Background: Videofluoroscopic swallowing study (VFSS) is currently considered the gold standard to precisely diagnose and quantitatively investigate dysphagia. However, VFSS interpretation is complex and requires consideration of several factors. Therefore, considering the expected impact on dysphagia management, this study aimed to apply deep learning to detect the presence of penetration or aspiration in VFSS of patients with dysphagia automatically. Methods: The VFSS data of 190 participants with dysphagia were collected. A total of 10 frame images from one swallowing process were selected (five high-peak images and five low-peak images) for the application of deep learning in a VFSS video of a patient with dysphagia. We applied a convolutional neural network (CNN) for deep learning using the Python programming language. For the classification of VFSS findings (normal swallowing, penetration, and aspiration), the classification was determined in both high-peak and lowpeak images. Thereafter, the two classifications determined through high-peak and low-peak images were integrated into a final classification. Results: The area under the curve (AUC) for the validation dataset of the VFSS image for the CNN model was 0.942 for normal findings, 0.878 for penetration, and 1.000 for aspiration. The macro average AUC was 0.940 and micro average AUC was 0.961. Conclusion This study demonstrated that deep learning algorithms, particularly the CNN, could be applied for detecting the presence of penetration and aspiration in VFSS of patients with dysphagia.

PURPOSE: This study was done to explore communication between nurses during preceptorship. METHODS: A qualitative study, using content analysis was conducted. Semistructured interviews were held with 10 nurses working in urban hospitals. RESULTS: A total of 226 significant statements were selected from the data and classified into 4 categories and 23 subcategories. Communication experiences of new nurses' own performance were responses to reproach - acceptance and apology, and unresponsiveness due to feeling small and uncomfortable; responses to questions - misanswer; responses to directions - unconditional acceptance. Communication experiences of new nurses' performance by nurse preceptors were kindness, stigmatization, talking behind one's back, criticism and reproach, impolite words, and emotional expression. Communication experiences of nurse preceptors's own performance were directives, sympathy, reproach, unkindness, authoritative strictness, and nonverbal expression: being cold, and lessening of tension. Communication experiences of nurse preceptors' performance by new nurses were response to criticism - recognition and apology for mistakes, evasion of responsibility, and excuses; responses to explanations-active acceptance, and difficulty with communication due to lack of comprehension. CONCLUSION: These results provide deep understanding of nurses' communication during preceptorship and should help in developing comprehensive education programs for preceptor nurses and new nurses.
Comprehension ; Education ; Hospitals, Urban ; Preceptorship* ; Qualitative Research ; Stereotyping

OBJECTIVE: The authors evaluated the effect of direct bypass (superficial temporal artery-middle cerebral artery bypass) in the prevention of rebleeding episodes in patients suffering from hemorrhagic moyamoya disease by comparing this method with indirect bypass. METHODS: Fifteen patients who had hemorrhagic moyamoya without aneurysm comprised the study group. The mean age of patients was 44.4 years and follow up period ranged from 0.8 to 7.1 years (mean; 3.61 years). Revascularization surgery was performed in 21 sides in 15 patients. Direct bypass was performed in 17 sides and indirect bypass in the other 4 sides. RESULTS: During the follow-up period after the revascularization surgery, three sides (14.3%) of the 21 sides presented with rebleeding episode, one of 17 sides (mean follow-up periods; 2.94 years) treated with direct method and 2 of 4 sides (mean follow-up periods; 6.45 years) treated with indirect method. Kaplan-Meier analysis of rebleedingfree survival showed quite different between direct and indirect method but statistically insignificant (p=0.0541). CONCLUSION: Direct bypass may reduce the risk of hemorrhage more effectively than indirect bypass. However, direct bypass cannot always prevent rebleeding.
Aneurysm ; Cerebral Arteries ; Follow-Up Studies ; Hemorrhage* ; Humans ; Kaplan-Meier Estimate ; Moyamoya Disease*

