• Journal of Trauma and Injury
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• 제25권4호
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• pp.247-253
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• 2012

Purpose: Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival. Methods: This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test. Results: Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not. Conclusion: The ISS was a prognostic factor for trauma patients with massive bleeding.

• 대한방사선기술학회지:방사선기술과학
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• 제42권3호
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• pp.187-194
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• 2019

The purpose of this study was to evaluate the pathologic results of hepatic parenchyma parameters such as liver parenchyma, liver surface, liver margin and liver, portal vein, spleen size, And to evaluate the usefulness of fibrosis progression and hepatic ultrasonography. The sensitivity, specificity, positive predictive value, and prognostic value according to the stage of fibrosis and grade of inflammation were divided into two groups according to the morphologic variable "A" through ultrasound and "B" We evaluated the predictive value and predicted the variables to evaluate fibrosis in clinical diagnosis and treatment of patients with chronic liver disease. The sensitivity and specificity of hepatic fibrosis in hepatic morphologic variables and other size variables were highest in liver surface and edge. The morphologic parameters used in the evaluation of fibrosis were clinically relevant in distinguishing the fibrosis stage from the results of liver biopsy.

• 한국전문물리치료학회지
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• 제29권3호
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• pp.200-207
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• 2022

Background: The oxygen uptake efficiency slope (OUES) is the most important index for accurately measuring cardiopulmonary function in patients with acute ischemic heart disease. However, the relationship between the OUES variables and important cardiopulmonary function parameters remain unelucidated for patients with acute ischemic heart disease, which accounts for the largest proportion of heart disease. Objects: The present cross sectional clinical study aimed to determine the multiple relationships among the cardiopulmonary function variables mentioned above in adults with acute ischemic heart disease. Methods: A convenience sample of 110 adult inpatients with ischemic heart disease (age: 57.4 ± 11.3 y; 95 males, 15 females) was enrolled at the hospital cardiac rehabilitation center. The correlation between the important cardiopulmonary function indicators including peak oxygen uptake (VO₂ peak), minute ventilation (VE)/carbon dioxide production (VCO₂) slope, heart rate recovery (HRR), and ejection fraction (EF) and OUES was confirmed. Results: This study showed that OUES was highly correlated with VO₂ peak, VE/VCO₂ slope, and HRR parameters. Conclusion: The OUES can be used as an accurate indicator for cardiopulmonary function. There are other factors that influence aerobic capacity besides EF, so there is no correlation with EF. Effective cardiopulmonary rehabilitation programs can be designed based on OUES during submaximal exercise in patients with acute ischemic heart disease.

• Journal of Hospice and Palliative Care
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• 제1권1호
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• pp.30-38
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• 1998

배경: 간암은 우리나라에 흔한 암으로 암등록 자료($1991{\sim}1992$)에 의하면 암발생율 3위, 암에 의한 사망 원인 중 2위를 차지한다. 암환자에서 환자의 생존기간을 예측하는 것은 환자의 진료에서 환자 자신이나 가족, 의료진에게 매우 중요하다고 생각된다. 본 연구는 간암 환자에서 환자의 생존 기간을 예측할 수 있는 예후 인자를 찾아 간암 환자의 진료에 도움이 되고자 하였다. 방법: 1995년 1월부터 6월 사이에 연세대학교 의과대학 부속 영동세브란스 병원에 간암으로 입원한 환자 91명(남자 73명, 여자 18명)을 대상으로 의무기록을 통해 입원 당시 임상적인 특성 28가지를 조사하였으며, 의무기록과 동사무소 기록을 가지고 1996년 7월 31일까지 추적하여 생존 여부를 확인하였다. Cox proportional hazard model을 이용하여 임상적 특성 중 사망위험도를 높이는 유의한 변수를 얻은 후 이를 예후 인자로 삼았다. 이것을 life regression analysis을 통해 예후 인자 각각이 존재할 때의 생존 기간 및 동반된 예후 인자 갯수에 따른 생존 기간을 예측하였다. 결과: 1) 원발성 간암 91명 중 남자가 73명(80.2%), 여자가 18명(19.8%)이며, 평균 연령은 $56.7{\pm}10.6$세이었고, 추적 불가능한 사람 16명을 제외한 75%명중 그 기간 사이에 사망한 사람이 57명(76%), 생존한 사람이 18명(24%)이었다. 2) 임상적인 특성 중 프로트롬빈 시간(prothrombin time) 40% 미만(RR: relative risk. 10.8), 체중감소(RR. 4.4), 고혈압의 과거력(RR. 3.2), 복수(RR. 2.8), 저칼슘혈증(RR. 2.5)인 경우가 환자의 사망위험도의 유의한 예후 인자였다(P<0.01). 3) 사망위험도 예후 인자 5가지가 모두 있는 경우는 생존 기간이 1.7일, 4가지만 있는 경우는 $4.2{\sim}10.0$일, 3가지만 있는 경우는 $10.4{\sim}41.9$일, 2가지만 있는 경우는 $29.5{\sim}118.1$일, 1가지만 있는 경우는 $124.0{\sim}296.6$일, 모두 없는 경우는 724.0일이었다. 결론: 간암 환자에서 프로트롬빈 시간의 연장(<40%), 체중감소 고혈압의 과거력, 복수, 저칼슘혈증(<8.7mg/dl) 등의 순으로 높은 사망위험도를 예측하게 하는 유의한 인자임을 알 수 있었고, 동반된 예후인자의 갯수로써 생존 기간을 예측할 수 있을 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권9호
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• pp.3915-3920
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• 2014

