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.

Multiple cerebral infarctions coexisting with peripheral artery occlusion have been rarely reported and occur only in specific conditions. Also, the characteristics of thrombosis related to the outbreak of the coronavirus disease 2019 (COVID-19) have been observed and studied recently. We report a case of concurrent multiple cerebral infarctions and peripheral embolism in a patient with a recent history of COVID-19 infection. A 62-year-old male patient who had recently been infected with COVID-19 presented to our emergency department with left hemiparesis. Supportive treatments were given post the diagnosis of multiple cerebral infarctions in the right cerebral hemisphere. During the supportive treatments, motor weakness was seen in the right upper extremity. Computed tomography revealed thrombi in the right axillary, brachiocephalic, and brachial arteries. The patient was already taking antiplatelet and anticoagulant agents and had no other underlying disease to develop such occlusions except his recent history of COVID-19 infection. We checked his laboratory tests for coagulation profiles throughout the hospitalization to verify a possible cause. We believe that large thrombi formation due to COVID-19 can simultaneously cause embolism in the cerebrum and peripheral regions. This pathology can result in symptoms that could make diagnosis difficult, delaying treatment decisions. This report, therefore, suggests that it is necessary to take into account a patient’s history of COVID-19 infection in such situations, especially when the patient presents with symptoms of a stroke.

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been acknowledged as an effective mean of preventing infection and hospitalization.However, the emergence of highly transmissible SARS-CoV-2 variants of concern (VOCs) has led to substantial increase in infections among children and adolescents. Vaccineinduced immunity and longevity have not been well defined in this population. Therefore, we aimed to analyze humoral and cellular immune responses against ancestral and SARSCoV-2 variants after two shots of the BNT162b2 vaccine in healthy adolescents. Although vaccination induced a robust increase of spike-specific binding Abs and neutralizing Abs against the ancestral and SARS-CoV-2 variants, the neutralizing activity against the Omicron variant was significantly low. On the contrary, vaccine-induced memory CD4+ T cells exhibited substantial responses against both ancestral and Omicron spike proteins.Notably, CD4+ T cell responses against both ancestral and Omicron strains were preserved at 3 months after two shots of the BNT162b2 vaccine without waning. Polyfunctionality of vaccine-induced memory T cells was also preserved in response to Omicron spike protein.The present findings characterize the protective immunity of vaccination for adolescents in the era of continuous emergence of variants/subvariants.

Purpose: Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. Methods This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the “frozen section biopsy” or “frozen section biopsy omission” group after lumpectomy. Patients with clinical stage T1–T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness.Discussion: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy.We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety.

Toxoplasma gondii is an intracellular protozoan parasite that infects approximately one third of the human popu- lation worldwide. Considering the toxicity and side effects of anti-toxoplasma medications, it is important to develop effec- tive drug alternatives with fewer and less severe off-target effects. In this study, we found that 4-hydroxybenzaldehyde (4- HBA) induced autophagy and the expression of NAD-dependent protein deacetylase sirtuin-1 (SIRT1) in primary murine bone marrow-derived macrophages (BMDMs). Interestingly, treatment of BMDMs with 4-HBA significantly reduced the number of macrophages infected with T. gondii and the proliferation of T. gondii in infected cells. This effect was impaired by pretreating the macrophages with 3-methyladenine or wortmannin (selective autophagy inhibitors) or with sirtinol or EX527 (SIRT1 inhibitors). Moreover, we found that pharmacological inhibition of SIRT1 prevented 4-HBA-mediated expres- sion of LC3-phosphatidylethanolamine conjugate (LC3-II) and the colocalization of T. gondii parasitophorous vacuoles with autophagosomes in BMDMs. These data suggest that 4-HBA promotes antiparasitic host responses by activating SIRT1- mediated autophagy, and 4-HBA might be a promising therapeutic alternative for the treatment of toxoplasmosis.

BACKGROUND: Although the importance of pharmaceutical care service has been growing to meet the needs of customers with the improvement of clinical and humanistic outcomes, there was not a systematic strategy to promote research in Korea. The aim of this study was to suggest the core agendas for pharmaceutical care services research and development (R&D) considering priorities. METHODS: Based on desk researches, we developed R&D agendas for the needs of improving pharmaceutical care services in the area of institution, community, and public health. To determine the priority of agendas in developing pharmaceutical care service, analytic hierarchy process (AHP) analysis was performed by the 14 experts. Criteria and subcriteria were assessed for significance by pairwise comparisons. Then, agendas were evaluated for importance according to each subcriteria, and rank ordered considering the weight calculated by multiplying the importance scores of the criteria and the subcriteria. RESULTS: We derived 25 agendas including 13 for institutional pharmaceutical care service, 8 for community pharmaceutical care service, and 4 for public-health related pharmaceutical care service. AHP model was constructed based on 4 criteria and 8 subcriteria by a hierarchical structure. From the AHP survey, the ‘Development of pharmaceutical care service for metabolic and chronic disease’ agenda accounted for the highest priority. CONCLUSION: We have developed the R&D agendas of the pharmaceutical care service which should be promoted. The results should be utilized by the government to nationally support the development of the standards and relevant regulations related to pharmaceutical care services in Korea.
Korea ; Pharmaceutical Services ; Public Health ; Social Control, Formal

