Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Objective: In Korea, radiology has been positioned towards the early adoption of artificial intelligence-based software as medical devices (AI-SaMDs); however, little is known about the current usage, implementation, and future needs of AI-SaMDs.We surveyed the current trends and expectations for AI-SaMDs among members of the Korean Society of Radiology (KSR). Materials and Methods: An anonymous and voluntary online survey was open to all KSR members between April 17 and May 15, 2023. The survey was focused on the experiences of using AI-SaMDs, patterns of usage, levels of satisfaction, and expectations regarding the use of AI-SaMDs, including the roles of the industry, government, and KSR regarding the clinical use of AI-SaMDs. Results: Among the 370 respondents (response rate: 7.7% [370/4792]; 340 board-certified radiologists; 210 from academic institutions), 60.3% (223/370) had experience using AI-SaMDs. The two most common use-case of AI-SaMDs among the respondents were lesion detection (82.1%, 183/223), lesion diagnosis/classification (55.2%, 123/223), with the target imaging modalities being plain radiography (62.3%, 139/223), CT (42.6%, 95/223), mammography (29.1%, 65/223), and MRI (28.7%, 64/223). Most users were satisfied with AI-SaMDs (67.6% [115/170, for improvement of patient management] to 85.1% [189/222, for performance]). Regarding the expansion of clinical applications, most respondents expressed a preference for AI-SaMDs to assist in detection/diagnosis (77.0%, 285/370) and to perform automated measurement/quantification (63.5%, 235/370). Most respondents indicated that future development of AI-SaMDs should focus on improving practice efficiency (81.9%, 303/370) and quality (71.4%, 264/370). Overall, 91.9% of the respondents (340/370) agreed that there is a need for education or guidelines driven by the KSR regarding the use of AI-SaMDs. Conclusion The penetration rate of AI-SaMDs in clinical practice and the corresponding satisfaction levels were high among members of the KSR. Most AI-SaMDs have been used for lesion detection, diagnosis, and classification. Most respondents requested KSR-driven education or guidelines on the use of AI-SaMDs.

Objective: Little is known about the effects of using different expert-determined reference standards when evaluating the performance of deep learning-based automatic detection (DLAD) models and their added value to radiologists. We assessed the concordance of expert-determined standards with a clinical gold standard (herein, pathological confirmation) and the effects of different expert-determined reference standards on the estimates of radiologists’ diagnostic performance to detect malignant pulmonary nodules on chest radiographs with and without the assistance of a DLAD model. Materials and Methods: This study included chest radiographs from 50 patients with pathologically proven lung cancer and 50 controls. Five expert-determined standards were constructed using the interpretations of 10 experts: individual judgment by the most experienced expert, majority vote, consensus judgments of two and three experts, and a latent class analysis (LCA) model. In separate reader tests, additional 10 radiologists independently interpreted the radiographs and then assisted with the DLAD model. Their diagnostic performance was estimated using the clinical gold standard and various expertdetermined standards as the reference standard, and the results were compared using the t test with Bonferroni correction. Results: The LCA model (sensitivity, 72.6%; specificity, 100%) was most similar to the clinical gold standard. When expertdetermined standards were used, the sensitivities of radiologists and DLAD model alone were overestimated, and their specificities were underestimated (all p-values < 0.05). DLAD assistance diminished the overestimation of sensitivity but exaggerated the underestimation of specificity (all p-values < 0.001). The DLAD model improved sensitivity and specificity to a greater extent when using the clinical gold standard than when using the expert-determined standards (all p-values < 0.001), except for sensitivity with the LCA model (p = 0.094). Conclusion The LCA model was most similar to the clinical gold standard for malignant pulmonary nodule detection on chest radiographs. Expert-determined standards caused bias in measuring the diagnostic performance of the artificial intelligence model.

