Objectives: A primary brain tumor starts to grow from brain cells, and it occurs as a result of errors in the DNA of normal cells. Therefore, this study was carried out to analyze the two-dimensional (2D) texture, morphology, and statistical features of brain tumors and to perform a classification using artificial intelligence (AI) techniques. Methods: AI techniques can help radiologists to diagnose primary brain tumors without using any invasive measurement techniques. In this paper, we focused on deep learning (DL) and machine learning (ML) techniques for texture, morphological, and statistical feature classification of three tumor types (namely, glioma, meningioma, and pituitary). T1-weighted magnetic resonance imaging (MRI) 2D scans were used for analysis and classification (multiclass and binary). A total of 102 features were calculated for each tumor, and the 20 most significant features were selected using the three-step feature selection method, which included removing duplicate features, Pearson correlations, and recursive feature elimination. Results: From the predicted results of multiclass and binary classification, a long short-term memory binary classification (glioma vs. meningioma) showed the best performance, with an average accuracy, recall, precision, F1-score, and kappa coefficient of 97.7%, 97.2%, 97.5%, 97.0%, and 94.7%, respectively. Conclusions The early diagnosis of primary brain tumors is very important because it can be the key to effective treatment. Therefore, this research presents a method for early diagnoses by effectively classifying three types of primary brain tumors.

Background: and Purpose This study aimed to investigate the applicability of deep learning (DL) model using diffusion-weighted imaging (DWI) data to predict the severity of aphasia at an early stage in acute stroke patients. Methods: We retrospectively analyzed consecutive patients with aphasia caused by acute ischemic stroke in the left middle cerebral artery territory, who visited Asan Medical Center between 2011 and 2013. To implement the DL model to predict the severity of post-stroke aphasia, we designed a deep feed-forward network and utilized the lesion occupying ratio from DWI data and established clinical variables to estimate the aphasia quotient (AQ) score (range, 0 to 100) of the Korean version of the Western Aphasia Battery. To evaluate the performance of the DL model, we analyzed Cohen’s weighted kappa with linear weights for the categorized AQ score (0–25, very severe; 26–50, severe; 51–75, moderate; ≥76, mild) and Pearson’s correlation coefficient for continuous values. Results: We identified 225 post-stroke aphasia patients, of whom 176 were included and analyzed. For the categorized AQ score, Cohen’s weighted kappa coefficient was 0.59 (95% confidence interval [CI], 0.42 to 0.76; P<0.001). For continuous AQ score, the correlation coefficient between true AQ scores and model-estimated values was 0.72 (95% CI, 0.55 to 0.83; P<0.001). Conclusions DL approaches using DWI data may be feasible and useful for estimating the severity of aphasia in the early stage of stroke.

Background: In this study, we report satisfactory clinical and radiological outcomes after autologous oblique structural peg bone and cancellous chip bone grafting without metal augmentation, including the use of a metal wedge, block, or additional stem, for patients with ≥ 10-mm-deep uncontained medial proximal tibial bone defects in primary total knee replacement. Methods: The study group included 40 patients with primary total knee replacement with ≥ 10-mm-deep uncontained tibial bone defects who underwent autologous oblique structural peg bone and cancellous chip bone grafting and were followed-up for at least 1 year. Tibial cutting was performed up to a depth of 10 mm from the articular surface of the lateral tibial condyle, after which the height and area of the remaining bone defect in the medial condyle were measured. The bone defect was treated by making a peg bone and chip bone using excised segments of the tibia and femur. In all cases, the standard tibial stem and full cemented fixation techniques were used without metal augmentation. Preoperative and final follow-up radiologic changes and clinical measures were compared, and prosthesis loosening and bone union were checked radiologically at final follow-up. Results: The mean depth of the bone defects was 10.9 mm, and the mean percentage of the area occupied by bone defects in the axial plane was 18.4%. The mean mechanical femorotibial angle was corrected from 19.5° varus preoperatively to 0.2° varus postoperatively (p < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up. Conclusions Even in patients with uncontained tibial bone defects ≥ 10-mm deep in primary total knee replacement, if the defect occupies less than 30% of the cut surface, autologous oblique structural peg bone and cancellous chip bone grafting can be used to achieve satisfactory outcomes with a standard tibial stem and no metal augmentation.

Background: In this study, we report satisfactory clinical and radiological outcomes after autologous oblique structural peg bone and cancellous chip bone grafting without metal augmentation, including the use of a metal wedge, block, or additional stem, for patients with ≥ 10-mm-deep uncontained medial proximal tibial bone defects in primary total knee replacement. Methods: The study group included 40 patients with primary total knee replacement with ≥ 10-mm-deep uncontained tibial bone defects who underwent autologous oblique structural peg bone and cancellous chip bone grafting and were followed-up for at least 1 year. Tibial cutting was performed up to a depth of 10 mm from the articular surface of the lateral tibial condyle, after which the height and area of the remaining bone defect in the medial condyle were measured. The bone defect was treated by making a peg bone and chip bone using excised segments of the tibia and femur. In all cases, the standard tibial stem and full cemented fixation techniques were used without metal augmentation. Preoperative and final follow-up radiologic changes and clinical measures were compared, and prosthesis loosening and bone union were checked radiologically at final follow-up. Results: The mean depth of the bone defects was 10.9 mm, and the mean percentage of the area occupied by bone defects in the axial plane was 18.4%. The mean mechanical femorotibial angle was corrected from 19.5° varus preoperatively to 0.2° varus postoperatively (p < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up. Conclusions Even in patients with uncontained tibial bone defects ≥ 10-mm deep in primary total knee replacement, if the defect occupies less than 30% of the cut surface, autologous oblique structural peg bone and cancellous chip bone grafting can be used to achieve satisfactory outcomes with a standard tibial stem and no metal augmentation.

