Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis, but differentiating between the diagnosis of TBM and viral meningitis (VM) is difficult. Thus, we have developed machine-learning modules for differentiating TBM from VM.Material and Methods: For the training data, confirmed or probable TBM and confirmed VM cases were retrospectively collected from five teaching hospitals in Korea between January 2000 - July 2018. Various machine-learning algorithms were used for training. The machinelearning algorithms were tested by the leave-one-out cross-validation. Four residents and two infectious disease specialists were tested using the summarized medical information. Results: The training study comprised data from 60 patients with confirmed or probable TBM and 143 patients with confirmed VM. Older age, longer symptom duration before the visit, lower serum sodium, lower cerebrospinal fluid (CSF) glucose, higher CSF protein, and CSF adenosine deaminase were found in the TBM patients. Among the various machinelearning algorithms, the area under the curve (AUC) of the receiver operating characteristics of artificial neural network (ANN) with ImperativeImputer for matrix completion (0.85; 95% confidence interval 0.79 - 0.89) was found to be the highest. The AUC of the ANN model was statistically higher than those of all the residents (range 0.67 - 0.72, P <0.001) and an infectious disease specialist (AUC 0.76; P = 0.03). Conclusion The machine-learning techniques may play a role in differentiating between TBM and VM. Specifically, the ANN model seems to have better diagnostic performance than the non-expert clinician.

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis, but differentiating between the diagnosis of TBM and viral meningitis (VM) is difficult. Thus, we have developed machine-learning modules for differentiating TBM from VM.Material and Methods: For the training data, confirmed or probable TBM and confirmed VM cases were retrospectively collected from five teaching hospitals in Korea between January 2000 - July 2018. Various machine-learning algorithms were used for training. The machinelearning algorithms were tested by the leave-one-out cross-validation. Four residents and two infectious disease specialists were tested using the summarized medical information. Results: The training study comprised data from 60 patients with confirmed or probable TBM and 143 patients with confirmed VM. Older age, longer symptom duration before the visit, lower serum sodium, lower cerebrospinal fluid (CSF) glucose, higher CSF protein, and CSF adenosine deaminase were found in the TBM patients. Among the various machinelearning algorithms, the area under the curve (AUC) of the receiver operating characteristics of artificial neural network (ANN) with ImperativeImputer for matrix completion (0.85; 95% confidence interval 0.79 - 0.89) was found to be the highest. The AUC of the ANN model was statistically higher than those of all the residents (range 0.67 - 0.72, P <0.001) and an infectious disease specialist (AUC 0.76; P = 0.03). Conclusion The machine-learning techniques may play a role in differentiating between TBM and VM. Specifically, the ANN model seems to have better diagnostic performance than the non-expert clinician.

OBJECTIVE: To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period. METHODS: The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured. RESULTS: One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73). CONCLUSION: The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.
Electric Impedance ; Female ; Humans ; Hypertension ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy* ; Uterine Artery*

PURPOSE: This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up. METHODS: We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=2), and StarClose (n=1) in this study. Four patients were implanted with 2 VCDs at the each side of bilateral femoral arteries, while the remaining 8 patients were inserted 1 VCD at the right femoral artery. Ultrasonography was performed within 10 days and at approximately 6 months after the angiographic procedure. Ultrasonographic morphology of the attached VCD and its relationship with the arterial wall were analyzed. RESULTS: Initial ultrasonography revealed the attached VCD as the relevant unique structure with successful deployment and hemostasis. Follow-up ultrasonography demonstrated partial absorption of hemostatic materials in cases of Angio-Seal (n=3), FemoSeal (n=5), and ExoSeal (n=3), changes in the soft tissue surrounding the femoral artery in case of Angio-Seal (n=1), arterial intimal hyperplasia in cases of FemoSeal (n=3), and no gross changes as compared with the initial ultrasonographic findings in cases of Perclose (n=2) and StarClose (n=1). CONCLUSION: Initial ultrasonographic evaluation reflected the unique structure of each VCD, with most of them being easily distinguishable. Follow-up ultrasonography revealed various changes in the affected vessels.
Absorption ; Femoral Artery ; Follow-Up Studies* ; Hemostasis ; Humans ; Hyperplasia ; Ultrasonography ; Vascular Access Devices

