Artificial Intelligence-Based Speech Analysis System for Medical Support / 대한배뇨장애요실금학회지

Purpose@#Prior research has indicated that stroke can influence the symptoms and presentation of neurogenic bladder, with various patterns emerging, including abnormal facial and linguistic characteristics. Language patterns, in particular, can be easily recognized. In this paper, we propose a platform that accurately analyzes the voices of stroke patients with neurogenic bladder, enabling early detection and prevention of the condition. @*Methods@#In this study, we developed an artificial intelligence-based speech analysis diagnostic system to assess the risk of stroke associated with neurogenic bladder disease in elderly individuals. The proposed method involves recording the voice of a stroke patient while they speak a specific sentence, analyzing it to extract unique feature data, and then offering a voice alarm service through a mobile application. The system processes and classifies abnormalities, and issues alarm events based on analyzed voice data. @*Results@#In order to assess the performance of the software, we first obtained the validation accuracy and training accuracy from the training data. Subsequently, we applied the analysis model by inputting both abnormal and normal data and tested the outcomes. The analysis model was evaluated by processing 30 abnormal data points and 30 normal data points in real time. The results demonstrated a high test accuracy of 98.7% for normal data and 99.6% for abnormal data. @*Conclusions@#Patients with neurogenic bladder due to stroke experience long-term consequences, such as physical and cognitive impairments, even when they receive prompt medical attention and treatment. As chronic diseases become increasingly prevalent in our aging society, it is essential to investigate digital treatments for conditions like stroke that lead to significant sequelae. This artificial intelligence-based healthcare convergence medical device aims to provide patients with timely and safe medical care through mobile services, ultimately reducing national social costs.

Neurobehcet’s Disease with Extensive Invasion of Cerebral Parenchyma

Neuro-Behcet’s disease (NBD) is defined as a combination of neurologic symptoms and/or signs in a patient with Behcet’s disease. A 38-year-old woman was admitted due to sensory aphasia. She had past medical history of generalized tonic-clonic seizure, retinal vasculitis, oral ulcer and cerebral vasculitis. Brain magnetic resonance imaging showed broad lesion in the left parieto-occipital lobe. Brain biopsy was performed to differentiate between central nervous system lymphoma and NBD. We report a rare case of NBD with extensive involvement of cerebral parenchyma.

Workload in Emergency Rooms among Clinical Specialties and Overburdened Neurologists

Background@#To evaluate workload in emergency rooms (ERs) among clinical specialties including neurology and investigate characteristics of neurological consultations in ER. @*Methods@#A nationwide survey was conducted to evaluate the number of specialists, resident physicians/surgeons, and emergency consultations of each clinical specialty in Korean tertiary referral hospitals from 2018 to 2019. Characteristics of neurological emergency consultations during the same period were investigated in one of the hospitals that participated. @*Results@#A total of 23 hospitals were included. Four irrelevant clinical specialties were excluded. The number of neurology specialists and resident physicians were 12.5/hospital (4.1% of all specialists) and 6.4/hospital (3.4% of all resident physicians/surgeons), respectively, while the mean numbers of specialists and resident physicians or surgeons per clinical specialty were 13.7/hospital and 8.6/hospital, respectively. Neurological consultations accounted for 11.0% of all ER consultations for severe patients (Korean Triage and Acuity Scale level 1-3). Annual ER consultations for severe patients per neurology specialist was 274.1, which was only second to pediatrics (290.0). Annual ER consultations for severe patients per resident physician was 406.6 which was 1.6 times higher than the second highest (internal medicine, 247.0). Frequent conditions for neurological ER consultation were dizziness (24.8%), motor weakness (23.9%), headache (10.6%), dysarthria (9.9%), and seizures (7.7%). Frequent primary diagnoses were cerebrovascular diseases (29.0%) and episodic and paroxysmal disorders (24.9%). @*Conclusions@#Workloads of neurology specialists for ER consultation were significantly heavy, and the workload of neurology resident physicians was the heaviest among all specialties. This should be considered in health care policies.

The Investigation on the Burden of Neurology Residents to Manage the Patient who Received Thrombolytic Treatment in the Emergency Department with Hyperacute Stroke

Background@#Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department. @*Methods@#We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019. @*Results@#Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77. @*Conclusions@#The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.

