• Journal of Breast Cancer
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• 제21권4호
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• pp.406-414
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• 2018

Purpose: T-cell immunoglobulin and mucin domain-containing molecule 3 (TIM-3) is an emerging immune response molecule related to T-cell anergy. There has been tremendous interest in breast cancer targeting immune checkpoint molecules, especially in the triple-negative breast cancer (TNBC). This study was designed to investigate TIM-3 expression on tumor infiltrating lymphocytes (TILs), its relationships with clinicopathological parameters and expression of programmed death receptor 1 (PD-1)/programmed death receptor ligand 1 (PD-L1), and its prognostic role. Methods: Immunohistochemistry on tissue microarray blocks produced from 109 samples of invasive ductal carcinoma type TNBC was performed with antibodies toward TIM-3, PD-1, PD-L1 and breast cancer-related molecular markers. Associations between their expression and clinicopathological parameters as well as survival analyses were performed. Results: TIM-3 was expressed in TILs from all 109 TNBCs, consisting of 17 cases (<5%), 31 cases (6%-25%), 48 cases (26%-50%), and 13 cases (>51%). High TIM-3 was significantly correlated with younger patients (p=0.0101), high TILs (p=0.0029), high tumor stage (p=0.0018), high PD-1 (p=0.0001) and high PD-L1 (p=0.0019), and tended to be associated with higher histologic grade, absence of extensive in situ components and microcalcification. High TIM-3 expression was significantly associated with a combinational immunophenotype group of high PD-L1 and high PD-1 (p<0.0001). High TIM-3 demonstrated a significantly better disease-free survival (DFS) (p<0.0001) and longer overall survival (OS) (p=0.0001), together with high TILs and high PD-1. In univariate survival analysis, high TIM-3 showed reduced relapse risk (p<0.0001) and longer OS (p=0.0003), together with high PD-1 expression. In multivariate analysis, high TIM-3 was statistically significant in predicting prognosis, showing better DFS (hazard ratio [HR], 0.0994; 95% confidence interval [CI], 0.0296-0.3337; p=0.0002) and longer OS (HR, 0.1109; 95% CI, 0.0314-0.3912; p=0.0006). Conclusion: In this study, we demonstrate that TIM-3 expression is an independent positive prognostic factor in TNBC, despite its association with poor clinical and pathologic features.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.545-550
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• 2019

Objective : Penumbra ACE68 reperfusion catheter is a new large bore aspiration catheter used for reperfusion of large vessel occlusion. The objective of this study was to investigate the efficacy of this catheter in comparison to that of previous Penumbra catheters in patients with acute ischemic stroke related to internal carotid artery (ICA) occlusion. Methods : Data of all eligible patients who received endovascular treatment (EVT) for ICA occlusion using Penumbra aspiration catheters between January 2015 and December 2018 were retrospectively reviewed. After dividing into two groups according to use of penumbra ACE68, baseline characteristics of patients, successful recanalization rate, puncture to recanalization time, and switch to stent base technique rate were assessed. Successful recanalization was defined by a thrombolysis in cerebral infarction (TICI) score ${\geq}2b$ and favorable functional outcome was defined according to modified Rankin scale (score, 0-2). Results : ACE68 reperfusion catheter was used in 29 of 75 eligible patients (39%). The puncture to recanalization time was significantly shorter ($26{\pm}18.2$ minutes vs. $40{\pm}24.9$ minutes, p=0.011) and the rate of switch to stent-based retrieval was significantly lower (3% vs. 20%, p=0.046) in ACE68 catheter group. Moreover, although not statistically significant, the successful recanalization rate was higher (83% vs. 76%, p=0.492) in ACE68 catheter group. Favorable functional outcome was observed in 48% of patients treated with ACE68 reperfusion catheter and in 30% of patients treated using other Penumbra systems (p=0.120). Baseline Alberta Stroke Program Early CT Scores ${\geq}8$ (odds ratio [OR], 9.74; 95% confidence interval [CI], 1.72-54.99; p=0.010) and successful recanalization (OR, 10.20; 95% CI, 1.13-92.46; p=0.039) were independent predictors of favorable outcome. Conclusion : EVT using ACE68 reperfusion catheter can be considered a first-line therapy in patients with acute ICA occlusion as it can achieve rapid recanalization and reduce the frequency of conversion to stent-retrieve therapy.

