Coronary artery calcium score (CACS) is a reliable predictor for future cardiovascular disease risk. Although deep learning studies using computed tomography (CT) images to predict CACS have been reported, no study has assessed the feasibility of machine learning (ML) algorithms to predict the CACS using clinical variables in a healthy general population. Therefore, we aimed to assess whether ML algorithms other than binary logistic regression (BLR) could predict high CACS in a healthy population with general health examination data.This retrospective observational study included participants who had regular health screening including coronary CT angiography. High CACS was defined by the Agatston score ≥ 100. Univariable and multivariable BLR was performed to assess predictors for high CACS in the entire dataset. When performing ML prediction for high CACS, the dataset was randomly divided into a training and test dataset with a 7:3 ratio. BLR, catboost, and xgboost algorithms with 5-fold cross-validation and grid search technique were used to find the best performing classifier. Performance comparison of each ML algorithm was evaluated with the area under the receiver operating characteristic (AUROC) curve.A total of 2133 participants were included in the final analysis. Mean age and proportion of male sex were 55.4 ± 11.3 years and 1483 (69.5%), respectively. In multivariable BLR analysis, age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10-1.15, p < 0.001), male sex (OR, 2.91; 95% CI, 1.57-5.38, p < 0.001), systolic blood pressure (OR, 1.02; 95% CI, 1.00-1.03, p = 0.019), and low-density lipoprotein cholesterol (OR, 1.00; 95% CI, 0.99-1.00, p = 0.047) were significant predictors for high CACS. Performance in predicting high CACS of xgboost was AUROC of 0.823, followed by catboost (0.750) and BLR (0.585). The comparison of AUROC between xgboost and BLR was significant (p for AUROC comparison < 0.001).Xgboost ML algorithm was found to be a more reliable predictor of CACS in healthy participants compared to the BLR algorithm. ML algorithms may be useful for predicting CACS with only laboratory data in healthy participants.
BACKGOUND: Lateral epicondylitis (LE) is one of the most common musculoskeletal disorders that causes pain. OBJECTIVES: We evaluated the effect of the inclusion of a minimal dose of corticosteroid in a solution comprising autologous whole blood (AWB), 20% dextrose, and 2% lidocaine for treating LE. METHODS: In this randomized prospective trial LE patients were allocated to the CS+ group (n= 70; solution comprising 1 mL AWB, 1 mL 20% dextrose, 0.4 mL 2% lidocaine, and 0.1 mL (0.4 mg) dexamethasone palmitate; injected into the common wrist extensor tendon) or the CS- group (n= 70; same solution as above but without dexamethasone palmitate). Five injections were administered at monthly intervals. At each visit, pain intensity was evaluated using the numeric rating scale (NRS), and grip strength was measured using a hand-grip dynamometer. RESULTS: In the CS+ and CS- groups, 1 and 10 patients dropped out, respectively. In both groups, the NRS scores at each evaluation were significantly lower than the pretreatment scores. The NRS scores from pretreatment to the second and third visits were significantly lower in the CS+ group than those in the CS- group. However, at the fourth and fifth visits, and 6 months after the last injection (the sixth visit), the degree of pain reduction between the groups was not significantly different. Grip strength increased significantly over time in both groups. At each evaluation, grip strength was significantly higher than that at the pretreatment stage. However, the degree of increase was not significantly different between groups. CONCLUSIONS: The inclusion of a minimal dose of corticosteroid in the AWB and 20% dextrose injection can reduce pain, especially during early treatment.
