• 대한한의학회지
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• 제45권1호
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• pp.17-43
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• 2024

Objectives: Underpinned by the context of a Korean traditional medicine cohort study on healthy aging, this research primarily aims to guide the selection of Clinical Outcome Assessments (COAs) for elderly healthy aging patient registry research, offering insights into the selection process; and secondly, to streamline the resource-intensive process of obtaining permissions for validated COAs, benefiting future traditional Korean medicine clinical researchers. Methods : In this study, we identified outcomes through a review of previous studies, followed by a process involving expert consultations to select the final outcomes. Subsequently, for the selected outcomes that were Clinical Outcome Assessments (COAs) developed tools, we searched in commercial databases to confirm the availability of Korean versions and the necessity of obtaining permissions. Finally, we obtained permissions for their utilization and, when needed, acquired the original instrument questionnaire through payment. Results: Through a literature review of existing observational studies, a total of 57 outcomes were selected, with 19 of them identified as COA instruments. Upon verifying usage permissions for these 19 instruments, it was found that 17 required author-specific permissions, and among these, 2 needed a purchase as they were commercially available. Conclusion: This study provides a detailed overview of outcome selection and permission acquisition for elderly patient registry research. It underscores the importance of Clinical Outcome Assessment (COA) tools and the rigorous approval process, aiming to enhance research reliability. Continuous verification of COA information is essential, and future research should explore Core Outcome Set (COS) development through consensus-building approaches like Delphi studies.

• IMMUNE NETWORK
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• 제22권4호
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• pp.34.1-34.19
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• 2022

Osteoarthritis (OA) is the most common form of arthritis associated with ageing. Vitamin D has diverse biological effect on bone and cartilage, and observational studies have suggested it potential benefit in OA progression and inflammation process. However, the effect of vitamin D on OA is still contradictory. Here, we investigated the therapeutic potential of vitamin D in OA. Six-week-old male Wistar rats were injected with monosodium iodoacetate (MIA) to induce OA. Pain severity, cartilage destruction, and inflammation were measured in MIA-induced OA rats. Autophagy activity and mitochondrial function were also measured. Vitamin-D (1,25(OH)₂D3) and celecoxib were used to treat MIA-induced OA rats and OA chondrocytes. Oral supplementation of vitamin D resulted in significant attenuations in OA pain, inflammation, and cartilage destruction. Interestingly, the expressions of MMP-13, IL-1β, and MCP-1 in synovial tissues were remarkably attenuated by vitamin D treatment, suggesting its potential to attenuate synovitis in OA. Vitamin D treatment in OA chondrocytes resulted in autophagy induction in human OA chondrocytes and increased expression of TFEB, but not LC3B, caspase-1 and -3, in inflamed synovium. Vitamin D and celecoxib showed a synergistic effect on antinociceptive and chondroprotective properties in vivo. Vitamin D showed the chondroprotective and antinociceptive property in OA rats. Autophagy induction by vitamin D treatment may be a promising treatment strategy in OA patients especially presenting vitamin D deficiency. Autophagy promoting strategy may attenuate OA progression through protecting cells from damage and inflammatory cell death.

• Korean Journal of Radiology
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• 제22권3호
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• pp.324-333
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• 2021

Objective: The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF. Materials and Methods: Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment. Results: A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8-32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5-46.1] %LV vs. 6.7 [0-17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54-17.74; p < 0.001). Conclusion: In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for long-term adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.

• Journal of Gastric Cancer
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• 제20권2호
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• pp.152-164
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• 2020

Purpose: To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC). Materials and Methods: This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively. Results: The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693-4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664-1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595-85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502-5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618-3.028; P<0.001) were determined as independent prognostic factors for DFS. Conclusions: S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제16권2호
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• pp.279-285
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• 2005

