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Development and Validation of 18F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

  • Xu Yang;Xia Lu;Jun Liu;Ying Kan;Wei Wang;Shuxin Zhang;Lei Liu;Jixia Li;Jigang Yang
    • Korean Journal of Radiology
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    • v.23 no.4
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    • pp.466-478
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    • 2022
  • Objective: 18F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of 18F-FDG PET/CT in identifying malignancy in patients with HLH by combining 18F-FDG PET/CT and clinical parameters. Materials and Methods: Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment 18F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson's chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). Results: The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686-0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of 18F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. Conclusion: 18F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using 18F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of 18F-FDG PET/CT images.

The First Newborn Screening Study of T-Cell Receptor Excision Circle and κ-Deleting Recombination Excision Circle for Severe Combined Immunodeficiency in Korea: A Pilot Study (국내 최초 T-Cell Receptor Excision Circle과 κ-Deleting Recombination Excision Circle 신생아 선별검사에 관한 연구)

  • Son, Sohee;Kang, Ji-Man;Kim, Jong Min;Sung, Sein;Kim, Yi-Seoul;Lee, Haejeong;Kim, BitA Reum;Lee, Yeon Kyoung;Ko, Sun Young;Shin, Son Moon;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.24 no.3
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    • pp.134-140
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    • 2017
  • Purpose: Severe combined immunodeficiency (SCID) is the most serious form of primary immunodeficiency. Infants with SCID are susceptible to life-threatening infections. To establish newborn screening for SCID in Korea, we performed a screening test for T-cell receptor excision circle (TREC) and ${\kappa}$-deleting recombination excision circle (KREC) in neonates and investigated the awareness of SCID among their parents. Methods: Collections of dried blood spots from neonates and parent surveys were performed at the Samsung Medical Center and Cheil General Hospital & Women's Healthcare Center in Korea. The amplification crossing point (Cp) value <37.0 was defined as TREC/KRECpositive based on cutoff values from measuring multiplex real-time polymerase chain reaction. A Cp value >39.0 was defined as negative. Results: For TREC/KREC screening, 141 neonates were enrolled; 63 (44.7%) were male. One hundred forty neonates (99.3%) had positive TREC/KREC results at the time of the initial test; 82.3% and 75.9% were positive and 17.0% and 23.4% were weakly positive for TREC and KREC, respectively. In one neonate (0.7%), the initial TREC/KREC test result was negative. However, repeated tests obtained and confirmed a positive result. For an awareness survey, 168 parents were engaged. Only 2% of parents (3/168) knew that the newborn screening test for SCID had been introduced and performed in other countries. Eighty-four percent of parents (141/168) replied that nationwide newborn SCID screening should be performed in Korean newborns. Conclusions: In this study, newborn SCID screening was performed along with assessment of public awareness of the SCID test in Korea. The study results showed that newborn SCID screening can be readily applied for clinical use at a relatively low cost in Korea.

Correlation of Pre-treatment FDG Uptake to Therapeutic Response and Relapse in Patients with Small Cell Lung Cancer (소세포폐암의 치료전 FDG섭취와 치료반응 및 재발과의 연관성)

