• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.450-457
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• 2019

Objective : Anterior cervical discectomy and fusion (ACDF) is commonly used surgical procedure for cervical degenerative disease. Among the various intervertebral spacers, the use of allografts is increasing due to its advantages such as no harvest site complications and low rate of subsidence. Although subsidence is a rare complication, graft collapse is often observed in the follow-up period. Graft collapse is defined as a significant graft height loss without subsidence, which can lead to clinical deterioration due to foraminal re-stenosis or segmental kyphosis. However, studies about the collapse of allografts are very limited. In this study, we evaluated risk factors associated with graft collapse. Methods : We retrospectively reviewed 33 patients who underwent two level ACDF with anterior plating using allogenous bone graft from January 2013 to June 2017. Various factors related to cervical sagittal alignment were measured preoperatively (PRE), postoperatively (POST), and last follow-up. The collapse was defined as the ratio of decrement from POST disc height to follow-up disc height. We also defined significant collapses as disc heights that were decreased by 30% or more after surgery. The intraoperative distraction was defined as the ratio of increment from PRE disc height to POST disc height. Results : The subsidence rate was 4.5% and graft collapse rate was 28.8%. The pseudarthrosis rate was 16.7% and there was no association between pseudarthrosis and graft collapse. Among the collapse-related risk factors, pre-operative segmental angle (p=0.047) and intra-operative distraction (p=0.003) were significantly related to allograft collapse. The cut-off value of intraoperative distraction ${\geq}37.3%$ was significantly associated with collapse (p=0.009; odds ratio, 4.622; 95% confidence interval, 1.470-14.531). The average time of events were as follows: collapse, $5.8{\pm}5.7months$; subsidence, $0.99{\pm}0.50months$; and instrument failure, $9.13{\pm}0.50months$. Conclusion : We experienced a higher frequency rate of collapse than subsidence in ACDF using an allograft. Of the various preoperative factors, intra-operative distraction was the most predictable factor of the allograft collapse. This was especially true when the intraoperative distraction was more than 37%, in which case the occurrence of graft collapse increased 4.6 times. We also found that instrument failure occurs only after the allograft collapse.

• 대한응급의학회지
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• 제29권6호
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• pp.679-686
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• 2018

Objective: The aim of this study was to identify the clinical characteristics and risk factors associated with the admission of patients in the emergency department (ED) within 30 days after discharge. Methods: A retrospective, observational study was conducted on adult patients presenting with abdominal pain to the ED of a single, urban, university hospital, between January 2014 and December 2015, who revisited the ED within 30 days after discharge. Data was collected on the emergency severity index level, time to contact doctors, physical examination, laboratory tests, use of computed tomography (CT), and patient disposition on revisitation. The primary outcome was hospital admission following an ED revisit in the 30-day period after the first visit. Results: During the study period, 19,480 patients visited the ED with the chief complaint of abdominal pain, and 13,577 were discharged. A total of 251 patients (1.29%) revisited the ED within 30 days, of which 89 were eligible for the study. The primary outcome was associated with not performing a CT scan on the initial visit and an increased C-reactive protein (CRP) value. Receiver operating characteristic curve analysis showed that a cut-off baseline CRP value of >0.35 mg/dL can predict the primary outcome with a sensitivity and specificity of 75% and 62.1%, respectively (area under the curve, 0.701; 95% confidence interval, 0.569-0.833; P=0.007). Conclusion: An increased CRP value and not performing abdominal CT were associated with a higher rate of admission following ED revisits of patients with abdominal pain. Future prospective studies on the role of abdominal CT imaging in patients presenting to the ED with abdominal pain will be needed.