BACKGROUND: We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality. MATERIALS AND METHODS: A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years). RESULTS: The porcine root group was older than the other groups (freestyle 55.9+/-14.3 years vs. mechanical 46.3+/-14.6 years, homograft 48.1+/-14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups. CONCLUSION: Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.
Adult ; Cardiopulmonary Bypass ; Diabetes Mellitus ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis ; Humans ; Incidence ; Marfan Syndrome ; Multivariate Analysis ; Postoperative Complications ; Prostheses and Implants ; Retrospective Studies ; Survival Rate ; Thromboembolism ; Transplantation, Homologous

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in immunocompromised patients. However, few data on clinical characteristics and outcomes of IPA in Korea have been reported. We conducted a nationwide multicenter study in Korea for evaluation of the epidemiology and clinical outcomes of invasive pulmonary aspergillosis. MATERIALS AND METHODS: A retrospective cohort study was conducted in 10 hospitals in Korea. We reviewed all adult patients who met the revised EORTC/MSG definitions between 2008 and 2010. RESULTS: A total of 334 cases, which included proven (26, 8%), probable (159, 48%), or possible (149, 44%) IPA, were identified. Patients with proven or probable IPA were evaluated, and, of these 185 IPA patients, 105 (57%) had neutropenia, 30 (16%) underwent hematopoietic stem cell transplantation, 25 (14%) underwent solid organ transplantation, and 32 (17%) without neutropenia and transplantation received immunosuppressive agents or corticosteroid. Aspergillus spp. were isolated from 42 patients (23%), and positive fungal culture rates from sterile fluid, sputum, and bronchoalveolar lavage fluid (BAL) were 67% (6/9), 21% (32/150), and 20% (9/44), respectively. Results of assays for sensitivity of serum and BAL galactomannan were 84% (155/184) and 89% (25/28), respectively. Amphotericin-B deoxycholate and itraconazole were most commonly administered as a primary therapy in 107 (58%) and 34 (19%) patients, respectively. Of 133 patients (73%) who received salvage therapy after primary antifungal therapy for a median period of six days (IQR 3-12), 82 (62%) patients were treated with voriconazole. Of 185 patients, 82 (44%) died within three months after diagnosis of IPA. CT findings, including small airway lesions and micronodules, ground glass opacities, and pleural effusion and persistent positive galactomannan status showed an independent association with worse outcome, while proven diagnosis of IPA showed an independent association with better outcome. CONCLUSIONS: Microbiologic confirmation of IPA was low in Korea; therefore, many Korean physicians were dependent on the galactomannan assay for microbiologic diagnosis. Primary therapy with Amphotericin-B deoxycholate followed by salvage therapy with voriconazole was the most common antifungal strategy for treatment of patients with IPA in Korea. Overall mortality and IPA-related mortality were comparable with data from Western clinical trials.
Adult ; Aspergillus ; Bronchoalveolar Lavage Fluid ; Cohort Studies ; Deoxycholic Acid ; Glass ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Invasive Pulmonary Aspergillosis ; Itraconazole ; Korea ; Mannans ; Neutropenia ; Organ Transplantation ; Pleural Effusion ; Pyrimidines ; Retrospective Studies ; Salvage Therapy ; Sputum ; Transplants ; Triazoles

OBJECTIVE: Recently, the prevalence of gall stone related with metabolic syndrome is increasing in Korea. The aim of this study was to reveal a relationship between components of metabolic syndrome and the development of gall bladder stones. METHODS: Among the subjects who visited a health promotion center of Soonchunhyang University Hospital from March 2009 to March 2010, a total of 5,201 adults were examined. Among them, the final 5,052 (male 3,403, female 1,649) adults were included. Sex, age, body mass index, waist circumference, blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol levels, and the presence of gall stones were measured. Metabolic syndrome was defined by criteria of 2004 American Heart Association/Updated National Cholesterol Education Program Adult Treatment Panel III. Analyses were adjusted by age and sex. RESULTS: This study showed that the prevalence of gall stone was 1.6% and metabolic syndrome was 19.3%. The results didn't show an association between gall stone risk and components of metabolic syndrome. But gall stone risk was increased according to aging, high total cholesterol in the abnormal body mass index group. In normal body mass index group, waist circumference was related with the development of gall stone. Total cholesterol level was related with the development of gall stone in overweight group. CONCLUSION: This study showed total cholesterol levels and waist circumference related with prevalence of gall stone in specific body mass index group.
Adult ; Aging ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting ; Female ; Gallstones ; Health Promotion ; Heart ; Humans ; Korea ; Overweight ; Prevalence ; Risk Factors ; Urinary Bladder ; Waist Circumference