• 구강회복응용과학지
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• 제35권2호
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• pp.90-97
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• 2019

목적: 교합접촉면적에 관련된 이전의 연구들은 교합두께 수준이나 교합측정방법 상 부정확성이 한계로 지적되어 왔다. 본 연구의 목적은 머리 위치가 교합접촉면적에 미치는 영향을 광조사교합분석법을 이용하여 조사하는 것이다. 연구 재료 및 방법: 건전한 치열을 갖는 54명(남성 44명, 여성 10명, 23 - 33세)을 대상으로 시험을 진행하였다. 머리 위치와 교합접촉면적의 관계를 알아보기 위해 시험대상은 치과용 유닛체어에 세 가지 자세(누운 자세($0^{\circ}$), 기울인 자세($45^{\circ}$), 직립 자세($90^{\circ}$))로 하여 최대 교두간 접촉위를 이용하여 악간관계기록을 채득하였다. 광조사교합분석기($BiteEye^{(R)}$)를 이용하여 교합접촉면적을 분석하였다. SPSS 25.0을 이용하여 유의수준 95%에서 통계분석을 시행하였다. 결과:머리 위치는 교합접촉면적과 유의미한 영향이 없는 것으로 나타났다(P > 0.05). 결론: 머리 위치는 교합접촉면적에 유의미한 영향이 없으므로 교합관계가 안정적이라면 최대 교두간접촉위의 악간관계 기록 채득 시 환자의 자세는 변수가 되지 않으며 광조사교합분석기를 이용한 교합접촉면적의 측정은 재료적, 용이성 측면으로 유용하다고 할 수 있다.

• 가정의학회지
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• 제39권6호
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• pp.333-339
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• 2018

Background: There is a distinction in alcohol consumption behavior between adults and college students. This study aims to verify the usability and the optimal cutoff point of Alcohol Use Disorders Identification Test-Korean revised version (AUDIT-KR) for screening alcohol use disorder in college students when the diagnostic and statistical manual of mental disorders (DSM), 5th edition diagnostic criteria is applied. Methods: A total of 922 college students living in Daejeon were enrolled and divided into two groups based on how many items they corresponded to among DSM-5 alcohol use disorder diagnostic criteria: those who corresponded to ${\geq}2$ of the 11 items were classified into the patient group (107 males, 89 females) while the others into the control group (311 males, 415 females). The participants were evaluated using AUDIT-KR to find the optimal cutoff point for screening alcohol use disorder, sensitivity, and specificity. Results: The mean${\pm}$standard deviation scores in the AUDIT-KR were $12.76{\pm}7.27$, $10.72{\pm}4.62$ for males and females, respectively, in the patient group. In contrast, in the control group the scores were $6.26{\pm}5.23$ and $3.95{\pm}3.59$ in males and females, respectively. The area under the receiver operating characteristic curve (95% confidence interval) regarding alcohol use disorder screening by AUDIT-KR was 0.768 (0.715-0.821) and 0.883 (0.848-0.919) for males and females, respectively. The optimal cutoff point of alcohol use disorder for males was >9, sensitivity 64.49%, and specificity 76.85%. The optimal cutoff point for females was >6, sensitivity 82.02%, and specificity 80.48%. Conclusion: This study suggested that AUDIT-KR can be used as a screening tool for alcohol use disorder in groups of college students when DSM-5 diagnosis criteria are applied.

