the incidence of Aino-related deformities, the need for a study of the Aino virus infection status in Korea was recognized. In this study, we investigated the nationwide seroepidemiological status of Aino virus infection. A total of 9,921 serum samples collected between 1993 and 2001, and 23,760 serum samples between 2002 and 2007 were tested using a virus neutralization assay. The seroprevalence of Aino virus was 73.1, 63.8, 44.9, 56.0, 38.5, 28.4 18.3, 19.6, and 23.2%, respectively, between 1993 and 2001, and 43.8, 42.9, 50.7, 55.3, 31.4, and 25.4%, respectively, between 2002 and 2007. Aino virus infection does not pose a major threat to the bovine industry in Korea till now. The future prospects for Aino virus infection in cattle, however, may change with the global warming phenomena. The results of this study may serve as a basis for future epidemiological studies on Aino virus infection.
Animals ; Cattle ; Congenital Abnormalities ; Epidemiologic Studies ; Global Warming ; Humans ; Incidence ; Infant, Newborn ; Korea ; Seroepidemiologic Studies ; Stillbirth ; Viruses

PURPOSE: To validate the use of harmonic ultrasonography (US) in the detection of gallbladder microlithiasis. METHODS: From November 30, 2012, to January 18, 2014, fundamental US (FUS) and harmonic US with a high background noise (HUS-N) were performed for evaluation of gallbladder during the routine abdomen US. During the US, a dot-like stone (or stones) with Brownian motion was regarded as a positive finding of microlithiasis. Fifty-five patients with microlithiasis in the gallbladder detected on US were enrolled as the subjects of a retrospective review. With respect to the obtained images, two abdominal radiologists independently scored the conspicuity of gallbladder microlithiasis on FUS and HUS-N by using a 4-grade scale. The statistical analysis employed a kappa test and a Wilcoxon rank-sum test. RESULTS: For FUS, the conspicuity grades of gallbladder microlithiasis were G1 in 25 and 37, G2 in 21 and 9, G3 in 6 and 6, G4 in 3 and 3 patients, while HUS-N showed G1 in 0 and 0, G2 in 3 and 2, G3 in 12 and 15, and G4 in 40 and 38 patients, respectively, by each of the two radiologists. The kappa value was 0.633 for FUS between the two radiologists and 0.708 for HUS-N. HUS-N showed better conspicuity of gallbladder microlithiasis than FUS with significant P-values of less than 0.001 and 0.001 for the two radiologists, respectively. CONCLUSION: Compared with FUS, HUS-N enables better detection of microlithiasis in the gallbladder.
Abdomen ; Cholecystolithiasis ; Gallbladder* ; Humans ; Noise ; Retrospective Studies ; Ultrasonography*

Purpose: Prognostic Index for Natural Killer Lymphoma (PINK) is the most widely accepted prognostic model for patients withextranodal natural killer/T-cell lymphoma (ENKTL) treated with non-anthracycline–based therapy. We aimed to evaluate the prognostic implications of serum β-2 microglobulin (β2M) in the context of PINK and proposed a new prognostic model. Materials and Methods: A total of 138 patients who were newly diagnosed with ENKTL and treated with non-anthracycline-based chemotherapy were identified. The cut-off value of high serum β2M was calculated by maximal-chi square methods (4.1 mg/L). A new prognostic model incorporating serum β2M into PINK was proposed and validated in an independent validation cohort (n=88). Results: The patients’ median age was 53.5 years (range, 19 to 80 years). Patients with high serum β2M levels had significantly worse overall survival (OS) and progression-free survival (PFS). In multivariate analysis, high serum β2M was an independent adverse prognostic factor for OS. A new PINK-B (Prognostic Index for Natural Killer Lymphoma-serum β-2 microglobulin) model stratifiedpatients into three groups with distinct OS and PFS in the training cohort (3-year OS, 84.1% [95% confidence interval, 75.1 to 94.2], 46.8% [36.1 to 60.8] and 17.6% [6.3 to 49.2] for the low-, intermediate, and high-risk groups, respectively; 3-year PFS, 70.6% [59.4 to 83.8], 35.9% [25.9 to 49.8], and 7.35% [1.1 to 46.7] for the low-, intermediate-, and high-risk groups, respectively). The PINK-B model was further validated in an independent cohort. Conclusion Serum β2M is an independent prognostic factor for ENKTL patients. The new serum β2M-based prognostic model may be useful for identifying ultra-high-risk patients, and it can easily be adopted into daily clinical practice.

Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.
Antibodies, Bacterial/blood ; Enzyme-Linked Immunosorbent Assay ; Fluorescent Antibody Technique, Indirect ; Humans ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Orientia tsutsugamushi/immunology ; Reagent Kits, Diagnostic ; Retrospective Studies ; Scrub Typhus/*diagnosis/microbiology ; Sensitivity and Specificity