Deok Won Kim

Clinical Accuracy of a New Apex Locator with an Automatic Compensation Circuit

A new circuit was designed to automatically compensate for measurement errors of an electronic apex locator in various electrolytes. Thirty-one root canals were clinically tested for accuracy. A file was inserted into the canal until the apex signal was obtained, at which point the file was immobilized with glass-ionomer cement. After extraction, the apical area was exposed and the position of the file tip was examined under an operating microscope. Distances from the major foramen and cemento dentinal junction (CDJ) were recorded. The average distance from the major foramen was -0.13 mm with a range of -1.28 mm and +0.46 mm. The average distance in 26 detectable CDJ samples was +0.18 mm with a range of -0.98 mm and +0.65 mm. The measurements, which were within +/- 0.5 mm, were 94% (29/31) from the major foramen and 92% (24/26) from the CDJ. Measurement consistencies within one SD were 81% for the major foramen and 65% for the CDJ, respectively. Measurements within two SD were 97% for the major foramen and 92% for the CDJ. There were no differences between the smaller (< # 25) and larger apical foramens (< or = 25) or vital and nonvital pulps.

Objective evaluation of treatment effects on port-wine stains using L*a*b* color coordinates.

Wide variations in port‐wine stains and their responses to various therapies pose a need for the development of an objective method to evaluate the effects of treatment. Several techniques such as laser Doppler, reflectance spectrometry, and tristimulus colorimetry have been used to evaluate the color of port‐wine stains, but these techniques are limited by cost, small test size area, and other factors. Therefore, we developed a simple and cost‐effective method of evaluating treatment results on port‐wine stains using the L*a*b* color coordinate system in combination with a personal computer. For 22 patients with port‐wine stains, the slide photographs were digitized using a slide scanner. L*a*b* color differences of the normal control and port‐wine stain sites were obtained before and after treatment, and treatment effect (percent) was calculated. By calculating each color difference between the lesion and normal skin both before and after treatment, problems arising from different illuminating conditions during photography were minimized. The results were compared with the visual evaluation conducted by three experienced plastic surgeons. The treatment effects analyzed by L*a*b* color coordinate ranged from 4 to 95 percent, with a mean of 48.1 percent, whereas treatment effects evaluated by the plastic surgeons ranged from 15 to 92 percent, with a mean of 51.1 percent. The subjective clinical grades correlated well with the treatment effects obtained by the proposed color analysis system (correlation coefficient, 0.89). The maximum difference in the effect of treatment for a patient evaluated by the three clinicians was up to 60 percent, which means that visual judgment is very subjective and variable. The color analysis system proposed as a result of this study is very easy, objective, quantitative, cost‐effective, and can be useful for the evaluation of treatment effects on colored skin lesions such as port‐wine stains. (Plast. Reconstr. Surg. 108: 842, 2001.)

Optimum electrode configuration for detection of leg movement using bio-impedance

Impedances and joint angles were simultaneously measured during ankle and knee movements. The correlation coefficients of the joint angle and the impedance change from human leg movement were obtained using an electro-goniometer and a four-channel impedance measurement system. Because the impedance changes resulting from ankle and knee movements depended heavily on the electrode placement, we determined the optimum electrode configurations for those movements by searching for high correlation coefficients, large impedance changes and minimum interferences in ten subjects (age: 20+/-4). Our optimum electrode configurations showed strong relationships between the ankle joint angle and lower leg impedance (correlation coefficient=-0.91+/-0.06) and between the knee joint angle and knee impedance (correlation coefficient=0.94+/-0.04). The reproducibilities of the impedance changes of five subjects due to the ankle and knee were 6.3+/-1.9% and 5.1+/-1.7% for the optimum electrode pairs, respectively. We propose that this optimum electrode configuration would be useful for future studies involving the convenient measurement of leg movements by the impedance method.