Neuropathic pain in the hands due to carpal tunnel syndrome (CTS) disturbs sleep and affects the quality of life.We evaluated the effect of ultrasound (US)-guided partial release of the transverse carpal ligament (TCL) using an 18-G needle in patients with refractory CTS.A prospective outcome study.The outpatient clinic of a single academic medical center.This study was prospectively conducted. A total of 155 consecutive patients (191 wrists) with refractory chronic CTS (M:F = 28:127; age = 54.7 ± 9.6 years; pain duration = 50.3 ± 36.3 weeks) were enrolled and underwent US-guided partial release of the TCL using a needle. The pain severity was measured using the Numeric Rating Scale (NRS) at 3 and 6 months after the treatment. Successful treatment outcomes were defined as more than 50% reduction in the NRS score at 6 months after the treatment compared with the score at pre-treatment and NRS score < 3 at 6 months after the treatment without any surgical intervention.There were 3 dropouts, and 188 wrists were included in the study. No side effects were reported. A total of 162 wrists (86.2%) showed successful treatment outcomes at 6 months after TCL release. Of the 26 wrists which had unsuccessful treatment outcomes, 6 received surgical treatment. The NRS scores at 3- and 6-month post-treatment were significantly reduced: the average NRS scores were 7.1 ± 0.6 at baseline, 1.9 ± 1.7 at 3 months after the treatment, and 1.7 ± 1.7 at 6 months after the treatment.We conducted our study without a control or a placebo group.We believe that US-guided partial release of the TCL using a needle can be an effective and safe technique for treating chronic refractory pain due to CTS. It can potentially be attempted before surgical treatment.
Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE.The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD.The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only.TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
For managing symptoms of adhesive capsulitis (AC), corticosteroid injection is typically conducted under the guidance of ultrasound via posterior glenohumeral recess (PGHR). It has been reported that pathologies such as inflammation and edema are most commonly observed in the coracohumeral ligament (CHL) and anterior and inferior joint capsules. We compared the therapeutic effects of corticosteroid injection into the CHL and inferior glenohumeral capsule (IGHC) with those of corticosteroid injection into PGHR in patients with AC.One hundred twenty consecutive patients with AC were included in this study and randomly allocated to either the CHL + IGHC group (n = 60) or the PGHR group (n = 60). Patients in both groups received 3 injections at 2 week intervals. After the first injection, if the patient's shoulder pain showed satisfactory improvement, further injections were not administered. The therapeutic effect was measured at 2 and 4 months after the first injection. Pain intensity was evaluated using the visual analog scale (VAS). Additionally, the passive range of motion (ROM) of the shoulder joint (abduction, external rotation, and internal rotation) was measured.VAS scores and ROM of abduction, external rotation, and internal rotation improved at follow-up evaluation in both groups (P < 0.05) (CHL and IGHC: VAS, pre-treatment = 6.5 ± 0.5, 2 months = 2.1 ± 0.8, 4 months = 1.4 ± 0.6; ROM-abduction, pre-treatment = 131.3° ± 16.4°, 2 months = 162.4° ± 8.2°, 4 months = 176.2° ± 5.6°; ROM-external rotation, pre-treatment = 31.6° ± 16.9°, 2 months = 67.2° ± 11.1°, 4 months = 81.3° ± 12.1°, ROM-internal rotation, pre-treatment = 6.2 ± 2.2, 2 months = 4.0 ± 2.2, 4 months = 2.7 ± 1.2; PGHR: VAS, pre-treatment = 6.5 ± 0.5°, 2 months = 3.9 ± 1.1, 4 months = 2.1 ± 1.1; ROM-abduction, pre-treatment = 132.1° ± 9.5°, 2 months = 145.5° ± 11.7°, 4 months = 167.4° ± 11.2°; ROM-external rotation, pre-treatment = 32.4° ± 13.4°, 2 months = 49.3° ± 13.2°, 4 months = 72.7° ± 18.0°, ROM-internal rotation, pre-treatment = 6.3 ± 1.4, 2 months = 5.4 ± 0.8, 4 months = 3.6 ± 1.0). However, the improvements were greater in patients who received corticosteroid injection into the CHL and IGHC compared to that into the PGHR at 2 and 4 months after the initiation of the treatment (P < 0.05).Long-term therapeutic outcomes were not investigated, and the therapeutic effect of corticosteroid injection into the CHL and IGHC was not compared with placebo injection.Corticosteroid injection into the CHL and IGHC might be a better treatment alternative for patients with AC.
Coronary artery aneurysms are uncommon, are usually associated with atherosclerosis, and rarely involve all three major coronary arteries. The present report describes a rare case of a young female patient presenting with acute myocardial infarction (AMI). Coronary angiography revealed multiple severe aneurysmal and stenotic changes. Based on clinical feature and angiographic findings, it was strongly suspected that the patient had polyarteritis nodosa (PAN) complicated by AMI. The patient was treated with standard cardiac medications and immunosuppressive agents and has remained stable without further complications during a follow-up period of 6 months.
