Reliability of society of fetal urology and Onen grading system in fetal hydronephrosis

Objective: To evaluate the reliability of the Society for Fetal Urology (SFU) and Onen grading systems for fetal hydronephrosis in prenatal ultrasound according to the level of experience of the examiner. Methods: We reviewed the prenatal ultrasound images of 146 fetuses (292 kidneys) that were diagnosed as having hydronephrosis between January 2005 and December 2014. One expert and two trainees assessed the prenatal renal ultrasound images using the SFU and Onen grading systems. The three examiners independently assessed each ultrasound image with both grading systems and reassessed the same images after 7 to 14 days. Cohen's kappa statistic was used to estimate intra- and inter-observer reliability in prenatal ultrasound images according to training level. Results: The intra-observer reliability of the SFU grading system (κ 0.873-0.945) showed almost perfect agreement and that of the Onen grading system (κ 0.749-0.913) showed substantial to almost perfect agreement. The overall inter-observer reliability of the SFU grading system (κ 0.620-0.825) showed substantial to almost perfect agreement and that of the Onen grading system (κ 0.618-0.724) showed substantial agreement. The weighted kappa value of inter-observer agreement was 0.223 to 0.400 for SFU grade 1 and 0.064 to 0.346 for SFU grade 3. For Onen grading, the inter-observer agreement was 0.012 to 0.214 for grade 2 and 0.193 to 0.334 for grade 3. Conclusion: Both the SFU and Onen grading systems showed good intra-observer agreement in prenatal ultrasonography. The inter-observer agreement was decreased in SFU grades 1 and 3 and Onen grades 2 and 3. Therefore, more focus should be given to SFU grades 1 and 3 and Onen grades 2 and 3 for trainees.ope

Comparison of nuchal translucency measurements obtained using Volume NT(TM) and two- and three-dimensional ultrasound

OBJECTIVE: To evaluate the feasibility of Volume NT(TM) , a new technique that automatically archives mid-sagittal plane views and measures the maximum nuchal translucency (NT) thickness, by comparing its measurements with those made with conventional two- (2D) and three-dimensional (3D) techniques. METHODS: This was a prospective study of 130 singleton pregnancies undergoing NT screening at 11 + 0 to 13 + 6 weeks of gestation. Fetuses with enlarged NT or multiple anomalies and those in the prone position were excluded. Success rate of NT measurement was assessed using Volume NT(TM) , 2D and 3D techniques. In cases in which all three techniques were successful, intra- and interobserver bias and levels of agreement for NT measurements within and between techniques were evaluated using Bland-Altman plots. RESULTS: Of 130 cases enrolled into the study, 16 were excluded from analysis due to enlarged NT (n = 3), prone position (n = 2) or missing data (n = 11). Among the 114 cases analyzed, NT measurement was successful by the conventional 2D method in 95.6% (109/114) of cases and by 3D and Volume NT(TM) measurements in 103 and 93 cases, respectively. Success rate was not significantly different between methods. In 89 cases, NT values were available using all three methods. Among them, mean ± SD 2D-NT was 1.3 ± 0.4 mm, 3D-NT was 1.2 ± 0.4 mm and Volume NT(TM) was 1.3 ± 0.4 mm. The mean differences of the intra- and interobserver variability of each method were not significantly different from zero for each method. CONCLUSIONS: Volume NT(TM) , a novel technique for automated NT measurement, is apparently reproducible and comparable with conventional 2D and 3D ultrasound techniques for NT measurement.ope

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

PURPOSE: The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. METHODS: We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. RESULTS: Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01). CONCLUSION: Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.ope

Acute Myeloid Leukemia in Suspected Sepsis after Caesarean Section

The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.ope

Safety of Exposure From Extremely Low Frequency Magnetic Fields During Prenatal Ultrasound Examinations in Clinicians and Pregnant Women

