OBJECTIVES: This paper proposes a measurement method to quantify the abnormal characteristics of the broken parts of ribs using local texture and shape features in chest radiographs. METHODS: Our measurement method comprises two steps: a measurement area assignment and sampling step using a spline curve and sampling lines orthogonal to the spline curve, and a fracture-ness measurement step with three measures, asymmetry and gray-level co-occurrence matrix based measures (contrast and homogeneity). They were designed to quantify the regional shape and texture features of ribs along the centerline. The discriminating ability of our method was evaluated through region of interest (ROI) analysis and rib fracture classification test using support vector machine. RESULTS: The statistically significant difference was found between the measured values from fracture and normal ROIs; asymmetry (p < 0.0001), contrast (p < 0.001), and homogeneity (p = 0.022). The rib fracture classifier, trained with the measured values in ROI analysis, detected every rib fracture from chest radiographs used for ROI analysis, but it also classified some unbroken parts of ribs as abnormal parts (8 to 17 line sets; length of each line set, 2.998 +/- 2.652 mm; length of centerlines, 131.067 +/- 29.460 mm). CONCLUSIONS: Our measurement method, which includes a flexible measurement technique for the curved shape of ribs and the proposed shape and texture measures, could discriminate the suspicious regions of ribs for possible rib fractures in chest radiographs.
Decision Support Techniques ; Rib Fractures ; Ribs ; Thorax

Objective: Patients are taken to the emergency department (ED) via a variety of transport systems. Proper ambulance use is important for improving patients’ transport quality and using limited resources allotted by the system effectively. Korea is a country with a well-developed public ambulance system established by the government. Therefore, this study was conducted to analyze the overuse or underuse of the ambulance system by patients who visited the ED. Methods: This study was conducted at the ED in three hospitals. A total of 459,647 patients visited these EDs over the three-year study period from 2016 to 2018. Medical records were investigated retrospectively. The study subjects were divided into three groups based on their triage score and ambulance use. Patients were classified into adequacy (Korean Triage and Acuity Scale [KTAS] 1-3, ambulance use or KTAS 4-5, non-ambulance use), underuse (KTAS 1-3, non-ambulance use) and overuse (KTAS 4-5, ambulance use) groups. Results: The mean age of patients was 46.7±26.0 years, and 237,118 (51.6%) were male. The adequacy group included 269,046 patients (58.5% of the patients). The underuse group had 162,575 patients (35.4%), and the overuse group included 328,026 patients (6.1%). Despite having KTAS level 1 or 2, the number of patients who did not use an ambulance was 14,792. Ambulances were used by 5,154 patients at KTAS 5 level. Conclusion Many patients use ambulances appropriately, but overuse and underuse of ambulances can still be observed. Guidelines on ambulance use are necessary for the efficient use of emergency medical resources and the safety of patients.

The prevalence of cheek lymphoma, especially a mucosa-associated lymphoid tissue lymphoma (MALT), is very rare. Non-specific symptoms and image findings of cheek lymphoma may mimic benign entities and make it difficult to diagnose. In this case report, we present a case of MALT lymphoma of the cheek mimicking benign entities on computed tomography and magnetic resonance imaging.