PUEPOSE: To evaluate the treatment results and complication of a femoral head fracture with posterior dislocation of the hip according to the Pipkin classification. MATERIALS AND METHODS: Ten cases of Thompson-Epstein type V femoral head fracture with a posterior dislocation of the hip were evaluated. According to the Pipkin classification, 5 cases were type I, 1 case was type III, and 4 cases were type IV. The average age at time of trauma was 38 (19~72) years, and the causes were traffic accidents in 9 cases and falls in 1 case. The average follow-up period was 33 (13~79) months. A reduction of the fracture was performed within 6 hours in 9 cases and 12 hours in 1 case. When the stability was achieved after the reduction, the choice of further treatment was made from either conservative treatment while maintaining skeletal traction, or surgical treatment according to the fracture type and instability. The complications were evaluated by a physical examination, simple radiography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: In Pipkin type I fractures, 4 cases were treated with conservative treatment and 1 case was treated with surgical treatment. One case of Pipkin type III fracture was treated with primary total hip arthroplasty. In Pipkin type IV fractures, 2 cases were treated surgically using a plate and 2 cases were treated with conservative treatment with skeletal traction. Bone union was achieved in all cases. One case of mild posttraumatic arthritis and 1 case of avascular necrosis was found, respectively in Pipkin type IV. CONCLUSION: The extent of the initial injury has an effect on the prognosis of a hip fracture and dislocation.
Accidents, Traffic ; Arthritis ; Arthroplasty, Replacement, Hip ; Classification ; Dislocations* ; Follow-Up Studies ; Head* ; Hip* ; Magnetic Resonance Imaging ; Necrosis ; Physical Examination ; Prognosis ; Radiography ; Traction

OBJECTIVE: This study was performed to examine the relationship between community-based social support and psychosocial distress in workers. METHODS: The study subjects were 596 workers recruited from 11 companies in Chungju city. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, job stress, work-based social support, community-based social support and level of psychosocial distress. RESULTS: Hierarchical multiple regression analysis showed that workers with no chronic disease, exercise and sufficient sleep had a higher score of psychosocial distress than those with chronic disease, no exercise, and not enough sleep. Coworker's work-based social support and community-based social support were negatively associated with psychosocial distress. The R square value of total independent variables on psychosocial distress was 0.409, and that of community-based social support on psychosocial distress was 0.052. CONCLUSION: This study showed that community-based social support served as a protective factor against psychosocial distress in some workers. We recommend the establishment of a worksite stress reduction program in occupational level as well as community-based social support.
Chronic Disease ; Chungcheongbuk-do ; Questionnaires ; Workplace

The Philadelphia (Ph) chromosome is a well- known chromosome abnormality in adults with B-lineage ALL, and is associated with a poor prognosis. This study compared the clinical manifestations and prognosis in adult Ph-positive and Ph-negative ALL patients. MATERIALS AND METHODS: We retrospectively analyzed the clinical records of adult patients newly diagnosed as B-lineage ALL, between January 1995 and February 2001. Fifty five patients were included in this study. We divided the patients into Ph-positive and Ph-negative groups. RESULTS: Eighteen of the 55 patients (32.7%) were found to have the Ph chromosome. At initial diagnosis, the Ph-positive patients had higher circulating leukocyte counts, lower platelet counts and had a greater tendency to bleed, than the Ph-negative group. The complete remission rates were 83.3% and 83.8% for the Ph-positive and the Ph-negative groups, respectively. Four of the Ph-positive, and 13 of the Ph-negative, patients underwent allogenic bone marrow transplantation. The median follow-up for the surviving patients was 39.3 months. The three-year survival rates were 10.4% and 51.8% for the Ph-positive and the Ph-negative groups, respectively. The median disease-free survival was 7.7 months for the Ph-positive group, but did not reach the median value in the Ph-negative group. Among the Ph-positive patients, age was the only factor that had an impact on the disease outcome. CONCLUSION: In adult B-lineage ALL, the Ph-positive patients had similar complete remission rates to other patients; however, the remission was of shorter duration, with a higher relapse rate in the Ph-positive patients. More effective treatments are needed to improve the survival of the Ph-positive patients.
Adult* ; Bone Marrow Transplantation ; Chromosome Aberrations ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Leukocyte Count ; Philadelphia Chromosome ; Platelet Count ; Prognosis* ; Recurrence ; Retrospective Studies ; Survival Rate

Treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (t-AML) are now well established as complications of cytotoxic chemotherapy. We experienced a 28-yr-old female patient who developed t-MDS/t-AML with characteristic chromosomal abnormalities including 11q23 chromosomal rearrangement following high-dose chemotherapy with autologous stem cell transplantation (ASCT) for non-Hodgkin's lymphoma. The patient was admitted with bulky abdominal masses of B cell lineage non-Hodgkin's lymphoma. After 2 cycles of systemic chemotherapy of the Vanderbilt regimen, the patient underwent ASCT with high dose chemotherapy of the BEAC regimen. She also received radiation of 48 Gy for the residual periportal lymphadenopathy. The initial cytogenetic analysis of the infused mononuclear cells revealed a normal karyotype. Twenty two months after the ASCT, pancytopenia was noted and her bone marrow aspirate showed dysplastic hemopoiesis with myeloblasts up to 12% of nonerythroid nucleated cells. The patient was diagnosed as t-MDS (refractory anemia with an excess of blasts). Cytogenetic analysis showed complex chromosomal abnormalities including 11q23 rearrangement, which is frequently found in topoisomerase II inhibitor-related hematologic malignancies. Four months later, it was noted that the t-MDS had evolved into an overt t-AML. Cytogenetic analysis showed an evolving pattern with more complex abnormalities. The patient was treated with combination che-motherapy, but her leukemic cells were resistant to the therapy.
Adult ; Antineoplastic Agents, Phytogenic/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/*adverse effects ; B-Lymphocytes/cytology ; Bone Marrow Cells/pathology ; Carmustine/*adverse effects ; Chromosome Aberrations ; Chromosomes, Human, Pair 11 ; Combined Modality Therapy/adverse effects ; Cyclophosphamide/*adverse effects ; Cytarabine/*adverse effects ; Etoposide/*adverse effects ; Female ; Gene Rearrangement ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Leukemia, Myeloid, Acute/*etiology/genetics ; Lymphoma, Non-Hodgkin/*therapy ; Myelodysplastic Syndromes/*etiology/genetics ; Neoplasms, Second Primary/*etiology ; Pelvis ; Pregnancy ; Pregnancy Complications, Neoplastic/*therapy ; Transplantation, Autologous

BACKGROUND: Von Willebrand factor (vWf) plays a crucial role in the early phase of hemostasis. Acquired von Willebrand disease (vWD) due to abnormalities of vWf multimers has been reported in patients with myeloproliferative disorders (MPD) who have high platelet counts. We compared the distribution of plasma vWf antigen and large vWf multimers in samples obtained from patients with MPD and reactive thrombocytosis (RT). Furthermore, we tried to find the relationship between the decrease of large vWf multimers in plasma and the bleeding complication. METHODS: Sixteen patients with MPD and twenty-five patients with RT with more than 600x103/microliter of platelets were included in the study. The numbers of platelets and leukocytes, platelet distribution width (PDW), mean platelet volume (MPV), platelet-large cell ratio (P-LCR), vWf : Ag and vWf multimers were measured. RESULTS: The mean values of platelets and leukocytes were 1,091x103/microliter, 82.9x103/ in MPD and 763x103/, 11.4x103/ in RT (P<0.05). Platelet parameters such as MPV,PDW, P-LCR were 11.2 fL, 10.2%, 28.6% in MPD, and 9.6 fL, 9.9%, 19.6% in RT (P<0.05). The levels of vWf : Ag and large vWf multimer were 120.8 U/dL, 13.8% in MPD and 184.3 U/ dL, 20.7% in RT (P<0.05). Large vWf multimers were decreased in 11 MPDs and 2 RTs. Bleeding diathesis appeared only in 2 MPDs with decreased large vWf multimers. Platelet or leukocyte count was inversely correlated with large vWf multimers, but vWf antigen was correlated with large vWf multimer. CONCLUSION: The findings of normal vWf antigen level and decreased percentage of large vWf multimers are more frequent in MPD than in RT, and the measurement of these parameters is useful to differentiate MPD from RT. Bleeding complication in the patients with MPD with decreased large vWf multimers might be prevented by correction of decreased large vWf multimers.
Blood Platelets ; Disease Susceptibility ; Hemorrhage ; Hemostasis ; Humans ; Leukocyte Count ; Leukocytes ; Mean Platelet Volume ; Myeloproliferative Disorders* ; Plasma ; Platelet Count ; Thrombocytosis* ; von Willebrand Diseases ; von Willebrand Factor*