Despite the prophylaxis and preemptive strategies using potent antiviral agents, cytomegalovirus (CMV) remains a major infectious cause of morbidity and mortality in allogeneic stem cell transplantation (SCT) recipients. Delayed immune reconstitution after SCT, such as cord blood and T-cell depleted SCT with the use of alemtuzumab, has been associated with an increased frequency of CMV disease as well as CMV reactivation. CMV disease involving central nervous system is an unusual presentation in the setting of SCT. We report a case of CMV ventriculoencephalitis after unrelated double cord blood SCT with an alemtuzumab-containing preparative regimen for Philadelphia-positive acute lymphoblastic leukemia.
Antibodies, Monoclonal/pharmacology/*therapeutic use ; Antibodies, Monoclonal, Humanized ; Antibodies, Neoplasm/pharmacology/*therapeutic use ; Antineoplastic Agents/pharmacology/*therapeutic use ; Cord Blood Stem Cell Transplantation/*adverse effects ; Cytomegalovirus/drug effects ; Cytomegalovirus Infections/*drug therapy/*etiology/physiopathology ; *Encephalitis/etiology/pathology/virology ; Fatal Outcome ; Humans ; Male ; *Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/drug therapy/virology ; Transplantation Conditioning/methods

OBJECTIVE: There is some controversy regarding the early onset or high incidence of coronary atherosclerosis in patients with systemic sclerosis (SSc). Measurements of the coronary calcification score (CCS) by multi-detector computed tomography (MDCT) is an accurate and non-invasive method for detecting coronary atherosclerosis, and a high level of CCS (> or =160) can predict coronary events. This study examined the CCS using MDCT and evaluated the risk of coronary events in patients with SSc. METHODS: The clinical and laboratory characteristics of 35 patients with SSc were examined. The CCS was measured by MDCT, and the risk of coronary events were evaluated by CCS and the Framingham risk score (FRS). RESULTS: In 35 patients (2 males and 33 females, 20 with limited and 15 with diffuse type), the mean age was 52+/-12 years and the disease duration was 8+/-7 years. The mean CCS was 10.1+/-30.8, the CCS of 28 patients (80%) was 0, and all patients had a CCS<160. The CCS had no significant correlation with the clinical and laboratory characteristics. The FRS was evaluated in 29 patients. Twenty eight patients were categorized into the low-risk group (FRS<10%) and only one was classified into the moderate-risk group (FRS=13%). CONCLUSION: These results suggest that the risk of coronary events due to coronary atherosclerosis might not be high in patients with SSc.
Calcinosis ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Incidence ; Male ; Scleroderma, Systemic

PURPOSE: Bilateral in situ internal thoracic artery (ITA) bypassing may result in excellent myocardial revascularization without increasing the risk of deep sternal wound infection. Although there have been concerns with the use of pedicled bilateral ITA, the risk of infection may not be greater than the use of skeletonized ITA. MATERIALS AND METHODS: The present study was retrospectively undertaken to determine if pedicled BITA grafts are associated with a higher risk of sternal wound complications. A total of 207 patients who underwent bilateral ITA bypasses with or without existing diabetes mellitus, and 162 patients of those received bilateral pedicled ITA and 98 patients received unilateral ITA bypass grafts. RESULTS: No sternal wound complications were noted in either the bilateral ITA or unilateral left ITA groups. CONCLUSION: Bilateral pedicled ITA harvesting was not associated with a greater incidence of infectious sternal complications compared to patients receiving unilateral ITA bypass grafts.
Aged ; Coronary Artery Disease/epidemiology/*surgery ; Diabetes Mellitus/epidemiology ; Female ; Humans ; *Internal Mammary-Coronary Artery Anastomosis/statistics & numerical data ; Male ; Mammary Arteries/*transplantation ; Mediastinitis/*epidemiology ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sternum ; Surgical Wound Infection/epidemiology ; Tissue and Organ Harvesting/*adverse effects/statistics & numerical data