목적: 춘천을 중심으로 강원도 북서 지역의 건강 검진자를 대상으로 하여 위식도 역류 증상의 종류별 빈도와 역류식도염, 내시경적으로 의심되는 바렛 식도의 빈도를 알아보고자 하였다. 증상의 종류별로, 내시경적 역류식도염의 유무로 분류하여 각각에서 바렛 식도, 위궤양, 십이지장궤양, 식도 열공, 흡연 및 음주 등의 생활 습관의 차이가 있는지 연구하였다. 방법: 2005년 7월 1일부터 2006년 6월 30일까지 내시경을 포함한 건강검진을 받은 총 1,011명을 연구대상으로 하였다. 설문지를 통하여 증상, 흡연, 음주, 성별, 나이, 과거 HP 치료력을 얻었으며 내시경을 통해 역류식도염, 바렛 식도, 위궤양, 십이지장궤양, 식도 열공 등을 관찰하였다. 증상 종류별로 전형적 증상군, 비전형적 증상군, 증상이 없는 무증상군과 증상의 빈도가 낮아 불편감 없는 군으로 분류하였고, 내시경적 역류식도염의 유무로 분류하여 각 군 간의 임상적 차이를 알아보았다. 결과: 춘천을 중심으로 강원 북서 지역에서 건강 검진자중, 일상 생활에 지장을 주는 정도의 가슴 쓰림과 위산 역류의 증상을 호소하는 경우는 7.5%였으며 내시경적으로 역류 식도염은 9.7%에서 관찰되었다. 바렛 식도는 6.8%에서 내시경적으로 의심되었다. 증상의 유무에 따라 내시경적 역류식도염의 유병률에 통계적 차이를 나타냈으며 성별에 의한 뚜렷한 차이를 관찰할 수 있었다. 내시경적 역류식도염의 성별에 의한 차이가 2.8:1로 남자에서 많은 것으로 관찰되었으며 이와 함께 식도 열공과 음주, 흡연, 기침도 남자에게서 보다 빈번했으며 가슴 쓰림, 속 쓰림, 기타 증상은 여자에게서 빈번히 나타났다. 결론: 증상이 있는 군에서 증상 종류에 따라 연구에 포함된 모든 항목에서 통계적인 차이가 없었고, 증상의 정도 및 빈도는 내시경적 역류식도염과 연관성이 없었다. 그러나 증상의 유무와 역류식도염과는 연관성이 있었다. 이번 연구로 춘천을 중심으로 한 강원 북서 지역의 위식도 역류병의 일면을 보았고 향후 일반 인구집단에 대한 위식도 역류병의 유병률 조사가 필요하겠다. 내시경적 역류식도염에서 지역적 유병률의 차이, 관찰자간 차이 및 실제적 증가가 있는지에 대한 연구가 필요할 것으로 보인다.
The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.
