Artificial Intelligence in Health Care: Current Applications and Issues

In recent years, artificial intelligence (AI) technologies have greatly advanced and become a reality in many areas of our daily lives. In the health care field, numerous efforts are being made to implement the AI technology for practical medical treatments. With the rapid developments in machine learning algorithms and improvements in hardware performances, the AI technology is expected to play an important role in effectively analyzing and utilizing extensive amounts of health and medical data. However, the AI technology has various unique characteristics that are different from the existing health care technologies. Subsequently, there are a number of areas that need to be supplemented within the current health care system for the AI to be utilized more effectively and frequently in health care. In addition, the number of medical practitioners and public that accept AI in the health care is still low;moreover, there are various concerns regarding the safety and reliability of AI technologyimplementations. Therefore, this paper aims to introduce the current research and application status of AI technology in health care and discuss the issues that need to be resolved.

Prediction of survival outcomes in patients with epithelial ovarian cancer using machine learning methods / 부인종양

OBJECTIVES: The aim of this study was to develop a new prognostic classification for epithelial ovarian cancer (EOC) patients using gradient boosting (GB) and to compare the accuracy of the prognostic model with the conventional statistical method. METHODS: Information of EOC patients from Samsung Medical Center (training cohort, n=1,128) was analyzed to optimize the prognostic model using GB. The performance of the final model was externally validated with patient information from Asan Medical Center (validation cohort, n=229). The area under the curve (AUC) by the GB model was compared to that of the conventional Cox proportional hazard regression analysis (CoxPHR) model. RESULTS: In the training cohort, the AUC of the GB model for predicting second year overall survival (OS), with the highest target value, was 0.830 (95% confidence interval [CI]=0.802–0.853). In the validation cohort, the GB model also showed high AUC of 0.843 (95% CI=0.833–0.853). In comparison, the conventional CoxPHR method showed lower AUC (0.668 (95% CI=0.617–0.719) for the training cohort and 0.597 (95% CI=0.474–0.719) for the validation cohort) compared to GB. New classification according to survival probability scores of the GB model identified four distinct prognostic subgroups that showed more discriminately classified prediction than the International Federation of Gynecology and Obstetrics staging system. CONCLUSION: Our novel GB-guided classification accurately identified the prognostic subgroups of patients with EOC and showed higher accuracy than the conventional method. This approach would be useful for accurate estimation of individual outcomes of EOC patients.

Diagnostic Accuracy of Imaging Study and the Impact of Clinical Risk Factors on the Presence of Residual Tumor Following Unplanned Excision of Soft Tissue Sarcomas / 대한정형외과학회잡지

PURPOSE: This study examined the diagnostic accuracy of an imaging study to find the factors that affect the presence of residual tumors after an unplanned excision of sarcomas. MATERIALS AND METHODS: Ninety-eight patients, who underwent a re-excision after unplanned surgery between January 2008 and December 2014, were enrolled in this study. Magnetic resonance imaging (MRI) was performed before reoperation in all patients. Positron emission tomography (PET)-computed tomography was performed on 54 patients. A wide re-excision and histology diagnosis were performed in all cases. The clinical variables were evaluated using univariate logistic regression and multivariate logistic regression. RESULTS: The presence of a deep-seated tumor increases the risk of remnant tumors (odds ratio: 3.21, p=0.02, 95% confidence interval: 1.25–8.30). The sensitivity for detecting residual tumors is high in MRI (sensitivity 0.79). CONCLUSION: Deep-seated tumors have a significantly higher risk of remnant tumors. Because the negative predictive value of MRI and PET scans is very low, reoperation should be performed regardless of a negative result.

Recurrence of a Unicameral Bone Cyst in the Femoral Diaphysis

Diaphyseal unicameral bone cysts of the long bone are generally known to originate near the growth plate and migrate from the metaphysis to the diaphysis during skeletal growth. In the case of unicameral bone cysts of diaphyseal origin, recurrence at the same location is extremely rare. We report a case of recurrence of a unicameral bone cyst in the diaphysis of the femur that developed 8 years after treatment with curettage and bone grafting. We performed bone grafting and lengthening of the affected femur with an application of the Ilizarov apparatus over an intramedullary nail to treat the cystic lesion and limb length discrepancy simultaneously.

Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates: Minimum 5-Year Follow-up

BACKGROUND: The authors conducted the present study to identify clinical and radiological prognostic factors in infants and neonates with septic arthritis of the hip. METHODS: The authors retrospectively reviewed the records of 31 patients with septic arthritis of the hip. All of the patients were younger than 18 months old. Follow-up periods ranged from 5 to 17 years. The following potential variables for predicting the prognosis were included in the assessment: gender, age, underlying diseases, duration of symptoms, changes of hip joint in X-ray, concomitant osteomyelitis, elevation of erythrocyte sedimentation rate and C-reactive protein, sepsis, pus drainage, synovial fluid culture, and infecting organisms. Clinical and radiological prognoses were analyzed at the final follow-up. RESULTS: Univariate analysis demonstrated that radiological prognoses were poorer in patients who had underlying diseases, a longer duration of symptoms, and pus drainage. However, on multivariate analysis, only the variable-duration of symptoms-was found to be statistically related with a poor radiological prognosis. CONCLUSIONS: Although poor prognosis for patients with several underlying diseases and radiological changes has already been established, a favorable outcome might be expected with prompt surgical drainage and appropriate antibiotics.

