A Visual Aid Tool for Detection of Pancreatic Tumour-Vessel Contact on Staging CT: A Retrospective Cohort Study.

Purpose: In pancreatic adenocarcinoma, the difficult distinction between normal and affected pancreas on CT studies may lead to discordance between the pre-surgical assessment of vessel involvement and intraoperative findings. We hypothesize that a visual aid tool could improve the performance of radiology residents when detecting vascular invasion in pancreatic adenocarcinoma patients. Methods: This study consisted of 94 pancreatic adenocarcinoma patient CTs. The visual aid compared the estimated body fat density of each patient with the densities surrounding the superior mesenteric artery and mapped them onto the CT scan. Four radiology residents annotated the locations of perceived vascular invasion on each scan with the visual aid overlaid on alternating scans. Using 3 expert radiologists as the reference standard, we quantified the area under the receiver operating characteristic curve to determine the performance of the tool. We then used sensitivity, specificity, balanced accuracy ((sensitivity + specificity)/2), and spatial metrics to determine the performance of the residents with and without the tool. Results: The mean area under the curve was 0.80. Radiology residents' sensitivity/specificity/balanced accuracy for predicting vascular invasion were 50%/85%/68% without the tool and 81%/79%/80% with it compared to expert radiologists, and 58%/85%/72% without the tool and 78%/77%/77% with it compared to the surgical pathology. The tool was not found to impact the spatial metrics calculated on the resident annotations of vascular invasion. Conclusion: The improvements provided by the visual aid were predominantly reflected by increased sensitivity and accuracy, indicating the potential of this tool as a learning aid for trainees.

Prevalence of osteoporosis in osteoarthritis: a systematic review and meta-analysis.

Data are contradictory regarding the relationship between osteoarthritis (OA) and osteoporosis (OP) with some studies showing the increased risk of OP in OA. The study was conducted to determine whether OP prevalence is increased in patients with OA, compared to age and sex-matched population. MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library (inception-2019) were searched for studies reporting the frequency, rate, prevalence, incidence, risk, or excess risk of OP in patients with OA compared to age and sex-matched population. Estimates were combined using a random effects model. Consistency was evaluated using the I2 statistic. Articles with fewer than 200 participants were excluded. Of 2772 articles, 49 had full article screening, and 8 articles met the inclusion criteria. Other articles reporting mean BMD and not OP were excluded. In women, 998 participants with OA were compared with 1903 controls. The pooled estimate of the odds ratio for prevalence of OP vs general matched population was not statistically different. In men, 136 participants with OA were compared with 682 controls. The results did not show a statistically significant difference in the frequency of OP in OA in men. According to the site of bone mineral density measurement, a higher prevalence of OP at lumbar spine was found in both men and women. The frequency of OP overall in participants with OA was not different, except for a higher prevalence of OP in lumbar spine in both men and women compared to the matched controls.

In Vitro Study of Licorice on IL-1ß-Induced Chondrocytes and In Silico Approach for Osteoarthritis.

Osteoarthritis (OA) is a common degenerative joint disorder that affects joint function, mobility, and pain. The release of proinflammatory cytokines stimulates matrix metalloproteinases (MMPs) and aggrecanase production which further induces articular cartilage degradation. Hypertrophy-like changes in chondrocytes are considered to be an important feature of OA pathogenesis. A Glycyrrhiza new variety, Wongam (WG), was developed by the Korea Rural Development Administration to enhance the cultivation and quality of Glycyrrhizae Radix et Rhizoma (licorice). This study examined the regulatory effect of WG against hypertrophy-like changes such as RUNX2, Collagen X, VEGFA, MMP-13 induction, and Collagen II reduction induced by IL-1ß in SW1353 human chondrocytes. Additionally, in silico methods were performed to identify active compounds in licorice to target chondrocyte hypertrophy-related proteins. WG showed inhibitory effects against IL-1ß-induced chondrocyte hypertrophy by regulating both HDAC4 activation via the PTH1R/PKA/PP2A pathway and the SOX9/ß-catenin signaling pathway. In silico analysis demonstrated that 21 active compounds from licorice have binding potential with 11 targets related to chondrocyte hypertrophy. Further molecular docking analysis and in vivo studies elicited four compounds. Based on HPLC, isoliquiritigenin and its precursors were identified and quantified. Taken together, WG is a potential therapeutic agent for chondrocyte hypertrophy-like changes in OA.

Machine-Deep-Ensemble Learning Model for Classifying Cybersickness Caused by Virtual Reality Immersion.

