Search

Objectives: This study aims to examine the longitudinal effects of mother-preschooler interaction on a child’s prosocial behavior and behavior problem. Furthermore, it examines the mediating role of child’s self-esteem between mother-preschooler interaction and child’s prosocial behavior and behavior problem.Methods: The participants were 882 children(452 boys and 430 girls) and their mothers from the 7th(T1) to 9th(T3) wave(2014~2016) of the Panel Study on Korean Children. Data were analyzed with a Structural Equation Model and a bootstrapping method was used to test the statistical significance of the mediation.Results: First, the mother-preschooler interaction did not have a direct longitudinal effect on a child’s prosocial behavior, but had an indirect effect through self-esteem after controlling gender. The bootstrapping result suggested that the indirect effect is statistically significant. Second, mother-preschooler interaction did not have longitudinal effects on behavior problem, both directly and indirectly, through child’s self-esteem. Consequently, the more the interaction between mothers and preschoolers, the higher the child’s self-esteem, which led to a higher prosocial behavior.Conclusion: The results of this study show the mediating effect of self-esteem on the relationship between mother-preschooler interaction and child’s prosocial behavior. These findings suggest that parents should provide children with experiences in various interactions. They also imply the importance of experience in interactions in meaningful social relations for positive behavior of children. These experiences could play a role improving confidence in one’s worth and, eventually, allow children to have positive behaviors in social relations. The limitations and other implications of this study are also discussed.

BACKGROUND: In the setting of multiple trauma, radiation exposure is considered a relevant issue because patients may require repeated imaging to evaluate injuries in different body parts. Recently, spectral shaping of the X-ray beam has been shown to be beneficial in reducing radiation exposure. We investigated the clinical feasibility of a tin-filtered 100 kV protocol for the diagnostic use, compared to routine dedicated maxillofacial CT at 120 kVp in patients with craniofacial trauma; we assessed the image quality, radiation dose, and interobserver agreement. METHODS: We retrospectively evaluated 100 consecutive patients who underwent dedicated maxillofacial CT for craniofacial trauma. Fifty patients were examined with a tin-filtered 100 kV protocol performed using a third-generation dual source CT. The other 50 patients were examined with a standard protocol on a different scanner. Two readers independently evaluated image quality subjectively and objectively, and the interobserver agreement was also assessed. CT dose index volume (CTDI(vol)) and dose-length product (DLP) were recorded to compare radiation exposure. A quality-control phantom was also scanned to prospectively assess the impact of tin filtration. RESULTS: All CT scans showed diagnostic image quality for evaluating craniofacial fractures. The tin-filtered 100 kV protocol showed sufficient-to-good image quality for diagnostic use; however, overall image quality and anatomic delineation from the tin-filtered 100 kV protocol were significantly lower than from the standard protocol. Interobserver agreement was moderate to almost perfect (k=0.56–0.85). Image noises in the air, eye globe, and retrobulbar fat were comparable between the two protocols (P>0.05), whereas both signal-to-noise ratio and contrast-to-noise ratio in the eye globe and retrobulbar fat showed a significant difference (P

This study aimed to evaluate a deep learning model for generating synthetic contrast-enhanced CT (sCECT) from non-contrast chest CT (NCCT). A deep learning model was applied to generate sCECT from NCCT. We collected three separate data sets, the development set (n = 25) for model training and tuning, test set 1 (n = 25) for technical evaluation, and test set 2 (n = 12) for clinical utility evaluation. In test set 1, image similarity metrics were calculated. In test set 2, the lesion contrast-to-noise ratio of the mediastinal lymph nodes was measured, and an observer study was conducted to compare lesion conspicuity. Comparisons were performed using the paired t-test or Wilcoxon signed-rank test. In test set 1, sCECT showed a lower mean absolute error (41.72 vs 48.74; P P P P P P ≤ .001). Synthetic CECT generated from NCCT improves the depiction of mediastinal lymph nodes.

