• 정신신체의학
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• 제30권2호
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• pp.155-164
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• 2022

연구목적 많은 선행 연구들은 제2형 당뇨병과 알츠하이머병이나 파킨슨병과 같은 단일의 신경퇴행성 질환과의 연관성을 보고하고 있다. 본 연구는 다양한 신경퇴행성 질환을 가진 집단(ND군)과 대조군 간에 제2형 당뇨병의 발생률을 조사하여 신경퇴행성 질환과 제2형 당뇨병 발생의 연관성을 조사하고자 한다. 방 법 국민건강보험공단 맞춤형 데이터베이스 자료를 이용하여 60-84세의 노인 인구집단을 ND군과 대조군으로 분류한 뒤 이들을 후향적으로 10년간 추적관찰 하면서 제2형 당뇨병의 발생 빈도와 발생 시까지 생존시간을 평가하였다. 연구 대상자는 ND군 8,814명과 대조군 37,970명이었다. 카플란-마이어 생존 분석과 다변량 콕스 비례 위험 모형을 이용하여 생존 곡선과 위험비를 구하였다. 결 과 ND군에서 제2형 당뇨병의 발생 비율(53.6%)이 대조군(44.7%)에 비해 유의하게 높았다. ND군은 대조군과 비교하여 제2형 당뇨병의 발생 위험성이 1.4배 증가하였다(HR, 1.43; 95% CI, 1.38-1.47). 연구 대상자 중 약 1/3은 10년의 추적 기간 동안에 제2형 당뇨병이 발생하기 전에 다른 신경퇴행성 질환들이 추가로 진단되었다. 두 군 모두에서, 추적 기간 동안에 다른 신경퇴행성 질환이 추가로 진단된 경우에 그렇지 않은 경우보다 제2형 당뇨병의 발생률이 더 높았다. 결 론 ND군은 대조군에 비해 제2형 당뇨병의 발생 위험도가 약 1.4배 높았으며 신경퇴행성 질환과 제2형 당뇨병 발생은 정적인 상관관계를 보였다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2539-2543
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• 2016

Background: In the Barcelona Clinic Liver Cancer (BCLC) system, only sorafenib is suggested for HCC patients having performance status (PS) 1 or 2 even if they have treatable lesions. In the current study, we aimed to explore the outcome of using aggressive treatment for HCC patients with PS 1 and 2. Materials and Methods: Five hundred and twenty four patients with HCC were enrolled in this study and divided into 2 groups: 404 PS 1 and 120 PS 2. Of the included 524 patients, 136 recceived non-aggressive supportive treatment and sorafenib, while 388 patients were offered aggressive treatment in the form of surgical resection, transplantation, percutaneous ablation, trans-arterial chemoembolization and/or chemoperfusion. All the patients were followed up for a period of 2 years to determine their survival. Results: Most HCC patients were CHILD A and B grades (89.4% versus 85.0%, for PS1 and PS2, respectively). Patients with PS1 were significantly younger. Out of the enrolled 524 patients, 388 were offered aggressive treatment, 253 (65.2%) having their lesions fully ablated, 94 (24.2%) undergoing partial ablation and 41 patients with no ablation (10.6%). The median survival of the patients with PS 1 who were offered aggressive treatment was 20 months versus 9 months only for those who were offered supportive treatment and sorafenib (p<0.001). Regarding HCC patients with PS 2, the median survivals were similarly 19.7 months versus 8.7 months only (p<0.001). Conclusions: Aggressive treatment of HCC patients with PS 1 and 2 significantly improves their survival. Revising the BCLC guidelines regarding such patients is recommended.

• 한국산학기술학회논문지
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• 제15권11호
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• pp.6694-6701
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• 2014

