• Radiation Oncology Journal
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• v.31 no.3
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• pp.111-117
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• 2013

Purpose: To determine whether the maximum standardized uptake value (SUV) of [$^{18}F$] fluorodeoxyglucose uptake by positron emission tomography (FDG PET) ratio of lymph node to primary tumor (mSUVR) could be a prognostic factor for node positive non-small cell lung cancer (NSCLC) patients treated with definitive radiotherapy (RT). Materials and Methods: A total of 68 NSCLC T1-4, N1-3, M0 patients underwent FDG PET before RT. Optimal cutoff values of mSUVR were chosen based on overall survival (OS). Independent prognosticators were identified by Cox regression analysis. Results: The most significant cutoff value for mSUVR was 0.9 with respect to OS. Two-year OS was 17% for patients with mSUVR > 0.9 and 49% for those with mSUVR ${\leq}0.9$ (p = 0.01). In a multivariate analysis, including age, performance status, stage, use of chemotherapy, and mSUVR, only performance status (p = 0.05) and mSUVR > 0.9 (p = 0.05) were significant predictors of OS. Two-year OS for patients with both good performance (Eastern Cooperative Oncology Group [ECOG] ${\leq}1$) and mSUVR ${\leq}0.9$ was significantly better than that for patients with either poor performance (ECOG > 1) or mSUVR > 0.9, 23% (71% vs. 23%, p = 0.04). Conclusion: Our results suggested that the mSUVR was a strong prognostic factor among patients with lymph node positive NSCLC following RT. Addition of mSUVR to performance status identifies a subgroup at highest risk for death after RT.

• The Journal of Korean Institute of Communications and Information Sciences
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• v.37 no.4C
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• pp.297-306
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• 2012

IT technology of U-healthcare system is being grafted onto medical services and the use of U-healthcare system are extending steadily. However, in case of patients using Implantable Medical Device (IMD) in U-healthcare system, patients' privacy protection and safe access to system recently has emerged as a major issue. This paper proposes a patients' privacy protection protocol to prevent any illegal accesses from third parties as state value and action value are synchronized after patients' information virtualization. The proposed protocol can limit the access range of patients' information according to authentication information of hospitals, doctors, nurses, and pharmacies registered in the U-healthcare server. Additionally, this protocol can increase management efficiency for patients' privacy by synchronizing state values and action values only for approved information and, by instituting this process, third parties cannot easily access patients' information.

• Investigative Magnetic Resonance Imaging
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• v.23 no.4
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• pp.351-360
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• 2019

Purpose: To investigate noninvasive biomarkers for predicting treatment response in patients with locally advanced HCC who underwent concurrent chemoradiotherapy (CCRTx). Materials and Methods: Thirty patients (55.5 ± 10.2 years old, M:F = 24:6) who underwent CCRTx due to advanced HCC were enrolled. Contrast-enhanced US (CEUS) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) were obtained before and immediately after CCRTx. The third CEUS was obtained at one month after CCRTx was completed. Response was assessed at three months after CCRTx based on RECIST 1.1. Quantitative imaging biomarkers measured with CEUS and MRI were compared between groups. A cutoff value was calculated with ROC analysis. Overall survival (OS) was compared by the Breslow method. Results: Twenty-five patients were categorized into the non-progression group and five patients were categorized into the progression group. Peak enhancement of the first CEUS before CCRTx (PE1) was significantly lower in the non-progression group (median, 18.6%; IQR, 20.9%) than that in the progression group (median, 59.1%; IQR, 13.5%; P = 0.002). There was no significant difference in other quantitative biomarkers between the two groups. On ROC analysis, with a cutoff value of 42.6% in PE1, the non-progression group was diagnosed with a sensitivity of 90.9% and a specificity of 100%. OS was also significantly longer in patients with PE1 < 42.6% (P = 0.014). Conclusion: Early treatment response and OS could be predicted by PE on CEUS before CCRTx in patients with HCC.