PURPOSE: The aim of the present study was to evaluate the efficacy and safety of the electromagnetic-type low-intensity extracorporeal shock wave therapy (Li-ESWT) in patients with erectile dysfunction (ED).MATERIALS AND METHODS: The randomized, sham-controlled, double-blind prospective study was performed at two referral hospitals. Participants were randomized in a 1:1 ratio to receive sham or Li-ESWT for 6 weeks. ED was evaluated at screening and at 4 and 7 weeks after treatment. Participants were asked to complete the international index of erectile function-erectile function (IIEF-EF) domain questionnaire, erection hardness scale (EHS), and sexual encounter profile questionnaire (SEPQ 2 and 3). The development of complications was investigated.RESULTS: Eighty-one of 96 patients completed the study. The median change in the IIEF-EF score in the Li-ESWT and sham groups was 5.1 and −2.2 (p<0.001), respectively, at the 7-week follow-up; 47.4% (18/38) patients had EHS <3, of which 77.8% (14/18) showed significant improvement in virtue of Li-ESWT treatment (p=0.001). A significant improvement was observed in the percentage of “Yes” responses to SEPQ 2 and 3 in the Li-ESWT group vs. sham group from baseline to 7-week follow-up (91.3% vs. 69.4%; p=0.008 and 50.0% vs. 14.3%; p=0.002, respectively). No patients reported pain or other adverse events during treatment or follow-up.CONCLUSIONS: Thus, Li-ESWT could have a role in improving erectile function. Furthermore, it is safe. We believe that Li-ESWT is an attractive new treatment modality for patients with ED.

PURPOSE: External tibia torsion and proximal tibial vara have been reported in severe varus deformed osteoarthritis, which is a tibio-femoral angle of more than 20°. The radiology measurements were compared with those of control group and the preoperative and follow-up radiology and clinical results were examined. MATERIALS AND METHODS: From January 2007 to March 2016, 43 knees from 37 persons, who underwent total knee arthroplasty for a severe varus deformity of more than 20° on the tibio-femoral angle on the standing radiographs and had a follow-up period more than two years, were examined. The mean follow-up period was 45.7 months. The control group, who underwent conservative treatments, had Kellgren-Lawrence grade three osteoarthritis and a tibio-femoral angle of less than 3° varus. The external tibial torsion of enrolled patients and control group were estimated using the proximal tibio-fibular overlap length and the tibial torsion values on computed tomography. The proximal tibia vara was measured using the proximal tibial tilt angle. The preoperative and postoperative proximal tibio-fibular overlap length, tibial torsion value, proximal tibial tilt angle, and hospital for special surgery (HSS) score were evaluated. RESULTS: The mean proximal tibio-fibular overlap length was 18.6 mm preoperatively and 11.2 mm (p=0.031) at the follow-up. The control group had a mean proximal tibio-fibular overlap length of 8.7 mm (p=0.024). The mean tibial torsion value was 13.8° preoperatively and 14.0° (p=0.489) at the follow-up. The control group had a mean tibial torsion value of 21.9° (p=0.012). The mean proximal tibial tilt angle was 12.2° preoperatively and 0° (p<0.01) at the follow-up. The control group had a mean proximal tilt angle of 1.2° (p<0.01). The preoperative tibiofemoral angle and mechanical axis deviation were corrected from preoperative 28.3° and medial 68.4 mm to postoperative 0.7° and medial 3.5 mm (p<0.01, p<0.01), respectively. The HSS scores increased from 34 points of preoperatively to 87 points at the last follow-up (p=0.028). CONCLUSION Patients with advanced osteoarthritis with a severe varus deformity of more than 20° had significant increases in the external tibial torsion and varus of the proximal tibia. The tibial torsion value before and after surgery in the enrolled patients was not changed statistically, but good clinical results without complications were obtained.