Investigations into the safety of ultrasonography in pregnancy have focused on the potential harm of ultrasound itself. However, no data have been published regarding the electromagnetic fields that ultrasound devices might produce. This study is the first to measure extremely low-frequency magnetic field (ELF-MF) exposure of clinicians and pregnant women during prenatal ultrasound examinations in the examination room from 2 different ultrasound devices and compare them with ELF-MFs during patient consultation in the consulting room.The ELF-MF intensities that clinicians and pregnant women were exposed to were measured every 10 seconds for 40 prenatal ultrasound examinations using Philips iU22 or Accuvix V20 Prestige machines and 20 patient consultations in a consulting room using portable ELF-MF measurement devices. The mean ELF-MF exposure of both clinicians and pregnant women was 0.18 ± 0.06 mG during prenatal ultrasound examination. During patient consultation, the mean ELF-MF exposures of clinicians and pregnant women were 0.10 ± 0.01 and 0.11 ± 0.01 mG, respectively. Mean ELF-MF exposures during prenatal ultrasound examination were significantly higher than those during patient consultations (P < 0.001 by Mann-Whitney U test).Our results provide basic reference data on the ELF-MF exposure of both clinicians and pregnant women during prenatal ultrasound monitoring from 2 different ultrasound devices and patient consultation, all of which were below 2 mG, the most stringent level considered safe in many studies, thus relieving any anxiety of clinicians and pregnant women regarding potential risks of ELF-MFs.ope

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.ope

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

OBJECTIVE: To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. METHODS: Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. RESULTS: Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (≥300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. CONCLUSION: Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.ope

Pregnancy outcomes in women with moyamoya disease: experiences at a single center in Korea

PURPOSE: Moyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD. MATERIALS AND METHODS: We conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded. RESULTS: We identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9±3.5 years old. The mean gestational age at delivery was 38.0±0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7±348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days. CONCLUSION: For pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.ope

Visualization of Greedy Algorithms using Computer Animation

그림이나 기호, 표 등으로 표현된 정보는 우리들에게 글로써 표현된 것보다 많은 정보를 제공하고 이해를 돕는다. 전산학의 자료구조 및 알고리즘 관련과목을 학습하는데 있어서도 프로그림 텍스트로 표현된 평면적인 테용을 애니메이션과 같은 컴퓨터 그래픽으로 구현하여 진행과정과 기능을 설명한다면 학습자는 그 알고리즘을 좀 더 쉽고 정확하게 이해할 수 있을 것이다. 본 논문매서는 알고리즘 설재 기법 중의 하나인 욕심장이 방법(Greedy Methods)을 4가지 문제(최적의 이원병합, 최소 비용 신장트리, 방향성 그래프의 최단경로, 빈 패킹)에 적용하여 Pc상에서 애니메이션으로 시각화 하였다. 최적의 이원병합 문재는 병합과정을 보기 좋은 트리형태와 각 자료가 갖는 크기에 따라 임의의 영역을 차지하면서 병합되는 블록형태의 2가지 측면으로 시각화하였다. 최소 비용 신장트리와 방향성 그래프의 최단경로 문재는 최소 비용의 최단경로를 찾는 과정을 학습자가 그래프상애서 단재별로 볼 수 있도록 표현하였고, 빈 패킹은 알고리즘이 수행되면서 각 자료가 알맞은 빈을 탐4한 후 결정된 빈에 채워지는 과정을 수치와 컬러로 표현하였다. 그리고 학습자는 프로그램에서 직접 자료를 입력한 후 새로운 자료에 따라 변화하는 알고리즘의 결과를 비교해 볼 수 있으며, 학습자가 애상할 수 있는 결과도 프로그램에 입력하여 시스템의 실행결과와 비교해 볼 수 있도록 하였다.;Algorithm visualization is becoming an important part in teaching concept on algorithms involving graph structures. In this study, we design and implement an algorithm visualization system for Greedy Methods, namely Optimal 2-way merge, Minimum cost spanning tree, Single source shortest path, and Bin packing algorithm. For each method, the user can supply the answer so that it can be checked with computer generated optimal solutions. This system can be applied to various computer aided education environments.목차 = ⅲ 논문개요 = ⅵ Ⅰ. 서론 = 1 A. 연구배경 및 목적 = 1 B. 연구내용 = 3 Ⅱ. 욕심장이 방법의 개념 = 4 A. 개요 = 4 B. 기본 원리 = 5 C. 욕심장이 방범을 적용할 수 있는 문제들 = 6 Ⅲ. 욕심장이 방법을 적용한 문제들의 애니때이션 설계 = 10 A. 알고리즘 애니메이션의 개념 = 10 B. 시스템흐름의 설계 = 11 Ⅳ. 알고리즘 애니메이션의 구현 = 16 A. 개발환경 = 16 B. 육심장이 방법을 적용한 문제들의 시각화 알고리즘 = 17 1. 최적의 이원 병합 (Optimal 2-Way Merge) = 17 2. 최소 비용 신장 트리 (Minimum cost Spenning Tree) = 21 3. 방향성 그래프의 최단경로 (Single Source Shortest Path) = 23 4. 빈 패킹 (Bin Packing) = 24 C. 구현내용 = 26 Ⅴ. 결론 = 36 참고문헌 = 38 ABSTRACT = 4

