Development and Validation of Deep Learning-Based Automated Detection of Cervical Lymphadenopathy in Patients with Lymphoma for Treatment Response Assessment: A Bi-institutional Feasibility Study.

The purpose is to train and evaluate a deep learning (DL) model for the accurate detection and segmentation of abnormal cervical lymph nodes (LN) on head and neck contrast-enhanced CT scans in patients diagnosed with lymphoma and evaluate the clinical utility of the DL model in response assessment. This retrospective study included patients who underwent CT for abnormal cervical LN and lymphoma assessment between January 2021 and July 2022. Patients were grouped into the development (n = 76), internal test 1 (n = 27), internal test 2 (n = 87), and external test (n = 26) cohorts. A 3D SegResNet model was used to train the CT images. The volume change rates of cervical LN across longitudinal CT scans were compared among patients with different treatment outcomes (stable, response, and progression). Dice similarity coefficient (DSC) and the Bland-Altman plot were used to assess the model's segmentation performance and reliability, respectively. No significant differences in baseline clinical characteristics were found across cohorts (age, P = 0.55; sex, P = 0.13; diagnoses, P = 0.06). The mean DSC was 0.39 ± 0.2 with a precision and recall of 60.9% and 57.0%, respectively. Most LN volumes were within the limits of agreement on the Bland-Altman plot. The volume change rates among the three groups differed significantly (progression (n = 74), 342.2%; response (n = 8), - 79.2%; stable (n = 5), - 8.1%; all P < 0.01). Our proposed DL segmentation model showed modest performance in quantifying the cervical LN burden on CT in patients with lymphoma. Longitudinal changes in cervical LN volume, as predicted by the DL model, were useful for treatment response assessment.

Defining Medical AI Competencies for Medical School Graduates: Outcomes of a Delphi Survey and Medical Student/Educator Questionnaire of South Korean Medical Schools.

PURPOSE: Given the increasing significance and potential impact of artificial intelligence (AI) technology on health care delivery, there is an increasing demand to integrate AI into medical school curricula. This study aimed to define medical AI competencies and identify the essential competencies for medical graduates in South Korea. METHOD: An initial Delphi survey conducted in 2022 involving 4 groups of medical AI experts (n = 28) yielded 42 competency items. Subsequently, an online questionnaire survey was carried out with 1,955 participants (1,174 students and 781 professors) from medical schools across South Korea, utilizing the list of 42 competencies developed from the first Delphi round. A subsequent Delphi survey was conducted with 33 medical educators from 21 medical schools to differentiate the essential AI competencies from the optional ones. RESULTS: The study identified 6 domains encompassing 36 AI competencies essential for medical graduates: (1) understanding digital health and changes driven by AI; (2) fundamental knowledge and skills in medical AI; (3) ethics and legal aspects in the use of medical AI; (4) medical AI application in clinical practice; (5) processing, analyzing, and evaluating medical data; and (6) research and development of medical AI, as well as subcompetencies within each domain. While numerous competencies within the first 4 domains were deemed essential, a higher percentage of experts indicated responses in the last 2 domains, data science and medical AI research and development, were optional. CONCLUSIONS: This medical AI framework of 6 competencies and their subcompetencies for medical graduates exhibits promising potential for guiding the integration of AI into medical curricula. Further studies conducted in diverse contexts and countries are necessary to validate and confirm the applicability of these findings. Additional research is imperative for developing specific and feasible educational models to integrate these proposed competencies into pre-existing curricula.

Real-World Safety and Clinical Outcomes of Macitentan in Asian Patients with Pulmonary Arterial Hypertension: A Prospective Multicenter Study.

BACKGROUND AND OBJECTIVE: Macitentan is approved for treating pulmonary arterial hypertension. However, the real-world evidence of macitentan use is limited. Therefore, we evaluated the safety and clinical outcomes of macitentan use in clinical practice under a post-marketing surveillance. METHODS: Patients with pulmonary arterial hypertension receiving macitentan treatment were prospectively and consecutively enrolled from 2014 to 2020 at 50 medical centers in Korea. Safety and clinical outcomes were monitored from baseline to the nearest timepoint of 24 weeks after macitentan initiation. The adverse events and adverse drug reactions were identified. Changes in the World Health Organization functional class were assessed as the primary clinical outcome, which was used to estimate the final effectiveness (both improved and maintained). Factors associated with safety and final effectiveness were identified. RESULTS: Among 474 patients enrolled in the study, 467 and 440 were included in the safety and clinical outcome analyses, respectively. Dyspnea, nasopharyngitis, and worsening pulmonary arterial hypertension were the most frequent adverse events with incidences of 5%, 3%, and 3%, respectively. The final effectiveness rate was 93%. Older age (adjusted odds ratio [aOR] = 1.021, p = 0.003) and higher level (III vs II) of baseline World Health Organization functional class (aOR = 1.784; p = 0.022) were significantly associated with a higher adverse event occurrence. Younger age (aOR = 0.947; p = 0.001) and shorter disease duration (aOR = 0.991; p = 0.010) were significantly associated with positive final effectiveness. CONCLUSIONS: This real-world study demonstrated the safety and clinical outcomes of macitentan use in Korean patients with pulmonary arterial hypertension. Macitentan was well tolerated and significantly effective with no new safety concerns during the 24 weeks.

