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Comparative Analysis of M4CXR, an LLM-Based Chest X-Ray Report Generation Model, and ChatGPT in Radiological Interpretation
No full textBackground/Objectives: This study investigated the diagnostic capabilities of two AI-based tools, M4CXR (research-only version) and ChatGPT-4o, in chest X-ray interpretation. M4CXR is a specialized cloud-based system using advanced large language models (LLMs) for generating comprehensive radiology reports, while ChatGPT, built on the GPT-4 architecture, offers potential in settings with limited radiological expertise. Methods: This study evaluated 826 anonymized chest X-ray images from Inha University Hospital. Two experienced radiologists independently assessed the performance of M4CXR and ChatGPT across multiple diagnostic parameters. The evaluation focused on diagnostic accuracy, false findings, location accuracy, count accuracy, and the presence of hallucinations. Interobserver agreement was quantified using Cohen’s kappa coefficient. Results: M4CXR consistently demonstrated superior performance compared to ChatGPT across all evaluation metrics. For diagnostic accuracy, M4CXR achieved approximately 60–62% acceptability ratings compared to ChatGPT’s 42–45%. Both systems showed high interobserver agreement rates, with M4CXR generally displaying stronger consistency. Notably, M4CXR showed better performance in anatomical localization (76–77.5% accuracy) compared to ChatGPT (36–36.5%) and demonstrated fewer instances of hallucination. Conclusions: The findings highlight the complementary potential of these AI technologies in medical diagnostics. While M4CXR shows stronger performance in specialized radiological analysis, the integration of both systems could potentially optimize diagnostic workflows. This study emphasizes the role of AI in augmenting human expertise rather than replacing it, suggesting that a combined approach leveraging both AI capabilities and clinical judgment could enhance patient care outcomes
Gender difference in the relationship between epicardial adipose tissue and central obesity
Get PDFBody fat distribution is closely related to cardiovascular disease than the amount of total body fat itself. The epicardial adipose tissue (EAT) measured by transthoracic echocardiography represents central obesity. We hypothesized that the gender affected the link between EAT thickness and body fat distribution. We measured EAT thickness using transthoracic echocardiography and total body fat and regional body fat distribution using dual-energy X-ray absorptiometry (DXA) in 390 patients (250 males, 59 ± 11 year-old). The EAT thickness was measured on the free wall of the right ventricle at the end of the diastole on parasternal long-axis view of echocardiography. The median and mean EAT thickness of 390 patients were 4.0 mm and 4.2 ± 1.2 mm, respectively. The mean EAT thickness revealed positive correlation with truncal fat mass to total body fat mass ratio (FMtrunk/FMtotal, R = 0.291, P = .024). Subgroup analysis categorized by gender demonstrated the female group has stronger correlation of EAT thickness with fat distribution than the male group (male: R = 0.174, P = .006, female: R = 0.378, P < .001). EAT thickness is closely related to body fat distribution. Females showed a more significant correlation between EAT thickness and central fat accumulation than males. EAT thickness might be considered as a relevant parameter of central obesity, especially in females
Survey on Alopecia Areata Patients’ Reported Factors that Determine Severity of Alopecia Areata: A Nationwide Multicenter Study
Get PDFBackground: Alopecia areata (AA) is characterized by hair loss on the scalp and body, significantly impacting patients' quality of life based on its severity. Objective: This study aims to identify crucial factors influencing the perception of severe AA from the patients' viewpoint. Methods: A web-based survey was conducted among AA patients attending dermatology departments at 21 university hospitals in Korea. The survey comprised 17 criteria, exploring both clinical characteristics of AA patients and subjective determinants of disease severity. Results: A total of 791 AA patients and their caregivers participated in the survey. Approximately 30% of respondents developed AA during childhood, with 43.5% experiencing chronic courses lasting over 3 years. Half of the participants exhibited more than 20% scalp hair loss, and 42% reported additional hair loss on other body parts, such as eyelashes and nose hair. Most respondents agreed that patients with ≥20% scalp hair loss should be categorized as having severe AA. They also identified longer disease duration, involvement of non-scalp body hair, treatment refractoriness, and social or mental impairment requiring medical intervention as factors indicating increased disease severity. Conclusion: This survey underscores the significant impact of AA on patients' quality of life and highlights existing unmet needs in current treatment modalities
