Revision surgery for failed anterior cruciate ligament reconstruction with extension deficiency.

BACKGROUND: Some patients with recurrent symptomatic instability after primary anterior cruciate ligament (ACL) reconstruction have an extension deficiency (ED). This study (a) compared preoperative clinical conditions between the ED and non-ED groups undergoing revision ACL reconstruction, (b) documented clinical and arthroscopic findings in ACL-reconstructed patients with reinstability and ED, and (c) determined whether the ED could be resolved and whether the clinical results of revision surgery differed between the ED and non-ED groups. METHODS: This study included 58 patients who underwent revision ACL reconstruction. Patients were divided into the ED and non-ED groups. Preoperatively, the demographics and clinical conditions of the two groups were compared. Intraoperatively, the pathological structures that related to ED were documented. After surgery, the degree of postoperative ED and functional outcomes were compared between the two groups at 2-year follow-up. RESULTS: The International Knee Documentation Committee subjective score and SF-36 physical component summary scores were worse in the ED group than the non-ED group preoperatively (54 vs 48 [P = 0.014]; 42 vs 39 [P = 0.031], respectively). Intraoperatively, the ED group showed significantly more frequent graft malposition (50% vs 5%), anvil osteophytes (44% vs 0%), and scarring around posterior intercondylar notch (100% vs 0%). However, there was no difference in the degree of postoperative ED and functional outcome between the two groups at follow-up. CONCLUSIONS: ED in patients with recurrent instability after primary ACL reconstruction could be treated with good clinical result by addressing the pathological conditions causing ED in addition to ACL re-reconstruction.

Mental Health and Personality Characteristics of University Students at Risk of Smartphone Overdependence.

The purpose of this study was to verify the relationship between the risk of smartphone dependence, mental health, and personality traits in university students using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), and to identify the MMPI-2-RF scales that can predict the risk of smartphone dependence. Of the 772 university students who participated in the study, 163 were in the smartphone overdependence group, accounting for 21.1% of the total survey respondents, which was one in five of those surveyed. High T-scores on the measure indicate greater psychopathology. The smartphone overdependence group had significantly higher T-scores than the general user group on all but three of the MMPI-2-RF scales, and the degree of smartphone overdependence was positively correlated with scores on these scales. There was no difference between the dependent and non-dependent groups on the interpersonal passivity, aesthetic-literary interest, and aggression scales, and scores on these three were not correlated with smartphone dependence. Among the MMPI-2-RF scales, those found to predict the risk of smartphone overdependence were the emotional/internalizing problems, behavioral/externalizing problems, antisocial behavior, cognitive complaints, helplessness/hopelessness, inefficacy, juvenile conduct problems, aggression, interpersonal problems, disconstraint, negative emotionality/neuroticism, and introversion/low positive introversion/low positive emotionality scales. Based on these findings, we propose that effective prevention and intervention for smartphone overdependence must be comprehensive and holistic rather than focusing on specific aspects of mental health or personality. The implications of the findings are discussed.

Clinical and radiographic factors associated with distal radioulnar joint instability in distal radius fractures.

BACKGROUND: Distal radioulnar joint (DRUJ) instability is an important cause of ulnar-sided wrist pain in distal radius fractures. However, instability is frequently undiagnosed and the clinical and radiographic factors associated with instability are not well understood. QUESTIONS/PURPOSES: We therefore identified clinical and radiographic factors associated with DRUJ instability in distal radius fractures. PATIENTS AND METHODS: We retrospectively reviewed all 221 patients who underwent surgical treatment for unstable distal radius fractures from 2007 to 2010. Ten patients (five men and five women) had DRUJ instability by intraoperative manual testing (Group I); these patients had a median age of 52 years. The other 211 patients (81 men and 130 women) (Group II) had a median age of 55 years. Clinical and radiographic data were compared between the groups. RESULTS: The incidence of open wounds at the wrist and the relative ulnar length measured on the prereduction radiograph were greater in Group I. An open wound at the wrist and positive ulnar variance of 6 mm or greater on the prereduction radiograph increased the risk of DRUJ instability (relative risks = 45 and 17, respectively) in distal radius fractures. CONCLUSIONS: An open wound at the wrist or positive ulnar variance of 6 mm or greater observed on the prereduction radiograph in patients with distal radius fractures should alert the physician to the possibility of DRUJ instability. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

A Keyword Analysis Study on Postpartum Obesity Using Big Data.