Computer Analysis of Daeguem Performance and Its Reproduction in MIDI Performance

최근 컴퓨터를 이용한 음악이 발달하고 미디(MIDI, Musical Digital Interface)를 사용하는 인구가 점차 늘어남에 따라 미디에 한국음악을 도입하고자 하는 노력이 많아지고 있다. 하지만 미디는 서양악기와 서양의 음계를 기준으로 하고 있기 때문에 미디를 사용하여 한국음악 고유의 특징을 살린 연주를 하기는 어렵다. 이에 미디를 사용하여 한국음악을 연주하는 방법에 관한 연구의 필요성을 느끼고, 한국의 대표적 관악기중 하나인 대금의 음계와 중요한 연주기법인 요성(搖聲)을 미디연주에서 재현하는 방법을 연구하고자 한다. 대금의 음계와 한국악기만의 독특한 연주기법인 요성을 미디연주로 재현하기 위해 먼저 이들을 분석하여 표준화된 데이터로 만들었다. 대금음계의 음정은 미디의 표준음계인 12평균율과 달랐는데, 12평균율에서 반음이 100cent인데 반해 대금음계에서 반음에 해당하는 1율(律)은 144cent 또는 90cent로 이루어져 있었다. 요성은 음고(frequency)와 음량(amplitude)이 지속적으로 변화되는 연주기법이므로 요성이 될 때 음고와 음량이 변화하는 폭과 속도를 컴퓨터를 이용하여 분석하였다. 그 결과 요성이 될 때 음고와 음량의 변화관계는 음고가 높아지면 음량도 커지고, 음고가 낮아지면 음량도 작아지고 있음을 알 수 있었다. 분석된 데이터는 미디에서 사용하는 데이터값으로 변환되어 미디 시퀀싱 프로그램(MIDI Sequencing Program)에 대입되어야 한다. 대금의 음계는 미디 시퀀싱 프로그램에서 대금음계의 음고와 가까운 12평균율의 음의 음고를 조작함으로써 대금의 음계를 미디연주로 재현할 수 있다. 미디에서 음고의 변화를 제어하는 메시지는 피치 휠 체인지(Pitch Wheel Change)로 이 메시지의 데이터값을 변화시키면 12평균율로 표현되지 않는 미소음정(微小音程)까지 변화시킬 수 있으므로 12평균율과 약간씩 음정의 차이가 있는 대금의 음계를 재현하는 것이 가능하였다. 요성을 재현하기 위해서는 음고와 함께 음량도 변화시켜야 하므로 미디 시퀀싱 프로그램에서 피치 휠 체인지 값을 변환시켜 음고를 변화시키고, 음량의 변화를 제어하는 메시지인 트랙볼륨(Track Volume)을 변환시켜 음량의 변화를 재현하였다. 이렇게 재현된 결과의 검증을 위하여 미디로 재현된 대금연주를 다시 녹음한 뒤 다시 컴퓨터를 사용하여 음고와 음량의 변화를 분석하였더니 실제 대금연주를 분석한 것과 흡사한 결과가 나왔다. 본 연구는 현존하는 미디체계를 사용하여 한국음악의 음계와 요성을 재현하는 방법을 연구한 것이기 때문에 음계를 재현하는 과정에서 음이 바뀔 때마다 각 음에 해당하는 피치 휠 체인지값을 대입해 주어야 했다. 또한 요성을 표현해 주기 위하여 수많은 미디 데이터값을 일일이 대입해 주어야 하는 어려움이 있다. 이에 한국음악의 디지털 표준이 연구되어 미디가 아닌 한국악기의 연주에 최적화된 독자적인 디지털 인터페이스가 개발된다면 컴퓨터를 사용하여 한국음악을 연주하고자 할 때 더욱 손쉽게 한국음악의 특징을 살린 연주를 할 수 있을 것이다. ; With the development of computer music and increase of people using MIDI(Musical Instrumental Digital Interface), a lot of efforts have been made to apply Korean classical music to MIDI. However, a method of applying Korean classical music to MIDI has limit in expressing characteristics of Korean classical music since MIDI is based on the scale of Western music. Accordingly, the study is related to a method of expressing characteristics of Korean classical music in performing Korean classical instruments with MIDI, particularly, a method of reproducing the scale of Daeguem, one of Korean classical wind instruments, and Yoseong, essential performance technique of Daeguem, with MIDI. First, in order to reproduce the scale of Daeguem, and Yoseong, a peculiar performance technique of Korean classical instruments, the scale of Daeguem and Yoseong are analyzed, and then are expressed in standardized data. An interval of Daeguem scale is different from 12-tone equal temperament, a standard scale of MIDI. That is to say, a semitone is 100cent in 12-tone equal temperament, meanwhile, one Yuel of Daeguem scale corresponding to the semitone of 12-tone equal temperament is composed of 144cent or 90cent. In Yoseong, frequency and amplitude are continuously