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Background Healthcare organizations have begun to adopt personal health records (PHR) systems to engage patients, but little is known about factors associated with the adoption of PHR systems at an organizational level. The objective of this study is to investigate factors associated with healthcare organizations’ adoption of PHR systems in South Korea. Methods The units of analysis were hospitals with more than 100 beds. Study data of 313 hospitals were collected from May 1 to June 30, 2020. The PHR adoption status for each hospital was collected from PHR vendors and online searches. Adoption was then confirmed by downloading the hospital’s PHR app and the PHR app was examined to ascertain its available functions. One major outcome variable was PHR adoption status at hospital level. Data were analysed by logistic regressions using SAS 9.4 version. Results Out of 313 hospitals, 103 (32.9%) hospitals adopted PHR systems. The nurse-patient ratio was significantly associated with PHR adoption (OR 0.758; 0.624 to 0.920, p = 0.005). The number of health information management staff was associated with PHR adoption (OR 1.622; 1.228 to 2.141, p = 0.001). The number of CTs was positively associated with PHR adoption (OR 5.346; 1.962 to 14.568, p = 0.001). Among the hospital characteristics, the number of beds was significantly related with PHR adoption in the model of standard of nursing care (OR 1.003; 1.001 to 1.005, p Conclusions One-third of study hospitals had adopted PHR systems. Standard of nursing care as well as information technology infrastructure in terms of human resources for health information management and advanced technologies were significantly associated with adoption of PHR systems. A favourable environment for adopting new technologies in general may be associated with the adoption and use of PHR systems.

Purpose Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit. Methods The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform. Results The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%. Conclusions The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.

Recent interest in medical artificial intelligence (AI) has increased with onset of the fourth industrial revolution. Real-time monitoring of patients is an important research area of medical AI. The medical AI is very closely related to the Internet of Things (IoT), a core element of the fourth industrial revolution. Attempts to diagnose and treat patients using IoT have been already applied to patients with chronic disease such as hypertension and arrhythmia. However, in the spine, research on IoT and digital biomarkers are still in the early stages. The digital biomarker obtained by IoT devices is objective and could represent real-time, real-world, and abundant data. Based on its characteristics, IoT and digital biomarkers can also be useful in the spine. Currently, research on real-time monitoring of physical activity or spinal posture is ongoing. Therefore, the authors introduce the basic concepts of IoT and digital biomarkers, their relationship to AI, and recent trends. Current and future perspectives of IoT and digital biomarker in spine are also discussed. In the future, it is expected that IoT, digital biomarkers, and AI will lead to a paradigm shift in the diagnosis and treatment of spinal diseases.

Objective Durotomy is a necessary procedure for resection of spinal intradural-extramedullary (IDEM) tumor. The purpose of this study was to investigate the prevalence and clinical implications of pneumocephalus after spinal IDEM tumor surgery and also the association between pneumocephalus and postoperative headache. Methods This prospective study was conducted in a cohort of 20 patients who were diagnosed with a spinal IDEM tumor and underwent surgical resection. The mean patient age was 53.6 years (range, 29–75 years). Histological findings revealed schwannoma in 16 cases (80.0%) and meningioma in 4 cases (20.0%). Brain computed tomography scan was performed immediately after surgery. The prevalence and severity were analyzed based on the classification into 4 groups according to the extension of pneumocephalus: absence, mild, moderate, and severe. A visual analog scale (VAS; range 0–10) for headache was reported daily for the first postoperative week. Headache-related pneumocephalus was defined as a VAS score of ≥5 points at least once in that 1-week period. Results The prevalence of pneumocephalus was 90.0% (18 patients). Five patients (25.0%) had severe pneumocephalus extending to the extra-axial space. Seven of the 20 patients (38.9%) complained of significant headache. Five of these patients had severe pneumocephalus, 1 patient had moderate pneumocephalus, and 1 patient had moderate pneumocephalus. A statistically significant association was observed between the severity of pneumocephalus and headache (P = 0.001). Conclusions Pneumocephalus is a common complication after spinal IDEM tumor surgery. This report is the first study to investigate the prevalence of pneumocephalus and analyze its association with headache after spine surgery. The severity of pneumocephalus was significantly related to postoperative headache.

