• Neonatal Medicine
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• 제25권4호
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• pp.161-169
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• 2018

Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.

• 보건행정학회지
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• 제30권4호
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• pp.493-504
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• 2020

Background: There have been many studies on the associations between body mass index (BMI) and cognitive function. However, no study has ever compared the associations across the methods of categorizing BMI. In this study, we aimed to fill the gap in the previous studies and examine whether the obesity paradox is valid in the risk of cognitive function. Methods: Of the 10,254 people aged 45 and older from the Korean Longitudinal Study of Ageing from 2006 to 2016, 8,970 people were finalized as the study population. The dependent variable was whether a person has a normal cognitive function or not, and the independent variables of interest were BMI categorized by the World Health Organization Western Pacific Regional Office (WHO-WPRO) method, the WHO method, and a 10-group method. Covariates included sociodemographic factors, health behavior factors, and health status factors. A generalized linear mixed model analysis with a logit link was used. Results: In the adjusted model with all covariates, first, in the case of BMI categories of the WHO-WPRO method, underweight (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.15-1.17), overweight (OR, 1.36; 95% CI, 1.35-1.36), and obese (OR, 1.34; 95% CI, 1.33-1.34) groups were more likely to have a normal cognitive function than a normal-weight group. Next, in the case of BMI categories of the WHO method, compared to a normal-weight group, underweight (OR, 1.15; 95% CI, 1.14-1.16) and overweight (OR, 1.06; 95% CI, 1.06-1.07) groups were more likely to have a normal cognitive function; however, obese (OR, 0.62; 95% CI, 0.61-0.63) group was less likely to have it. Lastly, in the case of the 10-group method, as BMI increased, the likelihood to have a normal cognitive function changed like a wave, reaching a global top at group-7 (26.5 kg/㎡ ≤ BMI <28.0 kg/㎡). Conclusion: The associations between BMI and cognitive function differed according to how BMI was categorized among people aged 45 and older in Korea, which suggests that cognitive function may be positively associated with BMI in some categories of BMI but negatively in its other categories. Health policies to reduce cognitive impairment need to consider this association between BMI and cognitive function.

• 보건행정학회지
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• 제30권4호
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• pp.479-492
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• 2020

Background: As the prevalence of hypertension is increasing in Korea, the government is seeking policy actions to manage patients with hypertension more efficiently. In this paper, we aimed to identify factors associated with the use of medical care at hospitals among outpatients with hypertension. Methods: We analyzed a total of 15,040 cases of 3,877 outpatients with hypertension obtained from the Korea Medical Panel database from 2010 to 2016. The dependent variable was whether a patient with hypertension visited a hospital or not; and independent variables were the patient's various socio-demographic, health-related, and heath-status characteristics. We conducted a generalized linear mixed model analysis with logit link for all the cases and then conducted it stratified by gender. Results: As a result of a multivariable analysis, women were less likely than to visit at a hospital (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.32-0.61) and people aged 65 years and older than those aged less than 65 years (OR, 0.71; 95% CI, 0.57-0.89). Residents in Busan, Ulsan, and Gyeongnam were more likely than those in than Seoul, Gyeonggi, Incheon, and Jeju to visit a hospital (OR, 1.40; 95% CI, 1.05-1.86). The likelihood of visiting a hospital was high in people belonging to a group of: the highest level of annual household income (OR, 1.73; 95% CI, 1.30-2.29); Medical care aid recipients (OR, 1.94; 95% CI, 1.34-2.83); people having three or more complex chronic diseases (OR, 1.59; 95% CI, 1.19-2.11); people having diabetes (OR, 1.81; 95% CI, 1.41-2.32); or people having ischemic heart disease or cerebrovascular disease (OR, 6.80; 95% CI, 5.28-8.76). Also, we found that factors associated with the use of medical care at hospitals among outpatients with hypertension differed between genders. Conclusion: A variety of factors seem to be associated with the use of medical care at hospitals among outpatients with hypertension. Future research needs to find a way to help patients with hypertension visit an appropriate medical institution between clinics and hospitals.