Methods: A total of 90 patients underwent APCT within 48 hours of surgery. Medical records were reviewed to determine each patient’s age, sex, body mass index, medical and surgical histories, characteristics of LLIF procedures, and subjective symptoms and abnormal findings in the physical examination related to acute abdomen after surgery. Various parameters were compared between patients with and without pneumoperitoneum. Results: Bowel injuries were identified in the first two patients and five patients (5.5%) were diagnosed with pneumoperitoneum only on APCT. We found that the greater the number of fused segments, the higher the incidence of postoperative bowel injury and/or pneumoperitoneum. The incidence was significantly high when the L2–3 level was included in the LLIF surgery. Conclusions Pneumoperitoneum after LLIF indicates damage to the peritoneum and the presence of bowel injury that may lead to peritonitis. However, it is difficult to distinguish pneumoperitoneum and/or bowel injury from general abdominal pain after surgery because patients may present with a wide range of symptoms. We recommend that APCT be routinely performed after LLIF surgery in order to promptly identify pneumoperitoneum and bowel injury.

Percutaneous transthoracic needle biopsy (PTNB) is one of the essential diagnostic procedures for pulmonary lesions. Its role is increasing in the era of CT screening for lung cancer and precision medicine. The Korean Society of Thoracic Radiology developed the first evidence-based clinical guideline for PTNB in Korea by adapting pre-existing guidelines. The guideline provides 39 recommendations for the following four main domains of 12 key questions: the indications for PTNB, pre-procedural evaluation, procedural technique of PTNB and its accuracy, and management of post-biopsy complications. We hope that these recommendations can improve the diagnostic accuracy and safety of PTNB in clinical practice and promote standardization of the procedure nationwide.

OBJECTIVES: The purpose of this study was to investigate the correlation of periodontitis with metabolic syndromes and menopause status. METHODS: The 2013 Korea National Health and Nutrition Examination Survey data of 645 postmenopausal and 663 premenopausal women were analyzed using the Pearson's chi-squared test and multiple regression analysis with the Statistical Package for the Social Sciences (PASW statistics) software version 21.0. Metabolic syndromes and community periodontal index (CPI) were analyzed. RESULTS: CPI 3, CPI 4 (P<0.001), and the prevalence of periodontal disease were significantly higher in the postmenopausal group (P<0.001). Periodontal disease was significantly higher (P<0.001) in postmenopausal women not using dental floss (2.69 times), hypertensive postmenopausal women (1.60 times), and premenopausal women with high blood glucose levels (1.67 times). In the multiple logistic regression analysis, after adjusting for age, smoking habit, and alcohol consumption, significant risk factors for periodontal disease were the lack of dental floss use (odds ratio [OR]: 1.83; 95% confidence interval [CI]: 1.26–2.67), menopause (OR: 1.71; 95% CI: 1.22–2.41), and number of metabolic syndromes (when 1 or 2, OR: 2.22 and 95% CI: 1.50–3.29; when 3 or more, OR: 2.22 and 95% CI: 1.58–3.13). CONCLUSIONS: In summary, menopause status is associated with periodontal disease. Therefore, oral health programs for middle-aged women with menopause and metabolic syndromes should be conducted to improve their oral health-related quality of life.
Alcohol Drinking ; Blood Glucose ; Dental Devices, Home Care ; Female ; Humans ; Korea ; Logistic Models ; Menopause ; Nutrition Surveys ; Oral Health ; Periodontal Diseases ; Periodontal Index ; Periodontitis ; Prevalence ; Quality of Life ; Risk Factors ; Smoke ; Smoking ; Social Sciences

