• Title/Summary/Keyword: 임상 결과 예측

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Prognostic Factors in Childhood IgA Nephropathy (소아 IgA 신병증의 예후에 관한 고찰)

  • Park Jae-Hyun;Kim Pyung-Kil;Jeong Hyeon-Joo;Choi In-Joon
    • Childhood Kidney Diseases
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    • v.1 no.1
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    • pp.17-23
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    • 1997
  • After the first description of IgA nephropathy by Berger in 1968, the prognosis of this disease was considered favourable. However recent studies have revealed that IgA nephropathy result in end stage renal desease in 25-30% by 20 years. Heavy proteinuria, hypertension, histological high class are regarded as poor prognostic factors. In 1996, Yagame et al reported the new histopathologic grading with a strong correlation between the grading, heavy proteinuria, high s-Cr level and renal survival. The aims of this study are to determine whether the pathological grading and other clinical parameters could contribute to predicting the outcome of this disease eventhough pediatric patients. Seventy nine patients (59 males, 20 females) with IgA nephropathy were examined. Patients were 2.08-15.17 years of age ($9.85{\pm}2.83$). The mean follow-up duration were $27{\pm}28$ months. Six of seventy nine patients progressed to chronic renal failure during the follow-up periods. High 24h urinary protein excretion at diagnosis were significantly higher in chronic renal failure patients (p<0.05). Hypertension at diagnosis were the significant associated factors in progression of chronic renal failure (p<0.05). Histological changes of IgA nephropathy in light microscopy were classified into five classes by WHO classification, four grades in Yagame's gradings. Among the seventy nine patients, 24 were as class 1, 30 as class 2, 23 as class 3; 4 as class 4, 0 as class 5 by WHO classification. 23 were classified grade 1, 31 as grade 2, 24 as grade 3, 1 as grade 4 by Yagame's grading. Among six patients who progressed to chronic renal failure, 1 clssified as class 1, 1 as class 2, 3 as class 3, 1 as class 4, 0 as class 5 by WHO Classification. 1 patients were classified as grade 1, 1 as grade 2, 3 as grade 3, 1 as grade 4 by Yagame's grading. (p>0.05) In conclusion, hypertension and heavy proteinuria at initial presentation were significantly associated with progression of chronic renal failure. The classification of WHO & Yagame's grading has no significant association with the progression of chronic renal failure in pediatric patients.

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The Prognostic Value of the Seventh Day APACHE III Score in Medical Intensive Care Unit (내과계 중환자들의 예후 판정에 었어서 제 7병일 APACHE III 점수의 임상적 유용성)

  • Kim, Mi-Ok;Yun, Soo-Mi;Park, Eun-Joo;Sohn, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.2
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    • pp.236-244
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    • 2001
  • Background : Most current research using prognostic scoring systems in critically ill patients have focused on prediction using the first intensive care unit (ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. Methods : 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the $1^{st}$ and $7^{th}$ APACHE III scores and the mortality risk. Results : 1 )The mean length of stay in the ICU was $10.3{\pm}13.8$ days. 2)The mean $1^{st}$ and $7^{th}$ day APACHE III scores were $59.7{\pm}30.9$ and $37.9{\pm}27.7$. 3) The mean $1^{st}$ day APACHE III score was significantly lower in survivors than in non- survivors($49.9{\pm}23.8$ vs $86.3{\pm}32.3$, P<0.0001). 4)The mean $7^{th}$ day APACHE III score was significantly lower in survivors than in non- survivors($30.1{\pm}18.5$ vs $80.1{\pm}30.4$, P<0.0001). 5)The odds ratios among the $1^{st}$ and $7^{th}$ day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. Conclusion : These results suggest that the seventh day APACHE III score is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the $1^{st}$ and $7^{th}$ day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the $7^{th}$ day APACHE III score is useful for predicting the clinical outcome.

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A Study on Parenting Competency of Mothers with Mental Illness (여성정신장애인의 양육능력에 관한 연구)

  • Seo, Mi-Kyoung
    • Korean Journal of Social Welfare
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    • v.60 no.2
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    • pp.77-98
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    • 2008
  • For women living with mental illness, motherhood may be a normalizing life experiences and offers the opportunity to develop competencies in a major life roles. So, the main premise of this study that social contexts, social support of spouse and extended family, is very important for successful parenting of mothers with mental illness. Thus this study analyzes the impact of marital relationship and social support of networks on three dimensions of parenting competency(expression of love, encouragement of independence, rational discipline) when the socioeconomic(age, number of offsprings, subjective economic level) and disability variables(diagnosis, severity of symptoms, chronicity, frequencies of psychiatric admission) are controlled. This study conducted the survey with 145 mothers with schizophrenia and mood disorder. The major finding of the study are : i) Using step-wise multiple regression, marital relationship, social supports and economic level affect significantly on the expression of love. ii) Using step-wise multiple regression, the most powerful influenced factor on encouragement of independence is marital relationship. iii) Using step-wise multiple regression, diagnosis, severity of symptoms, chronicity and economic level affect significantly on the rational discipline. That is two dimensions of parenting competency, expression of love and encouragement of independence, can be explained well by social contexts variables(marital relationship, social support, economic level). But only rational discipline can be explain well by disability factors. In conclusion, this study recommends service providers to use family based comprehensive case management for the mothers with mental illness.