본 연구에서는 시간연장보육을 받는 유아들이 보이는 문제행동 양상을 파악하기 위하여 종일반 유아와 시간연장반 유아들이 종일보육시간에 보이는 문제행동의 차이와 시간연장반 유아들이 종일보육과 시간연장보육시간에 보이는 문제행동의 차이를 살펴보고자 하였다. 이를 위해 어린이집의 종일반만 이용하는 유아 156명과 기준보육시간 이후 시간연장보육까지 받는 유아 169명의 종일반 교사와 시간연장반 교사가 Merrell(1994)이 개발한 The Preschool and Kindergarten Behavior Scale를 이진숙(2001)이 번안한 척도로 유아들의 문제행동을 평가하였다. 수집된 자료로 SPSS PC+ 18.0 프로그램을 이용하여 독립표본 t-검증과 대응표본 t-검증을 실시하였다. 본 연구의 결과는 다음과 같다. 첫째, 종일반 유아보다 시간연장반 유아들이 종일보육시간에 자기중심성, 행동과다, 공격성의 외현적 문제행동을 더 많이 보였으며 이러한 양상은 남아들에게 더 두드러지게 나타났다. 둘째, 남녀 유아 모두 종일보육보다 시간연장보육 시간에 더 높은 수준의 외현적 문제행동을 보였으며 특히, 여아들은 종일보육보다 시간연장보육 시간에 더 많은 내재적 문제행동을 보였다. 또한 남아들은 종일보육과 시간연장보육 시간 모두에서 여아들보다 외현적 문제행동을 더 많이 보였다. 본 연구의 결과는 시간연장보육 담당교사와 종일보육 담당교사, 그리고 유아의 가족 간에 밀접한 연계 및 협력체제를 구축하여 개별 유아의 요구를 파악하고 이를 적극적으로 반영하는 개별화된 보육서비스를 개발할 필요성을 시사한다.This study investigated differences in problem behaviors of full-day class children and behaviors of time-extended class children during full-day care and time-extended care to figure out aspects of behavior problems of young children depending on time-length staying at child-care centers. The subjects of this study were a total of 156 young children attending to full-day classes and 169 young children attending to time-extended classes of child-care centers. Full-day class teachers and time-extended class teachers assessed problem behaviors of the children, using the scale which Lee (2001) translated the Preschool and Kindergarten Behavior Scale developed by Merrell (1994). Collected data were analyzed by administering independent t-test and paired sample t-test using SPSS PC+18.0 program. The results of this study are summarized as follows. First, time-extended class children showed significantly more extrinsic behavior problems than full-day class children during full-day care, which was prominent to boys. Second, both boys and girls attending to time-extended classes showed significantly more extrinsic behavior problems during time-extended care than full-day care while girls also show more intrinsic behavior problems during time-extended care than full-day care. The results of the study implies necessity to develop care service based on each child’s needs by establishing collaborative system among personnel of full-day classes and time-extended classes and each child’ s family.
BACKGROUND: The knee joint is one of the most common diseases in elderly individuals. This is a progressive and debilitating condition. The purpose of knee osteoarthritis treatment is to manage pain, increase mobility, and improve the quality of life. OBJECTIVES: This study evaluated the therapeutic effect of radiofrequency thermocoagulation (RFTC) on the genicular nerves in patients with intractable pain due to knee osteoarthritis, as well as its effects on pain severity and magnetic resonance imaging (MRI) findings. STUDY DESIGN: A prospective outcome study. SETTING: The outpatient clinic of a single academic medical center. METHODS: We conducted a prospective study. Fifty consecutive patients with intractable knee pain due to osteoarthritis were enrolled and underwent ultrasound (US)-guided RFTC of the genicular nerves (medial superior genicular nerve, medial inferior genicular nerve, and lateral superior genicular nerve). Pain severity was measured using the Numeric Rating Scale (NRS), and knee osteoarthritis-associated symptoms were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at pretreatment and one, 3, and 6 months after RFTC treatment. We also analyzed the relationship between therapeutic outcomes and pain severity based on pre-treatment and knee MRI findings. RESULTS: No dropouts were observed. The most significant reduction in knee symptoms associated with knee osteoarthritis was observed after one month of treatment; however, at 3 and 6 months, there was a rebound effect, leading to a decrease in therapeutic efficacy. Nonetheless, there was still a noticeable decrease in symptoms due to knee osteoarthritis compared to those prior to RFTC treatment. The effect of RFTC treatment was better when pre-treatment pain was relatively less severe, knee effusion was not severe, there were no meniscal tears in the middle or posterior zones, no bone marrow edema in the middle and posterior zones of the femur and tibia, and no severe cartilage defects in the posterior femur and middle and posterior tibia. LIMITATIONS: We conducted our study without a control or a placebo group. CONCLUSION: RFTC of the genicular nerve is a good therapeutic option for controlling intractable pain following knee osteoarthritis. In addition, we found that a lower level of pain prior to treatment, along with the absence or lesser degree of knee joint effusion, as well as an absence or less severe middle or posterior knee pathologies associated with knee osteoarthritis, can predict a more favorable therapeutic outcome. KEY WORDS: knee, osteoarthritis, radiofrequency ablation, genicular nerve, pain, magnetic resonance imaging
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