• 고신대학교 의과대학 학술지
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• 제33권3호
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• pp.328-336
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• 2018

Objectives: Electrocardiograhy (ECG) is the first step in hypertrophic cardiomyopathy (HCMP) diagnosis. For various reasons, the T wave inversion (TWI) and ECG change with time and HCMP is not easy to diagnosis. The aim of this retrospective study was to investigate the association between TWI on ECG and apical HCMP. Methods: A total of 4,730 ECGs presenting TWI from January 2011 to March 2013 in Pusan National University Hospital were enrolled. 133 patients who were examined by both echocardiography and coronary angiogram were analyzed. Patients were divided into two groups: Group A (TWI ${\geq}$ 10 mm) and Group B (5 mm ${\leq}$ TWI < 10 mm). HCMP is defined by a wall thickness ${\geq}15mm$ in one or more LV myocardial segments. Apical HCMP is defined to be hypertrophy that is confined to LV apex. The patients who had ECGs with at least one month interval were divided 3 groups: Normal T wave, Abnormal T wave, and Persistent TWI. The prevalence of Apical HCMP and coronary artery disease (CAD) was reviewed among the three groups. Results: In this study there were a total 133 patients, with patients divided into Group A which had 15 patients and Group B which had 118 patients. Among the 23 patients with apical HCMP, three patients were Group A and twenty patients were Group B (P = 0.769). Regarding constancy of TWI, persistent TWI group was higher in apical HCMP than in other groups (P = 0.038). CAD had no difference between groups (P = 0.889). Conclusions: T wave negativity was not associated with incidence of apical HCMP. However, apical HCMP was diagnosed more frequently in patients with persistent TWI. Further follow up echocardiographic study is needed to evaluate the progression of apical HCMP in patients with TWI.

• 인지과학
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• 제32권3호
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• pp.117-139
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• 2021

짧은 시차를 두고 출현하는 기억과 검사배열 사이에 차이 항목의 유무를 찾아내는 변화탐지 원리는 검사배열 출현 시 기억항목들과 견주어 차이가 있는 한 항목을 탐색한다는 점에서 시각탐색 원리와 닮아있다. 본 연구는 두 과제 사이의 이러한 유사성을 배경으로, 시각단기기억 기반 변화탐지 과제에서 변화의 출현 가능성 증감이 변화탐지 반응의사결정에 미치는 영향 즉 변화출현확률 효과의 양상을 조사했다. 이를 위해 네 개의 색상 사각형에 뒤이어 출현한 또 다른 네 개의 색상 사각형 사이의 색상들을 비교해 색상 변화 항목의 유무를 판단하는 단순세부특징 변화탐지 과제를 실시했다. 변화 항목의 출현 가능성은 전체 시행 대비 20, 50 및 80% 확률로 처치되었으며 그에 따른 변화탐지 수행 오류와 탐지민감도 및 반응시간을 분석했다. 그 결과 변화 항목의 출현 가능성이 증가할수록 오경보는 증가하고 실수 반응은 감소했으며 정기각 반응시간 또한 지연된 것이 관찰되었다. 이 변화출현확률 효과는 시각탐색 과제에서 표적의 출현 가능성 증감에 따라 관찰되는 표적출현확률 효과와 매우 유사했으며 이는 두 효과를 초래하는 배경 원리가 서로 닮아있을 가능성을 시사한다.

• 한국환경복원기술학회지
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• 제24권1호
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• pp.69-80
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• 2021

The new town in Korea, developed as a large-scale housing plan, has created urban ecological corridors to provide habitat and movement routes to wildlife and to promote natural ecological flow. This study aimed to investigate the use of wildlife in 10 ecological corridors in Gwanggyo New Town through camera trap technology and confirm effectiveness by identifying environmental factors affecting the use of wildlife's urban ecological corridors. Our researchers installed 20 unmanned sensor cameras at each the entrance and exit of the ecological corridors, and monitored urban wildlife for 10 weeks. According to the monioring results, the main species in Gwanggyo New Town were identified not only raccons, cats, water deer, korean hare and avain but also magpies, dove, eurasian tree sparrow, ring-necked pheasant, and eurasian jay. The number of uses ecological corridors of urban residents was 801(13.49%), as high as that of urban wildlife (1,140, 19.20%), which was judged to have disturbed the use of ecological corridors by wildlife. However, most dominant species of urban wildlife are nocturnal so that, it was judged that they share home range with urban residents at a time interval. In addition, according to the correlation analysis results between the mammal using rate of the urban ecological corridors and environmental factors(ecological corridor-specific length, ecological corridor-specific width, cover degree, shielding degree, connected green area, separation of movement routes, and presence of streetlights), environmental factors were not statistically significant. However, the more the area of green space connected to ecological corridors, the more increasing the mammal using rate of ecological corridor(r=0.71, p<0.05). Therefore, the area of green space connected to the ecological corridors that is associated with rate of wildlife using corridors should be considered as a priority when developing an urban ecological corridors. In the future, this study will extend the observation period of the ecological corridors and continuously accumulate data by adding the number of observation cameras. Furthermore, it is expected that the results of this study can be used as basic data for the standards for urban ecological corridors installation.