This study selected Google and Naver, the most recognizable Internet portals in Korea, as subjects for analysis. "Postpartum obesity" and "postpartum depression" were used as keywords for data collection. This study aimed to provide basic data for solving maternal problems using big data. Keywords related to postpartum obesity were collected from the portal site Google from 1 January 2019 to 31 December 2019. The collected data were analyzed through simple frequency analysis, N-gram analysis, and keyword network. This study can be used as basic data for postpartum obesity-related programs or academic research. It is also expected to be used for research on the development of a mobile-based customized healthcare system focused on maternal health. Previous papers and data are still insufficient at solving the physical and mental problems related to postpartum obesity and depression. It is necessary to find ways to continuously integrate and collect data from mothers across the country.

An Attention Model With Transfer Embeddings to Classify Pneumonia-Related Bilingual Imaging Reports: Algorithm Development and Validation.

BACKGROUND: In the analysis of electronic health records, proper labeling of outcomes is mandatory. To obtain proper information from radiologic reports, several studies were conducted to classify radiologic reports using deep learning. However, the classification of pneumonia in bilingual radiologic reports has not been conducted previously. OBJECTIVE: The aim of this research was to classify radiologic reports into pneumonia or no pneumonia using a deep learning method. METHODS: A data set of radiology reports for chest computed tomography and chest x-rays of surgical patients from January 2008 to January 2018 in the Asan Medical Center in Korea was retrospectively analyzed. The classification performance of our long short-term memory (LSTM)-Attention model was compared with various deep learning and machine learning methods. The area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve, sensitivity, specificity, accuracy, and F1 score for the models were compared. RESULTS: A total of 5450 radiologic reports were included that contained at least one pneumonia-related word. In the test set (n=1090), our proposed model showed 91.01% (992/1090) accuracy (AUROCs for negative, positive, and obscure were 0.98, 0.97, and 0.90, respectively). The top 3 performances of the models were based on FastText or LSTM. The convolutional neural network-based model showed a lower accuracy 73.03% (796/1090) than the other 2 algorithms. The classification of negative results had an F1 score of 0.96, whereas the classification of positive and uncertain results showed a lower performance (positive F1 score 0.83; uncertain F1 score 0.62). In the extra-validation set, our model showed 80.0% (642/803) accuracy (AUROCs for negative, positive, and obscure were 0.92, 0.96, and 0.84, respectively). CONCLUSIONS: Our method showed excellent performance in classifying pneumonia in bilingual radiologic reports. The method could enrich the research on pneumonia by obtaining exact outcomes from electronic health data.

Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use.

This study aimed to examine smartphone use patterns, smartphone addiction characteristics, and the predictive factors of the smartphone addiction in middle school students in South Korea. According to the Smartphone Addiction Proneness Scale scores, 563 (30.9%) were classified as a risk group for smartphone addiction and 1261 (69.1%) were identified as a normal user group. The adolescents used mobile messengers for the longest, followed by Internet surfing, gaming, and social networking service use. The two groups showed significant differences in smartphone use duration, awareness of game overuse, and purposes of playing games. The predictive factors of smartphone addiction were daily smartphone and social networking service use duration, and the awareness of game overuse.

Attenuated Readiness Potential in the Absence of Executive Dysfunction in Adults With ADHD.

OBJECTIVE: Patients with ADHD display a decreased contingent negative variation in Go/NoGo tasks. It is unclear whether the attenuation is due to deficits of executive function or to disorder of motor planning. The readiness potential (RP) recorded during self-initiated movements could cast light on this question. METHOD: RP was recorded in 25 stably medicated adult ADHD patients and 21 healthy controls matched for age, education, and verbal IQ. Participants also completed neuropsychological tests of executive function. RESULTS: Compared with healthy controls, ADHD patients showed significantly diminished RP peaks and also decreased negativity in preparation of the movement at frontal locations. There were no significant group differences with regard to tests of executive function. CONCLUSION: In adults with ADHD, deficits of motor organization are also manifest in situations not involving external stimulus processing. The attenuated RP occurred in the absence of executive dysfunction. Results are consistent with partial independence between motor and executive dysfunction in ADHD.

Functional magnetic resonance cholangiography with Gd-EOB-DTPA: a study in healthy volunteers.