This study aims to classify cybersickness (CS) caused by virtual reality (VR) immersion through a machine-deep-ensemble learning model. The heart rate variability and respiratory signal parameters of 20 subjects were measured, while watching a VR video for ∼5 minutes. After the experiment, the subjects were examined for CS and questioned to determine their CS states. Based on the results, we constructed a machine-deep-ensemble learning model that could identify and classify VR immersion CS among subjects. The ensemble model comprised four stacked machine learning models (support vector machine [SVM], k-nearest neighbor [KNN], random forest, and AdaBoost), which were used to derive prediction data, and then, classified the prediction data using a convolution neural network. This model was a multiclass classification model, allowing us to classify subjects' CS into three states (neutral, non-CS, and CS). The accuracy of SVM, KNN, random forest, and AdaBoost was 94.23 percent, 92.44 percent, 93.20 percent, and 90.33 percent, respectively, and the ensemble model could classify the three states with an accuracy of 96.48 percent. This implied that the ensemble model has a higher classification performance than when each model is used individually. Our results confirm that CS caused by VR immersion can be detected as physiological signal data with high accuracy. Moreover, our proposed model can determine the presence or absence of CS as well as the neutral state. Clinical Trial Registration Number: 20-2021-1.

United adversarial learning for liver tumor segmentation and detection of multi-modality non-contrast MRI.

Simultaneous segmentation and detection of liver tumors (hemangioma and hepatocellular carcinoma (HCC)) by using multi-modality non-contrast magnetic resonance imaging (NCMRI) are crucial for the clinical diagnosis. However, it is still a challenging task due to: (1) the HCC information on NCMRI is insufficient makes extraction of liver tumors feature difficult; (2) diverse imaging characteristics in multi-modality NCMRI causes feature fusion and selection difficult; (3) no specific information between hemangioma and HCC on NCMRI cause liver tumors detection difficult. In this study, we propose a united adversarial learning framework (UAL) for simultaneous liver tumors segmentation and detection using multi-modality NCMRI. The UAL first utilizes a multi-view aware encoder to extract multi-modality NCMRI information for liver tumor segmentation and detection. In this encoder, a novel edge dissimilarity feature pyramid module is designed to facilitate the complementary multi-modality feature extraction. Secondly, the newly designed fusion and selection channel is used to fuse the multi-modality feature and make the decision of the feature selection. Then, the proposed mechanism of coordinate sharing with padding integrates the multi-task of segmentation and detection so that it enables multi-task to perform united adversarial learning in one discriminator. Lastly, an innovative multi-phase radiomics guided discriminator exploits the clear and specific tumor information to improve the multi-task performance via the adversarial learning strategy. The UAL is validated in corresponding multi-modality NCMRI (i.e. T1FS pre-contrast MRI, T2FS MRI, and DWI) and three phases contrast-enhanced MRI of 255 clinical subjects. The experiments show that UAL gains high performance with the dice similarity coefficient of 83.63%, the pixel accuracy of 97.75%, the intersection-over-union of 81.30%, the sensitivity of 92.13%, the specificity of 93.75%, and the detection accuracy of 92.94%, which demonstrate that UAL has great potential in the clinical diagnosis of liver tumors.

Comparative outcomes of lopinavir/ritonavir and hydroxychloroquine for the treatment of COVID-19 with mild-to-moderate severity: A retrospective observational study.

BACKGROUND: Lopinavir/ritonavir (LPV/r) and hydroxychloroquine (HCQ) are both being used to treat coronavirus disease 2019 (COVID-19), but their relative effectiveness is unknown. The purpose of this study was to compare the clinical outcomes of patients treated for COVID-19 with LPV/r or HCQ. METHODS: A retrospective observational study was conducted at 2 hospitals in Busan, South Korea, where approximately 90% of COVID-19 patients were hospitalised during February/March 2020. All patients aged ≥15 years that were hospitalised with mild or moderately severe COVID-19 received LPV/r or HCQ as their initial treatment and were included in the analysis. RESULTS: Among the 72 patients with mild-to-moderate disease severity on admission, 45 received LPV/r and 27 received HCQ as their initial therapy. A higher proportion of the LPV/r group had pneumonia on admission (LPV/r, 49% vs HCQ, 15%), but there were no other significant differences in the demographic or clinical characteristics between groups. Switching therapy due to clinical failure was significantly more common in the HCQ group than in the LPV/r group (41% [11/27] and 2% [1/45], respectively, P = .001). Disease progression was also significantly more common in the HCQ group than in the LPV/r group (44% [12/27] and 18% [8/45], respectively, P = .030). CONCLUSION: Based on our study results, HCQ shows no apparent advantage compared to LPV/r for preventing progression to severe disease in patients with COVID-19.

