Imaging versus Intervention in Managing Small Unruptured Intracranial Aneurysms: A Cost-Effectiveness Analysis.

OBJECTIVE: Current guidelines recommend active surveillance with serial magnetic resonance angiography (MRA) for management of small, asymptomatic unruptured anterior circulation aneurysms (UIAs). We sought to determine the cost-effectiveness of active surveillance compared to immediate surgery. METHODS: We developed a Markov cost-effectiveness model simulating patients with small (<7 mm) UIAs managed by active surveillance via MRA, immediate surgery, or watchful waiting. Inputs for the model were abstracted from the literature and used to construct a comprehensive model following persons from diagnosis to death. Outcomes were quality-adjusted life-years (QALYs), lifetime medical costs (2015 USD), and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness, deterministic, and probabilistic sensitivity analyses were performed. RESULTS: Immediate surgical treatment was the most cost-effective management strategy for small UIAs with ICER of USD 45,772 relative to active surveillance. Sensitivity analysis demonstrated immediate surgery was the preferred strategy, if rupture rate was >0.1%/year and if the diagnosis age was <70 years, while active surveillance was preferred if surgical complication risk was >11%. Probabilistic sensitivity analysis demonstrated that at a willingness-to-pay of USD 100,000/QALY, immediate surgical treatment was the most cost-effective strategy in 64% of iterations. CONCLUSION: Immediate surgical treatment is a cost-effective strategy for initial management of small UIAs in patients <70 years of age. While more costly than MRA, surgical treatment increased QALY. The cost-effectiveness of immediate surgery is highly sensitive to diagnosis age, rupture rate, and surgical complication risk. Though there are a wide range of rupture rates and complications associated with treatment, this analysis supports the treatment of small, unruptured anterior circulation intracranial aneurysms in patients <70 years of age.

The incidence and seasonal variation of necrotizing fasciitis in Korea: a nationwide cross-sectional study.

INTRODUCTION: Necrotizing fasciitis (NF) is a rare but fatal disease, and there is no known annual incidence of NF in Korea. The aim of this study was to investigate the incidence and seasonal variation of NF in Korea. METHODS: We analysed claims from the nationwide Korean Health Insurance Review and Assessment Service database. Patients who were hospitalized with an NF diagnosis code and received surgical intervention were classified as NF cases. Poisson regression models were used to assess the relationships of incidence rates with year, age and sex. A multivariate Poisson regression model was used to investigate variations in monthly NF incidence trends. RESULTS: From 2012 to 2017, the overall average annual NF incidence rate was found to be 0.86 per 100 000 population. NF incidence increased with age and was 2.5 times higher among males across all age groups. Two-thirds of cases occurred among patients with diabetes. The peak NF incidence occurred during the summer. Multivariate Poisson regression modelling using national meteorological variables suggested that mean temperatures and number of NF cases in the previous month were associated with the number of NF cases in the current month. DISCUSSION: Clinicians should consider NF when encountering an elderly man with diabetes during the summer.

Magnetic resonance imaging assessment of the substrate for hyposmia in patients with Parkinson's disease.

AIM: To assess whether multimodal magnetic resonance imaging (MRI) could detect neuroanatomical substrates that are distinctive to hyposmic Parkinson's disease (PD). MATERIALS AND METHODS: Among 102 PD patients, 62 were hyposmic and 40 were normosmic. For each patient, a sagittal structural three-dimensional (3D) T1-weighted image was obtained with the magnetisation-prepared rapid acquisition of the gradient-echo sequence to generate subcortical grey matter masking templates and to perform a voxel-based morphometry analysis of the subcortical grey matter volumes. A 3D multi-echo gradient sequence was run to obtain axial magnitude and phase images to produce a quantitative susceptibility map (QSM), and a diffusion-weighted image was acquired to generate an apparent diffusion coefficient (ADC) map. The volumes and average QSM and ADC values of the 15 subcortical grey matter structures were calculated, and the group differences were evaluated using a one-way analysis of covariance with age and gender as covariates. RESULTS: The QSM of the left thalamus significantly increased, while that of the right thalamus significantly decreased in hyposmia. No effects on the cortical volume changes were found other than aging. CONCLUSION: The present results suggest that accumulation of disease-related substances in the left and right thalamus and the increasing asymmetry between the two sides are associated with hyposmia in PD.

