• Journal of Yeungnam Medical Science
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• 제23권2호
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• pp.205-212
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• 2006

연구 배경: 고립성 폐결절의 30%~40%는 악성결절의 가능성이 높다. 따라서 고립성 폐결절의 악성감별이 무엇보다 중요하다. 최근 PET/CT가 악성 감별에 널리 사용되며, 또한 그 중요성이 커지고 있다. 이 연구의 목적은 integrated PET/CT의 여러 인자들을 비교하여 고립성 폐결절의 악성 여부를 구별하는데 유용한 지표를 찾기 위한 것이다. 재료 및 방법: 2005년 12월부터 2006년 4월까지 3 cm 미만의 고립성 폐결절로 내원한 환자 19명을 대상으로 하였다. 환자는 integrated PET/CT의 최대 SUV는 FDG 주입 후 1 시간, 2 시간에 측정하였다. 또한 대상 환자 모두 경피세침술로 조직검사를 하였다. Levene's test를 이용하여 integrated PET/CT에서, 조직검사로 확인된 양성결절과 악성결절의 SUV1, SUV2, 보존지수(retention index)의 차이를 비교하였다. 성적: 조직검사 결과 12명이 악성결절로 확인되었고, 7명은 양성결절로 진단되었다. SUV1(p=0.006)과 SUV2(p=0.022)는 양성결절보다 악성결절에서 높았으며 이들 값은 통계적으로 유의하였으나 보존지수는 유의한 차이가 없었다(p=0.526). ROC 곡선을 이용한 양성결절과 악성결절을 구분하는 기준값은 SUV1은 5.40, SUV2는 7.45였다. 이때 SUV1의 민감도는 66.7%, 특이도는 71.4%였으며, SUV2의 민감도는 75%, 특이도는 71.4%였다. 결론: 이상의 결과로 integrated PET/CT에서 일반적으로 널리 사용하고 있는 SUV1은 양성결절과 악성결절을 구별하는데 있어 유용하다는 것을 확인할 수 있었고, 아직 많이 연구되지 않은 SUV2 또한 통계학적으로 의미 있는 차이를 보임을 알 수 있었다. 양성결절과 악성결절을 구분하는 기준값은 각각 5.40, 7.45였다. 연구결과 고립성 폐결절의 악성여부를 구별하는데 SUV1, SUV2 모두 유용하게 사용될 수 있으나 SUV2가 SUV1에 비교하여 특이도는 같으나 더 높은 민감도를 나타내었다.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.67-73
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• 2006

Purpose: The arterial base deficit (BD) has proven to be useful in the evaluation and management of trauma patients. Indicators such as the Triage-Revised Trauma Score (t-RTS) and the systemic inflammatory response syndrome (SIRS) score have been used as triage tools for emergency trauma patients in Korea. The purpose of this study was to assess the usefulness of the initial BD in predicting injury severity and outcome in the trauma population. Methods: The medical records of 308 consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from January 2004 to December 2004 were carefully examined prospectively and retrospectively, and 291 patients were selected as subjects for this research. The SIRS score and the t-RTS were calculated based on the records from the emergency department, and the BD was calculated based on the arterial blood gas analysis obtained within 30 minutes of admission. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two - by - two matrices and by using a receiver operating characteristic (ROC) curve analysis. Results: When the mortality was used as the outcome parameter, the sensitivity and the accuracy of the initial BD were higher than those of the SIRS score (p<0.05) and were same as those of the t-RTS. The areas under the ROC curves of the initial BD, the SIRS score, and the t-RTS were $0.740{\pm}0.087$, $0.696{\pm}0.082$, and $0.871{\pm}0.072$, respectively (95% confidence interval). When emergency operation and blood transfusion requirements were used as outcome parameters, the comparisons of the sensitivities and the accuracies of the initial BD and the other two indicators showed the same pattern as mentioned above. The areas under the ROC curves of the initial BD were 0.7~0.8 and were larger than those of the SIRS score (p<0.05). Conclusion: The ability of the initial BD to predict injury severity and outcome was similar to those of the t-RTS and the SIRS score. Therefore, the authors suggest that the initial BD may be used as an alternative to previous triage tools for trauma patients.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.140-144
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• 2017