Treatment of Neglected Monteggia Fracture-Dislocation in Children / 대한정형외과학회잡지

PURPOSE: Our purpose is to evaluate the results of the operative treatment in neglected Monteggia fracture-dislocation in children. MATERIALS AND METHODS: We retrospectively analyzed 10 elbows in 10 patients who underwent surgery. All patients were classified as Bado type I, except one with type III. The mean duration of follow up was 2 years and 5 months. The mean age at the time of operation was 10 years and the mean time from injury to operation was 7 months. All 10 patients underwent open reduction of the radial head and reconstruction of annular ligament. Ulnar osteotomy was performed in 9 cases. Clinical assessment was done by Bruce et al.'s rating system. RESULTS: All 10 patients gained a mean of 35degrees of extension-flexion arc, however lost a mean of 29degrees of pronation-supination arc. And there were three complications, including dislocation of radial head in two patients and breakage of transarticular K-wire in one patient. According to Bruce et al.'s rating system, there were 4 excellent, 1 good, 3 fair, and 2 poor results. CONCLUSION: We found that the effect of the operative treatment of neglected Monteggia fracturedislocation in children was limited in majority of the patients. Particularly, the loss of pronation-supination arc was noticed postoperatively in most patients.

Congenital Clubfoot Treated with the Ponseti Method / 대한정형외과학회잡지

PURPOSE: This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot. MATERIALS AND METHODS: A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace. RESULTS: Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace. CONCLUSION: The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.

A Case of Anterior Chamber Irrigation with Distilled Water During Cataract Operation

PURPOSE: To report a case of anterior chamber irrigation with distilled water during cataract operation. METHODS: During the cataract operation of 56 year-old male patient, corneal edema and anterior chamber hazziness were noted after anterior chamber irrigation with distilled water for a minute. Distilled water was replaced rapidly balanced salt solution (BSS) as irrigation solution and operation was completed. At postoperative one day, corneal edema and anterior chamber exudative membrane were formed. After topical 5% NaCl, 1% prednisolone treatment, corneal edema and exudative membrane disappeared at postoperative sixth week. BCVA was 0.6. At postoperative ninth week, the patient complained of decreased visual acuity. On fundus exmination and flourescein angiography, cystoid macular edema (CME) was detected. RESULTS: After prednisolone oral administration and diclofenac eyedrop instillation, CME improved. At postoperative 24th month, BCVA was 0.8 and CME disappeared. CONCLUSIONS: From our experience of a case of anterior chamber irrigation with distilled water during cataract operation, if balanced salt solution replaces hypotonic solution rapidly as irrigation solution, corneal and other complications are managed properly, long term visual acuity appears good.

Secondary Intraocular Lens Implantation in Pediatric Aphakia

A retrospective study was done on secondary intraocular lens implantation in 19 children(22 eyes)who were not satisfied with aphakic glasses and were not tolerant with contact lenses.In all cases,postoperative visual acuity improved or remained at the preoperative level.In 10 cases,postoperative visual acuity was better than 20/40. After at least 12 months of follow-up,average difference of refractive power between the two eyes in the same patient is 0.79 diopter. Early postoperative complications related to secondary intraocular lens implantation were vitreous hemorrhage(1 eye)and IOL decentration. Vitreous hemorrhage was resorbed in three weeks.In case of IOL decentration,we repositioned the IOL.Late complcations during the follow-up period included development of dense capsular opacification in four eyes.They are all treated by Nd:YAG capsulotomy. After capsulotomy there were some improvement in visual acuity. From these results,secondary intraocular lens implantation appears to be a safe, effective method for correction of aphakic children who are not satisfied with aphakic glasses and/or intolerant of use of contact lenses.

The Clinical Consideration of Consecutive Extropia

We evaluated retrospectively the clinical characteristics of 16 consecutive exotropia patients over 10PD following surgery for esotropia, the patients were differentiated into nonoperative and operative group. The nonoperative group comprised of 11 patients with exodeviation 10PD through 20PD(mean 12.9PD) and the orthphoria through 15PD(mean 10.5PD) at final visit. The operative group of 5 patients with exodeviation of 10PD through 30PD(mean 21PD) at postoperatively 2 weeks and 20PD through 35PD(mean 24PD) before operation of consecutive exotropia. In the second operatio, 3 patients with adduction limitation were operated with advancement of medial rectus or recession of lateral rectus of same eye. Four patients showed orthotropia at postoperatively 2 weeks, and 2 patients revealed orthotropia at the final visit. The results suggest that the degree of deviation and adduction limitation will influence the choice of therapy and second operation method.

The Clinical Consideration of Consecutive Extropia

We evaluated retrospectively the clinical characteristics of 16 consecutive exotropia patients over 10PD following surgery for esotropia, the patients were differentiated into nonoperative and operative group. The nonoperative group comprised of 11 patients with exodeviation 10PD through 20PD(mean 12.9PD) and the orthphoria through 15PD(mean 10.5PD) at final visit. The operative group of 5 patients with exodeviation of 10PD through 30PD(mean 21PD) at postoperatively 2 weeks and 20PD through 35PD(mean 24PD) before operation of consecutive exotropia. In the second operatio, 3 patients with adduction limitation were operated with advancement of medial rectus or recession of lateral rectus of same eye. Four patients showed orthotropia at postoperatively 2 weeks, and 2 patients revealed orthotropia at the final visit. The results suggest that the degree of deviation and adduction limitation will influence the choice of therapy and second operation method.