Study Design and Protocol for a Randomized Controlled Trial to Assess Long-Term Efficacy and Safety of a Triple Combination of Ezetimibe, Fenofibrate, and Moderate-Intensity Statin in Patients with Type 2 Diabetes and Modifiable Cardiovascular Risk Factors (ENSEMBLE)
Get PDFBackground: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator-activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion: This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D
A universal immunohistochemistry analyzer for generalizing AI-driven assessment of immunohistochemistry across immunostains and cancer types
Get PDFImmunohistochemistry (IHC) is the common companion diagnostics in targeted therapies. However, quantifying protein expressions in IHC images present a significant challenge, due to variability in manual scoring and inherent subjective interpretation. Deep learning (DL) offers a promising approach to address these issues, though current models require extensive training for each cancer and IHC type, limiting the practical application. We developed a Universal IHC (UIHC) analyzer, a DL-based tool that quantifies protein expression across different cancers and IHC types. This multi-cohort trained model outperformed conventional single-cohort models in analyzing unseen IHC images (Kappa score 0.578 vs. up to 0.509) and demonstrated consistent performance across varying positive staining cutoff values. In a discovery application, the UIHC model assigned higher tumor proportion scores to MET amplification cases, but not MET exon 14 splicing or other non-small cell lung cancer cases. This UIHC model represents a novel role for DL that further advances quantitative analysis of IHC
Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021
Get PDFBackground: Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. Methods: Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). Findings: In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311–0·414) per 100 000. Mortality rates ranged from 1·01 (0·895–1·13) per 100 000 in central Latin America to 0·054 (0·0464–0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174–274) per 100 000, corresponding to 17 million (13·8–21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286–475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9–109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. Interpretation: Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. Funding: Bill and Melinda Gates Foundation
상급종합병원으로 내원한 근시굴절부등약시 환아의 임상 특징
No full textMasterⅠ. 서론 1
Ⅱ. 대상과 방법 3
Ⅲ. 결과 5
Ⅳ. 고찰 13
참고문헌 18
ABSTRACT 2
허혈성 뇌졸중 이후 장기적 기능 회복 전략: 뇌졸중 염증 반응 및 신경가소성 조절
No full textDoctorⅠ. Introduction 1
1. Ischemic stroke and secondary immune response 1
2. Loss of neural connections after stroke 3
3. Current treatment for acute ischemic stroke patients 4
3.1 Tissue plasminogen activator (tPA) 4
3.2 Endovascular thrombectomy 4
4. Therapeutic approaches to target post-stroke inflammation 5
5. Augmentation of the intrinsic capacity of neural plasticity 7
6. Aim of the study 8
II. Methods and materials 9
1. Animals 9
2. Photothrombotic ischemic stroke 10
3. Intracortical injection of adeno-associated virus (AAV) 11
4. Behavior test 11
4.1 Pellet retrieval test 11
4.2 Ladder walk test 13
4.3 Cylinder test 13
4.4 mNSS scoring 13
5. Tissue preparation and immuno-histochemistry 14
6. Image acquisition and analysis 15
7. Single cell dissociation and fluorescent activated cell sorting (FACS) cell sorting 16
8. RNA extraction and cDNA synthesis 17
9. Cytokine PCR array and string analysis 18
10. Semi and Real-time PCR 19
11. Tissue protein extraction and western blot analysis 20
12. In vivo phagocytosis analysis and 3D image reconstruction 21
13. Primary bone marrow-derived macrophage culture 22
14. Primary microglia culture 22
15. In vitro macrophage-microglia interaction model 23
16. Arginase activity assay 24
17. Botulinum toxin injection 24
18. Intra-cortical BDA analysis 25
19. MATLAB analysis 26
20. Statistical analysis 28
III. Results 29
Chapter A. Establishment of photothrombotic ischemic stroke model and behavioral test batteries to study therapeutic approaches for ischemic stroke 29
1. photothrombotic ischemic stroke mice model 29
2. Validation of behavioral test batteries for evaluation of functional recovery after stroke 32
Chapter B. Modulation of post-stroke inflammation targeting Arginase-1 (Arg1) following ischemic stroke 35
3. Assessment of time-dependent expression of Arg1 following photothrombotic ischemic stroke 35
4. Characterization of Arg1 expressional source after ischemic stroke 37
5. Specification of cellular source of arg1 expression using reporter animals 39
6. Validation of conditional knockout of (cKO) arg1 following ischemic stroke 41
7. Behavioral analysis for evaluation of functional recovery after ischemic stroke in Arg1 cKO animals 44