• Journal of Trauma and Injury
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• v.31 no.3
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• pp.151-158
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• 2018

Purpose: The regional emergency medical centers manage the patients with major blunt trauma according to the process appropriate to each hospital rather than standardized protocol of the major trauma centers. The primary purpose of this study is to evaluate the effectiveness and influence on prognosis of additional cervical-thoracic-lumbar-spine computed tomography (CTL-spine CT) scan in diagnosis of spinal injury from the victim of major blunt trauma with impaired consciousness. Methods: The study included patients visited the urban emergency medical center with major blunt trauma who were over 18 years of age from January 2013 to December 2016. Data were collected from retrospective review of medical records. Sensitivity, specificity, positive predictive value, and negative predictive value were measured for evaluation of the performance of diagnostic methods. Results: One hundred patients with Glasgow coma scale ${\leq}13$ underwent additional CTL-spine CT scan. Mechanism of injury was in the following order: driver, pedestrian traffic accident, fall and passenger accident. Thirty-one patients were diagnosed of spinal injury, six of them underwent surgical management. The sensitivity of chest, abdomen and pelvis CT (CAP CT) was 72%, specificity 97%, false positive rate 3%, false negative rate 28% and diagnostic accuracy 87%. Eleven patients were not diagnosed of spinal injury with CAP CT and C-spine lateral view, but all of them were diagnosed of stable fractures. Conclusions: C-spine CT scan be actively considered in the initial examination process. When CAP CT scan is performed in major blunt trauma patients with impaired consciousness, CTL-spine CT scan or simple spinal radiography has no significant effect on the prognosis of the patient and can be performed if necessary.

• Journal of Gastric Cancer
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• v.21 no.1
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• pp.49-62
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• 2021

Purpose: This study aimed to investigate the prognostic value of lymph node ratio (LNR) in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy. Materials and Methods: We retrospectively enrolled gastric cancer patients treated with neoadjuvant chemotherapy and curative surgery at the First Affiliated Hospital of Zhejiang University from 2004 to 2015 as the study cohort. Patients with the same inclusion criteria treated in 2016-2017 were enrolled as the validation cohort. Kaplan-Meier curves were assessed using the log-rank test to analyze the differences in overall survival (OS). Multivariate survival analysis was performed using the Cox proportional hazards model. The areas under the receiver operating characteristic curve of ypN and LNR categories for predicting the actual 3-year OS were compared. Results: A total of 265 patients were included in the proposal cohort. The median number of retrieved lymph nodes (rLNs) was 32. The number of positive lymph nodes (pLNs) increased as rLN increased (P=0.037), but the LNR remained relatively constant (P=0.462). The LNR was categorized into 4 groups according to the prognosis: ypNr0, node-negative with rLN>25; ypNr1, node-negative with rLN≤25 or 00.3. In the validation cohort of 43 enrolled patients, there was a clear distinction in OS that significantly (P<0.001) varied depending on the LNR values and LNR was the only independent prognostic factor in multivariate analysis (P<0.001). Conclusions: LNR was an independent prognostic factor for survival of patients with gastric cancer after preoperative chemotherapy and might be an alternative predictor for ypN stage.

• The Korean Journal of Nuclear Medicine
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• v.13 no.1_2
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• pp.7-14
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• 1979

Radionuclide cardiac angiography has distinct advantages in safety, patient comfort, cost and ease of performance. This method offers diagnostic accuracy equivalent to that of cardiac catheterization. By this method the qualitative and quantitative diagnosis of the cardiac shunts are available. Also for it is repeatable with ease and more physiologic, it has application in following pre- and post-operative shunt patients. We performed the radionuclide cardiac angiographies in 147 cases of heart diseases and 26 cases of normal group. 1. The detection of left-to-right shunt was possible in 22 of 24 patients, and 2 patients were not diagnosed due to small shunt amount. (Qp/Qs<1.3) In 21 patients of right-to-left shunt, all were diagnosed by radionuclide cardiac angiography. 2. With the pulmonary time-activity curve, $C_2/C_1$ ratio was calculated. In normal control group, a range of $C_2/C_1$ ratios of $21{\sim}38%$ was established with a mean value of $28.6{\pm}4.6%$. In patients with left-to-right shunts determined by catheterization data, the range of $C_2/C_1$ ratio was $33{\sim}90%$, with a mean value of $67.8{\pm}12.2%$. 3. In 8 cases of left-to-right shunt, $Q_p/Q_s$ ratios determined by radionuclide cardiac angiography were compaired with those of cardiac catheterization. The correlation coefficient was 0.907. (P<0.001) 4. Postoperative radionuclide cardiac angiographies were done in 21 cases. 3 of 13 patients with left-to-right shunts were found to have residual shunts. 8 patients with right-to-left shunts were confirmed to have no residual shunt.

