• 한국임상약학회지
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• 제32권3호
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• pp.251-259
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• 2022

Background: Intravenous fluid therapy is one of the most common interventions in critically ill patients. Normal saline is frequently used, but there have been some concerns about hyperchloremia. Due to closer to plasma composition, crystalloids have been used as alternatives to normal saline. However, the optimal choice of resuscitative fluids remains controversial. Methods: MEDLINE, EMBASE, and CENTRAL were comprehensively searched until July 2021 to compare balanced crystalloids with normal saline in critically ill patients with the risk factors for multiple organ dysfunction syndromes (MODS).The primary endpoint was composite mortality. Secondary outcomes were acute kidney injury (AKI)/acute renal failure (ARF), and new receipt of renal replacement therapy (RRT). Results: A total of 1,240 studies were searched, and finally, 8 randomized controlled trials and 5 cohort studies were included. In the meta-analysis of composite mortality of 30,710 patients, balanced crystalloids compared to normal saline were significantly associated with reduced mortality (OR 0.80, 95% CI 0.68-0.95). In AKI/ARF, balanced crystalloids had a lower risk than normal saline (OR 0.91, 95% CI 0.84-0.99). There was no difference between balanced crystalloids and normal saline in risk of new receipt of RRT (OR 0.91, 95% CI 0.80-1.04). Conclusion: In fluid resuscitation for patients at high risk of MODS, the use of balanced crystalloids showed a significantly lower incidence of mortality compared to normal saline.

• Journal of Radiation Protection and Research
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• 제49권1호
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• pp.50-64
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• 2024

Background: The reference dose coefficients (DCs) of the International Commission on Radiological Protection (ICRP) have been widely used to estimate organ doses of individuals for risk assessments. This approach has been well accepted because individual anatomy data are usually unavailable, although dosimetric uncertainty exists due to the anatomical difference between the reference phantoms and the individuals. We attempted to quantify the individual variation of organ doses for photon external exposures by calculating and comparing organ DCs for 30 individuals against the ICRP reference DCs. Materials and Methods: We acquired computed tomography images from 30 patients in which eight organs (brain, breasts, liver, lungs, skeleton, skin, stomach, and urinary bladder) were segmented using the ImageJ software to create voxel phantoms. The phantoms were implemented into the Monte Carlo N-Particle 6 (MCNP6) code and then irradiated by broad parallel photon beams (10 keV to 10 MeV) at four directions (antero-posterior, postero-anterior, left-lateral, right-lateral) to calculate organ DCs. Results and Discussion: There was significant variation in organ doses due to the difference in anatomy among the individuals, especially in the kilovoltage region (e.g., <100 keV). For example, the red bone marrow doses at 0.01 MeV varied from 3 to 7 orders of the magnitude depending on the irradiation geometry. In contrast, in the megavoltage region (1-10 MeV), the individual variation of the organ doses was found to be negligibly small (differences <10%). It was also interesting to observe that the organ doses of the ICRP reference phantoms showed good agreement with the mean values of the organ doses among the patients in many cases. Conclusion: The results of this study would be informative to improve insights in individual-specific dosimetry. It should be extended to further studies in terms of many different aspects (e.g., other particles such as neutrons, other exposures such as internal exposures, and a larger number of individuals/patients) in the future.

• Journal of Microbiology and Biotechnology
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• 제28권3호
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• pp.498-502
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• 2018

Molecular imaging is a powerful method for tracking various infectious disease-causing pathogens in host organisms. Currently, a dual molecular imaging method that can provide temporal and spatial information on infected hosts at the organism, organ, tissue, and cellular levels simultaneously has not been reported for Burkholderia pseudomallei, a high-risk pathogen that causes melioidosis. In this study, we have established an experimental method that provides spatiotemporal information on infected hosts using luminescent and fluorescent dual-labeled B. pseudomallei. Using this method, we visualized B. pseudomallei infection at the organism, organ, and tissue levels in a BALB/c mouse model by detecting its luminescence and fluorescence. The infection of B. pseudomallei at the cellular level was also visualized by its emitted fluorescence in infected macrophage cells. This method could be an extremely useful and applicable tool to study the pathogenesis of B. pseudomallei-related infectious diseases.