PURPOSE: Ischiofemoral impingement (IFI)-primarily diagnosed by magnetic resonance imaging (MRI)-is an easily overlooked disease due to its low incidence. The purpose of this study was to evaluate the usefulness of false profile view as a screening test for IFI. MATERIALS AND METHODS: Fifty-eight patients diagnosed with IFI between June 2013 and July 2017 were enrolled in this retrospective study. A control group (n=58) with matching propensity scores (age, gender, and body mass index) were also included. Ischiofemoral space (IFS) was measured as the shortest distance between the lateral cortex of the ischium and the medial cortex of lesser trochanter in weight bearing hip anteroposterior (AP) view and false profile view. MRI was used to measure IFS and quadratus femoris space (QFS). The receiver operating characteristics (ROC), area under the ROC curve (AUC) and cutoff point of the IFS were measured by false profile images, and the correlation between the IFS and QFS was analyzed using the MRI scans. RESULTS: In the false profile view and hip AP view, patients with IFI had significantly decreased IFS (P < 0.01). In the false profile view, ROC AUC (0.967) was higher than in the hip AP view (0.841). Cutoff value for differential diagnosis of IFI in the false profile view was 10.3 mm (sensitivity, 88.2%; specificity, 88.4%). IFS correlated with IFS (r=0.744) QFS (0.740) in MRI and IFS (0.621) in hip AP view (P < 0.01). CONCLUSION: IFS on false profile view can be used as a screening tool for potential IFI.
Area Under Curve ; Diagnosis, Differential ; Femur ; Hip ; Humans ; Incidence ; Ischium ; Magnetic Resonance Imaging ; Mass Screening ; Propensity Score ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Weight-Bearing

The prevalence of cheek lymphoma, especially a mucosa-associated lymphoid tissue lymphoma (MALT), is very rare. Non-specific symptoms and image findings of cheek lymphoma may mimic benign entities and make it difficult to diagnose. In this case report, we present a case of MALT lymphoma of the cheek mimicking benign entities on computed tomography and magnetic resonance imaging.

Feline panleukopenia virus (FPV) causes leukopenia and severe hemorrhagic diarrhea, killing 50% of naturally infected cats. Although intact FPV can serve as an antigen in the hemagglutination inhibition (HI) test, accidental laboratory-mediated infection a concern. A non-infectious diagnostic reagent is required for the HI test. Here, we expressed the viral protein 2 (VP2) gene of the FPV strain currently prevalent in South Korea in a baculovirus expression system; VP2 protein was identified by an indirect immunofluorescence assay, electron microscopy (EM), Western blotting (WB), and a hemagglutination assay (HA). EM showed that the recombinant VP2 protein self-assembled to form virus-like particles. WB revealed that the recombinant VP2 was 65 kDa in size. The HA activity of the recombinant VP2 protein was very high at 1:215. A total of 143 cat serum samples were tested using FPV (HI-FPV test) and the recombinant VP2 protein (HI-VP2 test) as HI antigens. The sensitivity, specificity, and accuracy of the HI-VP2 test were 99.3%, 88.9%, and 99.3%, respectively, compared to the HI-FPV test. The HI-VP2 and HI-FPV results correlated significantly (r = 0.978). Thus, recombinant VP2 can substitute for intact FPV as the serological diagnostic reagent of the HI test for FPV.

Mammalian reovirus (MRV) causes respiratory and intestinal disease in mammals. Although MRV isolates have been reported to circulate in several animals, there are no reports on Korean MRV isolates from wildlife. We investigated the biological and molecular characteristics of Korean MRV isolates based on the nucleotide sequence of the segment 1 gene. In total, 144 swabs from wild animals were prepared for virus isolation. Based on virus isolation with specific cytopathic effects, indirect fluorescence assays, electron microscopy, and reverse transcription-polymerase chain reaction, one isolate was confirmed to be MRV. The isolate exhibited a hemagglutination activity level of 16 units with pig erythrocytes and had a maximum viral titer of 105.7 50% tissue culture infectious dose (TCID50)/mL in Vero cells at 5 days after inoculation. The nucleotide and amino-acid sequences of the partial segment S1 of the MReo2045 isolate were determined and compared with those of other MRV strains. The MReo2045 isolate had nucleotide sequences similar to MRV-3 and was most similar (96.1%) to the T3/Bat/Germany/342/08 strain, which was isolated in Germany in 2008. The MReo2045 isolate will be useful as an antigen for sero-epidemiological studies and developing diagnostic tools.