• Obstetrics & gynecology science
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• 제61권6호
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• pp.662-668
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• 2018

Objective This study was to identify the risk factors for cytological progression in women with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL). Methods We analyzed data from women infected with the human papillomavirus (HPV) who participated in the Korean HPV cohort study. The cohort recruited women aged 20-60 years with abnormal cervical cytology (ASC-US or LSIL) from April 2010. All women were followed-up at every 6-month intervals with cervical cytology and HPV DNA testing. Results Of the 1,158 women included, 654 (56.5%) and 504 (43.5%) women showed ASC-US and LSIL, respectively. At the time of enrollment, 143 women tested positive for HPV 16 (85 single and 58 multiple infections). Cervical cytology performed in the HPV 16-positive women showed progression in 27%, no change in 23%, and regression in 50% of the women at the six-month follow-up. The progression rate associated with HPV 16 infection was higher than that with infection caused by other HPV types (relative risk [RR], 1.75; 95% confidence interval [CI], 1.08-2.84; P=0.028). The cytological progression rate in women with persistent HPV 16 infection was higher than that in women with incidental or cleared infections (P<0.001). Logistic regression analysis showed a significant relationship between cigarette smoking and cytological progression (RR, 4.15; 95% CI, 1.01-17.00). Conclusion The cytological progression rate in HPV 16-positive women with ASC-US or LSIL is higher than that in women infected with other HPV types. Additionally, cigarette smoking may play a role in cytological progression.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.125-133
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• 2021

Background: The coronavirus disease (COVID-19) can manifest in a range of symptoms, including both asymptomatic systems which appear nearly non-existent to the patient, all the way to the development of acute respiratory distress syndrome (ARDS). Specifically, COVID-19-associated pneumonia develops into ARDS due to the rapid progression of hypoxia, and although arterial blood gas analysis can assist in halting this deterioration, the current environment provided by the COVID-19 pandemic, which has led to an overall lack of medical resources or equipment, has made it difficult to administer such tests in a widespread manner. As a result, this study was conducted in order to determine whether the levels of oxygen saturation (SpO₂) and the fraction of inhaled oxygen (FiO₂) (SF ratio) can also serve as predictors of ARDS and the patient's risk of mortality. Methods: This was a retrospective cohort study conducted from February 2020 to Mary 2020, with the study's subjects consisting of COVID-19 pneumonia patients who had reached a state of deterioration that required the use of oxygen therapy. Of the 100 COVID-19 pneumonia cases, we compared 59 pneumonia patients who required oxygen therapy, divided into ARDS and non-ARDS pneumonia patients who required oxygen, and then investigated the different factors which affected their mortality. Results: At the time of admission, the ratios of SpO₂, FiO₂, and SF for the ARDS group differed significantly from those of the non-ARDS pneumonia support group who required oxygen (p<0.001). With respect to the predicting of the occurrence of ARDS, the SF ratio on admission and the SF ratio at exacerbation had an area under the curve which measured to be around 85.7% and 88.8% (p<0.001). Multivariate Cox regression analysis identified that the SF ratio at exacerbation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.846-0.991; p=0.029) and National Early Warning Score (NEWS) (HR, 1.277; 95% CI, 1.010-1.615; p=0.041) were significant predictors of mortality. Conclusion: The SF ratio on admission and the SF ratio at exacerbation were strong predictors of the occurrence of ARDS, and the SF ratio at exacerbation and NEWS held a significant effect on mortality.