목적 : 이 연구에서는 장시간 약물작용이 지속되는 MPH-OROS를 주의력결핍과잉운동장애 아동에게 투여하여 그 효용성과 안전성 및 부모 만족도를 평가하려고 하였다. 방법 : 연구대상은 DSM-IV의 진단기준을 이용하여 임상적으로 ADHD로 진단 받은 569명의 아동으로 하였다. 이미 약물을 복용중이거나 약을 복용한 적이 없는 아동을 대상으로 이전 약물에서 MPH-OROS로 약물을 바꾸거나 처음으로 MPH-OROS를 복용하였다. 증상의 정도는 MPH-OROS 약물 사용 전과 사용 1주 및 3주에 한국어판 Conners 부모용 평가척도를 사용하여 평가하였다. 임상 호전은 Clinical Global Impression Severity of illness(CGI-S)를 사용하여 MPH-OROS 약물 복용 전과 복용 1주 및 3주에 임상가가 평가하였고 Clinical global impression severity of improvement(CGI-I)로 약물 복용 1주 및 3주에 호전 정도를 평가하였다. 약물 복용 3주에는 약물 복용에 따른 부모 만족도를 설문 조사하였다. 결과 : MPH-OROS의 1일 평균 복용량은 기저선 $25.3{\pm}11.2mg$ 1주 $28.9{\pm}12.7mg$, 3주 $31.3{\pm}13.2mg$이었다. 시간에 따라 용량이 유의하게 증가하였고, 성에 따른 차이는 없었다. 전체의 $13\%$가 중도 탈락했으며, 그 원인으로는 부작용이 가장 많았다. CGI-I의 변화는 시간에 따라 유의하게 감소하는 모습을 보였고, 성에 따른 호전 정도의 차이는 나타나지 않았다. CGI-I에 의한 호전평가에서 MPH-OROS 치료 1주에 호전은 $72.3\%$이고 치료 3주에는 $87.4\%$였다. 한국판 Conners부모용 평가척도 합계 점수는 시간에 따라 유의하게 감소하였다. 한 가지 이상의 부작용을 경험하였던 환자는 119명으로 $20.7\%$에 달하였으며, 가장 많은 빈도로 나타난 것은 식욕부진이고, 불면, 두통, 오심의 순이었다. 기존에 속효성 메틸페니데이트를 사용하던 군과 약물을 처음 사용하는 군을 나누어 부작용 빈도를 살펴보았을 때 크게 차이가 나지 않았다. 부모만족도 설문 결과에서 MPH-OROS 약물치료에 대해 $94\%$의 부모는 전반적으로 만족한다고 응답하였다. 또한 부모가 보고하는 MPH-OROS 의 가장 큰 장점은 오후까지 약물효과 지속, 학교생활 및 수업태도, 가정생활 및 숙제, 과잉행동 개선의 순이었다. 결론 : MPH-OROS는 주의력결핍과잉운동장애의 치료에서 효과적이며 충분히 안전하다.

• Tuberculosis and Respiratory Diseases
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• 제83권1호
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• pp.31-41
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• 2020

Background: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. Methods: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, exsmokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. Results: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. Conclusion: The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

• Pediatric Infection and Vaccine
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• 제23권2호
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• pp.109-116
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• 2016

목적: 최근 관찰연구들에서 낮은 혈중 25(OH)D 농도가 호흡기 감염과 관련이 있다는 결과들이 보고되고 있다. 하지만, 소아의 무작위 대조 연구에서 비타민 D의 투여가 호흡기 감염을 예방하는 효과에 대해서는 아직 논란의 여지가 있다. 이번 연구는 비타민 D 보충 요법이 호흡기 감염 예방에 미치는 영향을 체계적 문헌고찰과 메타분석을 통하여 알아보고자 한다. 방법: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trial을 이용하여 소아의 호흡기 감염 예방을 위해 비타민 D 보충을 실험한 무작위 대조 연구들이 분석 대상에 포함되었다. 문헌의 비뚤림 위험도를 평가하기 위해 코크란 연합의 질 평가 방법(Cochrane Collaboration's tool for assessing the risk of bias)을 사용하였다. 연구별로 상대위험도와 95% 신뢰구간을 추출한 후, Review Manager 5.3을 이용하여 메타분석을 시행하였다. 결과: 총 7편의 무작위 대조 연구들이 메타분석 대상에 포함되었다. 임의효과모형을 사용하여 산출된 전체 비타민 D 보충군에서 상대적 위험도는 0.82 (95% CI: 0.69-0.98)이었고, 이질성에 대한 $I^2=62%$ 이었다. 연구 간의 이질성 원인을 파악하기 위해 시행한 하위 집단 분석에서 추적 관찰 기간이 1년 미만인 경우, 대상군의 나이가 5세 이상인 경우, 대상군이 환자인 경우, 비타민 D 투여 요법이 매일 요법인 경우 이질성이 감소하였다. 깔때기 그림에서 출판 비뚤림의 가능성을 시사하는 비대칭 소견을 보였다. 결론: 메타분석 결과는 소아에서 비타민 D 보충요법이 호흡기 감염을 예방하는 데 효과가 있을 수 있음을 보여준다. 하지만, 이번 연구에서는 분석대상에 포함된 연구들이 적고, 연구들 간에 이질성이 존재하며, 출판 비뚤림이 존재할 가능성이 있어 결과를 주의해서 해석할 필요가 있다.