changed, so that it is required to analyze changes of width and speed in the frequency and amplitude with a computer. According to the analyzed data, it has been realized that the frequency is proportional to the amplitude. In other words, the amplitude increases as the frequency becomes high, and the amplitude decreases as the frequency becomes low. At this time, the analyzed data is changed to a data value used in MIDI, and then is input to the MIDI Sequencing Program. The scale of Daeguem can be reproduced with MIDI by operating the frequency of 12-tone equal temperament, which is similar to the frequency of Daeguem scale, in the MIDI Sequencing Program. In MIDI, a message which controls the change of the frequency is the Pitch Wheel Change. That is, if a data value of the message is changed, the change of microtone which is not expressed in 12-tone equal temperament can be expressed. Accordingly, it is possible to reproduce the scale of Daeguem which have the interval slightly different from 12-tone equal temperament. To reproduce Yoseong, the amplitude has to be changed with the frequency. The frequency is controlled by a method of changing Pitch Wheel Change value in the MIDI Sequencing Program, and the change of amplitude is reproduced by changing Track Volume. At this time, the Track Volume is a message which control the change of amplitude. Then, Daeguem performance with MIDI is recorded, and the frequency and amplitude of Daeguem performance are analyzed with the computer so as to inspect the result of Daeguem performance reproduced in MIDI. Analysis shows that Daeguem performance reproduced with MIDI is similar to a real Daeguem performance. Herein, a method of reproducing the scale of Korean classical music and Yoseong with the existing MIDI system has been studied. In this method, it is necessary to input the Pitch Wheel Change value corresponding to each tone whenever the tone is changed since the existing MIDI system is used. Also, each MIDI data value has to be input so as to reproduce Yoseong. Accordingly, it is required to study a digital standardization of Korean classical music, and to develop a peculiar digital interface which is optimized in performing Korean classical instruments, so that it is possible to express characteristics of Korean classical music in performing Korean classical instruments with the computer.I. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구방법 = 2 C. 연구의 제한점 = 3 II. 대금연주의 분석 = 4 A. 대금의 음계 = 4 1. 한국음악의 12율과 서양의 12평균율 = 4 2. 대금음계의 음고 = 7 B. 요성 = 11 1. 요성의 개념 = 11 2. 요성의 분석 = 12 III. 대금음계와 요성의 미디연주에서의 재현 = 23 A. 재현에 필요한 기초연구 = 23 1. 음고의 주파수값과 음정의 센트값 = 23 2. 미디의 피치 휠 체인지(Pitch Wheel Change)값 = 25 3. 음량과 미디의 트랙볼륨(Track Volume)값 = 26 B. 대금의 음계 = 27 C. 요성 = 31 1. 음고의 변화 = 31 2. 음량의 변화 = 35 3. 유형별 재현 = 38 IV. 결론 = 50 참고문헌 = 52 부록 = 55 ABSTRACT = 8