• 대한두경부종양학회지
• /
• 제19권1호
• /
• pp.9-15
• /
• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• 한방비만학회지
• /
• 제13권1호
• /
• pp.33-45
• /
• 2013

Objectives: This study was aimed to find out the characteristics of ordinary symptoms between the control and patient groups, diagnosed as overweight or obesity, in Soyang, Taeeum, and Soeum Constitutions and among those 3 groups. Methods: As a prospective cross-sectional study based on medical records, 9213 patients, who visited Kyung Hee University Medical Center from May in 2007 to June in 2010, were included. To diagnose the constitution, Revised Questionnaire for the Sasang Constitution Classification II and examinations by oriental medical doctors who majored in Sasang Constitution Medicine were performed. Based on the World Health Organization criteria for Asian obesity assessment, body mass index (BMI) was classified into 3 groups; more than 25 as obesity, 23 to 25 as overweight, and less than 23 as normal. Ordinary symptoms questionnaire, which consists of 46 questions in 8 categories, were given to the subjects. One-way ANOVA test in continuous variables and chi-square test in categorical variables were carried out to analyze statistical significance. Results and Conclusions: 1) In general characteristics, we could find out the significant differences in age, sex, height, weight, BMI, waist circumference, blood pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, fasting blood sugar, and hemoglobin A1c among the 3 Constitutional groups. 2) Soyang Constitution of overweight and obesity has tendency to have higher appetite, like cool or cold water, defecate more, swear more, dislike heat, and have warmer or hotter extremities in the ordinary symptoms, compared with the control group. 3) Taeeum Constitution of overweight and obesity has tendency to have higher appetite, like cool or cold water, defecate more, swear more, dislike heat, and have warmer or hotter extremities in the ordinary symptoms, compared with the control group. 4) Soeum Constitution of overweight and obesity has tendency to have higher appetite and less fatigue in the ordinary symptoms, compared with the control group. 5) Soeum Constitution showed the slightest increase in appetite, preference about room temperature water, less number of feces, and feeling of chill and warmer extremities in ordinary symptoms, compared with Soyang and Taeeum Constitutions. Taeeum Constitution showed the distinct increase in appetite and sweating in ordinary symptoms, compared with Soyang and Soeum Constitutions.

• Asian Spine Journal
• /
• 제12권6호
• /
• pp.1060-1068
• /
• 2018

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

• 한국전자거래학회지
• /
• 제24권1호
• /
• pp.105-120
• /
• 2019

세계보건기구(WHO)를 비롯해 세계 각국의 정부기관은 항생제 오남용에 따른 항생제 내성균 감염에 대해 심각하게 경고하며 이를 예방하기 위한 관리와 감시를 강화하고 있다. 하지만 감염을 확인하기 위한 감염균 배양에 수일의 시간이 소요되면서 격리와 접촉주의를 통한 감염확산 방지 효과가 떨어져 선제적 조치를 위한 신속하고 정확한 예측 및 추정방법이 요구되고 있다. 본 연구는 Electronic Health Records에 포함된 질병 진단내역과 항생제 처방내역을 neural embedding model과 matrix factorization을 통해 embedding 하였고, 이를 활용한 딥러닝 기반분류 예측 모형을 제안하였다. 항생제 내성균 감염의 주요 원인인 질병과 항생제 정보를 embedding하여 환자의 기본정보와 병원이용 정보에 추가했을 때 딥러닝 예측 모형의 f1-score는 0.525에서 0.617로 상승하였고, 딥러닝 모형은 Super Learner와 같은 기존 기계학습 모형보다 더 나은 성능을 보여주었다. 항생제 내성균 감염환자의 특성을 분석한 결과, 감염환자는 동일한 질병을 진단받은 비감염환자에 비교해 J01 계열 항생제 사용이 많았고 WHO 권고기준(DDD)을 크게 벗어나는 오남용 청구사례가 6.3배 이상 높게 나타났으며 항생제 오남용과 항생제 내성균 감염간의 높은 연관성이 발견되었다.

• PNF and Movement
• /
• 제16권3호
• /
• pp.485-493
• /
• 2018

Purpose: This study provides a treatment for central nervous system development in patients with chronic stroke by investigating changes in the upper limb function over time. The correlations among the activities, participation, and environmental factors of the international classification of functioning (ICF), disability and health are also examined. Methods: The subjects of this study are 18 patients with chronic stroke who were hospitalized and treated at 00 hospital in the Chungcheongbuk-do province. Their upper extremity functions are evaluated using the manual function test (MFT). The activities, participation, and environmental factors are evaluated using the ICF generic form. The correlations between the total scores of the affected and unaffected sides and the ICF items are analyzed using the Pearson correlation analysis. The significance level is p<0.05. Results: When the correlations between the activities and participation areas of ICF and the total score of the affected side of MFT were examined, significant correlations (p<0.05) were found in the following items: changing basic body position (D410), lifting and carrying objects (D430), moving around using equipment (D465), using transportation (D470), washing oneself (D510), caring for body parts (D520), and dressing (D540). When the correlations between the activities and participation areas of ICF and the total score of the unaffected side of MFT were examined, significant correlations (p<0.05) were found among writing (D170), speaking (D330), eating (D550), and drinking (D560). In addition, when the correlation between the environment area of ICF and the total score of the unaffected side of the MFT were examined, significant correlations (p<0.05) were found between products and technology for personal use in daily living (E115) and immediate family (E310). Conclusion: The MFT of patients with chronic stroke is closely correlated with the activities, participation, and environmental factors of ICF. This result suggests that ICF can be used as a useful tool to comprehensively evaluate the abilities of the patient, including the upper extremity function.