Effects of Long-Acting Injectable Paliperidone Palmitate on Clinical and Functional Outcomes in Patients With Schizophrenia Based on Illness Duration.

OBJECTIVE: This study aimed to examine the degree of clinical and functional improvement after paliperidone long-acting injectable (LAI) administration according to the duration of illness. METHODS: Patients with schizophrenia diagnosed by ICD-10 criteria who were planned to start once-monthly paliperidone LAI were recruited from 2010 to 2017. Clinical and functional changes were measured every 4 weeks using the Clinical Global Impressions-Severity of Illness scale (CGI-S) and Personal and Social Performance scale (PSP), respectively, for 6 months after paliperidone LAI initiation. Improvements after starting paliperidone LAI were compared among patients with duration of illness < 3 years, ≥ 3 and < 10 years, and ≥ 10 years. RESULTS: A total of 1,166 participants (duration of illness < 3 years, n = 240; 3 ≤ duration of illness < 10 years, n = 442; duration of illness ≥ 10 years, n = 484) were enrolled. The total olanzapine-equivalent doses of antipsychotics and the LAI monotherapy proportion at the final visit were significantly different among the 3 duration of illness groups (dose: F2,1163 = 18.41, P < .001; monotherapy: χ²2 = 11.73, P = .003). The changes in CGI-S score were significantly different according to the duration of illness, and those with duration of illness < 3 years showed the best improvement (group × week: χ²12 = 25.33, P = .013). All 3 groups showed significantly improved PSP scores (week: χ²6 = 294.2, P < .001). CONCLUSIONS: Starting paliperidone LAI significantly improved clinical and functional outcomes in patients with schizophrenia, especially those with shorter duration of illness. These findings suggest that LAI antipsychotic administration may be considered in early-stage schizophrenia for improved outcomes.

A Prospective Study for Prediction of Psychotic Relapse Using the Korean Early Signs Scale in Patients With Schizophrenia.

INTRODUCTION: A psychotic relapse of schizophrenia is commonly preceded by nonpsychotic behavioral symptoms and signs, and detection of these early signs may enable prevention of relapse of schizophrenia. This study aimed to test the predictive validity of a Korean version of Early Signs Scale (K-ESS) for psychotic relapse for detecting the early signs. MATERIALS AND METHODS: In this multicenter noninterventional 52-week prospective study, outpatients diagnosed as having schizophrenia within 5 years were recruited. The K-ESS and Clinical Global Impression-Severity (CGI-S) scale were administered monthly until the end of the study or the relapse. The primary objective was to determine an optimal cutoff point of K-ESS score for prediction of psychotic relapse. The secondary objective was to assess the concurrent validity of the K-ESS using CGI-S scale. RESULTS: Among the 162 included patients, 14 (8.6%) relapsed during the 52-week study period. The optimal cutoff score of K-ESS was 15 with a sensitivity of 71.43% and a specificity of 52.70%, indicating poor predictive accuracy of K-ESS. A lower cutoff K-ESS score of 3 and a higher cutoff score of 28 were found in the subgroups with milder (CGI-S = 1-2) and severer (CGI-S = 3-4) symptom severity, respectively, with fair to good predictive accuracy. The K-ESS showed acceptable concurrent validity with CGI-S and concordance rate between self-rated and informant-rated scores. DISCUSSION: The predictive accuracy of K-ESS was limited by evaluation interval of a month. At least fortnightly follow-up would be needed for detection of early signs to prevent a psychotic relapse in schizophrenia.

Recent surge of ready meals in South Korea: can they be healthy alternatives?