Production of protein hydrolysate from Protaetia brevitarsis seulensis (Kolbe) larvae by enzyme treatment under high pressure.

To improve the industrial use of health-functional materials based on edible insects, the objective of this study was to establish optimal conditions for improving the quality of Protaetia brevitarsis seulensis larval (PBSL) hydrolysates. PBSL was extracted using four methodologies: atmospheric pressure 50 °C-water extraction, atmospheric pressure 95 °C-water extraction, atmospheric pressure 50 °C-water enzymatic hydrolysis, and enzyme treatment under high pressure (HPE). The quality characteristics of soluble solid content, extraction yield, total protein content, protein yield, protein content with low molecular weight (LMW) (< 1kD), and the amino acid composition of hydrolysates were compared based on the different methods. All of the quality characteristics were found to be higher for HPE extracts than for the other extracts. Under optimized HPE conditions, extraction yield, protein yield, protein content with LMW, amino acid content and the content of essential amino acids increased by 3.4, 4.4 1.4 1.5, and 1.3 times respectively, compared to the other methods.

Epidemiological characteristics of and containment measures for COVID-19 in Busan, Korea.

OBJECTIVES: To describe and evaluate epidemiological investigation results and containment measures implemented in Busan, where 108 cases were confirmed with coronavirus disease 2019 (COVID-19) between February 21, 2020 and March 24, 2020. METHODS: Any individual who tested positive for COVID-19 was classified as a confirmed case. Measures were taken to identify the source of infection and trace and quarantine contacts. Serial intervals were estimated and the effective reproduction number was computed. RESULTS: Of the total 18,303 COVID-19 tests performed between January 16, 2020 and March 24, 2020 in Busan, 108 yielded positive results (positive test rate, 0.6%). All confirmed cases were placed in isolation at hospitals. Of the 108 confirmed cases, 59 (54.6%) were female. The most common age group was 20-29 years with 37 cases (34.3%). Regarding symptoms at the time of diagnosis, cough (n=38, 35.2%) and fever (n=34, 31.5%) were most common; 12 cases (11.1%) were asymptomatic. The source of infection was identified in 99 cases (91.7%). A total of 3,223 contacts were identified and quarantined. Household contacts accounted for 196, and the household secondary attack rate was 8.2% (95% confidence interval [CI], 4.7 to 12.9). The mean serial interval was estimated to be 5.54 days (95% CI, 4.08 to 7.01). After February 26, (Rt) remained below 1 in Busan. CONCLUSIONS: The early containment strategy implemented in Busan shows that control is possible if outbreaks are of limited scope. In preparation for future outbreaks, public health and healthcare systems should be re-examined and put in a ready state.

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea.

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak. METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested. RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same. CONCLUSIONS: The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

Peritonitis with small bowel perforation caused by a fish bone in a healthy patient.

Perforation of the gastrointestinal tract by ingested foreign bodies is extremely rare in otherwise healthy patients, accounting for < 1% of cases. Accidentally ingested foreign bodies could cause small bowel perforation through a hernia sac, Meckel's diverticulum, or the appendix, all of which are uncommon. Despite their sharp ends and elongated shape, bowel perforation caused by ingested fish bones is rarely reported, particularly in patients without intestinal disease. We report a case of 57-year-old female who visited the emergency room with periumbilical pain and no history of underlying intestinal disease or intra-abdominal surgery. Abdominal computed tomography and exploratory laparotomy revealed a small bowel micro-perforation with a 2.7-cm fish bone penetrating the jejunal wall.

A Case of Myopathy, Encephalopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome with Intracardiac Thrombus [corrected].

Myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a multisystem clinical syndrome manifested by mitochondrial myopathy, encephalopathy, lactic acidosis and recurrent stroke-like episodes. A 27-year-old female with MELAS syndrome presented with cerebral infarction. Echocardiography revealed a thrombus attached to the apex of the hypertrophied left ventricle, with decreased systolic function. The embolism of the intracardiac thrombus might have been the cause of stroke. There should be more consideration given to the increased possibility of intracardiac thrombus formation when a MELAS patient with cardiac involvement is encountered.

Portable emergency telemedicine system over wireless broadband and 3G networks.

The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.

A portable dental image viewer using a mobile network to provide a tele-dental service.

We tested three imaging devices for suitability in emergency dental situations for telemedicine. The three devices were a special-purpose oral camera, a digital single lens reflex (DSLR) camera, and the built-in camera of a mobile phone. A total of 20 subjects volunteered to take part in the study. We simulated five different conditions which could affect the quality of the image and measured image transmission times across two widely available mobile networks (a CDMA-based 3G network and a Wireless Broadband Network, WiBRO). The DSLR produced the best quality images, although it was a relatively large device and not easy to use. The oral camera failed to give satisfactory images under certain conditions (i.e. without extra lighting, out of focus and head motion). In contrast, the mobile phone based camera was very easy to use and to handle, and it gave good information for initial diagnosis, even at high compression ratios. If the image acquisition conditions are carefully set up, this device might be the best for emergency dental trauma situations.

