• The Korean Journal of Pancreas and Biliary Tract
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• 제22권4호
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• pp.165-171
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• 2017

배경/목적: 담도암에서 플라스틱 스텐트 너비에 따른 스텐트 생존 차이에 대한 데이터는 부족하다. 이번 연구의 목적은 담도암에서 7-프렌치와 10-프렌치 플라스틱 스텐트의 생존 차이를 보고 어떤 인자가 개방성에 영향을 미치는지 확인하고자 한다. 방법: 2010년 1월부터 2014년 10월까지 연세대학교 원주세브란스기독병원에서 담도암으로 담도가 막힌 환자들을 등록하였다. 결과: 총 215명(7-프렌치:10-프렌치 = 89명:126명)의 환자를 후향적으로 등록하였다. 암의 위치는 총담관(111명), 간문부 담관(45명), 바터팽대부(59명)였다. 스텐트 이동이나 폐쇄는 두 군 간에 통계적 차이가 없었다. 중앙 스텐트 생존은 7-프렌치의 경우 3.3개월이었고 10-프렌치의 경우 5.9개월이었다(p = 0.543). 플라스틱 스텐트 너비는 스텐트 생존에 영향을 미치지 않았다(Hazard Ratio: 1.11, 95% CI 0.71-1.73, p = 0.649). 결론: 담도암 치료에 있어 7-프렌치와 10-프렌치 플라스틱 스텐트는 스텐트 이동이나 폐쇄 차이가 없었고 스텐트 생존에 있어 7-프렌치 플라스틱 스텐트가 10-프렌치에 비해 열등하지 않았다.

• Journal of Gastric Cancer
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• 제21권3호
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• pp.268-278
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• 2021

Purpose: While several prognostic models for the stratification of death risk have been developed for patients with advanced gastric cancer receiving first-line chemotherapy, they have seldom been tested in the Chinese population. This study investigated the performance of these models and identified the optimal tools for Chinese patients. Materials and Methods: Patients diagnosed with metastatic or recurrent gastric adenocarcinoma who received first-line chemotherapy were eligible for inclusion in the validation cohort. Their clinical data and survival outcomes were retrieved and documented. Time-dependent receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive ability of the models. Kaplan-Meier curves were plotted for patients in different risk groups divided by 7 published stratification tools. Log-rank tests with pairwise comparisons were used to compare survival differences. Results: The analysis included a total of 346 patients with metastatic or recurrent disease. The median overall survival time was 11.9 months. The patients were different into different risk groups according to the prognostic stratification models, which showed variability in distinguishing mortality risk in these patients. The model proposed by Kim et al. showed relative higher predicting abilities compared to the other models, with the highest χ² (25.8) value in log-rank tests across subgroups, and areas under the curve values at 6, 12, and 24 months of 0.65 (95% confidence interval [CI]: 0.59-0.72), 0.60 (0.54-0.65), and 0.63 (0.56-0.69), respectively. Conclusions: Among existing prognostic tools, the models constructed by Kim et al., which incorporated performance status score, neutrophil-to-lymphocyte ratio, alkaline phosphatase, albumin, and tumor differentiation, were more effective in stratifying Chinese patients with gastric cancer receiving first-line chemotherapy.

• Journal of Chest Surgery
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• 제56권3호
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• pp.155-161
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• 2023

Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m², p=0.025). Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

• Safety and Health at Work
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• 제14권2호
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• pp.141-152
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• 2023

Objective: We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARC Monographs program. Methods: A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results: Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I²) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions: There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.

• Korean Journal of Radiology
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• 제22권6호
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• pp.922-930
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• 2021