Objectives To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naive men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear. Materials and methods We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA 10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared. Results Data from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4–10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA 10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31–4.60, P = 0.005) were significantly associated with a detection of csPCa. Conclusions Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naive men with PSA 4–10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA

OBJECTIVE. The long scan time of brain MRI is a major drawback that limits its clinical use for evaluating pediatric patients who are inherently prone to motion and frequently require sedatives. This study investigated the clinical feasibility of a 1-minute ultrafast brain MRI protocol in pediatric patients by assessing its image quality in comparison with that of routine brain MRI. MATERIALS AND METHODS. Twenty-three patients were enrolled who underwent 1-minute ultrafast MRI and routine brain MRI protocols including five essential sequences (T1-weighted imaging, T2-weighted imaging, DWI, FLAIR, and T2*-weighted imaging). Total scan time for the same image contrast levels was 1 minute 11 seconds for ultrafast MRI versus 9 minutes 51 seconds for routine brain MRI. Two readers independently reviewed all images from the two MRI protocols and graded the image quality on a 4-point Likert scale. The Wilcoxon signed rank test was used to compare the readers' ratings; interobserver agreement between the readers was also assessed. RESULTS. Although the mean scores of overall image quality and anatomic delineation in ultrafast brain MR images were significantly lower than those in routine brain MR images, ultrafast brain MRI showed sufficient overall image quality and anatomic delineation with more than 2 points on the 4-point scale. CONCLUSION. The 1-minute ultrafast brain MRI protocol showed at least sufficient image quality compared with routine brain MRI. Therefore, 1-minute ultrafast brain MRI can be a viable first-line neuroimaging study for pediatric patients because of its shorter scan time, absence of radiation hazard, and reduced sedation requirements.

Purpose Acute ischemic strokes caused by steno-occlusive lesion of the cervical internal carotid artery are associated with poor clinical outcome. We evaluated the clinical efficacy of emergent carotid artery stenting for the management of these lesions. We compared the clinical outcomes regarding the intracranial lesion, namely tandem occlusions versus isolated cervical internal carotid artery occlusion. Materials and methods We retrospectively reviewed patients with acute ischemic stroke who underwent carotid artery stenting for cervical internal carotid artery steno-occlusive lesion between 2011 and 2018. After dividing the patients into two groups according to the presence or absence of intracranial lesions (tandem group and isolated cervical group), we analyzed demographic data, angiographic findings, and clinical outcomes. A modified Rankin Scale score ≤2 was defined as a favorable clinical outcome. Results Of 75 patients, 46 patients (61.3%) had tandem lesions, and the remaining 29 had only cervical internal carotid artery steno-occlusive lesion. Successful stenting was performed in all patients with favorable clinical outcomes (64.0%). Successful reperfusion score (thrombolysis in cerebral infarction ≥2 b) was 84.0%; tandem group (76.1%) versus isolated cervical group (96.6%) of cases. Mean modified Rankin Scale score at 90-days was 2.09. The rate of favorable clinical outcome showed no statistically significant difference between the two groups ( p = 0.454). Conclusions Endovascular treatment in patients with acute ischemic stroke due to cervical internal carotid artery steno-occlusive lesion is a technically feasible and clinically effective intervention regardless of intracranial occlusion. Therefore, we recommend endovascular treatment regardless of the presence of concomitant intracranial artery occlusion for patients with acute ischemic stroke caused by cervical internal carotid artery steno-occlusive lesion.

BackgroundTransradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study.Material & methodsDistal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period.ResultsThe technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes).ConclusionDistal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.

BackgroundIn CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known.ObjectivesTo compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance.MethodsImages and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared.ResultsPneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717-0.922 and OR = 0.610; CI = 0.441-0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172-3.344, OR = 3.505; CI = 2.718-5.650, and OR = 1.330; CI = 1.132-1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634-20.274 and OR = 3.738; CI = 1.860-7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax.ConclusionPneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.

To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs).The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168;A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.

Strongyloidiasis is chronic parasite infection caused by Strongyloides stercoralis . It is endemic in tropical and subtropical areas (1,2). Skin contact with dirty soil and poor sanitary conditions are risk factors for infection. Rhabditiform larvae in warm and moist soil can develop into filariform larvae that can penetrate human skin and migrate through circulation to lungs (3). These larvae escape to alveolar space and migrate to pharynx. By being swallowed in pharyngeal secretion, larvae can settle in small intestine and mature into adults.