Prevalence of and factors related to latent tuberculous infection among all employees in a referral hospital.

SETTING: Referral hospital, South Korea. OBJECTIVE: To investigate the prevalence of and factors related to latent tuberculous infection (LTBI) among all hospital employees. DESIGN: A cross-sectional study of 479 health care workers (HCWs) undergoing LTBI screening. RESULTS: Overall prevalence of LTBI was 15.7%, 43.1% of whom initiated and completed LTBI treatment. Compared with HCWs without LTBI, those with LTBI were more likely to be older (P < 0.001), male (P = 0.003), work in low-risk departments (P = 0.013) and have more years of employment (P < 0.001). LTBI prevalence was highest in physicians (27.8%), followed by HCWs without patient contact (23.4%), nurses (8.3%) and other HCWs in contact with patients (6.9%). In multivariate analysis, compared with HCWs aged <20 years, those aged 40 years were 4.08 times more likely to have LTBI (P = 0.007). In addition, compared with HCWs working for <1 year, those working for 1-5 years or for 5 years were respectively 7.55 (P = 0.014) and 13.69 (P = 0.001) times more likely to have LTBI. CONCLUSIONS: Our results suggest that modified LTBI screening strategies, including HCWs with no patient contact and encouraging LTBI treatment participation, might be helpful in improving LTBI control in HCWs.

Role of Imaging in Response Assessment and Individualised Treatment for Sarcomas.

The first systematic response evaluation criteria were established by WHO, based on the tumor size changes shortly after the computed tomography (CT) technique became available to the daily practice. RECIST, a simplified version of WHO criteria, and its newer version, RECIST1.1 are the currently available international response evaluation criteria in solid tumors and remains based on tumor size changes. While the introduction of molecularly targeted drugs has significantly improved the survival in patient with sarcomas, the evaluation of tumor response has become more complicated. Increasing number of studies have reported the lack of shrinkage in responding tumors and raised concerns of significant underestimation of responses using RECIST. The first such observation was made on gastrointestinal stromal tumor (GIST) treated with imatinib. In GISTs responding to imatinib, the degree of contrast enhancement on CT typically decreases significantly compared with the baseline, and, regardless of whether tumors shrink, heterogeneous hyperattenuating tumors become homogeneous hypoattenuating tumors with a smaller enhancing solid component. In current oncology practice, CT is a widely accepted method of evaluating tumor response. CT images are relatively simple to acquire and can be reasonably reproduced with no significant technical obstacles. FDG-PET is highly sensitive and specific in identifying responding sarcomas. It has mostly been used as a problem solver and for those with marginally resectable GIST. More recently, the utility of whole body MRI is undergoing exploration. This article discusses the traditional size-based response evaluation criteria, and introduces new evidence based response evaluation based on changes in morphology in addition to changes in tumor size on CT images, and whole body imaging is introduced at the end.

Quality analysis of randomized controlled trials in the International Journal of Impotence Research: quality assessment and relevant clinical impact.

The quality of randomized controlled trials (RCTs) reported in the International Journal of Impotence Research (IJIR) was analyzed. The original articles that reported RCTs and were published in the IJIR in 1997-2014 were identified by PubMed. Their methodological quality was assessed using the Jadad scale, van Tulder scale and Cochrane Collaboration Risk of Bias Tool. The review period was divided into three periods: early (1997-2002), mid (2003-2008) and late (2009-2014). The effect of study subject and presence of Institutional Review Board approval, intervention, funding and adequate allocation concealment on RCT quality was assessed. The frequency of RCT publication in the IJIR did not change over the 19-year study period. Numbers of low risk of bias articles were 1 (3.0%), 2 (4.4%) and 4 (12.1%) in the early, mid and late periods in Cochrane Collaboration Risk of Bias Tool (P=0.04). High-quality low risk of bias RCT publication frequency increased over time. Intervention and funding significantly influenced RCT quality. Thus, the number of RCTs published in the IJIR over time has remained constant while their quality has improved. Ongoing efforts to expand the numbers of RCTs and further improve the quality of research published by the IJIR will improve clinical practice.