Purpose: The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI). Methods: A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP). Results: The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were $24.2{\pm}6.1$ and $5.4{\pm}0.8$, respectively. The mean ONSD of the TBI group ($5.5{\pm}1.0mm$) was higher than that of the non-TBI group ($4.7{\pm}0.6mm$). Some significant differences in age ($55.3{\pm}18.1$ vs. $49.0{\pm}14.8$, p<0.001), GCS ($11.7{\pm}4.1$ versus $13.3{\pm}3.0$, p<0.001), and ONSD ($5.5{\pm}1.0$ vs. $4.7{\pm}0.6$, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912. Conclusions: An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.1861-1864
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• 2016

Although early diagnosis of thyroid nodule type is very important, the diagnostic accuracy of standard tests is a challenging issue. We here aimed to find an optimal combination of factors to improve diagnostic accuracy for distinguishing malignant from benign thyroid nodules before surgery. In a prospective study from 2008 to 2012, 345 patients referred for thyroidectomy were enrolled. The sample size was split into a training set and testing set as a ratio of 7:3. The former was used for estimation and variable selection and obtaining a linear combination of factors. We utilized smoothly clipped absolute deviation (SCAD) logistic regression to achieve the sparse optimal combination of factors. To evaluate the performance of the estimated model in the testing set, a receiver operating characteristic (ROC) curve was utilized. The mean age of the examined patients (66 male and 279 female) was $40.9{\pm}13.4years$ (range 15- 90 years). Some 54.8% of the patients (24.3% male and 75.7% female) had benign and 45.2% (14% male and 86% female) malignant thyroid nodules. In addition to maximum diameters of nodules and lobes, their volumes were considered as related factors for malignancy prediction (a total of 16 factors). However, the SCAD method estimated the coefficients of 8 factors to be zero and eliminated them from the model. Hence a sparse model which combined the effects of 8 factors to distinguish malignant from benign thyroid nodules was generated. An optimal cut off point of the ROC curve for our estimated model was obtained (p=0.44) and the area under the curve (AUC) was equal to 77% (95% CI: 68%-85%). Sensitivity, specificity, positive predictive value and negative predictive values for this model were 70%, 72%, 71% and 76%, respectively. An increase of 10 percent and a greater accuracy rate in early diagnosis of thyroid nodule type by statistical methods (SCAD and ANN methods) compared with the results of FNA testing revealed that the statistical modeling methods are helpful in disease diagnosis. In addition, the factor ranking offered by these methods is valuable in the clinical context.

• Pediatric Infection and Vaccine
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• 제24권1호
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• pp.1-6
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• 2017

목적: 본 연구에서는 delta neutrophil index (DNI)가 신생아 균혈증을 예측하는 지표로서의 효용성을 다른 지표들과의 비교를 통해 알아보고자 하였다. 방법: 원주세브란스 기독병원 신생아 중환자실에 발열을 주소로 입원한 환아들과 입원 중 발열이 있었던 생후 31일 미만 환아 146명을 대상으로 혈액배양검사와 동시에 시행한 총 백혈구 수, 절대호중구수, DNI, 혈소판 수, C-반응단백(C-reactive protein, CRP)에 대하여 분석하였다. 결과: 균혈증이 있었던 환아 77명의 평균 재태주수는 38.74주, 출생 체중은 3.20 kg였다. 대조군의 평균 재태주수는 33.34주, 출생 체중은 2.20 kg였다. 균혈증의 원인은 Staphylococcus aureus (22명), Staphylococcus epidermidis (18명), Streptococcus agalactiae (8명) 등이었다. DNI와 CRP만이 재태주수와 출생 체중 보정 후 균혈증과 연관성을 보여 area under the ROC curve를 조사하였고 DNI 0.70, CRP 0.68이었다. 결론: DNI는 신생아 균혈증을 예측하는 데 효과적인 지표이다. 다른 인자들과 함께 고려한다면 균혈증을 예측하는 데 더 도움이 될 것이다.