The executioner caspase-3 has been proposed as a pharmacological intervention target to preserve degenerating dopaminergic (DA) neurons because apoptotic mechanisms involving caspase-3 contribute, at least in part, to the loss of DA neurons in patients and experimental models of Parkinson's disease (PD). Here, we determined that genetic intervention of caspase-3 was sufficient to prevent cell death against oxidative stress (OS), accompanied by unexpected severe mitochondrial dysfunction. Specifically, as we expected, caspase-3-deficient DA neuronal cells were very significantly resistant to OS-induced cell death, while the activation of the initiator caspase-9 by OS was preserved. Moreover, detailed phenotypic characterization of caspase-3-deficient DA cells revealed severe mitochondrial dysfunction, including an accumulation of damaged mitochondria with a characteristic swollen structure and broken cristae, reduced membrane potential, increased levels of reactive oxygen species (ROS), and deficits in mitochondrial oxidative phosphorylation (OXPHOS) enzymes. Of great interest, we found that mitochondrial biogenesis was dramatically decreased in caspase-3-deficient DA cells, whereas their capability of mitophagy was normal. In accordance with this observation, caspase-3 gene knock down (KD) resulted in dramatically decreased expression of the key transcriptional activators of mitochondrial biogenesis, such as Tfam and Nrf-1, implicating a non-apoptotic role of procaspase-3 in mitochondrial biogenesis. Therefore, a prolonged anti-apoptotic intervention targeting caspase-3 should be considered with caution due to the potential adverse effects in mitochondria dynamics resulting from a novel potential functional role of procaspase-3 in mitochondrial biogenesis via regulating the expression of mitochondrial biogenesis activators. J. Cell. Biochem. 119: 347-357, 2018. © 2017 Wiley Periodicals, Inc.

Background and Objectives: To investigate the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and subsequent ultrasonography (US) for determining cervical nodal metastasis in oncology patients. Materials and Methods: Fifty-nine cervical lymph nodes (LNs) initially detected by PET/CT with subsequent neck US were included in this retrospective study. All LNs were subjected to US-guided fine-needle aspiration or core needle biopsy. The maximum standardized uptake value (SUVmax) and sonographic features were assessed. Results: Forty-three of 59 cervical LNs detected by PET/CT were malignant. PET/CT alone showed a highest diagnostic value for metastatic LNs with 81.4% sensitivity, 68.8% specificity, and 78% accuracy when SUVmax &ge, 5.8 was applied as an optimal cut-off value. Combined PET/CT and subsequent US diagnoses for determining nodal metastasis showed the following diagnostic performance: 81.4% sensitivity, 87.5% specificity, and 83.1% accuracy. There was a significant difference in the diagnostic performance between the two diagnostic imaging approaches (p = 0.006). Conclusions: Combined diagnosis using subsequent US showed a significantly higher diagnostic performance for determining nodal metastasis in the neck. Therefore, we believe that our proposed diagnostic strategy using subsequent US can be helpful in evaluating cervical LNs on PET/CT. Moreover, our results clarify the need for US-guided tissue sampling in oncology patients.

This study aimed to develop a dual-input convolutional neural network (CNN)-based deep-learning algorithm that utilizes both anteroposterior (AP) and lateral elbow radiographs for the automated detection of pediatric supracondylar fracture in conventional radiography, and assess its feasibility and diagnostic performance.To develop the deep-learning model, 1266 pairs of AP and lateral elbow radiographs examined between January 2013 and December 2017 at a single institution were split into a training set (1012 pairs, 79.9%) and a validation set (254 pairs, 20.1%). We performed external tests using 2 types of distinct datasets: one temporally and the other geographically separated from the model development. We used 258 pairs of radiographs examined in 2018 at the same institution as a temporal test set and 95 examined between January 2016 and December 2018 at another hospital as a geographic test set. Images underwent preprocessing, including cropping and histogram equalization, and were input into a dual-input neural network constructed by merging 2 ResNet models. An observer study was performed by radiologists on the geographic test set. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the model and human readers were calculated and compared.Our trained model showed an AUC of 0.976 in the validation set, 0.985 in the temporal test set, and 0.992 in the geographic test set. In AUC comparison, the model showed comparable results to the human readers in the geographic test set; the AUCs of human readers were in the range of 0.977 to 0.997 (P's0.05). The model had a sensitivity of 93.9%, a specificity of 92.2%, a PPV of 80.5%, and an NPV of 97.8% in the temporal test set, and a sensitivity of 100%, a specificity of 86.1%, a PPV of 69.7%, and an NPV of 100% in the geographic test set. Compared with the developed deep-learning model, all 3 human readers showed a significant difference (P's0.05) using the McNemar test, with lower specificity and PPV in the model. On the other hand, there was no significant difference (P's0.05) in sensitivity and NPV between all 3 human readers and the proposed model.The proposed dual-input deep-learning model that interprets both AP and lateral elbow radiographs provided an accurate diagnosis of pediatric supracondylar fracture comparable to radiologists.

