• Journal of Trauma and Injury
• /
• v.28 no.3
• /
• pp.104-107
• /
• 2015

Purpose: Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia. Methods: We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as $PaO_2/FiO_2$ ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality. Results: A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%. Conclusion: Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.42 no.5
• /
• pp.243-250
• /
• 2016

Objectives: Many studies have examined histopathological factors and various prognostic scores related to inflammation to predict outcomes. Here, we examined the prognostic value of the C-reactive protein/albumin (CRP/alb) ratio in oral squamous cell carcinoma (OSCC). Materials and Methods: This retrospective study included 40 patients with OSCC. Using univariate and multivariate analyses, we focused on the correlation of the CRP/alb ratio with clinicopathological characteristics and with overall survival. We then compared five inflammation-based prognostic scores, CRP/alb ratio, modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), based on receiver operating characteristic (ROC) curves. Results: The optimal cut-off value for the CRP/alb ratio was 0.085. The group with a high CRP/alb ratio had a high TNM clinical stage (P=0.002) and larger primary tumors (P=0.029), with statistically significant differences in lymph node metastasis and distant metastasis. In addition, when the CRP/alb ratio was high, multivariate analysis showed a lower survival rate (P=0.002; hazard ratio=6.078), and the ROC curve showed more outstanding discriminatory ability regarding overall survival compared to other inflammation-based prognostic scores. Conclusion: The CRP/alb ratio can be an independent prognostic factor when predicting prognosis in OSCC and has good prognostic ability.

• The Journal of Internal Korean Medicine
• /
• v.37 no.6
• /
• pp.978-989
• /
• 2016

Objectives: This study evaluated the diagnostic values of measuring the number of fungiform papillae in patients with burning mouth syndrome (BMS). Methods: Seventy participants (35 BMS patients and 35 Healthy control) participated in this study. The number of fungiform papillae (FP) was measured on the anterior part of the tongue within an area of $9mm^2$ using a digital camera. The subjects were evaluated on their yin deficiency and blood stasis conditions using the Yin-Deficiency Questionnaire (YDQ) and Blood Stasis Questionnaire (BSQ). Moreover, the severities of subjective tongue pain in the BMS patients were assessed using Visual Analog Scale. Results: There were significant differences in the number of FP and the YDQ and BSQ scores between the two groups. The number of FP and the YDQ scores in the BMS group showed statistically significant correlations with the VAS score of tongue pain. In the bivariate logistic regression analysis, the factor that most strongly contributed to BMS was the number of FP. The optimal cut-off value of the number of fungiform papillae was calculated as 5.5 with 71.4% sensitivity and 82.9% specificity. There was no statistically significant correlation between the number of FP and the YDQ or BSQ score. Conclusions: According to these findings, measuring the number of FP could be a valuable evaluation indicator of BMS.

• Korean Journal of Biological Psychiatry
• /
• v.23 no.4
• /
• pp.185-192
• /
• 2016

Objectives Treatment response of bipolar disorders (BDs) to long-term mood stabilizers maintenance has not been well explored because of complicated clinical and treatment courses. This study aims at investigating long-term clinical response of BDs to lithium and/or valproate in a naturalistic setting of a tertiary-care university-affiliated hospital. Methods Subjects were 65 patients with bipolar I (BD-I) disorders who had been treated with lithium and/or valproate for more than two years at single bipolar disorder clinic. Long-term response to the best treatment based on treatment algorithms and the current clinical standard of care was retrospectively evaluated using the Alda Scale and the Clinical Global Impression Scale for use in bi-polar illness (CGI-BP). Patients were classified into full responder and partial/non responder groups based on the total score of the Alda Scale with the cut-off score generated from the frequentist mixture analysis of the authors' previous study. Results The mean duration of treatment with the index medication was 69.2 months. Baseline demographic and clinical characteristics were not different among three mood stabilizer groups (valproate, lithium, and combination groups). Twenty-one subjects were classified into full responder group (32.3%). Treatment response assessed by the Alda Scale and CGI-BP scores was not different between lithium and valproate groups. The Alda Scale scores were well correlated with the CGI-BP scores (p < 0.05). Conclusions One third of the patients showed a full response to the long-term lithium and/or valproate treatment in BD-I. The degree of response was similar between lithium and valproate groups.