• 대한한의학회지
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• 제16권1호통권29호
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• pp.505-530
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• 1995

Recently some people in learned circles of oriental medicine raised a Question about a terminological problem, i.e., 'oriental medical'. This question was thought as an attempt to find out the identity of oriental medicine which exists among the various current medical knowledge systems. In spite of same object, human body, there are diverse medical knowledge systems which has different concepts and theories. This come from the difference of a view of object which defines the experiences of that. The knowledge system of oriental medicine was established by the view of object in oriental medicine which depended on the way of thinking as Yin and Yang. The view of object in oriental medicine has come out in the special cultural soil, namely, the oriental world. Because of this the view of object in oriental medicine cannot be seperated from the oriental world view. What distintive feature does the oriental world view have? It can be summarized as the holistic, dynamical and organic ideas of the world. The term 'oriental medical' is being used to emphasize the characteristic and the peculiarity of the oriental medicine among the various medical knowledge systems. Can the current so called scientific method accept this peculiar and special method of oriental medicine? The efforts of philosophers who had been stimulated by the awful scientific achivements and had tried to find out the unified method penetrating through all the empirical science by mobilizing the logic and mathematics has became out of date for the raise of a question about the inductive method. On the contrary, the theses of theory-laden observation was accepted widely and the relativism was accepted as a new established theory. But the relativism has its own problem. The relativism was founded upon the concept, the incommensurability, which Khun and Feyerabend had proposed. This concept was criticized strongly by some of philosophers because of its own self-refuting. The view of object in oriental medicine has a relative characteristic in the aspect of its urge that in accordance with the perspective a different medical knowledge system can be possible. But our possible choice is the moderate conceptual relativism. Therefore if the view of object in oriental medicine includes the relative aspect, there is the 'conceptual relativity' between the knowledge system of oriental medicine and the western medicine. This preview an important aspect for the standardization and modernizing research of oriental medicine by lending the knowledge of the western medicine. And when we choose the moderate conceptual relativism, it means that we do not support the extreme relativism, that is, 'anything goes'. The concept of truth and rationality cannot be abandoned, and it plays the role of the norm on the knowledge system of oriental medicine and other knowledge systems of medicine in a limited meaning. And the view of object in oriental medicine has an organic view about the human body and the characteristic which wants to interpret the phenomena of human body by using the holistic method. But the availability of this method will be evaluated by the achievements of oriental medicine. Finally what relationship does the theory of oriental medicine have with the world the theory is applied to? It is recognized that the theory of oriental medicine has the instrumental characteristic. But it can be thought the instrumentalism is different from the oriental medical standpoint in the aspect that the instrumentalism seperates the theoretical existence from the observational existence sharply. Because in the oriental thinking way there is no seperation between the mind of observer and the object and no conflict between the idealism and the realism like the western world. For this problem there must be a further study.