BACKGROUND: Multi-drug resistance (MDR) is one of the most important obstacles in the chemotherapy of acute leukemia, so the modulators of MDR have been developed and tried. METHODS: We measured MDR function and expressoin (surface and cytoplasmic p-glycoprotein and cytoplasmic multidrug-resistance associated protein (MRP)) and inhibitory effects of MDR modulators (cyclosporine and verapamil) by flow cytometry with MDR positive cell line and bone marrow aspirates of patients with acute leukemia (128 specimen). We compared these methods, and tried to clarify the effects of MDR on chemotherapy in patients with acute leukemia. RESULTS: The MDR functional assay and the detection method for inhibitory effects of MDR modulators (cyclosporine and verapamil) by flow cytometry using rhodamine 123 were established. These MDR functional assay was more sensitive, accurate, relatively simple and very economic, compared with the immunofluorescence assays of surface and cytopla-smic p-glycoprotein and cytoplasmic MRP. The positivity of MDR functional assay was observed in about 60% of patients with acute leukemia, and MDR activity (%) was inversely correlated with the complete remission rate and mean survival time. About 60% of the patients showing positive MDR activity revealed MDR inhibitory responses by cyclosporine and/or verapamil, especially all cases of acute myeloid leukemia in persistence after chemotherapy showed MDR inhibitory effect of cyclosporine. CONCLUSION: The chemotherapeutic out- comes of acute leukemia can be expected by MDR functional assay. And it is possible to overcome MDR by the administration of MDR modulator selected according to the results of the functional assay for MDR inhibitory effect in acute leukemia patients with MDR positivity.
Bone Marrow ; Cell Line ; Cyclosporine ; Cytoplasm ; Drug Resistance, Multiple* ; Drug Therapy ; Flow Cytometry ; Fluorescent Antibody Technique ; Humans ; Leukemia* ; Leukemia, Myeloid, Acute ; P-Glycoprotein ; Rhodamine 123 ; Survival Rate ; Verapamil

BACKGROUND: Survival time of patients with multiple myeloma has been reported to be closely related to the cytology of bone marrow smears and the histologic features of bone marrow biopsies. However, there have been many differences in morphological criteria applied by various authors. In this study, we evaluated the prognostic relevance of bone marrow features in patients with multple myeloma by investigation of the cytologic feature and the histologic patterns. MATERIALS AND METHODS: One hundred and seven previously untreated patients with multiple myeloma, admitted to Asan Medical Center, between 1989 and 1997, were studied. Bone marrow aspirations and biopsies were analyzed according to the criteria such as cytologic differentiation, volume of infiltration, pattern of infiltration, degree of hematopoiesis, and presence of fibrosis. RESULTS: 64 cases (59.8%) of 107 patients with multiple myeloma were plasmacytic type and 43 cases (40.2%) were plasmablastic type. Each median survival time was 35.0 months and 18.0 months (P<0.05). The patients with more than 25% of plasmablasts showed shorter median survival time than those with 1ess than 25% (18 months vs 38.9 months, P<0.05). The patients with nodular or packed marrow pattern revealed poorer prognosis than those with interstitial or interstitial/nodular pattern (P<0.05). The patients of plasmablastic type disclosed larger volume of myeloma cell infiltration and more packed marow pattern than those of plasmacytic type. CONCLUSIONS: The cytologic differentiation, the volume of infiltration and the patterns of infiltration were reliable predictors of survival in myeloma patients. Thus, for the prognostic evaluation and therapeutic plans, the descriptions for cytologic differentiation (especially percentage of plasmablasts), volume of infiltration and pattern of infiltration should be included in the bone marrow interpretation of multiple myeloma.
Aspirations (Psychology) ; Biopsy ; Bone Marrow* ; Chungcheongnam-do ; Fibrosis ; Hematopoiesis ; Humans ; Multiple Myeloma* ; Prognosis