PURPOSE: Coronary arterial lesion assessment in children can be difficult, depending on the coronary dominance pattern. Although it is easier to determine coronary dominance with echocardiography in children than in adults, it is still difficult. This study aimed to examine the coronary dominance pattern according to the objective coronary artery (CA) indices. METHODS: The CA diameter, aortic valve annulus, and abdominal aorta of 69 children without any cardiovascular disease were measured with cross-sectional echocardiography at Chungnam National University Hospital. To evaluate the coronary dominance pattern, echocardiography was primarily used; additionally, coronary computed tomographic angiography or coronary angiography (CAG). Coronary dominance was determined according to the status of the CA that gives rise to the posterior descending artery. RESULTS: The mean age was 4.02±2.78 years, and the mean body surface area (BSA) was 0.70±0.22 m². Right dominance was present in 78% and left in 22% of the subjects. In those with left dominance, the CA to aortic valve annulus diameter ratio was 0.125±0.021 in the right coronary artery (RCA) and 0.255±0.032 in the left coronary artery (LCA). In those with right dominance, the corresponding ratio was 0.168±0.028 in the RCA and 0.216±0.030 in the LCA (P<0.05). Significant differences were also found in the diametric ratios of the CA to BSA and abdominal aorta (P<0.05). CONCLUSION: The CA indices showed significant difference according to the coronary dominance pattern in early childhood. It is possible to indirectly determine the coronary dominance pattern with the CA indices in children using echocardiography. The accuracy of coronary artery lesion diagnosis can be improved by taking coronary dominance into account.
Adult ; Angiography ; Aorta, Abdominal ; Aortic Valve ; Arteries ; Body Surface Area ; Cardiovascular Diseases ; Child ; Chungcheongnam-do ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Echocardiography ; Humans ; Mucocutaneous Lymph Node Syndrome

PURPOSE: The aim of this study was to evaluate the applicability of machine learning methods that combine data on age and prostate-specific antigen (PSA) levels for predicting prostate cancer. MATERIALS AND METHODS: We analyzed 943 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy at Chungnam National University Hospital between 2014 and 2018 because of elevated PSA levels and/or abnormal digital rectal examination and/or TRUS findings. We retrospectively reviewed the patients’ medical records, analyzed the prediction rate of prostate cancer, and identified 20 feature importances that could be compared with biopsy results using 5 different algorithms, viz., logistic regression (LR), support vector machine, random forest (RF), extreme gradient boosting, and light gradient boosting machine. RESULTS: Overall, the cancer detection rate was 41.8%. In patients younger than 75 years and with a PSA level less than 20 ng/mL, the best prediction model for prostate cancer detection was RF among the machine learning methods based on LR analysis. The PSA density was the highest scored feature importances in the same patient group. CONCLUSIONS: These results suggest that the prediction rate of prostate cancer using machine learning methods not inferior to that using LR and that these methods may increase the detection rate for prostate cancer and reduce unnecessary prostate biopsy, as they take into consideration feature importances affecting the prediction rate for prostate cancer.
Biopsy ; Chungcheongnam-do ; Digital Rectal Examination ; Forests ; Humans ; Logistic Models ; Machine Learning ; Medical Records ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Support Vector Machine ; Ultrasonography

OBJECTIVE: To assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+). METHODS: This retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy. RESULTS: Of the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%). CONCLUSION: TVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.
Biopsy ; Chungcheongnam-do ; Cohort Studies ; Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Hyperplasia ; Incidental Findings ; Lost to Follow-Up ; Mass Screening ; Myoma ; Pathology ; Polyps ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