저밀도 지단백과 폐 기능과의 상관관계를 살펴보고자 2001년 1월부터 2011년 12월까지 일개지역 대학병원의 건강증진 센터를 방문하여 2회 이상 검사를 시행한 40-49세의 폐경 전 여성을 대상으로 연구하였다. 최종 384명의 대상자를 LDL(mg/dL)을 기준으로 초기와 추적검사에서 모두 100미만인 A군, 초기 검사에서는 100미만이었으나 추적검사에서 100이상인 B군, 초기 검사에서는 100이상이었으나 추적검사에서 100미만인 C군, 초기와 추적검사 모두에서 100이상인 D군으로 나누었다. 네 군간 폐 기능 검사는 초기, 추적검사 모두 통계적으로 유의한 차이를 보이지 않았다. 나이, 체질량지수, 흡연, 운동, 추적기간을 보정하여 LDL 변화량과 폐 기능 변화량에 대해 다중회귀분석을 시행한 결과 $FEV_1/FVC$/FVC에 대해 유의한 음의 상관관계가 나타났고(${\beta}=-0.109$, S.E.=0.029, P<0.001), 그 외에는 유의한 결과를 보이지 않았다. 결론적으로 LDL과 폐기능 변화량은 음의 상관관계가 있으며, 향후 대규모의 연구가 필요하다.

• Clinical and Experimental Pediatrics
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• 제49권11호
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• pp.1167-1173
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• 2006

목 적 : 신생아 패혈증을 진단하기 위해 단독 그리고 복합적인 다양한 선별검사를 분석하기 위해 일신기독병원의 신생아집중치료실에서 2001년 4월 1일부터 2005년 12월 31일까지 68개월 동안 시행했다. 방 법 : 패혈증의 임상증상이 있는 100명의 신생아와 증상이 없는 정상 신생아를 대상으로 연구를 시행했다. 신생아 패혈증의 진단을 위해 CRP, 총 백혈구 수, 총 호중구 수, 미숙호중구/총호중구 비(I/T비), 혈소판 수, 호중구의 변성, 다형 핵 백혈구에 대한 GAC를 사용했다. 결 과 : CRP는 A군에서는 50례 중 40례에서(86%) 양성이었고 B군에서는 50례 중 37례에서(74%) 양성이었으며 특이도는 94%였다. 총 호중구 수는 민감도와 특이도가 각각 A군에서는 72%와 86%였고 B군에서는 62%와 86%로 단일 검사상 민감도가 두 번째로 높았다. A군에서 GAC와 혈소판 수에 대한 각각의 민감도는 74%와 64%였다. A군과 B군에 대해 검사를 개별적으로 시행했을 경우와 함께 시행했을 경우에 대한 민감도, 특이도, 그리고 예측도를 계산했다. 결 론 : CRP, 총 백혈구 수, 총 호중구 수, 혈소판 수, 호중구의 변성과 다형 핵 백혈구에 대한 GAC는 신생아 패혈증이 없는 배양 검사 상 음성인 경우를 알아내는데 높은 민감도를 나타냈다. 더욱이 3가지 검사를 함께 시행할 경우에 민감도가 증가했다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7975-7979
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• 2015

Purpose: This study aimed to explore the value of IHC4 in predicting pathological response after neoadjuvant chemotherapy in patients with hormonal receptor (HR)-positive breast cancer (BC). Materials and Methods: In this retrospective exploratory study, data for 68 HR-positive BC patients who received neoadjuvant chemotherapy were recorded. IHC4 scores were calculated based on estrogen receptors/progesterone receptors, Ki-67 and HER2 status. Logistic and ordinal regression analyses in addition to likelihood ratio test were used to explore associations of IHC4 scores and other clinico-pathological parameters with pathological complete response (pCR) and pathological stage. Results: Taking the 25th percentile as the cut-off, a lower IHC4 score was associated with an increased probability of pCR (low; 52.9% vs. High; 21.6%, OR=4.1, 95% CI=1.28-13.16, p=0.018) and a lower pathological stage (OR=3.9, 95% CI=1.34-11.33, p=0.012). When the IHC4 score was treated as a continuous variable, a lower score was again associated with an increased probability of pCR (OR=1.010, 95% CI=1.001-1.018, p=0.025) and lower pathological stage (OR=1.009, 95% CI=1.002-1.017, P=0.008). Lower clinical stage was associated with a better pCR rate that was of borderline significance (P=0.056). When clinical stage and IHC4 score were incorporated together in a logistic model, the likelihood ratio test gave a P-value of 0.004 after removal of the IHC4 score and 0.011 after removal of the stage, indicating a more significant predictive value of the IHC4 score for pCR. Conclusions: This study suggests that the IHC4 score can predict pathological response to neoadjuvant chemotherapy in HR-positive BC patients. This finding now needs to be validated in a larger cohort of patients.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4335-4340
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• 2016

