Background: and Purpose Accurate classification of ischemic stroke subtype is important for effective secondary prevention of stroke. We used diffusion-weighted image (DWI) and atrial fibrillation (AF) data to train a deep learning algorithm to classify stroke subtype. Methods: Model development was done in 2,988 patients with ischemic stroke from three centers by using U-net for infarct segmentation and EfficientNetV2 for subtype classification. Experienced neurologists (n=5) determined subtypes for external test datasets, while establishing a consensus for clinical trial datasets. Automatically segmented infarcts were fed into the model (DWI-only algorithm). Subsequently, another model was trained, with AF included as a categorical variable (DWI+AF algorithm). These models were tested: (1) internally against the opinion of the labeling experts, (2) against fresh external DWI data, and (3) against clinical trial dataset. Results: In the training-and-validation datasets, the mean (±standard deviation) age was 68.0±12.5 (61.1% male). In internal testing, compared with the experts, the DWI-only and the DWI+AF algorithms respectively achieved moderate (65.3%) and near-strong (79.1%) agreement. In external testing, both algorithms again showed good agreements (59.3%–60.7% and 73.7%–74.0%, respectively). In the clinical trial dataset, compared with the expert consensus, percentage agreements and Cohen’s kappa were respectively 58.1% and 0.34 for the DWI-only vs. 72.9% and 0.57 for the DWI+AF algorithms. The corresponding values between experts were comparable (76.0% and 0.61) to the DWI+AF algorithm. Conclusion Our model trained on a large dataset of DWI (both with or without AF information) was able to classify ischemic stroke subtypes comparable to a consensus of stroke experts.

Several medications are approved to treat coronavirus disease 2019 (COVID-19) in Korea including nirmatrelvir/ritonavir, remdesivir, and regdanvimab. There is potential drug-drug interaction between antiepileptic drugs (AEDs) and the medications used to treat COVID-19. Several AEDs such as phenytoin, carbamazepine, phenobarbital, and primidone are strong cytochrome P450 inducers and can inhibit the drugs used for COVID-19. Particularly, these drugs are contraindicated with nirmatrelvir/ritonavir (Paxlovid®). There is a weaker drug-drug interaction between the AEDs and remdesivir. No significant interaction has been reported between the AEDs and molnupiravir. Pharmacokinetic interactions of the AEDs are important in effective management of COVID-19 in patients with epilepsy.

BACKGROUND: An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy. METHODS: We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR). RESULTS: Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were 61.9±5.3 ng/mL, 93.4±71.8 ng/mL, and 1,536.9±554.9 ng/mL, respectively. pNGAL level increased significantly in patients with severe albuminuria (P < 0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P < 0.001) and GFR (r=0.519; P < 0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR. CONCLUSIONS: pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.
Albuminuria ; Diabetes Mellitus ; Diabetic Nephropathies* ; Glomerular Filtration Rate ; Humans ; Kidney ; Lipocalins* ; Neutrophils* ; Plasma* ; Renal Dialysis ; Renal Insufficiency, Chronic ; Triage

OBJECTIVES: To assess the effect and safety of transcranial direct-current stimulation (tDCS) in primary chronic insomnia. METHODS: A one-month, double-blind, randomized, sham-controlled trial was performed. A total of 7 patients with primary chronic insomnia received tDCS using anodal (n=3), cathodal (n=2), or sham stimulation (n=2). They were followed up at 1 week and 1 month after treatment. The primary outcome measures included improvement in total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) at 1 month follow-up. RESULTS: TST and SE were improved with tDCS at 1 month follow-up in all patients (100%) of the anodal group, one (50%) of the cathodal group, and one (50%) of the sham group. tDCS improved SL at 1 month follow-up in two patients (67%) of the anodal group, one (50%) of the cathodal group, and none (0%) of the sham group. With respect to adverse events, transient itching sensation occurred in one patient of the anodal group. None of the other groups reported adverse events. CONCLUSIONS: Our results suggest that tDCS may be effective and safe for treatment of primary chronic insomnia. A larger controlled study needs to be further investigated.
Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Pruritus ; Sensation ; Sleep Initiation and Maintenance Disorders ; Transcranial Direct Current Stimulation

OBJECTIVES: The purposes of this study were to examine the reliability and validity of the Korean version of Social Communication Questionnaire (K-SCQ) and to determine cut-off scores for diagnosis of autism spectrum disorder (ASD). METHODS: A total of 166 subjects with ASD and their 186 unaffected siblings were recruited through child psychiatry clinics of university hospitals. Board certified child psychiatrists screened all probands suspected to have ASD based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. To confirm the diagnoses, the Korean versions of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised (K-ADI-R) were administered to all the subjects. All parents completed the K-SCQ and Social Responsiveness Scale (SRS). The non-ASD siblings were evaluated with the same instruments as the probands with ASD. We performed a factor analysis to examine the structure of K-SCQ. For testing the validity of K-SCQ, we compared the difference in Lifetime and Current scores of probands with ASD and their non-ASD siblings using t-test and analysis of covariance. Correlations between the K-SCQ and other measurements of ASD symptomatology, including K-ADI-R totals and domain scores and SRS, were examined. Receiver operation characteristic curve analysis was performed to extract cutoff scores discriminating affection status. RESULTS: Four factors were extracted through factor analysis of K-SCQ ; 1) social relation and play, 2) stereotyped behavior, 3) social behavior, and 4) abnormal language. Cronbach's internal consistency was .95 in K-SCQ Lifetime, and .93 in K-SCQ Current. There were significant differences in total score of K-SCQ, both in Lifetime and Current between the ASD group and non-ASD siblings group (p<.001). K-SCQ scores were significantly correlated with K-ADI-R subdomain scores and SRS total scores (p<.001). The best-estimate cut-off scores of K-SCQ for diagnosis of ASD were 12 for 48 months and over, and 10 for below 47 months. CONCLUSION: Our findings suggest that the K-SCQ is a reliable and valid instrument for screening autistic symptoms in the Korean population. Lower cut-off scores than the original English version might be considered when using it as a screening instrument of ASD.
Appointments and Schedules ; Autistic Disorder ; Child ; Autism Spectrum Disorder ; Child Psychiatry ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, University ; Humans ; Mass Screening ; Parents ; Psychiatry ; Reproducibility of Results ; Siblings ; Social Behavior ; Stereotyped Behavior