• Journal of Chest Surgery
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• 제54권2호
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• pp.106-116
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• 2021

Background: We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG). Methods: Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1-2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed. Results: The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality. Conclusion: Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.

• 한국산업보건학회지
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• 제30권4호
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• pp.387-393
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• 2020

Objective: This study aimed to investigate the differences in temporary threshold shift (TTS) and recovery patterns according to different types of sound and volume. Methods: TTS and recovery patterns were assessed for eight students after 30-minute exposure to both 70.0 dB and 90.0 dB of factory noise (noise) as well as music. TTS was measured before exposure and two minutes post exposure, and recovery patterns were evaluated every 10 minutes for one hour. The subjects performed activities of daily life and sleeping times as usual but taking drugs or drinking alcohol were prohibited. The experiment was repeated three times with an interval of at least 16 hours. ANOVA and T-test were carried out using SPSS 19.0 for Windows. Results: The hearing threshold of all subjects before exposure was less than 30 dB at all frequencies. Mean TTSs of 70 dB noise and 90 dB noise exposure were 0.14 and 4.48 dB (p<0.001). Meanwhile, the difference in music was insignificant (-0.63 dB and 0.55 dB, p=0.063). A significance in the difference was also found between the mean TTS of music and noise exposure, more obviously at 90.0 dB (p<0.001) than at 70 dB (p=0.232). The TTS differences were found frequency-wise in terms of sound type. Mean TTS by frequency was higher at 4,000 and 6,000 Hz than at other frequencies, and higher in noise than music at the same sound pressure. The TTS difference in each frequency between both sound types was significant at 90 dB (p<0.001). Subjects mostly recovered from TTS in one hour after exposure, but not with 90 dB-noise exposure. Conclusion: TTS and recovery patterns were different depending on the sound type. When exposed to factory noise, TTS was greater and recovery time was longer compared to music at the same sound pressure. These results suggested that the difference in cognitive processes and psychological factors according to the type of sound causes a change in TTS and recovery.

• 한국수자원학회논문집
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• 제53권12호
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• pp.1049-1057
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• 2020

본 연구는 드론을 이용하여 홍수기 하천에서의 유량측정방법 개발을 위해 수행하였다. 홍수기 유량측정은 예산, 인력, 안전 및 하천공사 등의 문제로 매년 모든 지점에서 유량 측정을 실시하지 못하는 어려움이 있다. 특히 태풍 등 큰 호우사상 발생 시 수위-유량관계 변화 검토가 필요하지만 앞에서 언급한 문제 등으로 인하여 측정에 어려움이 있다. 이런 문제점을 개선하기 위해 최소 인력이 단시간 간편하게 측정할 수 있는 방법을 개발하였다. 항공사진측량 개념으로 접근하여 의정부시(신곡교) 지점과 영동군(영동제2교) 지점 하도 주변에 확인 가능한 위치에 지상기준점(GCP, Ground Control Points) 4개점을 선점하고 VRS DGPS 장비를 이용하여 좌표측량을 수행하였다. 드론을 일정높이의 정지상태(Hovering)에서 하도 내 수 표면을 카메라의 인터벌 기능으로 3초 간격 정사영상을 촬영하였다. 정사 촬영된 항공사진의 좌표계를 평면지각좌표계인 GRS80 TM좌표계로 정의한 후 GCP 좌표를 활용하여 보다 정밀하게 정사보정을 실시하였다. 수표면에 유하하는 부유물의 3초 간격 위치를 X, Y좌표 분석을 통해 이동거리를 평균유속으로 산정하고 유하경로에 따른 통수단면적을 적용하여 유량을 산정하였다. 따라서 항공사진측량 기법을 적용하여 홍수기에 드론을 이용한 유량측정방법에 대한 적용성을 확인하였다.