• 대한방사선치료학회지
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• 제31권2호
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• pp.33-41
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• 2019

목 적: 용적변조회전 방사선치료(Volumetric Modulated Arc Therapy, VMAT)시, Planning Target Volume(PTV)을 중복 설정하여 손상위험장기(Organ At Risk, OAR)에 인접한 PTV Coverage 감소를 개선하기 위한 연구이다. 대상 및 방법: 본원에서 전뇌(Whole Brain), 담낭(Gall Bladder), 직장(Rectum) 방사선치료를 받은 환자를 대상으로 하였으며, PTV 내 Coverage가 부족한 부분에 PTV를 중복 적용한 치료계획과 적용하지 않은 치료계획으로 구성하여 Coverage 변화와 최대선량, 선량균질지수(Homogeneity Index, H.I.), 처방선량지수(Conformity Index, C.I.)를 비교하였으며, 손상위험장기(Organ At Risk, OAR)의 최대선량과 평균선량의 변화 또한 비교하였다. 결 과: 중복하여 적용한 PTV의 Coverage는 모든 환자에게서 증가하였고, 이에 따른 영향으로 전체 Coverage 또한 4명의 환자에게서 증가하였다. PTV의 최대선량은 5명의 환자에게서 증가하였으며, 모든 환자의 선량균질지수와 처방선량지수는 큰 차이를 나타내지 않았다. 수정체의 최대선량은 최대 1.12배 증가하였으나, 뇌줄기의 경우 2명의 환자에게서 최대선량이 감소하였다. 안구의 평균선량은 최대 1.15배 증가하였으며, 양측 이하선의 경우 큰 차이를 나타내지 않았다. 담낭암 환자의 경우 간과 결장의 평균선량은 각각 0.95배, 0.94배 감소하였으며, 십이지장의 평균선량은 큰 차이가 없었다. 직장암 환자의 경우 OAR로 설정한 양측 대퇴골두와 방광 모두 평균선량은 감소하였으며, 전체 MU는 1명을 제외한 4명의 환자에게서 비슷한 수준으로 나타났다. 결 론: OAR의 선량제한을 고려해가면서 적절하게 사용한다면, PTV의 Coverage 개선에 유용한 방법이라 생각한다.

• Korean Journal of Radiology
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• 제25권5호
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• pp.481-492
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• 2024

Objective: To evaluate the clinical and imaging characteristics of SARS-CoV-2 breakthrough infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Materials and Methods: This retrospective study analyzed consecutive adult patients hospitalized for COVID-19 who received at least one dose of the SARS-CoV-2 vaccine at two academic medical centers between June 2021 and December 2022. Immunocompromised patients (with active solid organ cancer, active hematologic cancer, active immune-mediated inflammatory disease, status post solid organ transplantation, or acquired immune deficiency syndrome) were compared with immunocompetent patients. Multivariable logistic regression analysis was performed to evaluate the effect of immune status on severe clinical outcomes (in-hospital death, mechanical ventilation, or intensive care unit admission), severe radiologic pneumonia (≥ 25% of lung involvement), and typical CT pneumonia. Results: Of 2218 patients (mean age, 69.5 ± 16.1 years), 274 (12.4%), and 1944 (87.6%) were immunocompromised an immunocompetent, respectively. Patients with active solid organ cancer and patients status post solid organ transplantation had significantly higher risks for severe clinical outcomes (adjusted odds ratio = 1.58 [95% confidence interval {CI}, 1.01-2.47], P = 0.042; and 3.12 [95% CI, 1.47-6.60], P = 0.003, respectively). Patient status post solid organ transplantation and patients with active hematologic cancer were associated with increased risks for severe pneumonia based on chest radiographs (2.96 [95% CI, 1.54-5.67], P = 0.001; and 2.87 [95% CI, 1.50-5.49], P = 0.001, respectively) and for typical CT pneumonia (9.03 [95% CI, 2.49-32.66], P < 0.001; and 4.18 [95% CI, 1.70-10.25], P = 0.002, respectively). Conclusion: Immunocompromised patients with COVID-19 breakthrough infection showed an increased risk of severe clinical outcome, severe pneumonia based on chest radiographs, and typical CT pneumonia. In particular, patients status post solid organ transplantation was specifically found to be associated with a higher risk of all three outcomes than hospitalized immunocompetent patients.