OBJECTIVE: To investigate the effects of hippotherapy for adult patients with brain disorders. METHOD: Eight chronic brain disorder patients (7 males, mean age 42.4+/-16.6 years) were recruited. The mean duration from injury was 7.9+/-7.7 years. The diagnoses were stroke (n=5), traumatic brain disorder (n=2), and cerebral palsy (n=1). Hippotherapy sessions were conducted twice a week for eight consecutive weeks in an indoor riding arena. Each hippotherapy session lasted 30 minutes. All participants were evaluated by the Berg balance scale, Tinetti Performance-Oriented Mobility Assessment, 10 Meter Walking Test, Functional Ambulatory Category, Korean Beck Depression Inventory, and Hamilton Depression Rating Scale. We performed baseline assessments twice just before starting hippotherapy. We also assessed the participants immediately after hippotherapy and at eight weeks after hippotherapy. RESULTS: All participants showed no difference in balance, gait function, and emotion between the two baseline assessments before hippotherapy. During the eight-week hippotherapy program, all participants showed neither adverse effects nor any accidents; all had good compliance. After hippotherapy, there were significant improvements in balance and gait speed in comparison with the baseline assessment (p<0.05), and these effects were sustained for two months after hippotherapy. However, there was no significant difference in emotion after hippotherapy. CONCLUSION: We could observe hippotherapy to be a safe and effective alternative therapy for adult patients with brain disorders in improving balance and gait function. Further future studies are warranted to delineate the benefits of hippotherapy on chronic stroke patients.
Adult ; Brain ; Brain Diseases ; Cerebral Palsy ; Compliance ; Depression ; Equine-Assisted Therapy ; Gait ; Humans ; Male ; Pilot Projects ; Stroke ; Walking

BACKGROUND: Recent evidence had shown from randomized trials published in July 2002 that demonstrated adverse cardiovascular disease events and other risks with hormone therapy in the form of oral estrogen combined with progestin caused limitation of its use. The purpose of this study was to describe change in medication of osteoporosis at an university hospital after the WHI clinical trial. METHODS: The study subjects were 644 and 656 women who underwent bone mass densiNometry (BMD) at an university hospital outpatient clinic in January 2002 and January 2003, respectively, with had no underlying disease for secondary osteoporosis. This study regarded January 2002 as before and Jan 2003 as after the publication of the WHI clinical trial. We analyzed change of Hormone replacement therapy (HRT), bisphosphonate, selective estrogen receptor modulator (SERM), tibolone, etc. RESULTS: More than one drug was prescribed for 425 (66%, before WHI) and 436 (66.5%, after WHI) patients among the two groups of study subjects, respectively. HRT was prescribed for 213 (33.07%) and 96 (14.63%) patients, respectively. The usage of the drugs decreased considerably after the publication of WHI clinical trial. This result was mainly due to the decline of combined estrogen/progesterone hormone therapy. The increase of bisphosphonate, SERM, calcium and vitamin D prescription was statistically significant. However, prescription for tibolone (livial) did not change. CONCLUSION: Combined estrogen/progesrerone therapy was considerably decreased after the publication of the Women's Health Initiative (WHI) clinical trial in accordance with the conclusion of the trial.
Calcium ; Cardiovascular Diseases ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Outpatient Clinics, Hospital ; Prescriptions ; Publications ; Selective Estrogen Receptor Modulators ; Vitamin D ; Women's Health*

Uterine arteriovenous malformation(AVM) is a rare cause of massive uterine bleeding. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Curettage may precipitate life-threatening hemorrhage and is therefore contraindicated when uterine AVM is suspected. These lesinons may be congenital or acquired. Acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynecologic malignancies. Until rescently, this condition was difficult to diagnose and management almost always required hysterectomy. Doppler flow ultrasound and pelvic angiography are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in woman who wish to retain their fertility. We have experienced one case of uterine AVM complicated by partial hydatidiform mole, which is presented with a brief review of the literature.
Angiography ; Arteriovenous Malformations* ; Choriocarcinoma ; Curettage ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hydatidiform Mole* ; Hysterectomy ; Menorrhagia ; Pregnancy ; Ultrasonography ; Uterine Hemorrhage ; Uterus*

OBJECTIVE: To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. METHODS: This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. RESULTS: Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. CONCLUSION: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.
Humans ; Pelvic Organ Prolapse* ; Pessaries* ; Silicones*

OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.
Cesarean Section ; Cicatrix ; Diagnosis ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Ultrasonography