Background: Hepatocellular carcinoma (HCC) is a dismal tumor with a high incidence, prevalence and poor prognosis and survival. Management of HCC necessitates multidisciplinary clinics due to the wide heterogeneity in its presentation, different therapeutic options, variable biologic behavior and background presence of chronic liver disease. We studied the different prognostic factors that affected survival of our patients to improve future HCC management and patient survival. Materials and Methods: This study is performed in a specialized multidisciplinary clinic for HCC in Kasr El Eini Hospital, Cairo University, Egypt. We retrospectively analyzed the different patient and tumor characteristics and the primary mode of management applied to our patients. Further analysis was performed using univariate and multivariate statistics. Results: During the period February 2009 till February 2013, 290 HCC patients presented to our multidisciplinary clinic. They were predominantly males and the mean age was $56.5{\pm}7.7years$. All cases developed HCC on top of cirrhosis that was mainly due to HCV (71%). Most of our patients were Child-Pugh A (50%) or B (36.9%) and commonly presented with small single lesions. Transarterial chemoembolization was the most common line of treatment used (32.4%). The overall survival was 79.9% at 6 months, 54.5% at 1 year and 22.4% at 2 years. Serum bilirubin, site of the tumor and type of treatment were the significant independent prognostic factors for survival. Conclusions: Our main prognostic variables are the bilirubin level, the bilobar hepatic affection and the application of specific treatment (either curative or palliative). Multidisciplinary clinics enhance better HCC management.

• Asian Pacific Journal of Cancer Prevention
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• 제16권5호
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• pp.2055-2060
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• 2015

Purpose: To present information about prognostic factors of gastric cancer patients treated in our Erzurum center including age, gender, tumour location, pathological grade, stage and the effect of treatment on survival. Materials and Methods: This retrospective study was performed on patients who applied to our clinic and diagnosed as gastric cancer. Age and gender of the patients, primary location, histopathological characteristics, TNM stage of the gastric cancers (GCs), treatment applied, oncological treatment modalities and survival outcomes were studied. A univariate analysis of potential prognostic factors was performed with the log-rank test for categorical factors and parameters with a p value < 0.05 at the univariate step were included in the multivariate regression. Results: A total of 228 patients with a confirmed diagnosis of gastric cancer were included in the study with a male/female ratio of 1.47. Median follow-up period was estimated as 22.3 (range, 3 to 96) months. When diagnosis of the patients at admission was analysed, stage III patients were most frequently encountered (n=147; 64.5%). One hundred and twenty-six (55.3%) underwent surgical treatment, while 117 (51.3%) were given adjuvant chemotherapy. Median overall survival time was 18.0 (${\pm}1.19$) months. Mean overall survival rates for 1, 2, 3 and 5 years were $68{\pm}0.031%$, $36{\pm}0.033%$, $24{\pm}0.031%$and $15.5{\pm}0.036%$, respectively. Univariate variables found to be significant for median OS in the multivariate analysis were evaluated with Cox regression analysis. A significant difference was found among TNM stage groups, location of the tumour and postoperative adjuvant treatment receivers (p values were 0.011, 0.025 and 0.001, respectively). Conclusions: This study revealed that it is possible to achieve long-term survival of gastric cancer with early diagnosis. Besides, in locally advanced GC patients, curative resection followed by adjuvant concomitant chemoradiotherapy based on the McDonald regimen was an independent prognostic factor for survival.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.419-422
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• 2013

Conventional classifications of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rather unsatisfactory because of the variation in survival within each subgroup. Molecular markers are being found able to predict patient outcome in more and more tumours. The aim of this study was to characterize the expression of the proteins cyclin D1, cyclin E and P53 in GEP-NETs and assess any prognostic impact. Tumor specimens from 68 patients with a complete follow-up were studied immunohistochemically for cyclin D1, cyclin E and P53 expression. High cyclin D1 and cyclin E immunostaining (${\geq}$ 5% positive nuclei) was found in 48 (71%) and 24 (35%) cases, and high P53 staining (${\geq}$ 10% positive nuclei) in 33 (49%). High expression of P53 was more common in gastric neuroendocrine tumors and related to malignant behavior, being associate with a worse prognosis on univariate analysis (RR=1.9, 95%CI=1.1-3.2). High expression of cyclin E was significantly associated with shorter survival in the univariate analysis (RR=2.0, 95%CI=1.2-3.6) and multivariate analysis (RR=2.1, 95%CI=1.1-4.0). We found no significant correlation between the expression of cyclin D1 and any clinicopathological variables. Our study indicated a prognostic relevance for cyclin E and P53 immunoreactivity. Cyclin E may be an independent prognostic factor from the 2010 WHO Classification which should be evaluated in further studies.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6935-6940
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• 2013

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.

