• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권4호
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• pp.366-376
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• 2020

Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

• 한국시뮬레이션학회논문지
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• 제33권2호
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• pp.37-44
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• 2024

한국형 헬기 개발사업의 성공적인 결과로 인하여 노후화된 UH-1및 500MD 헬기를 대체하는 수리온(Surion)에 대한 연구가 활발히 진행되고 있다. 특히, 높은 기동성을 보유한 수리온은 미래 전장에서의 병력수송 및 특수작전 등 다양한 임무를 수행할 것으로 예상되며 이를 지원하기 위한 저고도 전술기동 능력이 요구되고 있다. 그러나 수리온 운용시, 대공 위협 요소를 고려한 최적 저고도 전술기동에 대한 연구는 아직까지 미흡한 실정이다. 본 연구는 강화학습 기반의 알고리즘 중에 하나인 Proximal Policy Optimization(PPO) 알고리즘과 적 대공위협을 고려하여 수리온이 작전 목표지역까지 도달하도록 하는 저고도 상에서의 최적화된 기동 경로를 산출하는 방법론을 제안한다. 이를 위해, Unity 환경과 ML-Agents 라이브러리 상에서 실사화된 수리온 모델을 기초로 약 2×107 회의 강화학습을 진행하였고, 제안하는 방법을 적용하여 수리온의 최단시간 및 최소피해를 달성하는 최적 저고도 전술기동 경로를 산출하는 정책을 도출하였다. 그 결과, '최단 시간' 및 '최소 피해'라는 두 가지 기준을 충족하는 최적 경로가 도출되었다. 본 연구의 결과는 수리온 및 수리온 무인체계를 운용하는 다양한 작전에 활용되어 기동계획을 수립할 시 기동성, 작전성공율, 그리고 생존율을 예측하는데 보탬이 되기를 기대한다.

• Journal of Preventive Medicine and Public Health
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• 제49권1호
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• pp.35-44
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• 2016

Objectives: We investigated the associations of sarcopenia-defined both in terms of muscle mass and muscle strength-and sarcopenic obesity with metabolic syndrome. Methods: Secondary data pertaining to 309 subjects (85 men and 224 women) were collected from participants in exercise programs at a health center in a suburban area. Muscle mass was measured using bioelectrical impedance analysis, and muscle strength was measured via handgrip strength. Sarcopenia based on muscle mass alone was defined as a weight-adjusted skeletal muscle mass index more than two standard deviations below the mean of a sex-specific young reference group (class II sarcopenia). Two cut-off values for low handgrip strength were used: the first criteria were <26 kg for men and <18 kg for women, and the second criteria were the lowest quintile of handgrip strength among the study subjects. Sarcopenic obesity was defined as the combination of class II sarcopenia and being in the two highest quintiles of total body fat percentage among the subjects. The associations of sarcopenia and sarcopenic obesity with metabolic syndrome were evaluated using logistic regression models. Results: The age-adjusted risk ratios (RRs) of metabolic syndrome being compared in people with or without sarcopenia defined in terms of muscle mass were 1.25 (95% confidence interval [CI], 1.06 to 1.47, p=0.008) in men and 1.12 (95% CI, 1.06 to 1.19, p<0.001) in women, which were found to be statistically significant relationships. The RRs of metabolic syndrome being compared in people with or without sarcopenic obesity were 1.31 in men (95% CI, 1.10 to 1.56, p=0.003) and 1.17 in women (95% CI, 1.10 to 1.25, p<0.001), which were likewise found to be statistically significant relationships. Conclusions: The associations of sarcopenia defined in terms of muscle mass and sarcopenic obesity with metabolic syndrome were statistically significant in both men and women. Therefore, sarcopenia and sarcopenic obesity must be considered as part of the community-based management of non-communicable diseases.