• Communications for Statistical Applications and Methods
• /
• v.19 no.2
• /
• pp.277-286
• /
• 2012

For credit assessment models, the ROC curves evaluate the classification performance using two univariate cumulative distribution functions of the false positive rate and true positive rate. In this paper, it is extended to two bivariate normal distribution functions of default and non-default borrowers; in addition, the bivariate ROC curves are proposed to represent the joint cumulative distribution functions by making use of the linear function that passes though the mean vectors of two score random variables. We explore the classification performance based on these ROC curves obtained from various bivariate normal distributions, and analyze with the corresponding AUROC. The optimal threshold could be derived from the bivariate ROC curve using many well known classification criteria and it is possible to establish an optimal cut-off criteria of bivariate mixture distribution functions.

• Journal of Oral Medicine and Pain
• /
• v.43 no.4
• /
• pp.125-130
• /
• 2018

Purpose: The etiology of temporomandibular disorders (TMDs) is complex and multifactorial including trauma, anatomical, pathophysiological, social and psychological factors. Psychological factors can induce or sustain TMDs in various ways. And psychological problems, such as anxiety and depression can be occurred due to TMDs. Therefore, evaluation of psychological factors in patients with TMDs is important. Although disc displacement (DD) is crucial in clinical situation, most of studies have focused on the relationship of psychosocial factors and myofascial pain. And also, Subtypes of DD can cause different degrees of discomfort, it is necessary to evaluate the psychological states of the patients according to the subtype. The Hospital Anxiety Depression Scale (HADS) is one of the self-report questionnaire to evaluate the psychological factors. HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) are assessed through 14 questions. The purpose of this study was to evaluate anxiety and depression assessed by HADS in patients diagnosed with subtypes of DD according to diagnostic criteria for TMDs. Methods: Four hundred thirty nine patients were diagnosed as one of the subtypes of DD. One hundred fourty nine subjects with no symptoms were set as control groups. All of them answered the HADS for Koreans. The cut-off score for anxiety and depression was set a score of 8. The chi-square test was performed to evaluate association between DD and anxiety/depression. Results: There was a significant difference in HADS-D between five groups (p<0.01). However, there was no significant difference in HADS-A. All the DD groups showed a significant difference in HADS-D compared with the control group except the DD without reduction without limited opening group. The DD without reduction with limited opening group showed the highest rates in HADS-D (40.4%). Conclusions: Based on the above results, it is necessary to consider the depression in treatment of the patients with DDs.

• The Journal of Internal Korean Medicine
• /
• v.41 no.6
• /
• pp.1015-1029
• /
• 2020

Purpose: This study assessed the validity of a questionnaire (SEID-Q27) for diagnosis of chronic fatigue syndrome (CFS), designed based on the systematic exertion intolerance disorder (SEID) criteria. Methods: Two groups of participants were recruited: 1. a non-CFS control group: adult university personnel with a Chalder fatigue scale (CFQ) score ≥15, and 2. a CFS patient group: patients from an online CFS community diagnosed with CFS (diagnostic code of G93.3) with the symptoms present. The survey ran from September to October, 2020. The validity of the questionnaire was investigated by factor analysis and receiver operator characteristic (ROC) analysis. Results: Among the 35 adults surveyed, 30 (86%) participants had CFQ scores ≥15 (15 males and 15 females) and 5 (14%) had a CFS diagnosis (2 males and 3 females). The total mean score was significantly different between the two groups (CFS: 6.8±2.2 vs. control: 4.4±2.4, p<0.05). The area under the curve (AUC) was 0.827. With a cut-off point 62, the sensitivity was 60%, specificity 97%, and the discriminant ability of the survey was 79%. Conclusions: The SEID -Q27 appears to be a useful instrument for the diagnosis of CFS using SEID criteria. However, further large-scale studies are needed with greater numbers of participants.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.25 no.1
• /
• pp.30-40
• /
• 2022

Purpose: Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods: The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann-Whitney tests and logistic regression. Results: This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion: PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.6
• /
• pp.2941-2946
• /
• 2016