Normal 'heart' in Parkinson's disease: is this a distinct clinical phenotype?

BACKGROUND AND PURPOSE: Reduction of metaiodobenzylguanidine (MIBG) uptake has been observed in almost all patients with Parkinson's disease (PD), associated with hyposmia, orthostatic hypotension and rapid eye movement sleep behavioral disorder (RBD). In contrast, a subgroup of patients with PD with normal MIBG uptake have been reported to have milder disease and preserved cognition compared with those with lower MIBG. The aim of this study was to investigate whether non-motor manifestations of PD differ between patients with normal and abnormal myocardial MIBG uptake. METHODS: Among 160 de-novo cases of PD, 44 had normal MIBG uptake. Twelve candidate non-motor features were evaluated using questionnaires and laboratory tests. RESULTS: Patients with decreased MIBG uptake had more constipation, RBD, cognitive impairment, hyposmia and orthostatic hypotension than did those with normal MIBG uptake. On linear regression analysis, orthostatic hypotension, olfactory function and probable RBD were significantly associated with MIBG uptake in PD. The principal component analysis showed that the group with normal MIBG was not associated with non-motor impairments. CONCLUSIONS: These results suggest that patients with PD with normal MIBG scans have a relatively low disease burden compared with those with abnormal MIBG. Fewer synuclein pathologies in the myocardia and sympathetic ganglia in PD with preserved MIBG uptake might be associated with lower threshold patterns of Braak synuclein pathology for non-motor manifestations compared with PD with decreased MIBG.

Development and preliminary evaluation of culturally specific web-based intervention for parents of adolescents.

WHAT IS KNOWN ON THE SUBJECT?: Problematic parent-child relationships have been identified as one of the main predictors of adolescents' mental health problems, but there are few existing interventions that address this issue. The format and delivery method of existing interventions for parents are relatively inaccessible for parents with full-time jobs and families living in rural areas. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: The newly developed 'Stepping Stone' culturally specific web-based intervention, which is intended to help Korean parents of adolescents to acquire both knowledge and communication and conflict management skills, was found to be feasible and well-accepted by parents. This study enabled us to identify areas for improvement in the content and format of the intervention and strategies. This will potentially increase effect sizes for the outcome variables of parents' perception and behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This web-based intervention could be delivered across diverse settings, such as schools and community mental health centers, to increase parents' knowledge of adolescent's mental health and allow for early detection of mental health problems. Mental health nurses working in schools may spend a significant amount of time addressing students' mental health issues; thus, this web-based intervention could be a useful resource to share with parents and children. In this way, the mental health nurses could facilitate parental engagement in the intervention and then help them to continue to apply and practice the knowledge and skills obtained through the program. ABSTRACT: Introduction There is a need for accessible, culturally specific web-based interventions to address parent-child relationships and adolescents' mental health. Aims This study developed and conducted a preliminary evaluation of a 4-week web-based intervention for parents of adolescents aged 11 to 16 years in Korea. Methods We used a two-group, repeated measures, quasi-experimental study design to assess the feasibility of developing and implementing a web-based intervention for parents. Descriptive statistics, chi-square and t tests, and mixed effect modeling were used for data analysis. Results The intervention and 1-month follow-up survey were completed by 47 parents in the intervention group and 46 parents in the attention control (AC) group. The intervention was found to be feasible and well-accepted by parents. Discussion This culturally specific web-based intervention is a useful tool for knowledge dissemination among large numbers of parents. Areas for improvement in the content and format of the intervention and strategies to elicit significant parent-child interactions are provided. Implications for practice and conclusion The intervention could be disseminated in collaboration with mental health nurses working in schools to facilitate parents' participation.

Influence of Rapeseed Meal on Growth Performance, Blood Profiles, Nutrient Digestibility and Economic Benefit of Growing-finishing Pigs.