Objective Bone mineral density (BMD) is a very important factor in spinal fusion surgery using instrumentation. Our aim was to investigate the utility of Hounsfield units (HU) obtained from preoperative lumbar computed tomography (CT) to predict osteoporosis coupling with data of quantitative computed tomography (QCT) and dual X-ray absorptiometry (DEXA). Methods We reviewed 180 patients that underwent both QCT and lumbar CT for spine surgery. HU was retrospectively calculated on the lumbar CT of 503 lumbar vertebrae from L1 to L3. Femur DEXA was performed in all patients and spine DEXA was tested in 120 patients (331 vertebrae). BMD was grouped as osteoporosis (QCT3, DEXA T score≤-2.5) and non-osteoporosis (QCT≥80mg/cm3, DEXA T score>-2.5) for comparison of HU value. Results HU value and BMD showed significant correlations. The optima cut-off value based on QCT was higher than that of DEXA scans which had the best correlation for predicting osteoporosis. ROC curve analysis demonstrated that HU value with QCT of 146 has a sensitivity of 94.3% and a specificity of 87.5% for osteoporosis. Conclusions Significant correlation was found between HU measurement and BMD value. These findings provide evidence that HU measurement can be established as a means for predicting osteoporosis before spine fusion surgery with reduced radiation hazard.

Aim To predict survival time of Korean hepatocellular carcinoma (HCC) patients using multi-center data as a foundation for the development of a predictive artificial intelligence model according to treatment methods based on machine learning. Methods Data of patients who underwent treatment for HCC from 2008 to 2015 was provided by Korean Liver Cancer Study Group and Korea Central Cancer Registry. A total of 10,742 patients with HCC were divided into two groups, with Group I (2920 patients) confirmed on biopsy and Group II (5562 patients) diagnosed as HCC according to HCC diagnostic criteria as outlined in Korean Liver Cancer Association guidelines. The data were modeled according to features of patient clinical characteristics. Features effective in predicting survival rate were analyzed retrospectively. Various machine learning methods were used. Results Target was overall survival time, which divided into approximately 60 months (= / 60 m). Target distribution in Group I (total 514 samples) was 28.8%: (148 samples) less than 60 months, 71.2% (366 samples) greater than 60 months, and in Group II (total 757 samples) was 66.6% (504 samples) less than 60 months, 33.4% (253 samples) greater than 60 months. Using NG Boost method, its accuracy was 83%, precision 84%, sensitivity 95%, and F1 score 89% for more than 60 months survival time in Group I with surgical resection. Moreover, its accuracy was 79%, precision 82%, sensitivity 87%, and F1 score 84% for less than 60 months survival time in Group II with TACE. The feature importance with gain criterion indicated that pathology, portal vein invasion, surgery, metastasis, and needle biopsy features could be explained as important factors for prediction in case of biopsy (Group I). Conclusion By developing a predictive model using machine learning algorithms to predict prognosis of HCC patients, it is possible to project optimized treatment by case according to liver function and tumor status.

AIM To predict survival time of Korean hepatocellular carcinoma (HCC) patients by analyzing big data using Cox proportional hazards model. METHODS Big data of the patients who underwent treatment for HCC from 2008 to 2015, provided by Korea Central Cancer Registry, National Cancer Center, and Ministry of Health and Welfare, were analyzed. A total of 10 742 patients with HCC were divided into two groups, with Group I (3021 patients) confirmed on biopsy and Group II (5563 patients) diagnosed as HCC according to HCC diagnostic criteria as outlined in Korean Liver Cancer Association guidelines. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of recurrence after treatment and survival status. RESULTS A total of 3021 patients in Group I and 5563 patients in Group II were included in the study and the difference in survival time between the two groups was statistically significant (P < 0.05). Recurrence was only included in intrahepatic cases, and the rates were 21.2 and 19.8% while the periods from the first treatment to recurrence were 15.57 and 14.19 months, respectively. Age, diabetes, BMI, platelet, alpha-fetoprotein, histologic tumor maximum size, imaging T stage, presence of recurrence, and duration of recurrence were included in multivariate analysis. CONCLUSION By using nationwide, multicenter big data, it is possible to predict recurrence rate and survival time which can provide the basis for treatment response to develop a predictive program.