8. Histological analysis of immune cell activity and glial scar formation 47
9. Fibrotic scar formation after ischemic stroke in Arg1 cKO animals 49
10. Peri-neuronal net formation after ischemic stroke 52
11. Excitatory synapses in peri-infarct area 54
12. In vivo microglial synaptic elimination and phagocytic activity 56
13. Phagocytic marker expression in peri-infarct microglia 60
14. Microglial Cytokine profiles following deletion of Arg1 in infiltrating macrophages 62
15. Macrophage-microglial interactions under hypoxic induction of Arg1 66
16. Proposed model for role of Arg1 expressing infiltrating macrophages following stroke 68
Chapter C. Enhancement of neural plasticity and activity dependent strategies for treatment of ischemic stroke 70
17. Development of intra-cortical Biotinylated Dextran Amine (BDA) axonal tracing system 70
18. Tissue processing and data acquisition of BDA-labeled axon 72
19. Machine learning algorithm for pattern classification 74
20. Conversion of BDA axon signals to the pixelated axon density map 76
21. Comparison of axonal sprouting following stroke using machine learning algorithm 78
22. Classifier accuracy-based statistical analysis 80
23. Validation of knock-out of PTEN assessing down-stream target of PTEN: P-S6 kinase 82
24. Assessment of functional recovery after PTEN KO in ischemic stroke model 84
25. Evaluation of intra-cortical axonal plasticity in PTEN KO after stroke 87
26. Combinational therapy of PTEN KO with Constraint-induced movement therapy (CIMT) using Botulinum toxin A 89
IV. Discussion 92
V. Summary and conclusion 100
References 101
국문요약 11
DNA 손상 반응 과정에서 PARP1 결합 단백질인 TRIM44의 역할
No full textDoctorI. INTRODUCTION 1
A. DNA damage response 1
B. Poly(ADP-ribose) polymerase 1 1
C. ATM-dependent DNA damage signaling pathway 4
D. Ubiquitination and deubiquitination 6
E. Tripartite motif proteins 8
F. PARP inhibitors in cancer therapy 8
G. Aim of this study 11
II. MATRIALS & METHODS. 12
1. Cell culture 12
2. Plasmid and RNA interference. 12
3. Laser micro irradiation and immunofluorescence 13
4. FokI assay 14
5. Antibodies and reagents 14
6. Western blotting 14
7. Pull-down assay 15
8. Whole-cell extraction 15
9. Immunoprecipitation 15
10. Nuclear fraction 15
11. Chromatin fractionation 16
12. Chromatin Immunoprecipitation (ChIP) 16
13. Alkaline Comet assay 17
14. Clonogenic survival assay 18
15. Statistical analysis 18
III. RESULTS. 19
1. Screening of TRIM family 19
2. TRIM44 is recruited at the DNA damage site(s) in PARP1-dependent manner 23
3. The Glu-rich domain of TRIM44 is required to interact with PARP1. 28
4. Absence of TRIM44 induces hyperactivation of PARP1 at DNA lesions 34
5. TRIM44 regulates the activation of PARP1 by protecting the poly-ubiquitin chain 40
6. Hyperactivation of PARP1 by the absence of TRIM44 prevents the binding of ATM and MRN complexes to DNA lesions 44
7. TRIM44 affects sensitivity to DNA damage reagent 48
8. TRIM44 affects sensitivity to PARP inhibitor 51
9. TRIM44 affects re-sensitivity to PARP inhibitor in PARP inhibitor-resistant cancer cells 55
10. TRIM44 has the potential to be a key gene in the treatment of clear cell renal cell carcinoma 58
IV. DISCUSSION 61
REFERENCES. 65
국문요약. 7
전국 지역별 어린이 놀이시설에서 검출되는 토양내 기생충들의 모니터링(2016-2021)
No full textDoctorI. INTRODUCTION 1
A. Soil-borne parasites (nematodes) 7
(1) Ascaris lumbricoides 7
(2) Enterobius vermicularis 9
(3) Hookworms (Ancylostoma duodenale and Necator americanus) 11
(4) Toxocara canis and Toxocara cati 14
(5) Strongyloides stercoralis 16
(6) Trichostrongylus orientalis 18
(7) Trichuris trichiura 19
B. Snail-borne parasites (trematodes) 22
(1) Clonorchis sinensis 25
(2) Paragonimus westermani 28
(3) Metagonimus yokogawai 30
C. Water-borne parasites (protozoa) 32
(1) Giardia lamblia 35
(2) Cryptosporidium spp. 39
(3) Entamoeba histolytica 41
D. Aims of this study 43
II. MATERIALS AND METHODS 47
A. Subjects of investigation 47
B. Classification of samples 47
(1) Samples by regions 47
(2) Play facilities by sampling year 48
(3) Play facilities by year of construction 48
(4) Regular (Occasional) commission for each play facility 48
C. Methods collecting samples 49
D. Parasites test method 51
E. Range of parasites (eggs) to be investigated 53
III. RESULTS 54
A. Soil-borne parasite detection rates by region 54
A.1. Positive rates of Toxocara spp. by region 56
B. Detection rates of soil-borne parasites (eggs) by play facilities 58
B.1. Positive rates of Toxocara spp. by types of play facilities 60
C. Multiple contamination rates by play facilities 62
D. The genus of parasites (eggs) detected in play facilities 63
E. Contamination rate of play facilities by the year of construction 64
E.1. Positive rates of Toxocara spp. by the year of construction 70
F. The status of soil-borne parasites (eggs) detection in regular inspection areas 71
F.1. Positive rates of Toxocara spp. in regular inspection areas 72
IV. DISCUSSION 76
V. CONCLUSION 87
REFERENCES 90
국문요약 10