This study was conducted to investigate the influence of dietary rapeseed meal (RSM) on growth performance, blood profiles, nutrient digestibility and economic benefit of growing-finishing pigs. A total of 120 growing pigs ([Yorkshire×Landrace] ×Duroc) with an initial body weight (BW) 29.94±0.06 kg were used in this experiment. Pigs were randomly allotted into 1 of 5 treatments in a randomized complete block design and 6 replicates with 4 pigs per pen. Treatments were divided by dietary RSM supplementation levels (0%, 3%, 6%, 9%, or 12%) in growing-finishing diets. A linear decrease (p<0.05) of BW and average daily gain (ADG) were observed at 13th wk of finishing and overall periods of pigs. Additionally, gain-to-feed ratio (G/F) tended to decrease by dietary RSM supplementation in growing-finishing diets (linear, p = 0.07 and quadratic, p = 0.08). Concentrations of serum triiodothyronine and thyroxine were not influenced by dietary RSM treatments whereas thyroid gland and liver weight were increased at 13th wk of finishing period (linear, p<0.05; p<0.01) by increasing dietary RSM supplementation level. In blood profiles, serum total cholesterol and low density lipoprotein cholesterol concentrations were not differed by dietary treatments at 13th wk of finishing period whereas concentration of serum high density lipoprotein cholesterol was affected by the supplementation level of RSM, resulting in a linear RSM level responses (p<0.05). Serum blood urea nitrogen concentration tended to decrease (linear, p = 0.07; p = 0.08) at 6th wk of growing and 13th wk of finishing periods and digestibility of dry matter tended to decrease by dietary RSM (linear, p = 0.09). Crude protein, crude fat and nitrogen retention, whereas, were not affected by dietary RSM supplementation level. In the economic analysis, feed cost per weight gain was numerically decreased when RSM was provided up to 9%. Consequently, RSM could be supplemented to growing-finishing diets up to 9% (3.07 µmol/g Gls) without detrimental effects on growth performance of growing-finishing pigs.

Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System.

BACKGROUND: The effectiveness of continuous nationwide surveillance on healthcare-associated infections should be investigated in each country. AIM: To assess the rate of device-associated infections (DAIs) in intensive care units (ICUs) since the establishment of the Korean Nosocomial Infections Surveillance System (KONIS). METHODS: Nationwide data were obtained on the incidence rate of DAI in ICUs reported to KONIS by all participating hospitals. The three major DAIs were studied: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CABSI), and catheter-associated urinary tract infection (CAUTI). The pooled and year-wise incidence rates (cases per 1000 device-days) of these DAIs were determined for the period 2006 and 2012. In addition, data from institutions that had participated in KONIS for at least three consecutive years were analysed separately. FINDINGS: The number of ICUs participating in KONIS gradually increased from 76 in 2006 to 162 in 2012. Between 2006 and 2012, the incidence rate per 1000 device-days for VAP decreased significantly from 3.48 to 1.64 (F = 11, P < 0.01), for CAUTI the rate decreased non-significantly from 1.85 to 1.26 (F = 2.02, P = 0.07), and for CABSI the rate also decreased non-significantly from 3.4 to 2.57 (F = 1.73, P = 0.12). In the 132 ICUs that had participated in KONIS for at least three consecutive years, the VAP rate significantly decreased from the first year to third year (F = 20.57, P < 0.01), but the rates of CAUTI (F = 1.06, P = 0.35) and CABSI (F = 1.39, P = 0.25) did not change significantly. CONCLUSION: The decreased incidence rate of VAP in ICUs in Korea might be associated with the continuous prospective surveillance provided by KONIS.

Optimizing EEMCO guidance for the assessment of dry skin (xerosis) for pharmacies.

PURPOSE: People with dry skin (xerosis) are common in community pharmacies, but there is no consistent guidance for community pharmacists to evaluate and alleviate dry skin. Through evaluating any difference of the clinical scoring systems of EEMCO guidance between a dermatologist and pharmacists and the efficacy of moisturizers for the treatment of dry skin recommended by community pharmacists, we aim to validate a dry skin guidance through the help of community pharmacists. These results provide insight into how community pharmacists can help patients with dry skin. METHODS: The clinical scoring systems of EEMCO guidance used in this study comprised analog scales, the overall dry skin score (ODS), and the specific symptom sum score (SRRC) system. All pictures of the dry skin scored by pharmacists were visually evaluated by a dermatologist. The efficacy of the moisturizers was determined by the difference of the scales on day 0 and on day 28. RESULTS: In this study, 387 patients with dry skin from 157 community pharmacies were evaluated by pharmacists. Visual scale with divisions, ODS and SRRC that were evaluated by pharmacists on day 0 and day 28 were moderately reliable by a dermatologist. All parameters of dry skin were significantly improved by the moisturizers which were recommended by community pharmacists on day 28. CONCLUSION: Visual scale, ODS and SRRC can be generally measured to evaluate dry skin in community pharmacies with moderate degree of reliability. This finding has possible applications for investigating the assessment of the community pharmacists on clinical scoring system of dry skin and moisturizers.