Practical Drug Treatment Recommendations on the Drug Refractory Epilepsy Patients: 2021 Clinical Guideline Subcommittee for Epilepsy in the Korean Neurological Association

One third of the overall epilepsy population are estimated to be a drug refractory epilepsy (DRE), defined as the patients who failed to control seizure reduction, even tried two or more appropriate antiepileptic drugs (AEDs) trials. Those people need additional AEDs trials or other treatment options (resective surgery, neuromoulation, etc.). Here, we, clinical guideline committee of the Korean Neurological Association (KNA) introduce the recommendations of AEDs treatments including not only old and new AEDs currently available in Korea but also AEDs planned to be launched in the new future for DRE patients with literature review to help efficient decision of the clinician. The authors reviewed literatures and assessed efficacy and tolerability on 12 currently available and four newly introduced/or planned AEDs applied to DRE patients, published from November 2015 to July 2021. Brivaracetam, eslicarbazepine, canabidiol and cenobamate are the four AEDs that are newly introduced or planned to be launched soon. The reviewed articles are publications after November 2015, 2018 American Association of Neurology guideline, new AEDs which were introduced or planned to be launched as of 2021. All AEDs are classified based on the therapeutic rating scheme, generating recommendations. Overall 173 papers have been reviewed and analyzed for recommendation rationales. KNA introduce additional add-on treatment or conversional monotherapy guidelines on the drug refractory focal and generalized epilepsy. We hope these guidelines or recommendations to help clinical decision for the treatment of drug refractory epilepsy patients

Hepatocyte growth factor and soluble cMet levels in plasma are prognostic biomarkers of mortality in patients with severe acute kidney injury

Background@#Hepatocyte growth factor (HGF)/cMet pathway is necessary for repair and regeneration following acute kidney injury (AKI). We evaluated the clinical potential of plasma HGF and soluble cMet as prognostic biomarkers for severe AKI requiring continuous renal replacement therapy (CRRT). @*Methods@#One hundred thirty-six patients with severe AKI who participated in the VENUS (volume management under body composition monitoring in critically ill patients on CRRT) trial between 2017 and 2019 were enrolled in this study. We investigated associations between plasma HGF and cMet concentrations and all-cause mortality. @*Results@#Plasma HGF and soluble cMet levels were positively correlated. Patients were divided into three groups based on their HGF and soluble cMet concentrations. The day D 0, D2, and D7 highest concentration HGF groups had significantly higher in-hospital mortality after adjusting for sex, body mass index, Acute Physiology and Chronic Health Evaluation II, and age-adjusted Charlson comorbidity index score, especially on D7 (hazard ratio, 4.26; 95% confidence interval, 1.71–10.62; p = 0.002). D7 soluble cMet level was also associated with mortality. Receiver operating characteristic curve analysis indicated that D7 HGF and soluble cMet levels were best at predicting mortality. Addition of plasma HGF and soluble cMet to conventional prognostic indices significantly improved the predictive value for mortality on D7. However, plasma HGF and soluble cMet were not associated with fluid status. @*Conclusion@#Plasma HGF and soluble cMet levels were significant predictors of the outcomes of severe AKI patients undergoing CRRT. There was no correlation between plasma HGF and soluble cMet levels and fluid balance.

Association between Dialysis Adequacy and Cognition in Patients with Peritoneal Dialysis

Objective@#Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis. @*Methods@#Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck’s depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function. @*Results@#RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V. @*Conclusion@#Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.

Anti-LGI1 Antibody Limbic Encephalitis Associated with Hepatocellular Carcinoma

Anti-leucine-rich glioma inactivated-1 (LGI1) antibody has been known as the most common antibody in autoimmune limbic encephalitis. We report a case of a 63-year-old woman who presented with repetitive memory impairment. She was diagnosed with anti-LGI1 limbic encephalitis by clinical symptoms, magnetic resonance imaging, electroencephalography, and antibody test. Hepatocellular carcinoma (HCC) was discovered incidentally. Clinical seizures were completely controlled after hepatic segmentectomy without immunotherapy. This is the first case report showing the relationship between HCC and anti-LGI1 limbic encephalitis.