OBJECTIVES: The purpose of this study was to investigate the reasons for unmet dental needs in Korea and to find ways to improve dental care accessibility by using data from the 6th National Health and Nutrition Survey. METHODS: This study was performed using data collected from the 6th National Health and Nutrition Examination Survey (KNHANES). A total of 2,251 subjects were selected for the study. Statistical analysis was performed using SPSS 21.0 on data files obtained according to complex sampling design, and a significance level of 0.05 was used. General characteristics of the subjects, oral health status, and unmet dental needs were examined for a complex sampling frequency analysis, and the differences in distribution were analyzed using chi-square analysis. Relevant factors were determined using logistic regression analysis. RESULTS: According to the logistic regression analysis, in Model 1, gender, household income, employment status, and subjective health status were found to be significantly related to unmet dental needs (P<0.05). In Model 2, subjective health status, subjective oral health status, and chewing difficulty were significantly related to unmet dental needs (P<0.001). Model 3 showed a significant relationship between subjective health status, subjective oral health status, chewing difficulty, periodontal disease, and unmet dental needs (P<0.001). CONCLUSIONS: We conclude that the reasons for the unmet dental needs in Korea are socioeconomic status, general health status, and oral health status. In the future, economic barriers to obtaining dental care need to be overcome through improvements in health insurance policies and systems and diversification of private insurance. Oral health should be improved through oral health education, which can create awareness and provide motivation for maintaining oral health.
Adult ; Dental Care ; Diagnostic Self Evaluation ; Education ; Employment ; Family Characteristics ; Humans ; Information Storage and Retrieval ; Insurance ; Insurance, Health ; Korea ; Logistic Models ; Mastication ; Motivation ; Nutrition Surveys ; Oral Health ; Periodontal Diseases ; Social Class

OBJECTIVES: This study aimed to contribute to the development of an oral health education program on organized professional toothbrushing by determining its effects on plaque control in patients undergoing orthodontic treatment. METHODS: The subjects in the experimental group participated in the professional toothbrushing and oral health education weekly for 4 weeks, and those in the control group participated in the same program without professional toothbrushing education. RESULTS: The difference in knowledge, attitude, and behaviors on oral health was higher among the experimental group who underwent professional toothbrushing and oral health education program than those in the control group. The effects of toothbrushing time on the plaque index were significantly lower in experimental group than those in the control group. CONCLUSIONS: It is suggested that adequate oral health and professional toothbrushing education program should be implemented to improve oral health.
Education ; Humans ; Oral Health ; Toothbrushing

The authors confirm that the author name and the title were incorrect in the last isuse of the journal.

OBJECTIVES: To investigate the effects of Computerized Neuropsychologic Test (CNT) on cognitive function and daily life performance in subacute post-stroke patients with cognitive impairment. METHODS: Korean Mini-Mentals State Examination (K-MMSE), Korean version of Modified Barthel Index (K-MBI) were investigated in 125 subacute post-stroke patients with cognitive impairment. We analyzed K-MMSE and K-MBI which were conducted 63 patients who had received CNT and 62 patient who had not received CNT from baseline to 8 weeks follow-up. In the experimental group, initial K-MMSE and K-MBI were conducted 13.3 ± 6.8 weeks after the onset of stroke and their age was 63.4 ± 13.3. In the control group, initial K-MMSE and K-MBI were conducted 13.2 ± 7.7 weeks after the onset of stroke and their age was 65.1 ± 11.6. RESULTS: The 8 weeks follow-up total K-MMSE score and total K-MBI score of experimental group were significantly higher than control group (P < 0.05). In K-MMSE subsection, orientation, judgement, recall, language & visual reconstruction were significantly higher in experimental group than control group (P < 0.05). In K-MBI subsection, personal hygiene, bathing self, toilet, dressing, ambulation, chair/bed transfer were significantly higher in experimental group than control group (P < 0.05). The change of total K-MMSE score of experimental group was significantly correlated with change of total K-MBI score (P < 0.05), but control group was not (P > 0.05). In K-MMSE subsection, change of orientation, registration, language and visual reconstruction were correlated with total K-MBI s core after CNT. Especially, the experimental group, total K-MBI score of the left hemisphere damage group was significantly higher than the right hemisphere damage group (P < 0.05). CONCLUSIONS: This study shows that CNT is effective on subacute post-stroke patients with cognitive impairment. Improvement of cognitive function can expect a positive outcome on daily life performance, in particular, it can be expected to improve the prognosis of patients with stroke, the left hemisphere lesions.
Bandages ; Baths ; Cognition ; Cognition Disorders* ; Cognitive Therapy ; Follow-Up Studies ; Humans ; Hygiene ; Neuropsychological Tests* ; Prognosis ; Stroke ; Walking