Background: Bone metastasis is a single condition but presents with various patterns and severities. Skeletal-related events (SREs) deteriorate overall performance status and reduce quality of life. However, guidelines for early detection and management are limited. This study includes a survey of the prevalence of bone metastasis in cases with common cancers in Thailand as well as a focus on survival patterns and SREs. Materials and Methods: A retrospective cohort analysis was conducted using a database of the Chiang Mai Cancer Registry and the Musculoskeletal Tumor Registry of the OLARN Center, Chiang Mai University. The prevalence of bone metastasis from each type of primary cancer was noted and time-to-event analysis was performed to estimate cancer survival rates after bone metastasis. Results: There were 29,447 cases of the ten most common cancers in Thailand, accounting for 82.2% of the entire cancer registry entries during the study period. Among those cases, there were 2,263 with bone metastases, accounting for 7.68% of entries. Bone metastasis from lung, liver, breast, cervix and prostate are common in the Thai population, accounting for 83.4% of all positive cases. The median survival time of all was 6 months. Of the bone metastases, 48.9% required therapeutic intervention, including treatment of spinal cord and nerve root compression, pathological fractures, and bone pain. Conclusions: The frequency of the top five types of bone metastasis in Thailand were different from the frequencies in other countries, but corresponded to the relative prevalence of the cancers in Thailand and osteophilic properties of each cancer. The results of this study support the establishment of country specific guidelines for primary cancer identification with skeletal lesions of unknown origin. In addition, further clinical studies of the top five bone metastases should be performed to develop guidelines for optimal patient management during palliative care.

• 대한물리치료과학회지
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• 제27권2호
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• pp.25-35
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• 2020

Background: There are many situations where walking in an actual community needs to change direction along with walking on a straight path, and this situation needs to be reflected in assessing walking ability of the community. Therefore, in this study, we tried to determine whether the assessments can distinguish the level of walking in the community. Design: Retrospective cohort study. Methods: Fifty-two survivors with chronic stroke have participated in the study. According to the evaluation result of 10mWT, the subjects of 0.8m/s and above were classified as the group who could walk in the community (n=22), and the subjects of 0.4m/s~0.8m/s were classified into the group who could not walk in the community (n=30). Modified Rivermead Mobility Index, Postural Assessment Scale for Stroke, Fugl-Meyer Assessment, Berg Balance Scale, 10-meter Walk Test (10mWT) were used to evaluate the motor skills. Furthermore, Activities-specific Balance Confidence Scale was used to evaluate psychological factors, and Timed Up & Go Test (TUG), Figure-of-Eight Walk Test (F8WT), Four Square Step Test (FSST), Step Test (ST) were applied to evaluate dynamic balance and mobility. Results: As a result for distinguishing walking levels in the community, TUG was 14.25 seconds, F8WT was 13.34 seconds, FST was 19.43 seconds, and ST of affected side and non-affected side were 6.5 points and 7.5 points, respectively. TUG (AUC=0.923), F8WT (AUC=0.905), and FST (AUC=0.941) were highly accurate, but the ST of affected side and non-affected side (AUC=0.806, 0.705) showed the accuracy of the median degree, respectively. Conclusion: To distinguish walking levels in the community of survivors with chronic stroke, TUG and FSST have been found to be the best assessment tool, and in particular, FSST could be very valuable in clinical use as the most important assessment tool to distinguish walking levels in the community.

• 한국산학기술학회논문지
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• 제13권5호
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• pp.2219-2231
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• 2012