Objective: It is uncertain why a b-value range of 1500-2000 s/mm² is optimal. This study was aimed at qualitatively and quantitatively analyzing the optimal b-value range of synthetic diffusion-weighted imaging (sDWI) for evaluating prostatic index lesions. Materials and Methods: This retrospective study included 92 patients who underwent DWI and targeted biopsy for magnetic resonance imaging (MRI)-suggested index lesions. We generated sDWI at a b-value range of 1000-3000 s/mm² using dedicated software and true DWI data at b-values of 0, 100, and 1000 s/mm². We hypothesized that lesion conspicuity would be best when the background (i.e., MRI-suggested benign prostatic [bP] and periprostatic [pP] regions) signal intensity (SI) is suppressed and becomes homogeneous. To prove this hypothesis, we performed both qualitative and quantitative analyses. For qualitative analysis, two independent readers analyzed the b-value showing the best visual conspicuity of an MRI-suggested index lesion. For quantitative analysis, the readers assessed the b-value showing the same bP and pP region SI. The 95% confidence interval (CI) or interquartile range of qualitatively and quantitatively selected optimal b-values was assessed, and the mean difference between qualitatively and quantitatively selected b-values was investigated. Results: The 95% CIs of optimal b-values from qualitative and quantitative analyses were 1761-1805 s/mm² and 1640-1771 s/mm² (median, 1790 s/mm² vs. 1705 s/mm²; p = 0.003) for reader 1, and 1835-1895 s/mm² and 1705-1841 s/mm² (median, 1872 s/mm² vs. 1763 s/mm²; p = 0.022) for reader 2, respectively. Interquartile ranges of qualitatively and quantitatively selected optimal b-values were 1735-1873 s/mm² and 1573-1867 s/mm² for reader 1, and 1775-1945 s/mm² and 1591-1955 s/mm² for reader 2, respectively. Bland-Altman plots consistently demonstrated a mean difference of less than 100 s/mm² between qualitatively and quantitatively selected optimal b-values. Conclusion: b-value range showing a homogeneous background signal may be optimal for evaluating prostatic index lesions on sDWI. Our qualitative and quantitative data consistently recommend b-values of 1500-2000 s/mm².

• Korean Journal of Radiology
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• 제24권6호
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• pp.529-540
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• 2023

Objective: To compare the diagnostic performance and clinical outcomes of 2-mSv computed tomography (CT) and conventional-dose CT (CDCT), following radiology residents' interpretation of CT examinations for suspected appendicitis. Materials and Methods: Altogether, 3074 patients with suspected appendicitis aged 15-44 years (28 ± 9 years, 1672 females) from 20 hospitals were randomly assigned to the 2-mSv CT (n = 1535) or CDCT (n = 1539) groups in a pragmatic trial from December 2013 and August 2016. Overall, 107 radiology residents participated in the trial as readers in the form of daily practice after online training for 2-mSv CT. They made preliminary CT reports, which were later finalized by attending radiologists via addendum reports, for 640 and 657 patients in the 2-mSv CT and CDCT groups, respectively. We compared the diagnostic performance of the residents, discrepancies between preliminary and addendum reports, and clinical outcomes between the two groups. Results: Patient characteristics were similar between the 640 and 657 patients. Residents' diagnostic performance was not significantly different between the 2-mSv CT and CDCT groups, with a sensitivity of 96.0% and 97.1%, respectively (difference [95% confidence interval {CI}], -1.1% [-4.9%, 2.6%]; P = 0.69) and specificity of 93.2% and 93.1%, respectively (0.1% [-3.6%, 3.7%]; P > 0.99). The 2-mSv CT and CDCT groups did not significantly differ in discrepancies between the preliminary and addendum reports regarding the presence of appendicitis (3.3% vs. 5.2%; -1.9% [-4.2%, 0.4%]; P = 0.12) and alternative diagnosis (5.5% vs. 6.4%; -0.9% [-3.6%, 1.8%]; P = 0.56). The rates of perforated appendicitis (12.0% vs. 12.6%; -0.6% [-4.3%, 3.1%]; P = 0.81) and negative appendectomies (1.9% vs. 1.1%; 0.8% [-0.7%, 2.3%]; P = 0.33) were not significantly different between the two groups. Conclusion: Diagnostic performance and clinical outcomes were not significantly different between the 2-mSv CT and CDCT groups following radiology residents' CT readings for suspected appendicitis.

• Korean Journal of Radiology
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• 제24권9호
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• pp.827-837
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• 2023

Objective: To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the oneweek CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). Results: Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) (P = 0.727). Conclusion: Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.

• Clinical Nutrition Research
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• 제12권4호
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• pp.283-292
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• 2023

The aim of this study was to investigate whether dairy intake was associated with the severity of coronavirus disease 2019 (COVID-19) disease and the probability of hospitalization of patients. This cross-sectional study was conducted on 141 patients with COVID-19 with an average age of 46.23 ± 15.88 years. The number of men (52.5%) participating in this study was higher than that of women. The association between dairy intake and COVID-19 was evaluated by multivariable logistic regression analysis. The risk of hospitalization in the highest tertile of dairy intake was 31% lower than in the lowest tertile (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.37-1.25, p trend = 0.023). Higher milk and yogurt intake was associated with a reduced risk of hospitalization due to COVID-19. Patients in the third tertiles were about 65% (p for trend = 0.014) and 12% (p for trend = 0.050) less likely to be hospitalized than those in the first tertile, respectively. Dairy consumption, especially low-fat ones, was associated with a lower risk of hospitalization due to COVID-19 and lower severity of COVID-19.

