• Kidney Research and Clinical Practice
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• 제37권4호
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• pp.338-346
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• 2018

Background: The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. Methods: Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. Results: Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. Conclusion: GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

• 한방비만학회지
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• 제17권2호
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• pp.127-132
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• 2017

Objectives: Recently, many studies have demonstrated that the waist-to-height ratio (WHtR) is more correlated with metabolic syndrome than the waist-hip ratio (WHR), body mass index (BMI). The aim of this study was to investigate and compare WHtR as a predictor of metabolic syndrome with other anthropometric indices. Methods: Approximately 3,800 data of subjects were used for the analysis, and data from Korean Medicine Data Centar). Receiver operating characteristic curve was performed and area under the curve (AUC) was calculated to find the usefulness of WHtR, WHR, and BMI. Results: WHtR was the most predictive factor with the highest diagnostic value for metabolic syndrome than WHR, BMI. AUC of WHtR was significantly higher in total subjects, men and women. Conclusions: WHtR may be the simple and effective anthropometric index for metabolic syndrome.

• Journal of Yeungnam Medical Science
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• 제38권4호
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• pp.318-325
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• 2021

Background: The diagnosis and prediction of prognosis are important in patients with sepsis, and presepsin is helpful. In this study, we aimed to examine the usefulness of presepsin in predicting the prognosis of sepsis in Korea. Methods: Patients diagnosed with sepsis according to the sepsis-3 criteria were recruited into the study and classified into surviving and non-surviving groups based on in-hospital mortality. A total of 153 patients (32 and 121 patients with sepsis and septic shock, respectively) were included from July 2019 to August 2020. Results: Among the 153 patients with sepsis, 91 and 62 were in the survivor and non-survivor groups, respectively. Presepsin (p=0.004) and lactate (p=0.003) levels and the sequential organ failure assessment (SOFA) score (p<0.001) were higher in the non-survivor group. Receiver operating characteristic curve analysis revealed poor performances of presepsin and lactate in predicting the prognosis of sepsis (presepsin: area under the curve [AUC]=0.656, p=0.001; lactate: AUC=0.646, p=0.003). The SOFA score showed the best performance, with the highest AUC value (AUC=0.751, p<0.001). The prognostic cutoff point for presepsin was 1,176 pg/mL. Presepsin levels higher than 1,176 pg/mL (odds ratio [OR], 3.352; p<0.001), higher lactate levels (OR, 1.203; p=0.003), and higher SOFA score (OR, 1.249; p<0.001) were risk factors for in-hospital mortality. Conclusion: Presepsin levels were higher in non-survivors than in survivors. Thus, presepsin may be a valuable biomarker in predicting the prognosis of sepsis.

• Journal of Gastric Cancer
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• 제19권3호
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• pp.315-328
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• 2019

Purpose: To investigate the clinical value of serum miR-221-3p and miR-122-5p expression levels in the diagnosis and prognosis of gastric cancer. Materials and Methods: Serum samples from 141 gastric cancer cases (gastric cancer group), 110 gastric polyps (gastric polyp group), and 75 healthy people (healthy control) were used to detect miR-221-3p and miR-122-5p expression using real-time reverse transcription polymerase chain reaction. Results: Serum miR-221-3p expression was significantly higher in the gastric cancer group than in the gastric polyp group, and it was significantly lower than that before operation. The miR-221-3p expression was significantly higher in the death group than in the survival group. The proliferation and migration ability significantly increased and the apoptosis rate significantly decreased by miR-221-3p transfection in gastric cancer cells. In contrast, the function of miR-122-5p in gastric cancer cells was opposite of miR-221-3p. Serum miR-221-3p expression was negatively correlated with that of miR-122-5p in gastric cancer. Serum miR-221-3p and miR-122-5p expressions were significantly correlated with the degree of differentiation, tumor, node, metastasis stage, lymph node metastasis, and invasion depth. miR-221-3p and miR-122-5p expression levels were independent prognostic factors for postoperative gastric cancer. In the diagnosis and predicting prognosis of gastric cancer, receiver operating characteristic analysis revealed that the area under curve of combined detection of serum miR-221-3p and miR-122-5p expression had a greater diagnostic effect than either single maker. Conclusions: The miR-221-3p and miR-122-5p are involved in the development of gastric cancer, and they have important clinical values in gastric cancer diagnosis and prognosis.

• Acute and Critical Care
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• 제33권4호
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• pp.216-221
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• 2018

Background: In this study, we analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, and Mortality Probability Model $(MPM)_0$ III in order to determine which system best implements data related to the severity of medical intensive care unit (ICU) patients. Methods: The present study was a retrospective investigation analyzing the discrimination and calibration of APACHE II, APACHE IV, SAPS 3, and $MPM_0$ III when used to evaluate medical ICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015 to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least 24 hours. The discrimination abilities of the three systems were evaluated using c-statistics, while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction model was created using logistics regression analysis. Results: For the APACHE IV, SAPS 3, $MPM_0$ III, and APACHE II systems, the area under the receiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highest discrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 for SAP 3, and 0.670 for $MPM_0$ III. All severity scoring systems showed good calibrations: APACHE II (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square, 9.290; P=0.318), and $MPM_0$ III (chi-square, 11.128; P=0.133). Conclusions: APACHE IV provided the best discrimination and calibration abilities and was useful for quality assessment and predicting mortality in medical ICU patients.