BACKGROUND AND PURPOSE: The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS: We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS: The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS: The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

To evaluate the predictive value of virtual monoenergetic images (VMIs) by assessing tumor conspicuity on dual-layer spectral detector CT (SDCT) and correlate tumor conspicuity on VMI with prognostic biomarkers in patients with breast cancer. Sixty-four patients underwent arterial phase and 90-s delayed phase dual-layer SDCT. A retrospective tumor conspicuity analysis of 14 benign tumors and 65 breast cancers was performed using conventional images (CIs) and VMI at 40 keV (VMI40) on arterial and delayed phase scans (CIART, VMI40ART, CIDE, VMI40DE). Mean Hounsfield units (HU) of tumors were measured on VMI40ART and VMI40DE. A receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic accuracy between image sets. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 levels were evaluated using histopathology. Correlations between VMI analyses and histological characteristics of cancers were analyzed. Cancers on VMI40 had a significantly higher conspicuity score and mean HU than benign tumors (p

The aim of this study was to evaluate the clinical feasibility and effectiveness of bedside peripherally inserted central catheter (PICC) using portable digital radiography (DR) in intensive care unit (ICU) patients. Sixty-five ICU patients who underwent PICC were enrolled in this study between May 2016 and May 2017. Of these 65 patients, 45 (69.2%) underwent the procedures bedside in ICU using portable DR, and 20 (30.8%) underwent the procedures at the intervention clinic, both performed by a single interventional radiologist. We retrospectively reviewed electronic medical records for clinical presentation, total procedural time, total radiation dose, total patient transfer time, and clinical outcomes. We performed an independent t test to compare the clinical effectiveness between the 2 groups. The technical and clinical success rates were 100% in both groups, and there were no procedure-related complications. The total radiation dose of bedside PICC at ICU was significantly lower than that of conventional PICC at the intervention clinic (557.9 mGy∗cm2 ± 209.2 vs 985.2 mGy∗cm2 ± 547.6, P

BACKGROUND Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding. OBJECTIVE To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms. METHODS A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics. RESULTS The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P

OBJECTIVE To evaluate the computed tomography (CT) findings and clinical characteristics of pulmonary tuberculosis (TB) in patients with emphysema, compared with those without emphysema. MATERIALS AND METHODS Thirty-nine patients (M:F = 36:3; mean age, 64.8 years) who were diagnosed with chronic obstructive pulmonary disease and had emphysema in pretreatment chest CT scans were included in this study (emphysema group). Their clinical presentation, laboratory findings, and CT findings were compared with those of 57 pulmonary TB patients without chronic obstructive pulmonary disease and emphysema (M:F = 52:5; mean age, 64.3 years) (nonemphysema group). RESULTS Fever was a more frequent clinical presentation and the C-reactive protein level was higher in the emphysema group. Among CT findings, consolidation and ground-glass opacity were seen more frequently in the emphysema group (82% and 69% vs 42% and 19%, respectively, P < 0.001). Consolidation was more often nonsegmental than lobular or segmental. Tree-in-bud appearance was less frequently noted in the emphysema group (36% vs 79%, P < 0.001). The location of main lesions (upper lung vs middle/lower lung) was not different between the 2 groups. CONCLUSIONS Pulmonary TB in emphysema patients often shows bacterial pneumonia-like features, that is, presence of consolidation and ground-glass opacity and lack of bronchogenic spread on chest CT scans, combined with the presence of fever and a high C-reactive protein level. Sputum smear for acid-fast bacteria should be performed early in emphysema patients with pneumonia in TB-endemic areas.

Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 &plusmn, 1191 mL, range 1000&ndash, 4500 mL) was significantly lower than that in the surgical group (4435 &plusmn, 1376 mL, range 1500&ndash, 10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 &plusmn, 1154 mL, range 1200&ndash, 8000 mL) was significantly lower than that in the surgical group (3840 &plusmn, 1464 mL, range 1800&ndash, 15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.

We investigated the capability of a trained deep learning (DL) model with a convolutional neural network (CNN) in a different scanning environment in terms of ameliorating the quality of synthetic fluid-attenuated inversion recovery (FLAIR) images. The acquired data of 319 patients obtained from the retrospective review were used as test sets for the already trained DL model to correct the synthetic FLAIR images. Quantitative analyses were performed for native synthetic FLAIR and DL-FLAIR images against conventional FLAIR images. Two neuroradiologists assessed the quality and artifact degree of the native synthetic FLAIR and DL-FLAIR images. The quantitative parameters showed significant improvement on DL-FLAIR in all individual tissue segments and total intracranial tissues than on the native synthetic FLAIR (p &lt, 0.0001). DL-FLAIR images showed improved image quality with fewer artifacts than the native synthetic FLAIR images (p &lt, 0.0001). There was no significant difference in the preservation of the periventricular white matter hyperintensities and lesion conspicuity between the two FLAIR image sets (p = 0.217). The quality of synthetic FLAIR images was improved through artifact correction using the trained DL model on a different scan environment. DL-based correction can be a promising solution for ameliorating the quality of synthetic FLAIR images to broaden the clinical use of synthetic magnetic resonance imaging (MRI).

Objective To evaluate the incidence and risk factors of emetic complications associated with the intravenous administration of low-osmolality iodinated contrast media (ICM) in children undergoing computed tomography (CT). Materials and methods All children who underwent contrast-enhanced CT between April 2017 and July 2019 were included. Pediatric patients were instructed on the preparative dietary protocol at our institution. Experienced nurses in the radiology department monitored the children during the CT scans and recorded any emetic complications in their electronic medical records. These data were used to calculate the incidence of emetic complications. Various patient factors and technical factors, including fasting duration, the type and volume of ICM, and ongoing chemotherapy, were evaluated to identify risk factors for emetic complications using univariate and multivariate logistic regression analyses. Results Among the 864 children (mean age, 8.4 ± 5.7 years) evaluated, 18 (2.1%) experienced emetic complications (6 experienced nausea only and 12 experienced nausea and vomiting). None of the children developed aspiration pneumonia. The mean fasting duration of patients with emesis was 7.9 ± 5.7 hours (range, 3-21 hours), whereas that of patients without nausea was 8.7 ± 5.7 hours (range, 0-24 hours). Fasting duration was not associated with the development of nausea and vomiting (p = 0.634). Multivariate logistic regression analysis revealed that ongoing chemotherapy (odds ratio [OR] = 4.323; 95% confidence interval [CI] = 1.430-13.064; p = 0.009), iomeprol use (OR = 7.219; 95% CI = 1.442-36.146; p = 0.016), and iohexol use (OR = 5.241; 95% CI = 1.350-20.346; p = 0.017) were independent risk factors for emetic complications. Conclusion Only a small proportion (2.1%) of children experienced nausea or vomiting after exposure to low-osmolality ICM. Many children underwent excessive fasting; however, fasting duration was not associated with nausea and vomiting. Moreover, ongoing chemotherapy and the use of iomeprol or iohexol were identified as potential risk factors for emetic complications in children.