  • Seo, Young-Soon;Kwon, Seong-Young;Jeong, Shin-Young;Song, Ho-Chun;Min, Jung-Joon;Kim, Kyu-Sik;Kim, Young-Chul;Bom, Hee-Seung
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.6
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    • pp.538-545
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    • 2007
  • Purpose: We evaluated correlation of $^{18}F$-FDG uptakes, therapeutic response and relapse in pre-treatment $^{18}F$-FDG PET/CT in patients with SCLC. Materials and methods: We included 26 patients with pathologically proven small cell lung cancer. Total 102 lesions (26 lungs, 69 lymph nodes and 8 metastatic lesions) were evaluated. All patients underwent $^{18}F$-FDG PET/CT for staging. The maxSUV was used as a parameter of $^{18}F$-FDG uptake. The patients were divided into responders and non-responders according to response criteria on chest CT scan after 3 cycles of chemotherapy. We compared maxSUV between two groups by using independent t-test. To access correlation with $^{18}F$-FDG uptake and relapse, maxSUV and interval time to relapse was analyzed by correlation analysis. The cutoff value of maxSUV was evaluated by ROC curve. Results: Twelve-one patients (81%) were responders and five patients were non-responders on follow-up chest CT scan. The mean maxSUV of main lung lesions in responders and non-responders were $14.15{\pm}3.72$ and $9.17{\pm}2.15$, respectively. The maxSUV in the responders was significantly lower than that in non-responders (p<0.05). According to ROC curve, point of cut that predicts therapeutic response was 8.98 with 100% sensitivity and 57% specificity. The correlation analysis between $^{18}F$-FDG uptakes and interval time to relapse showed a significant negative correlation (p<0.05, r=-0.757). Conclusion: The pre-treatment $^{18}F$-FDG uptake of responders was significantly lower than that of non-responders. Patients with high $^{18}F$-FDG uptake in pre-treatment $^{18}F$-FDG PET/CT relapse earlier.

A Study on the Application of Bushings Fire Prevent Structure to Prevent Fire Spread of Transformer (변압기의 화재확산 방지를 위한 부싱 방화구조체 적용에 관한 연구)

  • Kim, Do-Hyun;Cho, Nam-Wook;Yoon, Choung-Ho;Park, Pil-Yong;Park, Keun-Sung
    • Fire Science and Engineering
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    • v.31 no.5
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    • pp.53-62
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    • 2017
  • Electric power which is the energy source of economy and industries requires long distance transportation due to regional difference between its production and consumption, and it is supplied through the multi-loop transmission and distribution system. Prior to its actual use, electric power flows through several transformations by voltage transformers in substations depending on the characteristics of each usage, and a transformer has the structure consisting of the main body, winding wire, insulating oil and bushings. A transformer fire that breaks out in substations entails the primary damage that interrupts the power supply to houses and commercial facilities and causes various safety accidents as well as the secondary economic losses. It is considered that causes of such fire include the leak of insulating oil resulting from the destruction of bottom part of bushings, and the chain reaction of fire due to insulating oil that reaches its ignition point within 1 second. The smoke detector and automatic fire extinguishing system are established in order to minimize fire damage, but a difficulty in securing golden time for extinguishing fire due to delay in the operation of detector and release of gas from the extinguishing system has become a problem. Accordingly, this study was carried out according to needs of active mechanism to prevent the spread of fire and block the leak of insulating oil, in accordance with the importance of securing golden time in extinguishing a fire in its early stage. A bushings fireproof structure was developed by applying the high temperature shape retention materials, which are expanded by flame, and mechanical flame cutoff devices. The bushings fireproof structure was installed on the transformer model produced by applying the actual standards of bushings and flange, and the full scale fire test was carried out. It was confirmed that the bushings fireproof structure operated at accurate position and height within 3 seconds from the flame initiation. It is considered that it could block the spread of flame effectively in the event of actual transformer fire.

Relationship between Insomnia and Depression in Type 2 Diabetics (2형 당뇨병 환자에서 불면증과 우울 증상의 관련성)