Hypersensitivity to RF fields emitted from CDMA cellular phones: A provocation study

With the number of cellular phone users rapidly increasing, there is a considerable amount of public concern regarding the effects that electromagnetic fields (EMFs) from cellular phones have on health. People with self-attributed electromagnetic hypersensitivity (EHS) complain of subjective symptoms such as headaches, insomnia, and memory loss, and attribute these symptoms to radio frequency (RF) radiation from cellular phones and/or base stations. However, EHS is difficult to diagnose because it relies on a persons subjective judgment. Various provocation studies have been conducted on EHS caused by Global System for Mobile Communications (GSM) phones in which heart rate and blood pressure or subjective symptoms were investigated. However, there have been few sham-controlled provocation studies on EHS with Code Division Multiple Access (CDMA) phones where physiological parameters, subjective symptoms, and perception of RF radiation for EHS and non-EHS groups were simultaneously investigated. In this study, two volunteer groups of 18 self-reported EHS and 19 non-EHS persons were tested for both sham and real RF exposure from CDMA cellular phones with a 300 mW maximum exposure that lasted half an hour. We investigated not only the physiological parameters such as heart rate, respiration rate, and heart rate variability (HRV), but also various subjective symptoms and the perception of EMF. In conclusion, RF exposure did not have any effects on physiological parameters or subjective symptoms in either group. As for EMF perception, there was no evidence that the EHS group better perceived EMF than the non-EHS group.

A Noninvasive Estimation of Hypernasality Using a Linear Predictive Model

AbstractThe pronunciation of a speaker with a defective soft palate is marked by hypernasality and an operation may be necessary to repair the defective soft palate to reduce this hypernasality. An assessment of hypernasality is necessary to quantify the effect of the surgery. The current clinical methods for assessing hypernasality are uncomfortable or require expensive equipment. In this paper, a new quantitative method is proposed to estimate hypernasality. This method requires only a microphone and a personal computer equipped with a sound card. Zeros in the frequency response of the vocal tract system are one of the major characteristics of hypernasality. The proposed method made use of the fact that a linear predictive model with a typical order for the human vocal tract system is not accurate when the vocal tract system has zeros in its frequency response. Hypernasality was estimated by comparing the distance between the sequences of linear predictive cepstrum of low- and high-order linear predictive models. The proposed method provides a better correlation (0.58) with nasalance measured by a nasometer than Teager method (0.44) for all the data. Furthermore, the proposed method showed higher correlation of 0.84 than 0.71 of the Teager method for data with a nasalance higher than 35%. Since the proposed method needs only digitized speech data, it is much less invasive and provides an easy and cost-effective evaluation of hypernasality.

Screening for Prediabetes Using Machine Learning Models

The global prevalence of diabetes is rapidly increasing. Studies support the necessity of screening and interventions for prediabetes, which could result in serious complications and diabetes. This study aimed at developing an intelligence-based screening model for prediabetes. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used, excluding subjects with diabetes. The KNHANES 2010 data (n = 4685) were used for training and internal validation, while data from KNHANES 2011 (n = 4566) were used for external validation. We developed two models to screen for prediabetes using an artificial neural network (ANN) and support vector machine (SVM) and performed a systematic evaluation of the models using internal and external validation. We compared the performance of our models with that of a screening score model based on logistic regression analysis for prediabetes that had been developed previously. The SVM model showed the areas under the curve of 0.731 in the external datasets, which is higher than those of the ANN model (0.729) and the screening score model (0.712), respectively. The prescreening methods developed in this study performed better than the screening score model that had been developed previously and may be more effective method for prediabetes screening.

A new severity predicting index for hemorrhagic shock using lactate concentration and peripheral perfusion in a rat model.

ABSTRACT Forty percent of trauma deaths are due to hemorrhage, with 33% to 56% occurring in the prehospital environment. This study proposes a new index (NI) based on the ratio of serum lactate concentration (LC) to peripheral perfusion (PP) as an indicator of hemorrhage-induced mortality during the prehospital stage. Thirty-six anesthetized rats were randomized into three groups according to volume of controlled blood loss. We measured heart rate (HR), systolic and diastolic blood pressures (SBP and DBP), mean arterial pressure (MAP), pulse pressure (PPR), respiration rate (RR), temperature (TEMP), LC, PP, shock index (SI = HR/SBP), and proposed the new hemorrhage-induced mortality index (NI = LC/PP). Peripheral perfusion, defined as peripheral tissue perfusion and skin microcirculation, was continuously monitored by laser Doppler flowmetry. All parameters were analyzed for changes between prehemorrhage and posthemorrhage to investigate the effects of hemorrhage on mortality. Areas under a receiver operating characteristic curve (AUCs) in descending order for NI, SI, PP, SBP, MAP, PPR, DBP, TEMP, LC, RR, and HR were 0.975, 0.941, 0.922, 0.919, 0.903, 0.884, 0.847, 0.816, 0.783, 0.744, and 0.672, respectively. The correlation coefficients with mortality for NI, SI, PP, SBP, MAP, PPR, DBP, TEMP, LC, RR, and HR were -0.818, -0.759, 0.726, 0.721, 0.694, 0.662, 0.597, 0.544, -0.487, 0.420, and -0.296, respectively, with the same order as the AUC. NI was shown to be an optimal independent mortality predictor on multivariable logistic regression analysis. In conclusion, the newly proposed hemorrhage-induced mortality index, based on blood lactate/PP ratio, was a better marker for predicting mortality in rats undergoing acute hemorrhage in comparison to the other parameters evaluated in this study.