• Journal of Oral Medicine and Pain
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• v.48 no.3
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• pp.106-111
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• 2023

Purpose: In this study, we evaluate the potential of the relative ratio of capsular width (RCW) between the affected side (Aff) and non-affected side (Non-aff) in patients with temporomandibular joint (TMJ) arthralgia. We assessed whether RCW may hold greater diagnostic significance than the objective capsular width (CW) reported in previous studies when diagnosing arthralgia using ultrasonography (US). Methods: Forty-nine patients were assessed using US, excluding four patients with bilateral arthralgia. The patients were divided into two groups: 40 with unilateral arthralgia (UA), and nine without arthralgia (NA). We measured CW and masseter muscle thickness using US. Moreover, we employed RCW to analyze the variances between the groups. The numerical rating scale (NRS) and RCW were compared before and after dexamethasone injection in 10 patients who underwent follow-up evaluations. Results: Within the UA group, CW on the Aff was found to be significantly larger compared to the Non-aff (p<0.001). Additionally, RCW in the UA group was greater than that in the NA group (p<0.01). Furthermore, after dexamethasone injection, a reduction in the NRS and RCW values was observed in the 10 patients who were followed up. Conclusions: While previous studies have suggested a link between arthralgia and TMJ effusion, making CW a possible indirect diagnostic indicator for arthralgia, our findings propose that RCW could hold more diagnostic value than objective CW. However, additional studies are required to standardize the protocols for interpreting US results and determining the cutoff value of RCW in diagnosing TMJ arthralgia.

• Korean Journal of Radiology
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• v.23 no.1
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• pp.60-67
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• 2022

Objective: To categorize multiparametric MRI features of Bacillus Calmette-Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer. Materials and Methods: The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50-88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm²) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types. Results: The median lesion size was 22 mm with the interquartile range (IQR) of 18-26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen's kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4-8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions. Conclusion: BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.

• Korean Circulation Journal
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• v.52 no.10
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• pp.785-794
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• 2022

Background and Objectives: Self-monitoring of blood pressure (SMBP) is a reliable method used to assess BP accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feed-back algorithm (SMBP-App) for tailored recommendations. In this study, we aim to evaluate whether SMBP-App is superior to SMBP alone in terms of BP reduction and drug adherence improvement in patients with hypertension. Methods: Self-Monitoring of blood pressure and Feed-back using APP in Treatment of UnconTrolled Hypertension (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. Patients with uncomplicated essential hypertension will be randomly assigned to the SMBP-App (90 patients) and SMBP alone (90 patients) groups. In the SMBP group, the patients will perform home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients will receive additional recommendations from the application in response to the obtained BP value. Follow-up visits will be scheduled at 12 and 24 weeks after randomization. The primary endpoint of the study is the mean home systolic BP. The secondary endpoints include the drug adherence, the home diastolic BP, home and office BP. Conclusions: SMART-BP is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App. If we can confirm its efficacy, SMBP-App may be scaled-up to improve the treatment of hypertension.

• The World Journal of Men's Health
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• v.39 no.1
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• pp.123-130
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• 2021

Purpose: To perform real-time quantitative measurements of penile rigidity for patients with erectile dysfunction (ED) using shear-wave elastography (SWE). Materials and Methods: A total of 92 patients with clinically diagnosed ED filled out an abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire and underwent SWE as well as penile color Doppler ultrasound (CDUS) after intracavernosal injection for penile erection. Elasticity measurements were repeated on two sites of the corpus cavernosum (central and peripheral elasticity of corpus cavernosum [ECC]) and the glans penis during the erection phase. Correlations between penile elasticity and rigidity scores or IIEF-5 were evaluated statistically. Penile elasticity was also compared with the ED types based on CDUS. Results: The mean age of all patients was 53.5±13.4 years, and the mean IIEF-5 score was 9.78±5.01. The rigidity score and central ECC value demonstrated a significant correlation (r=-0.272; 95% confidence interval: -0.464 to -0.056; p=0.015). The IIEF-5 score was not significantly correlated with penile elasticity. Vascular ED patients showed significantly higher central ECC values than nonvascular ED patients (p<0.001). At a cut-off value of 8.05 kPa, the central ECC had a specificity of 41.5%, a sensitivity of 84.6%, and an area under the ROC curve of 0.720 with a standard error of 0.059 (p=0.019) for predicting vascular ED. Conclusions: Quantitatively measuring Young's modulus of the corpus cavernosum using SWE could be an objective technique for assessing penile erectile rigidity and the vascular subtype in patients with ED.