  • Lee, Jin Hwan;Cheon, Jin Sook;Choi, Young Sik;Kim, Ho Chan;Oh, Byoung Hoon
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.1
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    • pp.50-59
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    • 2019
  • Objectives : Many of the patients with type 2 diabetes are associated with sleep problems, and the rate of insomnia is known to be higher in the general population. The aims of this study were to know the frequency and clnical characteristics of insomnia, and related variables to insomnia in patients diagnosed with type 2 diabetes. Methods : For 99 patients from 18 to 80 years of age (65 males and 34 females) with type 2 diabetes, interviews were performed. Total sleep time and sleep latency was evaluated. Insomnia was evaluated using the Korean Version of the Insomnia Severity Index (ISI-K). Severity of depressive symptoms were evaluted using the Korean version of the Hamilton Depression Scale (K-HDRM). According to the cutoff score of 15.5 on the ISI-K, subjects were divided into the group of type 2 diabetics with insomnia (N=34) and those without insomnia (N=65) at first, and then statistically analyzed. Results : TInsomnia could be found in 34.34% of type 2 diabetics. Type 2 diabetics with insomnia had significantly more single or divorced (respectively 11.8%, p<0.05), higher total scores of the K-HDRS ($11.76{\pm}5.52$, p<0.001), shorter total sleep time ($5.35{\pm}2.00hours$, p<0.001), and longer sleep latency ($50.29{\pm}33.80minutes$, p<0.001). The all item scores of the ISI-K in type 2 diabetics with insomnia were significantly higher than those in type 2 diabetics without insomnia, that is, total ($18.38{\pm}2.69$), A1 (Initial insomnia) ($2.97{\pm}0.76$), A2 (Middle insomnia) ($3.06{\pm}0.69$), A3 (Terminal insomnia) ($2.76{\pm}0.61$), B (Satisfaction) ($3.18{\pm}0.72$), C (Interference) ($2.09{\pm}0.97$), D (Noticeability) ($2.12{\pm}1.09$) and E (Distress) ($2.21{\pm}0.81$) (respectively p<0.001). Variables associated with insomnia in type 2 diabetics were as following. Age had significant negative correlation with A3 items of the ISI-K (${\beta}=-0.241$, p<0.05). Total scores of the K-HDRS had significant positive correlation, while total sleep time had significant negative correlation with all items of the ISI-K (respectively p<0.05). Sleep latency had significant positive correlation with total,, A1, B and E item scores of the ISI-K (respectively p<0.05). Conclusions : Insomnia was found in about 1/3 of type 2 diabetics. According to the presence of insomnia, clinical characteristics including sleep quality as well as quantity seemed to be different. Because depression seemed to be correlated with insomnia, clinicians should pay attention to early detection and intervention of depression among type 2 diabetics.

An Analytical Validation of the GenesWellTM BCT Multigene Prognostic Test in Patients with Early Breast Cancer (조기 유방암 환자를 위한 다지표 예후 예측 검사 GenesWellTM BCT의 분석적 성능 시험)

  • Kim, Jee-Eun;Kang, Byeong-il;Bae, Seung-Min;Han, Saebom;Jun, Areum;Han, Jinil;Cho, Min-ah;Choi, Yoon-La;Lee, Jong-Heun;Moon, Young-Ho
    • Korean Journal of Clinical Laboratory Science
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    • v.49 no.2
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    • pp.79-87
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    • 2017
  • GenesWell$^{TM}$ BCT is a 12-gene test suggesting the prognostic risk score (BCT Score) for distant metastasis within the first 10 years in early breast cancer patients with hormone receptor-positive, HER2-negative, and pN0~1 tumors. In this study, we validated the analytical performance of GenesWell$^{TM}$ BCT. Gene expression values were measured by a one-step, real-time qPCR, using RNA extracted from FFPE specimens of early breast cancer patients. Limit of Blank, Limit of Detection, and dynamic range for each of the 12 genes were assessed by serially diluted RNA pools. The analytical precision and specificity were evaluated by three different RNA samples representing low risk group, high risk group, and near-cutoff group in accordance with their BCT Scores. GenesWell$^{TM}$ BCT could detect gene expression of each of the 12 genes from less than $1ng/{\mu}L$ of RNA. Repeatability and reproducibility across multiple testing sites resulted in 100% and 98.3% consistencies of risk classification, respectively. Moreover, it was confirmed that the potential interference substances does not affect the risk classification of the test. The findings demonstrate that GenesWell$^{TM}$ BCT have high analytical performance with over 95% consistency for risk classification.