OBJECTIVES Little is known about the platforms and functionalities of mobile-based personal health record (PHR) applications. The objective of this study was to investigate these two features of PHR systems. METHODS The unit of analysis was general hospitals with more than 100 beds. This study was based on a PHR survey conducted from May 1 to June 30, 2020 and the National Health Insurance administrative data as of March 31, 2020. The study considered the platform, Android and iPhone operation system (iOS), and types of functionalities of PHR systems. Among the 316 target hospitals, 103 hospitals had adopted PHR systems. A logistic regression analysis was used. RESULTS This study found that 103 hospitals had adopted mobile-based PHR systems for their patients. Sixty-four hospitals (62.1%) were adopting both Android and iOS, but 36 (35.0%) and 3 (2.9%) hospitals were adopting Android only or iOS only, respectively. The PHR systems of hospitals adopting both platforms were more likely to have functions for viewing prescriptions, clinical diagnostic test results, and upcoming appointment status compared to those adopting a single platform (p < 0.001). The number of beds (odds ratio [OR] = 1.004; confidence interval [CI], 1.001-1.007; p = 0.0029) and the number of computed tomography systems (CTs) per 100 beds (OR = 6.350; CI, 1.006-40.084; p = 0.0493) were significantly associated with the adoption of both platforms. CONCLUSIONS More than 60% of hospitals had adopted both Android and iOS platforms for their patients in Korea. Hospitals adopting both platforms had additional functionalities and significant association with the number of beds and CTs.

Emergency room processes are often exposed to the risk of unexpected factors, and process management based on performance measurements is required due to its connectivity to the quality of care. Regarding this, there have been several attempts to propose a method to analyze the emergency room processes. This paper proposes a framework for process performance indicators utilized in emergency rooms. Based on the devil&rsquo, s quadrangle, i.e., time, cost, quality, and flexibility, the paper suggests multiple process performance indicators that can be analyzed using clinical event logs and verify them with a thorough discussion with clinical experts in the emergency department. A case study is conducted with the real-life clinical data collected from a tertiary hospital in Korea to validate the proposed method. The case study demonstrated that the proposed indicators are well applied using the clinical data, and the framework is capable of understanding emergency room processes&rsquo, performance.

Objectives A significant proportion of patients with acute minor stroke have unfavorable functional outcome due to early neurological deterioration (END). The purpose of this study was to evaluate the applicability of machine learning algorithms to predict END in patients with acute minor stroke. Patients and methods We collected clinical and neuroimaging information from patients with acute minor stroke with NIHSS score of ≤ 3. Early neurological deterioration was defined as any worsening of NIHSS score within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2. We also compared clinical and neuroimaging information between patients with and without END. Four machine learning algorithms, i.e., Boosted trees, Bootstrap decision forest, Deep neural network, and Logistic Regression, were selected and trained by our dataset to predict early neurological deterioration Results A total of 739 patients were included in this study. 78 patients (10.6%) experienced END. Among 78 patients with END, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. On multivariate analysis, the initial NIHSS score (P = 0.003), hemorrhagic transformation (P = 0.010), and stenosis (P = 0.014) or occlusion (P = 0.004) of a relevant artery were independently associated with END. Of the four machine learning algorithms, Boosted trees, Deep neural network, and Logistic Regression can be used to predict END in patients with acute minor stroke (Boosted trees: accuracy = 0.966, F1 score = 0.8 and area under the curve = 0.934, Deep neural network :0.966, 0.8, and 0. 904, and Logistic Regression : 0.966, 0.8, and 0.885). Conclusions This study suggests that machine learning algorithms that integrate clinical and neuroimaging information can be used to predict END in patients with acute minor stroke. Further studies based on larger, multicenter datasets are needed to predict END accurately for designing treatment strategies and obtaining favorable functional outcome.