• 지역사회간호학회지
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• 제29권1호
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• pp.108-119
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• 2018

Purpose: The purpose of this study is to estimate the prevalence of the metabolic syndrome in pre-menopausal housewives and to explore controllable and uncontrollable factors regarding metabolic syndrome. Methods: The study population of this cross-sectional survey was from the Korean Health and Nutrition Examination Survey (KHANES) 2010 through 2015, including the fifth and sixth population-based studies. The criteria for metabolic syndrome include waist circumference, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein (HDL) based on Korean Clinical Practice Guideline for Metabolic Syndrome by the Korean Academy of Family Medicine 2015. Results: Among the 2,498 subjects, 247 subjects had metabolic syndrome and the prevalence was estimated to be 9.9%. The number of subjects who met the criterion of HDL was 936 (36.2%), which was the most prevalent among the criteria for metabolic syndrome. Statistically significant (p<.05) factors include age, livinghood benefit group, perceived health status, obesity, family history of DM, sleeping time, awareness of stress,leukocyte, and erythrocyte count. The odds ratio of obesity in the BMI ${\geq}25$ group was 12.59 times as high as that of the BMI <25 group (p<.001) for metabolic syndrome. Conclusion: The prevalence of metabolic syndrome in pre-menopausal housewives in the survey was not low, and it is necessary to develop and apply comprehensive health habit management programs to improve controllable factors including exercise and food intake.

• Childhood Kidney Diseases
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• 제15권2호
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• pp.107-115
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• 2011

소아에서 급성 신손상의 흔한 원인들로는 신허혈, 신독성 약물들, 그리고 패혈증 등이 있으며, 신대체요법 시작시의 저혈압, 신대체 요법 동안 승압제의 사용, 그리고 신대체 요법 시작시의 수액 과부하 정도가 환자의 생존(소아 중환자실 퇴원)에 영향을 미치는 요인들로 알려져 있다. 지속적 신대체 요법의 빠른 시작은 급성 신손상을 가진 환자들에게서 사망률과 예후에 나쁜 영향을 미치는 수액 과부하를 감소시키는 것으로 보고되었다. 이에 저자들은 소아 환자에게서 지속적 신대체 요법의 실제 처방과 급성 신손상, 수액 과부하, 그리고 지속적 신대체 요법간의 연관성 및 치료결과를 살펴보고자 한다. 결론적으로, 급성 신손상을 가진 소아의 치료에 있어서 과도한 수액 과부하가 발생하기 전에 빠른 지속적 신대체 요법의 시작이 필요하다고 제시하는 바이다.

• 기본간호학회지
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• 제25권2호
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• pp.120-133
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• 2018

Purpose: A meta-analysis was conducted to evaluate effectiveness of education programs using video recording and feedback in the improvement of competency in clinical skills for health care majors. Methods: Six databases were searched and inclusion criteria were randomized controlled trials (RCTs) or non-randomized controlled trials (NRTs) reporting level of skill competency using numerical measurements. Data analysis and synthesis were performed using Comprehensive Meta-Analysis software and Revman program. Results: Of 1,568 records, 11 studies met inclusion criteria. Statistically significant effectiveness of education programs using video recording and feedback was identified. A low risk of bias was detected among both RCTs and NRTs. Meta-analysis showed that the intervention groups had more effective improvements in skill competency (standardized mean difference [SMD]: 0.74; 95% CI: 0.33~1.16). Results of subgroup analysis showed higher effects when interventions dealt with one skill, used self-reflection with expert feedback, and included instruction from instructor in the education programs. Conclusion: Findings suggest that schools for health care majors should actively adopt video and feedback based skill training allowing educators to design effective programs. Potential is higher for students to achieve higher competency when they train with one skill at a time, use of instruction and receive feedback from experts.

