• Journal of Biomedical Engineering Research
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• v.42 no.3
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• pp.71-79
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• 2021

Currently, the naked eyes-based diagnosis of bone metastases on CT images relies on qualitative assessment. For this reason, there is a great need for a state-of-the-art approach that can assess and follow-up the bone metastases with quantitative biomarker. Radiomics can be used as a biomarker for objective lesion assessment by extracting quantitative numerical values from digital medical images. In this study, therefore, we evaluated the clinical applicability of non-invasive and objective bone metastases computer-aided diagnosis using radiomics-based biomarkers in CT. We employed a total of 21 approaches consist of three-classifiers and seven-feature selection methods to predict bone metastases and select biomarkers. We extracted three-dimensional features from the CT that three groups consisted of osteoblastic, osteolytic, and normal-healthy vertebral bodies. For evaluation, we compared the prediction results of the classifiers with the medical staff's diagnosis results. As a result of the three-class-classification performance evaluation, we demonstrated that the combination of the random forest classifier and the sequential backward selection feature selection approach reached AUC of 0.74 on average. Moreover, we confirmed that 90-percentile, kurtosis, and energy were the features that contributed high in the classification of bone metastases in this approach. We expect that selected quantitative features will be helpful as biomarkers in improving the patient's survival and quality of life.

• Composites Research
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• v.34 no.3
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• pp.186-191
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• 2021

The lumbar spinal fusion is a treatment performed to restore the stability of the degenerated lumbar. In this study, the intervertebral discs between two or more segments are removed and a bone graft is inserted to harden the segments. The pedicle screw system is inserted to vertebral bodies to fix two or more segments so that they can be firmly fused. In this study, a total of 7 patient-specific lumbar finite element models were created and pedicle screw systems were installed. The connecting rods made of titanium and CFR-PEEK was inserted to the generated models. Finite element analysis was conducted for four representative spine behaviors and statistical analysis was performed to investigate the biomechanical effects by the material properties of connecting rods. The intradiscal pressure of adjacent segments and the range of motion of the joints of each segment were investigated. In the subjects who used CFR-PEEK instead of Ti for connecting rods, the intradiscal pressure of adjacent segments tend to decrease and the range of motion of each segment tend to increase. However, no statistically significant difference in tendency was observed under all loading conditions.

• Journal of radiological science and technology
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• v.44 no.6
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• pp.623-627
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• 2021

Cervical foraminal stenosis is a disease in which the nerves that pass from the spinal canal to the limbs are narrowed and the nerves are compressed or damaged. Due to the lack of an imaging method that provides quantitatively stenosis, this study attempted to evaluate the area of the cervical vertebrae by reconstructing a three-dimensional computed tomography image, and to determine the area of the neural foramen in normal adults to calculate the stenosis rate. Using a three-dimensional image processing program, the surrounding bones including the posterior spinous process, lateral process, and lamellar bones of the cervical vertebra were removed so that the neural foramen could be observed well. A region of interest including the neural foraminal area of the three-dimensional image was set using ImageJ, and the number of pixels in the neural foraminal area was measured. The neural foraminal area was calculated by multiplying the number of measured pixels by the pixel size. To measure the largest neural foraminal area, it was measured between 40~50 degrees in the opposite direction and 15~20 degrees toward the head. The average area of the right C2-3 foramen was 44.32 mm², C3-4 area was 34.69 mm², C4-5 area was 36.41 mm², C5-6 area was 35.22 mm², C6-7 area was 36.03 mm². The average area of the left C2-3 foramen was 42.71 mm², C3-4 area was 32.23 mm², C5-6 area was 34.56 mm², and C6-7 area was 31.89 mm². By creating a reference table based on the neural foramen area of normal adults, the stenosis rate of patients with neural foraminal stenosis could be quantitatively calculated. It is expected that this method can be used as basic data for the diagnosis of cervical vertebral foraminal stenosis.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.1
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• pp.51-62
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• 2022

Objectives Objective of this study is to investigate the role of paraspinal muscles by examining the correlation between slip percentage (SP) of spondylolisthesis and fatty infiltration of lumbar paraspinal muscle. Methods Retrospective analysis was performed on 45 patients diagnosed with spondylolisthesis based on medical records. Using T2-weighted axial magnetic resonance imaging, cross-sectional areas (CSAs) of psoas major (PM), multifidus (MU) and erector spinae (ES) were calculated and divided by CSA of lower level vertebral body (VB). SP was measured using sagittal T2-weighted images. Correlation of SP with muscle relative cross-sectional area (RCSA) and muscle fatty infiltration by Goutallier classification was respectively analyzed using Spearman correlation. Statistic assessment conducted by Wilcoxon signed rank test and paired t-test using program GraphPad prism 5 (GraphPad Software, Inc., San Diego, CA, USA). Results Spondylolisthesis forward slip percentage by Taillard's method was negatively associated with both side MU RCSAs. No significant correlation was found between PM RCSA, ES RCSA and SP. Forward slippage was significantly correlated with fatty infiltration of lumbar paraspinal muscle measured by Goutallier classification. Conclusions This study is to understand the role of paraspinal muscle affecting spinal instability by investigating correlation between statistical deviation of lumbar muscle characters (RCSA, fatty infiltration of lumbar muscle) and SP. We found that spondylolisthesis SP is positively related to fatty infiltration of lumbar paraspinal muscle. and is negatively associated with both side MU RCSAs.