BACKGROUND AND OBJECTIVES: Mesenchymal stem cells (MSCs) are used to treat autoimmune or inflammatory diseases. Our aim was to determine the immunomodulatory mechanisms elicited by MSCs during inflammation. METHODS AND RESULTS: We cocultured MSCs with peripheral blood mononuclear cells for a mixed lymphocyte reaction or stimulated them by phytohemagglutinin. Morphological changes of MSCs and secretion of acetylcholine (ACh) from MSCs were measured. The effects of an ACh antagonist and ACh agonist on lymphocyte proliferation and proinflammatory-cytokine production were determined. The inflammatory milieu created by immune-cell activation caused MSCs to adopt a neuronlike phenotype and induced them to release ACh. Additionally, nicotinic acetylcholine receptors (nAChRs) were upregulated in activated peripheral blood mononuclear cells. We observed that ACh bound to nAChR on activated immune cells and led to the inhibition of lymphocyte proliferation and of proinflammatory-cytokine production. MSC-mediated immunosuppression through ACh activity was reversed by an ACh antagonist called α-bungarotoxin, and lymphocyte proliferation was inhibited by an ACh agonist, ACh chloride. CONCLUSIONS: Our findings point to a novel immunomodulatory mechanism in which ACh secreted by MSCs under inflammatory conditions might modulate immune cells. This study may provide a novel method for the treatment of autoimmune diseases by means of MSCs.
Acetylcholine ; Autoimmune Diseases ; Humans ; Immunosuppression ; Inflammation ; Lymphocyte Culture Test, Mixed ; Lymphocytes ; Mesenchymal Stromal Cells ; Methods ; Phenotype ; Receptors, Nicotinic

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 cm2. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

PURPOSE: Testosterone replacement therapy is an effective treatment for late-onset hypogonadism (LOH) despite a few contraindications and side-effects. The aim of this study was to determine whether modified Ojayeonjonghwan (KH-204, Korean herbal formula) improved LOH. KH-204 is a strong antioxidant herbal formula. We evaluated the effect of Korean herbal prescription on androgen receptor (AR) expression in an aged rat model of LOH. MATERIALS AND METHODS: Eighteen-month-old rats were used as aged LOH rat models. Eighteen Sprague-Dawley rats were randomly divided into three equal groups of six animals each and treated with one of the following: 1) normal control group (oral administration with distilled water, n=6), 2) KH-204 200 group (oral administration with 200 mg/kg of KH-204, n=6), and 3) KH-204 400 group (oral administration with 400 mg/kg of KH-204, n=6). After four weeks of treatment (once daily, distilled water or KH-204), serum testosterone levels, changes in testicular and epididymal weight, Western blotting analysis of AR expression and measurement of oxidative stress were examined. RESULTS: Treatment with the herbal formulation KH-204 200 mg/kg and 400 mg/kg (1) increased the weights of testis and epididymis; (2) increased the level of serum testosterone; (3) increased the level of superoxide dismutase and reduced the level of 8-hydroxy-20-deoxyguanosine; and (4) upregulated AR expression in testicular tissue. CONCLUSIONS: KH-204 might be an effective alternative for LOH. It improves antioxidant mechanisms and increases testicular AR expression without side-effects.
Aging* ; Animals ; Blotting, Western ; Epididymis ; Hypogonadism* ; Male ; Models, Animal* ; Oxidative Stress ; Phytotherapy ; Prescriptions ; Rats* ; Rats, Sprague-Dawley ; Receptors, Androgen* ; Superoxide Dismutase ; Testis ; Testosterone ; Water ; Weights and Measures

PURPOSE: Many patients with benign prostatic hyperplasia need treatment for remaining storage symptoms after surgery. Therefore, we evaluated the effect of the phytotherapeutic agent WSY-1075 on persistent detrusor overactivity (DO) after the relief of bladder outlet obstruction (BOO). MATERIALS AND METHODS: Rats were assigned to 3 groups: control (n=6), persistent DO (n=6), and persistent DO treated with the phytotherapeutic agent WSY-1075 (n=6). Persistent DO after relief of partial BOO was generated in the rat model, and 6 of the rats with this condition were orally administered WSY-1075. After 4 weeks of administration, cystometry was performed. Additionally, 8-hydroxy-2-deoxyguanosine and superoxide dismutase were measured to evaluate oxidative stress in the bladder. Pro-inflammatory cytokines, such as interleukin-8 and tumor necrosis factor-α, were analyzed, as were the M2 and M3 muscarinic receptors of the bladder. RESULTS: Significantly increased contraction pressure and a decreased contraction interval were observed in the persistent DO group after relief of BOO. Moreover, oxidative stress, pro-inflammatory cytokines, and M3 muscarinic receptors were significantly increased. After treatment with WSY-1075, significantly reduced DO was observed by cystometry in comparison with the persistent DO group. Additionally, significantly decreased levels of oxidative stress, pro-inflammatory cytokines, and M3 muscarinic receptors in the bladder were observed after treatment with WSY-1075. CONCLUSIONS: Treatment with WSY-1075 improved persistent DO after the relief of BOO mediated by antioxidative and anti-inflammatory effects. Further studies are necessary to identify the exact mechanism of the treatment effect of WSY-1075.
Animals ; Cytokines ; Humans ; Interleukin-8 ; Lower Urinary Tract Symptoms ; Models, Animal ; Necrosis ; Oxidative Stress ; Phytotherapy ; Prostatic Hyperplasia ; Rats ; Receptors, Muscarinic ; Superoxide Dismutase ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Bladder, Overactive