• Clinical and Experimental Pediatrics
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• 제50권5호
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• pp.443-448
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• 2007

목 적 : 급성 폐손상이 있는 소아에서 혈액 응고 과정에서 중요한 역할을 하는 AT-III의 예후인자로서의 의미를 확인하고자 대상 환자에서 진단 초기의 AT-III 값을 측정하고 사망여부에 따라 AT-III 값을 비교 분석하고 지금까지 알려진 여러 예후인자들과 비교 분석하였다. 방 법 : 2004년 6월부터 2005년 12월까지 18개월 동안 서울대학교병원 소아중환자실에 입원한 198명의 환자 중 급성 폐손상의 정의를 만족하고 기계적 환기요법을 받은 21명의 환자를 대상으로 인구의학적인 변수와 기저질환, 초기 안정화 이후의 호흡지수들, 기계적 환기요법의 여러 설정 등을 측정하였다. 중환자실 입원 24시간 이내의 PRISM-III 점수, LIS 점수를 측정하였고 입원 3시간 내의 AT-III 값을 측정하였다. 사망여부에 따라 두 군으로 분류한 후 예후인자를 비교분석하였고, PRISM-III 값과 AT-III 값에 대해서는 상관관계와 회귀분석을 함께 시행하였다. 단변수 분석에서 사망여부에 따라 통계적으로 유의한 변수에 대해서 중회귀 분석을 시행하여 상대위험도를 측정하였다. 결 과 : 18개월 동안 198명이 입원하였고 21명의 환자가 진단기준을 만족하였다. 남자가 13명(61.9%)였고 연령은 5(1-14)세였다. 급성 폐손상이 발생한 장소가 병원이 아닌 경우가 33.3%였고 기저질환이 폐 병변인 경우가 66.7%였다. 대상 환자 중 AT-III 값이 70% 이하인 경우가 10명(42.9%)이였고 8명의 환자가 사망하여 사망률은 38.1%였다. 사망에 따른 두 군 간의 비교에서 초기 안정화 이후 동맥혈 pH와 $PaO_2/FiO_2$는 사망한 환자군에서 유의하게 더 낮았고, OI와 호기말 양압은 사망한 환자군에서 유의하게 더 높았다. 폐 유순도는 사망한 환자군에서 유의하게 더 낮았다. LIS와 PRISM-III는 사망한 환자군에서 모두 유의하게 높았고 AT-III는 사망한 환자군에서 유의하게 더 낮았다. AT-III와 PRISM-III 값은 유의한 상관관계를 보였다. 중회귀분석에서 PRISM-III, LIS, OI는 모두 다른 변수에 독립적으로 유의한 사망의 위험인자였으며 70% 미만으로 정의한 AT-III 감소는 급성 폐손상 환자에서 다른 변수에 독립적으로 사망의 유의한 위험인자였다(OR 2.725, 95% CI 1.284-4.119). 결 론 : 급성 폐손상으로 기계적 환기요법을 시행 받은 소아환자를 대상으로 한 본 연구에서 초기 AT-III 값은 PRISM-III 값과 유의한 상관관계를 보였으며, 또한 사망한 환자군에서 AT-III 값이 유의하게 더 낮았고 이것은 다른 위험인자의 영향을 보정한 상태에서도 독립적인 사망의 위험인자였다. 이로써 AT-III가 급성 폐손상의 유의한 조기 예후 예측인자라는 것을 확인하였으며 향후 급성 폐손상/급성 호흡부전증후군 환자에서 응고장애를 정상화 할 수 있는 처치들이 예후를 향상시킬 수 있을 가능성을 제시하였다.

• 한국환경과학회지
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• 제6권5호
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• pp.425-435
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• 1997

One-dimensional thermodynamic mixed layer model to stimulate variations of meteorological variables wish the planetary boundary layer has been developed In this study. This model consists of 2 prognostic equations, which can predict the variations of potential temperature and mixing ratio and several diagnostic equations. Physics within the surface and mixed layers has been considered seperately in the model. For the variations of the model, Its result has been analysed and compared with observated data over Ole Dukyang Bay for one day, July 23, 1992. The simulated height of mixed layer is comparable to the observation and the variations of temperature and mixing ratio in the mixed layer are also reasonably simulated. Those Imply that the model responds appropriately with given boundary conditions In sprite of Its simplilfied assumptions applied to the model and insufficient boundary and Initial conditions.