Intensity of Extremely Low-frequency Electromagnetic Fields Produced in Operating Rooms during Surgery at the Standing Position of Anesthesiologists

Background:Numerous electronic devices have been introduced into operating rooms. Although little is known about the relationship between exposure to electromagnetic fields and health hazards, several studies have demonstrated causal relationships between electromagnetic fields exposure and various symptoms, cancers, and other diseases. Methods:This study was approved by the Institutional Review Board. The intensity of extremely low-frequency electromagnetic fields was measured during surgery with the extremely low-frequency electromagnetic field strength measurement system at the standing position of anesthesiologists in 18 operating rooms and analyzed with EMDEX analysis and graphical program (EMCALC 95; ENERTECH, Campbell, CA). Results:The average measurement duration per operating room per day was 7.41 ± 0.70 h (mean ± SD). The average sample number of measurements was 888.11 ± 82.75 per operating room. The average magnetic field was 5.83 ± 5.23 milliGuass (mG) (range, 0.10–33.80 mG), with 70% of these levels 2 mG or greater. Conclusions:The authors’ results indicate that anesthesiologists in operating rooms are exposed to extremely low-frequency electromagnetic field levels that exceed magnetic field intensity of 2 mG recommended by the Swedish Board for Technical Accrediation for production by computer monitors and detected 30 cm from them. It currently is not clear if this exposure has health effects on anesthesiologists and other operating room personnel.

Osteoporosis Risk Prediction for Bone Mineral Density Assessment of Postmenopausal Women Using Machine Learning

Purpose A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women compared to the ability of conventional clinical decision tools. Materials and Methods We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Examination Surveys. The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests, artificial neural networks (ANN), and logistic regression (LR) based on simple surveys. The machine learning models were compared to four conventional clinical decision tools: osteoporosis self-assessment tool (OST), osteoporosis risk assessment instrument (ORAI), simple calculated osteoporosis risk estimation (SCORE), and osteoporosis index of risk (OSIRIS). Results SVM had significantly better area under the curve (AUC) of the receiver operating characteristic than ANN, LR, OST, ORAI, SCORE, and OSIRIS for the training set. SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0% at total hip, femoral neck, or lumbar spine for the testing set. The significant factors selected by SVM were age, height, weight, body mass index, duration of menopause, duration of breast feeding, estrogen therapy, hyperlipidemia, hypertension, osteoarthritis, and diabetes mellitus. Conclusion Considering various predictors associated with low bone density, the machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis.

Volume and distances of the maxillary sinus in craniofacial deformities with midfacial hypoplasia

Objective: Craniofacial deformities (CFDs) frequently accompany midfacial hypoplasia. The authors evaluated characteristics of maxillary sinuses that had CFDs with variable degrees of midfacial hypoplasia. Study Design: Cross-sectional survey with chart review. Setting: Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Subjects and Methods: We investigated 40 patients with CFDs having midfacial hypoplasia. Study group 1 (SG 1) consisted of eight patients with Crouzon syndrome (16 maxillary sinuses). Study group 2 (SG 2) consisted of 10 patients with midfacial hypoplasia after palatoplasty (20 maxillary sinuses). Study group 3 (SG 3) consisted of 22 patients with Pruzansky grade I hemifacial microsomia (22 maxillary sinuses on the affected sides). Data on volume and three-dimensional distances (height, width, and depth) from computed tomography were collected and compared with each corresponding control group. Correlation coefficient between volume and the three distances was also calculated. Results: The volume, height, width, and depth of the maxillary sinus were significantly decreased in SG 1 (P < 0.01). In SG 2, only the depth was significantly decreased (P < 0.05). In SG 3, there were no significant differences in any parameters. A multiple-regression analysis between the volume and the three distances showed a statistically significant relationship for width in SG 1, width and height in SG 2, and all distances in SG 3. Conclusion: There were differences in the structure of the maxillary sinuses among patients with different CFDs.