Cost-effectiveness of Xpert® MTB/RIF for diagnosing pulmonary tuberculosis in the United States.

SETTING: Conventional approaches to tuberculosis (TB) diagnosis and resistance testing are slow. The Xpert® MTB/RIF assay is an emerging molecular diagnostic assay for rapid TB diagnosis, offering results within 2 hours. However, the cost-effectiveness of implementing Xpert in settings with low TB prevalence, such as the United States, is unknown. OBJECTIVE: We evaluated the cost-effectiveness of incorporating Xpert into TB diagnostic algorithms in the United States compared to existing diagnostics. DESIGN: A decision-analysis model compared current TB diagnostic algorithms in the United States to algorithms incorporating Xpert. Primary outcomes were the costs and quality-adjusted life years (QALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). RESULTS: Xpert testing of a single sputum sample from TB suspects is expected to result in lower total health care costs per patient (US2673) compared to diagnostic algorithms using only sputum microscopy and culture (US2728) and improved health outcomes (6.32 QALYs gained per 1000 TB suspects). Compared to existing molecular assays, implementation of Xpert in the United States would be considered highly cost-effective (ICER US39992 per QALY gained). CONCLUSION: TB diagnostic algorithms incorporating Xpert in the United States are highly cost-effective.

Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia.

This study evaluated the effect of limb lengthening on longitudinal growth in patients with achondroplasia. Growth of the lower extremity was assessed retrospectively by serial radiographs in 35 skeletally immature patients with achondroplasia who underwent bilateral limb lengthening (Group 1), and in 12 skeletally immature patients with achondroplasia who did not (Group 2). In Group 1, 23 patients underwent only tibial lengthening (Group 1a) and 12 patients underwent tibial and femoral lengthening sequentially (Group 1b). The mean lengthening in the tibia was 9.2 cm (59.5%) in Group 1a, and 9.0 cm (58.2%) in the tibia and 10.2 cm (54.3%) in the femur in Group 1b. The mean follow-up was 9.3 years (8.6 to 10.3). The final mean total length of lower extremity in Group 1a was 526.6 mm (501.3 to 552.9) at the time of skeletal maturity and 610.1 mm (577.6 to 638.6) in Group 1b, compared with 457.0 mm (411.7 to 502.3) in Group 2. However, the mean actual length, representing the length solely grown from the physis without the length of distraction, showed that there was a significant disturbance of growth after limb lengthening. In Group 1a, a mean decrease of 22.4 mm (21.3 to 23.1) (4.9%) was observed in the actual limb length when compared with Group 2, and a greater mean decrease of 38.9 mm (37.2 to 40.8) (8.5%) was observed in Group 1b when compared with Group 2 at skeletal maturity. In Group 1, the mean actual limb length was 16.5 mm (15.8 to 17.2) (3.6%) shorter in Group 1b when compared with Group 1a at the time of skeletal maturity. Premature physeal closure was seen mostly in the proximal tibia and the distal femur with relative preservation of proximal femur and distal tibia. We suggest that significant disturbance of growth can occur after extensive limb lengthening in patients with achondroplasia, and therefore, this should be included in pre-operative counselling of these patients and their parents.

Effect of heating system using a geothermal heat pump on the production performance and housing environment of broiler chickens.