PURPOSE: To describe the patterns of bile distribution in the biliary tree, duodenum, jejunum, and stomach, and to determine the gallbladder ejection fraction (GBEF) by using functional magnetic resonance cholangiography (MRC) with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in healthy volunteers. MATERIALS AND METHODS: Forty subjects were included in this study. After conventional MRC, pre-fatty meal MRC (PRFM) was obtained at 30, 40, 50, and 60min after contrast agent injection. Then, post-fatty meal MRC (POFM) was obtained every 10min for 1h. We assessed the PRFM and POFM for opacification of contrast agent in the first- and second-order intrahepatic ducts (IHDs) and the common bile duct (CBD). Contrast agent opacification in the cystic duct was assessed, and the percentage volume of contrast agent filling in the gallbladder (GB) was calculated on PRFM. We calculated the GBEF and assessed the presence of contrast agent in the GB, duodenum, jejunum, and stomach. RESULTS: Thirty-six (90%) subjects showed grade 3 CBD opacification (visible contrast and well-defined bile duct border) on 60-min PRFM. Thirty-four (85%) subjects showed grade 3 first-order IHD opacification on 60-min PRFM. All (100%) subjects showed cystic duct opacification of contrast agent, and the average percentage volume of contrast agent filling in the GB was 68.81%±16.84% on 60-min PRFM. The GBEF at 30-min POFM was 35.00%±18.26%. Ten (25%) subjects had no contrast agent in the stomach and small bowel on all PRFMs. Twelve (30%) subjects had contrast medium in the stomach on PRFM and/or POFM. CONCLUSIONS: Functional MRC with Gd-EOB-DTPA can allow determining the distribution of bile in the biliary tree and small intestine, as well as the GBEF.

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease.

BACKGROUND: Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. AIMS: The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. STUDY DESIGN: Cross sectional study. METHODS: We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (<3 cm in diameter), mass (any masses ≥3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. RESULTS: The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. CONCLUSION: Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolidation. Therefore, PNTB is useful for the accurate diagnosis of pulmonary TB in the following cases: airspace consolidation or mass associated with underlying usual interstitial pneumonia, emphysema mimicking lung malignancy or cases of bacterial pneumonia.

Development of new cardiac deformity indexes for pectus excavatum on computed tomography: feasibility for pre- and post-operative evaluation.

PURPOSE: The aim of this study was to evaluate new cardiac deformity indexes (CDIs) for diagnosis of pectus excavatum as well as morphological assessment of heart on computed tomography (CT). MATERIALS AND METHODS: We retrospectively evaluated the CT images of the control group (n=200), and the pectus excavatum before and after correction groups (n=178), and calculated the CDIs; cardiac compression index (CCI), and cardiac asymmetry index (CAI). We also calculated chest wall compression index (CWCI) and asymmetry index (CWAI) on the axial images. We performed logistic regression analysis using each index and age as predictor variables. RESULTS: The CDIs (CCI and CAI) were significant (p < 0.05) in the diagnosis of pectus excavatum, regardless of age (p = 0.4033, p = 0.8113). The CWCI and CWAI were significant (p < 0.05) and significantly affected by age (p < 0.05). If we selected 1.82 as the cutoff of the CCI, the sensitivity and specificity were 99.4% and 98%, respectively. The following cutoffs and the sensitivity and specificity were obtained: 1.15 for the CAI gave 94.4% and 94.5%, 3.05 for the CWCI gave 92.1% and 92%, and 1 for the CWAI gave 62.4% and 65%, respectively. The CCI after repair improved from 2.83 +/- 0.84 to 1.84 +/- 0.33, while the CWCI improved from 4.49 +/- 1.61 to 2.57 +/- 0.44. CONCLUSION: CDIs such as the CCI and CAI may be potentially useful to detect and estimate repair for pectus excavatum.

Primary large cell neuroendocrine carcinoma of the breast: radiologic and pathologic findings.

Some breast neoplasms are classified as primary neuroendocrine carcinomas because they are positive for neuroendocrine markers. Although neuroendocrine carcinomas can originate from various organs of the body, primary neuroendocrine carcinomas of the breast are extremely rare. The diagnosis of primary neuroendocrine carcinoma of the breast can only be made if nonmammary sites are confidently excluded or if an in situ component can be found. Here we report a primary large-cell neuroendocrine carcinoma (LCNL) involving the left breast. Breast ultrasonography revealed a lobulated, heterogeneous, low-echoic mass in the left breast, and the lesion appeared as a well-defined, highly-enhancing mass on a chest computed tomography scan. Ultrasound-guided core needle biopsy was performed on the mass, and primary LCNC was confirmed by histopathologic examination.