Test anxiety and self-efficacy significantly influence the mastery of nursing skills. Facial expression recognition tools are central components to recognising these elements. This study investigated the frequent facial expressions conveyed by nursing students and examined the relationships between nursing skill mastery, test anxiety, self-efficacy, and facial expressions in a test-taking situation. Thirty-three second-year nursing students who were attending a university in a Korean metropolitan city participated. Test anxiety, self-efficacy, and facial expressions were collected while the students inserted indwelling catheters. Using Microsoft Azure software, the researchers examined the students’ facial expressions. Negative facial expressions, such as anger, disgust, sadness, and surprise, were more common during the test-taking situation than the practice trial. Fear was positively correlated with anxiety. None of the facial expressions had significant relationships with self-efficacy; however, disgust was positively associated with nursing skill mastery. The facial expressions during the practice and test-taking situations were similar; however, fear and disgust may have been indicators of test anxiety and skill mastery. To create a screening tool for detecting and caring for students’ emotions, further studies should explore students’ facial expressions that were not evaluated in this study.

As medical computer-aided design (CAD) has improved, virtual 3-dimensional medical images have been gaining more easily without any special practice. These images can be applied to various clinical fields. This article illustrates virtual preoperative simulation for excision of spinal tumors using medical CAD software. The software was used directly by the surgeon. The process of virtual preoperative simulation for spinal tumor surgery was found to be not inordinately complicated. And, virtual simulation was helpful in determining surgical steps as well as understanding the surgical anatomy.

Operating rooms (ORs) are one of the most important facilities in any hospital, and efficient OR scheduling is necessary to optimize hospital profits as well as to provide good healthcare services. In this study, we focus on an OR scheduling problem for a Korean university hospital with 32 ORs, in which the surgeons’ preferred rooms and times are considered. Cooperative operation (CO-OP), which is a type of operation in which multiple surgeons cooperatively manage patients, is also considered. Although CO-OP is performed in many large hospitals, there appears to be no accessible literature on this subject. We propose a mathematical programming model and solution approach to solve the scheduling problem. The objective is to minimize both the number of ORs used and the overtime, while providing a satisfactory result based on surgeons' OR preferences. Experimental results on real cases demonstrated the effectiveness of the proposed algorithm in generating better schedules than those manually generated by a hospital manager or mathematically generated using a commercial solver.

Objective This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique’s usefulness and limitations. Methods Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. Results The mean follow-up period was 25 months (range, 3–58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. Conclusion One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.

STUDY DESIGN A cadaveric study. OBJECTIVE To investigate possible variations of posterior pharyngoesophageal (PE) wall thickness in the horizontal plane and their implications for anterior spine surgery. SUMMARY OF BACKGROUND DATA Lower cervical levels (C5-7) are most commonly involved in cases of PE injury, and PE wall thickness could be one of the proposed reasons for the high incidence of PE injuries at these levels. The purpose of this study was to document thickness variations of the posterior PE wall at different cervical spine levels, because the study could provide valuable anatomical information that could reduce iatrogenic injuries caused by retractors or instrumentation. METHODS Thirteen formaldehyde-fixed cadaveric specimens were included in current study. PE specimens were harvested from epiglottis to suprasternal notch within 2 months of formaldehyde fixation and sectioned axially. Four slices corresponding to the superior and inferior borders of thyroid cartilage, cricoid cartilage, and 2 cm below cricoid cartilage were sectioned. Posterior PE wall thickness was measured at three zones as follows: median, lateral, and paramedian. Posterior PE wall thicknesses were measured by a pathologist. RESULTS Based on one-way ANOVA, posterior PE wall thickness showed several significantly different variations depending on cervical level and horizontal plane. PE walls were thinnest at the level of cricoid cartilage (P

Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5–7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage.

A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper-thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography. Radiotherapy for spinal metastasis and subsequent chemotherapy was carried out. Sixteen months after pancreatectomy, gait disturbance occurred and follow-up thoracic magnetic resonance imaging (MRI) showed aggravation of metastasis at T2 and T4 compressing the spinal cord. We performed a decompressive laminectomy with subtotal resection of the tumor masses and pedicle screw fixation at C7–T6. Neurologic status improved after the operation. Histopathologic examinations revealed the tumor as metastatic mucin producing adenocarcinoma. Three months after surgery, motor weakness and pain was reappeared. MRI showed large amount of epidural fluid collection. We performed wound revision and there was large amount of gelatinous fluid at the epidural space. We suggest that postoperative mucin collection and wound problems should be considered after surgery for mucin producing metastatic pancreatic tumor.