A geothermal heat pump (GHP) is a potential heat source for the economic heating of broiler houses with optimum production performance. An investigation was conducted to evaluate the effect of a heating system using a GHP on production performance and housing environment of broiler chickens. A comparative analysis was also performed between the GHP system and a conventional heating system that used diesel for fuel. In total, 34,000 one-day-old straight run broiler chicks were assigned to 2 broiler houses with 5 replicates in each (3,400 birds/replicate pen) for 35 d. Oxygen(,) CO(2), and NH(3) concentrations in the broiler house, energy consumption and cost of heating, and production performance of broilers were evaluated. Results showed that the final BW gain significantly (P < 0.05) increased when chicks were reared in the GHP broiler house compared with that of chicks reared in the conventional broiler house (1.73 vs. 1.62 kg/bird). The heating system did not affect the mortality of chicks during the first 4 wk of the experimental period, but the mortality markedly increased in the conventional broiler house during the last wk of the experiment. Oxygen content in the broiler house during the experimental period was not affected by the heating system, but the CO(2) and NH(3) contents significantly increased (P < 0.05) in the conventional broiler house compared with those in the GHP house. Fuel consumption was significantly reduced (P < 0.05) and electricity consumption significantly increased (P < 0.05) in the GHP house compared with the consumption in the conventional house during the experiment. The total energy cost of heating the GHP house was significantly lower (P < 0.05) compared with that of the conventional house. It is concluded that a GHP system could increase the production performance of broiler chicks due to increased inside air quality of the broiler house. The GHP system had lower CO(2) and NH(3) emissions with lower energy cost than the conventional heating system for broiler chickens.

Compensation scheme for complementary and alternative medicine use in asbestos-related diseases in New South Wales, Australia.

WHAT IS KNOWN AND OBJECTIVE: Asbestos use has resulted in a high global incidence rate of asbestos-related diseases (ARDs). These diseases require high costs of compensation and medical expense, although definite cures have yet to be found. Complementary and alternative medicine (CAM) has been used as a means to attenuate symptoms of ARDs. Our objective is to describe the compensation scheme for CAM use for a population with ARDs in New South Wales (NSW), Australia. COMMENT: Expenses of CAM have conditionally been compensated by the workers compensation dust-diseases board (DDB) to a population with ARDs. The DDB approves patients` claim for the use of CAM if it is justifiable and related to compensable ARDs. To obtain the DDB`s approval for the CAM cost, a written recommendation letter by the treating medical doctors is required that justifies the use of CAM and that this option does not pose any adverse effects on the compensated patients. WHAT IS NEW AND CONCLUSION: The use of CAM in a subject with ARDs does not have significant benefits of overall survival but does somewhat improve quality of life. However, awareness of the provisions of the compensation scheme for CAM use in a population with ARDs should be carefully informed and also emphasized any side effects on progress of ARDs.

Screening options for Down syndrome: how women choose in real clinical setting.

OBJECTIVE: To study pregnant women's preference among various screening options for Down syndrome (DS) in routine clinical setting, and its potential association with women's demographic characteristics. METHODS: Women aged 35 years and older carrying singleton pregnancy were offered a variety of screening tests for DS before 14 weeks of gestation. Their preference was confirmed by the test they actually underwent. The association between women's choice of test and a number of demographic characteristics was studied using multinomial regression. RESULTS: Among 1967 eligible women, 619 opted for first-trimester screening test (FTS), 924 for partial integrated test (PIT), and 424 for full integrated test (FIT). Nulliparous women and working mothers were more likely to choose FTS and FIT. Women with history of subfertility were more likely to choose FIT. Women with family history of chromosomal abnormalities were more likely to choose FTS. The choice of screening test could be predicted for 49.9% of women using four demographic characteristics. CONCLUSIONS: Among older women of predominantly Chinese ethnicity, integrated test is a favorite alternative to FTS. Their choice of DS screening test can be predicted by their obstetric and socioeconomic characteristics. Many women show willingness to pay for a test with a lower false-positive rate.

Development of automatized new indices for radiological assessment of chest-wall deformity and its quantitative evaluation.