Background: The limitations of total serum PSA values remain problematic, especially after an initial negative prostate biopsy. In this prospective study of Chilean men with a continued suspicion of prostate cancer due to a persistently elevated total serum PSA, abnormal digital rectal examination and initial negative prostate biopsy were compared with the use of the on-line Chun nomagram, detection of primary malignant circulating prostate cells (CPCs) and free percent PSA to predict a positive second prostate biopsy. We hypothesized that men negative for circulating prostate cells have a small risk of clinically significant prostate cancer and thus may be conservatively observed. Men positive for circulating prostate cells should undergo biopsy to confirm prostate cancer. Materials and Methods: Consecutive men with a continued suspicion of prostate cancer underwent 12 core TRUS prostate biopsy; age, total serum PSA and percentage free PSA and Chun nomagram scores were registered. Immediately before biopsy an 8ml blood simple was taken to detect primary mCPCs. Mononuclear cells were obtained by differential gel centrifugation and identified using double immunostaining with anti-PSA and anti-P504S. Biopsies were classifed as cancer/no-cancer, mCPC detecton test as negative/positive and the total number of cells/8ml registered. Areas under the curve (AUC) for percentage free PSA, Chun score and CPCs were calculated and compared. Diagnostic yields were calculated with reference to the number of possible biopsies that could be avoided and the number of clinically significant cancers that would be missed. Results: A total of 164 men underwent a second biopsy; 41 (25%) had cancer; the AUCs were 0.65 for free PSA, 0.76 for the Chun score and 0.87 for CPC detection, the last having a significantly superior prediction value (p=0.01). Using cut off values of free PSA <10%, Chun score >50% and ${\geq}1$ CPC detected, CPC detection had a higher diagnostic yield. Some 4/41 cancers complied with the criteria for active surveillance, free PSA and the Chun score missed a higher number of significant cancers when compared with CPC detection. Conclusions: Primary CPC detection outperformed the use of free PSA and the Chun nomagram in predicting clinically significant prostate cancer at repeat prostate biopsy.

• Journal of Korean Neurosurgical Society
• /
• v.64 no.1
• /
• pp.78-87
• /
• 2021

Objective : Intraoperative neurophysiological monitoring (IONM) has been widely used during spine surgery to reduce or prevent neurologic deficits, however, its application to the surgical management for cervical myelopathy remains controversial. This study aimed to assess the success rate of IONM in patients with cervical myelopathy and to investigate the factors associated with successful baseline monitoring and the effect of increasing the stimulation intensity by focusing on motor evoked potentials (MEPs). Methods : The data of 88 patients who underwent surgery for cervical myelopathy with IONM between January 2016 and June 2018 were retrospectively reviewed. The success rate of baseline MEP monitoring at the initial stimulation of 400 V was investigated. In unmonitorable cases, the stimulation intensity was increased to 999 V, and the success rate final MEP monitoring was reinvestigated. In addition, factors related to the success rate of baseline MEP monitoring were investigated using independent t-test, Wilcoxon rank-sum test, chi-squared test, and Fisher's exact probability test for statistical analysis. The factors included age, sex, body mass index, diabetes mellitus, smoking history, symptom duration, Torg-Pavlov ratio, space available for the cord (SAC), cord compression ratio (CCR), intramedullary increased signal intensity (SI) on magnetic resonance imaging, SI length, SI ratio, the Medical Research Council (MRC) grade, the preoperative modified Nurick grade and Japanese Orthopedic Association (JOA) score. Results : The overall success rate for reliable MEP response was 52.3% after increasing the stimulation intensity. No complications were observed to be associated with increased intensity. The factors related to the success rate of final MEP monitoring were found to be SAC (p<0.001), CCR (p<0.001), MRC grade (p<0.001), preoperative modified Nurick grade (p<0.001), and JOA score (p<0.001). The cut-off score for successful MEP monitoring was 5.67 mm for SAC, 47.33% for the CCR, 3 points for MRC grade, 2 points for the modified Nurick grade, and 12 points for the JOA score. Conclusion : Increasing the stimulation intensity could significantly improve the success rate of baseline MEP monitoring for unmonitorable cases at the initial stimulation in cervical myelopathy. In particular, the SAC, CCR, MRC grade, preoperative Nurick grade and JOA score may be considered as the more important related factors associated with the success rate of MEP monitoring. Therefore, the degree of preoperative neurological functional deficits and the presence of spinal cord compression on imaging could be used as new detailed criteria for the application of IONM in patients with cervical myelopathy.