• 대한정형외과학회지
• /
• 제55권4호
• /
• pp.331-337
• /
• 2020

목적: 지방육종의 치험 예들을 분석하여 생존율에 영향을 미치는 예후 인자를 밝히고, 향후 효과적인 치료의 접근에 도움이 되고자 한다. 대상 및 방법: 2002년부터 2015년까지 지방육종으로 진단, 치료받은 환자 총 45예 중 고분화 지방육종 4예를 제외한 41예를 분석하였다. 성별, 나이, 발생 부위, 병기, 조직학적 분류, 방사선 치료, 항암 화학 치료 등이 무병 생존율에 미치는 영향에 대한 후향적 연구를 시행하였다. 점액성 지방육종으로 진단된 28예에 대해서는 원형세포 성분 포함 여부에 따른 분석을 추가로 진행하였다. 결과: 진단 시 평균 연령은 52.05세(25-82세), 평균 추시 기간은 63.7개월이었으며, 평균적인 무병 생존율은 41.7%였다. 점액성 지방육종의 경우 무병 생존율은 43.2%였다. 분석 결과 나이, 발생 부위 조직학적 분류 등은 무병 생존율에 영향을 미치지 못하였으나 병기(Musculoskeletal Tumor Society stage)와 성별에서 통계적으로 유의한 연관을 나타내었다. 점액성 지방육종에 대해서는 원형세포 성분에 따른 결과의 차이를 보이지 않았다. 결론: 지방육종의 병기와 환자의 성별이 예후에 영향을 미치는 유효한 인자로 나타났다. 지방육종은 여러 예후 인자들에 의해 치료 결과에 차이를 보이므로, 치료에 있어 이러한 점을 고려하여야 한다.

• Journal of Periodontal and Implant Science
• /
• 제51권6호
• /
• pp.398-408
• /
• 2021

Purpose: In this study, we aimed to evaluate the clinical validity of the modified tunneling technique using minimal soft tissue harvesting and volume-stable collagen matrix in the anterior mandible. Methods: In total, 27 anterior mandibular teeth and palatal donor sites in 17 patients with ≥1 mm of gingival recession (GR) were analyzed before and after root coverage. For the recipient sites, vertical vestibular incisions were made in the interdental area and a subperiosteal tunnel was created with an elevator. After both sides of the marginal gingiva were tied to one another, a prepared connective tissue graft and volume-stable collagen matrix were inserted through the vestibular vertical incision and were fixed with resorbable suture material. The root coverage results of the recipient site were measured at baseline (T₀), 3 weeks (T₃), 12 weeks (T₁₂), and the latest visit (T_l). For palatal donor sites, a free gingival graft from a pre-decided area avoiding the main trunk of the greater palatine artery was harvested using a prefabricated surgical template at a depth of 2 mm after de-epithelization using a rotating bur. In each patient, the clinical and volumetric changes at the donor sites between T₀ and T₃ were measured. Results: During an average follow-up of 14.5 months, teeth with denuded root lengths of 1-3 mm (n=12), 3-6 mm (n=11), and >6 mm (n=2) achieved root coverage of 97.01%±7.65%, 86.70%±5.66%, and 82.53%±1.39%, respectively. Miller classification I (n=12), II (n=10), and III (n=3) teeth showed mean coverage rates of 97.01%±7.65%, 86.91%±5.90%, and 83.19%±1.62%, respectively. At the donor sites, an average defect depth of 1.41 mm (70.5%) recovered in 3 weeks, and the wounds were epithelized completely in all cases. Conclusions: The modified tunneling technique in this study is a promising treatment modality for overcoming GR in the anterior mandible.