Feline panleukopenia virus (FPV) causes leukopenia and severe hemorrhagic diarrhea, killing 50% of naturally infected cats. Although intact FPV can serve as an antigen in the hemagglutination inhibition (HI) test, accidental laboratory-mediated infection a concern. A non-infectious diagnostic reagent is required for the HI test. Here, we expressed the viral protein 2 (VP2) gene of the FPV strain currently prevalent in South Korea in a baculovirus expression system; VP2 protein was identified by an indirect immunofluorescence assay, electron microscopy (EM), Western blotting (WB), and a hemagglutination assay (HA). EM showed that the recombinant VP2 protein self-assembled to form virus-like particles. WB revealed that the recombinant VP2 was 65 kDa in size. The HA activity of the recombinant VP2 protein was very high at 1:215. A total of 143 cat serum samples were tested using FPV (HI-FPV test) and the recombinant VP2 protein (HI-VP2 test) as HI antigens. The sensitivity, specificity, and accuracy of the HI-VP2 test were 99.3%, 88.9%, and 99.3%, respectively, compared to the HI-FPV test. The HI-VP2 and HI-FPV results correlated significantly (r = 0.978). Thus, recombinant VP2 can substitute for intact FPV as the serological diagnostic reagent of the HI test for FPV.

Mammalian reovirus (MRV) causes respiratory and intestinal disease in mammals. Although MRV isolates have been reported to circulate in several animals, there are no reports on Korean MRV isolates from wildlife. We investigated the biological and molecular characteristics of Korean MRV isolates based on the nucleotide sequence of the segment 1 gene. In total, 144 swabs from wild animals were prepared for virus isolation. Based on virus isolation with specific cytopathic effects, indirect fluorescence assays, electron microscopy, and reverse transcription-polymerase chain reaction, one isolate was confirmed to be MRV. The isolate exhibited a hemagglutination activity level of 16 units with pig erythrocytes and had a maximum viral titer of 105.7 50% tissue culture infectious dose (TCID50)/mL in Vero cells at 5 days after inoculation. The nucleotide and amino-acid sequences of the partial segment S1 of the MReo2045 isolate were determined and compared with those of other MRV strains. The MReo2045 isolate had nucleotide sequences similar to MRV-3 and was most similar (96.1%) to the T3/Bat/Germany/342/08 strain, which was isolated in Germany in 2008. The MReo2045 isolate will be useful as an antigen for sero-epidemiological studies and developing diagnostic tools.

Purpose: The aims of the present study were to evaluate the immunogenicity of an inactivated rabies vaccine based on the ERAGS strain Materials and Methods: The ERAGS virus propagated in Vero cells was inactivated with 3 mM binary ethylenimine for 8 hours. Three types of inactivated rabies vaccines were prepared to determine the minimum vaccine virus titers. Four further types of inactivated rabies vaccines were prepared by blending inactivated ERAGS with four different adjuvants; each vaccine was injected into mice, guinea pigs, and dogs to identify the optimal adjuvant. The immunogenicity of a Montanide (IMS) gel-adjuvanted vaccine was evaluated in cats, dogs, and cattle. Humoral immune responses were measured via a fluorescent antibody virus neutralization method and a blocking enzyme-linked immunosorbent assay. Results: The minimum virus titer of the inactivated rabies vaccine was over 107.0 50% tissue culture infectious doses (TCID50 values)/mL. Of the four kinds of adjuvants, the IMS gel-adjuvanted vaccine induced the highest mean viral neutralizing antibody (VNA) titers of 6.24 and 2.36 IU/mL in guinea pigs and dogs, respectively, and was thus selected as the vaccine for the target animals. Cats, dogs, and cattle inoculated with the IMS gel-adjuvanted vaccine developed protective VNA titers ranging from 3.5 to 1.2 IU/mL at 4 weeks post-inoculation (WPI). Conclusion Our data indicate that cats, dogs, and cattle inoculated with an inactivated rabies vaccine derived from the ERAGS strain developed protective immune responses that were maintained to 12 WPI.