• 대한수혈학회지
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• 제23권2호
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• pp.136-144
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• 2012

배경: 신선동결혈장은 응고인자의 보충을 위한 치료적 투여를 주된 목적으로 하지만, 실제로 적응증이 아닌 경우에도 부적절하게 사용되는 경우가 종종 있다. 방법: 년 2010년 7월부터 2011년 6월까지 1년간 세브란스병원 혈액은행에서 출고된 신선동결혈장의 적정 사용에 대한 평가를 시행하였다. 평가기준은 2009년 대한수혈학회에서 발간한 수혈가이드라인과 세브란스병원의 수혈적정성 평가 전산시스템에 기초하였다. 결과: 신선동결혈장은 1년 간 총 1,949명에게 4,982회에 걸쳐 17,733단위가 출고되었고, 이 중 1,990회(총 건수의 39.9%)가 부적절 수혈로 평가되었다. 진료과별 사용 건수는 소화기내과 등의 내과 계열이 흉부외과나 일반외과 등의 외과 계열보다 많았다. 그러나 부적절 사용 비율은 외과 계열이 내과 계열보다 높았다. 질병분류별 사용건수와 이들의 부적절 사용 비율은 유사한 양상을 보였는데, 종양, 소화 계통의 질병, 순환 계통의 질병군이 높은 사용 건수와 부적절 사용 비율을 보였다. 결론: 수혈의 적정성 유지를 위해서는 각 의료기관에서 수혈 적정성이 항상 평가되고, 그 결과를 임상의사들에게 정기적으로 피드백하는 과정이 중요하며, 이와 더불어 신선동결혈장 수혈 적응증에 대한 새로운 고찰이 필요할 것으로 사료된다.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.336-343
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• 2019

Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제30권1호
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• pp.2-8
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• 2019

Objectives: This study aimed to compare the quality of life reported by patients with attention-deficit/hyperactivity disorder (ADHD) to the patients' quality of life as reported by their caregivers. In addition, it aimed to examine how emotional problems, including depression and anxiety, and the severity of the symptoms affect the quality of life reported by the patients and their caregivers. Methods: The patients' quality of life and their degree of depression and anxiety were measured using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Child Self-Report, the Children's Depression Inventory (CDI), and the Revised Children's Manifest Anxiety Scale, respectively. The caregivers' perception of the patients' quality of life and severity of the ADHD symptoms were measured using the PedsQL 4.0 Parent Proxy Report and the Conners' Parent Rating Scale (CPRS), respectively. A total of 66 participants completed the survey. The independent-samples t-test, Pearson's correlation analysis, and multiple regression analysis were conducted. Results: The mean score of the PedsQL 4.0 Child Self-Report was significantly higher than the mean score of the PedsQL 4.0 Parent Proxy Report. However, for school function, the PedsQL 4.0 Child Self-Report score was significantly lower than that of Parent Proxy Report. The correlation between the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores was significant only for emotional function and social function. The multiple regression analysis showed that the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores were significantly predicted by the CDI and CPRS scores, respectively. Conclusion: Our results demonstrate that there are clear differences between the quality of life reported by the patient themselves and that reported by their caregivers. In addition, the findings suggest that it is critical to treat the patients' accompanying depressive symptoms.

• 대한치과보철학회지
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• 제57권2호
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• pp.160-170
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• 2019

상악 전치부와 같은 기능 및 심미성의 개선이 조화롭게 요구되는 부위의 치료 시에는 다른 부위보다 더 많은 지식과 기술을 필요로 한다. 특히 전방 유도(anterior guidance)를 결정하는 상악 전치부 설면 외형을 제대로 형성하지 못하면, 기능적인 불편감과 함께 전체 치열의 불안정성을 야기한다. 적절한 원리를 이용하여 전방유도를 설정한 후 임시 수복물 제작 및 조정을 통해 조화로운 전방 유도를 확보했다면 임시 수복물의 설면 외형을 최종 보철물로 정확하게 재현하는 방법에 대해 주의 깊게 고려해야 할 필요가 있다. 본 증례에서는 체계적인 진단 및 치료를 위하여 수정된 Dahl 원리(modified Dahl principle) 및 computer-aided design/computer-aided manufacturing (CAD/CAM) 시스템의 복제 기법(copy-milled)을 이용하여 적절한 전방 유도를 설정하고, 지대치의 디지털 이미지와 임시 수복물의 디지털 이미지를 중첩시켜 보다 정확하게 보철물 형태를 재현하고자 하였다. 이에 기능적, 심미적 개선을 도모하여 환자와 술자 모두에게 만족스러운 치료결과 및 예후를 얻었기에 보고하는 바이다.