• 한국화재소방학회논문지
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• 제32권6호
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• pp.1-6
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• 2018

본 논문은 배관용으로 사용되고 있는 황색절연링형(yellow insulation ring type) 금속플렉시블호스(CSST)를 인위적으로 열화(deterioration)시켜 소손되었을 때의 특성을 분석하는데 있다. 배관용 CSST는 튜브, 보호피막, 너트, 황색절연링, 패킹(packing), 이음쇠(socket)로 구성되어 있다. 그리고 튜브와 이음쇠 접속은 기밀성과 절연성능 향상을 위해 황색절연링과 고무 패킹을 사용한 것으로 판단된다. 실험에서 얻은 데이터를 95% 신뢰 구간에서 검증한 결과 AD (Anderson-Darling)는 0.945, P값은 0.015로 해석되었다. 배관용 CSST의 실험 데이터는 신뢰성이 있다는 것이 확인되었다. 가스 토치에 의해서 소손된 CSST의 산술적 평균 절연저항은 $16.7k{\Omega}$으로 가장 컸으며, 전기적인 소손을 입은 CSST는 상대적으로 가장 낮은 $208{\Omega}$, 정상 제품은 $1.72k{\Omega}$으로 분석되었다. 그러므로 화재 현장에서 수거한 CSST의 절연저항 값을 분석하면 소손 원인 판정에 활용할 수 있을 것이다. 또한, 대전류공급장치(PCITS)로 CSST에 최대 전류 97 A를 약 5 s 동안 흘린 결과 보호피막 및 절연링은 정상 제품과 차이가 없었으나 금속 튜브의 일부에서 용융이 형성된 것을 확인할 수 있었다.

• Tuberculosis and Respiratory Diseases
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• 제82권4호
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• pp.319-327
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• 2019

Background: Radial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated. Methods: The study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis. Results: Among 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203-12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424-7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens. Conclusion: R-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.

• 대한불안의학회지
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• 제15권2호
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• pp.115-121
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• 2019

Objective : The purpose of this study was to investigate prevalence of psychiatric symptoms and determine predictors of emotional distress of military hospital surgical patients. Methods : This study examined 104 orthopedic patients admitted to the Armed Forces Military Hospital September-November 2018. For the study, every subject completed self-assessment inventories regarding depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), sleep problems (Pittsburgh Sleep Quality Index), problematic alcohol and tobacco use (Cut off, Annoyed, Guilty, Eye-opener screening), and psychiatric history. We performed the Student's t-test and the chi-square test for the collected data to investigate the prevalence of psychiatric symptoms, including emotional distress. Logistic regression analysis was used to examine the risk factors related to emotional distress of hospitalized military personnel. Results : There were no significant differences in socio-demographic and psychiatric symptoms between soldiers and officers. The prevalence of depressive and/or anxiety symptoms (emotional distress) was 21.2% (n=21). In the logistic regression analysis, psychiatric history [Adjusted Odds Ratio (AOR)=18.99 ; 95% Confidence Interval (CI)=1.42-253.57 ; p=0.026] and low military life satisfaction (AOR=15.67; 95% CI=1.46-168.11 ; p=0.023) correlated with emotional distress. Conclusion : Soldiers admitted to the military hospital showed similar prevalence of emotional distress as those at general hospitals. Considering military circumstances, it is necessary to detect and intervene regarding soldiers with a psychiatric history and low military life satisfaction to promote mental health at military hospitals.

• Tuberculosis and Respiratory Diseases
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• 제82권4호
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• pp.306-310
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• 2019

Background: Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC). Methods: TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively. Results: Among tuberculin skin test (TST) ${\geq}10mm$ (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea ($42.8{\pm}9.9years$ vs. $35.4{\pm}10.0years$, p<0.01). Additionally, the mean TST size was significantly bigger in NKR ($17.39{\pm}3.9mm$ vs. $16.57{\pm}4.2mm$, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159-20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191-9.974; p=0.02). Conclusion: LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.

• 대한응급의학회지
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• 제29권5호
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• pp.430-436
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• 2018

Objective: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. Methods: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. Results: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67). Conclusion: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.

• 대한응급의학회지
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• 제29권5호
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• pp.485-492
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• 2018

Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81). Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.