OBJECTIVE Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes. METHODS We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon's signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores. RESULTS Pre-to-postoperative VAS (p

Carbon nanotubes (CNTs) are promising candidates as novel scaffolds for peripheral nerve regeneration. Schwann cells (SCs) are attractive therapeutic targets due to their pivotal role in peripheral nerve regeneration, but primary SCs have limitations for clinical application. However, adipose-derived stem cells (ASCs) may differentiate into Schwann-like cells. The present study assesses the potential applicability of multiwall CNTs (MWNTs) composited with polydimethylsiloxane (PDMS), which were then seeded with differentiated adipose-derived stem cells (dASCs) to promote neuronal differentiation and growth. Aqueous MWNT dispersion was filtered, and the PDMS/MWNT sheets were prepared using a simple printing-transfer method. Characterization of PDMS/MWNT sheets indicated their unique physical properties, such as superior mechanical strength and electroconductivity, compared with bare PDMS sheets. ASCs were differentiated into Schwann-like cells using a mixture of glial growth factors. Dorsal root ganglion (DRG) neurons were co-cultured with SCs and dASCs on PDMS/MWNTs sheets or noncoated dishes. An alamar blue proliferation assay of dASC and SCs showed significantly more dASC and SCs cultured on PDMS/MWNT sheets at 48 h and 72 h than when cultured on noncoated dishes (p

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.

Objective Cervical pedicle screw (CPS) placement is very challenging due to high risk of neurovascular complications. We devised a new technique (medial funnel technique) to improve the accuracy and feasibility of CPS placement. Methods We reviewed 28 consecutive patients undergoing CPS instrumentation using the medial funnel technique. Their mean age was 51.4 years (range, 30–81 years). Preoperative diagnosis included degenerative disease (n=5), trauma (n=22), and infection (n=1). Screw perforations were graded with the following criteria: grade 0 having no perforation, grade 1 having 50% of screw diameter. Grades 0 and 1 were considered as correct position. The degree of perforation was determined by 2 junior neurosurgeons and 1 senior neurosurgeon. Results A total of 88 CPSs were inserted. The rate of correct placement was 94.3%; grade 0, 54 screws; grade 1, 29 screws; grade 2, 4 screws; and grade 3, 1 screw. No neurovascular complications or failure of instrumentation occurred. In perforated screws (34 screws), lateral perforations were 4 and medial perforations were 30. Conclusion We performed CPS insertion using medial funnel technique and achieved 94.3% (83 of 88) of correct placement. And it can decrease lateral perforation.

Artificial nerve guidance conduits (aNGCs) prepared from polymer scaffolds and carbon nanotubes (CNTs) possess unique chemical and physical properties, and have been widely used in preclinical trials to promote neuronal differentiation and growth. However, there have been only a few reports on the clinical applicability of CNT sheets for proliferation of primary neuronal cells due to safety concerns. The present study assesses the ability and potential applicability of multiwalled CNTs (MWNTs) composited with polydimethylsiloxane (PDMS) sheets to promote and enhance the proliferation of primary neuronal cells. In this study, the aqueous MWNT dispersion was filtered, and the PDMS/MWNT sheets were prepared using a simple printing transfer method. Characterization of PDMS/MWNT sheets demonstrated their unique physical properties such as superior mechanical strength and electroconductivity when compared with PDMS sheets. The effect of the PDMS/MWNT sheets on the neural cell proliferation and cytotoxicity was evaluated using MTT and alamar blue assays. Our results indicate the viability and proliferation of primary neuronal cells and Schwann cells in PDMS/MWNT sheets increased over twice when compared with a noncoated dish that is not usual in the primary neuronal cell growth control (p

