Objective: To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. Materials and Methods: A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343;median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male:female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). Results: Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. Conclusion The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.

Paraneoplastic cancer polyarthritis is a very rare manifestation of musculoskeletal disorders associated with several solid and hematologic malignancies. We describe a 71-year-old woman who presented initially with an abrupt onset of rheumatoid arthritis-like symmetrical polyarthritis. The patient was diagnosed with pancreatic cancer with multiple hepatic metastases approximately six months later. Her symptoms of polyarthritis improved after the introduction of medication including non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. This case suggests that a hidden malignancy should always be considered in elderly patients, who present with an abrupt onset of symmetric polyarthritis for the first time in their life.
Aged ; Antirheumatic Agents ; Arthritis ; Arthritis, Rheumatoid ; Female ; Hematologic Neoplasms ; Humans ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Paraneoplastic Syndromes

Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature.
Antigen-Antibody Complex ; Autoantibodies ; Autoimmune Diseases ; Azathioprine ; Biopsy ; Dermatomyositis ; Female ; Humans ; Inflammation ; Methotrexate ; Muscles ; Panniculitis ; Prednisolone ; Skin ; Subcutaneous Fat ; Upper Extremity

Brucellosis is an endemic zoonotic disease, particularly in the Middle East and Mediterranean regions, and can involve many organs and tissues. Recently, the incidence of human brucellosis has increased rapidly in Korea. Brucellosis may often appear as other infections and asymptomatic conditions because of its range of clinical manifestations. Therefore, its diagnosis is frequently missed or delayed. Early diagnosis of brucellar spondylitis is important for reducing the number and intensity of complications. Therefore, it should be included in a differential diagnosis of back pain with an unknown origin. Brucellosis is normally transmitted to humans by direct contact with infected animals or by the ingestion of unpasteurized dairy products. We report an unusual case of brucellar spondylitis complicated by acupuncture.
Acupuncture ; Animals ; Asymptomatic Diseases ; Back Pain ; Brucellosis ; Dairy Products ; Diagnosis, Differential ; Early Diagnosis ; Eating ; Humans ; Incidence ; Korea ; Mediterranean Region ; Middle East ; Spondylitis

Turner's syndrome (TS) is characterized by short stature and gonadal dysgenesis. It is often associated with systemic manifestations, such as cardiovascular, gastrointestinal, and musculoskeletal disorders. Although very rare, it is possible for TS to accompany autoimmune disease, including thyroid disease, inflammatory bowel diseases, diabetes mellitus, psoriatic arthritis, and juvenile rheumatoid arthritis. A 39-year-old woman was referred for symmetric polyarthritis of her hands and feet. She had been diagnosed with Turner's syndrome with 46,XO,-X,+fragment before the age of 22 years and had developed autoimmune hypothyroidism treated with thyroid hormone replacement. At the time of first visit, she had polyarthralgia with morning stiffness for more than 3 months. The musculoskeletal examination revealed symmetrical polyarthritis affecting the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, fulfilling the ACR 1987 revised criteria for rheumatoid arthritis (RA). Here, we present an unusual case of RA associated with TS. It is important to pay meticulous attention to patients with TS so that inflammatory arthritis is not neglected and the diagnosis is not delayed.
Adult ; Arthralgia ; Arthritis ; Arthritis, Juvenile Rheumatoid ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Diabetes Mellitus ; Female ; Foot ; Gonadal Dysgenesis ; Hand ; Humans ; Hypothyroidism ; Inflammatory Bowel Diseases ; Metatarsophalangeal Joint ; Thyroid Diseases ; Thyroid Gland ; Turner Syndrome