• 한국정보통신학회논문지
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• 제18권4호
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• pp.973-985
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• 2014

본 연구는 자동차 정비업체의 설립 시에 고려해야할 입지선정요인을 선정하고 AHP(Analytic Hierarchy Process)를 이용해서 요인별로 상대적 중요도를 나타내는 가중치를 도출하는 연구이다. 자동차 정비업체는 매우 높은 설립비용이 발생함에도 불구하고 대부분은 경영자의 경험적 판단에 의지하여 입지를 선정하는 것이 현실이다. 또한 창업비용이 낮고 서비스 활동이 단순한 소규모 점포의 입지선정과 관련된 연구는 많이 진행되고 있으나 자동차 정비업체에 대한 입지선정의 연구와 사례는 부족하여 연구가 필요한 실정이다. 본 연구에서는 1급, 2급, 3급 정비업체별로 입지선정요인의 가중치를 도출하고 서로 비교분석해 보았다. 그 결과 정비업체별로 입지를 선정하는데 있어서 중요하게 고려해야할 요인이 차이가 있음을 알 수 있었다. 본 연구는 정비업체의 입지선정과 관련된 의사결정시에 발생할 수 있는 위험을 줄일 수 있도록 과학적인 방법을 제시한 것에 의의가 있다.

• Archives of Plastic Surgery
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• 제43권4호
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• pp.328-338
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• 2016

Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4-156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.3-8
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• 2020

Genital lymphedema (GL) is an uncommon and disabling disease that manifests as enlargement of the genital region resulting from the disturbance of lymphatic drainage. Although conservative treatment such as decompression is typically the first-line approach, surgical intervention has been shown to be effective in certain cases. This study aimed to systematically review studies evaluating available surgical alternatives for the treatment of male GL. A systematic search strategy using keyword and subject headings was applied to PubMed, Scopus, EMBASE, and Cochrane Library in May 2019. Studies investigating various surgical techniques to treat penile and scrotal lymphedema were included. The potential risk of bias of included trials was evaluated using the methodological index for non-randomized studies (MINORS). In total, 13 studies met the inclusion criteria, nine of which were determined to be high-quality. The average MINORS score was 12.45 for studies involving excision and 14 for studies involving lymphovenous anastomosis (LVA). The most common reason for a low score was a failure to describe the inclusion criteria. Recurrence of lymphedema during follow-up was reported in four studies involving excision and in no studies involving LVA. In general, the quality of the included literature was considered to be fair. Although surgical intervention might not always prevent the recurrence of lymphedema, all of the studies reported improved quality of life after the procedure. This study could be used as the basis for evidence-based guidelines to be applied in clinical practice for managing male GL.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.102-109
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• 2018

Background: A sians were known to have a relatively lower incidence of venous thromboembolism (VTE), and there is insufficient evidence to suggest a specific D-dimer threshold level for screening VTE in patients with acute stroke. Methods: We prospectively enrolled patients with acute ischemic stroke admitted to Jeju National University Hospital. The inclusion criteria were: 1) aged ${\geq}18$ years, 2) admission within seven days of symptom onset, and 3) an initial National Institute of Health Stroke Scale (NIHSS) score >1 for the affected lower limb. Ultrasound scans of the lower limbs and plasma D-dimer assays were performed on days 7-14 and 15-28 after stroke onset. Results: Of 285 patients admitted during the study period, 52 patients met inclusion criteria (mean age 74.5, male 40.4%, median initial NIHSS score 12, and unable to walk unassisted at discharge 76.9%). During 7-14 days, 23 of 52 patients (44.2%) had a D-dimer level above 1.57 mg/L, and 9.6% had a level above 5.50 mg/L. Proximal deep vein thrombosis (DVT) was detected in 3 patients (5.8%, 95% confidence Interval 1.2-16.0%) on ultrasound examination. All DVTs were found in elderly female patients with severe leg weakness. No patient was diagnosed with pulmonary embolism during the study period. Conclusion: The incidence of VTE seems to be very low among Korean patients with acute ischemic stroke. Advanced age, female sex, and severe leg weakness were important risk factors for developing DVT in this study.