Objective The purpose of this study was to investigate the incidence, cause, and influence of the adverse drug reactions (ADRs) associated with long-term intravenous antibiotics in patients with pyogenic spondylitis (PS). Methods We retrospectively reviewed the medical records of 84 patients with PS who underwent intravenous antibiotic therapy in our hospital from January 2001 to December 2012. ADRs were categorized to drug eruption, acute renal failure (ARF), hematologic toxicity, toxic hepatitis, pseudomembranous colitis (PMC), drug fever, and neuronal toxicity. Incidence and onset time of each ADR after antibiotic therapy were analyzed with the incidence of ADRs according to types of antibiotics. Results ADRs occurred in 38 of the 84 patients (incidence: 45.2%). The use of antibiotics was longer in the patients with ADRs (62.7 days) than in the patients without ADRs (44.3 day). The incidence of drug eruption, ARF, hematologic toxicity, toxic hepatitis, PMC, drug fever, and neuronal toxicity were 22.6, 11.9, 11.9, 10.7, 7.1, 3.6%, and 1.2%, respectively. The duration of antibiotics administration was related to the occurrence of PMC (p=0.001). ADRs were more common in patients treated by glycopeptides including vacomycin and teicoplanin. Conclusion The incidence of ADRs due to long-term intravenous antibiotics was as high as 45.2% in patients with PS. Therefore, we speculate that the possibility of delayed ADRs should be considered after long-term use of the antibiotics. Furthermore, close observation is mandatory to identify and treat ADRs promptly, even though PS revealed the improvement after antibiotic therapy.

Objective In general, quadriplegic patients use their voices to call the caregiver. However, severe quadriplegic patients are in a state of tracheostomy, and cannot generate a voice. These patients require other communication tools to call caregivers. Recently, monitoring of eye status using artificial intelligence (AI) has been widely used in various fields. We made eye status monitoring system using deep learning, and developed a communication system for quadriplegic patients can call the caregiver. Methods The communication system consists of 3 programs. The first program was developed for automatic capturing of eye images from the face using a webcam. It continuously captured and stored 15 eye images per second. Secondly, the captured eye images were evaluated for open or closed status by deep learning, which is a type of AI. Google TensorFlow was used as a machine learning tool or library for convolutional neural network. A total of 18,000 images were used to train deep learning system. Finally, the program was developed to utter a sound when the left eye was closed for 3 seconds. Results The test accuracy of eye status was 98.7%. In practice, when the quadriplegic patient looked at the webcam and closed his left eye for 3 seconds, the sound for calling a caregiver was generated. Conclusion Our eye status detection software using AI is very accurate, and the calling system for the quadriplegic patient was satisfactory.

Background context Lumbar intradural disc herniation (IDH) is rare, and intradural cyst associated with IDH is quite rare. Only seven cases of an intradural cyst associated with lumbar disc herniation have been reported, and all were gas-filled cysts. We report the first case, to our knowledge, of a fluid-filled intradural cyst associated with IDH. Purpose To report an extremely rare case of a fluid-filled intradural cyst associated with lumbar IDH and suggests the possible pathogenesis. Study design Case report. Methods An 82-year-old woman presented with right leg pain and motor weakness. Computed tomography and magnetic resonance imaging (MRI) scans showed calcified lumbar disc herniation and an intradural cystic mass at the L1–L2 level. An MRI, which was performed 2 years before admission, showed an IDH without a cyst at the same level. Results Surgical resection of the intradural cyst was performed. Intraoperative finding showed a fluid-filled intradural cyst with 1-cm diameter of displacing nerve rootlets. The cyst was connected with extradural cystic components through a ventral dural hole, but the tract was blocked by fibrous septum. Histopathologic examination showed a pseudocyst that consisted of degenerative cartilaginous and fibrous tissues, including degenerative disc materials. We concluded that the cyst was an intradural cyst transformed from the intradural disc fragment. Conclusions The current case is the first report to our knowlege of a fluid-filled intradural cyst associated with IDH. The possible mechanism may be focal degeneration and spontaneous absorption of the intradural disc with fluid production. Unlike the gas-filled intradural cysts, the cause of the pure fluid-filled cyst may be disconnection from the intervertebral vacuum because of a calcified disc and septation of the cyst.

Intelligent automobile technology and IT convergence, the development of new imaging technology media applications based on open source Android installed on tracked, wheeled smart phone application technology and the development of intelligent vehicles as a new paradigm a lot of research and development being made. Android-based intelligent automotive applications, technology, and evolved into the center of a set of various multimedia technologies move beyond the limits of the means of each of multimedia platforms, services and applications that have been developed in such a distributed environment, has been developed according to a variety of services through technology mobile terminal device technology is an absolute requirement. In this paper, SVC Codec, real-time video and graphics processing and SoC design intelligent vehicles middleware applications with monolithic system specification through Android-based design of intelligent vehicles dedicated middleware research experiments on open platforms, and provides various terminal services functions SoC based on a newly designed and standardized interface analysis techniques in this study were verified through experiments.