OBJECTIVE: The present study analysed and compared the nutritional qualities of private brand (PB) and national brand (NB) ready meal (RM) products in South Korea. DESIGN: Data on RM products were collected via a food information database (EatSight) between February and May of 2017. A total of ninety-one PB products from a leading discount store chain in South Korea and 415 NB products were selected and divided into four main categories of 'refrigerated soups/stews', 'refrigerated noodles', 'frozen rice/noodles' and 'frozen dumplings'. Nutritional information was extracted for each product and analyses were performed to compare nutritional differences. SETTING: South Korea. PARTICIPANTS: A total of 506 RM products. RESULTS: PB products explained the highest percentage of refrigerated RM products while NB products occupied the highest percentage of frozen ones. Notably, main PB and NB products showed evident nutritional problems. Among PB products, refrigerated soups/stews were significantly higher in energy, fat, Na, saturated fat and trans-fat. Likewise, in the case of NB products, frozen rice/noodles were significantly higher in Na and saturated fat. Particularly, overall Na contents were high. When the Korean guidance on traffic-light labelling was applied, a mere 0·2 and 5·9 % of total RM products showed all four and three green lights, respectively. Meanwhile, those with no green lights accounted for 42·3 %. CONCLUSIONS: Although it is difficult to draw a definitive conclusion on the comparative nutritional qualities due to the lack of consistency in the results, the study suggests that there is room to improve the nutritional qualities of overall RM products.

A prospective, open-label, multicenter, observational study to evaluate the efficacy and safety of bortezomib-melphalan-prednisone as initial treatment for autologous stem cell transplantation-ineligible patients with multiple myeloma.

Bortezomib-melphalan-prednisone (VMP) showed superior efficacy versus MP as first-line treatment for transplantation-ineligible multiple myeloma (MM). This study investigated the efficacy of VMP for Korean patients with MM.Overall, 177 MM patients received 9 cycles of VMP in this prospective, multicenter, observational study. The primary endpoint was 2-year progression-free survival (PFS).Thirty-nine (22%) patients were aged ≥ 75 years and 83 (47.4%) patients had International Staging System stage III. A median of 5 cycles were delivered. Overall response rate (ORR) was 72.9%, and complete response (CR) rate was 20.3%. With a median follow-up of 11.9 months, median PFS was 17 months. The 2-year PFS and overall survival (OS) rates were 29.2% and 80.0%, respectively. Median OS was not reached. PFS was significantly different depending on performance status (Eastern Cooperative Oncology Group < 2 vs. ≥ 2; p = 0.0002), ß2-microglobulin level (< 5.5 vs. ≥ 5.5 mg/L; p = 0.0481), and cumulative dose of bortezomib (< 35.1 vs. ≥ 35.1 mg/m2; p < 0001). The common adverse events (AEs) were in line with the well-known toxicity profiles associated with VMP.In conclusion, VMP is a feasible and effective front-line treatment for transplant-ineligible older patients with MM in Korea. Continuing therapy with prompt adjustment of treatment according to AEs may be important to improve outcomes of elderly patients.

An event-specific DNA microarray to identify genetically modified organisms in processed foods.

We developed an event-specific DNA microarray system to identify 19 genetically modified organisms (GMOs), including two GM soybeans (GTS-40-3-2 and A2704-12), thirteen GM maizes (Bt176, Bt11, MON810, MON863, NK603, GA21, T25, TC1507, Bt10, DAS59122-7, TC6275, MIR604, and LY038), three GM canolas (GT73, MS8xRF3, and T45), and one GM cotton (LLcotton25). The microarray included 27 oligonucleotide probes optimized to identify endogenous reference targets, event-specific targets, screening targets (35S promoter and nos terminator), and an internal target (18S rRNA gene). Thirty-seven maize-containing food products purchased from South Korean and US markets were tested for the presence of GM maize using this microarray system. Thirteen GM maize events were simultaneously detected using multiplex PCR coupled with microarray on a single chip, at a limit of detection of approximately 0.5%. Using the system described here, we detected GM maize in 11 of the 37 food samples tested. These results suggest that an event-specific DNA microarray system can reliably detect GMOs in processed foods.

Genome wide expression analysis of the effect of Pinelliae Rhizoma extract on psychological stress.

Pinelliae Rhizoma has been used traditionally as an antidepressant in Oriental medicine. In this study, the effect of Pinelliae Rhizoma extract (PRe) on psychological stress was investigated in mice. The results of an elevated plus-maze experiment revealed that application of psychological stress to mice led to the development of an abnormal behavioral pattern. However, oral administration of PRe significantly reduced the abnormal behavior of mice with a recovery rate of 75.5%. To elucidate the molecular mechanism by PRe, a microarray analysis of the brains of mice was conducted. The results of this analysis revealed that 456 genes were up-regulated and 392 genes were down-regulated in response to psychological stress. The expression of most of the genes that were altered in response to psychological stress was restored to normal levels in PRe treated mice, with a recovery rate of 81.5% and 85.2% being observed for up- and down-regulated genes, respectively. Finally, when the interaction network information was analysed, the recovery rate of the core node genes (46 up- and 29 down-regulated genes) in PRe treated mice was found to be over 95%, which indicates that this final set of genes may be the effective target of PRe.