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Myocardial Perfusion SPECT as a Screening Test before Planned Vascular Surgery for Predicting Perioperative Cardiac Complications (혈관 수술 후 심장 합병증 발생을 예측하기 위한 선별 검사로서 심근 관류 단일 광자 단층촬영의 유용성에 대한 연구)

  • Lee, Hyung-Chae;Hwang, Youn-Ho;Wi, Jin-Hong;Jun, Hee Jae;Lee, Yang-Haeng;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.43 no.1
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    • pp.25-32
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    • 2010
  • Background: Patients with vascular diseases commonly have coronary artery disease and associated cardiac problems. Therefore, their underlying heart diseases may be induced or exacerbated after vascular surgery. The effectiveness of SPECT imaging, which is a relatively simple and non-invasive imaging modality, for assessing these underlying heart diseases is still controversial. This study was performed to evaluate the clinical effect of tests and treatment based on SPECT imaging prior to vascular surgery on the development of post-operation cardiac complications. Material and Method: Sixty three patients who were treated at Inje University Pusan Paik Hospital between April 2004 and September 2007 and who underwent adenosine infusion technetium-99m (Tc-99m) tetrofosmin SPECT imaging prior to vascular surgery were selected for this study and we retrospectively reviewed their records. Result: The sensitivity and specificity of detecting a perfusion defect on SPECT to predict the development of cardiac complications was relatively low at 41.2% and 52.2%, respectively. However when coronary angiographies were done on the patients with abnormal SPECT and this was followed by aggressive treatment such as coronary artery intervention and coronary artery bypass grafting based on the angiography results, there was a tendency for lower cardiac complication rates. Conclusion: SPECT imaging shows low effectiveness as a screening test for predicting cardiac complications after vascular surgery.

Evaluation of Hazardous Zones by Evacuation Scenario under Disasters on Training Ships (실습선 재난 시 피난 시나리오 별 위험구역 평가)

  • SangJin Lim;YoonHo Lee
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.30 no.2
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    • pp.200-208
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    • 2024
  • The occurrence a fire on a training ship with a large number of people on board can lead to severe casualties. Hence the Seafarers' Act and Safety Life At Sea(SOLAS) emphasizes the importance of the abandon ship drill. Therefore, in this study, the training ship of Mokpo National Maritime University, Segero, which has a large number of people on board, was selected as the target ship and the likelihood and severity of fire accidents on each deck were predicted through the preliminary hazard analysis(PHA) qualitative risk assessment. Additionally, assuming a fire in a high-risk area, a simulation of evacuation time and population density was performed to quantitatively predict the risk. The the total evacuation time was predicted to be the longest at 501s in the meal time scenario, in which the population distribution was concentrated in one area. Depending on the scenario, some decks had relatively high population densities of over 1.4pers/m2, preventing stagnation in the number of evacuees. The results of this study are expected to be used as basic data to develop training scenarios for training ships by quantifying evacuation time and population density according to various evacuation scenarios, and the research can be expanded in the future through comparison of mathematical models and experimental values.

Wild Boar (Sus scrofa corranus Heude ) Habitat Modeling Using GIS and Logistic Regression (GIS와 로지스틱 회귀분석을 이용한 멧돼지 서식지 모형 개발)

  • 서창완;박종화
    • Spatial Information Research
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    • v.8 no.1
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    • pp.85-99
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    • 2000
  • Accurate information on habitat distribution of protected fauna is essential for the habitat management of Korea, a country with very high development pressure. The objectives of this study were to develop a habitat suitability model of wild boar based on GIS and logistic regression, and to create habitat distribution map, and to prepare the basis for habitat management of our country s endangered and protected species. The modeling process of this restudyarch had following three steps. First, GIS database of environmental factors related to use and availability of wild boar habitat were built. Wild boar locations were collected by Radio-Telemetry and GPS. Second, environmental factors affecting the habitat use and availability of wild boars were identified through chi-square test. Third, habitat suitability model based on logistic regression were developed, and the validity of the model was tested. Finally , habitat assessment map was created by utilizing a rule-based approach. The results of the study were as folos. First , distinct difference in wild boar habitat use by season and habitat types were found, however, no difference in wild boar habiat use by season and habitat types were found , however, ho difference by sex and activity types were found. Second, it was found, through habitat availability analysis, that elevation , aspect , forest type, and forest age were significant natural environmental factors affecting wild boar hatibate selection, but the effects of slope, ridge/valley, water, and solar radiation could not be identified, Finally, the habitat at cutoff value of 0.5. The model validation showed that inside validation site had the classification accuracy of 73.07% for total habitat and 80.00% for cover habitat , and outside validation site had the classification accuracy of 75.00% for total habitat.