Relationship between Disability Self-Awareness and Insight in Patients with Schizophrenia / 생물치료정신의학

Objectives@#：We aimed to evaluate the relationship between disability self-awareness and insight in patients with schizophrenia. @*Methods@#：We enrolled 58 clinically stable patients with schizophrenia. The World Health Organization Disability Assessment Schedule (WHODAS) self-report was used to identify self-awareness of functional ability. The Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia Scale (CGI-SCH), and Personal and Social Performance Scale (PSP) were utilized to evaluate clinical symptoms and global function. Whereas Insight Scale for Psychosis (ISP) was applied for insight. Statistical analyses were performed using correlation and linear regression. @*Results@#：The WHODAS had a significant correlation with the general psychopathology subscale and total score of PANSS, CGI-SCH, and PSP. Moreover, ISP had a strong correlation with the overall WHODAS score and all domains. In the linear regression analysis, ISP had significant effects on the overall WHODAS score after adjusting for additional variables. @*Conclusion@#：Disability self-awareness was significantly correlated with the level of insight in patients with schizophrenia. Clinicians need to consider patients’ insight during the discussion of functional ability.

18FTHK5351 PET Imaging in Patients with Mild Cognitive Impairment

Background@#and PurposeMild cognitive impairment (MCI) is a condition with diverse clinical outcomes and subgroups. Here we investigated the topographic distribution of tau in vivo using the positron emission tomography (PET) tracer [18F]THK5351 in MCI subgroups. @*Methods@#This study included 96 participants comprising 38 with amnestic MCI (aMCI), 21 with nonamnestic MCI (naMCI), and 37 with normal cognition (NC) who underwent 3.0-T MRI, [18F]THK5351 PET, and detailed neuropsychological tests. [18F]flutemetamol PET was also performed in 62 participants. The aMCI patients were further divided into three groups: 1) verbal-aMCI, only verbal memory impairment; 2) visual-aMCI, only visual memory impairment; and 3) both-aMCI, both visual and verbal memory impairment. Voxel-wise statistical analysis and region-of-interest -based analyses were performed to evaluate the retention of [18F]THK5351 in the MCI subgroups. Subgroup analysis of amyloid-positive and -negative MCI patients was also performed. Correlations between [18F]THK5351 retention and different neuropsychological tests were evaluated using statistical parametric mapping analyses. @*Results@#[18F]THK5351 retention in the lateral temporal, mesial temporal, parietal, frontal, posterior cingulate cortices and precuneus was significantly greater in aMCI patients than in NC subjects, whereas it did not differ significantly between naMCI and NC participants. [18F] THK5351 retention was greater in the both-aMCI group than in the verbal-aMCI and visualaMCI groups, and greater in amyloid-positive than amyloid-negative MCI patients. The cognitive function scores were significantly correlated with cortical [18F]THK5351 retention. @*Conclusions@#[18F]THK5351 PET might be useful for identifying distinct topographic patterns of [18F]THK5351 retention in subgroups of MCI patients who are at greater risk of the progression to Alzheimer's dementia.

The Prevalence of Rapid Eye Movement Sleep Behavior Disorder in Amyloid Positron Emission Tomography Positive Alzheimer's Disease

OBJECTIVES@#Rapid eye movement (REM) sleep behavior disorder (RBD) is well known as a prodromal symptom of neurodegenerative disease, especially α-synucleinopathy. In the previous literature, it has been reported the incidence rate of RBD in Alzheimer's disease (AD) is about 10%. This incidence rate is relatively low, if we consider that nearly half of AD patients also have Lewy body pathology. The objective of this study is to determine the incidence rate of RBD among patients with AD, confirmed by amyloid positron emission tomography (PET) image.@*METHODS@#We enrolled 57 patients with clinically probable AD patients who identified AD pathology in amyloid PET scan. RBD was evaluated with REM sleep behavior disorder questionnaire-Korean vesion (RBDQ-KR), which validated the RBD screening questionnaire as Korean version to confirm RBD. Detailed neuropsychological tests were measured using the Seoul Neuropsychological Screening Battery (SNSB).@*RESULTS@#We analyzed RBDQ-KR data collected from 57 AD patients. Dementia due to AD was 36 patients (63.2%) and mild cognitive impairment (MCI) due to AD was 21 (36.8%). AD with RBD was 14 (24.6%). Among these, AD dementia with RBD was 13 (36.1%), and MCI due to AD with RBD was 1 (4.8%). There were no significant differences in cognitive function between the patients with or without RBD, evaluated by detailed neuropsychological test.@*CONCLUSIONS@#In this study, the incidence of RBD in AD was not rare; therefore, if the patient shows symptoms of RBD, we should not rule out AD.