OBJECTIVES: The objective of this study was to investigate clinical and neuropsychological factors associated with treatment response and adverse events of atomoxetine in children with attention-deficit/hyperactivity disorder (ADHD) in Korea. METHODS: Children with ADHD were recruited at the Department of Psychiatry of Asan Medical Center from April 2015 to April 2018. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. The subjects were subsequently treated with atomoxetine for 12 weeks and illness severity was scored using the ADHD Rating Scale, Clinical Global Impression-Severity scale (CGI-S) and/or Improvement scale (CGI-I), at pre- and post-treatment. They also completed the Advanced Test of Attention (ATA), while their caregivers completed the Korean Personality Rating Scale for Children (KPRC) at pre- and post-treatment. Independent t-test, Fisher's exact test, χ2 test, mixed between-within analysis of variance and correlation analysis were used for statistical analysis. RESULTS: Sixty-five children with ADHD (mean age: 7.9±1.4 years, 57 boys) were enrolled, of which, 33 (50.8%) were treatment responders. Scores on the social dysfunction subscale of the KPRC (p=0.021) and commission errors on the visual ATA (p=0.036) at baseline were higher in treatment non-responders than in responders; however, the statistical significances disappeared after adjusting for multiple comparisons. Mood changes were also observed in 13 subjects (20.0%), and three of them discontinued atomoxetine due to this. Additionally, atomoxetine-emergent mood change was observed more frequently in girls (p=0.006), while the intelligence quotient (p=0.040) was higher in those subjects with mood changes than in those without. CONCLUSION: The results of our study suggest that clinical and neuropsychological factors could be associated with treatment response or adverse events of atomoxetine in children with ADHD. Further long-term studies with larger samples are needed.
Atomoxetine Hydrochloride ; Caregivers ; Child ; Chungcheongnam-do ; Diagnosis ; Female ; Humans ; Intelligence ; Korea ; Mood Disorders

OBJECTIVES: We examined the factor structure of the Adolescent version of the General Behavior Inventory (A-GBI) for Koreans. METHODS: We retrospectively reviewed the medical records of 220 adolescents (age, 12–18 years) who completed the A-GBI through the Department of Psychiatry at Asan Medical Center, Seoul, Korea, from October 2011 to December 2018. Caregivers of the study participants completed the Parent version of the GBI (P-GBI) 10-item Mania Scale. The adolescents were evaluated based on the A-GBI, Children's Depression Inventory (CDI), and Revised-Children's Manifest Anxiety Scale (RCMAS). Subsequently, an exploratory factor analysis (EFA) using the maximum likelihood method with direct oblimin rotation and correlation analyses with other scales were performed. RESULTS: The EFA identified a two-factor structure as having the best fit: factor I included depressive symptoms and factor II included hypomanic/biphasic symptoms. Factor I was very strongly correlated with the A-GBI depressive subscale (r=0.990, p<0.001) and strongly correlated with CDI (r=0.764, p<0.001) and RCMAS (r=0.666, p<0.001). Factor II was also very strongly correlated with the A-GBI hypomanic/biphasic subscale (r=0.877, p<0.001) and weakly correlated with CDI (r=0.274, p<0.001) and RCMAS (r=0.332, p<0.001). CONCLUSION: The above findings support a two-dimensional model of mood symptoms in Korean youth.
Adolescent ; Bipolar Disorder ; Caregivers ; Chungcheongnam-do ; Depression ; Factor Analysis, Statistical ; Fibrinogen ; Humans ; Korea ; Manifest Anxiety Scale ; Medical Records ; Methods ; Parents ; Prothrombin ; Retrospective Studies ; Seoul ; Weights and Measures

The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growth”in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.
Academies and Institutes ; Budgets ; Chungcheongnam-do ; Delivery of Health Care ; Education ; Health Personnel ; Health Policy ; Humans ; Policy Making ; Professionalism

The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.
Chungcheongnam-do ; Headache ; Humans ; Hydrocephalus ; Korea ; Male ; Neurocysticercosis ; Neuroimaging ; Ovum ; Pathology ; Prevalence ; Retrospective Studies ; Seizures ; Taenia solium ; Taeniasis ; Tertiary Care Centers ; Ventriculoperitoneal Shunt

PURPOSE: We investigated the sensitivity of various evaluating modalities in predicting a pathologic complete response (pCR) after preoperative chemoradiation therapy (PCRT) for locally advanced rectal cancer (LARC). METHODS: From a population of 2,247 LARC patients who underwent PCRT followed by surgery at Asan Medical Center, Seoul, Korea from January 2007 to June 2016, we retrospectively analyzed 313 patients (14.1%) who showed a pCR after surgery. Transrectal ultrasound (TRUS), high-resolution magnetic resonance imaging (MRI), abdominopelvic computed tomography (AP-CT), and endoscopy were performed within 2 weeks prior to surgery. RESULTS: Of the 313 patients analyzed, 256 (81.8%) had a pCR after radical surgery and 57 (18.2%) showed total regression after local excision. Preoperative TRUS, MRI, and AP-CT were performed in 283, 305, and 139 patients, respectively. Among these 3 groups, a prediction of a pCR of the primary tumor was made in 41 (14.5%), 51 (16.7%), and 27 patients (19.4%), respectively, before surgery. A prediction of a clinical N0 stage was made in 204 patients (88.3%) using TRUS, 130 (52.2%) using MRI, and 78 (65.5%) using AP-CT. Of the 211 patients who underwent endoscopy, 87 (41.2%) had a mention of clinical CR in their records. A prediction of a pathologic CR was made for 124 patients (39.6%) through at least one diagnostic modality. CONCLUSION: The various evaluation methods for predicting a pCR after PCRT show a predictive sensitivity of 0.15–0.41 for primary tumors and 0.52–0.88 for lymph nodes. Endoscopy is a relatively superior modality for predicting the pCR of the primary tumor of LARC patients.
Chungcheongnam-do ; Endoscopy ; Humans ; Korea ; Lymph Nodes ; Magnetic Resonance Imaging ; Polymerase Chain Reaction ; Rectal Neoplasms ; Retrospective Studies ; Seoul ; Ultrasonography