• Journal of Yeungnam Medical Science
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• 제38권2호
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• pp.136-141
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• 2021

Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m² in the AKI group and 78.07±21.23 mL/min/1.73 m² in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.536-542
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• 2023

Objective : Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. Methods : This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1 g) was applied on the dura mater and bone flap in 105 patients (18.1%; vancomycin powder group). Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within 1-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Results : Surgical site infection occurred in 31 patients (5.3%) and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4-333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105, 0.0%) was significantly lower than that in the conventional group (31/475, 6.5%; crude odds ratio [OR], 0.067; 95% confidence interval [CI], 0.006-0.762; adjusted OR, 0.068; 95% CI, 0.006-0.731; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Conclusion : Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.

• Korean Journal of Radiology
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• 제23권5호
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• pp.505-516
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• 2022

Objective: To evaluate whether artificial intelligence (AI) for detecting breast cancer on mammography can improve the performance and time efficiency of radiologists reading mammograms. Materials and Methods: A commercial deep learning-based software for mammography was validated using external data collected from 200 patients, 100 each with and without breast cancer (40 with benign lesions and 60 without lesions) from one hospital. Ten readers, including five breast specialist radiologists (BSRs) and five general radiologists (GRs), assessed all mammography images using a seven-point scale to rate the likelihood of malignancy in two sessions, with and without the aid of the AI-based software, and the reading time was automatically recorded using a web-based reporting system. Two reading sessions were conducted with a two-month washout period in between. Differences in the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and reading time between reading with and without AI were analyzed, accounting for data clustering by readers when indicated. Results: The AUROC of the AI alone, BSR (average across five readers), and GR (average across five readers) groups was 0.915 (95% confidence interval, 0.876-0.954), 0.813 (0.756-0.870), and 0.684 (0.616-0.752), respectively. With AI assistance, the AUROC significantly increased to 0.884 (0.840-0.928) and 0.833 (0.779-0.887) in the BSR and GR groups, respectively (p = 0.007 and p < 0.001, respectively). Sensitivity was improved by AI assistance in both groups (74.6% vs. 88.6% in BSR, p < 0.001; 52.1% vs. 79.4% in GR, p < 0.001), but the specificity did not differ significantly (66.6% vs. 66.4% in BSR, p = 0.238; 70.8% vs. 70.0% in GR, p = 0.689). The average reading time pooled across readers was significantly decreased by AI assistance for BSRs (82.73 vs. 73.04 seconds, p < 0.001) but increased in GRs (35.44 vs. 42.52 seconds, p < 0.001). Conclusion: AI-based software improved the performance of radiologists regardless of their experience and affected the reading time.

• 재무관리연구
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• 제25권1호
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• pp.51-84
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• 2008

자기주식매입 공시 후 1년 이내에 유상증자를 실시한 표본을 이용하여 자기주식의 유상증자에 대한 신호효과를 검증하였다. 자기주식직접매입은 유상증자의 신주발행가격을 부양시키는 반면, 자기주식펀드 및 신탁은 신주발행가격을 끌어올리는 역할을 하지 못함을 발견했다. 또한 자기주식매입이 유상증자 시 신주발행가격을 올리기 위한 거짓신호로 사용된 가능성을 검증하기 위해서 표본집단들과 대응집단의 장기성과를 비교하였다. 자기주식매입이 선행된 표본들은 유상증자에 비해 장기저성과정도가 심하지 않았으며, 자기주식 펀드 및 신탁이 선행된 유상증자기업의 장기성과 또한 대응집단과 유의하게 다르지 않다는 실증결과를 발견하였다. 따라서 자기주식매입이 신주발행가격의 시세조정을 위해 불공정하게 사용되고 있다는 기존의 주장에 대한 증거를 발견하지 못하였다.