• 한국지구과학회지
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• 제40권6호
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• pp.584-598
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• 2019

본 연구에서는 지역 기상-해양 접합모델을 이용하여 2018년 8월 28일부터 30일까지 한반도 서울-경기지역에 내린 강수에 대해 대기-해양 상호작용의 효과를 분석하였다. 지역 기상-해양 접합모델에서 기상모델은 WRF (Weather Research Forecasts)가 사용되었으며, 해양모델은 ROMS (Regional Oceanic Modeling System)가 사용되었다. 단일 기상 모델은 WRF모델만 이용되었으며, ECMWF Re-Analysis Interim 의 해수면온도자료가 바닥경계자료로 사용되었다. 관측자료와 비교하여, 대기-해양 상호작용의 효과가 고려된 접합모델은 서울-경기지역의 강수 및 황해 해수면온도에 대해 공간상관계수가 각각 0.6과 0.84로 이는 지역 기상모델보다 높게 나타났다. 또한, 평균편향오차(MBE, Mean Bias Error)은 각각 -2.32와 -0.62로 지역 기상모델 보다 낮은 오차율을 보였다. 상당온위와 해수면온도 및 역학적 수렴장으로 분석한 대기-해양 상호작용의 효과는 황해 해수면온도의 변화를 유도하였고, 그 변화는 하층대기에서 열적 불안정과 운동학적 수렴대의 차이를 발생시켰다. 열적 불안정과 수렴대는 결과적으로 서울-경기 지역에서 상승운동을 유도하였고, 결과적으로 기상-해양 접합모델에서 모의된 강수가 관측과 더 유사한 공간분포를 나타냈다. 그러나 복잡한 관계에 있는 대기-해양 상호작용의 효과를 더 명확히 파악하기 위해서는 다양한 사례연구와 장기적인 분석이 필요하지만, 본 연구는 기상-해양 상호작용이 강수 예보에 중요성에 대한 또 다른 증거를 제시한다.

• 대한원격탐사학회지
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• 제32권2호
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• pp.119-131
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• 2016

한반도 에어로졸 라이다 관측 네트워크(Korea Aerosol Lidar Observation Network; KALION)의 라이다 관측자료 처리 및 실시간 표출을 위한 표준 알고리즘을 개발하였다. KALION 표준 알고리즘은 라이다 관측으로부터 얻어진 후방산란강도와 편광소멸도 자료를 이용하여 (1) 에어로졸과 구름 구분, (2) 에어로졸 유형 구분, (3) 에어로졸 소산계수 그리고 (4) 에어로졸 질량농도를 산출하는 단계로 구성이 되어 있다. 에어로졸의 유형은 후방산란강도와 편광소멸도 자료에 근거하여, (대륙 기원) 청정기단 에어로졸(clean continental aerosol), 황사(dust aerosol) 그리고 오염 입자(polluted continental/urban pollution aerosol)로 구별된다. 에어로졸 소산계수에 필요한 라이다 상수는 약 9년간의 라이다와 스카이 라디오미터 자료로부터 도출된 63.31 sr을, 에어로졸 질량소산효율은 약 9년간의 라이다와 기상청 Particulate Matter($PM_{10}$) 질량농도 자료를 이용하여 도출된 $3.36m^2\;g^{-1}$ (황사는 $1.39m^2\;g^{-1}$)을 적용한다. 2015년 3월 28일부터 30일까지 라이다 관측 사례(서울 관악)에서 KALION 표준 알고리즘을 통해 산출된 에어로졸 유형 구분, 특히 황사 판별 결과는 기상청의 황사 보고와 잘 일치하였으며, 2006년 6월부터 약 9년 동안의 라이다 관측자료로부터 산출된 에어로졸 질량농도 역시 지상 $PM_{10}$ 농도와 약 $3{\mu}g\;m^{-3}$ 내에서 잘 일치하였다. 향후 에어로졸의 유형에 따른 서로 다른 라이다 상수 및 에어로졸 질량소산효율 적용 알고리즘, 빙정 구름(ice cloud)과 물방울 구름(water droplet cloud) 구분 알고리즘, 그리고 운저 고도와 혼합고 판별 알고리즘을 개발할 계획에 있다.