BACKGROUND: Few studies have reported the results of arthroscopic coracoplasty concomitantly conducted with subscapularis tear. Therefore, this study was conducted to examine and compare the outcomes of arthroscopic subscapularis repair after arthroscopic coracoplasty using either the subacromial approach or rotator interval approach. METHODS: We retrospectively reviewed 51 patients who underwent coracoplasty with subscapularis repair. The patients were grouped according to whether the subacromial approach group (24 patients) or rotator interval approach group (27 patients) was used during coracoplasty. Preoperative and postoperative visual analogue scale scores, American shoulder and elbow surgeons scores, Korean shoulder scores, and range of motion (ROM) were assessed. Assessment of repaired rotator cuff tendon integrity was performed at 1 year after surgery using either magnetic resonance imaging or ultrasonography. RESULTS: At final follow-up, overall functional scores and ROM improved significantly in both groups when compared with preoperative values (p>0.05). The re-tear rates were not significantly different between groups; however, the rotator interval approach group showed a significant increase in ROM compared with that in the subacromial approach group (p<0.05). CONCLUSIONS: Arthroscopic coracoplasty conducted concomitantly with subscapularis repair can provide a satisfactory outcome. There were no significant differences between the two approach groups regarding final functional scores and re-tear rates. However, the rotator interval approach group showed a greater increase in ROM at final follow-up, especially in external rotation.
Arthroscopy ; Elbow ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff ; Shoulder ; Surgeons ; Tears* ; Tendons ; Ultrasonography

OBJECTIVE: To investigate the causes and characteristics of golf-related shoulder injuries in Korean amateur golfers. METHODS: Golf-related surveys were administered to, and ultrasonography were conducted on, 77 Korean amateur golfers with golf-related shoulder pain. The correlation between the golf-related surveys and ultrasonographic findings were investigated. RESULTS: The non-dominant shoulder is more likely to have golf-related pain and abnormal findings on ultrasonography than is the dominant shoulder. Supraspinatus muscle tear was the most frequent type of injury on ultrasonography, followed by subscapularis muscle tear. Investigation of the participants' golf-related habits revealed that only the amount of time spent practicing golf was correlated with supraspinatus muscle tear. No correlation was observed between the most painful swing phases and abnormal ultrasonographic findings. Participants who had not previously visited clinics were more likely to present with abnormal ultrasonographic findings, and many of the participants complained of additional upper limb pain. CONCLUSION: Golf-related shoulder injuries and pain are most likely to be observed in the non-dominant shoulder. The supraspinatus muscle was the most susceptible muscle to damage. A correlation was observed between time spent practicing golf and supraspinatus muscle tear.
Golf ; Shoulder Pain* ; Shoulder* ; Tears ; Ultrasonography ; Upper Extremity

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

BACKGROUND: Few studies have reported the results of arthroscopic coracoplasty concomitantly conducted with subscapularis tear. Therefore, this study was conducted to examine and compare the outcomes of arthroscopic subscapularis repair after arthroscopic coracoplasty using either the subacromial approach or rotator interval approach. METHODS: We retrospectively reviewed 51 patients who underwent coracoplasty with subscapularis repair. The patients were grouped according to whether the subacromial approach group (24 patients) or rotator interval approach group (27 patients) was used during coracoplasty. Preoperative and postoperative visual analogue scale scores, American shoulder and elbow surgeons scores, Korean shoulder scores, and range of motion (ROM) were assessed. Assessment of repaired rotator cuff tendon integrity was performed at 1 year after surgery using either magnetic resonance imaging or ultrasonography. RESULTS: At final follow-up, overall functional scores and ROM improved significantly in both groups when compared with preoperative values (p>0.05). The re-tear rates were not significantly different between groups; however, the rotator interval approach group showed a significant increase in ROM compared with that in the subacromial approach group (p<0.05). CONCLUSIONS: Arthroscopic coracoplasty conducted concomitantly with subscapularis repair can provide a satisfactory outcome. There were no significant differences between the two approach groups regarding final functional scores and re-tear rates. However, the rotator interval approach group showed a greater increase in ROM at final follow-up, especially in external rotation.
Arthroscopy ; Elbow ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff ; Shoulder ; Surgeons ; Tears ; Tendons ; Ultrasonography