Association of Depression with Atypical Features and Metabolic Syndrome in Korean Adults / 정신신체의학

OBJECTIVES@#This study aimed to investigate the association between depression with atypical features and metabolic syndromes in Korean adults using the 2016 Korean National Health and Nutrition Examination Survey (KNHANES) data.@*METHODS@#We used the 2016 KNHANES data to enroll 277 participants with a score of 10 or higher on Patient Health Questionnaire-9. Depression with atypical features was diagnosed when at least two of the following criteria were met : 1) sleeping more than 10 hours a day ; 2) weight gain of more than 3 kg in a year ; and 3) fatigue/anergia. Depression was divided into two groups based on the presence/absence of atypical features. Physical and mental health, and risk of metabolic syndrome were compared between the groups.@*RESULTS@#Among the 277 participants, 91 had depression with atypical features. We identified significant differences in age, sex, income, and education between the two groups. After adjusting for these variables, depression with atypical features had lower EuroQol-5D index scores (p<0.001) and higher prevalence of metabolic syndromes (p=0.035) compared to the depression without atypical features. Depression with atypical features had higher odds ratio (OR) in association with metabolic syndromes after adjusting for confounding variables (OR=1.923 ; 95% confidence interval : 1.069–3.460).@*CONCLUSIONS@#Depression with atypical features increases the risk of metabolic syndromes and lowers the quality of life.

¹⁸F-THK5351 PET Imaging in the Behavioral Variant of Frontotemporal Dementia

BACKGROUND AND PURPOSE: Behavioral variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia, which has clinical symptoms of progressive personality and behavioral changes with deterioration of social cognition and executive functions. The pathology of bvFTD is known to be tauopathy or TDP-43 equally. We analyzed the 18F-THK5351 positron emission tomography (PET) scans, which were recently developed tau PET, in patients with clinically-diagnosed bvFTD. METHODS: Forty-eight participants, including participants with behavioral variant frontotemporal dementia (bvFTD, n=3), Alzheimer's disease (AD, n=21) and normal cognition (NC, n=24) who completed 3T magnetic resonance images, 18F-THK5351 PET scans, and detailed neuropsychological tests were included in the study. Voxel-wise statistical analysis and region of interest (ROI)-based analyses were performed to evaluate the retention of THK in bvFTD patients. RESULTS: In the voxel-based and ROI-based analyses, patients with bvFTD showed greater THK retention in the prefrontal, medial frontal, orbitofrontal, anterior cingulate, insula, anterior inferior temporal and striatum regions compared to NC participants. Left-right asymmetry was noted in the bvFTD patients. A patient with extrapyramidal symptoms showed much greater THK retention in the brainstem. CONCLUSIONS: The distribution of THK retention in the bvFTD patients was mainly in the frontal, insula, anterior temporal, and striatum regions which are known to be the brain regions corresponding to the clinical symptoms of bvFTD. Our study suggests that 18F-THK5351 PET imaging could be a supportive tool for diagnosis of bvFTD.

Pontine Infarct Presenting as Peripheral Type Unilateral Facial Palsy

Acute peripheral facial palsy usually manifests Bell's palsy of unknown cause, and rarely lacunar infarct which located in facial nucleus can mimic peripheral facial palsy. A 73 year-old man with isolated facial asymmetry diagnosed with lacunar infarction which selectively involve the facial fascicles which lie in inferolateral aspect of pons. Clinicians should take into account the possibility of central lesion and brain stem infarction, even when patients present with isolated peripheral type facial palsy.

