Bone age assessments are a complicated and lengthy process, which are prone to inter- and intra-observer variabilities. Despite the great demand for fully automated systems, developing an accurate and robust bone age assessment solution has remained challenging. The rapidly evolving deep learning technology has shown promising results in automated bone age assessment. In this review article, we will provide information regarding the history of automated bone age assessments, discuss the current status, and present a literature review, as well as the future directions of artificial intelligence-based bone age assessments.

Bone age assessments are a complicated and lengthy process, which are prone to inter- and intra-observer variabilities. Despite the great demand for fully automated systems, developing an accurate and robust bone age assessment solution has remained challenging. The rapidly evolving deep learning technology has shown promising results in automated bone age assessment. In this review article, we will provide information regarding the history of automated bone age assessments, discuss the current status, and present a literature review, as well as the future directions of artificial intelligence-based bone age assessments.

Purpose: The aim of this study was to evaluate the clinical efficacy of a Tanner-Whitehouse 3 (TW3)-based fully automated bone age assessment system on hand-wrist radiographs of Korean children and adolescents. Materials and Methods: Hand-wrist radiographs of 80 subjects (40 boys and 40 girls, 7-15 years of age) were collected. The clinical efficacy was evaluated by comparing the bone ages that were determined using the system with those from the reference standard produced by 2 oral and maxillofacial radiologists. Comparisons were conducted using the paired t-test and simple regression analysis. Results: The bone ages estimated with this bone age assessment system were not significantly different from those obtained with the reference standard (p>0.05) and satisfied the equivalence criterion of 0.6 years within the 95% confidence interval ( - 0.07 to 0.22), demonstrating excellent performance of the system. Similarly, in the comparisons of gender subgroups, no significant difference in bone age between the values produced by the system and the reference standard was observed (p>0.05 for both boys and girls). The determination coefficients obtained via regression analysis were 0.962, 0.945, and 0.952 for boys, girls, and overall, respectively (p=0.000); hence, the radiologist-determined bone ages and the system-determined bone ages were strongly correlated. Conclusion This TW3-based system can be effectively used for bone age assessment based on hand-wrist radiographs of Korean children and adolescents.

BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques. CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS: Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Conduction ; Breast ; Cardiomyopathies ; Cardiopulmonary Resuscitation ; Humans ; Methods ; Pneumonia ; Thoracic Wall

BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques.CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.
Acute Kidney Injury* ; Female ; Hemofiltration ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypothyroidism* ; Middle Aged ; Muscle, Skeletal ; Muscles ; Myoglobin ; Rhabdomyolysis*

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.
Acute Kidney Injury* ; Female ; Hemofiltration ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypothyroidism* ; Middle Aged ; Muscle, Skeletal ; Muscles ; Myoglobin ; Rhabdomyolysis*

OBJECTIVES: Common genetic SNPs in two genes, encoding catechol-O-methyltransferase (COMT) and methylenetetrahydrofolate reductase (MTHFR), which are interconnected with COMT gene regulation, have been reported to contribute to schizophrenia risk. In this study, we evaluated the association between functional polymorphisms in COMT and MTHFR and schizophrenia risk with a case-control study in a Korean population. METHODS: We performed a case-control study by genotyping analysis using 360 cases and 348 controls in Korean subjects to determine the association between functional polymorphisms in COMT and MTHFR and schizophrenia risk. RESULTS: Four functional SNPs in COMT (Val158Met and rs165599) and MTHFR (C677T and A1298C) were genotyped by primer extension assay. None of the genotype distributions for the four SNPs was significantly different between cases and controls. Stratified analysis did not show any significant gender difference for any polymorphism. In addition, we found no evidence of a gene-gene interaction in the analysis of combined genotypes. CONCLUSION: Our results suggest no significant association between the selected functional polymorphisms of COMT or MTHFR in Korean schizophrenia subjects. However, further studies are required to confirm our findings in a larger number of subjects.
Case-Control Studies ; Catechol O-Methyltransferase ; Genotype ; Methylenetetrahydrofolate Reductase (NADPH2) ; Polymorphism, Single Nucleotide ; Schizophrenia

Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function.
Ventricular Dysfunction, Left/*diagnosis/*etiology ; Stress, Psychological/*complications ; Myocardial Infarction/diagnosis ; Magnetic Resonance Imaging/*methods ; Humans ; Female ; Electrocardiography ; Echocardiography ; Diagnosis, Differential ; Aged

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.
Angioplasty ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Heart Rate* ; Heart* ; Humans ; Oxygen ; Transplants