The midpalatal suture area and maxillary interdental area are suitable site for the placement of orthodontic mini-implant. The purpose of this study was to provide a guideline to indicate the best location for mini-implant placement as it relates to the thickness of soft tissue and cortical bone. Fifteen maxilla from 15 cadavers were cut in midsagittal plane and buccopalatal plane to measure the thickness of soft tissue and cortical bone of midpalatal and maxillary posterior interdental areas. Sectioned samples were scanned and the thickness was measured. The thickness of soft tissue and cortical bone were measured at 6 points from the interdental papilla with 5-mm intervals in the mid-sagittal section. And, the thickness of soft tissue and cortical bone were also measured at 5 points from the alveolar crest with 1-mm intervals in the buccopalatal section. The mean and standard deviation of the measurement were calculated. Soft tissue thickness at the midpalatal suture area was 1.46 mm at 15 mm from the interdental papilla and remained uniformly thick posterior to this point, and steeply increased at 35 mm area posteriorly. Cortical bone thickness were greatest (2.13 mm) at 20 mm from the interdental papilla and remained uniformly thick posterior to this point, and decreased at 30 mm area posteriorly. Palatal soft tissues thickness in all groups was thinnest at the 1 mm from the alveolar crest and gradually increased from alveolar crest to apical portion. Cortical bone thickness in all groups was thickest at the 1 mm from the alveolar crest and slightly decreased from alveolar crest to apical portion. Buccal soft tissue thickness in all groups was thickest at the 1 mm from the alveolar crest and gradually decreased from alveolar crest to apical portion. Cortical bone thickness in all groups was thinnest at the 1 mm from the alveolar crest and slightly increased from alveolar crest to apical portion. Soft tissue thicknesses were greater on the palatal side than on the buccal side. Cortical bone thicknesses of the buccal side were thicker than the palatal side. These results provide anatomical data of soft tissue and cortical bone thickness to assist in the determination of safe location for the mini-implant placement in the midpalatal and maxillary interdental areas.
Cadaver ; Gingiva ; Maxilla ; Sutures

PURPOSE: The purpose of this study was to describe the experiences of job satisfaction in clinical nurses. METHODS: Data was collected from three focus groups composed of 17 hospital nurses. Each focus group had an interview for an average of two and a half hours with the guidance of researchers. The main question was "how do you describe your lived experience of job satisfaction as a clinical nurse?" Qualitative data from the field notes and transcribed notes were analyzed using a grounded theory methodology developed by Strauss and Corbin. RESULTS: The core category of experience of job satisfaction in clinical nurses was identified as "Finding success." Supportive interpersonal relationships and environment affected this category. In the process of attaining job satisfaction through finding success, the participants were using four interactional strategies such as giving meaning, finding self-esteem, extending the horizon of life, and strengthening self-capability. The dimensions of job satisfaction in clinical nurses were the sense of achievement, stability, and pride. CONCLUSION: The results of this study yields very useful information for nursing mangers to design a program which enhances job satisfaction of clinical nurses based on interactional strategies.
Adult ; Female ; Focus Groups/*methods ; Humans ; Interviews as Topic ; *Job Satisfaction ; Life Style ; Models, Nursing ; Nursing Staff, Hospital/*psychology ; Self Care ; Self Efficacy

OBJECTIVE: To evaluate the therapeutic effect of single-dose methotrexate injection for ectopic pregnancy and determine the possible predictors of therapeutic failure. METHODS: We retrospectively reviewed 127 patients' records with methotrexate injection (50 mg/m2) for unruptured ectopic pregnancy from January 2001 to December 2006. The transvaginal sonographic findings in each case were analyzed according to the presence and size of an ectopic mass, endometrial pattern, amount of intraperitoneal fluid, presence of yolk sac and presence of pseudogestational sac. Patient's age, pretreatment beta-hCG levels and clinical symptoms were also recorded. Success of treatment was regarded only when single or another dose of methotrexate injection was needed to lower the beta-hCG levels to non-pregnant state (<5 mIU/ml). RESULTS: Of 127 patients, 65 cases (51.2%) succeeded with single-dose of methotrexate, 44 cases (34.6%) multi-dose of methotrexate, and ultimately 18 cases (14.2%) surgical procedures. Elevated pretreatment beta-hCG levels, size of an ectopic mass, trilaminar endometrial pattern, presence of yolk sac and vaginal bleeding were the main predictors of single-dose methotrexate treatment failure. CONCLUSION: Single-dose methotrexate injection was proved to be safe and effective method for ectopic pregnancy. Transvaginal sonographic findings could be important prognostic factors as well as pretreatment beta-hCG levels.
Female ; Humans ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic* ; Retrospective Studies ; Treatment Failure ; Ultrasonography ; Uterine Hemorrhage ; Yolk Sac

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.
Abdominal Neoplasms/metabolism/*pathology ; Adult ; Female ; Granular Cell Tumor/metabolism/*pathology ; Humans ; Immunohistochemistry ; Rectus Abdominis/metabolism/*pathology ; S100 Proteins/metabolism

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.
Abdominal Neoplasms/metabolism/*pathology ; Adult ; Female ; Granular Cell Tumor/metabolism/*pathology ; Humans ; Immunohistochemistry ; Rectus Abdominis/metabolism/*pathology ; S100 Proteins/metabolism