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Differences in the Clinical Characteristics of Children with Urinary Tract Infections Based on the Results of $^{99m}Tc$-Dimercaptosuccinic Acid Renal Scanning (요로감염 소아에서 입원 초기 시행한 DMSA 신 스캔 결과에 따른 임상양상의 차이에 대한 연구: DMSA 신 스캔의 임상적 의미)

  • Kim, Dong Ouk;Lee, Sang Min;Lee, Jeong Bong;Ko, Young Bin;Kim, Su Jin
    • Childhood Kidney Diseases
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    • v.17 no.2
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    • pp.110-116
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    • 2013
  • Purpose: The $^{99m}Tc$-Dimercaptosuccinic acid (DMSA) renal scan is used primarily for the diagnosis of renal scarring and acute pyelonephritis in children with urinary tract infections (UTI). This study aimed to evaluate clinical differences based on the positive or negative results of DMSA scans and kidney ultrasonography (US) in pediatric UTI. Method: We retrospectively reviewed 142 pediatric patients with UTI who were admitted to Myongji Hospital from January 2004 to December 2012. We performed a comparative analysis of clinical parameters such as age, sex, white blood cell (WBC) count, neutrophil count, blood urea nitrogen (BUN) level, creatinine (Cr) level, C-reactive protein (CRP) level, and durations of hospitalization and fever, grouped by the results of the DMSA scans and kidney US. Results: The mean age of the patients was $33.8{\pm}48.3$ months, and 78 (55%) were male. Fifty-two patients had abnormal DMSA findings, and 71 patients had abormal kidney US findings (test positive groups). In the DMSA scan positive group, there were significant differences in age, WBC counts, neutrophil counts, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on kidney US, and incidence of vesicoureteral reflux (VUR) compared with the scan negative group. The kidney US positive group had significant differences in age, neutrophil count, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on the DMSA scans, and more frequent VUR compared with the US negative group. Conclusion: Our data suggest that there were no major differences in clinical parameters based on the results of the DMSA scans compared with kidney US in pediatric UTI. However, as kidney US and DMSA scan were performed to predict VUR, the sensitivity and negative predictive value was increased.

Factors Associated with the Development of Pleural Thickening in Tuberculous Pleurisy (결핵성 흉막염 치료 후 흉막비후의 예측인자)

  • Park, Jae-Seuk;Chun, Yong;Choi, Eun-Kyung;Jee, Young-Koo;Lee, Kye-Young;Kim, Keum-Youl
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.1
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    • pp.17-24
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    • 1999
  • Background : A sizable percentage of tuberculous pleurisy patients are known to have residual pleural thickening(RPT) despite adequate anti-tuberculous chemotherapy. But, the predictive factors related to the development of RPT is not well known. Therefore, we studied to determine which factors are related to the development of RPT after completion of therapy. Methods: By retrospective review of medical records, fifty-eight patients initially diagnosed as having tuberculous pleurisy between March 1995 and January 1998 were separated into two groups : 27 patients in group 1 had RPT on simple chest radiography, while 31 patients in group 2 had no RPT after 6 month of anti-tuberculous chemotherapy. The clinical characteristics, radiologic findings and pleural fluid findings of the two group were compared at the time of diagnosis and during the course of therapy. Results: 47% of patients had RPT after 6 month of chemotherapy, and RPT was more common in man than in women(54% vs 29%, p=0.092). In group 2 patients, complete resorption of pleural lesion occurred rather late stage of therapy(1-2 month: 26%, 3-4 month: 29%, 5-6 month: 45%). Group 1 patients had increased percentage of loculated pleural lesion(26 % vs 19%) and increased white blood cell and lymphocyte count, lactate dehydrogenase level in pleural fluid ($3527\pm5652$ vs $2467\pm2201$/ml, $2066\pm2022$ vs $1698\pm1835$/ml and $1636\pm1143$ vs $1441\pm923$IU/mL respectively) than group 2 at the time of diagnosis, but statistically insignificant. Duration of symptom prior to treatment, size of pleural effusion, presence of parenchymal lung lesion, level of total protein, glucose and adenosine deaminase(ADA)activity in pleural fluid were similar in both group. Conclusion: 53% of tuberculous pleurisy patients showed slow but complete resorption of pleural lesion after 6 month of chemotherapy. But, no clinical, radiological and pleural fluid findings are predictive for the development of RPT.