• 한국방사선학회논문지
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• 제13권5호
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• pp.757-763
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• 2019

최근 넓은 동적 범위 특성을 제공하는 평판 디텍터 개발을 바탕으로 의료보건 환경이 디지털화되고 있는 현 시점에서 적절한 필터 두께의 재설정이 요구되고 있으나, 현 임상에서는 기존 아날로그 시스템에서 연구된 정보를 바탕으로 NCRP에서 제안한 권고 기준을 이용하고 있다. 이에 본 연구에서는 디지털방사선 촬영에서 알루미늄 필터를 이용하여 환자선량 최적화와 더불어 선량크리프의 최소화 가능성을 고찰하였다. 연구 결과, 알루미늄 필터의 두께를 증가함에 따라 유사한 선예도를 가지는 의료영상을 획득 시 피폭되는 피부입사선량을 최대 19.3% 저감할 수 있는 것으로 나타났으나, 영상학적 관점에서 중요한 해상력이 1.01 lp/mm의 큰 변화가 분석되었다. 이러한 해상력의 변화는 X선 빔 경화 현상으로 인하여 피사체에서 발생하는 산란선이 증가하기 때문으로 사료되며, 산란 열화 인자를 통하여 산란선량에 의한 영향이 증가하는 것을 정량적으로 검증하였다. 하지만, 최근 개발되어 광범위하게 적용되고 있는 평판 디텍터는 방사선에 대한 민감도가 높고 넓은 동적 범위 특성을 가지므로 필터 두께에 따라 산란선의 비율에 대한 증가분과 대응하여 적정한 해상력을 유지할 수 있을 것으로 사료되며, 더 나아가 피폭선량 저감을 통해 선량크리프를 최소화 할 수 있을 것으로 기대된다.

• 대한임상검사과학회지
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• 제53권1호
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• pp.122-130
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• 2021

수술중신경계감시에서 혼입되는 artifact의 종류는 매우 다양하고 검사에 방해 되는 artifact의 제거 또한 필수적이다. 그리고 artifact를 제거해서 검사의 질을 향상시키는 것이 검사자의 역량이며 환자의 안전을 위한 최선의 방법이다. 하지만 경험이 부족해서 수술실의 장비나 마취에 관한 사항들에 대한 숙지가 미흡한 경우 상황에 맞는 적절한 방법으로 artifact를 제거할 수 없다. 만약 artifact가 구별 및 제거되지 않고 진행된 검사의 판독은 수술 진행에 혼선을 초래하며 이는 신속하고 정교함이 요구되는 신경외과 수술에 치명적인 문제가 될 수 있다. 본 논문에서는 수술 중에 발생하는 artifact의 원인을 전기적요인과 비전기적인 요인 그리고 기타 요인들로 분류하였고 상황에 맞게 artifact를 제거하는 방법과 검사법에 대해 언급하였다. 수술실의 환경이 동시에 여러가지 상황을 고려해야 하는 매우 민감한 조건이지만, 다양한 artifact의 형태와 원인을 숙지하여 안정적이고 원활한 수술중신경계감시가 되길 바란다.