Analysis of golf swing motion for specific properties of club shaft (클럽 샤프트(Club Shaft) 특성에 따른 골프 스윙(Golf Swing)동작 분석)

  • Kim, Sung-Il;Kim, Ky-Hyoung;Kim, Hyung-Soo;Lee, Hyun-Seob;Kim, Jin-Uk;Ahn, Chan-Gyu;Kim, Hee-Jin
    • Korean Journal of Applied Biomechanics
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    • v.12 no.2
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    • pp.17-32
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    • 2002
  • The purpose of this study was to find the rational method to analyze golf swing with specific property of club shaft. Three subjects were filmed by two high speed digital cameras with 500 fps. The phase analyzed was downswing of each subject. The three-dimensional coordinates of the anatomical landmarks were obtained with motion analysis system Kwon3d 3.0 version and smoothed by lowpass digital filter with cutoff frequency 6Hz. From these data, kinematic and kinetic variables were calculated using Matlab(ver 5.0) The variables for this study were angular velocity and accelerations, which were calculated and following conclusions have been made : 1) Golf swing time of stiff club is faster than that of regular club. 2) In shoulder joint motion of swing with the stiff club, x-stiff showed mort rapid negative acceleration than that of regular club. 3) In regular club, the velocity of club head would be more effective velocity, which was increasing, than those of other clubs before impact. 4) In wrist joint motion of swing with stiff club, x-stiff club showed faster than regular club in the downswing and impact more rapid negative acceleration.

Effects of Lipopolysaccride-induced Stressor on the Expression of Stress-related Genes in Two Breeds of Chickens (Lipopolysaccride 감염처리가 닭의 품종간 스트레스연관 유전자 발현에 미치는 영향)

  • Jang, In Surk;Sohn, Sea Hwan;Moon, Yang Soo
    • Korean Journal of Poultry Science
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    • v.44 no.1
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    • pp.1-9
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    • 2017
  • The objective of the present study was to determine the expression of genes associated with lipopolysaccharide (LPS)-induced stressor in two breeds of chickens: the Korean native chicken (KNC) and the White Leghorn chicken (WLH). Forty chickens per breed, aged 40 weeks, were randomly allotted to the control (CON, administered the saline vehicle) and LPS-injected stress groups. Samples were collected at 0 and 48 h post-LPS injection, and total RNA was extracted from the chicken livers for RNA microarray and quantitative real-time polymerase chain reaction (qRT-PCR) analyses. In response to LPS, 1,044 and 1,193 genes were upregulated, and 1,000 and 1,072 genes were downregulated in the KNC and WLH, respectively, using a ${\geq}2$-fold cutoff change. A functional network analysis revealed that stress-related genes were downregulated in both KNC and WLH after LPS infection. The results obtained from the qRT-PCR analysis of mRNA expression of heat shock 90 (HSP90), 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), activating transcription factor 4 (ATF4), sterol regulatory element-binding protein 1 (SREBP1), and X-box binding protein 1 (XBP1) were confirmed by the results of the microarray analysis. There was a significant difference in the expression of stress-associated genes between the control and LPS-injected KNC and WLH groups. The qRT-PCR analysis revealed that the stress-related $HSP90{\alpha}$ and HMGCR genes were downregulated in both LPS-injected KNC and WLH groups. However, the HSP70 and $HSP90{\beta}$ genes were upregulated only in the LPS-injected KNC group. The results suggest that the mRNA expression of stress-related genes is differentially affected by LPS stimulation, and some of the responses varied with the chicken breed. A better understanding of the LPS-induced infective stressors in chicken using the qRT-PCR and RNA microarray analyses may contribute to improving animal welfare and husbandry practices.