Objective To investigate the clinical feasibility of synthetic diffusion-weighted imaging (sDWI) at different b-values in patients with breast cancer by assessing the diagnostic image quality and the quantitative measurements compared with conventional diffusion-weighted imaging (cDWI). Materials and Methods Fifty patients with breast cancer were assessed using cDWI at b-values of 800 and 1500 s/mm2 (cDWI800 and cDWI1500) and sDWI at b-values of 1000 and 1500 s/mm2 (sDWI1000 and sDWI1500). Qualitative analysis (normal glandular tissue suppression, overall image quality, and lesion conspicuity) was performed using a 4-point Likert-scale for all DWI sets and the cancer detection rate (CDR) was calculated. We also evaluated cancer-to-parenchyma contrast ratios for each DWI set in 45 patients with the lesion identified on any of the DWI sets. Statistical comparisons were performed using Friedman test, one-way analysis of variance, and Cochran's Q test. Results All parameters of qualitative analysis, cancer-to-parenchyma contrast ratios, and CDR increased with increasing b-values, regardless of the type of imaging (synthetic or conventional) (p < 0.001). Additionally, sDWI1500 provided better lesion conspicuity than cDWI1500 (3.52 ± 0.92 vs. 3.39 ± 0.90, p < 0.05). Although cDWI1500 showed better normal glandular tissue suppression and overall image quality than sDWI1500 (3.66 ± 0.78 and 3.73 ± 0.62 vs. 3.32 ± 0.90 and 3.35 ± 0.81, respectively; p < 0.05), there was no significant difference in their CDR (90.0%). Cancer-to-parenchyma contrast ratios were greater in sDWI1500 than in cDWI1500 (0.63 ± 0.17 vs. 0.55 ± 0.18, p < 0.001). Conclusion sDWI1500 can be feasible for evaluating breast cancers in clinical practice. It provides higher tumor conspicuity, better cancer-to-parenchyma contrast ratio, and comparable CDR when compared with cDWI1500.

Ultrafast brain MRI is required for uncooperative patients and time-critical diseases such as stroke because it reduces scan times and motion artifacts. This study investigated the clinical feasibility of a 1-min ultrafast brain MRI protocol for detecting intracranial abnormalities in restless and uncooperative patients. We retrospectively reviewed the records of 25 patients who underwent a 1-min ultrafast MRI protocol using T1-weighted image, T2-weighted image, echo-planar fluid-attenuated inversion recovery, diffusion-weighted image, and T2*-weighted image between March 2017 and May 2017. Simple methods were applied for ultrafast MRI protocol to reduce scan time as follows: parallel imaging techniques, multiband technique on diffusion sequence, and echo-planar fluid-attenuated inversion recovery. The images were compared with the routine brain MRI protocol using synthetic MRI, and quality was assessed by two independent readers. The Wilcoxon signed-rank test was used to compare the readers’ ratings of the routine MRI protocol and ultrafast MRI protocol images. Using a four-point assessment scale, overall image quality and anatomical delineation of ultrafast brain MRI images were lower than those of routine brain MRI images. However, the ultrafast protocol demonstrated sufficient overall image quality and anatomical delineation with an assessment rating greater than two points. The ultrafast protocol had fewer artifacts than the routine protocol using synthetic MRI. Although the overall image quality and anatomical delineation of the 1-min ultrafast MRI were inferior to those of the routine brain MRI protocol, the ultrafast protocol showed at least sufficient image quality. Therefore, this protocol may be an option in specific clinical situations involving non-cooperative, restless, or pediatric patients, or patients with time-critical disease such as stroke. Further study is required to validate our findings.

To determine the feasibility of using high-resolution volumetric zero echo time (ZTE) sequence in routine lung magnetic resonance imaging (MRI) and compare free breathing 3D ultrashort echo time (UTE) and ZTE lung MRI in terms of image quality and small-nodule detection. Our Institutional Review Board approved this study. Twenty patients underwent both UTE and ZTE sequences during routine lung MR. UTE and ZTE images were compared in terms of subjective image quality and detection of lung parenchymal signal, intrapulmonary structures, and sub-centimeter nodules. Differences between the two sequences were compared through statistical analysis. Lung parenchyma showed significantly (p

Rationale: Poroid hidradenoma (PH) is a rare variant of benign sweat gland neoplasm without connection to the epidermis. This tumor presents clinically as a solitary lesion with a cystic component located in the subcutaneous layer abutting the skin. On ultrasound, it appears as a circumscribed complex cystic and solid mass abutting the dermis. The occurrence of PH in the breast is very rare. Its features overlap with intraductal papilloma and papillary carcinoma. Patient concerns: A 66-year-old woman presented with a palpable lump in her right breast. Diagnoses: Clinical examination revealed dark bluish dome-shaped nodule which presented as circumscribed round isodense mass on mammography and oval complex cystic and solid mass abutting the dermis on ultrasound. Clinically, a papillary neoplasm was suspected. Interventions: The patient underwent En bloc surgical excision including the overlying epidermis and the surrounding adipose tissue to prevent recurrence. Outcomes: A well-demarcated, non-encapsulated grayish white mass composed of a partly solid and partly cystic area was completely removed and histopathologically confirmed as PH. At the 12-month follow-up, no recurrence was evident. Lessons: PH should be considered in the differential diagnosis of a slowly growing breast mass that is bluish, cystic, and solid and abuts the dermis.