• Journal of Preventive Medicine and Public Health
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• 제24권3호
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• pp.363-372
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• 1991

백혈구수와 고혈압과의 관계를 알아보기 위해 1985년에 일부 농촌 거주자와 1986년에 일부 도시 거주자를 대상으로 혈액학적인 검사와 장기별로 기능검사를 통해서 건강선별조사를 했던 자료를 이용했다. 농촌거주자는 1985년에 경상북도 경산군에서 남자 206명, 여자 203명을 마을, 통, 반을 기준으로 다단계 집락추출법으로 추출했다. 도시 거주 대상자는 1985년 12월에 대구시에 거주하고 있는 20세 이상의 주민의 성별, 연령별 구성비율에 부합되게 농촌과 같은 표본추출방법으로 600명을 선정했으나 600명중 384명만이 본 조사에 응해주어서 나머지 인원은 피보험대상자들의 정기 신체검사를 위해 대학병원 건강관리과에 내원한 사람들 중에서 성, 연령을 짝지어서 추출했다. 이들 자료에서 백혈구수 측정이 빠진 사람, 고혈압력을 포함한 질병 유소견자와 검사상 극도의 비정상적인 수치를 보이는 자들을 농촌 거주자에서 36명 (8.8%), 도시 거주자에서 29명 (4.8%)을 제외시켜서 최종분석에 이용된 자는 도시가 571명, 농촌이 373명이었다. 백혈구수 측정은 ELT-8 Laser shadow method 를 이용했으며 단위는 $cells/mm^3$ 였다. 혈압 측정은 Aneroid 혈압계를 사용해서 표준화한 후 측정했다. 고혈압자의 정의는 수축기혈압 140 mmHg/확장기혈압이 90 mmHg 이상인 자로 했다. 농촌과 도시를 합한 총대상자에대해 고혈압자와 정상 혈압자간의 백혈구수의 평균을 비교하면 정상 혈압자에서 $6490.61{\pm}1941.32$, 고혈압에서 $6965.93{\pm}1997.01$로서 고혈압자에서 백혈구수의 평균이 통계적으로 유의하게 더 높았으며 (P=0.00), 농촌에서 동일한 방향의 유의한 차이를 보였다 (P=0.03). 그 외의 거주지와 성별로 층화한 각 층에서는 유의한 평균차이를 보이는 결과는 없었다. 총대상자에서 백혈구수 1/5분위수를 기준으로 했을 때 2/5분위수의 비차비가 0.99 (95% confidence interval, CI 0.62-1.59), 3/5분위수가 1.41 (95% CI 0.90-2.21), 4/5분위수가 1.76(95% CI 1.14-2.72), 5/5분위수가 1.80 (95% CI 1.15-2.82)로서 백혈구수가 증가 함에따라 고혈압의 유병율이 일정하게 상승하는 것을 알 수 있었으며 경향분석에서도 유의한 경향($X^2_{trend}=5.53,\;df=1,\;P<0.05$)을 나타내었다. 나머지 층에서는 유의한 비차비도 없었으며 유의한 경향 역시 보이지 않았다. 그러나 거주지와 성별로 층화한 각 층에서 연령, 흡연과 음주량을 다중지수회귀분석으로 통제를 했을 때 단일분석시 통계적인 유의성을 보였던 전체 대상자의 비차비는 통계적으로 유의하지 않게 되었고 그 크기 역시 작아지고 불안정해졌다. 전체적으로 비차비의 크기가 조금씩 줄었으며 경향분석에서도 유의한 경향을 보인 층은 없었다. 이러한 사실은 백혈구수와 고혈압과의 가설을 처음으로 제시했던 Friedman등의 연구가 고혈압의 예측변수를 찾기위해 800여개의 변수와 고혈압발생과의 관계를 보는 과정에서 우연히 발견된 통계적인 1종오차의 결과 일지도 모른다는 것을 시사해주는 결과이다.

• Clinical and Experimental Pediatrics
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• 제53권1호
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• pp.80-84
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• 2010