• 대한임상검사과학회지
• /
• 제54권4호
• /
• pp.239-248
• /
• 2022

임상미생물학 분야에서 세균의 분류는 끊임없이 변화하는 상태에 있다. 무산소성 세균의 대규모 분류와 명명법은 지난 수십년 동안 발생되었는데, 주로 16S rRNA 염기서열 분석 및 전체 게놈 염기서열(WGS) 분석과 같은 분자 기술의 발전 때문이다. 새로운 균속과 균종이 추가되었고, 기존 균종과 균속은 재분류되었거나 재명명되었다. 임상미생물검사실의 주요 역할은 임상적으로 중요한 세균의 정확한 동정 및 적절한 감수성 시험, 그리고 신속한 보고 및 임상의와의 의사 소통이다. 무산소성 세균의 분류학적 변화는 진단적으로 적절한 보고 항균제의 선택과 항균제 감수성 해석 기준의 적용에 잠정적으로 영향을 미칠 수 있다. 이는 신흥 병원성 무산소성 세균의 항균제 내성 및 잘못된 동정은 환자 치료에 있어서 부적절한 경험적 치료를 유발할 수 있기 때문이다. 따라서, 임상미생물검사실은 주기적으로 무산소성 세균의 분류학적 변경 사항을 업데이트하고, 임상의에게 이러한 변경 사항을 적절하게 알려야 한다. 이 논문에서는 임상적으로 중요한 무산소성 세균의 분류에 관한 업데이트을 제시하였고, 이전의 균명 또는 동의어을 함께 기술하였다. 무산소성 세균의 분류 업데이트는 무산소성 세균 감염에 대한 항균제 요법을 안내하고, 치료 실패를 예방하는데 임상미생물검사실과 임상의 모두에게 도움이 될 수 있다.

• Korean Journal of Radiology
• /
• 제22권5호
• /
• pp.751-758
• /
• 2021

Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis. Materials and Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error. Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively. Conclusion: Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제7권1호
• /
• pp.40-47
• /
• 2004

목 적: 효율적인 진단과 치료 및 적절한 의학적 교류를 목적으로 소아 위장관 알레르기 질환의 새로운 분류법이 발표되었다(J Pediatr Gastroenterol Nutr 2000;30:S87-94). 그러나 명칭과 분류의 변경으로 이미 알려진 질환들이 새로운 질환으로 보고되기도 하는데, 저자들은 새로운 분류법에 따른 소아 위장관 알레르기 질환의 질병군에 관하여 알아보고, 국내에서 이미 보고된 관련 문헌을 함께 고찰하여 의학적 교류에 혼선을 최소화 하고자 한다. 방 법: 2003년 3월부터 7월까지 계명대학교 의과대학 소아과를 방문하여, 우유 유발 및 제거시험, 내시경을 이용한 조직생검 등을 이용하여 소아 GI-CMA로 진단된 37례(남 19, 여 18)를 대상으로 후향성 조사하였다. 새로운 분류에는 포함되지 않았으나 위식도역류 관련 알레르기를 추가하였다. 국내 문헌은 소아과학회지, 소아소화기영양학회지, 소아알레르기호흡기학회지를 근거로 고찰하였다. 결 과: 1) 대상 환아의 연령은 2주~15개월, 평균 $5.4{\pm}4.8$개월이었다. 2) 출생체중은 전례에서 10~90백분위수를 차지하였으며, 25~75백분위수가 25례(68%)를 차지하였다. 내원 당시 체중은 3백분위수 이하가 18례(49%)이었다. 3) 증상발현에서 진단까지 걸린 시간은 2주~12개월, 평균 $2.4{\pm}3.3$개월이었다. 4) IgE 군인 IgE 매개형 우유알레르기(IGE) 6례(16%), IgE와 Non-IgE 혼합군인 호산구성 위장관염(EOS) 2례(5%), Non-IgE군인 전형적 우유 단백질 유발 장관염(CMPIE-T) 7례(19%), 비전형적 우유 단백질 유발 장관염(CMPIE-AT) 5례(14%), 알레르기성 대장염(AC) 12례(32%)이었다. 위식도역류증 관련 우유 알레르기(GERA)는 5례(14%)이었다. CMPIE-T 전례에서 소장 조직생검상 장병증이 관찰되었다. 5) 진단 당시 연령은 IGE $4.3{\pm}0.8$개월, EOS 생후 2주와 14개월, CMPIE-T $3.8{\pm}4.6$개월, CMPIE-AT $10.4{\pm}3.8$개월, AC $3.4{\pm}3.9$개월, GERA $7.8{\pm}5.7$개월로 질환군간 유의한 차이를 보였다(p<0.05). 6) 내원 당시 3백분위수 이하를 보인 경우가 IGE 17%, EOS 0%, CMPIE-T 86%, CMPIE-AT 60%, AC 25%, GERA 100%로 질환군간 유의한 차이를 보였다(p<0.05). 7) 국내 문헌을 고찰하여 소아 위장관 우유 알레르기 질환은 만성설사, 난치성설사, 우유 불내성, 우유 알레르기, 위장관 알레르기, 우유 과민성 장병증, 호산구성 위장관염, 알레르기성 대장염 등의 용어로 보고되었다. 결 론: 새로운 분류법에 따른 소아 위장관 우유 알레르기 질환은 연령, 임상 증상, 위장관 침범 부위에 따라 특징적인 유형으로 구분할 수 있으며, 임상적으로 드물지 않다. 국내의 문헌을 통하여 다양한 용어로 각 유형의 알레르기 질환들은 연구 보고되어 왔다.