• Journal of the korean academy of Pediatric Dentistry
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• v.48 no.4
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• pp.414-424
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• 2021

The purpose of this retrospective study was to evaluate the skeletal and dental maturity according to the vertical facial type and sex in Korean children in the developmental stage. In total, 184 participants aged 8 - 14 years were selected and divided into three groups based on the mandibular plane angle. For the comparison between the sexes, the three groups were each divided into male and female subgroups. The skeletal and dental maturity were assessed using lateral cephalograms, hand-wrist radiographs and panoramic radiographs. The vertical growth group showed significantly greater cervical vertebral and hand-wrist maturity than that in the horizontal growth group. Dental maturity was the highest in the vertical growth group. Girls showed greater skeletal maturity than boys, and no distinct difference was observed between the dental maturity of the sexes. Analysis of the vertical facial type in children can provide ancillary indicators that may help determine the optimal timing for orthodontic treatment initiation. Earlier initiation of orthodontic treatment may be considered for patients with vertical facial growth patterns.

• Pediatric Infection and Vaccine
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• v.29 no.2
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• pp.96-104
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• 2022

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disorder presenting with sterile osteomyelitis, most often presenting in childhood. Although the etiology is understood incompletely, its association with other auto-inflammatory diseases including inflammatory bowel disease (IBD); psoriasis; Wegener's disease; arthritis; and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome suggests that dysregulated innate immunity may play an important role in the pathogenesis. We report a case of a 13-year-old boy with CRMO associated with Crohn's disease (CD) successfully treated with infliximab after failure of non-steroidal anti-inflammatory drug (NSAID) treatment. He initially was diagnosed with CRMO based on symmetric and aseptic bone lesions with no fever, lack of response to antibiotic treatment, vertebral involvement, and normal blood cell counts. Despite five months of NSAID treatment, his musculoskeletal symptoms were aggravated, and he developed gastrointestinal symptoms. Finally, he was diagnosed with CRMO associated with CD. Due to the severity of symptoms, infliximab was initiated and produced symptom improvement. This case supports infliximab as another choice for treatment of bowel symptoms in addition to the bone and joint symptoms of CRMO when other first-line treatments are ineffective.

• KIPS Transactions on Software and Data Engineering
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• v.12 no.1
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• pp.51-58
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• 2023

In this paper, we propose an organ segmentation technique for the automatic extraction of medical diagnostic indicators from X-ray images. In order to calculate diagnostic indicators of heart disease and spinal disease such as VHS(vertebral heart scale) and Cobb angle, it is necessary to accurately segment the thoracic spine, carina, and heart in a chest X-ray image. A deep neural network model in which the high-resolution representation of the image for each layer and the structure converted into a low-resolution feature map are connected in parallel was adopted. This structure enables the relative position information in the image to be effectively reflected in the segmentation process. It is shown that learning performance can be improved by combining the OCR module, in which pixel information and object information are mutually interacted in a multi-step process, and the channel attention module, which allows each channel of the network to be reflected as different weight values. In addition, a method of augmenting learning data is presented in order to provide robust performance against changes in the position, shape, and size of the subject in the X-ray image. The effectiveness of the proposed theory was evaluated through an experiment using 145 human chest X-ray images and 118 animal X-ray images.

• Korean Journal of Applied Biomechanics
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• v.33 no.2
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• pp.73-83
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• 2023

Objective: Adolescent idiopathic scoliosis patients make up 40% of all scoliosis patients, and it is likely to increase even more because of the increase in sitting times due to the pandemic. Method: The subject of this study was a 16-year-old female student. The Cobb's Angle at initial value was 42° at the thoracic and 33° at the lumbar. The subject's height was 161.6 cm, and the type of scoliosis was 3CL. The brace was built with fabric materials with the size information from the X-ray information and actual measurements. The brace was made for the adolescents to wear for a longer time by making them put pressure on the same pressure points of the existing braces. The subjects were required to wear the device for 16 hours every day for three months. Additional features to check the pressure and time were synchronized through an app for easier communication and management with the responsible investigator. Results: After wearing the 3D Fabric brace, Cobb's angle changed from 42° to 33° at the thoracic and 33° to 23° at the lumbar. The ATR changed from 9° to 8° at the thoracic and 11° to 6° at the lumbar. As a result, the changes in the ATR angle do relate to the decrease of Cobb's angle, which made the angle of scoliosis that is bent in a three-dimensional way improve, making the height of the subject increase from 161.6 cm to 163.5 cm. Conclusion: Through this study, developing a brace that is made in the form of the 3CL to align the strap direction and putting pressure on the proper pressure points makes Cobb's angle and the ATR smaller. This means that there is a positive effect on the changes in height. A brace made of light fabric material is a good brace to help treat adolescent idiopathic scoliosis. There was an opinion that it is more comfortable to wear than existing braces, but it seems necessary to conduct a quantitative study about the before and after of wearing the brace and a survey for Korean specific cases.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.624-633
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• 2021

Objective: To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. Materials and Methods: A phantom, simulating the L2-4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. Results: The skeletal muscle area (threshold, -29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30-150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0-44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. Conclusion: Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.