Korea Health Industry Development Institute, Bureau of Health Industry PolicyHealthcare optimization is mandatory to strengthen the competitiveness of domestic healthcare industry. Heal-thcare optimization aims to increase service quality, patient safety, and system efficiency. This paper reviews various healthcare optimization cases of developed countries, synopsizes the current status of domestic heal-thcare industry, points out several reasons why healthcare optimization is not active in Korea, and suggests some vitalization ways.

This study focuses the architectural planning solution and guiding principle for English only classroom spatial layout and operation program to establish English educational environment proper to English curriculum contents and methodology by the grade level of elementary school. To accomplish this purpose of the study, this study proceeds as follows. First, the English facility condition such as type of classroom, retainment and floor space were researched and analyzed through the nationwide survey for elementary schools to understand English educational environment. Second, the study analyzes English educational procedures, contents and methodology and most typical educational scenes, facilities and equipments are extracted through the analysis. Finally, the study pursues the spatial layout factors and proposes the architectural planning principle for English only classroom to provide English educational environment per its size and type. Key Words : English curriculum, English experience center, Education Facilities, Educational Scenes, Remodeling

Capsaicin is a major pungent ingredient found in hot pepper, has long been reported to control of obesity and anti-carcinogenic activities. Capsaicin induced apoptosis in a various cancer cells, however the precise molecular mechanisms have been poorly understood. In present study, the effect of capsaicin in cell viability the U87MG human glioma cells and its molecular mechanisms of cell death were investigated. Capsaicin induced reduction of cell viability in doseand time-dependent manners. Apoptosis was determined based on the increase of positive TUNEL stained cells. The mechanisms of apoptosis were related with mitochondrial pathway (Bcl-2/Bax), activation of MAPK pathway. These data suggest that capsaicin could be a novel chemotherapeutic agent of human malignant gliomas.

In this paper, high-tech IT Convergence, to the development of complex technology, special technology, video object recognition technology was considered only as a smart - phone technology with the development of personal portable terminal has been developed crossroads. Technology-based detection of 3D face recognition technology that recognizes objects detected through the intelligent video recognition technology has been evolving technologies based on image recognition, face detection technology with through the development speed is booming. In this paper, based on human face recognition technology to detect the object recognition image processing technology is applied through the face recognition technology applied to the IP camera is the party of the mouth, and allowed the ability to identify and apply the human face recognition, measurement techniques applied research is suggested. Study plan: 1) face model based face tracking technology was developed and applied 2) algorithm developed by PC-based measurement of human perception through the CPU load in the face value of their basic parameters can be tracked, and 3) bilateral distance and the angle of gaze can be tracked in real time, proved effective.

In this study, we carried out a survey on the degree of recognition for the brand of the Korea Institute of Geoscience and Mineral Resources (KIGAM) to contribute to reestablishing the status and role of KIGAM as an institution that people proud of by effectively delivering KIGAM`s various research activities and achievements to people. About 49.9% of external publics recognized that there was relevance between research achievements of geo-technology and national brand. On the contribution of research achievements of geo-technology to promoting Korea`s power of science and technology, 42.3% gave positive answers. On research achievements of mineral resources technology, just 14.4% replied they saw such results. As alternatives to promote the degree of recognition for brand, we suggested development of beneficial message, operation of brand management committee, promotion of involvement of research achievements of mineral resources technology about people-friendly subjects, development and distribution of "board game for education on mineral resources technology" for youths, activation of location PR, activation of online Q&A bulletin board, finding out star researchers, and president`s PI activities.

The variation of microstructure and corrosion characteristics with the applied annealing conditions of a HANA-4 (Zr–1.5Nb–0.4Sn–0.2Fe–0.1Cr) alloy were studied by utilizing transmission electron microscopy and a corrosion test at 360 °C in a water environment. The samples were annealed at temperature ranges from 540 to 660 °C up to 16 h after β quenching at 1050 °C. The corrosion behaviour with the annealing conditions was divided into two groups following the second phase characteristics. The suitable annealing temperature to obtain good corrosion resistance in the HANA-4 alloy ranged from 570 to 600 °C.