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Usefulness of Tuberculin Skin Test by Tuberculin PPD RT23 2 TU (Tuberculin PPD RT23 2 TU를 이용한 투베르쿨린 피부반응 검사의 의의)

  • Yang, Jong-Wuk;Jeon, Man-Jo;Kim, Sung-Jung;Lee, Hyang-Lim;Lee, Seung-Jun;Lee, Myoung-Goo;Kim, Dong-Gyu;Park, Myoung-Jae;Kang, Min-Jong;Hyoen, In-Gyu;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.4
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    • pp.401-408
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    • 2002
  • Background : Tuberculin skin test is a method to examine M. tuberculosis infection and has been used all over the world. But various factors make it difficult to understand testing results. In 2000, the American Thoracic Society recommended that skin test results should be decided by considering risk factors of the tested. In Korea, high tuberculosis infection rate and BCG vaccination rate make it difficult to differentiate current infection, past infection, and no infection by the skin test. This study was attempted to examine a negative predictive value of the skin test to understand how the skin test acts on deciding administration of anti-tuberculosis drug. Methods : From Mar. 1 to Jul. 31 in 2001, the test was performed for patients hospitalized in Department of Internal Medicine, Hallym University College of Medicine, Chunchon, Korea by administering Tuberculin PPD RT23 2 TU (0.1 ml)to them that has been currently used in Korea based on Mantoux method. They were decided to be infected with tuberculosis bacilli by following diagnostic standard: 1) tuberculosis bacilli was cultured in sputum by microbiological diagnostic standard or Acid-fast bacilli was proven on a microscopic examination or 2) tuberculosis bacilli was not proven in the aforesaid microbiological test by clinical diagnostic standard, while there was opinion or symptom suitable for tuberculosis by radiographic or histological standard so the doctor decided to apply the tuberculosis treatment. Results : In this study, total 210 patients except 20 patients (8.7%) among 230 hospitalized patients were evaluated. Their average age was 60±16.8 years, and male-female rate was 1.28 : 1 (male: 118, female: 92). Number of patient, who was diagnosed and decided as tuberculosis, was 53(25.2%). Pulmonary tuberculosis was found in 45 patients (84.9%); 22 patients were decided to be positive in the Acid-fast bacilli smear test by microbiological examination (culture positive: 13, culture negative: 9), and 23 patients were decided to be tuberculosis patients by clinical diagnosis standard. Tuberculosis pleuritis was found in 8 patients (15.1%); 4 patients were diagnosed and decided by histological standard, and 4 patients were decided and treated by clinical standard. In differentiating patients into 'Negative' and 'Positive' by the skin test standard of the American Thoracic Society, negative predictive value 92.3%, positive predictive value 47.3%, sensitivity and specificity were 83%, 68.8%, respectively. Conclusion : In hospitalized respiratory patients, there was high negative predictive vlaue 92.3% by tuberculin skin test, therefore skin test would be a important factor for deciding administration of anti-tuberculosis drug on negative skin test patient.

Prediction and Evaluation of Landslide Hazard Based on Regional Forest Environment (지역산림환경을 기반으로 한 산사태 발생 위험성의 예측 및 평가)

  • Ma, Ho-Seop;Kang, Won-Seok;Lee, Sung-Jae
    • Journal of Korean Society of Forest Science
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    • v.103 no.2
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    • pp.233-239
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    • 2014
  • This study was carried out to propose the criteria for the prediction of landslide occurrence through analysis the influence of each factor by using the quantification theory. The results obtained from this study are summarized as follows. From a stepwise regression analysis between the landslide area($m^2$) and environmental factors, the factors strongly affecting the landslide sediment($m^2$) were the Parents rock (igneous), cross slope(complex), coniferous forests (forest type) and slope gradient ($21{\sim}30^{\circ}$). According to the range, it was shown in order of Cross slope (0.2922), Parents rock (0.2691), Forest type (0.2631) and Slope gradient (0.2312). The range of prediction score of landslide occurrence has been distributed between score 0 and score 1.0556, the median value was score 0.5278. The prediction for class I was over 0.7818, for class II was 0.5279 to 0.7917, for class III 0.2694 to 0.5278 and for class IV was below 0.2693. The prediction on landslide occurrence appeared relatively high accuracy rate as 72% for class I and II. Therefore, this score table for landslide will be very useful for judgement of dangerous slope.