• 대한영상의학회지
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• 제84권3호
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• pp.627-637
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• 2023

목적 환자의 자세가 극하근의 힘줄병의 단계, 두께와 관찰가능 범위에 영향을 주는지 알아보고자 하였으며, 이로써 내전자세에서 초음파로 극하근을 평가하는 것이 가능한지 알고자 하였다. 대상과 방법 이 연구는 극하근을 세 가지 다른 자세(중립자세, 내전자세, 반대쪽 어깨에 손을 얹은 자세)로 평가한 48명의 환자의 52개의 어깨를 대상으로 하였다. 두 명의 영상의학과 전문의가 후향적으로 극하근의 힘줄병의 단계를 grade 0에서 grade 3까지, 관찰가능 범위를 grade 1에서 grade 4까지 판정하였다. 극하근의 두께는 다른 영상의학과 전문의가 단축 영상에서 측정하였다. 일반화추정방정식을 통계적 기법으로 사용하였다. 결과 반대쪽 어깨에 손을 얹은 자세에서 힘줄병의 단계는 내전자세보다 누적승산비가 2.087(p = 0.004, 95% 신뢰구간: 1.268-3.433)로 더 높았으나, 중립자세에서 힘줄병은 단계는 내전자세(p = 0.146)와 반대쪽 어깨에 손을 얹은 자세(p = 0.370)와 유의한 차이가 없었다. 극하근의 두께(p < 0.001)는 자세에 따라 유의한 차이가 있었으나, 관찰가능 범위(p = 0.530)는 유의한 차이가 없었다. 결론 환자의 자세는 극하근의 힘줄병의 단계와 두께에는 영향을 주었지만 관찰가능 범위에는 영향을 주지 않았다. 내전자세에서도 초음파로 극하근을 평가하는 것이 가능하다.

• 농촌의학ㆍ지역보건
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• 제38권3호
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• pp.182-194
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• 2013

본 연구는 국민건강영양조사를 이용하여 도시와 농촌지역에 거주하는 노인의 건강행태와 질병수준을 파악하고, 사회인구학적 특성을 통제한 상태에서 도시와 농촌지역의 노인의 건강수준을 비교하고자 수행하였다. 제4기 국민건강 영양조사(2007년-2009년) 자료를 이용하였으며, 65세 이상 노인으로 건강면접조사, 보건의식행태조사, 검진조사에 참여하여 분석에 필요한 변수가 모두 확보된 3,823명을 최종 연구대상으로 하였다. 지역의 분류는 행정지역과 동, 읍면으로 구분된 거주지역을 이용하여 '대도시', '도시', '농촌'으로 분류하였다. 가중치를 적용한 복합표본분석을 시행하여 지역에 따른 건강행태, 정신 건강 및 만성질환수준 증의 건강상태를 비교하였다. 연구결과, 우리나라 65세 이상 노인의 건강수준은 농촌지역이 사회경제적 여건은 도시지역에 비해 열악하지만 노인의 건강행태나 건강상태는 도시지역에 비해 더 양호함을 알 수 있었다. 농촌지역을 대도시 지역과 비교할 경우 건강행태 및 건강상태의 교차비는 독감접종 1.58(95% 신뢰구간 1.25-2.01)로 유의하게 높았고, 유연성운동 0.47(0.37-0.59), 근력운동 0.56(0.38-0.81), 비만 0.76(0.62-0.92)로 유의하게 낮았다. 질환 이환 중 관절염(0.81, 95% 신뢰구간: 0.66-0.99)과 당뇨병(0.70, 0.55-0.89)의 교차비는 농촌지역에서 대도시지역에 비해 통계적으로 유의하게 낮았다. 결론적으로 65세 이상 노인의 건강행태와 건강 수준은 이들의 거주 지역에 따라 차이가 있음을 알 수 있었다. 따라서 노인의 건강 수준의 향상을 위해서는 지역 특성과 여건에 맞는 프로그램의 개발이 필요하며, 거주 지역에 따른 차이를 설명할 수 있는 특성을 파악하고자 하는 연구가 이루어져야 할 것으로 생각된다.