목 적 : 이 연구의 목적은 영아 연축 환아들의 장기적 예후를 분석하며 그들의 신경학적 발달지연에 영향을 주는 예후인자들을 찾고자 한다. 방 법 : 저자들은 1994년에서 2007년까지 서울아산병원에서 영아 연축으로 진단받은 72명의 소아들에 대하여 후향적 분석을 시행하였다. 이들 중 43명에 대한 전화 상 질문서 및 의무기록을 통하여 현재의 신경학적 발달에 대한 평가를 시행하였다. 불량한 장기적 예후와 관련된 인자들의 확인을 위해 로지스틱 회귀분석을 사용하였다. 결 과 : 13명(30.2%)이 특발성이며 30명(69.8%)이 증후성이었다. 11명(25.6%)이 ACTH 치료에 반응하였으며, 치료지연은 $1.3{\pm}1.9$개월이었다. 18명(41.8%)이 초기치료에 호전된 반응을 보였으며, 평균 추적기간은 $7.2{\pm}1.5$년이었다. 장기 예후 분석에서는 22명(51.2%)이 중등도 이상의 신경학적 발달지연을 보였으며, 그 중 2명(4.8%)이 사망하였다. 단변량 분석에서는 증후성 영아 연축과 초기 치료에 불량한 반응이 중등도 이상의 신경학적 발달지연과 관련된 유의한 위험인자였으나, 다변량 분석에서는 초기 치료에 불량한 반응만이 위험인자로 확인되었다. 결 론 : 영아 연축 환아의 전반적인 예후는 불량하였고 초기치료에 불량한 반응을 보인 환자군에서 장기적 예후가 더욱 불량하였다. 이러한 결과는 경련의 초기 조절이 영아 연축 환아에서 신경학적 발달지연과 관련된 장기적 예후에 영향을 줄 수 있음을 시사한다.

• Clinical and Experimental Pediatrics
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• 제51권11호
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• pp.1158-1164
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• 2008

목 적: 저자들은 중환자실에 입원하는 환아들에 대한 소아사망률지표 2 (pediatric index of mortality 2, PIM2)와 소아사망위험도 III (pediatric risk of mortality III, PRISM III)의 유효성을 평가하고자 하였다. 방 법: 2003년 1월부터 2007년 12월까지 단일 기관 중환자실에 입실하여 치료받았던 환아의 의무기록을 후향적으로 조사하였다. 중환자실에 입실하여 2시간 이내에 사망하거나 절망적인 상태의 퇴원인 경우는 제외하였다. 환아들의 일반적인 특성에 대해서 Student's t-test와 ANOVA를, PIM2와 PRISM III 항목에 대해서 생존한 환아와 사망한 환아 사이에 상관분석을 시행하였다. 또한, 사망률 예측의 정도에 대한 정확성을 위해서 Hosmer-Lemeshow 적합도에 대한 다중회귀분석과 수용자 작업특성곡선을 사용하였으며 예측사망율의 과대 또는 과소 평가는 표준화된 사망비를 이용하여 검증하였다. 결 과: 193 증례의 의무기록을 검토하였으나 3예가 중환자실에 입실한 2시간이내에 사망하여 190예에 대하여 분석을 시행하였다. PIM2의 항목들은 수술이나 술기 후에 입원한 경우와 저위험군의 항목을 제외하고 생존과 연관성이 있었다. PRISM III에서는 심혈관/신경계 징후, 동맥혈가스분석의 항목이 관련성이 있었으나 생화학과 혈액학적 검사소견은 연관성이 유의하지 않았다. 수용자 작업특성곡선으로 확인한 예측도는 모두 의의가 있었으며 PIM2의 곡선하면적이 0.858 (95% 신뢰도: 0.779-0.938), PRISM III가 0.798 (95%신뢰도: 0.686-0.891)이었다. 또한, 표준화된 사망비는 두 가지 지표 모두 1에 가까웠으며 다중회귀분석을 이용한 Hosmer-Lemeshow 적합도에서 PRISM III가 ${\chi}^2(13)=12.899$, P=0.456이었으며, PIM2는 ${\chi}^2(13)=14.986$, P=0.308이었다. 그러나 PIM2가 가능도비검정에서 PRISM III보다 유의한 특성을 가지고 있었다(${\chi}^2(4)=55.3$, P<0.01). 결 론: 저자들은 중환자실에 입실하는 소아 환자에서 사망률을 예측하는 두 가지 지표(PIM2, PRISM III)가 의미가 있다는 사실을 확인하였다. 저자들은 PIM2가 PRISM III보다 보다 정확하고 적절하다고 생각된다.