A mobile telemedicine system for remote consultation in cases of acute stroke.

A mobile telemedicine system, capable of transmitting video and audio simultaneously, was designed for consulting acute stroke patients remotely. It could use a wireless local area network (e.g. inside the hospital) or a mobile phone network (e.g. outside the hospital). When initiating a call, the sending unit chose a suitable encoding profile based on the measured data throughput, in order to allocate appropriate bit rates for video and audio transmission. The system was tested using a portable digital assistant (PDA) type phone and smart phone as receiving units. Video and audio recordings were made from five patients (two normal and three stroke patients) and then transmitted at different rates. Subjectively, both video and audio qualities improved as the data throughput increased. The physical findings, including facial droop, arm drift and abnormal speech, were observed remotely by four specialists according to the Cincinnati Pre-hospital Stroke Scale guideline. A comparison between the face-to-face method and the mobile telemedicine method showed that there were no discrepancies at bit rates of more than 400 kbit/s. We conclude that specialists could generally conduct remote consultations for stroke patients either using a public mobile network or a wireless LAN.

Real-time Ambulance Location Monitoring using GPS and Maps Open API.

The term 'Open API' has been recently in use by recent trends in social media and web 2.0. It is currently a heavily sought after solution to interconnect Web sites in a more fluid user-friendly manner. We could have benefits easily development and high efficiency.

Instant wireless transmission of radiological images using a personal digital assistant phone for emergency teleconsultation.

The instant transmission of radiological images may be important for making rapid clinical decisions about emergency patients. We have examined an instant image transfer system based on a personal digital assistant (PDA) phone with a built-in camera. Images displayed on a picture archiving and communication systems (PACS) monitor can be captured by the camera in the PDA phone directly. Images can then be transmitted from an emergency centre to a remote physician via a wireless high-bandwidth network (CDMA 1 x EVDO). We reviewed the radiological lesions in 10 normal and 10 abnormal cases produced by modalities such as computerized tomography (CT), magnetic resonance (MR) and digital angiography. The images were of 24-bit depth and 1,144 x 880, 1,120 x 840, 1,024 x 768, 800 x 600, 640 x 480 and 320 x 240 pixels. Three neurosurgeons found that for satisfactory remote consultation a minimum size of 640 x 480 pixels was required for CT and MR images and 1,024 x 768 pixels for angiography images. Although higher resolution produced higher clinical satisfaction, it also required more transmission time. At the limited bandwidth employed, higher resolutions could not be justified.

Evaluation of compressed video-images for emergency telemedicine work with trauma patients.

Video-encoders in telemedicine systems need to adjust their coding methods for operation on heterogeneous networks on which bandwidth fluctuates. We evaluated MPEG-4 compressed video-pictures of three trauma patients. We compared the original video-frames with compressed video-frames in terms of the peak signal-to-noise ratio (PSNR). In a qualitative evaluation, three emergency specialists scored the quality of the video-images blind, on a five-point scale (1= bad to 5 = excellent). The PSNR increased as the bit rate increased from 0.2 to 6 Mbit/s. When the bit rate was fixed, in other words at a given network bandwidth, a higher PSNR was obtained at the expense of spatial resolution and frame rate. The video quality was highly affected by the amount of camera shake. Emergency telemedicine systems require a high bit rate, high spatial resolution and a high frame rate to achieve optimum video quality. However, if the bandwidth is limited (i.e. the bit rate is fixed), temporal resolution becomes more important than spatial resolution.

Evaluation of two mobile telemedicine systems in the emergency room.

Two different prototype mobile telemedicine systems were constructed for use in the emergency room. They could transmit physiological signals as well as video pictures and sound. One device, the mobile emergency bed (MEB), was powered by battery and had a wireless connection to the local-area network (LAN). For the other, the mobile emergency server (MES), a patient monitor, video-camera and microphone were connected by a radio-frequency link to a server. A functional evaluation and a clinical evaluation (by 12 emergency doctors in six emergency centres) were performed on both prototypes. The bandwidth and the video quality of the MEB were better than those of the MES, because of the digital transmission of the wireless LAN. The MES was better for directing patient treatment and teleconsultation; the MEB was better for static patients in the emergency centre. In general, the MES was more suitable for practical emergency telemedicine work.