Pre-operative diagnosis of chest-wall deformity is important for successful surgical correction and post-operative evaluation of funnel chest patients. However, conventional indices that define the severity of deformity have several limitations; manually calculated and cannot supply information about asymmetry. We developed four indices that can represent both the depression and the asymmetry of the chest-wall, and can automatically be extracted by computerized image processing technique. Three indices, including eccentricity index (EI), flatness index (FI), and circularity index (CI), were suggested to represent the depression of the chest-wall, and one index, rotation index (RI), to represent the asymmetry of the chest-wall. To verify the feasibility of new indices, several synthetic images and real CT images were used to analyze the performance of new indices and the statistical relationship with conventional Haller index. The experimental results showed possible application of suggested indices to the diagnosis of funnel chest patient. Suggested indices showed clear trends of change with the severity of chest-wall deformation in regards to both the depression and the asymmetry. Results of statistical analysis showed high correlation between new indices and HI, showing possibility of replacing HI.

The epidemiology of total knee replacement in South Korea: national registry data.

OBJECTIVE: Knee osteoarthritis (OA) is prevalent among the elderly in Asian countries; however, the utilization of total knee replacement (TKR) is unknown. Using data from a national registry, we sought to estimate the incidence of TKR by age and sex, and the trend for TKR utilization from 2002 to 2005 in South Korea. METHODS: Reimbursement records from all hospitals in South Korea were extracted from the Health Insurance Review Agency (HIRA) database. Records with both the procedure code corresponding to a TKR and the diagnosis code of knee OA were selected. We estimated the age- and sex-specific rates of TKR. To compare the rate of TKR between men and women, we calculated age-standardized risk ratios. A TKR registry from a single centre containing more clinical information was analysed, and the differences in the clinical features between men and women were compared. RESULTS: From 2002 to 2005, 47 961 TKRs were performed in subjects over the age of 40 yrs due to OA. The rate of TKR has increased over the 4 yrs and was much higher in women than in men. Compared with men, the age-standardized rate ratios for TKR in women ranged from 7.4 to 8.0. The single-centre registry data revealed that there was no difference in age, disease duration and the Kellgren-Lawrence grade at the time of surgery between men and women. CONCLUSION: Using a national database, we found that the rate of TKR increased steadily from 2002 to 2005 in South Korea. The TKR rate in women was much higher than that in men. Risk factors that account for such disparity in TKR utilization need to be further investigated.

Risk assessment of human exposure to cypermethrin during treatment of mandarin fields.

The potential dermal and respiratory exposure assessment and risk assessment for applicator were performed with cypermethrin EC. The pesticide was applied on a mandarin field using a power sprayer. Gloves were used for the hand exposure assessment, mask for face, and dermal patches for the other parts of the body. Personal air monitor equipped with a XAD-2 resin was used for the respiratory exposure assessment. During the application of cypermethrin in the field, the rate of potential dermal exposure ranged from 28.1 to 58.8 mg/h. The major exposure parts were upper-arms (22.1-24.6%) and legs (thigh and shin, 28.3-29.2%) for females and thigh (21.0-46.9%) and hand (14.9-19.3%) for males. Females were exposed more than males. No exposure was detected from the respiratory monitoring. For risk assessment, the potential dermal exposure (PDE), the absorbable quantity of exposure (AQE), and the margin of safety (MOS) were calculated. Among those four risk assessments, MOS was < 1 in only trial I, which indicated any possibility of risk. However, in the others, the possibility of risk was little. Moreover, the safe work time ranged from 3.61 h to 9.69 h.

Physical phantom of typical Korean male for radiation protection purpose.

Dose distribution within a human body can be measured using physical anthropomorphic phantoms. In an effort to establish reference Korean physical model, the first Korean physical phantom of average Korean adult male was constructed using computed tomography (CT) images of a healthy volunteer. The body dimension of the subject was close to that of average Korean male. The source images were obtained using fusion positron emission tomography machine at Radiation Health Research Institute in Korea, and ported into rapid prototyping process. The physical phantom was composed of three tissue-equivalent materials: epoxy resin, urethane foam and polyurethane representing bone, lungs and soft tissues, respectively. The densities of the tissue-equivalent materials were close to those recommended by the International Commission on Radiation Units and measurements. To facilitate dose mapping, the phantom was sliced into 2 cm sections. Hole grids for thermoluminescence (TL) dosemeter chips were drilled. To verify the appropriateness of the physical phantom, organ doses of selected organs were measured for reference photon beam, and compared with those computed by tomographic model constructed from the same CT images. Absorbed doses converted from TL relative response showed good agreement within 7% with those calculated.