• 한국임상수의학회지
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• 제36권1호
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• pp.23-29
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• 2019

While research findings suggest that the highly pathogenic avian influenza (HPAI) is the leading cause of economic loss in Korean poultry industry with an estimated cumulative impact of $909 million since 2003, identifying the environmental and anthropogenic risk factors involved remains a challenge. The objective of this study was to identify areas at high risk for potential HPAI outbreaks according to the likelihood of HPAI virus detection in wild birds. This study integrates spatial information regarding HPAI surveillance with relevant demographic and environmental factors collected between 2003 and 2018. The Maximum Entropy (Maxent) species distribution modeling with presence-only data was used to model the spatial risk of HPAI virus. We used historical data on HPAI occurrence in wild birds during the period 2003-2018, collected by the National Quarantine Inspection Agency of Korea. The database contains a total of 1,065 HPAI cases (farms) tied to 168 unique locations for wild birds. Among the environmental variables, the most effective predictors of the potential distribution of HPAI in wild birds were (in order of importance) altitude, number of HPAI outbreaks at farm-level, daily amount of manure processed and number of wild birds migrated into Korea. The area under the receiver operating characteristic curve for the 10 Maxent replicate runs of the model with twelve variables was 0.855 with a standard deviation of 0.012 which indicates that the model performance was excellent. Results revealed that geographic area at risk of HPAI is heterogeneously distributed throughout the country with higher likelihood in the west and coastal areas. The results may help biosecurity authority to design risk-based surveillance and implementation of control interventions optimized for the areas at highest risk of HPAI outbreak potentials.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제30권3호
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• pp.116-120
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• 2019

Objectives: This study was conducted to re-validate the clinical efficacy of the Korean Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (K-AARS), which is a self-report scale for ADHD in adults, and to determine the clinical utility and cut-off scores of K-AARS. Methods: The participants were 135 drug naïve adults with ADHD and 144 healthy controls. To diagnose ADHD based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, two board-certified pediatric psychiatrists interviewed the participants and completed the Mini International Neuropsychiatric Interview. K-AARS was applied to all participants. K-AARS comprises six clinical subscales, one impairment subscale, and one driving behavior subscale. The receiver operating characteristic analysis was conducted to calculate the cut-off scores of K-AARS. Results: All subscale scores, including six clinical subscale, impairment subscale, and driving behavior subscale scores, were found to be significant in distinguishing adults with ADHD from healthy controls. The sensitivity and specificity of the six clinical subscales were 63.0-77.0% and 66.7-79.9%, respectively. The combined total score of the six clinical subscales, had a sensitivity of 80.0% and specificity of 79.9%. Conclusion: The discriminative power of K-AARS for the diagnosis of ADHD in adults was excellent, and K-AARS and the empirical diagnosis of adults can be useful in diagnosing ADHD in adulthood.

• Imaging Science in Dentistry
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• 제49권2호
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• pp.97-102
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• 2019

Purpose: This study was conducted to evaluate the effect of different spatial resolutions of a photostimulable phosphor plate (PSP) radiography system on the detection of proximal caries lesions. Materials and Methods: Forty-five extracted human permanent teeth were radiographed using a PSP system (VistaScan Perio Plus) and scanned at the 4 resolutions (10 lp/mm, 20 lp/mm, 25 lp/mm, and 40 lp/mm) available in the system. Three independent examiners scored the images for the presence and absence of proximal caries lesions using a 5-point scale. The presence or absence of caries was confirmed by histological sections of the examined teeth (defined as the gold standard). Intra- and inter-observer reproducibility was calculated by the weighted kappa test. One-way analysis of variance with the post hoc Tukey test was used to compare the area under the receiver operating characteristic curve for the classifications made with each resolution. Results: For the detection of enamel lesions, the spatial resolution of 10 lp/mm was significantly superior to the other resolutions. However, the spatial resolution did not affect the detection of caries lesions in dentin (P>0.05). Conclusion: Spatial resolution may influence the accuracy of the detection of incipient caries lesions in radiographs with PSP plates. Images with low spatial resolution seem to be more appropriate for this purpose.

• Imaging Science in Dentistry
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• 제49권2호
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• pp.139-151
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• 2019

Purpose: This study was performed to investigate the effect of exposure parameters on image quality obtained using a cone-beam computed tomography (CBCT) scanner and the relationship between physical factors and clinical image quality depending on the diagnostic task. Materials and Methods: CBCT images of a SedentexCT IQ phantom and a real skull phantom were obtained under different combinations of tube voltage and tube current (Alphard 3030 CBCT scanner, 78-90 kVp and 2-8 mA). The images obtained using a SedentexCT IQ phantom were analyzed technically, and the physical factors of image noise, contrast resolution, spatial resolution, and metal artifacts were measured. The images obtained using a real skull phantom were evaluated for each diagnostic task by 6 oral and maxillofacial radiologists, and each setting was classified as acceptable or unacceptable based on those evaluations. A statistical analysis of the relationships of exposure parameters and physical factors with observer scores was conducted. Results: For periapical diagnosis and implant planning, the tube current of the acceptable images was significantly higher than that of the unacceptable images. Image noise, the contrast-to-noise ratio (CNR), the line pair chart on the Z axis, and modulation transfer function (MTF) values showed statistically significant differences between the acceptable and unacceptable image groups. The cut-off values obtained using receiver operating characteristic curves for CNR and MTF 10 were useful for determining acceptability. Conclusion: Tube current had a major influence on clinical image quality. CNR and MTF 10 were useful physical factors that showed significantly associations with clinical image quality.

• Acute and Critical Care
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• 제33권4호
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• pp.222-229
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• 2018

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.