본 연구에서는 우리나라 30세 이상 성인들의 허혈성심장질환(ischemic heart disease, IHD) 발생률을 계산하고, 지질지표(콜레스테롤, 중성지방, 고밀도지단백콜레스테롤, 저밀도지단백콜레스테롤)가 허혈성심장질환 발생에 미치는 위험도를 파악하고자 19개 대학 및 종합병원의 건강검진센터에서 검진을 받은 417,642명을 대상으로 1993년 9월부터 2009년 6월까지 평균 8.5년동안 허혈성심장질환의 발생을 추적관찰하였다. 자료수집은 검진자들에 대한 설문조사지를 이용하였고, 허혈성심장질환의 발생여부는 국민건강보험공단의 데이터베이스에서 확인하였다. 발생률은 발생밀도로 계산하였고, 혈청지질 지표에 따른 허혈성심장질환의 발생 위험도는 콕스의 비례위험 회귀모형을 이용하여 연령, BMI, 생활양식을 보정한 상태에서 성별에 따른 위험요인별 위험비와 95% 신뢰구간을 계산하였다. 연구결과 TC/HDL 비의 증가에 따라 IHD의 발생 위험비는 남자에서 1.21배에서 1.84배까지, 여자는 1.26배에서 1.86배까지 증가하였으며, TG/HDL 비의 증가에 따른 IHD의 발생 위험비는 남자에서 1.17배에서 1.49배까지, 여자는 1.42배에서 1.97배까지, LDL/HDL 비에 따라 IHD의 발생 위험비는 남자에서 1.26배에서 1.82배까지, 여자는 1.26배에서 1.68배까지 증가하였다. 결론적으로 혈청지질지표는 심혈관질환의 중요한 위험요인으로 총콜레스테롤, 저밀도지단백콜레스테롤, 중성지방은 혈중 농도가 높을수록, 고밀도지단백콜레스테롤은 낮을수록 IHD의 위험이 높아지는 것으로 나타났고, TC/HDL 비, TG/HDL 비, LDL/HDL 비에서 단독의 지질지표보다 위험도가 더 높게 나타나는 경향이 있었다. 따라서 추후 허혈성 심장질환의 예방 및 관리에는 혈청지질지표의 비도 감안하여야 한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권3호
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• pp.191-196
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• 2020

Objectives: Beyond the original application approved by the U.S. Food and Drug Administration, recombinant human bone morphogenetic protein-2 (rhBMP-2) is used for medication-related osteonecrosis of the jaw (MRONJ) treatment because of its bone remodeling enhancement properties. The purpose of the study was to investigate the bone formation effect of rhBMP-2/absorbable collagen sponge (ACS) in patients with MRONJ. Materials and Methods: In this retrospective cohort study, 26 female patients diagnosed with MRONJ and who underwent mandibular sequestrectomy at Ajou University Dental Hospital from 2010 to 2018 were included. The experimental group was composed of 18 patients who received rhBMP-2/ACS after sequestrectomy, while the control group was composed of 8 patients who did not receive rhBMP-2/ACS after sequestrectomy. A total dose of 0.5 mg of rhBMP-2 was used in the experimental group at a concentration of 0.5 mg/mL. Follow-up panoramic X-rays were taken immediately after the surgery and more than 6 months after the surgery. Using those X-rays, a radiographic index of bone defect area was calculated using the modified Ihan Hren method, which measures radiographic density of the normal bone and the defect site. Results: This study suggests that rhBMP-2 contributes to new bone formation. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the experimental group was 68.4% and 79.8%, respectively. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the control group was 73.4% and 76.7%, respectively (Wilcoxon signed rank test, P>0.05). The mean radiographic index increased 11.4% in the experimental group and 3.27% in the control group (Mann-Whitney U-test, P<0.05). Conclusion: Based on the results, use of rhBMP-2/ACS on bone defect sites after sequestrectomy could be a successful strategy for treatment of MRONJ patients.

• 병원약사회지
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• 제35권4호
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• pp.418-429
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• 2018

Background : To improve medication adherence in elderly patients, the role of pharmacists in teambased services has been highlighted in the literature. However, not much is known about the role and the service elements involved in comprehensive geriatric programs in South Korea. This study was designed to describe the current status of medication adherence in geriatric patients based on the comprehensive geriatric assessment program and analyze the predictive factors for medication adherence in a tertiary teaching hospital. Methods : A retrospective cohort study was performed using electronic medical records of 247 patients from March 1st, 2015 to August 31st, 2015. Medication adherence and the types of non-adherence were also collected. Predictive factors for adherence were evaluated by including factors related to demographics, medications, illness, and patterns of medical usage. Results : The mean age of the study population was 81.2 years (range 65~98 years) and they were taking 9.7 drugs on an average (SD 5.0 drugs). The overall rate of non-adherence was 34%. About 48% of the patients had any forms of assistance in the medication administration. The most common type of non-adherence was "self-adjustment". The multivariate analyses revealed that age (adjusted odds ratio, 0.87 [95% CI, 0.80-0.96]; p 0.05) and the number of inappropriate medications (adjusted odds ratio, 0.59 [95% CI, 0.40-0.89]; p 0.05) were strong predictors for non-adherence. Conclusions : These results indicate that strategic considerations of the predictors of non-adherence should be improved in medication counseling services targeting elderly patients.