The Evaluation of Images with Various Filters in I-131 SPECT/CT (I-131 SPECT/CT에서 Ringing Artifact 감소를 위한 다양한 Filter값의 적용)

  • Kim, Ha Gyun;Kim, Soo Mee;Woo, Jae Ryong;Oh, So Won;Lee, Jae Sung;Kim, Yu Kyeong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.18 no.1
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    • pp.62-68
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    • 2014
  • Purpose: After I-131 therapy, SPECT/CT is useful in identifying location of thyroid remnants and metastasis of thyroid cancers. An excessive uptake of thyroid leads to a ringing artifact in the SPECT images. The aim of this study is to investigate and suggest a proper post filters to remove ringing artifact and produce better image quality. Materials and Methods: A low-cost, customized thyroid-mimicking phantom, consisting of an acrylic bottle and a hollow sphere was used for SPECT/CT Discovery (GE Healthcare, USA). It was filled with I-131 solution. The ratio of hollow sphere to background were varied as 50:1, 200:1, 1000:1 and 4000:1. Acquired images were reconstructed by OSEM (2 iterations, 10 subsets) with and without Evolution (resolution recovery correction, GE). Three different post-filters were applied; Butterworth (cut off: 0.38 to 0.58 with intervals of 0.05), Hanning (cut off: 0.8 to 1 with intervals of 0.05) and Gaussian (FWHM: 3 to 5 with intervals of 0.5) filters. Contrast, background variability, air area variability, and full width half maximum (FWHM) were compared. Results: Higher contrasts were obtained from the SPECT images with Evolution than without Evolution. In the case of images without Evolution, image distortion such as star artifact was generated. For all sphere-to-background ratio, the Butterworth filter showed better constrasts and FWHMs than other two filters, but the ringing artifact was still generated in all studies except 50:1 and it was decreased as cutoff value was increased. The ringing artifact didn't appear with Hanning and Gaussian filters at all studies, however constrats and FWHMs with Gaussian was worse than Hanning filter. For the images having ringing artifacts, the background variability and air area variability were increased. Conclusion: In this study, we suggested that it is desirable to use Hanning filter when the ringing artifact is generated and to use Butterworth filter when ringing artifact is not generated in I-131 SPECT.

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2013 Records Regime Issues and Prospects for Public Records Management in Korea (한국 공공기록관리의 쟁점과 전망 2013년 기록관리체제를 위하여)

  • Ahn, Byung-Woo;Lee, Sang-min;Sim, Seong-Bo;Nam, Kyeong-Ho;Kim, Jin-Sung;O, Dong-Seok;Jeong, Tae-Young
    • The Korean Journal of Archival Studies
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    • no.34
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    • pp.3-28
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    • 2012
  • The year of 2013 is the first year that the new president takes the power and administrates the national affairs. In Korea, when the new president comes, the new administration brings big changes in the politics, economy, and society. The government management style has been changed according to the orientation and styles of the new president. Public records management is a critical and effective business tool to establish and carry out the government policies as well as an essential tool for democracy. Modern democracy is based on good governance. Creation and free use of full and accurate public records makes the good communication between the government and the public possible, and people's participation in the policy-making and surveillance of government activities for public good can work. During the present administration, communication between the president and the people was cutoff and people's participation in the national affairs have been further limited. Furthermore, in the present administration, the public records management was not regarded important, Whatever new administration comes, the year of 2013 is the time for the new administration to realize again the importance of the public records management and put it back to the normal track. Here are the major issues in the public records management to be concerned and resolved; (1) to ensure technological and institutional management of the electronic records in the government and safe transfer of the massive electronic records, (2) to establish an independent national records management and archives authority to be based on good governance, (3) to innovate the public records management in the public agencies including their agency records offices (RMO) and records management systems (RMS) (4) to establish local government archives and document local government policies and activities (5) supporting and promotion for documentation of the total society as a public service (6) expanding employment of professional records managers and archivists in the central and local governments, and standardization of professional competency and certification. In this paper, I will introduce the major issues in the public records management and suggest the policies and solutions that the Korean records professionals considered and discussed. This analysis and suggestions are the outcome of our professional considerations and discussions.