• 한국의료질향상학회지
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• 제27권2호
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• Journal of Korean Neurosurgical Society
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• 제65권6호
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• pp.790-800
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• 2022

Objective : EID3 (EP300-interacting inhibitor of differentiation) was identified as a novel member of EID family and plays a pivotal role in colorectal cancer development. However, its role in glioma remained elusive. In current study, we identified EID3 as a novel oncogenic molecule in human glioma and is critical for glioma cell survival, proliferation and invasion. Methods : A total of five patients with glioma were recruited in present study and fresh glioma samples were removed from patients. Four weeks old male non-obese diabetic severe combined immune deficiency (NOD/SCID) mice were used as transplant recipient models. The subcutaneous tumor size was calculated and recorded every week with vernier caliper. EID3 and AMP-activated protein kinase α1 (AMPKα1) expression levels were confirmed by real-time polymerase chain reaction and Western blot assays. Colony formation assays were performed to evaluate cell proliferation. Methyl thiazolyl tetrazolium (MTT) assays were performed for cell viability assessment. Trypan blue staining approach was applied for cell death assessment. Cell Apoptosis DNA ELISA Detection Kit was used for apoptosis assessment. Results : EID3 was preferentially expressed in glioma tissues/cells, while undetectable in astrocytes, neuronal cells, or normal brain tissues. EID3 knocking down significantly hindered glioma cell proliferation and invasion, as well as induced reduction of cell viability, apoptosis and cell death. EID3 knocking down also greatly inhibited tumor growth in SCID mice. Knocking down of AMPKα1 could effectively rescue glioma cells from apoptosis and cell death caused by EID3 absence, indicating that AMPKα1 acted as a key downstream regulator of EID3 and mediated suppression effects caused by EID3 knocking down inhibition. These findings were confirmed in glioma cells generated patient-derived xenograft models. AMPKα1 protein levels were affected by MG132 treatment in glioma, which suggested EID3 might down regulate AMPKα1 through protein degradation. Conclusion : Collectively, our study demonstrated that EID3 promoted glioma cell proliferation and survival by inhibiting AMPKα1 expression. Targeting EID3 might represent a promising strategy for treating glioma.

• 대한유전성대사질환학회지
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• 제21권1호
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• pp.22-27
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• 2021

프로피온산혈증은 PCCA 및 PCCB 유전자의 돌연변이로 발생하며 대사산물의 축적으로 신생아기부터 근긴장 저하, 구토, 케톤산증, 고암모니아혈증, 경련 등이 나타나 사망에 이를 수 있고, 비교적 후기에 신경학적 증상과 함께 발현하는 경과를 보이기도 한다. 저자들은 특별한 과거력 없이 지내던 중 확장성 심근병증이 확인된 16세 남아에서 유전자 검사로 프로피온산혈증이 진단된 1례를 보고하는 바이다.

• International journal of advanced smart convergence
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• 제12권3호
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• pp.89-103
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• 2023

Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders that can lead to serious consequences, including hypertension and/or cardiovascular diseases, if not treated promptly. Continuous positive airway pressure (CPAP) is widely recognized as the most effective treatment for OSA, which needs the proper titration of airway pressure to achieve the most effective treatment results. However, the process of CPAP titration can be time-consuming and cumbersome. There is a growing importance in predicting personalized CPAP pressure before CPAP treatment. The primary objective of this study was to optimize the CPAP titration process for obstructive sleep apnea patients through EEG feature engineering with machine learning techniques. We aimed to identify and utilize the most critical EEG features to forecast key OSA predictive indicators, ultimately facilitating more precise and personalized CPAP treatment strategies. Here, we analyzed 126 OSA patients' PSG datasets before and after the CPAP treatment. We extracted 29 EEG features to predict the features that have high importance on the OSA prediction index which are AHI and SpO2 by applying the Shapley Additive exPlanation (SHAP) method. Through extracted EEG features, we confirmed the six EEG features that had high importance in predicting AHI and SpO2 using XGBoost, Support Vector Machine regression, and Random Forest Regression. By utilizing the predictive capabilities of EEG-derived features for AHI and SpO2, we can better understand and evaluate the condition of patients undergoing CPAP treatment. The ability to predict these key indicators accurately provides more immediate insight into the patient's sleep quality and potential disturbances. This not only ensures the efficiency of the diagnostic process but also provides more tailored and effective treatment approach. Consequently, the integration of EEG analysis into the sleep study protocol has the potential to revolutionize sleep diagnostics, offering a time-saving, and ultimately more effective evaluation for patients with sleep-related disorders.