Tau PET Imaging in a Patient with Posterior Cortical Atrophy Using ¹⁸F-THK5351

No abstract available.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assess the 5-year outcome of patients considering surgery for complaint of cervical and radiating pain treated by selective nerve root block (SNRB). MATERIALS AND METHODS: Between January 2001 and December 2007, 39 cases were selected from patients who underwent SNRB before the operation and were followed-up for more than five years. The mean follow-up period was 64.3 months and the mean age was 57.7 years. The patients were divided into the operation group and the only cervical SNRB group. The groups were compared for gender, age, duration, disease, single or multi-level, and root compression rate on magnetic resonance imaging. The clinical results were analyzed using the neck disability index (NDI) and the visual analogue scale (VAS) score. RESULTS: Among the 39 cases scheduled for the operation, 20 cases (51.3%) did not proceed to the operation and 13 cases among them were treated with additional conservative treatment. The average VAS score for the operation group and the cervical SNRB group was 8.1 points and 7.5 points at the preoperative state and the pre-injection state. After surgical treatment and cervical nerve root block, the scores were 3.0 points for all. The NDI for the operation group was 11.3 points at the last follow-up. The NDI for the cervical nerve root block group was 13.6 at the last follow-up. There was no significant difference between the two groups. Shorter duration and younger age tended to show a higher operation rate. At the last follow-up, 7 cases (17.9%) after cervical SNRB had persistent symptom relief without other treatment. CONCLUSION: Cervical SNRB is considered an effective treatment for patients with cervical disease with radiating pain and who are scheduled for an operation.

A Practical Definition of Epilepsy

In 2005, the ILAE conceptually defined epilepsy as a disorder of the brain, characterized by an enduring predisposition to generate epileptic seizures and by its psychosocial consequences. In clinical practice, this definition of epilepsy is usually taken to mean at least two unprovoked seizures more than 24 h apart. The operational definition for special circumstances that do not meet the criteria of two unprovoked attacks has been recommended. In 2014, the ILAE refined the practical definition of epilepsy. With this definition, epilepsy is a disease of the brain with either: (1) at least two unprovoked (or reflex) seizures occurring more than 24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals past the applicable age of an age-dependent epilepsy syndrome or those who have remained seizure-free for the past 10 years, without seizure medicines for the past 5 years.

Subarachnoid Hemorrhage Showed Only on T2-Weighted Magnetic Resonance Imaging

We present the case of a 28-year-old pregnant woman with subarachnoid hemorrhage who was initially unable to undergo a CT scan and exhibited interestingly high signal intensities only on T2-weighted MRI without any signal change on fluid attenuated inversion recovery and gradient-echo imaging. These findings could be explained by a combination of factors that increase the signal intensity with elevations in the concentrations of protein and oxyhemoglobin due to massive bleeding and with the decreased fluid void signal inferred by the presence of hydrocephalus.

Diffuse Calcification Restricted on Periventricular White Matter by Primary Hypoparathyroidism

No abstract available.

A Randomized Comparative Study of Blind versus Ultrasound Guided Glenohumeral Joint Injection of Corticosteroids for Treatment of Shoulder Stiffness

BACKGROUND: We prospectively compared the response to blind and ultrasound-guided glenohumeral injection of corticosteroids for treatment of shoulder stiffness. METHODS: A total of 77 patients with shoulder stiffness between April 2008 and March 2012 were recruited. Patients were randomized to receive either a blind (group 1, n=39) or ultrasound-guided (group 2, n=38) glenohumeral injection of 40 mg triamcinolone. The clinical outcomes and shoulder range of motion (ROM) before injection, at 3, 6, and 12 months after injection and at the last follow-up were assessed. The same rehabilitation program was applied in both groups during the follow-up period. RESULTS: There was no significant difference in demographic data on age, sex, ROM, and symptom duration before injection between groups (p>0.05). There were no significant differences in ROM including forward flexion, external rotation at the side, external rotation at 90o abduction, and internal rotation, visual analogue scale for pain and functional outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder test between the two groups at any time point (p>0.05). CONCLUSIONS: Based on the current data, the result of ultrasound-guided glenohumeral injection was not superior to that of blind injection in the treatment of shoulder stiffness. We suggest that ultrasound-guided glenohumeral injection could be performed according to the patient's compliance and the surgeon's preference. Once familiar with the non-imaging-guided glenohumeral injection, it is an efficient and reliable method for the experienced surgeon. Ultrasound could be performed according to the surgeon's preference.