• Journal of Radiation Protection and Research
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• 제35권1호
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• pp.43-48
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• 2010

방사선의 선질은 X선관의 target에 따라 결정된다. 유방검사의 경우 Molybdenum target을 사용하는데 22~28 kV 범위에서 평균 17.9~19.5 keV의 Mo 특성에너지를 얻어 유방의 high contrast 영상을 얻을 수 있다. 따라서 본 연구에서는 최근 대부분의 유방 검사장치에 이용되는 Mo/Mo 조합 유방장치의 미세병변 탐지능력을 측정하기 위하여 ALVIM TRM 팬텀을 이용하여 그 기초적인 실험으로 획득한 영상을 ROC(receiver operating characteristic) curve를 통해 분석하였다. 유방의 평균 피사체 두께가 40 mm로 가정하고 kV와 mAs, 그리고 두께변화에 따른 질환 검출능력을 실험한 결과, kV 변화에서는 Speck과 Fiber의 병소 검출능력이 거의 차이를 보이지 않은 것으로 나타났으며, mAs와 피사체두께 변화에서는 많은 차이를 보이는 것으로 나타났다. 즉, 유방의 피사체 평균두께인 약 40 mm에서는 관전압 변화가 병소의 검출능력에 많은 영향을 끼치지 않으므로 평균 두께의 피사체에서는 관전압을 높여서는 안된다.

• Clinical and Experimental Reproductive Medicine
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• 제38권3호
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• pp.153-158
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• 2011

Objective: The aim of this study was to investigate whether anti-M$\ddot{u}$llerian hormone (AMH) levels could be predict ovarian poor/hyper response and IVF cycle outcome. Methods: Between May 2010 and January 2011, serum AMH levels were evaluated with retrospective analysis. Three hundred seventy infertile women undergoing 461 IVF cycles between the ages of 20 and 42 were studied. We defined the poor response as the number of oocytes retrieved was equal or less than 3, and the hyper response as more than 25 oocytes retrieved. Serum AMH was measured by commercial enzymelinked immunoassay. Results: The number of oocytes retrieved was more correlated with the serum AMH level (r=0.781, $p$ <0.01) than serum FSH (r=-0.412, $p$ <0.01). The cut-off value of serum AMH levels for poor response was 1.05 ng/mL (receiver operating characteristic [ROC] curves/area under the curve [AUC], $ROC_{AUC}$=0.85, sensitivity 74%, specificity 87%). Hyper response cut-off value was 3.55 ng/mL $ROC_{AUC}$=0.91, sensitivity 94%, specificity 81%). When the study group was divided according to the serum AMH levels (low: <1.05 ng/mL, middle: 1.05 ng/mL - 3.55 ng/mL, high: >3.55 ng/mL), the groups showed no statistical differences in mature oocyte rates (71.6% vs. 76.5% vs. 74.8%) or fertilization rates (76.9% vs. 76.6% vs. 73.8%), but showed significant differences in clinical pregnancy rates (21.7% vs. 24.1% vs. 40.8%, $p$=0.017). Conclusion: The serum AMH level can be used to predict the number of oocytes retrieved in patients, distinguishing poor and high responders.

• Asian Spine Journal
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• 제12권6호
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• pp.1085-1091
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• 2018

Study Design: Case-control. Purpose: To determine optimal cut-off value for body mass index (BMI) in predicting surgical success in patients with lumbar spinal canal stenosis (LSCS). Overview of Literature: BMI is an essential variable in the assessment of patients with LSCS. Methods: We conducted a prospective study with obese and non-obese LSCS surgical patients and analyzed data on age, sex, duration of symptoms, walking distance, morphologic grade of stenosis, BMI, postoperative complications, and functional disability. Obesity was defined as BMI of ${\geq}30kg/m^2$. Patients completed the Oswestry Disability Index (ODI) questionnaire before surgery and 2 years after surgery. Surgical success was defined as ${\geq}30%$ improvement from the baseline ODI score. Receiver operating characteristic (ROC) analysis was used to estimate the optimal cut-off values of BMI to predict surgical success. In addition, correlation was assessed between BMI and stenosis grade based on morphology as defined by Schizas and colleague in total, 189 patients were eligible to enter the study. Results: Mean age of patients was $61.5{\pm}9.6years$. Mean follow-up was $36{\pm}12months$. Most patients (88.4%) were classified with grades C (severe stenosis) and D (extreme stenosis). Post-surgical success was 85.7% at the 2-year follow-up. A weak correlation was observed between morphologic grade of stenosis and BMI. Rates of postoperative complications were similar between patients who were obese and those who were non-obese. Both cohorts had similar degree of improvement in the ODI at the 2-year followup. However, patients who were non-obese presented significantly higher surgical success than those who were obese. In ROC curve analysis, a cut-off value of ${\leq}29.1kg/m^2$ for BMI in patients with LSCS was suggestive of surgical success, with 81.1% sensitivity and 82.2% specificity (area under the curve, 0.857; 95% confidence interval, 0.788-0.927). Conclusion: This study showed that the BMI can be considered a parameter for predicting surgical success in patients with LSCS and can be useful in clinical practice.