ELISAs and rapid diagnostic tests (RDTs) are widely used for diagnosing dengue virus (DENV) infection. Using 138 single blood samples, we compared the ability to detect non-structural (NS)-1 antigen and anti-DENV IgM/IgG antibodies among (1) DENV Detect NS1 ELISA, DENV Detect IgM capture ELISA and DENV Detect IgG ELISA (InBios International, Inc.); (2) Anti-Dengue virus IgM Human ELISA and Anti-Dengue virus IgG Human ELISA (Abcam); (3) Dengue virus NS1 ELISA, Anti-Dengue virus ELISA (IgM) and Anti-Dengue virus ELISA (IgG) (Euroimmun); (4) Asan Easy Test Dengue NS1 Ag 100 and Asan Easy Test Dengue IgG/IgM (Asan Pharm); (5) SD BIOLINE Dengue Duo (Standard Diagnostics); and (6) Ichroma Dengue NS1 and Ichroma Dengue IgG/IgM (Boditech Med). For NS1 antigen detection, InBios and Euroimmun showed higher sensitivities (100%) than the RDTs (42.9–64.3%). All tests demonstrated variable sensitivities for IgM (38.1–90.5%) and IgG (65.7–100.0%). InBios and Boditech Med demonstrated higher sensitivity (95.6% and 88.2%, respectively) than the other tests for combined NS1 antigen and IgM antibody. Five NS1 antigen tests had good agreement (92.8–98.6%) without showing positivity for chikungunya. However, all IgG tests demonstrated potential false-positivity with variable ranges. Clinical laboratories should note performance variations across tests and potential cross-reactivity.
Antibodies ; Chungcheongnam-do ; Dengue Virus ; Dengue ; Diagnosis ; Diagnostic Tests, Routine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulin M

PURPOSE: This preliminary study was conducted to evaluate the association between Oncotype DX (ODX) recurrence score and traditional prognostic factors. We also developed a nomogram to predict subgroups with low ODX recurrence scores (less than 25) and to avoid additional chemotherapy treatments for those patients. MATERIALS AND METHODS: Clinicopathological and immunohistochemical variables were retrospectively retrieved and analyzed from a series of 485 T1-3N0-1miM0 hormone receptor-positive, human epidermal growth factor 2‒negative breast cancer patients with available ODX test results at Asan Medical Center from 2010 to 2016. One hundred twenty-seven patients (26%) had positive axillary lymph node micrometastases, and 408 (84%) had ODX recurrence scores of ≤25. Logistic regression was performed to build a nomogram for predicting a low-risk subgroup of the ODX assay. RESULTS: Multivariate analysis revealed that estrogen receptor (ER) score, progesterone receptor (PR) score, histologic grade, lymphovascular invasion (LVI), and Ki-67 had a statistically significant association with the low-risk subgroup. With these variables, we developed a nomogram to predict the low-risk subgroup with ODX recurrence scores of ≤25. The area under the receiver operating characteristic curve was 0.90 (95% confidence interval [CI], 0.85 to 0.96). When applied to the validation group the nomogram was accurate with an area under the curve = 0.88 (95% CI, 0.83 to 0.95). CONCLUSION: The low ODX recurrence score subgroup can be predicted by a nomogram incorporating five traditional prognostic factors: ER, PR, histologic grade, LVI, and Ki-67. Our nomogram, which predicts a low-risk ODX recurrence score, will be a useful tool to help select patients who may or may not need additional ODX testing.
Breast Neoplasms ; Breast ; Chungcheongnam-do ; Drug Therapy ; Epidermal Growth Factor ; Estrogens ; Female ; Humans ; Humans ; Logistic Models ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Micrometastasis ; Nomograms ; Prognosis ; Receptors, Progesterone ; Recurrence ; Retrospective Studies ; ROC Curve