• 대한방사선기술학회지:방사선기술과학
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• 제43권5호
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• pp.337-341
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• 2020

Although the screening with a mammography has been shown to be economical, simple and effective in detecting breast cancer, it is accompanied by the risk from radiation. Therefore, this study analyzed the glandular dose and organ dose according to the target-filter combination and the presence and absence of implants using Monte Carlo simulation. The results indicate that at a tube voltage of 30 kV and a tube current of 50 mAs, the dose increased in the order of Mo/Mo. Mo/Rh, Rh/Rh and W/Rh in proportion to the atomic number of the target-filter. In addition, in phantom without implant a reduction in dose was seen when compared to the phantom with implant. The organ dose was highest in the lens except for the breast on the examination side regardless of the presence or absence of the implant. These results may contribute to use basic data for the diagnostic reference level of breast plastic surgery patients.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.8009-8013
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• 2015

Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were $11.6{\pm}1.8g/dL$ and $11.7{\pm}1.7g/dL$, respectively; and the nadir Hb level post operation and the final Hb level before discharge were $8.3{\pm}1.6g/dL$ and $10.2{\pm}1.6g/dL$, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

• Childhood Kidney Diseases
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• 제15권1호
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• pp.1-13
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• 2011

Hypertension is a major risk factor of atherosclerosis which results in cardiovascular disease, and remains a major health problem worldwide. While children are more likely to have secondary hypertension, recent studies support the theory that the prevalence of essential hypertension in children and adolescents is increasing with the global epidemic of childhood obesity, and close attention is needed. Evaluation of hypertension in the pediatric age group should be guided by the age at presentation, and renal diseases must be considered in every child with hypertension, because of the prevalence of renovascular and renal parenchymal disorders as the etiology in any age group. The majority of children with chronic kidney disease are hypertensive, and many have associated end organ damage. Thus, once hypertension has been confirmed, end organ care as well as pharmacologic therapy must be continued. In renovascular hypertension, as cure could be gained with surgical/endovascular intervention, accurate diagnosis is important and it is recommended that every suspected child should undergo angiography.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.522-529
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• 2013

Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.

• 한국방사선학회논문지
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• 제16권6호
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• pp.709-718
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• 2022

본 연구의 목적은 토모테라피 방사선치료에서 고밀도 알루미늄, 티타늄, 강철 금속 삽입물에 대한 단층촬영(CT)을 평가하고 자 하였다. 다양한 밀도의 원통형 막대를 포함한 금속 삽입물과 함께 원통형 토모팬텀을 이용하여 영상을 얻었다. 총 세 가지의 CT 영상에 대해 평균 CT 값(number)와 표준 편차를 구하고, 치료계획 선량평가도 수행하였다. 고밀도 금속 삽입물이 CT값과 변화가 가장 컸다. 타겟에 대한 선량평가(적합성 지수, CI)에서 반복적 금속 인공물 감소 알고리즘(iMAR)이 적용된 영상이 그렇지 않은 영상에 비해 약 20% 좋았으나 유의한 차이는 없었다. iMAR은 표적 및 장기의 묘사에 도움을 주고 토모테라피를 이용한 3차원 입체조형 방사선치료기술(3D-CRT)에서 불확실성을 줄이는 데 도움이 될 것으로 사료된다.