• 대한소아치과학회지
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• 제49권2호
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• pp.131-139
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• 2022

이번 연구는 소아의 인접면 우식을 진단하는데 있어 사용하고 있는 구내방사선 사진에서 심층학습(deep learning) 알고리즘을 활용하여 치아우식을 진단하는 모델의 성능을 평가하고자 하였다. 제1유구치와 제2유구치 사이의 인접면이 포함된 500개의 구내방사선 사진을 대상으로 연구를 시행하였다. 치아우식을 진단하는 모델의 학습에는 Resnet50 기반의 인공신경망 모델을 사용하였다. 평가자료군에서 진단모델의 정확도, 민감도, 특이도를 구하고, ROC 곡선을 얻어 AUC 값을 바탕으로 분류 모델의 성능을 평가하였다. 학습 모델의 정확도는 0.84, 민감도는 0.74, 특이도는 0.94로 나타났으며 AUC는 0.86으로 나타났다. 인공신경망을 기반으로 하는 소아의 구내방사선 사진에서의 인접면 우식의 진단 모델은 비교적 높은 정확도를 보여주었다. 심층학습 모델은 구내방사선 사진상에서 인접면 우식을 진단하는데 있어 향후 치과의사를 보조하는 진단 도구로서 활용될 수 있을 것이다.

• Animal Bioscience
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• 제36권9호
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• pp.1336-1349
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• 2023

Objective: The study was conducted to screen differentially expressed miRNAs in sows at early pregnancy by high-throughput sequencing and explore its mechanism of action on embryo implantation. Methods: The blood serum of pregnant and non-pregnant Landrace×Yorkshire sows were collected 14 days after artificial insemination, and exosomal miRNAs were purified for high throughput miRNA sequencing. The expression patterns of 10 differentially expressed (DE) miRNAs were validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The qRT-PCR quantified the abundance of serum exosomal miR-192 in pregnant and control sows, and the diagnostic power was assessed by receiver operating characteristic (ROC) analysis. The target genes of DE miRNAs were predicted with bioinformatics software, and the functional and pathway enrichment analysis was performed on gene ontology and the Kyoto encyclopedia of genes and genomes terms. Furthermore, a luciferase reporter system was used to identify the target relation between miR-192 and integrin alpha 4 (ITGA4), a gene influencing embryo implantation in pigs. Finally, the expression levels of miRNAs and the target gene ITGA4 were analyzed by qRT-PCR, and western blot, with the proliferation of BeWo cells detected by cell counting kit-8 (CCK-8). Results: A total of 221 known miRNAs were detected in the libraries of the pregnant and non-pregnant sows, of which 55 were up-regulated and 67 were down-regulated in the pregnant individuals compared with the non-pregnant controls. From these, the expression patterns of 10 DE miRNAs were validated. The qRT-PCR analysis further confirmed a significantly higher expression of miR-192 in the serum exosomes extracted from pregnant sows, when compared to controls. The ROC analysis revealed that miR-192 provided excellent diagnostic accuracy for pregnancy (area under the ROC curve [AUC]=0.843; p>0.001). The dual-luciferase reporter assay indicated that miR-192 directly targeted ITGA4. The protein expression of ITGA4 was reduced in cells that overexpressed miR-192. Overexpression of miR-192 resulted in the decreased proliferation of BeWo cells and regulated the expression of cell cycle-related genes. Conclusion: Serum exosomal miR-192 could serve as a potential biomarker for early pregnancy in pigs. miR-192 targeted ITGA4 gene directly, and miR-192 can regulate cellular proliferation.