Background and purpose We investigated the clinical feasibility of synthetic MRI with a 4-min single scan using a 48-channel head coil as a routine neuroimaging protocol in daily practice by assessing its diagnostic image quality. Methods We retrospectively reviewed the imaging data of 89 patients who underwent routine brain MRI using synthetic MRI acquisition between February 2017 and April 2017. Image quality assessments were performed by two independent readers on synthetic T1 fluid-attenuated inversion recovery (FLAIR), T2-weighted, T2 FLAIR, and phase-sensitive inversion recovery sequences acquired using multiple-dynamic multiple-echo imaging. Interobserver reliability between the two readers was assessed using kappa (κ) statistics. Results On a 4-point assessment scale, the overall image quality and anatomical delineation provided by synthetic brain MRI were found to be good with scores of more than 3 points for all sequences except for the T2 FLAIR sequence. The synthetic T2 FLAIR sequence provided sufficient image quality but showed more pronounced artifacts, especially the CSF pulsation artifact and linear hyperintensity along the brain surface. Interobserver agreement for evaluating image quality of all synthetic sequences was good to excellent (κ, 0.61–0.99; P Conclusion Synthetic MRI can be acceptable as a routine clinical neuroimaging protocol with a short scan time. It can be helpful to design customized and flexible neuroimaging protocols for each institution.

In this study, the applicability of geotextile mesh soil nails on slopes was evaluated by numerical analysis to reduce environmental problems which a general soil nailing might produce and to improve its economical efficiency and construction convenience. To this end, in situ pull-out tests were conducted for both general soil nail and geotextile mesh soil nail and their pull-out characteristics were analyzed. Also, finite difference method was used to verify the suitability of numerical simulation. Parameters for nail and ground conditions were selected and sensitivity analysis was performed for the evaluation of slope stability. In addition, analysis was performed by limit equilibrium method which is widely used for slope stability analysis in practice. As a result, if the nail diameter was same, there is no big difference between geotextile mesh soil nails and general soil nails in terms of slope stability. Therefore it can be expected that geotextile mesh soil nails could be effective for slope reinforcement since they could keep a slope as stable as general soil nails and give better economical efficiency and construction convenience than general soil nails.

The failure to trigger mitophagy is implicated in the pathogenesis of familial Parkinson disease that is caused by PINK1 or Parkin mutations. According to the prevailing PINK1-Parkin signaling model, mitophagy is promoted by the mitochondrial translocation of Parkin, an essential PINK1-dependent step that occurs via a previously unknown mechanism. Here we determined that critical concentrations of NO was sufficient to induce the mitochondrial translocation of Parkin even in PINK1 deficiency, with apparent increased interaction of full-length PINK1 accumulated during mitophagy, with neuronal nitric oxide synthase (nNOS). Specifically, optimum levels of NO enabled PINK1-null dopaminergic neuronal cells to regain the mitochondrial translocation of Parkin, which appeared to be significantly suppressed by nNOS-null mutation. Moreover, nNOS-null mutation resulted in the same mitochondrial electron transport chain (ETC) enzyme deficits as PINK1-null mutation. The involvement of mitochondrial nNOS activation in mitophagy was further confirmed by the greatly increased interactions of full-length PINK1 with nNOS, accompanied by mitochondrial accumulation of phospho-nNOS (Ser1412) during mitophagy. Of great interest is that the L347P PINK1 mutant failed to bind to nNOS. The loss of nNOS phosphorylation and Parkin accumulation on PINK1-deficient mitochondria could be reversed in a PINK1-dependent manner. Finally, non-toxic levels of NO treatment aided in the recovery of PINK1-null dopaminergic neuronal cells from mitochondrial ETC enzyme deficits. In summary, we demonstrated the full-length PINK1-dependent recruitment of nNOS, its activation in the induction of Parkin translocation, and the feasibility of NO-based pharmacotherapy for defective mitophagy and ETC enzyme deficits in Parkinson disease.